exam 1 Flashcards
Conduction
Heat transfer by direct contact. Energy exchange
is by direct collision between molecules of two
materials at different temperatures. Heat is
transferred from the warmer to the cooler
material. Example: hot packs.
Heat transfer through direct contact (e.g., hot packs, ice packs).
Convection
Heat transfer by circulation of a medium of a
warmer temperature. Unlike conduction where
there is constant contact between the thermal
agent and the patient, here the agent is in
motion. New parts of the warm medium contact
the body part constantly, resulting in faster heat
transfer. Example: whirlpool.
Heat transfer via fluid movement (e.g., whirlpool, fluidotherapy).
Conversion
Heat by changing or converting one form of
energy to another. The temperature of the
thermal agent does not affect heat. Effect is due
to power of energy source. Does not require
contact, but energy must be able to be
transmitted or conducted to patient. Example:
ultrasound: sound converted to heat.
Heat produced through energy change (e.g., ultrasound, diathermy).
Evaporation
Transfer of energy results from change of form
from liquid to vapor. This will often result in
cold treatment to patient, as heat transfer will be
from patient to the spray. Example: vapocoolant
spray.
Heat loss through evaporation of liquid (e.g., cold sprays, vapor coolant sprays).
We use modalities for several reasons:
Modify inflammation
Promote tissue healing
Relieve pain
Increase (or decrease) collagen extensibility
Modify muscle tone
Reduce swelling
Increase muscle strength
Promote muscle relaxation
Contraindications ultrasound
- Cancer
- Pregnancy
- Joint cement or plastic components
- In area of pacemaker
- Blood clots
- Over eyes, genitals, carotid sinus, spinal cord
- Epiphyseal plates
- Breast implants
Length of treatment based on size of transducer head for ultrasound.
Treatment time is 5 minutes for area that is
twice the size of the sound head.
—-must be atleast 8 mins for reimbursement
Diathermy Contraindications
- Metal implants
- Pacemakers and other implanted elect. devices
- DVT
- Active bleeding
- Cancer
- Pregnancy or over IUD
- Over eyes, testes, growing epiphyseal plates
Contraindications Low Level Laser Therapy (LLLT)
- Over the eyes
- Site of cancer
- Pregnancy – over the abdomen or lower back
- Could trigger seizure in epilepsy
- Directly over a tattoo, especially red ink
- DVT
Contraindications cryotherapy/cold
- Cold hypersensitivity
- Cold intolerance
- Raynaud’s disease/phenomenon
- Over a regenerating peripheral nerve
- Over area of impaired circulation
- Cryoglobulinemia
- DVT/thrombophlebitis
- Chronic wounds/PVD
- Anterior neck/carotid sinus
radiation
Heat transfer from hot to cooler material
without need for an intervening medium. This is
the way the sun feels hot to our skin. Example:
infrared lamp.
Contraindications to Superficial Heat
- Acute inflammation, infection
- Active Cancer or recent radiation
- Active bleeding, open wounds
- Cognitive/mental impairment
- Thrombophlebitis, superficial or DVT
- Peripheral vascular disease
- Cardiac insufficiency
- Multiple Sclerosis (may be considered a
precaution)
stages of inflammation
- Inflammatory stage
- Proliferative stage
- Maturation stage
Inflammatory Stage - I
- Lasts from day 1 to day 4-6 after injury.
- Protective response that prepares
structure/wound for healing. - Without inflammation, healing would not
occur!!
Proliferative Stage - II
- Begins as early as day 3, and usually lasts for 21
days. - This stage is the rebuilding stage of healing.
Maturation Stage - III
- Day 21-1 year
- During this stage the wound/structure is
modified into a mature form.
Effects of Heat
- Vasodilation
- Decreased pain, increased pain threshold
- Decreased muscle spasm
- Temporary decrease in muscle strength and
endurance - Increased metabolism
- Increased soft tissue extensibility
Types of Superficial Heat
- Hot packs
- Fluidotherapy
- Paraffin
- Whirlpool
Hot Packs
- Water temperature in hydrocollator should be
160-165 degrees. - Treatment time is 15-30 minutes, generally 20
minutes. - Pack with 6-8 layers of toweling. Terry cloth
covers are equal to 2 layers of toweling.
_______ is heat transferring by circulation of a medium of a warmer temperature.
Convection
Fluidotherapy
- Temperature range is 105-125 degrees.
- Treatment time is 15-30 minutes, generally 20
minutes. - Skin should be clean and free of jewelry.
Fluidotherapy effects
- Decrease pain
- Increase soft tissue extensibility
- Stimulate hypersensitive areas to decrease
hypersensitivity.
