Electrophysical Agents Flashcards
What are the types of thermal agents?
Superficial cold
Superficial heat
therapeutic US
diathermy
What are the modes of heat transfer? (5)
Conduction - direct contact between two different temps
Convection - between circulating medium and material of a different temp
conversion - nonthermal conversion of energy into heat
radiation - radiation source without the need for intervening medium or contact
evaporation - result of liquid turning into vapour
What are the types of cryotherapy?
cold pack
ice massage
cold bath
vapocoolant spray
controlled cold compression unit
cryo cuff
What are the effects of cryotherapy?
hemodynamic effects - v/c, increased blood viscosity
neuromuscular - decrease ner conduction velocity, increase pain threshold, altered muscle strength, decreased spasticity, facilitation of muscle contraction
metabolic effects - decrease metabolic rate
altered tissue extensibility
What are the indications for cryotherapy?
manage inflam, edema, pain
modify spasticity
manage MS symptoms
facilitation
What are the C/I to cryotherapy?
cold hypersensitivity
cold intolerance
cryoglobulinemia
paroxysmal cold hemoglobinuria
raynaulds disease
over a regenerating peripheral nerve
over area with compromised circulation or has PVD
What are the precautions to cryotherapy?
over superficial main branch of nerve
over open wound
hypertension
poor sensation or mentation
very young and very old
What are the adverse effects of cryotherapy?
tissue death
frostbite
nerve damage
unwanted v/d
How long do you keep a cold pack on for?
20 minutes max
What are the types of thermotherapy?
hot packs
parrafin wax
fluidotherapy
infrared lamps
contrast bath
What are the effects of thermotherapy?
hemodynamic - v/d
neuromuscular - increased nerve conduction velocity, increase pain threshold, altered muscle strength (decreased)
metabolic - increased meta rate
altered tissue extensibility
What are the indications for thermotherapy?
manage pain
decreased ROM and joint stiffness
accelerate healing
What are the C/I to thermotherapy?
malignancy
recent or potential hemorrhage
thronophlebitis
impaired sensation
impaired mentation
IR irradiation of eyes
What are the precautions to thermotherapy?
Acute injury
inflammation
edema
pregnancy
impaired circulation
poor thermal regulation
cardiac insufficiency
metal in the area
demyelinated nerves
over an open wound
over areas with recent application of topical counterirritants
What are the adverse effects of thermotherapy?
burns, fainting, bleeding
How many layers do you put on between heat pack and skin?
6-8 layers (cover being 2-3)
In what intervals do you inspect the skin for hot packs?
5 minutes
How long does a heat pack stay on for?
20 minutes
What do you ask the patient to remove before applying heat pack?
Jewellery
How many hand dips do you perform for parrafin bath
5-10
How long does the parafin wax stay in place for?
10-15 minutes
What are the effects of US?
thermal
increased tissue temp
acceleated met rate
pain reduction / control
muscle spasm reduction
increased circulation
increased soft tissue extensibility
alteration of nerve conduction velocity
non-thermal
enhance tissue healing
decrease inflam
increases cell permeability
What are the parameters for thermal effects, 1-2 cm depth US
freq 3Mhz
duty cycle 100% continuous
intensity 0.5 W/cm2
duration - 2xERA (5-10 minutes)
What are the parameters for non-thermal effects, 1-2 cm depth US
freq 3Mhz
duty cycle 20%
intensity 0.5-1.0 W/cm2
duration - 2xERA (5-10 minutes)
What are the parameters for thermal effects, 5 cm depth US
freq 1Mhz
duty cycle 100% continuous
intensity 1.5-2.0 W/cm2
duration - 2xERA (5-10 minutes)
What are the parameters for non-thermal effects, 5 cm depth US
freq 1Mhz
duty cycle 20%
intensity 0.5-1.0 W/cm2
duration - 2xERA (5-10 minutes)
What are the indications of US?
ST shortening (deep heating)
Pain
dermal ulcers
surgical skin incision
tendon and ligament injuries
resorption of calcium deposits
bone fractures
phonophoresis
What are the C/I of US?
