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Modalities Spring Midterm > EMR Physical Agents: Diathermy and Laser > Flashcards

EMR Physical Agents: Diathermy and Laser Flashcards

1
Q

What is electromagnetic radiation (EMR)?

A

composed of electrical and magnetic fields that vary over time and are oriented perpendicular to one another

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2
Q

What is natural EMR?

A
  • uv radiation from sun, magnetic field of earth
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3
Q

What is manufactured EMR?

A
  • light bulbs, computers, appliances
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4
Q

What is light in terms of EMR?

A
  • electromagnetic energy in or close to visible range of electromagnetic spectrum
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5
Q

What is infrared radiation used for?

A

superficial heating

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6
Q

What are microwave and shortwave used for (physical agent)?

A

Diathermy

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7
Q

What is EMR categorized by?

A

its frequency and wavelength

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8
Q

Frequency and wavelength of EMR are ________ ___________

A

inversely proportional

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9
Q

What kind of EMR is nonionizing?

A

Lower frequency (longer wavelength)

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10
Q

What are examples of lower frequency EMR?

A
  • shortwaves
  • microwaves
  • IR
  • visible light
  • UV
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11
Q

Can nonionizing radiation break molecular bonds?

A

NO - medically safe :)

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12
Q

What kind of EMR is ionizing?

A

Higher frequency (shorter wavelength)

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13
Q

What are examples of ionizing EMR?

A
  • x rays
  • gamma rays
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14
Q

What does ionizing mean?

A

can break molecular bonds to form ions and inhibit cell division

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15
Q

Is ionizing EMR used clinically?

A

VERY small doses for imaging (x-ray)
- LARGE doses to intentionally destroy tissue (cancer treatments)

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16
Q

_____ in large doses can become ionizing

A

UV

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17
Q

When is intensity of EMR greatest?

A

when…
- energy output is high
- radiation source is close to the patent
- beam is perpendicular to the skins surface

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18
Q

What do the physiological effects of EMR on the subject depend on?

A
  • frequency/wavelength (types of EMR, ionizing or nonionizing)
  • intensity of the radiation
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19
Q

What is energy(J) equal to?

A

power (W) x time (s)

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20
Q

What mode of transfer is diathermy (thermal)?

A
  • conversion mode of heat transfer
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21
Q

What is thermal diathermy?

A
  • an electromagnetic form of energy which causes the rotation of polar molecules, “converts” to heat when friction between the molecules increases tissue temp
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22
Q

What is the range of shortwave diathermy? (SWD)

A

1.8 - 30 MHz

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23
Q

What is the intensity of continuous diathermy to generate heat?

A

10-25 watts intensity generates heat

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24
Q

What is pulsed diathermy?

A
  • low intensity
  • nonthermal and produces other physiological changes
  • non thermal shortwave therapy (SWT)
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25
Q

What are the types of applicators used with diathermy?

A
  • inductive coil -> produces most heat in deeper tissues with high electrical conductivity
  • capacitive plates -> more heat in skin/superficial tissues
  • magnetron (not common)
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26
Q

What are thermal effects of continuous SWD?

A
  • vasodilation
  • increased rate of nerve conduction
  • reduction of pain
  • increased soft tissue extensibility
  • accelerated enzyme activity
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27
Q

What are nonthermal effects with SWT?

A
  • pulsed will not have thermal activity bc the transient heat of tissues will diffuse between pulses
  • modulated pain, edema, and inflammation through altered cell membrane function and activity
  • increased microvascular perfusion
  • increased blood flow/circulation
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28
Q

What is continuous SWD used for clinically?

A

produces thermal effects in deep tissues
- increased circulation in skin, subcutaneous tissues and muscles

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29
Q

What are advantages of continuous diathermy (SWD)?

A
  • can heat larger areas that US
  • can heat with more depth than heat packs
  • can be used when direct contact contraindicated
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30
Q

What are disadvantages of diathermy?

A
  • not widely used
  • EMR field cannot be readily contained and can interfere with other equipment
  • equipment is large, expensive and cumbersome
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31
Q

What are the clinical used of Nonthermal shortwave therapy (SWT)?

A
  • accelerates edema resolution
  • reduce pain after injury
  • accelerate soft tissue healing
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32
Q

Where is SWT seen most often? Why?

A

in SNF
- long duration of treatments
- no med equipment to interfere with

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33
Q

What should the positioning of the drum applicator allow?

A

An air gap for heat to dissipate
- pt must remain still to maintain gap

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34
Q

What should we avoid with positioning of drum?

