Modalities Terms Flashcards

Question

Principles of Heat Transfer: Extent of Temperature Change

Answer 1

Extent of temperature change results from the following: ◦ Temperature difference between the heat agent and the intervention tissue ◦ Time of exposure to the heat agent ◦ Thermal conductivity of the intervention tissue ◦ Intensity of the heat agent

Answer 2

Hemodynamic effects o Vasodilation-increase blood flow Neuromuscular effects o Changes in nerve conduction velocity and firing rate o Increased pain threshold o Decrease in muscle strength ~ 30 minutes after application of heat o MMT prior to applying heat Increased metabolic rate Increased tissue extensibility

Answer 3

SUPERFICIAL HEAT ◦ Primarily ↑ temperature of the skin and subcutaneous tissues with less effect on deeper structures ◦ Skin is heated in 8-10 min. & maintained up to 30 min. ◦ 15 – 30 min is usually necessary to ↑ muscle temp 1 ̊C at a depth of 3 cm ◦ Generally heats to depths <2 cm from surface of skin Examples: hot packs, warm whirlpool, fluidotherapy, paraffin, infrared lamps DEEP HEAT ◦ Increase the temperature at depths of 3 to 5 cm Examples: shortwave diathermy & ultrasound

Answer 4

Pain control o Decreased muscle spasm o Increased pain threshold Increased ROM and decreased joint stiffness o Increase collagen extensibility Accelerated healing o Vasodilation o Increased cellular metabolic rate o Promotes reabsorption of hematomas Infrared radiation for psoriasis o Reduce psoriatic plaques by increasing skin temperature

Answer 5

o Acute injury or inflammation o Pregnancy o Impaired circulation o Poor thermal regulation o Edema o Cardiac insufficiency o Metal in the area o Over open wound o Demyelinated nerves o Over area where topical counterirritants have been applied

Answer 6

o Recent or potential hemorrhage o Thrombophlebitis - A condition in which a blood clot in a vein causes inflammation and pain o Impaired sensation o Impaired mentation o Malignant tumor o Infrared radiation irradiation of the eyes

Answer 7

Burns o To avoid, heating agents should not be applied for longer periods or at higher than recommended temperatures Fainting o Inadequate cerebral blood flow due to peripheral vasodilation and decreased BP o Keep patient head elevated with a pillow during treatment to help present postural hypotension after heat application Bleeding o May be aggravated in areas of acute trauma or pts. with hemophilia (condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury)

Answer 8

o Most commonly used for delivery of superficial moist heat o Contain a hydrophilic substance (ie- silica gel) o Stored in thermostatically controlled units filled with water and maintained at about (158-167 degrees F)

Answer 9

To prevent overheating and the possibility of burns : o There most be adequate toweling (6-8 layers of towels [Boards answer]) or commercially manufactured terrycloth covers (equivalent to 2-4 layers of towels) The packs come in various shapes and sizes to ensure optimal contact with the skin’s surface

Answer 10

The pack will cool as it is in use and must be back in the tank enough time to reach the optimal temp before re- use (minimum of 30 minutes) Hot packs can leak or rupture so they must be checked regularly as it could be a safety issue The water level must be maintained at the optimal level of this can impact the functioning of the unit

Answer 11

1. Remove clothing, jewelry from area and inspect skin 2. Wrap hot pack in 6 to 8 layers of dry towels (hot pack cover equals 2-3 layers). ◦ Use more layers of towels if body part is on top of hot pack 3. Apply wrapped hot pack to the treatment area and secure it 4. Provide patient with a bell or means to call for assistance 5. After 5 minutes check with patient’s report and inspect area being treated (for redness, blistering: if noted, discontinue) 6. After 20 minutes, remove hot pack and inspect treatment area (slight redness and warmth is normal) 7. Inspect patient’s skin following treatment for any adverse reaction that may have occurred

Answer 12

a flammable, translucent, waxy solid Uses conductive heat Good use for superficial heating of distal extremities o Able to maintain contact over contoured surfaces Contraindications: open wounds, skin conditions/infection Temperature of paraffin bath b/n 126-134 ̊ F

Answer 13

Remove all jewelry, inspect area, wash and dry area prior to application 1. Dip-wrap (or glove method for wrist and hand) o Safe, practical * most common o Dip and remove body part from paraffin 6- 10 times o Solid-glove formed insulates body part against heat loss o Wrap patient’s hand in plastic bag, wax paper and then in towel 2. Dip-immerse o Patient dips 1-2 times in paraffin, then returns hand to paraffin for remainder of treatment, up to 20 minutes o Not recommended for safety concerns 3. Paint o Used when dipping is not practical, painted layer of paraffin onto treatment area with brush, repeat 6-10x Inspect patient’s skin following treatment for any adverse reaction that may have occurred

Answer 14

Provides heat through convection Patient places distal extremity into machine for treatment which provides dry, superficial heat by using fine cellulose particles through which heated air is blown o Allows stimulation of both thermoreceptors & mechanoreceptors (desensitization) Contraindications: open wounds, skin conditions/infection Treatment temperature 110-118° F

Answer 15

 Generally used for distal extremity  Warm or hot water, then in cool/cold water  Causes fluctuations in blood flow over a 20-minute treatment o May increase superficial blood flow and skin temperature  Usually used clinically when treatment goal is to achieve benefits of heat Decreased pain, increased flexibility (and avoiding increased edema)  Varying sensory stimulus -> promotes pain relief and desensitization  Chronic edema patients, subacute trauma, inflammatory conditions (sprains, strains, tendinitis, hyperalgesia or hypersensitivity due to CRPS or other)

Answer 16

1. Intense cold 2. Aching and/or burning sensation 3. Anesthesia to analgesia (Feels better) 4. Numbness

Answer 17

Over the superficial main branch of a nerve Over an open wound Hypertension Poor sensation Poor mentation Very young and very old patients

Answer 18

Cold hypersensitivity Cold intolerance Disorders: oCryoglobulinemia oParoxysmal cold hemoglobinuria oRaynaud’s Disease Area of regenerating peripheral nerves Area of circulatory compromise oPeripheral Vascular Disease

Answer 19

Soft silica gel encased in strong plastic/vinyl cover Various shapes and sizes in order to contour to the body Stored in freezer units set at temperature 23°F Packs are returned to unit for a minimum of 30 minutes between uses ( 2 hours+ before initial use)

Answer 20

1. Remove clothing, jewelry from area and inspect skin 2. Wrap the CP in a single layer of moist toweling; may use thin dry towel if slower, less intense cooling is desired 3. Elevate area to be treated if edema is present 4. Place CP on treatment area, molding to fit body part 5. Provide patient with a bell or means to call for assistance 6. Treatment time: 10-20 min to control pain, inflammation or edema; 30 minutes to control spasticity 7. Inspect patient’s skin following treatment for any adverse reaction that may have occurred Part 2 1. Prepare a pack by filling a plastic bag with crushed ice or small ice cubes. 4:1 ratio of water to rubbing alcohol (alcohol decreases freezing temperature) 2. Spread a large terrycloth towel and place the bag in the center folding the edges to make a pack. To increase comfort for the patient moisten the towel slightly with warm water 3. Place the pack on the patient covering the involved area and molding the pack as much as possible. 4. Leave the pack in place for 10 to 30 minutes 5. Remove the pack, dry the patient, check skin and physiologic responses. ** note: more insulation may be needed with use of ice pack because it provides more aggressive cooling

Answer 21

Freeze water in paper/styrofoam cup Therapist applies ice directly to target area Good for home use

Answer 22

Alternate pump cold water and air into sleeve wrapped around patient’s limb. Water temperature: 50- 77oF Compression applied by intermittently inflating the sleeve with air Most commonly used directly after surgery to control post-op inflammation, edema

Answer 23

Vapocoolant sprays are used to achieve brief and rapid cutaneous cooling by evaporation prior to stretching Indications: myofascial pain syndromes, trigger points, restricted motion, and minor sports injuries

Answer 24

The application of a pulling mechanical force. Is most commonly used to alleviate pressure on structures, such as joints or nerves, that produce pain\ or other sensory changes, or that become inflamed, when compressed.

Answer 25

The natural tension or resistance in a muscle when it is at rest. - Also known as residual muscle tension or tonus. - Is the continuous and passive part contraction of muscles. - Or the muscle's resistance to passive stretch during resting state. - It helps to maintain posture and declines during REM sleep.