Pregnancy
Pacemaker
Thrombophlebitis (clots)
malignant tumor (cancer)
joint cement
plastic components
*CAN USE WITH METAL
eyes
reproductive organs
CNS tissue (if not covered by bone)
What are the precautions of US?
acute inflam (no thermal)
epiphyseal plates (causes early closure)
fractures (only on low intensity)
breast implants
What are the adverse effects of US?
Burns
Infection
How do you minimize risk of burns with US?
moving US head (4cm/sec)
don’t apply with impaired circulation or sensation
don’t apply after any intervention may impair sensation
reduce over superficial bone
reduce if c/o discomfort with US
How do you minimize risk of infection with US?
clean US transducer with 70% alcohol
How do you test if an US device is working?
if water around sound head bubbles
What are good transmission mediums for US?
water-based gel, water, phonophoresis meds
What are the types of diathermy and what are they used for?
Short wave
-continuous - deep heats (CAN ALSO DEEP HEAT A LARGER AREA COMPARED TO US)
-pulsed - non-thermal effects
microwave
-continuous
-pulsed
What are the effects of diathermy?
thermal - same as heating
non-thermal - enhanced healing
What are the indications for SWD?
thermal - manage pain ,decreased ROM and joint stiffness, accelerate healing
non-thermal - manage pain / edema, soft tissue healing, nerve healing, bone healing
What are the adverse effects of SWD?
burns
overexposure to electromagnetic radiation
What are the c/I to diathermy (including thermal)
see book - so many
what are the precautions to diathermy?
see book - so many
What is crucial to do before applying thermal level diathermy?
wrap the area to be treated with towelling to absorb local perspiration
How long to do apply thermal level diathermy for?
20 minutes
How long do you apply PSWD for?
30-60 minutes
Why would you used electrical currents?
Pain control
Production of muscle contraction
Promote tissue healing
edema control
enhance transdermal drug delivery
What are the types of waveforms for electrical currents?
Direct - continuous unidirectional
Alternating - continuous bi-directional
Pulsed - non-continuous
-monophasic - unidirectional
-biphasic - bi-directional
What are the parameters for electrical currents?
pulse duration - shorter (pain) and longer (contraction)
phase duration
interpulse interval (time between pulses)
Amplitude
frequency (pulses per sec)
on:off time
ramp up - get to max amp
ramp down - get down from max amp to zero
What are the C/I for electrical currents?
Pregnancy
pacemaker
thrombophlebitis (clots)
unstable arrhythmias
over carotid sinus
What are the precautions for electrical currents
Cardiac disease
impaired mentation or sensation
malignant tumors (cancer)
skin irritation or open wounds
What are the adverse effects of electrical currents?
Burns - most common DC or AC, inadequate conduction medium
skin irritation or inflam
pain
What are some considerations when placing the electrodes?
no wrinkles
do not place over bony prominencese
space appropriately - closer = more superficially, further = travels deeper
What electrical currents are used for pain control?
TENS - high rate, low rate, burst mode
IFC
Premod
What electrical currents are used for muscle contraction?
Innervated muscles - Russian current, NMES/FES
Non-innervated muscles - EMS
What electrical currents are used for tissue healing?
High volt pushed current (HVPC)
Iontophoresis
What is high frequency TENS? Including mechanism and parameters
Short period relief of pain through pain gate
Parameters:
PD: 50-80 (SHORT)
Freq: 100-150 Hz (HIGH)
Amp: client controlled
Duration: up to 24 hours as much as needed
What is low frequency TENS? Including mechanism and parameters
Longer period relief of pain through endogenous opioids (descending inhibition) - high enough to produce a muscle contraction
Parameters:
PD: 200-300 (LONG)
Freq: 2-10 Hz (LOW)
Amp: visible muscle contraction
Duration: no longer than 45 mins
What is burst mode TENS? Including mechanism and parameters
Stimulation is delivered in bursts activating endogenous opioids (descending inhibition)
Parameters:
PD: 10 bursts
Freq: 100-300 Hz
Amp: visible muscle contraction
Duration: 20-30 mins
What is IFC? Including effects and electrode placement
Modulates pain using two separate medium freq alternating currents - which interfere at targeted area
More tolerated than TENS, larger and deeper area, long-lasting
same leads cross paths marking X over target
What are premodulated current (premod)?
