Chapter 15 - Using Therapeutic Modalities Flashcards
electromagnetic energy
electrical stimulation, shortwave & microwave diathermy, ultraviolet therapy, laser therapy
electromagnetic energy travels
without a medium
3,000,000 m’s in a vacuum
in a straight line
conduction
heat is transferred from a warmer object to a cooler one
skin temperature influenced by
type of heat or cold medium
conductivity of tissue
quantity of blood flow in the area
speed at which heat is being dissipated
high temperature limit
116.6 degrees farenheit
at 113 degress - should not go longer than 30 min
types of modalities using conduction
MHP, paraffin, electric heating pads, ice/cold packs
Convection
transference of heat through the movement of fluids or gases
ex. whirlpool bath
radiation
heat energy is transferred from one object through space to another object
types of radiation modalities
shortwave/microwave diathermy, infrared heating, ultraviolet therapy
Conversion
generation of heat from another energy form such as sound, electricity, and chemical agents
types of conversion modalities
ultrasound, diathermy, liniments/balms
ultrasound
mechanical energy into heat energy at tissue interfaces
inaudible, acoustic vibrations of high frequency that may produce thermal or non-thermal physiological effects
diathermy
heat produced by applying electrical current of specific wavelengths to skin
liniments/balms
create heating sensation through counterirritation of sensory nerve endings
Extent of tissue cooling
depends on type of cold medium, length of exposure, and conductivity of tissue
38.8 degrees farenheit
muscle temperatures can be reduced as deep as 4 cm
which tissue are good conductors
muscle is good, fat is poor conductor
vasoconstriction occurs when
cold for 15-30 min at 50 degrees
hunting response
slight increase in temperature during cooling (not vasodilation)
physiological effects of cold
increased blood viscosity, decrease in release of chemical mediators, decreased capillary permeability
decreased secondary hypoxic death
decreased muscle spasm
frostbite occurs at what temp
26.6-24.8 degrees farenheit
raynaud’s phenomenon
cold exposure causes vasospasm of digital arteries lasting for 2 minutes to hours
possible contraindications of cold
hypersensitivity
cold allergies
over superficial nerves
uncovered, open wounds
circulatory insufficiency
already decreased sensation
ice massage
32 degrees
10-15 cm area, 5-10 min
cold/ice water immersion
50-60 degrees
10-15 min
ice bag
34-36 degrees
wet ice packs are best
15-20 min
vapocoolant sprays
fluori-methane
reduce spasm, increase ROM, treat trigger points
Cryokinetics
cryotherapy and exercise
ice until dumb (12-20 min)
exercise 3-5 min
ice until numb 3-5 min
repeat 3-5x
effective tissue temperature for thermotherapy
100-113 degrees farenheit
or
40-45 degrees celcius
thermotherapy effects
increased extensibility increased viscosity decreased joint stiffness reduced pain reduced muscle spasm increased nerve conduction velocity reduce inflammation, edema, exudate increased blood flow, venous return, and lympathic drainage assist inflammation
superficial heat
infrared modality
indirectly heats deeper tissues by circulation and conduction
moist heat is greater than dry heat
contra-indications of heat
acute inflammation, impaired circulation, poor thermal regulation, anesthetic areas, infections, malignancy, neoplasm, low back/abdomen during pregnancy
moist heat packs
160-170 degrees
silicate gel in cotton pad
6 layers of toweling
break pain-spasm cycle (sedative)
whirlpool baths
100-110 degrees
convection and conduction
paraffin
126-130 degrees
glove methond: 6-12 dips, paraffin cools in between, wrap in plastic bag, rest for 30 min
immersion: submerge for 20-30 min,
contrast bath
100-110; 50-60 degrees farenheit
3:1 or 4:1 warm:cold for 19-20 minutes
attenuation
sound scatters and is absorbed as it penetrates tissue - energy transferred is decreased
1 MHz or 3 MHz
one/three million cycles per second
absorption increases with increase in frequency
US equipment
high-freq generator provides current through a co-axial cable to a transducer inside the applicator US head
(crystal - barium titanate, zirconate titanate)
2-3 mm thick and 1-3 cm diameter
Reverse piezoelectric effect
alternating current passing through crystal causes expansion contraction of crystal (produces acoustic energy)
1.0/3.0 MHz - frequency absorption
- 0: 3-5 cm
3. 0: 1-2 cm
effective radiating area
surface of transducer that produces sound energy