Answer 26

Goal: Decrease Tone Effective Agents: Neutral warmth, prolonged cryotherapy, or EMG biofeedback to hypertonic muscles; Motor ES or quick ice of ANTAGONISTS. Contraindicated Agents: Quick ice of AGONISTS.

Answer 27

Goal: Increase Tone Effective Agents: Quick ice, motor ES, or EMG biofeedback to agonists Contraindicated Agents: Thermotherapy (Heat)

Answer 28

Goal: Normalize tone Effective Agents: Functional ES Contraindicated Agents: N/A

Answer 29

The application of shortwave or microwave electromagnetic energy to produce heat within tissues, particularly deep tissues.

Answer 30

After Pathological or Physical Insult: I. Inflammation Phase 1) Vasoconstriction 2) Vasodilation 3) Clot Formation 4) Phagocytosis (Phagocytes go "nom nom" II. Proliferation Phase 5) Epithelization 6) Fibroplasia/Collagen Production 7) Wound Contracture 8) Neovascularization III. Maturation Phase 9) [Collagen Synthesis/Lysis (Breakdown)] Balance 10) Collagen Fiber Orientation 11) Healed Injury

Answer 31

Drugs that decrease the inflammatory response through many mechanisms involving many cell types.

Answer 32

Cells in many tissues, particularly wounds, that are the primary producers of collagen.

Answer 33

Type I: The most abundant for of collagen, found in skin, bone, tendons, and most organs. Type II: The predominant collagen in cartilage. Type III: A thin, weak-structured collagen with no consistent organization, initially produced by fibroblasts after tissue damage.

Answer 34

1) Acute 2) Subacute 3) Chronic

Answer 35

Characteristics  Direct result of actual or potential tissue injury due to a wound, disease process or invasive procedure  Pharmacological treatment is usually first defense  Nonpharmacological treatment may include physical agents, & patient education  Predictable in characteristics  Lasts < 6 weeks

Answer 36

 Inflammation = Redness and Swelling  Sudden, severe pain  The inability to weight bear  Decreased mobility  Muscle spasm  Extreme weakness  Visible dislocation or break of a bone  Red, black, blue bruising

Answer 37

 Tissue repair occurs  Pharmacological treatment continues  Nonpharmacological treatment continues  Subacute pain is a subset of acute pain: It is pain that has been present for at least 6 weeks but less than 3 months

Answer 38

 Fragile scar tissue forming  Yellow, green or brown bruising  Range of motion increases  Inflammation decreases

Answer 39

 May or may not relate to an actual physical injury and may persist well beyond the presence of physical finding to support it  Approx. 1/3 U.S. residents have chronic pain at some point in life  3 Criteria help to define chronic pain:  Cause is often uncertain or not correctable  Medical treatments have been ineffective  Pain persists for longer than 3 months  Often leads to long term loss of function and psychosocial stresses  Often treated by a team approach with emphasis on psych support, behavior modification and guidance

Answer 40

 Pain with movement is dull or achy, not sharp  Pain at the very end of a range of movement  Dull ache at rest  Bruising is gone  Signs of inflammation are gone  Scar tissue is maturing

Answer 41

 Visual analog (Visual scale with "No Pain" to "Worst Pain Possible")  Numeric scales (0-10)  Faces Scale  Neonatal Infant Pain Scale [NIPS] (Bodily Reactions)  Comparison with a predefined stimulus - Ex. "How does it feel reaching your head behind your head?"  Semantic differential scales (Used to get a more detailed description of pain, choose from groups of choice words to best describe pain)  Word lists and categories to describe pain  Daily activity/pain logs  Body diagrams (Drawing or coloring in where pain is)  Open-ended, structured interviews  Physical examination and testing (Ex. Strength or Postural Assessment)

Answer 42

Pain > Muscle Guarding > Restricted ROM > Muscle Weakness & Atrophy > Decreased Function > Psychological Stress > (Back to) > Pain

Answer 43

- Physical Agents - Pharmacological - Exercise - Cognitive behavioral therapy - Comprehensive pain management problems - Pacing (Exercise or everyday life)

Answer 44

- Neural process of encoding noxious (harmful) stimuli - Nociceptive system: may facilitate or inhibit signal before conscious perception - Nociceptive signals transmitted by CNS by primary afferent neurons (C fibers, A- delta fibers, A-beta fibers) types of sensory neurons that transmit different sensations, differing in their speed (fastest to slowest: A-beta > A-delta > C), myelination (A-beta/delta have myelin, C does not), and function, with A-beta handling touch/pressure, A-delta signaling sharp pain/temperature, and C fibers transmitting dull, burning pain, itch, and temperature

Answer 45

* Transmit detailed information rapidly from peripheral cutaneous structures * Respond to intense mechanical stimulation and heat or cold * Localized sensations that are “sharp, stabbing, or pricking” * Are not blocked by opioids

Answer 46

* Transmit information from deeper tissues (joints, viscera) more slowly than A-delta fibers * Provoked by chemical mediators * Diffuse sensations that are “dull, throbbing, aching, burning, tingling, or tapping” * Blocked with opioid medication

Answer 47

Ascending pathways carry sensory information up the spinal cord to the brain, while descending pathways carry motor commands down from the brain to the spinal cord and muscles.

Answer 48

Like switching train tracks. Over stimulation of A-beta fibers (non-nociceptive [non-pain sensation] receptors) can block painful stimulations from A-delta and C fibers (nociceptive [pain]) receptors. Gate Control Theory–pain severity determined by the balance of excitatory and inhibitory inputs in the spinal cord

Answer 49

- Naturally occurring “pain killers” in our bodies (opiopeptins/endorphins) - Release of opiopeptins (endorphins) is stimulated by a variety of factors including intense pain, intense exercise, acupuncture, laughter, meditation and relaxation - Opiopeptins bind to opioid receptors, which results in inhibition of pain signals - Bearable levels of painful stimuli (TENS, acupuncture) are thought to release opiopeptins

Answer 50

- A tensional mechanical force applied to the body that separates joint surfaces, elongates surrounding tissue - Applied manually by clinician or mechanically by machine or patient using body weight and gravity

Answer 51

- Distract joint surfaces - Reduce protrusions of nuclear disc material - Stretch soft tissue - Relax muscles - Mobilize joints

Answer 52

The separation of two articular surfaces perpendicular to the plane of articulation  Reduces joint compression and widens intervertebral foramina  May reduce pressure on articular surfaces, intraarticular structures, or spinal nerve roots  Requires enough force  50% of body weight for lumbar joints  7% of body weight for cervical joints

Answer 53

Clicking back of disc fragment of small nuclear protrusions  Suction caused by decreased intradiscal pressure pulling displaced parts of disc back to center  Tensing of posterior longitudinal ligament at posterior aspect of disc; pushing disc material anteriorly

Answer 54

Increase in length of soft tissue (muscle, tendons, ligaments, discs) increases distance between vertebral bodies and facet joints  Moderate, prolonged force has been shown to increase length of tendons, and increase joint mobility

Answer 55

Facilitate relaxation of paraspinal muscles by reduced pressure on pain sensitive structures or gating by intermittent traction  Intermittent Traction  Static Traction (Blank areas will receive info later)

Answer 56

Joint mobility increased by high force traction stretching of surrounding soft tissue structures  Repetitive oscillatory motion of intermittent traction may move joints sufficiently to stimulate mechanoreceptors, the decreasing joint-related pain  Mechanical traction mobilizes many joints at once whereas manual techniques are more localized

Answer 57

- Spinal disc bulge or herniation - Spinal nerve root impingement - Joint hypomobility - Subacute joint inflammation - Muscle spasm

Answer 58

Static Traction: - may interrupt pain-spasm-pain cycle. Low-load Intermittent Traction: - may interrupt pain-spasm-pain cycle. Higher Load Traction: - may reduce underlying cause of pain.