IFC but uses two electrodes and delivers an alternating current of varying amps
modules pain but not as much depth and distance
What is a russian current?
medium frequency alternating current to produce muscle contraction in innervated muscles
Timing:
Stim: 10 sec
rest: 50 sec
Total: 10 minutes (10 total contractions)
What is NMES?
Produces muscle contractions in innervated muscles
helps strengthen muscles, prevent or slow down atrophy, reduce spasticity, improve CV health, increase bone mineral density and restore function
*can help with neuro population if intact peripheral nerves
Use FMES if during functional activity - NEED LMN, NMJ, MUSCLE
What are the differences between NMES contractions and physiological contractions?
Recruitment - NMES type II first, then type I (physiological opposite)
Onset - NMES - rapid jerky, physiological - smooth graded
What is EMS? Including parameters
muscle contraction in denervated muscle
electrical current lasts >10ms
helps slow down or reverse atrophy, enhance cushioning and improve cosmetic appearance, no improvements in function
*see chart in book for parameters
Where do you place electrodes for EMS?
one over motor point (muscle belly) and other anywhere along muscle parallel
What is high volt pulsed current?
high volt monophasic current to promote tissue healing by ionic effects (attracting or repelling cells that carry a charge) through galcanotaxis
enhances anti-microbial activity, attracts appropriate cell types - increases collagen production via fibroblast activity, reduces edema
What is iontophoresis?
use of electrical current to enhance delivery of topical meds through skin - less side effects than other routes
What are electromagnetic agents?
Laser and light therapy
UV radiation
Diathermy
What is laser and light therapy?
Laser - Light amplification by stimulated emission of radiation
*still within the visible or near visible part of electromagnetic spectrum
Low level laser therapy - is what is used for therapy
What are the effects of laser?
Promote healing
modulate inflam
inhibit bacterial growth
promote v/d
alter nerve conduction velocity
accelerate nerve regeneration
What are the effects of laser?
Promote healing
modulate inflam
inhibit bacterial growth
promote v/d
alter nerve conduction velocity
accelerate nerve regeneration
What are the indications for laser?
ST healing
bone healing
pain
inflammatory conditions
lymphedema
neurological conditions
What are the C/I of laser?
malignancy
within 4-6 months after radiation therapy
direct irradiation of eyes
over hemorrhaging regions
over endocrine glands (thyroid)
What are the precautions of laser?
Pregnancy
epiphyseal plates in children
impaired sensation and mentation
photophobia
high photosensitivity
photosensitizing medication
What are the adverse effects of laser?
retinal damage
burns
burning sensation
transient tingling
mild erythema
skin rash
increased pain
increased numbness
What is UV radiation?
Electromagnetic radiation which wavelengths are just shorter than visible light but longer than those of xrays
What are the effects of UV radiation?
erythema productive
tanning
epidermal hyperplasia
vit D synthesis
bactericidal
What are the indications for UV radiation?
psoriasis
wound healing
What are the contraindication for UV radiation?
irradiation to the eyes
skin cancer
pulmonary TB
cardiac, kidney, liver disease
fever
systemic lupus erythematosus
What are the precautions for UV radiation?
photosensitivity
photosensitizing meds
recent xray
note: UV should not be repeated until the effects of previous dose have disappeared
What are the adverse effects of UV radiation?
Burns
premature skin aging
carcinogenesis
eye damage
What are the types of hydrotherapy?
whirlpool
full body immersion (hubbard tank)
exercise pool
non-immersion wound irrigation
What are the physical properties of water?
