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Physical Modality > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Tissue temp. rise of Thermotherapy

A

1: Increases metabolic rate
2-3: Reduces muscle spasm and pain, increases blood flow
4 or more: Increases the collagen extensibility

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2
Q

Hot Pock - Superficial Thermotherapy

A
  • 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
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3
Q

Paraffin Bath - Superficial Thermotherapy

A
  • 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
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4
Q

General Indications for Superficial Thermotherapy

A
  • Pain control
  • Increase ROM and decrease joint stiffness
  • Accelerate healing
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5
Q

Contraindications for Superficial Thermotherapy

A
  • 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
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6
Q

Precautions for Superficial Thermotherapy

A
  • Areas near or over eyes
  • anterior neck and carotid sinus
  • pregnant women
  • people with cardiac failures
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7
Q

Safe for superficial Thermotherapy

A
  • 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
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8
Q

Safe practice for superficial thermotherapy

A
  • risk of burn increases with the amount of subcutaneous fat
  • should not lie on top of hot packs, can compromise the vasodilatation response
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9
Q

Clinical Signs of Tissue Temperature Rise

A
  • Erythema (reddness)
  • Blisters, mottling
  • Pupil dilation
  • Decrease in BP
  • Increase in HR

*STOP thermotherapy if BP drops 15-20 mmHG

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10
Q

Treatment parameters of Thermotherapy

A
  • Intensity
  • Duration
  • Coupling medium

*change in skin appearance

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11
Q

Conventional US in PT

A
  • 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

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12
Q

Duty Cycle for Pulse US

A
  • Proportion of time that US is on during a single pulse period, in a percentage or a ratio
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13
Q

ERA

A
  • Effective radiating area, area of the crystal
  • Always smaller than the sound head surface
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14
Q

Strength & Intensity of US wave

A
  • Strength: Acoustic power produced by the crystal (W)
  • Intensity: Power per unit area of the crystal (W/cm2)
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15
Q

Spatial peak Intensity vs. Spatial Average Intensity

A
  • Spatial Peak Intensity: Peak Intensity of the US output over the ERA
  • Spatial Average Intensity: average intensity of the US output across the ERA
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16
Q

Beam Nonuniformity Ratio (BNR)

A
  • ratio of spatial peak intensity to spatial average intensity
  • 5:1 and 6:1 usually
  • the lower the ratio, the more uniform the output
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17
Q

Spatial Peak Intensities of () have been shown the damage tissue

A

8 W/cm2

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18
Q

How to minimize the potential of creating standing waves?

A
  • continue to move the head
  • hold the soundhead perpendicular
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19
Q

General Indications for Conventional US - Thermal

A
  • Deeping Heating modality
  • Joint contracture and scar tissue
  • Subacute and chronic soft-tissue inflammation
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20
Q

General Indications for Conventional US- Nonthermal

A
  • To facilitate healing
  • Acute injury or inflammation of soft tissue
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21
Q

General Guidelines for Applying US

A
  • warmth within 2-3 minutes
  • preferably 2-3 X ERA
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22
Q

Number and Frequency of US treatments

A
  • depend on goals of treatment and patient’s response
  • Treatment effect usually deetectable with 1 or 3 treatments
23
Q

US parameters

A
  • Frequency
  • Mode
  • Intensity
  • Treatment Time
24
Q

Types of Electrical Currents

A
  • 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)
25
Q

Time-Dependent parameters for PC

A
  • 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
26
Q

Electrode arrangement

A
  • 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
27
Q

Electrical Currents

A
  • Nerve depolarization: short pulses of electricity (NMES)
  • Muscle Depolarization: pulses longer than 10 sec (EMS)
28
Q

Adverse Effects

A
  • 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)
29
Q

NMES

A
  • Time Modulated / Burst AC/ Russian Current: bursts per second
  • Pulsed current: pulses per second
30
Q