A

direct contact with skin, esp when infection present

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35
Q

Why do we wrap the area to be treated with a towel with diathermy?

A
  • to absorb patient perspiration
  • avoid potential burns
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36
Q

What can we do to the applicator to minimize risk of cross contamination?

A

Cover with plastic

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37
Q

What needs to be removed before a diathermy treatment?

A

Jewelry and other metal objects
- be mindful of bras with underwire

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38
Q

What type of patient should we NEVER use diathermy on?

A

patients with implanted stimulators
- such as deep brain stimulators or pacemakers

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39
Q

What are the treatment parameters for diathermy?

A
  • thermal ~20 mins
  • nonthermal: 30-60 minutes once or twice a day
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40
Q

What can happen with diathermy at normal intensities that we need to be aware of?

A

BURNS
- soft tissue
- caries significantly with the type of tissue
- fat layers are at greatest risk of burning (not well vascularized = not cooled as effectively by vasodilation)

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41
Q

Why do we wrap a patient in towels to avoid burns?

A
  • water is preferentially heated by all forms of diathermy, to avoid scalding by hot perspiration, the patients skin needs to be kept dry
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42
Q

Why should a patient not stand near the diathermy unit?

A

if they are pregnant or have a pacemaker

43
Q

What are the levels of dosage for diathermy?

A
  • Level I = 0 watts
  • level II = 12 watts
  • level III = 24 watts
  • level IV = 48 watts
44
Q

What is most light?

A

polychromatic (consists of various wavelengths of light)

45
Q

What is LASER light?

A
  • Light Amplification by Stimulater Emission of Radiation
46
Q

What are the different types of laser light?

A
  • monochromatic (single wavelength)
  • coherent (waves are in phase, stick together)
  • directional (little divergency, laser pointer)
47
Q

What is low-level laser therapy? (LLLT)

A
  • low intensity “cold” lasers
  • low level light devices in visible red and IR range
48
Q

What is LLLT used for?

A
  • promote tissue healing
  • control pain and inflammation
49
Q

What are high-intensity “hot” lasers?

A
  • used for surgery, destroy tissue
  • narrow beam generates heat within selective tissues and destroys tissue, cauterizes as it cuts
  • NOT USED FOR REHAB
50
Q

Are all lasers “LASERS”?

A

NO

51
Q

What are light devices names based on?

A

What type of photodiode they are comprised of

52
Q

Are some “Laser” devices comprised of multiple photodiodes?

A

Yes, including laser and LED diodes

53
Q

What are photodiodes?

A
  • small, sturdy, inexpensive conductors of energy
  • semiconductors with positive and negative charges that output energy
54
Q

What are some photodiode types?

A
  • laser diodes
  • LEDs
  • SLDs
55
Q

Why is LASER monochromatic?

A
  • remains at ~ 632.8 nm wavelength
  • coherent
  • directional
  • superficial penetration ~ 5 mm
56
Q

What color does LASER appear in the visible light spectrum?

A

RED

57
Q

What does the color of the light depend on?

A

wavelength (usually red)

58
Q

What does LED stand for?

A

Light - Emitting Diode

59
Q

What kind of laser is LED?

A

infrared laser
- not technically a laser
- light appears one color but not coherent or monochromatic

60
Q

Why is LED nondirectional?

A
  • more diffuse spread of light
  • coverage of larger treatment areas
61
Q

What does it mean that LED is low concentration of energy?

A

Longer application times tolerable

62
Q

What kind of LED laser is most commonly used for patient treatment? Why?

A

Red LED lasers, best depth of penetration into human tissue

63
Q

What is the depth of penetration of red LED laser into human tissue?

A

~ 600-700 nm

64
Q

What is an SLD?

A
  • Supra Luminous Diode
65
Q

What are the characteristics of SLD?

A
  • almost monochromatic
  • non-coherent
  • nondirectional (spreads less than LED but more than LASER)
  • deeper penetration 2-4 cm
  • high - intensity (shorter application times)
66
Q

What are the properties of light therapy?-

A
  • wavelength
  • power
  • power density
  • energy
  • energy density
67
Q

What does the wavelength affect with light therapy?

A
  • depth of tissue penetration
68
Q

What type of wavelength penetrates deeper?

A

longer deeper than shorter

69
Q

What penetrates more deeply than visible redlight?

A

IR

70
Q

Can LEDs penetrate deeper than LASERs?

