Equipment, Devices and Technologies; Therapeutic Modalities Flashcards
A dependent patient must be ___ when changing positions in order to avoid shearing of skin across the bed.
lifted
Practice moving ____ from one side of the bed to the other.
segmentally
Min A is ___%.
Mod A is ___%.
Max A is ___%.
25%
50%
75%
Dependent transfer of three person carry/lift.
Used to carry someone from stretcher to…
One therapist holds ____ , the second supports___, and the third supports ____.
Therapist at the ____initiates commands.
bed or plinth
head and upper trunk
trunk
LE
head
Dependent transfer of two person lift.
Used to transfer patient between….
One therapist holds…..
Other therapists holds….
two surfaces of different heights or when transferring a patient to the floor.
underneath axilla; grab L forearm in R hand and R forearm in L hand.
mid to distal thighs and LE
Stand pivot transfer requirements…
Lead with ….
Can also be used therapeutically for someone with CVA leading with….
unilateral WB restrictions or hemiplegia
uninvolved
involved
Measuring seat height in w/c
measured from heel to popliteal fold and add 2 inches
Measuring seat depth in w/c
posterior buttock to popliteal fold and subtract 2 inches
Measuring seat width in w/c
measure widest aspect of buttocks, hips or thighs and add 2 inches
Measuring back height in w/c
measure seat of chair to floor of axilla with users shoulder flexed to 90 degrees and subtract 4 inches
Final back height of w/c should be below the ____of the scapulae
inferior angles
Back height is affected by
cushion
Measuring armrest height in w/c
seat of chair to olecranon process with users elbow flexed to 90 degrees and add one inch
Hemi frame w/c is used for those who
self propel using LE
One-hand drive frame w/c is used for those who
self propel using one UE
Amputee frame w/c is used for those who
self propel but center of gravity is shifted posteriorly due to amputation
Geri chair w/c is used for those who
are not able to self propel or safely operate a power mobility device
Reclining chair w/c is used for those who are
unable to perform weight shifting or unable to sit upright for extended periods.
moderate to severe trunk involvement
Backward tilt-in-space frame w/c is used for those who
are unable to sit upright or perform weight shifts but also has issues sliding or has extensor tone
Sling back in w/c is for those who
require no postural support and has no neuromuscular deficits.
usually not for long term
Planar back in w/c is for those who
require mild to moderate trunk support due to tone
Curved back in w/c is for those who
require moderate trunk support
Custom molded insert in w/c is for those who
require significant trunk support
If the back height is below inferior angle of scapula the pt is able to
self propel and has good trunk control
If the back height is above inferior angle of scapula the pt is
able to self propel but requires additional spinal support
Planar seat in w/c is for those who
have no seated deformity
Curved seat in w/c is for those who
require mild to aggressive supportive curvature to provide increased contact between lower body and seat
Custom molded seat in w/c is for those who
require customized seat support to correct pelvic obliquity or a fixed asymmetrical deformity
Bevel (undercut) front edge of seat in w/c is for those
who self-propel using LE
Planar lateral supported for trunk in w/c is for those who
require mild to moderate lateral support duet o listing or scoliosis
Contoured or curved lateral supports for trunk in w/c is for those who
require total contact lateral support for significant lateral listing or scoliosis
Chest strap in w/c is for those who
require trunk support to correct for anterior listing
Chest harness in w/c is for those who
require both trunk and shoulder support to correct for anterior listing
Full length arm rests in w/c are for those
who perform STS
require additional postural support
pt utilizing lap board
Tubular or single posted arms in w/c are for those who
require minimal support for UE and easy access to wheels for propulsion and easily removal of arms
Fixed or non-removable armrests in w/c are for those who
require durable UE support
Covered rim wheel in w/c are for those that
require assistance for adequate grasp or friction when hands are in contact with wheel rims
Proportional control of power w/c
modulate speed
Non-proportional control of power w/c
pre-set speed
Bariatric w/c has weight limit of
300-1,000 lbs
Proper fit positioning of crutches
6 inches in front
2 inches lateral
crutch height should be no greater than 3 finger widths from the axilla
Lofstrand crutches can be used with all levels of ….
They require the ___ level of coordination.
Arm cuff should be positioned ….
Platform attachment can be utilized.
WB
highest
one an one half inches below olecranon process so it doesnt interfere with elbow flexion
Quad canes can better assist with limited ___ on an involved LE.
WB
Canes can be used in what types of gait patterns?
