705 Flashcards
mechanisms of heat transfer
conduction
convection
radiation
conversion
shortwave diathermy microwave diathermy infrared light UV light Laser Are all forms of
electromagnetic therapy
By direct contact of body with heat or cold modality
conduction
particles (air or water) move across the body, creating a temperature variation
convection
transfer of heat from a warmer source to a cooler source through a conducting medium such as infrared lamps transferring heat through air
Radiation
converting one type of energy to a thermal energy
conversion
when does cryotherapy have the greatest benefit
acute injury
cold therapy indications
acute, chronic pain acute swelling myofascial trigger points muscle guarding, spasms acute muscle/ligament sprain acute contusion bursitits tenosynovitis tendinitis delayed onset muscle soreness
instructions for cryotherapy
within 24 hours of acute injury
apply for less than 20 min without pressure
BMI >25 will require longer
contraindications for cryotherapy
impaired circulation peripheral vascular disease hypersensitivity to cold skin anesthesia open wounds or skin conditions infections
indications for heat therapy
subacute, chronic pain subacute, chronic inflammatory conditions resolution of swelling.edema removal myofascial trigger points muscle guarding, spasms subacute muscle/ligament sprain subacute contusion
contraindications for heat therapy
impaired circulation peripheral vascular disease skin anesthesia open wounds or skin condiditons acute musculoskeletal conditions
typical temp of a warm whirlpool
98-110 degrees F
typical temp of a cold whirlpool
50-60 degrees F
treats chronic joint pain
relaxes stiff muscles
improves blood flow
helpful for chronic skin disorders such as eczema and psoriasis
increases ROM for people with arthritis, bursitis and other chronic conditions
Paraffin
characteristics of diathermy
thermal and non thermal effects
depth of penetration deeper
maintains higher temp 2-3 times longer than heating pad
emits electromagnetic energy at a much higher frequency 915-2450 MHz
frequency increases the penetration of energy in the tissue decreases, thus providing a more shallow tissue heating effect
generate a stronger electrical feild
microwave diathermy
continuous and pulsed
three specific frequencies and corresponding wavelengths
13 MHz, 22m
27 MHz, 11m
40 MHz, 7m
heating of deep tissues (continuous) or non thermal physiological effects (pulsed)
shortwave diathermy
occurs when both the biological tissues and oscillating generator are oscillating at the same frequency
only with complete resonance can the electromagnetic energy be fully delivered to the tissues
tuning
size of transducer that is producing the vibration
Effective radiating area
some parts of crystal may emit more energy than others (hot spots) move sound head at all times
this can be 6:1 or less and be acceptable
means on area of head is emmitting 6xs more energy
beam non-uniformity ratios
in ultrasound frequency and depth of penetration are
inversely related
higher frequency less penetration
lower frequency deeper penetration
transforms mechanical energy to electircal energy
piezoelectric effect
propagation through tissue
more dense tissue- closer together the molecules are and faster the energy will be transmitted and more energy will be absorbed
contraindications for ultrasound
not over abdomen or low back during pregnancy not to eyes, genital or over heart not over pacemaker not over tumors or abdominal growth not over infection or abscess not over ischemic areas not to insensate areas not in presence of thrombus not to epiphyseal plate in growing children
ultrasound is used to enhance delivery of selected medication into tissue
phonophoresis
contraindications for massage
edema from total system fialure acute inflammatory edema any area known or with suspected clot any site of known or suspected aneurysm tumors over open lesions, conditions that spread abnormal abdominal mass non union FX graft sites
long stroking, gliding movements following length of muscle
used to apply lubricant
begins and ends massage
not intended to move deep muscle mass
physiological effect when moving from periphery towards heart
effleurage
kneading, compress and release movements used to lift subcutaneous tissue up and off underlying structures
petrissage
small circular strokes with deep pressure done with the thumb; linear strokes done with sides of hand, finger tips, back of hand heel of hand
used to loosen/soften tight mm tissue
friction
percussive strokes using alternating hands in rapid rhythmic motion
tapping: finger tips
hacking: ulnar boarder of hands
cupping
pinchment: alternate pinching with thumb and index finger
tapotement
transmitting trembling motion from PT hands onto tissue
use after deep pressure of trigger point
used for joints after deep stroking
vibration
pull skin in opposite directions perpendicular to muscle
connective tissue massage
find tender area and may feel tightness in the area
apply pressure with finger or thumb
duration 1-5 min/point
trigger point massage
