Chp 15. Using Therapeutic Modalities Flashcards
Examples of thermal energy modalities
Cryotherapy and thermotherapy
Examples of electrical energy modalities
Electrical stimulating currents, iontophoresis
Examples of electromagnetic energy modalities
Shortwave and microwave diathermy, infrared lamps, ultraviolet light therapy, low power lasers
Examples of sound energy modalities
Ultrasound, extracorporal shockwave therapy
Examples of mechanical energy modalities
Intermittent compression, traction, massage
List the desirable therapeutic effects of heat
-increased extensibility of collagen tissues
-decrease joint stiffness
-reduce pain
-relieving muscle spasm
-reducing inflammation, edema and exudates in postacute phase of healing
-increased blood flow
Heat and cold relieving pain through what pain theory?
Gate control theory
Ischemia
Reduced blood flow
List the mechanisms through which heat assists w/the healing process
-raising temp
-increased metabolism
-reduce oxygen tension
-lowering pH level
-increased capillary permeability
-releasing bradykinin and histamine which cause vasodilation
Conduction
Occurs when heats transferred from a warmer object to a cooler one
When using heat, to avoid tissue damage what should the temperature not exceed? And when in close contact?
-shouldnt exceed 116.6 F
-close contact w/medium shouldnt exceed 113 F for 30 mins
Convection
Refers to transference of heat through the movements of liquid and gases
Give an example of a modality that uses both convection and conduction
Whirlpool
-conduction-skin contact w/higher water temp
-convection- water swirling around skin surface
Radiation, example
Process where heat energy is transferred from one object through space to another; shortwave diathermy
Does moist or dry heat cause a greater indirect increase in deep tissue temperature? Which can be tolerated at higher temps moist or dry?
-moist heat causes great indirect increase in deep tissue temp
-dry heat can be tolerated at higher temps
Hydrocollator water kept at?
Kept at 160-170F, retains heat for 20-30 mins
Hydrocollator indications
Relaxes and reduces the pain-guarding-ischemia-hypoxia-pain cycle
Hydrocollator limitations
-deeper tissues like muscle arent heated bc of subcutaneous fat
-increased blood flow to skin, cools and carries away heat externally applied
Hydrocollator application
-place cover and towels over pack, create space between skin and hot pack
-15-20 mins
-patient shouldnt lie on the pack
Whirlpool indications
Reduces swelling, pain, and muscle spasm
Whirlpool application
-as volume of body part increases, temperature should decrease, not exceed 104F for full body
-water jet placed on side of tank not directly over injury (acute phase mainly)
-ranges >55F-110F
-when streams directed at injury, should be 8-10 in away
-20-30 min
Whirlpool special considerations
-whirlpool emptied and disinfected (inside and out) after every patient
-all outlets have ground fault interrupters (GFIs)
-on/off switch should be far from whirlpool
Paraffin bath equipment parameters
-maintain temp of 126-130F
-mixture of 25kgs of paraffin wax to 1 liter of mineral soil
Paraffin bath indications
-chronic injuries in angular areas such as wrist, hands, ankle, feet,elbows
Paraffin bath application
-dipped and wrapped in plastic bag or dipped and reimmersed 8-10 times
-clean body parts before use
-remove wax and add back into mixture
Paraffin bath special considerations
-avoid open wounds/areas of poor circulation
-mixture replaced every 6 months
POLICE stands for
Protection, optimal loading, ice, compression, elevation
(use ice day of injury up until 2 weeks after)
What factors affect the extent to which the tissue is cooled?
-cold medium applied
-duration of cold exposure
-conductivity of area being cooled
Is fat or muscle tissue a better cold conductor?
Muscle tissue, muscle has a higher water content
Hunting response
When tissue has been cooled for 30 minutes, intermittent periods of vasodilation occur lasting 4-6 mins
Phsyiological effects of cold
-lower metabolic rate, as a result decreases muscle guarding
-reduces swelling in acute phase
-produces vasoconstriction
-decreases free nerve ending excitability, peripheral nerve exictability
What factors affect nerve fiber response to cold? What nerve fibers are most and least sensitive to cold?
