Chapter 15: Therapeutic Modalities Flashcards
What are the 4 forms of thermal energy transmission?
Conduction: heating through direct contact, hydroc/paraffin/ice pack/cold pack
Convection: heating indirectly through a medium, hot/cold whirlpools
Radiation: transfer of heat through space from one object to another, shortwave diathermy
Conversion: heating through other forms of energy, balms/shortwave diathermy
What are some of the physiological effects of thermotherapy?
Increase extensibility of collagen fibers, decreasing joint pain, reduce pain/inflammatio/edema, relieve mm spasm, increase blood flow
What is ischemia?
Lack of blood flow to a body part
What is the temperature of the paraffin bath? Hydrocullator? Warm whirl pool?
126-130, 160-170, <104
What are the physiological effects of cryotherapy?
Vasoconstriction of the arterioles and venules, numbness, collagen stiffness
What is the hunting response?
It causes a slight temperature increase during cooling (vasodilation if 20-30 minutes of cold)
What is Raynaud’s phenomenon?
A condition that causes vasospasm of digital arteries lasting minutes to hours and could lead to tissue death. SYS: skin blanching, cyanosis, skin pallor then red, numbness, tingling, burning
What is the spray & stretch technique?
Using vapocoolant spray to for treating trigger points & myofascial pain. Stretch the muscle with the trigger point, hold 12cm away, spray the length of the muscle, firmly stretch to tolerance & keep spraying. After the first spray session, warm with a hot pack or vigorous massage.
What are the main uses of vapocoolant spray?
Reduce muscle guarding & increase ROM
What is cryokinetics? How many minutes of ice/exercise? Should passive exercises me performed?
12-20 minutes of icing, exercise 3-5, ice 3-5, etc…Only active exercises
What is the temperature of the cold tub?
50-60 degrees
What are the precautions of cryotherapy?
Intensity of the activity should be limited by the nature of the healing process and perceptions of pain.
What is Ohm’s Law?
Ohm: resistance of passing an electrical current along a conductor.
V=IR
voltage across a resistor is proportional to the current. OR the current through a conductor between two points is directly proportional to the potential difference across the two points.
What is a direct current?
AKA a monophasic or galvanic current. Flows in one direction from the positive pole to the negative pole
What is an alternating current?
AKA biphasic…the direction of the current flow reverses once during each cycle…pain & mm contraction. Continuos and bidirectional flow of charged particles – no net charge.
What is a pulsatile wave?
AKA Russian…3 or more pulses grouped together, interrupted for short periods then repeat
What is the beta-endorphin model of pain control? How does noxious pain control work?
E-stim stimulates sensory nerves to release encephalin from local sites throughout the CNS and the release of B endorphins from the pituitary gland into the cerebrospinal fluid. Pain modulation when applying a current close to the painful site. Point stimulator set as high as tolerable with maximum pulse duration.
What are 4 things electrical muscle contraction can be used for?
Muscle pumping contractions, muscle strengthening, muscle reeducation, & retardation of atrophy
What is iontophoresis? Dexamethasone? Lidocaine?
Ionto uses electrical current to drive ions into the skin. Dex: antiinflam…Lid: local anesthetic
What are the physiological effects of ultrasound?
Stimulates the repair of soft tissue and relieves pain. It is a deep heating modality
What is attenuation?
A decrease in intensity as sound enters deeper tissues
What is the piezoelectric effect?
Electrical current produced by applying pressure to certain synthetic crystals (quartz)…causes expansion and contraction of the crystals which produces oscillation voltage at the frequency.
What is the effective radiating area?
The portion of the surface of the ultrasound transducer that produces the sound wave (energy)
What is cavitation?
A nonthermal effect, formation of gas-filled bubbles that expand & compress due to ultrasonically induced pressure changes in tissue fluids. Increases blood flow in area around the bubbles
What is Beam Nonuniformity Ratio?
The amount of variability in intensity of the ultrasound beam, lower BNR= more uniform, optimal uniformity of 1:1
What is micro-streaming?
Nonthermal effect…unidirectional movement of fluids along cell membrane boundaries from the mechanical pressure wave in ultrasonic field. Can alter cell membrane structure and function
What is underwater ultrasound & how far from the body part should the transducer be?
Suggested for irregular body parts…transducer should be 1 inch from the body part.
What is phonophoresis?
A method of transporting molecules through the skin with US. Hydrocortisone and anesthetic into tissues ,…helpful for trigger points, tendinitis, bursitis
What does LASER stand for?
Light Amplification by Stimulated Emission of Radiation
What are some of the physiological effects of laser therapy?
Helium neon (red,2-5mm direct, 10-15mm indirect) or gallium arsenide lasers (invisible, 1-2cm direct, 5cm indirect)… acceleration of collagen synthesis, decrease microorganisms, increase vascularization, reduce pain and inflam, trigger points
What is the main therapeutic effect of diathermy?
Temperature increases in deeper tissues, high water content tissues absorb the heat, absorbed by fat
What are the main precautions when using diathermy?
Difficult to treat localized body parts, dosage is subjective, towels between applicator and skin, not to be used with metal objects, avoid when hemorrhaging/pregnant/open wounds/contacts, cables and coils can’t touch each other, deep ache may be present
What are the 5 types of traction?
