7.2 - Modalities Flashcards
What modalities should be used for superficial vs deep heat?
Superficial heat (1-3 cm):
- Hot packs
- Wax bath
Deep Heat (up to 5 cm):
- Continuous US
Describe the indications for heat modalities
Increase metabolic rate
Increase blood flow
Increase elasticity & flexibility of connective tissue
Decrease pain (analgesia)
Describe the contraindications to heat modalities
Lack of sensation
Lack of mentation
Vascular insufficiency
recent or potential bleeding
Acute inflammation
Active infection
Cancer
What temperature should moist hot packs be maintained at?
70-75 deg C
(158-167 deg F)
How many layers should be used for moist hot packs?
6-8 layers of padding
Manufactured hot pack covers = 2-3 layers of thickness
When do moist hot packs reach peak heat?
Around 5-9 min
Heat lasts up to 20 min
Why would a paraffin wax bath be useful?
Describe how to apply this modality
Good contact in contoured areas (feet, hands)
Dip 6-10 times, then wrap extremity in a towel to insulate heat for 10-15 min
At what temperature should a warm whirlpool be maintained?
36-40 deg C
(97-104 deg F)
Describe the goals of cryotherapy
Control inflammation
Analgesia
Reduce spasticity in patients w/ UMN dysfunction
Edema control
Describe the contraindications to cryotherapy
Cold-sensitivity symptoms (severe pain, numbness)
Cold hypersensitivity (cold urticaria)
Raynaud’s syndrome
Paroxysmal cold hemoglobinuria
Cryoglubilinemia
Compromised circulation / PAD
Describe the typical sequence of sensations in response to cryotherapy
“IBAAN”
1) Intense cold
2) Burning
3) Aching
4) Analgesia
5) Numbness
How long should cryotherapy be applied for?
Typically 15-20 min
Ice massage: 5-10 min
Cathode vs anode
Cathode = NEGATIVE electrode
Anode = POSITIVE electrode
What is the duty cycle?
On time / (on + off time) = duty cycle
Ex: 25% duty cycle = 1 sec on, 3 sec off
Describe the indications / goals for each of the following electrotherapy
TENS
NMES
Hi-Volt
Iontophoresis
TENS - analgesia
NMES - muscle re-education
Hi-volt - wound healing
Ionto - medication delivery (typically anti-inflammatory)
Describe the contraindications for e-stim
pacemakers
Implanted defribillator
DVT
Pregnancy (over / around abdomen or lower back)
How does TENS work?
Gate Control Theory
Activation of large diameter afferent neruons (A-beta fibers) –> blocks stimulation of small-diameter nociceptive fibers (a-delta, C-fibers)
Overwhelmed w/ non-noxious stimulus, the brain detects less pain
Describe the parameters for TENS
HIGH frequency - 100-150 Hz
(freq too high to cause muscle contraction)
SHORT pulse duration - 50-80 usec
Amplitude - comfort sensory
What is the benefit of inferential current?
4 electrodes w/ crossing paths
Covers large area & penetrates deeper
What is FES?
When NMES is used during functional activity
Describe the parameters for NMES
Lower frequency - 35-80 pps
Longer pulse duration - 125-130 usec
1:3-5 on:off cycle (16-25% duty cycle)
Typically 10s on, 50s off time for ~10 min (~10 contractions)
For iontophoresis, the “delivery” electrode should have the __________ charge as the medication
Same
(like a magnet)
Describe the parametors for iontophoresis
Tx duration typically 40-80 mAmin
Amplitude typically 1-4 mA
Multiply Amplitude (mA) x duration = mA min
Describe the polarity of each of the following medications used for iontophoresis
Iodine
Salicylates
Acetic acid
Dexamethasone
Lidocaine
“ISAD” = negative
Lidocaine = positive
What does “gain” refer to in regards to EMG biofeedback?
Gain = the “sensitivity” of the device
Increased gain = increased sensitivity (easier to detect differences in EMG)
Describe the contraindications for spinal traction
Spinal integrity loss
Trauma (without diagnostic testing)
Instability / hypermobility
Abdominal hernia
Spinal cord compression
Pregnancy (lumbar)
Vertebral artery occlusion
Aortic aneurysm
TMJ dysfunction (cervical)
What is the most common angle to perform cervical traction at?
10-30 deg flexion
Increased angle –> lower C-spine
Describe the appropriate parameters for cervical traction
Acute phase - 7-9 lbs, static, 5-10 min
Joint distraction - 20-30 lbs, 15/15 hold/relax, 20-30 min
Decreased muscle spasm - 11-15 lbs, 5/5, 20-30 min
Disc problems - 11-15 lbs, 60/20, 20-30 min
Describe the parameters for lumbar traction
Acute pahse - 30-45 lbs, static, 5-10 min
Joint distraction - 50% BW, 15/15, 20-30 min
Decrease muscle spasm - 25% BW, 5/5, 20-30 min
Disc problems - 25% BW, 60/20, 20-30 min
Describe the contraindications for compression therapy
Acute pulmonary edema
Congestive heart failure
Acute DVT
Fracture
Dermatologic infections
Describe the parameters for intermittent pneumatic compression
Pressure >30 mmHg
2-4 hrs per treatment, 2x/day
On:Off times = 90 sec: 30 sec
Describe the effects of US
Temperature increase
Blood flor increase
Contraindications for US
Cancer
Pregnancy (over abdomen / pelvis)
Pacemaker (local area)
Heart
DVT region
Epiphyseal plates
Impaired sensation or mentation
Describe the parameters for US
Lower frequency for greater depth
- 1 MHz –> 3-5 cm depth
- 3 MHz –> 0-2 cm depth
Intensity: 0.5 - 2.0 W/cm2 based on pt feedback
Duty Cycle: 100% for thermal effects
Duration: 5-10 min
Move US head at a rate of 4 cm / sec (2x the size of the sound head)
Apply to area no greater than 2x the head size
