Exam 1 Flashcards
Tissue temp. rise of Thermotherapy
1: Increases metabolic rate
2-3: Reduces muscle spasm and pain, increases blood flow
4 or more: Increases the collagen extensibility
Hot Pock - Superficial Thermotherapy
- Hydrocollator: 160 to 165 degrees F
- immersed for at least 30 minutes before usage
- Recommended treatment duration: 20 minutes
- Never applied directly over skin
- 6 to 8 layers of toweling between the pack and skin
- check on the patient every 5 minutes
Paraffin Bath - Superficial Thermotherapy
- Paraffin bath: 124 - 130 degrees F
- Check the temperature of the bath first
- use the wax as an exercise tool immediately post tx
- wrap for 15 to 20 minutes
- Immersed hand should not touch the sides and the bottom of the paraffin bath
General Indications for Superficial Thermotherapy
- Pain control
- Increase ROM and decrease joint stiffness
- Accelerate healing
Contraindications for Superficial Thermotherapy
- Large Areas in pregnant women
- suspected malignancy
- tuberculosis
- active DVT or thrombophlebitis
- impaired sensation
- bleeding tissue with untreated hemorrhagic
- recently radiated tissues
- large areas in people with cardiac disease
- cognition or communication impairments
- impaired circulation
location of eczema - edema
- reproductive organs
Precautions for Superficial Thermotherapy
- Areas near or over eyes
- anterior neck and carotid sinus
- pregnant women
- people with cardiac failures
Safe for superficial Thermotherapy
- intact skin with metal, plastic, or cement implants
- areas over electronic devices
- areas near chronic wounds
- superficial or regenerating nerves
- head, chest, or heart
- areas over active epiphysis
- persons with hypertension
Safe practice for superficial thermotherapy
- risk of burn increases with the amount of subcutaneous fat
- should not lie on top of hot packs, can compromise the vasodilatation response
Clinical Signs of Tissue Temperature Rise
- Erythema (reddness)
- Blisters, mottling
- Pupil dilation
- Decrease in BP
- Increase in HR
*STOP thermotherapy if BP drops 15-20 mmHG
Treatment parameters of Thermotherapy
- Intensity
- Duration
- Coupling medium
*change in skin appearance
Conventional US in PT
- Frequency: 1-3 MHz
- Intensity: 0.1 - 3 W/cm2
- Usage: soft tissue pathology
*1 MHz: 2-5 cm beneath the skin
* 3 or 3.3 MHz: within 1-2 cm of skin
Duty Cycle for Pulse US
- Proportion of time that US is on during a single pulse period, in a percentage or a ratio
ERA
- Effective radiating area, area of the crystal
- Always smaller than the sound head surface
Strength & Intensity of US wave
- Strength: Acoustic power produced by the crystal (W)
- Intensity: Power per unit area of the crystal (W/cm2)
Spatial peak Intensity vs. Spatial Average Intensity
- Spatial Peak Intensity: Peak Intensity of the US output over the ERA
- Spatial Average Intensity: average intensity of the US output across the ERA
Beam Nonuniformity Ratio (BNR)
- ratio of spatial peak intensity to spatial average intensity
- 5:1 and 6:1 usually
- the lower the ratio, the more uniform the output
Spatial Peak Intensities of () have been shown the damage tissue
8 W/cm2
How to minimize the potential of creating standing waves?