weight of water pushing against a surface
filtration force
hydrostatic pressure
attraction of water to large molecules
attracts water in from the interstitial space
osmotic pressure
lymph organs
thymus lymph nodes spleen tonsils lymph follicles of mucous memebrane
lymphatic failure
transport capacity normal
lymphatic load increased
dynamic
edema
lymphatic failure
transport capacity decreased
lymphatic load normal
mechanical
lymphedema
lymphatic failure
transport capacity decreased
lymphatic load increased
combination
lymphedema
lymphatic failure
transport capacity normal/decreased
lymphatic load increased due to right ventricular failure
hemodynamic
cardiacedema
lymph drainage contraindications
malignant diseases acute infection DVT cardiac edema renal fialure radiation fibrosis (local) peripheral arterial disease (compression)
the upward thrust acting in the opposite direction to the force of gravity
the more deeply immersed you are in water, the less you weigh
allows a reduction in oint compression forces by being weightless
buoyancy
the pressure exerted by a fluid at equilibrium due to the force of gravity
hydrostatic pressure
ideal temp for aquatic therapy
92 degrees
contraindications for aquatic therapy
any infection fever heart failure UTI incontinence epilepsy blood clots fear of water
aquatic therapy technique similar to tai chi slow movements and deep breathing movements must flow decrease pain, increase balance
ai chi
aquatic therapy technique
method of muscle re-education
therapist uses physiclal properties of water to interact with patient
bad ragaz
aquatic therapy technique
water and land based therapy
starts in water working on balance and postural awareness
focus on vertical alignment first, incorporate exercises in different planes
burdenko method
aquatic therapy technique
uses games for variety of educational and therapeutic reasons
used mainly with pediatrics and patients with disabilities
no buoyant aids are used
purpose is water freedom
hallwick
aquatic therapy technique cradling one on one program free flowing nature promotes self-awareness of muscle tension promote relaxation decrease pain
Watsu
contraindications for e stim
patients with an electronic demand-type cardiac pacemaker
over the carotid sinus
internally
over the eyes
transcranially or int he upper cervical regions in patient with history or CVA
transthoracically (careful of heart)
over any area that would have a tendency to hemorrhage
over laryngeal or pharyngeal muscles
where is a motor end plate generally found
proximal 1/3 of the muscle
movement of charged particles
measured in amps
current (I)
change in electrical potential between two points
the greater this is the deeper we can drive current into the body
how hard we push the current
voltage (V)
relative opposition to movement of charged particles
measured in ohms with direct current or impedence with alternating current
Resistance (R)
events in a definded amount of time, measured in pulses per second (pps), cycles per second (cps or Hertz), beats per second (bps)
frequency
intensity or maximum voltage
generally in millivolts (mV)
amplitude
Frequency: muscle contractions generally don’t get any stronger than ______. we use ______ with a long ______ pulse duration
50 Hz
20-40 Hz
>300 ms
frequency: sensory stimulation is generally delivered at _________ as a shorter pulse duration
80-120 Hz
getting used to a feeling and diverting attention from it
accommodation
modulations that can delay accomodation
amplitude modulation
frequency modulation
current flow in one direction for a finite period of time
phase
the time from the beginning to the end of an electrical event (even if the waveform leaves and returns to the baseline several times)
pulse
positively charged atoms
cations
negatively charged atoms
anions
negative terminal, attracts cations
cathode
positive terminal, attracts anions
anode
patients often report feeling a slight tingle prior to muscle movement but before it becomes painful, why is this
sensory fibers can be slightly bigger than motor fibers (pick up faster)
cutaneous nerves are near the skin surface where the current density is the greatest
stimulating bigger nerve fibers will override any signals coming from smaller ones through inhibitory interneurons
gate theory of pain control
electrotherapeutic current that stimulates peripheral nerves
TENS transcutaneous electrical nerves stimulators
electrotherapeutic current that stimulate muscle directly
neuromusclular electrical simulators NMES
gold standard for acute pain management
2 channels
variety of features depending on the unit
TENS transcutaneous electrical nerve stimulation
electrotherapeutic current contraindications
cardiac pacemakers HX of cardiac arrythmias phrenic or urinary bladder stimulators deep brain stimulators carotid sinus (scalene triangle) temporal lobe eyes larynx locations malignancy superficial skin lesion pelvic region in pregnancy anxiety
pain inhibition level 1
periphery
subsensory
pain inhibition level 2
occurs in dorsal horn
sensory
pain inhibition level 3
involves hormonal system
motor