2 point
4 point
modified 2 and 4 point
When guarding during ambulation what side do you stand on as the therapist?
to the affected side
2 point gait
two crutches or canes
opposite crutch and LE move forward together.
Each step is one point and a complete cycle is two points.
3 point gait
walker or crutches
involves one injured LE that may have decreases WB
AD is advanced, then the injured LE, then the uninjured LE.
AD and each LE is a separate point.
4 point gait
similar to 2 point gait but doesnt move extremities simultaneously with device.
This is for those with impaired coordination, balance or significant strength deficits.
Each advancement of LE and crutch is a point.
Guarding during ascending stairs using handrail
stand opposite side and behind
Guarding during ascending stairs not using handrail
stand behind patient slightly toward affected side
Ascending stairs with crutches/cane
turn crutch sideways and hold HR and crutch in same hand
Those with a femoral line, hip flexion WOM should be limited to
not >80 degrees
CVP catheter is aka
and what does it do?
central line
measures pressures in RA or superior vena cava by means of indwelling venous catheter and pressure manometer.
Used to evaluate R ventricular function, R atrial venous pressure and circulating blood volume.
With a CVP catheter, avoid ….
For internal jugular insertion limit….
For subclavian insertion limit…..
If this is dislodged it is a…
excessive movement and physical activity
limit head and neck movement
limit ipsilateral shoulder ROM to 90 degrees
life-threatening emergency
Indwelling R atrial catheter is aka
and is used for ….
Limit what kind of movements with this one?
Avoid what else?
Hickman
long-term use of substances in to venous system
limited repeated ipsilateral shoulder movements
limit aquatic therapy
avoid soft tissue mobilization and manual techniques over access point
Pulmonary artery catheter is aka
and is used for..
Limit….
For internal jugular insertion limit….
For subclavian insertion limit….
For femoral insertion limit….
Dislodging this is a…
Swan-Ganz
continuous monitoring of pulmonary artery pressure
excessive movement and physical activity
head and neck movement
ipsilateral shoulder ROM to 90 degrees
ipsilateral hip flexion to 70
life threatening
Intracranial pressure monitor:
Must notify… before starting physical activity.
Changing bed height might….
Maintain head and neck….
What position of bed, neck and hip increase ICP?
nursing
alter transducer reading
neutral
Trendelenburg
neck flexion
excessive hip flexion
NG tubes need to be stopped with patient in what position?
upright or semi-Fowler’s position for at least 30 min prior to supine activities
Those with G tube or PEG tube should not
lie flat during feeding
PEJ (jejunostomy tube) is used for
long-term feeding
also should not lie flat
PICC line is used for ….
precautions for this
long-term administration of medications
ROM exercise of involved extremities allowed
Use of axillary crutches is often contraindicated due to risk of occluding blood flow or causing thrombus
Avoid excessive ___and ___ movements but functional mobility can still be performed with ….and tracheostomy tube.
head and neck movements
endotracheal tube (intubated)
Displacement of ET tube is a …
PTs should develop what kind of communication with those who are intubated?
Are out of bed activities allowed?
life-threatening
nonverbal
yes
With an oxygen tent, avoid ….
Electrical devices should…. be used inside.
opening more often than necessary
not
Those with woundvac if it is how full… it should be emptied before activity.
more than half full
Arteriography
catheter inserted into artery either through groin or arm to heart.
Used to identify arteriosclerosis, aneurysm, vascular malformations, tumors or blockages.
Arthrography
visualize joints
CT used to diagnose
spinal lesion
diagnostic studies of brain
EEG does what?
record electrical activity of the brain
epilepsy or narcolepsy
EMG doe what?
records electrical activity of selected muscle or group of muscles during voluntary contraction
Fluoroscopy can show motion
within joints or movement of dye within digestive tract
Myelography looks at
spinal cord
nerve roots
meninges
diagnoses:
bone displacement, spinal stenosis, disk herniation, spinal cord compression, infection/inflammation of meninges or tumors
PET looks for
tumors or other lesions
Venography diagnoses
DVT
tumors
valve dysfunction
Ice massage can be used as a stimulus to
facilitate a desired motor response in those with impaired motor control.
applied with direct pressure over muscle belly for 3-5 seconds or quickly stroked over targeted muscle belly to enhance contraction.
Ice massage area and time
10cm x 15 cm
5-10 minutes
Phases of cooling
intense cold
burning
aching
analgesia
Cold packs should be applied for how long?