Answer 59

1.When motion is contraindicated (MD’s orders) 2.Acute injury or inflammation 3.Joint hypermobility or instability 4.Peripheralization of symptoms with traction 5.Uncontrolled hypertension

Answer 60

1.Structural disease/conditions affecting spine 2.When belt pressure may be hazardous, for example, pregnancy 3.Displaced annular fragment 4.Medial disc protrusion 5.When severe pain fully resolves with traction (could mean a nerve root is completely impinged or that something else is going on - not that the issue is resolved) 6.Claustrophobia 7.Inability to tolerate prone or supine position 8.Disorientation 9.For cervical traction: TMJ problems, dentures

Answer 61

- Involves electronic traction units that exert a pulling force through a rope and various halters & straps - Lumbar or Cervical or Hip - Static (same force applied throughout treatment Advantages: - Force and time well controlled, readily graded, replicable - Does not require clinician to remain with patient - Static or intermittent - Static weighted devices are convenient for home use Disadvantages - Electrical motorized devices costly - Time-consuming to setup - Lack of patient control or participation - Belts or halter may be poorly tolerated - Does not mobilize spine and individualized segments

Answer 62

Position varies according to target tissue  Supine with knees and hips flexed  More separation of posterior structures (facet joints, IV foramina)  Supine with knees and hips extended  More separation of anterior structures (disc spaces)  Prone  Symptoms reduced with extension, increased lumbar paraspinal relaxation Static vs. Intermittent  Research isn’t clear on which is more effective  Static  Area is inflamed  Symptoms aggravated by motion  Symptoms are related to disc protrusion  Intermittent  Disc protrusions-long hold times  Joint dysfunction Adverse Effects: - Excessive force may increase symptoms - Rebounding increase in pain; start low, increase slowly - Lumbar radicular discomfort after cervical traction - Belt irritation to the skin

Answer 63

Angle of Pull  Position varies according to target tissue  Angle of pull for upper C/S: 5-10 º  Angle of pull of lower C/S: 20-30º  Neutral is used of Atlanto-occipital joint separation  Flexed position: greater separation of posterior structures:  Facet joints, intervertebral foramina  Neutral/extended position: greater separation of anterior structures:  Disc spaces Static  Area is inflamed  Symptoms aggravated by motion  Symptoms are related to disc protrusion  Intermittent  May be better for pain reduction  Better for increasing cervical ROM  Facet problems tend to respond better to intermittent with short cycles  Disc problems respond better to intermittent with longer on/off *Correct Numbers*: Upper Cervical Spine Angle of pull: 5-10* Lower Cervical Spine angle of pull 20-30* Amount of pull: 7-20 (max) % of body weight (BW)

Answer 64

- Uses body weight to exert distractive force of the spine - Can be used for lumbar but not cervical spine - Good when low forces are required

Answer 65

- Patient placed in a vertical, inverted position secured in placed by boots and straps - Patient maintains inverted position up to 2 minutes -> then returns upright for 1-2 minutes. Repeat up to 6x - Caution:  Stresses cardiovascular system  Increased systolic and diastolic pressure*  Increases intracranial and intra-optic pressure

Answer 66

Application of force by the PTA in the direction of distracting the joints

Answer 67

Subjective:  Record any patient statements regarding symptoms especially if they have had a previous traction treatment, how it effected their symptoms etc. Any other pertinent statements that apply to the use of traction (i.e. anything that would indicate a precaution or contraindication) Objective:  Patient position  Type of traction: cervical or lumbar; intermittent or static (including cycle if intermittent)  Force used  Angle of pull  Bilateral vs. unilateral pull  Treatment time  Frequency of treatment  Patient response to treatment Assessment:  Patient’s response to the treatment  Any objective changes following the treatment Plan:  Continuation of traction for subsequent treatments  Any changes to the traction intervention for subsequent treatments  The need to communicate with the PT

Answer 68

Refers to the application of a mechanical force to increase pressure on the treated body part Physiological Effects of Compression 1. Improves venous and lymphatic circulation o Limiting fluid outflow into interstitial spaces o Returning fluids to the circulatory and lymphatic system 2. Limits the size and shape of new soft tissue formation o Acts as a second skin with diminished elasticity when applied to scar tissue or residual limbs 3. Increases tissue temperature o Compression sleeves, stockinette and bandages insulate the limb o Stimulate the enzyme collagenase and break down collagen and reduce scar formation

Answer 69

 Edema  REDUCE the INCIDENCE of Deep Vein Thrombosis (DVT)  Venous stasis ulcers  Residual limb shaping  Control of hypertrophic scarring

Answer 70

 Edema caused by blockage of circulation  Active infection  Malignancy in affected extremity

Answer 71

- Edema - Reduce incidence of DVT - Venous Stasis Ulcer - Residual Limb Shaping - Hypertrophic Scarring (leads to Keloid Scaring)

Answer 72

Tissue fluid balance - is controlled by hydrostatic pressure and osmotic pressure inside and outside the blood vessels. Normally hydrostatic pressure is slightly higher than osmotic pressure and plasma protein levels are high and thus fluid in kept with the venous system for flow toward the heart.

Answer 73

Gates in veins throughout the body that are closed at rest (preventing backflow) are opened during muscle contraction. However, for various reasons (like age) the values are unable to completely close - if at all, and are limited in their ability to prevent backflow. Ex. increases risk of DVT

Answer 74

 Older age  Surgery  Trauma  Hospital of nursing home confinement  Cancer  Central line catheterization  Transvenous pacemaker  Prior superficial vein thrombosis  Varicose veins  Paralysis  Use of oral contraceptives,  Pregnancy  Hormone therapy

Answer 75

an open wound on the lower leg, typically above the ankle, caused by poor blood flow (venous insufficiency) in the veins

Answer 76

the process of preparing the residual limb for a prosthesis, which involves reducing swelling and creating a conical shape through methods like elastic bandages, shrinker socks, or liners

Answer 77

 Used in early treatment of lymphedema; later compression garments used to maintain edema control  *Figure-eight application technique ; spiral wrapping not recommended b/c it can result in uneven pressure and thus uneven control of edema  *Distal to proximal direction of application, with slightly more tension applied more distally than proximally  Works by applying either resting and/or working pressure

Answer 78

- Resting pressure: exerted by elastic bandage when it is put on stretch either at rest or when patient is moving - Working pressure: produced by active muscles pushing against inelastic bandage and is produced only when patient is moving and contracting the muscles

Answer 79

Long-stretch bandage ◦ “High-stretch” can extend 100-200% ◦ Provide greatest resting pressure - consistent pressure ◦ Little to no working pressure because they stretch rather than resist when muscle expand - Ex. ACE wrap, Tubigrip Short-stretch bandage ◦ “Low-stretch” can extend 30-90% ◦ Produce low resting pressure ◦ Cause resistance and high working pressure during muscle activity - During activity short-stretch bandages work with the bandaged muscles to increase circulation. - Ex. Comprilan, Artico

Answer 80

Advantages ◦ Inexpensive ◦ Quick to apply once skill is mastered ◦ Readily available ◦ Extremity may be used during treatment ◦ Safe for acute conditions Disadvantages ◦ Does not reverse edema when used alone ◦ Effective only for controlling edema formation ◦ Moderate skill required ◦ Compression not quantifiable/replicable ◦ Bulky/unattractive ◦ Inelastic bandage does not control edema in flaccid limb

Answer 81

Basically when the limb is lower than the heart

Answer 82

For optimal benefit, compression garments must be worn for 23-24 hour/day, every day Because the garments lose compression force over time, they should be replaced about every 6 months or if there is a significant change in the size of the limb

Answer 83

- Purpose: to maintain limb size and to prevent re- accumulation of fluid during the day when the limb is in dependent position, can also help to control scar tissue formation. - Most garments provide a pressure gradient so that the compression is greatest distally and decreases proximally

Answer 84

Heart failure or pulmonary edema  Recent or acute DVT, thrombophlebitis, pulmonary embolism  Obstructed lymphatic or venous return  Severe Peripheral Artery Disease  Acute local skin infection (cellulitis)  Significant hypoproteinemia  Acute trauma or fracture  Arterial revascularization

Answer 85

 Impaired sensation or mentation  Uncontrolled HTN  Cancer  Superficial peripheral nerves

Answer 86

 ROM measurements (before and after)  Blood pressure (before, during and after)  Peripheral pulses (most distal pulse)  Girth measurements (before and after)  Pressure sensation (before)  Skin integrity (before, during and after)  Edema assessment

Answer 87

 **Pressure should be set lower than the patient’s diastolic pressure (Also, a common board question)  Recommended pressures range from 30-60 mm Hg for the upper extremity and 40-80 mm Hg in the lower extremity  On/off cycles vary dependent upon dx  Duration: minimum of 2 hours out of 24 hours  Frequency: daily or twice daily (recommended); minimum of 3 times/week to be beneficial

Answer 88

 Inform & educate the patient of the effects and goals of treatment  Explain rationale for treatment  Explain the procedure prior to patient set-up  Inform patient how to stop treatment or alert the PT or PTA  Static compression device worn between pneumatic treatments

Answer 89

Subjective: Record any patient statements regarding symptoms especially if they have had a previous compression treatment, how it effected their symptoms etc. Any other pertinent statements that apply to the use of compression (i.e. anything that would indicate a precaution or contraindication) Objective: Compression Documentation Objective  Blood pressure before and after treatment  Type of device (static or intermittent compression)  Patient position  Body part  Inflation and deflation cycle times  Inflation pressure  Total treatment time  Patient response to treatment  Wound size before and after treatment  Skin condition before and after treatment  Circumference measurements before and after treatment Assessment: ◦ Patient’s response to the treatment ◦ Any objective changes following the treatment Plan: ◦ Continuation of compression for subsequent treatments ◦ Any changes to the compression intervention for subsequent treatments ◦ The need to communicate with the PT

Answer 90

“Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational interventions, should not be considered physical therapy.”