A

Yes, some

71
Q

What is power of light therapy?

A

Unit of light intensity (mW)

72
Q

What does power of light therapy determine?

A

Clinical effects
- hot lasers = high power
- COLD lasers = low power

73
Q

What class of cold lasers is used for therapy?

A

3B

74
Q

What is power density also known as?

A

Irradience

75
Q

What is power density of light therapy measured in?

A

mW/cm2

76
Q

What does the energy of light therapy determine?

A

Dose

77
Q

What is energy of light therapy?

A

power over a period of time

Energy (J) = Power (W) x Time (s)

78
Q

What is the energy density also known as in light therapy?

A

“Fluence” of treatment

79
Q

What is the energy density measured in?

A

Energy / Unit of area (J/cm2)

80
Q

What is the energy density based on ?

A

Clinical indication

81
Q

What is duration of energy density dependent on?

A

Dose
- clinician does not change time of treatment

82
Q

What are chromophores?

A
  • part of a molecule that gives tissue its color by absorbing some wave lengths and reflecting others
83
Q

How are photons absored?

A

by chromophores causing a cascade of cellular changes

84
Q

What can absorbed photons (light energy) stimulate chromophores to do?

A
  • under go chemical reactions and promote a cascade of biochemical events that influence tissues function
85
Q

What are the physiological effects of light therapy?

A
  • stimulate mitochondria to produce more ATP**
  • stimulate production of mRNA to promote fibroblasts increased collagen production
  • induce vasodilation/circulation
  • inhibit bacterial/fungi growth
  • modulate inflammation by decreasing mediators
  • improve nerve conduction and regeneration after injury
86
Q

What primarily generates ATP?

A

Mitochondria

87
Q

What is ATP used for?

A

energy source in all cellular reactions

88
Q

What does laser light do to the mitochondria?

A
  • improves mitochondrial function and increases ATP production by up to 70%
89
Q

What is the evidence for clinical usage of light therapy?

A

EVIDENCE IS VERY LIMITED
- may be biomodulating and facilitate healing

90
Q

What are clinical indications of light therapy?

A
  • WOUND HEALING / fx healing
  • neurological conditions
    > CTS, diabetic peripheral neuropathy, alters nerve conduction velocity
  • MSK disorders
    > soft tissue and arthritic conditions due to reduction in inflammatory mediators
  • Lymphedema
    > treatment in axillary region of women post mastectomy to reduce limb volume
  • pain management
    > arthritis tendinopathy, TMJ, DOMS, LBP, neck pain, trigger points, chronic pain
    > analgesic effects most pronounced when laser/light applied to skin overlying the involved nerves or dermatomal area
91
Q

What are low dosages of light therapy used for?

A
  • more acute or superficial conditions
92
Q

What are higher doses of light therapy used for?

A

chronic or deeper condiotns

93
Q

What happens with a higher dose of light therapy?

A

increased duration of treatment

94
Q

What is the AVERAGE treatment dose for light therapy?

A

4-12 J/cm2

95
Q

Why do we wear goggles with light therapy?

A

SAFETY
- both clinician and patient should be wearing protective goggles
- should be marked indicating the wavelength range they attenuate (block)
- dont point in your or the pt’s eyes & never look directly in it

96
Q

What kind of lasers can emit light that is not visible but can still damage the retina?

A

IR lasers

97
Q

What should we know about units and goggles?

A
  • only use goggles provided with the laser unit, other goggles/glasses nonspecific to that unit will not prevent possible eye damage
98
Q

Are burns rare with light therapy?

A

YES (3B)

99
Q

What will happen if the diodes are on for a prolonged period of time?

A

they will become warm

100
Q

What is a concern with LEDs?

A

long time to deliver therapeutic done of energy

101
Q

What type of patient are LEDs not appropriate for?

A

those with poor sensation or mentation

102
Q

What are some contraindications of light therapy?

A
  • directly to eyes
  • within 4-6 months of radiotherapy
  • hemorrhagic lesions
  • locally to endocrine glands
  • malignancy
103
Q

What are some precautions with light therapy?

A
  • pregnancy (to LB or abdomen)
  • epiphyseal plates
  • impaired sensation or mentation
  • photophobia
  • high sensitivity to light
  • pretreatment with photosensitizers (medications)
104
Q

What do we document when using laser, LED, SLD, light therapy?

A
  • type of diode
  • wavelength
  • power
  • area of the body treated
  • treatment dose/ energy density

Modalities Spring Midterm (6 decks)

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