Clinical use of NMES

A
  • muscle contraction (Innervated muscle)
  • Edema control
31
Q

Muscle Contraction - Electrical

A
  • 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
32
Q

Muscle Contraction - Physiological

A
  • Activates slow-twitch muscle fibers 1st
  • Less Fatigue, slow-twitch more fatigue resistant
33
Q

Muscle contraction; overload

A
  • physiological: increase the weight
  • electrical: increase the total amount of current

*limited by patient tolerance and fatigue

34
Q

Outcomes of NMES

A
  • 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
35
Q

NMES electrode placement

A
  • Motor point: usually over the middle of muscle belly
  • parallel to the direction of muscle fibers
  • keep electrodes separated
36
Q

Pulse duration for NMES application

A

150 to 350 microseconds

37
Q

Frequency for NMES application

A
  • 50 pps (pulsed current)
  • 50 bps (bursts per second for Russian current)
38
Q

On: Off Time

A
  • 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)
39
Q

Ramp up time for NMES

A
  • usually 1 to 2 seconds
  • ramp time for gait should be 0 second
40
Q

Treatment time for NMES

A
  • for muscle strengthening: recommended 10 to 20 contractions
  • for muscle reeducation: no more than 20 minutes/session
41
Q

Waveform for NMES

A
  • pulse biphasic
  • Russian current ( Time-modulated / Burst AC)
42
Q

Tissue Temperatures for Cryotherapy

A
  • 73: Peripheral nerve activity decreases
  • 32 to 68: will perceive pain but tissue not frozen
  • 48: nerve conduction ceases
  • 28: skin freezes
43
Q

Effects of Cryotherapy - Hemodynamic

A
  • Initial decrease in blood flow: helps to decrease edema
  • Later, cold-induced vasodilation: hunting response
44
Q

Effects of Cryotherapy - Neuromuscular

A
  • Decreases nerve conduction velocity
  • Increases pain threshold
  • Alters muscle strength
  • Decreases muscle spasm
  • Decreases muscle spasticity
45
Q

Effects of Cryotherapy - Metabolic

A
  • Decreases rate of all metabolic reactions
  • Controls acute inflammation
  • Decreases activity of cartilage-degrading enzymes
46
Q

Effects of Cryotherapy - Soft Tissue

A
  • Decreases connective tissue extensibility
47
Q

General Indications for Cryotherapy

A
  • Control of acute inflammation
  • Edema control
  • Pain control
  • Modification of muscle spasm or spasticity
48
Q

Cryotherapy - 5 stages of sensation

A
  1. Intense cold
  2. Burning
  3. Aching
  4. Analgesia
  5. Numbness
49
Q

Tissue damage if too cold

A
  • 1 degree: red, mild edema
  • 2 degrees: edema, blisters
  • 3 degrees: Frostbite = necrosis of tissue
  • 4 degrees: Severe frostbite = gangrene & neurological complications
50
Q

Safe practice for Cryotherapy (ratio)

A
  • ratio between rewarming period and treatment time: at least 2:1 * but 6:1 is preferred
51
Q

Cold Pack

A
  • should not put it directly on the skin
  • Application duration: 20 minutes or until the area is numb
52
Q

Application duration for Ice Cup

A

5-10 minutes

53
Q

Effects of Cryotherapy

A
  • Pain: Decrease
  • Muscle Spasm: Decrease
  • Blood Flow: Decrease
  • Edema Formation: Decrease
  • Nerve conduction velocity: Decrease
  • Metabolic Rate: Decrease
  • Collagen extensibility: Decrease
  • Joint stiffness: Increase
54
Q

Effects of Thermotherapy

A
  • Pain: Decrease
  • Muscle Spasm: Decrease
  • Blood Flow: Increase
  • Edema formation: Increase
  • Nerve conduction velocity: Increase
  • Metabolic rate: Increase
  • Collagen extensibility: Increase
  • Joint stiffness: Decrease

Physical Modality (8 decks)

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