Specific heat - higher than air
Thermal conductivity - higher than air
Buoyancy - decrease stress on wb joints, helps raise weak body parts, assist therapist
Resistance - occurs against the direction of the motion, increases in relation to speed, increases in relation to frontal area
Hydrostatic pressure - increases in proportion to the depth of fluid
What are the effects of hydrotherapy?
cleansing effects - remove debris, antimicrobial additives
MSK effects - strength, decrease wb
CV effects - increase venous circ, cardiac volume and output, decreased HR, SBP, rate of oxygen uptake
Resp effects - increase WOB, decrease EIA
renal effects - diuresis, increased Na and K excretion
psychological - relaxing or invigorating
What are the benefits for hydrotherapy?
MSK - decreased wb, velocity dependent resistance, OKC/CKC, effects on bone density loss, fibro
Neuro - proprioceptive input, increased safety and improved balance
Reduced cardiac fitness- cardiac conditioning inpatients with poor tolerated for land based
Preg - decrease wb, decreased increase HE, decreased risk of maternal hyperthermia
EIA - decreased
Age related - improved balance, strength, CR fitness, functional mobility
What are the indications for hydrotherapy?
superficial heating or cooling
water exercise
managing pain
managing edema
wound care
What are the c/i of hydrotherapy?
cardiac instability
infectious conditions that may be spread by water
bowel incontinence
severe epilepsy
suicidal patients
What are the precautions of hydrotherapy?
confusion or disorientation
alcohol ingestion
limited strength, endurance, balance, ROM
meds
urinary incontinence
fear of water
resp problems
What are the adverse effects of hydrotherapy?
infection
drowning (full immersion)
What are the types of compression?
Static
intermittent
sequential
What are the effects of compression?
improve venous and lymphatic circulation
limits the shape and size of tissue
increases tissue temp
What are the indications for compression?
Edema
preventions of DVT
venous stasis ulcers
residual limb shaping after amputation
control of hypertrophic scarring
What are the C/I for compression?
heart failure or pulmonary edema
DVT, thrombophlebitis or PE
obstructed lymphatic or venous return
severe PAD
ulcers from arterial insufficiency
acute local skin infection
significant hypoproteinemia
acute trauma or fracture
arterial revascularization
What are the precautions for compression?
impaired sensation or mentation
uncontrolled hypertension
cancer
stroke or significant cerebrovascular insufficiency
superficial peripheral nerves
What are the adverse effects of compression?
tourniquet effect - impaired arterial circulation, ischemia, impaired healing, tissue death
superficial peripheral nerve compression
What are the types of compression devices?
compression bandage
compression garment - anti-embolism stocking (16-18), scar tissue control (20-30), edema control (30-40)
intermittent pneumatic compression pump
What manner do you wrap the compression bandage around limb
figure eight manner, distal to proximal
How do you check for signs of circulation or nerve compression after compression bandaging?
ask patient regarding S + S
colour changes
capillary refilll check
How do you check for signs of circulation or nerve compression after compression bandaging?
ask patient regarding S + S
colour changes
capillary refilll check
What is traction? Including types
separation of joint surfaces as a result of mechanical forces
manual, mechanical, gravity assisted
What are the effects of traction?
joint distraction
reduction of disc protrusion
soft tissue stretching
muscle relaxation
joint mobilization
What are the indications for traction?
disc bulge and herniation
nerve root impingement
joint hypomobility
subacute joint inflammation
paraspinal muscle spasm
What are the C/I of traction?
where motion is C/I
acute injury or inflammation
joint hypermobility or instability
peripheralization of symptoms with traction
uncontrolled hypertension
What are the precautions of traction?
structural disease or conditions affecting the spine
when pressure from traction belts may be hazardous
displaced annular fragment
medical disc protrusion
when severe pain fully resolves with traction
claustrophobia or other psychological aversion to traction
inability to tolerate the prone or supine position
disorientation
TMJ problems
What are the adverse effects of traction?
potential increase in symptoms
refer to C/I and precautions