Can be reapplied every…
If treatment goal is spasticity reduction, can extend treatment time to …
20 min
1-2 hours
30 min
Vapocoolant spray is used for
trigger points
Standard size of hot pack is
12x12 inches
How many layers of towel need to be used with a hot pack ?
If commercial hot pack, how many layers of towels?
6-8
2-3
Pts cannot lie___ of hot back
on top of
Fluidotherapy used for
tissue healing, skin desensitization, edema management
Infrared lamp use for
soft tissue healing
Amount of infrared lamp tissue temperature increase is
directly proportional to amount of radiation that penetrates tissue
What should you do to protect outside target area tissue in infrared lamps?
protective toweling
How many times do you dip the hand in parrafin in a dip-wrap method?
6-10 times
What do you document when using modalities?
body part treated
modality used
treatment duration
parameters
response to treatment
outcome measure
Deep heating agents can heat to depths of
3-5 cm
Deep thermotherapy examples are
ultrasound and diathermy
Direct coupling agents in US are…
gel
lotion
Indirect coupling agents in US are…
employed when treatment area is excessively small, irregularly shaped or unable to tolerate pressure from transducer.
Water is an example.
Effective radiation area (ERA) is always smaller than
total size of transducer head
Spatial averaged intensity is calculated by…
power output in Watts/total effective radiating area of soundhead in cm2
Lower BNR is
preferred because pts are less likely to experience hot spots during treatment
Attentuation
decrease in energy intensity as US travels through tissues
Tissues high in water content: blood, plasma have a ___ rate of absorption while more dense tissues have…
low
high
US delivered at a higher frequency is absorbed more …. .than US delivered at a lower frequency.
rapidly
Superficial tissues frequency
3 MHz
Deep tissue frequency
1 MHz
Portion of treatment time US is generated during entire treatment is referred to as the
duty cycle
Duty cycle is calculated by
on time / on+off time x100
Continuous US is for
heat
Pulsed US is for
non thermal
Duty cycle for pulsed US
20% or lower
Duty cycle for continuous US
100%
An area two to three times the transducer typically requires a duration of
5 min
Longer duration of US may be necessary when
using lower intensities or lower frequencies
US should not be used for
areas 4x larger than ERA
US with thermal effects is used at what stage of healing
later stages
US is used how often
2-3 x per week
US with nonthermal effects can be used when
earlier in healing process
once a day
Most common frequency used for shortwave diathermy is
27.12 MHz
Dosing for diathermy:
Dose I
Dose II
Dose III
Dose IV
no sensation of heat
mild heating
moderate heating
vigorous heating
Diathermy treatment time with thermal effects?
Non-thermal?
20 min
30-60 min
When to use diathermy?
when increase in temp is required at tissue depths greater than those achieved with superficial heating agents and when target area will not tolerate direct contact with thermal agent.
Diathermy can heat surfaces ____x the typical US transducer.
25
Water temps for acute inflammation of distal extremities?
32-70 degrees
Water temps for exercise?
79-92 degrees
Water temps for wound care?
92-96 degrees
Water temps for cardiopulm compromise or treatment of burns?
96-98 degrees
Water temps for pain management?
99-104 degrees
Water temps for RA or OA and increased ROM?
104-110 degrees
Flexion position for lumbar traction is in what position and results in greater separation of
supine
posterior structure: facet joints, intervertebral foramen
Extended position for lumbar traction is in what position and results in greater separation of
prone
anterior structure like disks
Static traction is for
symptoms that are slightly exaggerated by movement
Intermittent traction is for
joint mobes
or those who cannot tolearate static
Force during relax period of intermittent traction is usuallly
50% of force during hold
Coefficient of friction is
0.5
How many pounds should be used for initial traction session?
Force of __% of body weight used for stretching soft tissue, muscle spasm, disk protrusion.
Force of ___% used for
30
25%
50%
Disk related symptoms treatment time for traction
other spinal conditions?
10 min
30 min
Flexion traction for cervical spine:
Upper is how many degrees?
Mid?
Lower?
0-5
10-20
25-35
Intermittent cervical traction
reducing pain and increasing ROM
Force for cervical traction initially
Percentage of body weight for soft tissue, muscle spasm or disk.
Percentage of body weight for joint distraction
Force should not exceed how many pounds?