Answer 91

For home and clinic: ◦ Educates the patient of the effects and goals of treatment ◦ Explain rationale for treatment ◦ Receives informed consent ◦ Explain the procedure prior to patient set-up ◦ Inform patient how to stop treatment or alert the PT or PTA For home: ◦ Proper operation of equipment ◦ Provide written instructions or appropriate diagram

Answer 92

codes that identify services rendered by a healthcare professional

Answer 93

 Relevant interview responses  Relevant data collection  Patient position  Specific area treated  Specifics of modality application-intensity, duration, other parameters  Response to treatment  Any home program and precautions that were instructed to the patient

Answer 94

Muscle contraction is the source of movement and can be observed as the net force or torque generated around a joint

Answer 95

Must be assessed when there is no active resistance to the muscle stretch Changes with move

Answer 96

*Don't need to memorize sub-types of hypo and hypertonicity for this class* Hypotonicity–abnormally low tone Decreased resistance to stretch Flaccidity is total absence of tone - For example, can occur in cerebrovascular accidents (stroke), Down Syndrome, poliomyelitis Hypertonicity–abnormally high tone Rigidity – resists stretch regardless of velocity Spasticity – resists stretch at higher velocities Clonus – rhythmic oscillations or beats of involuntary contraction in response to quick stretch Dystonia-involuntary sustained muscle contraction usually resulting in abnormal postures or repetitive twisting movements For example, can occur after stroke

Answer 97

SOUND WAVES (INAUDIBLE) WITH A FREQUENCY GREATER THAN 20,000 HERTZ * WHEN APPLIED TO THE BODY IT HAS THERMAL AND NONTHERMAL EFFECTS

Answer 98

A GRADUAL DECREASE IN INTENSITY AS ULTRASOUND TRAVELS THROUGH TISSUE (The further away from the source of the sound the smaller the wave)

Answer 99

SOME TISSUES ARE CAPABLE OF GREATER ABSORPTION OF ULTRASOUND THAN OTHERS * ABSORPTION IS TISSUE AND FREQUENCY SPECIFIC * HIGHER ABSORPTION OCCURS IN TISSUES WITH A HIGH COLLAGEN RATE (TISSUE) AND WITH HIGHER US FREQUENCIES (FREQUENCY DEPENDENT)

Answer 100

GENERALLY, TISSUES WITH HIGHER PROTEIN CONTENT(COLLAGEN) ABSORB ULTRASOUND TO A GREATER EXTENT * CARTILAGE & BONE AT UPPER END OF THIS SCALE, BUT MAJORITY OF ULTRASOUND ENERGY STRIKING THE SURFACES IS LIKELY TO BE REFLECTED Best absorption in: tendon, ligament, fascia, joint capsule, and scar tissue.

Answer 101

REFLECTION OF A SOUND WAVE OCCURS WHEN THE WAVE PASSES BETWEEN TWO TISSUES AND A FRACTION OF THE WAVE 'BOUNCES' BACK. * REFRACTION OCCURS WHEN THE ULTRASOUND SIGNAL IS DEFLECTED FROM A STRAIGHT PATH AND THE ANGLE OF DEFLECTION IS AWAY FROM THE TRANSDUCER

Answer 102

More concentrated towards the middle (of the transducer) * AREA OF THE CRYSTAL THAT ACTUALLY PRODUCES SOUND WAVES * THE POWER GENERATED FROM US IS NOT UNIFORM AND THEREFORE, SOME PORTIONS OF THE US BEAM ARE MORE INTENSE THAN OTHERS AS IT LEAVES THE TRANSDUCER; ENERGY IS CONCENTRATED NEAR THE CENTER * ERA IS ALWAYS SMALLER THAN THE TOTAL SIZE OF THE TRANSDUCER HEAD*

Answer 103

- Multiple waves emerge from the head - Energy diverges as it moves away from the source - Energy is uniform close to head * Near zone (Fresnel zone) - Becomes less consistent farther away from the head *Spatial peak intensity

Answer 104

* RATIO BETWEEN THE SPATIAL PEAK INTENSITY AND SPATIAL AVERAGED INTENSITY * THE HIGHER THE QUALITY OF THE CRYSTAL, THE LOWER THE BMR * A LOWER BNR IS MORE FAVORABLE SINCE PATIENTS WILL BE LESS LIKELY TO EXPERIENCE HOT SPOTS AND DISCOMFORT DURING TREATMENT

Answer 105

* SELECTED ACCORDING TO THE DEPTH OF THE TISSUE TO BE TREATED * US DELIVERED AT A HIGHER FREQUENCY IS ABSORBED MORE RAPIDLY THAN US DELIVERED AT A LOWER FREQUENCY * 3 MHZ REACHES SOFT TISSUES 1-2 CM DEEP * 1 MHZ REACHES SOFT TISSUES UP TO 5 CM DEEP

Answer 106

* MEASURES THE QUANTITY OF ENERGY DELIVERED PER UNIT AREA * SPATIAL AVERAGE INTENSITY: THE AVERAGE INTENSITY OF THE ULTRASOUND INPUT OVER THE AREA OF THE TRANSDUCER; EXPRESSED IN W/CM² * SELECTED ACCORDING TO TREATMENT GOAL * 3 MHZ INCREASES TISSUE TEMPERATURE ~3 TIMES FASTER THAN 1MHZ WHEN SAME

Answer 107

DUTY CYCLE: PORTION OF TREATMENT TIME THAT ULTRASOUND IS GENERATED DURING THE ENTIRE TREATMENT CONTINUOUS: UNINTERRUPTED FLOW OF SOUND WAVES; INTENSITY REMAINS CONSTANT * 100% * USED WHEN THE GOAL IS TO INCREASE TISSUE TEMPERATURE

Answer 108

PULSED: PRODUCED BY INTERMITTENTLY INTERRUPTING THE SUPPLY OF ELECTRICAL ENERGY TO THE US HEAD, WHICH CAUSES THE SOUND WAVES TO BE DISCONTINUOUS * 20%- MOST RECOMMENDED PULSED CYCLE * USED WHEN NONTHERMAL EFFECTS DESIRED duty cycle = on time/(on time + off time)

Answer 109

- Pregnant - History of Cancer (Where, what, & how long ago?) - Pacemaker

Answer 110

GENERALLY DIVIDED INTO: 1. THERMAL 2. NONTHERMAL * IT IS ALMOST INEVITABLE BOTH WILL OCCUR DURING APPLICATION * DOMINANT EFFECT WILL BE INFLUENCED BY TREATMENT PARAMETERS

Answer 111

* INCREASE EXTENSIBILITY OF COLLAGEN STRUCTURES * DECREASE JOINT STIFFNESS & INFLAMMATION * PAIN RELIEF * INCREASE BLOOD FLOW * DECREASE MUSCLE SPASMS * INCREASED METABOLIC RATE * ENHANCED IMMUNE SYSTEM RESPONSE * DECREASED VISCOSITY OF TISSUE FLUIDS

Answer 112

PARAMETERS: * 1 MHZ FREQUENCY, 1.0 – 1.5 W/CM2 INTENSITY, CONTINUOUS [Deep Tissue] (Lower Frequency = Deeper) * 3 MHZ FREQUENCY, 0.5-.8 W/CM2 INTENSITY, CONTINUOUS [Superficial Tissue] * INCREASE TISSUE TEMPERATURE: PATIENT SHOULD FEEL WARMTH IN 2-3 MINUTES * PATIENT’S REPORT OF WARMTH IS USED TO DETERMINE FINAL ULTRASOUND INTENSITY * IF TOO HIGH PATIENT WILL C/O DEEP ACHE * IF TOO LOW PATIENT WILL NOT FEEL ANY INCREASE IN TEMPERATURE

Answer 113

* STIMULATION OF TISSUE REGENERATION * PAIN RELIEF * SOFT TISSUE REPAIR * INCREASE BLOOD FLOW * INCREASE SKIN AND CELL MEMBRANE PERMEABILITY