pain inhibition level 4
involves brainstem sites and dorsolateral funiculus
noxious
pain inhibition level 5
involves cortical area
placebo
pain inhibition at the subsensory level
microcurrent electrical nerve stimulators MENS
peak amplitude below 1 mA (too low to stimulate either nerve or muscle)
pain inhibition at the sensory level
below motor threshold
conventional TENS
pain inhibition at the motor level
used for subacute or chronic pain
visible muscle contraction
current density is affected by ______
placing the electrodes closer together results in _______
spacing of the electrodes
superficial current density
1 pps=
muscle twitch
10 pps =
summation
25-30 pps =
tetanus
NMES electrode placeement
active electrode should be negative
negative electrode placed distally and positive electrode placed proximally
contraindications for iontophoresis
near venous/arterial thrombosis or thrombophlebitis
over areas impaired sensation
cardiac pacemaker
the drug electrode should be the same as the _________ for iontophoresis
drug polarity
in iontophoresis positive drugs should be placed under the ________ and negative drugs should be placed under the ______
anode (positive electrode)
cathode (negative electrode)
most common med used for iontophoresis and used to treat inflammation
what electrode should it be placed under
dexamethasone (DSP)
has a negative polarity, cathode
iontophoresis
used for pain
polarity
lidocaine
positive
iontophoresis
size of electrode: current density should not exceed ______ is the cathodes is used or ____ if the anode is used
0.5 mA/cm^2
1 mA/cm^2
most common problem associated with iontophoresis
chemical burns
occurs because of current not ion
interferential beat frequency for pain
80-150 bps
interferential beat frequency for edema
1-10 bps
interferential beat frequency for muscle rehab
20-50 bps
phases of wound healing
hemostasis
inflammatory
proliferation
remodeling
occurs immediately after injury
vasoconstriction
platelet aggreation
fibrin deposition, clot is end product
hemostasis
clean wound site for tissue restoration, vasodilation and phagocytosis
provides hemostatsis- vasoconstriction platelet aggregation, thromboplasitn makes clot
inflammatory phase
time for inflammatory phase
starts at time of injury and lasts 3-7 days
would defect fills in with new tissue, skin integrity restored angiogenesis granulation collagen synthesis by fibroblasts wound contraction occurs
proliferation
time frame for proliferation
3-5 days post injury - 3 weeks
capillary buds extend into the wound bed. endothelial cells fill wound space creating capillaries with loose junctions and gaps in endothelial lining causing edematous look
capillary loops look like small granules: granulation
angiogenesis
will not exceed 70-80% of tensile strength f original
begins as granulation tissue is formed
balance between collagen synthesis and lysis
remodeling
time frame for remodeling
21-28 days after injury to 1-2 years
imbalance in collagen synthesis and lysis, dehiscence, keloids
chronic remodeling
healing sequence continuous and within expected time frame
little or no complications
acute wounds
failure or delay of healing component
dont respond to regulatory growth signals
associated with: repeated trauma ppor perfusion/oxygenation, excessive inflammation, concomitant disorders/genetic factors
chronic wounds
causes of incident pain
debridement
major trauma
causes of episodic pain
dressing changes,
open to air,
medication cleansing
causes of continuous pain
underlying cause,
infection,
disease process
what unit do you use to measure a wound
cm
length of a wound is measured
12:00-6:00
width of a wound is measured
3:00-9:00
deepest area of the wound bed
depth
tissue loss into the depths of the wound
deadspace
measue the pathway and document the time on the clock
tunneling
tissue loss parallel to wound surface
undermining
loss of epidermis and down into but not through the dermis
partial thickness
through the dermis extending down to subcutaneious tissue, muscle may have exposed structure
full thickness
inspection and palpation at least withing 4 cm of wound edge
periwound
capillary refill: longer than _____ then arterial occlusion
2-3 seconds
venous refill:
less than ______ venous insufficiency
_______ normal
greater than _____ arterial insufficiency
5 sec
5-15 sec
15 sec
pulse grading
0=absent 1+= barely palpable 2+= plapable, but diminished 3+= normal 4+= prominent, suggestive of aneurysm
ABI
ankle/brachial systolic
measurement of O2 diffusing across the skin from the capillary beds
grading
transcutaneous oxygen measurment
30 mmHg will heal/debridement safe
ABI results
> 1: calcifed vessels if diabetic, do not exceed 250 mmHg, non compressible and may damage artery
exchar
black
fibin
stringy
what to document on exudate
amount
color
character
epidermal involvement
erythema, tenderness, pain
cause: sunburn, hot liquid
superficial burn
dermal involvement
barge blisters, pain, edema, weeping
cause: hot liquid, flame injury, flash injury
superficial partial thickness burn