1MHz is more divergent than 3 MHz
transverse wave
displacement perpendicular to direction of propagation (solids)
longitudinal wave
displacement in direction of wave propagation (liquids and solids -soft tissue)
beam non-uniformity ratio
amount of variability
ideal 1:1
typically 6:1
US - intensity
w/cm^2
power/ERA
types of US
continuous - intensity remains constant
pulsed - intensity periodically interrupted
ducty cyle - % of time that US is being generated
Biphasic Current
alternating current
-direction of current reveres itself once during each cycle
uses: pain modulation or muscle contraction
Monophasic Current
Direct current
flows only from positive to negative pole
pain modulation, muscle contraction, produce ion movement
most commonly used in AT settings
Pulsatile Current
3+ pulses grouped together
interrupted and repeat at regular intervals
used in interferential pre-modulated and Russian currents
type of current parameters
waveform modulation intensity duration frequency polarity electrode setup
waveform
graphic representation of the shape, direction, amplitude, and direction of a particular electrical currents (sine, square, triangular)
modulation
ability of the e-stim unit to change the magnitude or duration of a waveform
bursts, continuous, surging (biphasic), monophasic, or pulsatile
Intensity
voltage output of the e-stim unit.
low voltage - 150 V - monophonic
high voltage - 500 V - biphasic or monophasic
Duration
length of time that current is flowing
pulse or width duration
normally is preset
frequency
number of waveforms being emitted by the e-stim unit in 1 second
pules/sec (pps)
cycles per second (cps
Hertz (Hz)
polarity
direction of current flow
electrode set up
large pads - dispersive - away from tx area
small pad - active - close as possible to tx area
e-stim parameters for gate control
intensity adjuted to create tingling
no contraction - with pulse and freq high as possible
e-stim parameters for descending pathway control
very high intensity, almost painful, 10 microseconds for pulse duration; freq at 80 pps
opiate pain control e-stim parameters
intensity - as high as can be tolerated
pulse duration - max
freq - 1-5 pps
muscle pumping e-stim parameters
freq - 20-40 pps
surged mode at 5 seconds each for on/off modes
injured part elevated
active contraction encouraged
muscle strengthening e-stim parameters
high-freq bi-phasic current 50-60 pps surging curent at 15 sec on, 50 sec off 10 reps, 3x a week combined with titanic muscle contraction with maximal active contraction against resistance
retardation of atrophy e-stim parameters
high-freq bi-phasic
30-60 pps to elicit a tetanic contraction
voluntary isometric contraction
muscle re-education
intensity increased to comfortable contraction
30-50 pos using interrupted or surged current
15-20 min, several times per day
iontophoresis
drives ions into the body via electrical current
interferential indications
pain control, joint pain w/ swelling, neuritis, retarded callus formation following fx, restricted mobility
20-25 pps for muscle contraction and 50-120 pps for pain management
shortwave diathermy
emits electromagnetic energy that is capable of producing temperature increases in the deeper tissues
Laser
light amplification by stimulated emission of radiation
Helium-NEon) or (Gallium-Arsenide
physiological effects of thermal US
increased blood flow, metabolism, enzymatic activity, collagen extensibility,
decreased viscosity, pain, chronic inflammation, muscle spasm, joint stifffness
mild heating US
1 degrees celcius - accelerates metabolic rate
Moderate heating US
2-3 degrees celcius - reduces muscle spasm, pain, chronic inflammation, increase blood flow
vigorous heating 3-4 degrees celcius
decreases viscoelastic properties of collagen
physiologic effects of non-thermal US
microstreaming
cavitation
separation of collagen fibers
increased extensibility
increased fibroblastic activity
mechanical break-up of metabolites and waste products
reduction of edema and pain
microstreaming
flow of fluid/tissue components causes mechanical pressure waves - alters cell membrane permeability to Na+ and Ca2+ ions
Cavitation
formation of gas-filled bubbles that expand and compress due to pressure changes in fluid
stable: - increased fluid flow around bubbles
unstable: can cause damage
monopolar electrode
small (active) and large (dispersive) pad
bipolar elctrode
2 equally sized pads
bifurcate electrode
dispersive pad, and 2 active pads
quadpolar electordes