Answer 114

- Thermal - Shakes the tissue REFERS TO THE FORMATION OF GAS-FILLED BUBBLES THAT EXPAND AND COMPRESS SECONDARY TO THE PRESSURE CHANGES CAUSED BY ULTRASOUND

Answer 115

FREQUENCY (DEPENDENT UPON DEPTH OF TARGET TISSUE) * 1 MHZ FREQUENCY OR 3 MHZ FREQUENCY DUTY CYCLE * 20% INTENSITY * ACUTE CONDITIONS 0.1-0.3W/CM² * SUB-ACUTE CONDITIONS 0.2 TO 0.5 W/CM² * CHRONIC CONDITIONS 0.5-1.0 W/CM² Acute: Days 0-6 Sub-Acute: Days 3-20 Chronic: Day 9 onward

Answer 116

DIRECT CONTACT 1. WATER BASED MEDIUM GEL * BETWEEN THE TRANSDUCER AND PATIENT’S SKIN TO ELIMINATE AIR POCKETS INDIRECT CONTACT 1. WATER IMMERSION * USED WHEN TREATMENT AREA IS IRREGULARLY SHAPED OR UNABLE TO TOLERATE DIRECT PRESSURE FROM TRANSDUCER * BASIN MADE OF RUBBER OR PLASTIC TO MINIMIZE AMOUNT OF REFLECTION PRESENT WITHIN THE METALS * TRANSDUCER PARALLEL TO TREATMENT SURFACE 0.5-3.0 CM AWAY * WIPE AWAY AIR BUBBLES ON SKIN AND TRANSDUCER 2. CUSHION CONTACT * USE OVER BONEY PROMINENCES OR OPEN WOUNDS

Answer 117

* DESPITE STORING GEL AT ROOM TEMPERATURE (~70°), GEL FEELS COLD ON SKIN (AT ~ 92°) * HEATING GEL DECREASE VISCOSITY-GEL TENDS OF SLIDE OF SKIN CURVATURES * BACTERIAL CONTAMINATION STUDIES SHOW * 52.7% OF TIPS ON US GEL BOTTLES POSITIVE FOR BACTERIA * 35.5% SOUND HEADS POSITIVE FOR BACTERIA

Answer 118

* DETERMINED BY: * SIZE OF TREATMENT AREA * DEPTH OF PENETRATION * DESIRED THERAPEUTIC EFFECTS * GENERALLY 5-10 MINUTES, TOTAL TIME~ 1 ½ MINUTES FOR EVERY NUMBER OF TIMES TRANSDUCER FITS INTO TREATMENT AREA US is not effective for large areas

Answer 119

NUMBER DEPENDENT UPON * THERAPEUTIC OBJECTIVES & LEVEL OF ACUITY-THERMAL EFFECTS APPLIED DURING SUBACUTE AND CHRONIC PHASES OF HEALING NONTHERMAL EFFECTS APPLIED EARLIER IN HEALING RESPONSE * PATIENT RESPONSE-POSITIVE RESPONSE SHOULD BE EVIDENT WITHIN 3 TREATMENTS FREQUENCY * THERMAL APPLICATIONS- 2-3X/WEEK * NONTHERMAL APPLICATIONS-DAILY

Answer 120

MOVING OF SOUND HEAD * SPEED * 3-4 CM PER SECOND (About an inch/sec) * TYPE OF STROKE * MOVE SO CENTER OF HEAD CHANGES POSITION * SMALL OVERLAPPING CIRCLES AID IN “WASHING OUT” HOT SPOTS ON THE CRYSTALS, WHEREAS LONGITUDINAL STROKES MAY KEEP HOT SPOT TRAVERSING THE SAME TISSUE REPEATEDLY * ANGLE OF CONTACT (Completely flat) * IDEAL IS PERPENDICULAR TO SURFACE * TREATMENT HEAD AT <15° ON PLANE OF SKIN, MAJORITY OF BEAM WILL TRAVEL THROUGH SKIN SURFACE

Answer 121

* MAINTAIN CONSISTENT ENERGY TRANSFER TO DECREASE RISK OF BURNS * KEEP TRANSDUCER MOVING * MAINTAIN EVEN CONTACT * REMOVE AIR BUBBLES * KEEP OFF BONY PROMINENCES * DO NOT HOLD TRANSDUCER IN THE AIR (WILL CRACK PIEZOELECTRIC CRYSTAL) * AVOID INTENSITIES HIGHER THAN RECOMMENDED THERAPEUTIC LEVELS * MOVE SOUND HEAD AT 3-4 CM/SECOND ( ~ 1 INCH PER SECOND)

Answer 122

- Soft tissue repair - Contractures - Trigger points - Dermal ulcer - Scar tissue - Stretching of shortened soft tissue - Reduce pain - Subacute and chronic inflammation - Peripheral nerve injury - Muscle spasm - Alter membrane permeability for tissue healing

Answer 123

- Acute inflammation - Fractures - Open non-acute stable wounds - Decreased cognition and mentation - Pressure sensitivity - Metal implants

Answer 124

Three big questions: - Pregnant - History of Cancer (Where, what, & how long ago?) - Pacemaker - Malignant Tumor - Pregnancy - CNS tissue - Joint cement or Plastic components - Pacemaker - Thrombophlebitis & DVT - Eyes, heart and genitalia/reproductive organs - Areas of decreased circulation & decreased temperature sensation - Epiphyseal plates

Answer 125

* INFORM & EDUCATE THE PATIENT OF THE EFFECTS AND GOALS OF TREATMENT OF U.S. * EXPLAIN RATIONALE FOR TREATMENT * EXPLAIN THE PROCEDURE PRIOR TO PATIENT SET-UP * INFORM PATIENT HOW TO STOP TREATMENT OR ALERT THE PT OR PTA

Answer 126

1. EVALUATE CLINICAL FINDINGS, GOALS OF TREATMENT 2. DETERMINE IF US IS MOST APPROPRIATE 3.CONFIRM THAT US IS NOT CONTRAINDICATED 4. APPLY AN ULTRASOUND TRANSMISSION MEDIUM TO THE AREA TO BE TREATED 5. SELECT SOUND HEAD WITH ERA ABOUT ½ SIZE OF TREATMENT AREA 6. SELECT OPTIMAL TREATMENT PARAMETERS (FREQUENCY, INTENSITY, DUTY CYCLE, DURATION) 7. CLEAN THE SOUND HEAD 8. PLACE THE SOUND HEAD ON THE TREATMENT AREA9. TURN ON THE ULTRASOUND MACHINE 10. MOVE THE SOUND HEAD WITHIN TREATMENT AREA 11. CLEAN SOUND HEAD AND MEDIUM FROM PATIENT, REASSESS PATIENT 12. DOCUMENT

Answer 127

Healing Phases (Conditions) - Inflammatory (Acute): Day 0-6 - Proliferative (Sub-Acute) Day 3-20 - Maturation

Answer 128

Provides information about physiological or biomechanical processes that can be acted on for improved function and performance. * Requires user action * Unlike other physical agents, does not result from transfer of energy to targeted area The information is picked up by the biofeedback unit in the form of electrical potentials then translated into an audio and or a visual signal that the patient can relate to activity of the body thus increasing the level of awareness to conscious attention so we can learn to control various body systems Does NOT measure muscle contraction but rather electrical activity associated w/ muscle contraction*

Answer 129

Direct Accurate, numerical value of bioprocesses, for example, heart rate monitor Transformed Provides a representative signal of muscular electrical activity, for example, EMG

Answer 130

* An operant conditioning technique used to improve voluntary control over a target muscle through use of visual and or auditory information and done in small progressive steps * The information is directly proportional to the level of muscle activity (auditory &/or visual) * The electrodes are placed over the target muscle and the patient is asked to attempt activity contraction of the target muscle (for weakened muscles) or they are asked to attempt to relax a muscle for inhibition (relaxation of a dystonic muscle) – they will see the needle move or hear a level of static that indicates the level of muscle activity

Answer 131

* Stages of BF training are designed to help the patient do the following: * Attain awareness of both present and desired physiologic activities and movement patterns * Gain control of specific bodily activity * Transfer self-control to functional use * Train in a calm & non-distracting environment * Give brief, clear commands (assess patient understanding) * Avoid fatigue (give frequent rest periods ) * Gradually increase difficulty * Focus on specific tasks that result in short term functional gains * Allow for repetition – enough for functional carry-over without the device * Incorporate into functional training * Can combine with facilitation techniques (ie-PNF quick stretch) * Provide a home program to enhance training effectiveness

Answer 132

locations of the skin where electrical stimulation most effectively causes muscles to contract

Answer 133

Electricity is often described by - Current (rate of flow)  The directed flow of charge from one place to another  Measured in amperes - Voltage (driving force)  Measure of electromotive force/electrical potential difference  Electrons will only flow b/n 2 points when there is a difference in the quantity  Measured in volts - Resistance(impedance)  Describes the ability of a material to oppose the flow of ions through it  Measured in ohms

Answer 134

Don't say, "I'm going to use electricity on you."