small amount of dermis remains white or charred blood flow compromised less pain cause: flame, chemical, electrical injury
deep partial thickness burn
into to through subcutaneous tissue
cause: flame, chemical, and electrical
full thickness burn
result of complete or partial arterial blockage limiting perfusion causing tissue necrosis/ulceration
arterial
coronary disease CHF COPD hypertension diabetes mellitus end stage renal disease hypercholesterolemia
illnesses associated with arterial wounds
location: between toes and distal tips of toes, dorsal aspect of foot and over phalangeal heads, tibia, LATERAL MALLEOLUS
thin dry skin, absence of hair, shiny, smooth, cool to touch
pulses absent or diminished
arterial wound
dry gangrene, “punched out” smooth edges, erythematous halo, black/gray necrotic tissue
wound is painful
decreased pain and increased skin redness int he dependent position
increased pain and skin pallor with elevation
claudication
arterial wound
caused by valvular incompetence, obstruction of deep venous system, or congenital absence or malformation of venous valves
venous ulcer
dull ache or heaviness c/o pain in dependent position
decreased pain with elevation
venous ulcer
location: superior to malleoli, usually medial
eschar or slough, wed, yellow fibrous, moderate to heavy exudate, irregular and shallow wound edges
surrounding skin is dry and scaly, presence of vericose veins, hemosiderin staining
pulses present
venous ulcer
Location: tips of toes, lateral aspect of the foot and dorsum of the foot, metatarsal heads especially 1st and 5th, heels, midfoot, and at location of orthopedic deformity
diabetic ulcer
all wounds have delay in healing
surrounding skin is cracking; callous formation
diabetic ulcer
the most common type of diabetic neuropathy
causes pain or loss of feeling in the toes, feet, legs, hands and arms
sensory neuropathy
causes changes in digestion, bowel and bladder function, sexual response, and perspiration
can affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes
autonomic neuropathy
results in muscle atrophy and weakness
motor meuropathy
stage 1 pressure ulcer
intact skin with non-blanchable redness of a localized area usually over a bone prominence
stage 2 pressure ulcer
partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed without slough
may also present as an intact or open/ruptured serum filled blister
stage 3 pressure ulcer
full thickness tissue loss
subcutaneous fat may be visible
may include undermining and tunneling
stage 4 pressure ulcer
full thickness tissue loss with exposed bone tendon or muscle
unstagabel pressure ulcer
full thickness tissue loss in which the base of the ulcer is covered by slough or eschar in the wound bed
purple or marron localized area os discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and or shear
deep tissue injury
skin tears without tissue loss
category I skin tear
skin tear with partial tissue loss
category II skin tear
skin tears with complete tissue loss
category III skin tear
TIME for wound bed preparatin
tissue debridement
inflammation and infection control
moisture balance
epithelial edge advancement
delivery of a fluid or cleansing solution to the wound surface by mechanical force
remove debris
cleaning
removal of non-viable tissue and foreign materials from the wound
debridement
safe irrigation
4-15 psi
low pressure irrigation
high pressure irrigation
8-15 psi
presence of bacteria on the wound surface that are not actively multiplying
contamination
presences of replicating micro-organisms
colonization
presence of replicating microorganisms, beginning to cause local tissue damage
critical colonization
invasion of bacteria into healthy surrounding tissue
lab results equal or greater than 100,000 organisms
infection
advancing kerotinocytes at wound edges roll under. Migration stops due to keratinocytes touching each other
epiboly
a bacterial film present on most chronic wounds which blocks healing, can be removed by maintenance debridement
biofilm
attraction of a cell in response to a chemical signal
chemotaxis
involuntary weight loss muscle wasting presence of edema without cardiac cause poor wound healing cracking at edges of mouth hair loss chronic infections lethargy poor skin turgor
signs of malnutrition
dry mouth cracked lips sunken eyes dark urine poor skin turgor trouble swallowing smooth shiny tounge
signs of dehydration
betadine
dakins soulution
acetic acid
hydrogen peroxide
topical antiseptics
iodosorb aquacel AG silvadene silverlon anticoat hydrofera blue
antimicrobial dressings
triple antibiotic ointment
bactroban (mupirocin)
polymyxin
bacitracin
topical antibodies
indicated for:
moist, pressure, infected wounds
provides moist environment, high absorptive capacity and protects agianst contamination and trauma
contraindicated for dry wounds
alginates
indications: partial and full thickness
encourages deposition of collagen, absorbent, may use with topical agents
contraindicated for full thickness burns or eschar
collagens
indications:
partial to full thickness wounds
minimal to heavy drainage, granulation tissue, necrotic tissue
autolytic debridement