10 lbs
7-10%
13-20%
30
Compression works to keep
venous and lymphatic flow from pooling in venous system and interstitial space
Therapeutic effects of compression
control peripheral edema
management of scar formation
preventing DVT
promote lymphatic and venous return
shaping of residual limb
When to use compression?
edema
hypertrophic scarring
lymphedema
new residual limb
DVT risk
stasis ulcers
Working pressure in compression bandages
pressure is only exerted when patient is active
Compression bandages offer greater pressure in which direction
distally than proximally
applied with figure 8
Long-stretch bandages provide greatest ____ pressure applying ___-____mmHg of pressure. Very little working pressure. Long-stretch are used in those who are…
resting
60-70
immobile
Short-stretch bandages produce low pressure at ___ and high ____pressure. Moderately effective while patient is active or at rest. Most often used during…..
Pts must have functional…
rest
working
exercise
functional calf muscle and functional gait pattern.
Multi-layered bandages produce ___-___ resting pressure through the use of several bandages containing elastic and inelastic layers.
These are most commonly used to treat….
moderate to high
venous stasis ulcers
Semirigid bandages most often consist of …
These treat…. and example?
treated gauze applied to distal extremity
venous stasis ulcers
Unna boot
Off the shelf compression garments provide force of ___-___mmhg and used to prevent …. on bed rest.
Stocking are to be worn at all times unless bathing.
Garments used for scar tissue control ___-____mmHg.
Garments used for edema control ____-____mmHg.
16-18
DVT
20-30
30-40
Compression garments last how long?
6 months
Intermittent compression is most often delivered using
intermittent pneumatic compression pump
Intermittent pneumatic compression pump is used to reduce
chronic and/or post-traumatic edema
Before using intermittent pneumatic compression pump what should be taken?
BP and girth measurements
Inflation of intermittent pneumatic compression pump should not exceed…
Arterial capillary pressure is approximately ___mmHg and inflation below this point will not typically have…..
Inflation pressure greater than SBP may…
diastolic BP
30
therapeutic value
restrict arterial blood flow and create a medical emergency
Treatment of UE with intermittent pneumatic compression pump should be ____-____mmHg.
LE ____-____mmHg.
Treatment time?
Times per week?
30-60
40-80
30 min to 4 hours
3x/week
up to 4x/day
Rate of CPM
two cycles per minute
Direct current of is used with
iontophoresis
When direct current or a monophasic pulsed waveform is used, ___ electrode remains the cathode and the other the anode.
In alternating the cathode and anode are ….
one
changing
Unequal size electrodes are used, the current will be more concentrated in..
smaller electrode
If electrodes are in close proximity, current is more dense in
superficial tissues
If electrodes are further apart, current is more dense in
deeper tissues
Monopolar technique
stimulating or active electrode is over target area.
second dispersive electrode is placed at another site away from target area.
active is smaller than dispersive
used with wounds, iontophoresis, and edema
Bipolar technique
two active electrodes placed over target area
equal in size
for muscle weakness, neuromuscular facilitation, spasms and ROM
Amplitude
magnitude of current
Average amplitude
average amount of current supplied over a period of time
Peak amplitude
maximum positive or negative point from zero where the pulse is maintained.
Higher the amplitude, greater the
peak amplitude
Rise time is the time it takes for
current to move from zero to the peak intensity within each phase
Fast rise times are necessary with ____ capacitance tissues, such as large motor nerves.
Rise times are typically…
low
very short
Decay time
time it takes for current to move from peak intensity to zero
Phase begins when current departs from
zero line and ends as the current returns to zero line.
Pulse duration
amount of time it takes for two phases of a pulse with biphasic current
In monophasic current, the phase duration and pulse duration are…
the same
Frequency is labeled as…
expressed as..
rate
pulses per second or hertz
Common categories of modulation include
bursts, interrupted pulses and ramps
Bursts
occur when ceases flow but only for a little bit of time without true interruption of muscle contraction
Interrupted pulses
stop muscle contraction
Functional electrical stimulation example
anterior tib for DF in walking
In FES, electrodes should be separated by
minimum of 2 inches
Pulse duration in NMES
shorter pulse durations are more comfy with small muscles
longer pulse duration are more comfy with large muscles
When pulse duration is shortened, a greater…
current amplitude will be required to produce the same strength contraction
Frequency in NMES
smooth tetanic contraction usually produced at a frequency of 35-50 pps
Higher frequencies in NMES will not produce a stronger contraction but will….
promote more rapid fatigue.