-depends on myelination and diameter of the fiber
-most sensitive to cold: gamma efferent myelinated fibers to muscle spindles
-next most sensitive: alpha motor nerves
-least sensitive: unmyelinated pain fibers and sympathetic nerves
Describe the sensation a patient will feel during cold application
CBAN
Cold, burning, aching, numbness
Why do the effects of cold last longer than heat?
Fat acts as an insulator against rewarming
In which temperatures does frostbite occur?
26.6-24.8 F
Raynauds phenomenon
Medical condition in which the spasm of small arteries causes reduced blood flow to end arterioles. Usually in the fingers and less commonly in toes
Nerve palsy
Occurs when cold is applied to a part that has motor nerves close to it like the peroneal nerve at the fibular head. Condition usually resolves on its own
Cryokinetics
Combination of cryotherapy and exercise. Goal is to numb the injured part and then work toward achieving normal ROM through progressive active exercise
Cryokinetics application
-Apply for 12-20 mins so that area is numb
-proceed with exercise
-reapply ice for 3-5 mins so area becomes numb again, and perform exercise
-exercises should be performed when area is numb and progress in intensity and be pain free
Depolarization of nerves
When an electrical current is applied to nerve tissue as a sufficient intensity and duration and reaches that tissues excitability threshold it results in membrane depolarization or firing.
As intensity and duration of electrical stimulation increase what nerve fibers will depolarize first?
First-sensory fibers, then-motor fibers, last-pain fibers
Direct current; used for
-AKA monophasic, only a single phase of current that flows in one direction only from the positive pole to the negative pole
-used for pain modulation, muscle contraction, or to produce ion movement
Alternating current; used for
-aka biphasic, one phase the current flows towards positive pole and in the second phase the current flows towards the negative pole, current reverses the direction of flow each cycle
-used for pain modulation, muscle contraction
Pulsatile current; used for
-aka polyphasic current, groups of phases are interrupted for short periods of time and repeat themselves at regular intervals
-interferential pre-modulated and russian currents
Modulation; name the diffrent types of modulation
Changing the magnitude or duration of a waveform. Can be continuous, bursts, surging/alternating, direct, pulsatile currents.
Continuous modulation
Long-duration uninterrupted current, applied often w/a direct current
Burst modulation
Interpulse interval that briefly interrupts current output, used w/pulsatile currents
Surging modulation
Current intensity gradually ramps-up to some max amplitude and then gradually ramps down
Current intensity; whats low and high and what is each used for?
Current intensity is the voltage output
-low: 150V used for causing ion movement
-high: 500v used to stimulate muscle contraction
Pulse duration/pulse width
The length of time that current is flowing
Frequency; units
The number of waveforms being emitted by the electrical stimulating unit in 1 second; pulses per second (pps), cycles per ssecond (cps), or hertz (Hz)
Polarity
Direction of current flow toward either a positive or negative pole
When using a large electrode and a small electrode where will most of the current be concentrated?
The large pad disperses the current while the small pad concentrates the current (usually small pad is placed close to the nerve/motor point)
Indications for electrical stimulation
-depolarization of sensory nerves to modulate pain
-depolarization of motor nerve fibers to elicit muscle contraction
-create electrical field in biological tissues to stimulate/alter healing process at the cellular level
-create electrical field on the skins surface to transport ions beneficial to healing process into deeper target tissues (iontophoresis)
Electrical stimulation, gate control application; parameters
-stimulation of sensory nerves causes the gate to pain to be closed
-if stimulation stops, gate is open and pain returns
-intensity should cause tingling sensation but no muscle contraction frequency set as high as can be to create as much sensory cutaneous stimulation as possible
Electrical stimulation, Descending pathway pain control parameters
-current intensity should be high approaching a noxious level, pulse duration should be 10 microseconds, frequency
Should be 80 pulses per second
Electrical stimulation, opiate pain control, parameters
Electrical current placed close to site of pain or acupuncture/trigger points both local and distant from pain area.
-current intensity as high as tolerable, pulse duration as max possible on machine, frequency 1-5 pps