Answer 135

The amount of current that flows (I) is equal to the amount of force (E) (volts) divided by the resistance (R) I=E/R Current = Voltage/Resistance - The greater the resistance, the less current flows.

Answer 136

ability to store charge in an electric field and oppose change in current flow  Examples: nerve and mm membranes have high capacitive reactance that opposes charge movement

Answer 137

Opposition to current flow in the body Example: Adipose tissue has a high impedance  Greater intensity current would be required to stimulate muscle covered by adipose tissue than an area with little fat  Cleaning the skin, shaving hair, warming the area will also decrease impedance

Answer 138

Continuous stream of charged particles flowing in one direction from anode (positive [+] electrode) to cathode (negative [-] electrode) Not commonly used for electrotherapy b/c generally uncomfortable for patient Low level DC used for: Stimulation of denervated muscles Iontophoresis *line on graph is staple shaped

Answer 139

 Continuous, sinusoidal, bidirectional flow of charged particles  Each electrode is positive for one phase and then negative as the current reverses  Most frequently used in a modulated form as burst or time-modulated  AC current used for:  Pain control  Muscle contraction *Picture on graph is wavy above and below line. Used clinically in the form of:  Interferential current  Pre-modulated current  Russian protocol

Answer 140

Two different criss-crossing currents - Usually very comfortable for pt.'s - Doesn't need to be turned up to high intensity due to criss-cross effect  Produced by interference of two medium frequency ACs with slightly different frequencies  2 pairs of electrodes so they intersect  Usually preset carrier frequency (2500, 4000, or 5000 Hz)  More comfortable, deeper penetration than biphasic pulsed waveforms  Used for pain relief, increased circulation, mm stimulation

Answer 141

 Produced with a single circuit and two electrodes  Disadvantage vs. IF:  Doesn’t have lower current amplitude to the skin  Treats a smaller area

Answer 142

 Medium frequency AC with a carrier frequency of 2500 Hz  10-ms-long bursts with 50 bursts/second with a 10-ms interburst interval  Used for strengthening

Answer 143

- Direct Current  Current flows equally throughout the stimulation time  Only parameters are * amplitude * total treatment time - Alternating and pulsed currents  Pulse duration  Phase duration  Interpulse interval - Other  Amplitude  Frequency  On and off time  Ramp up and ramp down time

Answer 144

 Amplitude: refers to the magnitude of current flow  Peak amplitude must be large enough to exceed threshold for the nerve or mm cell  Labeled as strength or intensity  Measured in volts

Answer 145

 Phase: period when electrical current flows in one direction  Phase duration: how long a phase lasts  Pulse: period when electrical current flows in any direction  may be 2 or more phases  Pulse duration: how long each pulse lasts  Interpulse interval: amount of time between pulses

Answer 146

# of cells to fire at a more  The number of cycles (for AC) or pulses (for PC) that occur per second  Also known as the ‘rate’  Measured in hertz (1 Hz = 1 cycle/sec.) or pulses per second (pps)  Frequency affects # of action potentials elicited during stimulation  High frequency causes same rapid rate

Answer 147

On & Off Times  On Time: when the current is on  produces muscle contraction  Off Time: when the current is off  allows muscle to relax  May be expressed as a ratio Ramp Up & Ramp Down Time Ramp up: number of seconds it takes for current amplitude to increase from zero Ramp down: number of seconds it takes for current amplitude to decrease from maximum amplitude

Answer 148

 The rapid sequential depolarization and repolarization of a nerve that occurs in response to a stimulus and transmits along the axon. The AP is the message unit of the nervous system  *Absolute refractory period: AP’s can’t occur in the same segment of the nerve no matter how strong the stimulus is  *Relative refractory period: during this time a greater stimulus than usual is required to produce another AP

Answer 149

 Once an AP is generated, it triggers an AP in the adjacent area of the nerve membrane. This process is called propagation.  Propagation occurs in only one direction  Speed of AP depends upon 1. Diameter of nerve  the greater the diameter, the faster the AP will travel 2. Myelin-fatty sheath that wraps around certain axons  AP’s travel faster in myelinated (vs. unmyelinated) nerves

Answer 150

Normally -> Slow-twitch type I fibers are activated before fast-twitch type II * Slow-twitch: smaller, produce lower force contractions, more resistant to fatigue and atrophy * Fast-twitch: larger, produce stronger and quicker contractions, fatigue rapidly and more prone to atrophy PPT. 12, Slide 6

Answer 151

Patients with reduced mm strength from surgery, immobilization, or other muscle- weakening pathology, early use of ES and adding ES to physiological exercise can accelerate strength gains

Answer 152

Electrically stimulated mm contractions * Fast-twitch type II muscle fibers activated 1st * Stimulated contractions more fatiguing than physiological contraction, thus longer rest times should be provided * Best to perform physiological contractions with E-stim

Answer 153

Overload principle * The greater the load placed on a muscle and the higher the force contraction it produces, the more strength that muscle will gain * Electrically stimulated contraction force increased by increasing the total amount of current (via increased pulse duration, current amplitude, or electrode size) which recruits more fibers Specificity * Muscle contractions specifically strengthen the mm fibers that contract * ES has more effect on type II (fast twitch) muscle fibers than on type I(slow twitch). * Disuse atrophy is primarily of type II (fast twitch) fibers

Answer 154

* Muscle strengthening for orthopedic conditions * Cardiorespiratory and functional training in patient populations * Muscle strengthening for healthy adults and athletes * Improved muscle coordination and motor control for neurological conditions * Edema control and improved circulation * Retardation of atrophy and return of function in denervated muscle

Answer 155

NMES, generally applied to quads, has potential to increase * Peak oxygen uptake * 6-minute walk test distance * Muscle strength * Flow-mediated dilation (widening of artery when blood flow increases to that artery) * Depressive symptoms * Global quality of life

Answer 156

* To increase strength in healthy muscles, contractions need to be at least 50% of the maximum voluntary isometric contraction (MVIC)- requires more forceful contractions * Sports medicine/performance/rehabilitation * Addition of NMES to strength training * can enhance strength gains * may or may not enhance functional performance * is not a substitute for sports-specific training

Answer 157

* PNS-directly increases mm strength * CNS- repetitive practice and increased general excitability (motor and sensory) may enhance brain plasticity and cortical motor output * brain plasticity: brains ability to change and adapt as a result of experience * motor cortex: region of the cerebral cortex involved in the planning, control, and execution of voluntary movements * Antagonist contraction reduces agonist spasticity (by causing reciprocal inhibition of agonist) * Agonist contraction increases agonist strength and control * Lower extremity stimulation * Improved gait * Increased ankle dorsiflexion torque * Reduced agonist-antagonist co-contraction * Increased probability of returning home * Upper extremity stimulation * Reduce shoulder subluxation * Improve grasping function * EMG-triggered NMES * when pt. voluntarily contracts the agonist mm, the device senses EMG activity, triggering NMES to assist in the contraction

Answer 158

* Counteract disuse muscle atrophy * Improve circulation * Contract muscle to assist with locomotion * Contract muscles to assist with hand grasp, respiration, conditioning, bowel and bladder voiding * For FES to be effective, it must: * Sufficient force to carry out activity * Not painful * Can be controlled and repeated * Acceptable to the user

Answer 159

Demand cardiac pacemaker Implanted defibrillator Unstable arrhythmia Over carotid sinus Over venous or arterial thrombosis Pregnancy (over abdomen, low back)** When contraction of muscle may disrupt healing

Answer 160

Cardiac disease Impaired sensation Impaired mentation Malignancy** (If they are terminally ill then it's fine) Skin irritation/open wound May cause delayed-onset muscle soreness

Answer 161

* Dependent upon desired strength of contraction; the higher the amplitude, the greater the strength of contraction * Injured tissue: current amplitude set so that contraction is ≥10% to 50% maximum voluntary isometric contraction (MVIC) of uninjured limb * Normal tissue: current amplitude must be high enough to produce a contraction that is at least 50% MVIC