On/off time for NMES
on time=6-10 seconds
off time= 5x longer
Ramp times for NMES if on time is 6-10 seconds
1-4 seconds
Treatment time and contractions for NMES
10 contractions with max of 20 contractions
Conventional TENS duration and frequency with amplitude?
short duration
high frequency
low current amplitude
Acupuncture-like TENS is for
frequency, duration, amplitude
muscle twitching for longer lasting relief
low frequency
long duration
high amplitude
Brief intense TENS frequency, duration and amplitude
high frequency
long duration
high amplitude for a motor response
Noxious TENS frequency, duration and amplitude
high or low frequency
long duration
highest tolerated amplitude
Interferential current is used for
pain relief
increased circulation
muscle stimulation
Iontophoresis
like charges repel
so positive solution will repel from a positive electrode
Safety concerns with electricity
always turn intensity dial to zero before unplugging
keep equipment 3-5 meters from each other
Indications for Iontophoresis
pain
calcium deposits
fungal infection
hyperhidrosis
inflammation
ischemia
keloids
muscle spasm
myositis ossificans
plantar warts
wounds
scar tissue
Dosage in ionto
40-80 mA
40 mA-min can be delivered in___ min with a current amplitude of ___mA.
10
4.0
Current amplitudes in ionto range from
1-4
Electrode containing ion solution is referred to as the …
The second electrode is called the ___ electrode and is placed….
Recommended spacing is …
As spacing increases the current density in superficial tissues…..
Smaller electrodes have ___ current density and used to treat specific lesion.
Larger electrodes are used when treatment area is ____.
Slowly increase intensity towards max of ___ mA.
Treatment should last ___-___min.
active
dispersive
away from active
equivalent to diameter of active electrode
decreases
higher
less well defined
4
10-20
Acidic reaction with ionto
from hydrochloric acid under positive
Alkaline reaction to ionto
from sodium hydroxide under negative
Can leave active electrode on skin for how long?
12-24 hours
Acetic acid what what polarity and used for what?
negative
calcific deposits
myositis ossificans
Dexamethasone has what polarity and is used for what?
negative
inflammation
Iodine has what polarity and is used for what?
negative
scars
adhesive capsulitis
Lidocaine has what polarity and is used for what?
positive
analgesia
inflammation
Magnesium sulfate has what polarity and is used for what?
positive
muscle spasms
ischemia
Salicylates has what polarity and is used for what ?
negative
muscle and joint pain
plantar warts
Zinc oxide has what polarity and is used for what?
positive
healing
dermal ulcers
wounds
With EMG, normal relaxed muscle should exhibit
electrical silence
With EMG, spontaneous potentials during rest means
nerve or muscle damage
Fibrillation potentials in EMG
LMN disease
Positive sharp wave in EMG
denervated muscle disorders at rest, primary muscle disease like muscular dystrophy
Fasciculations in EMG
irritation/degeneration of anterior horn cell, nerve root compression or muscle spasms
Repetitive discharges in EMG
myopathies, lesion of anterior horn cells and peripheral nerves
Voluntary polyphasic potentials in EMG
myopathies, muscle or peripheral nerve involvement
EMG sites:
C6-7
C7-8
C8-T1
L4-5
L5-S1
L5-S2
S1-2
triceps and flexor carpi radialis
extensor indicis proprius
abductor pollicis brevis
first dorsal interossei
tib anterior
fibularis longus
glute max and hamstrings
gastroc
Centrifugal direction in massage
Centripetal direction in massage
center of body out
moving from extremities toward center of body
Effleurage..
Stroke direction
Can also be applied as..
light stroke for reflexive response
towards heart
deep stroke for mechanical and reflexive response
Friction massage for
chronic inflammation
overuse injuries
Tapotement
rapid alternating movements: tapping, hacking, cupping, slapping
enhances stimulation to peripheral nerve endings
Vibration massage
initiates motion from forearm while maintaining contact. Primarily used for relaxation
Air temp during massage
72-75
Standard w/c seat specifications
18 in wide
16 in deep
20 in high
Walker, crutches, cane should allow flexion of elbows ___-___ degree.s
20-25
Superficial heating agents produce the larges temp elevation within ___ cm from skin surface.
0.5
Paraffin has a low
specific heat
Area of ___-___ times of size of US transducer typically requires duration of ….
2-3
5 minutes
Minimal erythemal dose refers to…
smallest does of UV light needed to produce an area of mild redness within 8 hours of UV exposure that disappears within 24 hours after exposure.
Static traction is more desirable for
acute symptoms
Pulsatile current is characterized by
non-continuous flow of direct or alternating current
Small electrodes exhibit increased current…..
increased ….. and decreased current…
density
impedance
flow
Likelihood of burn using ionto can be decreased by…
increasing size of cathode relative to anode