2 sets of electrodes - IFC
biofeedback
electronic instruments to accurately measure, process, and feed back reinforcing info via auditory or visual signals
EMG biofeedback
measures electrical activity in muscle fibers - quality of contraction
Mechanical response to massage
encourage venous and lymphatic drainage
mildly stretch tissue
avoid stagnant edema
physiological responses to massage
increased: circulation, metabolism, removal of lactic acid
Effleurage
stroking
light - sedative
deep - compression of soft tissue
hand over hand or cross body methods
petrissage
kneading
loose and heavy tissues
wrings out muscle, loosens adhesions, squeeze out material in to circulation
friction
used around joint where tissue is thin or unyielding
circular movement
stretch underlying tissue, develop heat, increase circulation
Tapotement
percussion
cuping, hacking, pincing
vibration
produces trebling effect
relax and sooth
indications for traction
spinal nerve root
impingement
use to decrease muscle guarding
treat muscle strain
treat sprain of spinal ligaments
relax discomfort resulting form normal spinal compression
diathermy
emit electromagnetic energy capable of producing temperature increases in deeper tissues,
good for larger surface areas
shortwave diathermy
heats deeper tissue with high freq electrical current
- through a condenser (electrostatic field heating, patient is part of circuit)
- electromagnetic/induction field heating (heated by field, patient is not in circuit)
- pulsed diathermy - output of continuous shortwave diathermy is consistently interuppted
shortwave diathermy equipment
power amplifier (converts AC-DC)
Applicators: condenser - electrodes
or
inductive coil or drum
shortwave diathermy indications
bursitis, capsulitis, osteoarthritis, deep muscle spasm, strains
can reach temps of 107
Microwave Diathermy
lower freq cause less conversion of energy into subQ tissue
easily absorbed
microwave diathermy equipment
AC–>DC by magnetron oscillator
coaxial cable transports energy from magnetron oscillator to applicator head
indications for microwave diathermy
fibrositis, myositis, osteoarthritis, bursitis, calcific tendinitis, sprains, strains, post-traumatic joint stiffness,
can penetrate up to 5 cm
conductive thermal energy
thermotherapy, cryotherapy
electrical energy using modalities
E-stim currents, iontophoresis, biofeedback
sound energy using modalities
ultrasound, extracorporeal shockwave therapy
mechanical energy using modalities
traction, massage, intermittent compression
velocity=
wavelength x frequency
characteristics of electromagnetic radiation:
- ) produced when sufficient electrical or chemical forces are applied to any material
- ) travel readily through space at an equal velocity (300,000,000 meters/sec)
- ) Direction of travel is always in a straight line
Electromagnetic radiation can be do what when contacting tissue?
reflection, transmitted, refracted, absorbed
Arndt-Schultz Principle
No changes or reactions can occur in the tissues unless the amount of energy absorbed is sufficient to stimulate the absorbing tissues
Law of Grotthus-Draper
if the energy is not absorbed utmost be transmitted to the deeper tissues
> absorption =
Cosine Law
the smaller the angle between the propagating radiation and the right angle, the less radiation reflected and the greater the absorption
inverse square law
the intensity of the radiation striking a surface varies inversely with the square of the distance from the source
“moving the object away from energy source = less absorption”
pulsed SWD can cause
depolarization in damaged cells correcting dysfunction
when should Diathermy be used?
if skin/tissue is tender and cannot handle pressure
if SubQ tissue is thick and deep heating is required
if 1 MHz US is contraindicated, Pulsed SWD will produce the same magnitude and depth of muscle heating
if the tx area is a large area
when should UV Therapy be used
cause chemical changes in skin, that have a bactericidal effect
effects are superficial in nature
treat skin lesions
topical agents are often better options
when should low level lasers be used
when you do not desire thermal effects
soft tissue and fracture healing
pain management
all electrical stimulating currents are classified as what?
Transcutaneous Electrical stimulating currents
Types of Transcutaneous electrical stimulating currents
EMS - Electrical muscle stimulators
TENS - Transcutaneous Electrical Nerve Stimulators
LIS/MENS - Low Intensity Stimulators
