7.2 - Modalities Flashcards by Brett Traeger

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

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Describe the indications for heat modalities

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

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Describe the contraindications to heat modalities

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

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What temperature should moist hot packs be maintained at?

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

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How many layers should be used for moist hot packs?

6-8 layers of padding

Manufactured hot pack covers = 2-3 layers of thickness

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When do moist hot packs reach peak heat?

Around 5-9 min

Heat lasts up to 20 min

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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

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At what temperature should a warm whirlpool be maintained?

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

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Describe the goals of cryotherapy

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

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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

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Describe the typical sequence of sensations in response to cryotherapy

“IBAAN”

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

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How long should cryotherapy be applied for?

Typically 15-20 min

Ice massage: 5-10 min

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Cathode vs anode

Cathode = NEGATIVE electrode

Anode = POSITIVE electrode

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What is the duty cycle?

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

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

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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)

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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