7.2 - Modalities

Question 1

What modalities should be used for superficial vs deep heat?

Answer 1

Superficial heat (1-3 cm):
- Hot packs
- Wax bath

Deep Heat (up to 5 cm):
- Continuous US

Question 2

Describe the indications for heat modalities

Answer 2

Increase metabolic rate
Increase blood flow
Increase elasticity & flexibility of connective tissue
Decrease pain (analgesia)

Question 3

Describe the contraindications to heat modalities

Answer 3

Lack of sensation
Lack of mentation
Vascular insufficiency
recent or potential bleeding
Acute inflammation
Active infection
Cancer

Question 4

What temperature should moist hot packs be maintained at?

Answer 4

70-75 deg C
(158-167 deg F)

Question 5

How many layers should be used for moist hot packs?

Answer 5

6-8 layers of padding

Manufactured hot pack covers = 2-3 layers of thickness

Question 6

When do moist hot packs reach peak heat?

Answer 6

Around 5-9 min

Heat lasts up to 20 min

Question 7

Why would a paraffin wax bath be useful?

Describe how to apply this modality

Answer 7

Good contact in contoured areas (feet, hands)

Dip 6-10 times, then wrap extremity in a towel to insulate heat for 10-15 min

Question 8

At what temperature should a warm whirlpool be maintained?

Answer 8

36-40 deg C
(97-104 deg F)

Question 9

Describe the goals of cryotherapy

Answer 9

Control inflammation
Analgesia
Reduce spasticity in patients w/ UMN dysfunction
Edema control

Question 10

Describe the contraindications to cryotherapy

Answer 10

Cold-sensitivity symptoms (severe pain, numbness)
Cold hypersensitivity (cold urticaria)
Raynaud’s syndrome
Paroxysmal cold hemoglobinuria
Cryoglubilinemia
Compromised circulation / PAD

Question 11

Describe the typical sequence of sensations in response to cryotherapy

Answer 11

“IBAAN”

1) Intense cold
2) Burning
3) Aching
4) Analgesia
5) Numbness

Question 12

How long should cryotherapy be applied for?

Answer 12

Typically 15-20 min

Ice massage: 5-10 min

Question 13

Cathode vs anode

Answer 13

Cathode = NEGATIVE electrode

Anode = POSITIVE electrode

Question 14

What is the duty cycle?

Answer 14

On time / (on + off time) = duty cycle

Ex: 25% duty cycle = 1 sec on, 3 sec off

Question 15

Describe the indications / goals for each of the following electrotherapy

TENS
NMES
Hi-Volt
Iontophoresis

Answer 15

TENS - analgesia

NMES - muscle re-education

Hi-volt - wound healing

Ionto - medication delivery (typically anti-inflammatory)

Question 16

Describe the contraindications for e-stim

Answer 16

pacemakers
Implanted defribillator
DVT
Pregnancy (over / around abdomen or lower back)

Question 17

How does TENS work?

Answer 17

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

Question 18

Describe the parameters for TENS

Answer 18

HIGH frequency - 100-150 Hz
(freq too high to cause muscle contraction)

SHORT pulse duration - 50-80 usec

Amplitude - comfort sensory

Question 19

What is the benefit of inferential current?

Answer 19

4 electrodes w/ crossing paths

Covers large area & penetrates deeper

Question 20

What is FES?

Answer 20

When NMES is used during functional activity

Question 21

Describe the parameters for NMES

Answer 21

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)

Question 22

For iontophoresis, the “delivery” electrode should have the __________ charge as the medication

Answer 22

Same
(like a magnet)

Question 23

Describe the parametors for iontophoresis

Answer 23

Tx duration typically 40-80 mAmin

Amplitude typically 1-4 mA

Multiply Amplitude (mA) x duration = mA min

Question 24

Describe the polarity of each of the following medications used for iontophoresis

Iodine
Salicylates
Acetic acid
Dexamethasone
Lidocaine

Answer 24

“ISAD” = negative

Lidocaine = positive

Question 25

What does “gain” refer to in regards to EMG biofeedback?

Answer 25

Gain = the “sensitivity” of the device

Increased gain = increased sensitivity (easier to detect differences in EMG)

Question 26

Describe the contraindications for spinal traction

Answer 26

Spinal integrity loss
Trauma (without diagnostic testing)
Instability / hypermobility
Abdominal hernia
Spinal cord compression
Pregnancy (lumbar)
Vertebral artery occlusion
Aortic aneurysm
TMJ dysfunction (cervical)

Question 27

What is the most common angle to perform cervical traction at?

Answer 27

10-30 deg flexion

Increased angle –> lower C-spine

Question 28

Describe the appropriate parameters for cervical traction

Answer 28

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

Question 29

Describe the parameters for lumbar traction

Answer 29

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

Question 30

Describe the contraindications for compression therapy

Answer 30

Acute pulmonary edema
Congestive heart failure
Acute DVT
Fracture
Dermatologic infections

Question 31

Describe the parameters for intermittent pneumatic compression

Answer 31

Pressure >30 mmHg
2-4 hrs per treatment, 2x/day
On:Off times = 90 sec: 30 sec

Question 32

Describe the effects of US

Answer 32

Temperature increase
Blood flor increase

Question 33

Contraindications for US

Answer 33

Cancer
Pregnancy (over abdomen / pelvis)
Pacemaker (local area)
Heart
DVT region
Epiphyseal plates
Impaired sensation or mentation

Question 34

Describe the parameters for US

Answer 34

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