Answer 162

* 20 to 30 pps for small muscles * 35 to 50 pps for larger muscles * >50 to 80 pps may not only increase muscle strengthening but also increase fatigue * As frequency increases 35-50 pps, twitches begin to summate into a smooth tetanic contraction

Answer 163

Duty Cycle: provides the muscle with relaxation time and limit the influence of fatigue * On time ranges from 6-10 seconds * Off time approximately 5x longer duty cycle = one time/ (one time + off time) Ramp: allows current amplitude to gradually increase to a preset maximum & then gradually decrease * On 6 to 10 seconds * Off 50 to 120 seconds * On to off ratio 1:5 to 1:3 * Ramp up/ramp down time 1 to 4 seconds, longer with spastic antagonist muscles

Answer 164

* Patients should complete a minimum of 10 contractions and a maximum of 20 contractions * Based on typical On:Off times (on for 10 seconds, off for 50 seconds), performing 10 contractions should take approximately 10 minutes

Answer 165

 Evaluate the patient.  Determine appropriateness and safety.  Select device.  Prepare patient.  Explain procedure.  Remove metal and clothing in treatment area.  Inspect the skin.  Position patient and device.  Select and apply electrodes.  Select treatment parameters.  Waveform, polarity, frequency, pulse duration, on:off time, ramp up/ramp down, treatment duration  Turn on machine.  Assess outcome.  Document

Answer 166

Self-Adhesive Electrodes:  Most commonly used (either single use or reusable)  Composed of flexible conductors such as foil or metal mesh, conductive gel (decreases resistance) layered with an adhesive surface  Advantage: convenience of application  Disadvantage: current may not be uniform after multiple uses due to gel drying out  Store on plastic sheet in a sealed plastic bag. Mark patient name/ID# on package (electrodes should not be shared)  Sensitive skin electrodes available (blue gel-less adhesive, more water) Carbon Rubber Electrodes  Longer lasting than self-adhesive  Used with conductive gel or sponge soaked in water  Must be secured to the patient  Should be cleaned after each treatment - warm, soapy water Conductive Fabric Electrodes  Made from conductive thread  Garment electrode; to treat an entire area that conventional electrodes won’t cover  Usually expensive; single patient use

Answer 167

 Electrodes should conform to the body part treated  Should not be placed over bony prominences-increases risk of discomfort and burns  Distance/spacing between electrodes affects the depth and path of electrical current -The closer electrodes are the more superficial

Answer 168

Current density = current amplitude (mA)/ electrode size (cm*2) The current density may be altered either by increasing or decreasing current intensity or by changing the size of the electrode

Answer 169

 Informational: (especially important for home use)  Expected outcome of treatment  Number of expected treatments  Treatment time  How to operate the unit safely & properly  Application of electrodes (diagrams for placement)  Dials and adjustments-purpose & consequence of adjustment  How to inspect & protect skin before & after treatments  When to discontinue treatment  When to notify the PT  Be sure to provide ALL SAFETY INSTRUCTIONS clearly and best if the patient is given something in writing for retention as well as appropriate diagrams (for home)

Answer 170

- Sensory- level electrical stimulation (high-rate/high frequency TENS)  Short-duration pulse  High frequency  Amplitude to produce a comfortable sensory response, but below the motor threshold (without muscle contraction) - Pain relief is usually brief and only occurs when the current is being generated  Used during ADL’s  Treatment time up to 24 hours/day TENS uses the Gate Control theory (sensory level)

Answer 171

 Electrical stimulation may also control pain by stimulating and releasing endogenous (endorphins and enkephalins)  Modulate pain by repetitive stimulation of motor nerves to produce brief, repetitive muscle contractions to stimulate endogenous release * Motor level/low rate TENS or burst mode uses this theory

Answer 172

 Motor-level electrical stimulation (low rate/low frequency TENS)  Long-duration pulse (100 to 300 μs)  Low frequency (2 to 10 pps)  Amplitude should be sufficient to generate mm twitching  Usually controls pain 4-5 hours after 20-30 min. treatment  Produces painful noxious stimulus; Use no more than 30 minutes per session to avoid delayed-onset muscle soreness

Answer 173

High-rate TENS  Recommended when sensation, but not mm contraction, will be tolerated such as after a recent injury when inflammation is present, or when tissues may be damaged by contraction Low-rate TENS  Recommended when a longer duration of pain control is desired and mm contraction is likely to be tolerated

Answer 174

Prevents accommodation (getting used to it) and also for patient comfort (in choosing which waveform feels more comfortable).

Answer 175

Direct Current (DC) Alternating Current (AC) Interferential Current (low-frequency)

Answer 176

 Interferential Current (low-frequency)  Pulsed biphasic waveform produced by 2 intersecting ACs (channels must cross)  This waveform most commonly used for pain control  May be more comfortable and penetrate larger, deeper area  Pre-modulated Current  Pulsed monophasic waveform  Variation of IFC-uses only 2 electrode  TENS unit  Pulsed biphasic currents

Answer 177

- For Acute Pain:  High frequency, sensory intensity and narrow pulse duration  Options  IFC or Pre-modulated  High voltage pulsed stimulation  Biphasic  Microcurrent - For Sub-acute to Chronic Pain:  Low frequency, sensory to motoric response, long pulse duration  Options  Biphasic  IFC or Pre-modulated  High voltage pulsed stimulation  Micro-current

Answer 178

 Around the painful area (most common)  Over trigger points or acupuncture points  Areas of decreased skin resistance  Area proximal to site of pain (i.e. if limb casted), along pathway of sensory nerve supplying the area  Surrounding area of pain (4 electrodes)  Pulsed currents: area so that 2 electrodes current intersect  IFC: intersection of 2 currents

Answer 179

* Demand cardiac pacemaker * Implanted defibrillator * Unstable arrhythmia * Over carotid sinus * Over venous or arterial thrombosis * Pregnancy (over trunk)** * Do not use when muscle contractions may disrupt healing

Answer 180

* Cardiac disease * Impaired sensation * Impaired mentation * Malignancy** * Skin irritation/open wound * May cause delayed onset muscle soreness (low-rate) * Avoid aggravating activities

Answer 181

 Negative electrode (cathode) used to promote healing of inflamed/infected wound  Positive electrode (anode) for wounds WITHOUT infection/inflammation *Electrodes CAN be placed in the wound without using adhesive and by using gauze and other proper material.

Answer 182

 Galvanotaxis to attract appropriate cell types * Normal response to tissue injury & causes specific cells to move to injured healing area (due to increase in charge of damaged tissues) * Directional movement of cells in response to an electrical field; application of ES can enhance all phases of wound healing  Activate cells by altering cell membrane function * Activation of fibroblasts, which are cells that make collagen to close a wound  Enhance antimicrobial activity * Kills bacteria

Answer 183

Chronic Wounds Edema Control Transdermal Drug Delivery

Answer 184

 Edema due to inflammation ◦ Area is hot, red, swollen ◦ Negative polarity HVPC retards formation of acute edema ◦ Negative charge repels negatively charged serum proteins ◦ Roughly 50% reduction; similar magnitude to ibuprofen or cold water immersion  Edema due to lack of muscle contraction ◦ Area is cold, pale, swollen ◦ Healthy muscles contract to promote fluid return from periphery ◦ Treat with motor level ES and elevation

Answer 185

 Demand cardiac pacemaker  Implantable cardiac defibrillator  Unstable arrhythmias  Over carotid sinus  Areas where venous/arterial thrombosis or thrombophlebitis present  Pregnancy**  Malignant tumors***  Do not apply iontophoresis after any intervention that is likely to alter skin permeability

Answer 186

 Cardiac disease  Impaired mentation  Impaired sensation  Skin irritation  Infection control

Answer 187

 Excessive granulation formation  Skin irritation  Burns

Answer 188

Waveform - High-volt pulsed current (HVPC) Polarity - Negative - early inflammatory phase/infected - Positive – proliferation phase/clean Pulse duration 40 to 200 μs (Generally preset in the machine 70 to 100 μs and can’t be changed) Frequency 60 to 125 pps Amplitude Comfortable sensory, without motor response (Don't memorize frequencies) Treatment time 45 to 60 minutes, at least 5x/week Edema Control  Determine cause of edema  Position patient to promote blood flow out of extremity, may combine with ice and compression  Waveform: ◦ High-volt pulsed current (HVPC) for inflammation ◦ Biphasic for lack of muscle contraction

