PRECAUTIONS!!!!

Question 1

precautions for cryotherapy

Answer 1

Precautions
• Never place a cold gel pack directly on the skin
• Never longer than 20 mins
• Avoid use with patients with cold urticaria, PVD, hypertension, frostbite opr monitor closely
• Avoid over superficial nerves
• Avoid over an open wound
• Avoid over areas of poor sensation
• Obese patients may need more time to achieve effects (muscle has higher water content, conducts heat more efficiently than adipose or fat tissue.
• Kids and elderly may need more layering due to decrease adipose.

Question 2

contraindications for

Answer 2

Contraindications
•	Cold hypersensitivity
•	Raynauds
•	Cryoglobulinemia
•	Over a regenerating peripheral nerve
•	Compromised circulation

Question 3

precautions for Superficial Heat Agents

Answer 3

• Mild Impaired sensation
• Tumors/cancer in past
• Acute inflammation
• DVT (deep vein thrombosis)
• Pregnancy
• Bleeding tendencies
• Infection
• Advanced cardiac disease
• Impaired mental status
• RA (rheumatoid arthritis)

Question 4

contraindications for Superficial Heat Agents

Answer 4

• Acute injury or inflammation
• Impaired sensation ( worse than 2.83 on Semmes Weinstein)
• malignancy

Question 5

Precautions and Contraindication for contrast baths

Answer 5

include those listed for both cryotherapy and heat therapy::
contraindications
• Acute injury or inflammation
• Impaired sensation ( worse than 2.83 on Semmes Weinstein)
• malignancy

precautions: 
•	Mild Impaired sensation
•	Tumors/cancer in past
•	Acute inflammation
•	DVT (deep vein thrombosis)
•	Pregnancy
•	Bleeding tendencies
•	Infection
•	Advanced cardiac disease
•	Impaired mental status
•	RA  (rheumatoid arthritis)

Question 6

precautions for ultrasound

Answer 6

• Metal or plastic implants: keep moving

* Unhealed fracture sites: some literature indicates low frequency promotes bone growth

Question 7

contraindications for ultrasound

Answer 7

• Never over the eye, heart, pregnant uterus, or reproductive organs.
• Never over central nervous system tissue or pacemaker
• Malignancy or area of infection
• Area of decreased circulation or thrombophlebitis
• Area of impaired sensation
• Never high intensity (greater than 1.0) over growth plates: officially can do low intensity under 18 years but use judiciously. Many practitioners avoid US completely with under 18 years.
• Never allow sound head to be stationary
• Stop if patient has any pain

Question 8

precautions for Electromodalities:

Answer 8

1. Polio, MS, Peripheral Vascular Disease
2. Seizure
3. Decrease sensation
4. Over bony area
5. Over excess adipose tissue/obesity
6. Over superficial metal implants
7. Skin irritation or wound
8. Use of machinery or sleep while unit on
9. Around microwave or cell phone use
10. Cognitive, esp when planning home use.

Question 9

contraindications for electromodalities

Answer 9

1. Demand Pacemaker
2. Over carotid artery/anterior neck triangle
3. Trans-cerebral electrode placement - seizures
4. Undiagnosed pain – unknown etiology
5. Over pregnant uterus
6. Infection (except when used in wound healing)
7. Cancer

Question 10

Contraindications for iontophoresis in addition to general electrical modality precautions

Answer 10

• Allergy to medication
• Allergy to sulfites (preservative to medications)
• Allergies to shellfish – (if using Iodex for scar management)
• Diabetes – alters sugar levels when using corticosteroids
• Precaution: Consider effect of heat on dispersal of medication

Question 11

Contraindications and Precautions for TENS

Answer 11

general electro-modality

Question 12

Precautions and Contraindications for NMES

Answer 12

Follows standard electrical modality precautions and remember:
• Any time active exercise is contraindicated, NMES is contraindicated