composites
indications:
partial and full thickness
minimal to mod drainage
donor sites, skin grafts
protect wound base from trauma during dressing changes, introduce topical medications and wound fillers to the wound
contraindications
not for dry , shallow, eschar , copious exudate
contact layers
indications:
mod to heavy drainage, autolytic debridement or softening
granulation tissue, compression, hypergranulation
contraindicated for dry wounds, cavity wounds
foam
indications
partial and full thickness
necrotic tissue
scant to mod drainage
autolytic debridement, promotes granulation and epithelization
contraindications: infected wounds, tunnels, undermining, lesions, caution with diabetic feet
hydrocolloids
indications: partial and full thickness wounds granulation tissue necrotic tissue burns. contraindications: not recommended for highly exudative wounds
hydrogels
indications light to heavy exudate partial to full thickness necrotic tissue granulation tissue infected wounds contraindications: dry wounds
specialty absorptive
indications superficial wounds with minimal drainage partial thickness eschar granulation tissue contraindications: does not adhere well in moist environment risks for epidermal stripping
transparent films
indications partial to full thickness wounds minimal to mod drainage infected wounds cavity wounds contraindications: dry wounds
wound fillers
how often should you reposition in bed
every 2 hours
how often should you adjust in sitting
every 15 min
magnitude of the voltage
amplitude
measure of the force of the flow of electrons
voltage
measure of the rate of the flow of current
amperage
unidirectional and continuous
one second or longer duration
direct current
unidirectional or bidrectional
interrupted
milliseconds or less duration
pulsatile
individual waveform
pulse
component of the pulse that rises in one direction above or below the baseline
phase
ratio of on time/total cycle time
duty cycle
twin peaked monophasic no alkaline/acidity effects greater penetration short pulse duration at higher frequencies pain, edema, spasm, weakness
high voltage pulsed current
monophasic or biphasic low voltage microcurrent
long pulse duration at low frequency
bone healing, wound, pain
microcurrent (MENS)
pulsatile polyphasic waveform
strengthening
Russian
muscle re-education edema contracture management atrophy reduction strengthening
NMES
asymetrical balanced waveform
pain
TENS
chronic disorder characterized by the abnormal accumulation of lymph fluid in the tissues of one or more body regions
lymphedema
lymphatic failure
transport capacity = normal
lymphatic load = increased
treat with RICE
dynamic (edema)
lymphatic failure
transport capacity = decreased
lymphatic load = normal
treat with CDT
mechanical (lymphedema)
lymphatic failure
transport capacity = decreased
lymphatic load = increased
treat with CDT
combination
lymphedema
lymphatic failure
transport capacity = normal/decreased
lymphatic load = increased due to right ventricular failure
hemodynamic (cardiac edema)
brief swelling in hand
subclinical
stage 0 lymphedema
edema
soft
pitting
no pain
stage 1 lymphedema reversible
edema fibrotic changes, difficult to pit can reduce edema to normal can soften filaments but not reverse fibrosis no pain
stage 2 lymphedema spontaneously irreversible
severe edema
fibrosis
no pitting, too much fibrosis
pain and skin discoloration
stage 3 lymphedema irreversible
bilateral symmetrical involvement pitting foot involvement stemmer negative soft edema typically no ulcerations elevation effective
orthostatic edema
bilateral symmetrical soft edema quick refill with pitting attempts no foot involvement cellulitis skin discoloration- hemosiderin hx of CHF stemmer negative elevation effective
venous insufficiency
bilateral symmetric soft edema quick refill with pitting attempt elevation effective discoloration, occasionally hx of CHF stemmers negative
CHF
bilateral associated with obesity symmetrical soft edema minimal pitting elevation ineffective stemmer negative
lipedema
gold standard manual lymph drainage compressive bandaging/garments therapeutic exercise skin care and hygiene patient education
complete decongestive therapy (CDT)
contraindications for CDT
malignant diseases acute infection DVT cardiac edema renal failure radiation fibrosis (local) peripheral arterial disease (compression)
percentage for burns
9% for head, each UE, anterior chest, posterior chest, abdomen, posterior lower back, each anterior and posterior portion of the LE
1% for the perineum
epidermis only
slight edema no blisters
painful because the nerve endings are still intact
superficial burn
epidermis and papillary layer of the epidermis
red, mottled, edematous
blisters, painful
spontaneous healing minimal scarring
superficial partial thickness burn
epidermis and to the reticular layer of the dermis
deep partial thickness burn
all epidermal and dermal, may include subcutaneous layer
requires grafting
full thickness burn
subcutaneous tissue involvement
significant surgical intervention potentially including amputation
subdermal burn