Manual-change force, direction, duration and position
Mechanical- lumbar/cervical, harness on table
Positional- for comfort or tx goal, ex: laying on back with legs and hips flexed
Wall-mounted- cervical, plates, sand bags or water bags for weight
Inverted- lengthens the spine, gravity pulls trunk weight down
What are some physiological effects of traction?
Separate vertebral bodies and stretch ligaments and joints, relieve pressure and pain, stretch muscles, increase and change joint proprioception
What are some different forms of compression?
Intermittent, continuous, with cold/ice
What are the general treatment parameters when using intermittent compression?
30-50mmHg for upper, 30-60mmHg for lower, thirty minutes reduces edema
What are the 5 types of massage?
Effleurage-stroking light and deep, either sedation or encourages venous and lymphatic drainage
Pettrissage- loose and heavy kneading, pick up muscles and rolling in opposite direction, loosens
adhesions, squeezes congestive materials into general circulation
Friction- used where tissue is thin, scars/adhesions/muscle spasms/fascia, stretches underlying tissues develop friction in the area and increase circulation around the joint
Tapotement- percussion, hacking, pinching, stimulation to nerves
Vibration- quivering or trembling effect, relax and soothe
What are some physiological effects of massage?
Increase circulation, increase metabolism to muscles and aid in removing metabolites (lactic acid) helps overcome venostasis and edema, helps with normal venous blood return to the heart
Understand the basics of ice massage, ice immersion, and ice packs
massage: used of the belly of the muscle, tendon, bursae ,or myofasical trigger points. small body area. 10 minutes, comfort must be taken into consideration
immersion: circumferential cooling is desired. 15 minutes. overcoolig can cause frostbite. allergies?
packs: two types - gel and liquid bag within crystals. should use a towel to prevent reaction with skin.
What is fluidotherapy?
therapeutic environment with dry heat and forced convection through a suspended airstream. effective in decreasing pain, increasing joint ROM, decreasing muscle guarding, and decreasing swelling. 15-20 minutes
Understand basics of moist heat and WWP
moist heat: general relaxation. heat for 20-30 minutes. use towels. doesn’t heat deeper muscles, no lying on packs.
WWP: massage and water immersion, provides conduction and convention, more body underwater the cooler it should be. should no exceed 20 minutes.
What are the 4 types of sensory receptors?
mechanoreceptors: mechanical stress or strain
chemoreceptors: chemical stimuli
nociceptors: damage or threat of damage to body tissues
proprioceptors: sense of position
thermoreceptors, osmoreceptors, magnetoreceptors, electroreceptors, photoreceptors
What are excitable tissues?
tissue that can undergo rapid change in their membrane potential which is important to transport electrical signals.
Difference between cutaneous, deep somatic, visceral, and psychogenic pain
cutaneous: pain caused by the body surface
deep somatic: caused by the activation of pain receptors in musculoskeletal tissues
visceral: pain we feel when our internal organs are damaged or injured and is by far the most common form of pain
psychogenic: pain fro the brain
When in the healing process should contrast be used?
works well on chronic pain and stiffness. contrast is best utilized a few days after the initial injury. go back a forth, but ALWAYS end with COLD
What are some precautions in using thermotherapy?
pregnancy (avoid abdomen and low back), poo circulation, edema, cardiac insufficiency, areas with metal, open wound, areas where topical counterirritants have recently been applied
What is the difference between shortwave and microwave diathermy?
micro has higher frequency and shorter wavelength than shortwave. it generates a strong electrical field and relatively little magnetic field. penetration of shortwave is deeper, but micro has an easier application. micro treats 1 aspect of body while shortwave treats 2.
both are used for thermal physiological effects
What are the amplitude, peak-to-peak amplitude, phase duration, and pulse duration?
amplitude: measure of its change over a single period
peak-to-peak amplitude: difference between the maximum positive and maximum negative amplitudes
phase duration: same as pulse duration
pulse duration: the time from the beginning of the first phase to the end of the last phase of one pulse, the width of the pulse
What is frequency?
The number of waves or pulses per second … usually measured in Hz.
What is impedance?
opposition to the current flow, tissue that resist flow, adipose, bone, tendons, and fascia.
What is duty cycle?
Ratio of on time to total cycle time. the higher the duty cycle the more fatiguing the treatment.
What is current measured in? resistance? voltage?
current: measured in amperes
resistance: measured in ohms
voltage: measured in volts
What is an asymmetrical current?
changes in amplitude over time. ramp up or ramp down.
What are the first order neurons? What are second order? what are third order?
first: they are located in the dorsal root ganglia or the sensory ganglia or cranial nerves. they conduct impulses from cutaneous receptors and proprioreceptors to the brain and spinal cord
second: conducts the impulse from the brainstem-spinal cord to the thalamus
third: conducts nerve impulses from the thalamus to the primary somatosensory area
What are the various neurotrasmitters?
serotonin: active in descending pathways
norepinephrine: inhibits pain transmission between first and second order neurons
substance P: active in small-diameter primary afferent neurons
enkephalins: found in descending patyways
B-endorphin: found in the CNS