Answer 189

The amplitude and duration of electrical current required to produce an AP depends on the type of nerve being stimulated  In general, lower current amplitudes and shorter pulse durations can stimulate APs in sensory nerves, whereas higher amplitude or longer pulses are needed to stimulate APs in motor nerves

Answer 190

Electrical Muscle Stimulation (EMS)  Denervated mm contact when a directly applied electrical current produces APs in mm cells Neuromuscular Electrical Stimulation (NMES)  Innervated mm contract in response to electrical stimulation when a stimulated AP reaches the mm via the motor nerve that innervates it

Answer 191

 Methods of parenteral drug delivery (outside the intestine) ◦ Injections ◦ Passive transcutaneous delivery for delivery over an extended period of time ◦ Electrorepulsive forces – IONTOPHORESIS ◦ Mechanical forces - PHONOPHORESIS

Answer 192

 Uses direct current (DC)  Palm-sized current-controlled devices in which the iontophoretic dosage may be programmed for each patient  Has the potential to enhance transcutaneous permeation of both ionic and non-ionic compounds better than passive delivery How it works: - An electrode of the same polarity as the charge on the drug drives the drug into the skin by electrostatic repulsion - Based on theory that like charges repel

Answer 193

Anti-inflammatory:  Dexamethasone phosphate – most common ◦ Negative charge Local anesthetic  Lidocaine ◦ Positive charge  In most states, physical therapists are not allowed to dispense medications therefore a prescription is necessary to acquire certain medications  Some patient’s will procure their own medication with a prescription and bring it to the PT session for the treatment.

Answer 194

 Active electrode (drug delivery electrode) is placed over area of pathology  Drug delivery electrode should have the same polarity as the active ion of the drug to be delivered  Dispersive electrode usually contains saline and is placed away from drug delivery electrode, minimally equivalent to the diameter of the active electrode

Answer 195

Current Density - Current Density = current amplitude (mA)/electrode size (cm*2) - The current density may be altered either by increasing/decreasing current intensity or by changing the size of the electrode Dosage - Dosage Calculation * Dosage (mA*min) = Current (mA) x time (minutes) *Usually 40mA*min is recommended dosage Frequency of Application - Dependent upon: * Ion selected * Underlying condition * Patient tolerance * Relative effectiveness of treatment Skin Integrity  Common for skin under active electrode to have a reddish color after treatment; usually goes away in ~ 1 hour - Signs of skin irritation or burns:  Small blisters  Acidic reaction: Occurs as a results of hydrochloric acid forming under positive electrode (anode)  Alkaline reaction: Occurs as a result of sodium hydroxide forming under the negative electrode (cathode)

Answer 196

Indications  Inflammation  Pain  Calcium Deposits  Fungal infection  Hyperhidrosis  Ischemia  Keloids  Muscle spasm  Myositis ossificans  Plantar warts  Scar tissue  Wounds Precautions (Possible adverse reactions during the treatment ◦ Tingling ◦ Stinging ◦ Pulling sensation ◦ Burning sensation ◦ Pain Contraindications  Drug allergies  Skin sensitivity reactions to specific ions  ↓ Sensation  Recent scars  Implanted metal  Active bleeding  Pacemakers

Answer 197

Although drugs delivered by phonophoresis are initially more concentrated at the delivery site, the are quickly distributed around the body by the vascular system  Limited amount of evidence in literature that supports the efficacy of phonophoresis  Medication is mixed in an inert base able to transmit ultrasonic energy  Ultrasound gel used most commonly Common Medications - Corticosteroid * Indications: Inflammation * Ex) Hydrocortisone -Salicylates *Indications: Inflammation; Pain * Ex) Dexamethasone - Anesthetic * Indications: Pain; Trigger Points * Ex) Lidocaine

Answer 198

Musculoskeletal Inflammation  Tendonitis  DeQuervain’s Tenosynovitis  Plantar fasciitis  Temporomandibular Dysfunction (TMD/TMJ)  Bursitis - Precautions and Contraindications are the same as those for Ultrasound + Allergic reaction to medication - Treatment parameters, Safety considerations, Pt. education, & documentation (with medication used) all the same as US

Answer 199

Comprised of electric energy and magnetic fields that vary over time and are oriented perpendicular to each other. * Travel through space WITHOUT the need of a medium * Natural sources: earth’s magnetic field, sun’s UV waves * Manufactured sources: light bulbs, domestic electrical appliances, computers, power lines

Answer 200

* Laser * Diathermy * Ultraviolet * Infrared Lamps

Answer 201

Intensity of any type of EMR reaching the body is greatest when energy output is high, the radiation source is close to the patient, and the beam is perpendicular to the surface of the skin

Answer 202

* Low-intensity lasers (cold lasers) are generally used to promote tissue healing and to control pain and inflammation by nonthermal mechanisms * Most common form of electromagnetic therapy

Answer 203

Used surgically: * Generates heat and destroys only the tissue directly in the beam, while avoiding damage to surrounding tissues * Beam is sterile * Allows fine control * Cauterizes as it cuts * Produces little scarring

Answer 204

can be described in terms of: * Power in watts (W) or energy in joules (J) * Density or surface area of irradiation (cm2) * Power density (W/cm2) * Energy density (Joules) J/cm2

Answer 205

* Promote ATP production by mitochondria * Promote collagen production by fibroblasts * Modulate inflammation * Inhibit bacterial growth * Promote vasodilation * Alter nerve conduction velocity and regeneration

Answer 206

- Soft tissue (wounds) and bone healing - Arthritis - Lymphedema - Neurological conditions - Pain management

Answer 207

* Low back or abdomen during pregnancy * Epiphyseal plates in children * Impaired sensation * Impaired mentation * Photophobia/light sensitivity * Pretreatment with photosensitizer

Answer 208

* Direct radiation of eyes; patients and clinicians should wear provided goggles * Malignancy * Within 4 to 6 months after radiotherapy * Hemorrhage * Over thyroid or other endocrine glands

Answer 209

* Exposure of eyes to laser can cause retinal damage. * Reports of * Transient tingling * Mild erythema * Rash * Burning sensation * Increased pain/numbness * Burns from warm diode

Answer 210

Shortwave (SWD) only allowed in the USA Better than US for larger areas of tissue * The application of shortwave or microwave electromagnetic energy to produce heat and other physiological changes within tissues Continuous Shortwave Diathermy (CSWD) * Thermal Application (vasodilation, ↑ soft tissue extensibility, elevated pain threshold/reduced pain, altered muscle strength, ↑ rate of nerve conduction/enzymatic activity) * Penetrates 3 to 5 cm below the skin surface (deeper than HP) * Heats larger area than US * Not reflected by bone, thus does not pose risk of periosteal burning- like US * Indications: heating large, deep structures (knee/hip joint, diffuse area of spine), ↓ joint stiffness when used in conjunction with stretching, pain control, accelerated tissue healing Pulsed Shortwave Diathermy (PSWD) * Nonthermal Applications(altered cell membrane function and cellular activity, increased microvascular profusion) * Penetrates 3 to 5 cm below the skin surface * Indications: control of pain & edema, soft tissue healing, nerve healing, bone healing, OA

Answer 211

1. Inductive Coil-Produces more heat in deeper structures 2. Capacitive Plates- Produces more heat in superficial structures

Answer 212

Thermal & Non-thermal * Near electronic or magnetic equipment * Obesity * Copper bearing intrauterine contraceptive devices * Skeletal immaturity

Answer 213

Thermal - Pain control - Increase range of motion (if applied in conjunction with stretching) - Decreased joint stiffness - Accelerated tissue healing Non-Thermal - Control of pain and edema - Soft tissue (wound) healing - Nerve healing - Bone healing - Osteoarthritis symptoms

Answer 214

Thermal & Non-thermal * Implanted or transcutaneous nerve stimulators including cardiac pacemakers * Metal implants * Malignancy * Pregnancy * Eyes * Testes * Growing epiphyseal plates

Answer 215

* Diathermy produces diffuse radiation that could irradiate a therapist. * Recommended to stay 1 to 2m away from continuous diathermy applicators, when on * Recommended to stay 30 to 50 cm away from all SWT applicators, when on * Pregnant therapists should avoid exposure to SWD and MWD.

Answer 216

- Psoriasis - Wound healing* (only relevant one for PT) - Acne - Vitamin D deficiency/Osteomalacia - Sinusitis

Answer 217

* Advantages * Does not require contact with the patient * Observation of the area during treatment as this medium does not require direct contact * Disadvantage * Infrared radiation does not apply a focused treatment * Uneven distribution of energy transference Caution: Absorbed more in darker skin

Modalities Terms Flashcards

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