- continue to move the head
- hold the soundhead perpendicular
General Indications for Conventional US - Thermal
- Deeping Heating modality
- Joint contracture and scar tissue
- Subacute and chronic soft-tissue inflammation
General Indications for Conventional US- Nonthermal
- To facilitate healing
- Acute injury or inflammation of soft tissue
General Guidelines for Applying US
- warmth within 2-3 minutes
- preferably 2-3 X ERA
Number and Frequency of US treatments
- depend on goals of treatment and patient’s response
- Treatment effect usually deetectable with 1 or 3 treatments
US parameters
- Frequency
- Mode
- Intensity
- Treatment Time
Types of Electrical Currents
- Direct Current (DC): Current moves in one direction, continuously, at one polarity
- Alternating Current (AC): Polarity of current switches back and forth sinusoidally
- Pulse Current (PC): Can be monophasic/biphasic (number of polarity), symmetric/asymmetric (waveform), balanced/unbalanced (net charge)
Time-Dependent parameters for PC
- frequency: pulses per second
- pulse duration: pulse width
- on: off time
- Ramp up/ ramp down time
- Amplitude: Current intensity
- Modulation: changing machine parameters to create different patterns
- Burst Mode / Time modulated
- Russian current: one burst = one pulse
Electrode arrangement
- when the electrodes are closer together, they do not travel as deep - if they are farther apart, they travel deeper into the tissue
- can be arranged in Monopolar, Bipolar, and Quadripolar
Electrical Currents
- Nerve depolarization: short pulses of electricity (NMES)
- Muscle Depolarization: pulses longer than 10 sec (EMS)
Adverse Effects
- Burns (most common with AC/DC current)
- Skin reactions (irritation/inflammation from electrodes): a different type of electrode should be tried
- Pain (ramp up slowly for a longer period of time for better patient tolerance)
NMES
- Time Modulated / Burst AC/ Russian Current: bursts per second
- Pulsed current: pulses per second
Clinical use of NMES
- muscle contraction (Innervated muscle)
- Edema control
Muscle Contraction - Electrical
- Activates fast twitch muscle fibers first
- Type IIb, Type IIa, Type I
- More fatiguing (fast twitch muscle fibers fatigue quicker)
- Longer rest times are needed
Muscle Contraction - Physiological
- Activates slow-twitch muscle fibers 1st
- Less Fatigue, slow-twitch more fatigue resistant
Muscle contraction; overload
- physiological: increase the weight
- electrical: increase the total amount of current
*limited by patient tolerance and fatigue
Outcomes of NMES
- increase strength and motor control after CNS injury
- Can use functional electric stim (FES): using NMES in a more functional manner
- Increase MSK strength
- Increase motor control
- increase sensory awareness
- effectiveness supported by several large RCTs
NMES electrode placement
- Motor point: usually over the middle of muscle belly
- parallel to the direction of muscle fibers
- keep electrodes separated
Pulse duration for NMES application
150 to 350 microseconds
Frequency for NMES application
- 50 pps (pulsed current)
- 50 bps (bursts per second for Russian current)
On: Off Time
- Strengthening: 1:5 (10 sec on & 50 sec off) to 1:4 to 1:3
- Muscle pump: 1:1 (5 sec on & 5 sec off)
Ramp up time for NMES
- usually 1 to 2 seconds
- ramp time for gait should be 0 second
Treatment time for NMES
- for muscle strengthening: recommended 10 to 20 contractions
- for muscle reeducation: no more than 20 minutes/session
Waveform for NMES
- pulse biphasic
- Russian current ( Time-modulated / Burst AC)
Tissue Temperatures for Cryotherapy
- 73: Peripheral nerve activity decreases
- 32 to 68: will perceive pain but tissue not frozen
- 48: nerve conduction ceases
- 28: skin freezes
Effects of Cryotherapy - Hemodynamic
- Initial decrease in blood flow: helps to decrease edema
- Later, cold-induced vasodilation: hunting response
Effects of Cryotherapy - Neuromuscular
- Decreases nerve conduction velocity
- Increases pain threshold
- Alters muscle strength
- Decreases muscle spasm
- Decreases muscle spasticity
Effects of Cryotherapy - Metabolic
- Decreases rate of all metabolic reactions
- Controls acute inflammation
- Decreases activity of cartilage-degrading enzymes
Effects of Cryotherapy - Soft Tissue
- Decreases connective tissue extensibility
General Indications for Cryotherapy
- Control of acute inflammation
- Edema control
- Pain control
- Modification of muscle spasm or spasticity
Cryotherapy - 5 stages of sensation
- Intense cold
- Burning
- Aching
- Analgesia
- Numbness
Tissue damage if too cold
- 1 degree: red, mild edema
- 2 degrees: edema, blisters
- 3 degrees: Frostbite = necrosis of tissue
- 4 degrees: Severe frostbite = gangrene & neurological complications
Safe practice for Cryotherapy (ratio)
- ratio between rewarming period and treatment time: at least 2:1 * but 6:1 is preferred
Cold Pack
- should not put it directly on the skin
- Application duration: 20 minutes or until the area is numb
Application duration for Ice Cup
5-10 minutes
Effects of Cryotherapy
- Pain: Decrease
- Muscle Spasm: Decrease
- Blood Flow: Decrease
- Edema Formation: Decrease
- Nerve conduction velocity: Decrease
- Metabolic Rate: Decrease
- Collagen extensibility: Decrease
- Joint stiffness: Increase
Effects of Thermotherapy
- Pain: Decrease
- Muscle Spasm: Decrease
- Blood Flow: Increase
- Edema formation: Increase
- Nerve conduction velocity: Increase
- Metabolic rate: Increase
- Collagen extensibility: Increase
- Joint stiffness: Decrease