Paraffin
- Temperature of wax is controlled by machine,
but should be about 125 degrees. - Treatment time is 15-30 minutes, generally ~20
minutes. - Used frequently for arthritis, hand conditions.
Effects of Ultrasound
- Increase skin and cell membrane permeability
- Increase histamine release
- Increase macrophage response
- Increase rate of protein synthesis by fibroblasts
TISSUE SPECIFIC
Effects of Diathermy
Effects are:
* Thermal – increases tissue temperature,
superficially and deep. Effect of heat is same as
hot packs, ultrasound.
* Non-thermal – altered cell permeability, altered
cell functions, found with pulsed diathermy and
ultraviolet, stimulates macrophages and protein
synthesis.
- Control of pain and edema
- Soft tissue and wound healing
- Deceased blood flow
Diathermy Contraindications
- Metal implants
- Pacemakers and other implanted elect. devices
- DVT
- Active bleeding
- Cancer
- Pregnancy or over IUD
- Over eyes, testes, growing epiphyseal plates
Diathermy, infrared radiation, and ultraviolet are (low, high) frequency types of radiation.
low
Uses for UVC-ultraviolet
- Psoriasis
- Wound healing
Light Therapy
- Tissue repair via vasodilation/increased
blood flow - Decrease inflammatory conditions
- Pain reduction via Gate Control theory
Infrared Light/red light
- Growth factor production and collagen
synthesis may be improved at
wavelengths around 660-680 nm. - Stimulation of new small blood vessel
growth is promoted by 880 nm
wavelengths.
Effects of Cold
- Vasoconstriction
- Decreased nerve conduction velocity
- Increased pain threshold
- Analgesic effect via Gate Control theory
- Altered muscle strength
- Decreased spasticity
- Increased tone in flaccid muscle
- Decreased metabolic rate
cold treatment time
5-15 mins
phases of cold
Cold
Burning
Aching
Numbness
What Causes Chronic Inflammation?
paused healing at any point
acute inflammation
short-term inflammatory response that occurs quickly in response to an injury or infection
difference between 1 and 3 Megahertz
1MHz travels up to 5cm (DEEPER)
3MHz travels up to 2.5cm (BONY/SUPERFICIAL)
Parameters - US Frequency
- 1 MHz depth of penetration is 1½ to 2 inches
deep. - 3 MHz depth of penetration is ½ to 1 inch deep.
- 2 MHz, if you have this choice is 1 to 1 ½ inches
deep.
(1 inch = 2.5 cm)
Parameters - US Intensity
- With 1 MHz frequency, usual range is 1.0-
1.5 w/cm2 - With 3 MHz frequency, usual range is 0.5-
1.0 w/cm2
Parameters - US Time
- Treatment time is 5 minutes for area that is
twice the size of the sound head. - To get reimbursed for most insurances, you
must do at least 8 minutes of ultrasound.
Parameters - US Duty Cycle
- With inflammation, used pulsed duty cycle. The
more inflamed, the less on time. (10% rather
than 20%, for example) - To heat, prior to stretching or for pain, use
continuous sound. (can US in stretches position) - As a patient is transitioning from inflamed to
not-inflamed, consider using 50% pulsed.
receptors
mechanoreceptors
chemoreceptors
thermoreceptors
nocioreceptors
mechanoreceptors
pressure/touch
chemoreceptors
taste
thermoreceptors
temp change
nocioreceptors
pain
Restricted Motion Due to
Muscle Contracture
Contracture of muscle is a
shortening of the muscle,
possibly due to prolonged
immobilization. The muscle
fibers form links with each other
that are abnormal.
Restricted Motion Due to
Capsular Tightness
- Capsule is deepest layer of
joint. Lies next to joint.
Restricted due to
immobilization or pathology
like “frozen shoulder” –
adhesive capsulitis.
Restricted Motion Due to Edema
- Edema is an excessive
amount of fluid in a joint
or tissue. If the joint is
swollen with fluid, this
stretches the joint
capsule and limits
motion
Restricted Motion Due to Adhesion
- An adhesion is an
abnormal linking of one
structure to another. An
example of adhesions is
scar tissue that tightens
down to surrounding
tissue
Restricted Motion Due to Mechanical
Block
- An example is a bone fragment or piece of
cartilage in the joint. If this block moves in the
joint, restricted motion may change frequently
(become restricted suddenly, then become
normal, etc.)
Restricted Motion Due to
Weakness
- Weakness will restrict active motion, not passive
motion. - Motion will be restricted in direction of motion
that muscle produces upon contraction.
Restricted Motion Due to
Pain, Motivation, etc.
- Patient may limit motion due to pain, or lack of
motivation. In this case, end feel will be
different.
Restriction can be caused by…
pain
motivation
weakness
mechanical block
adhesion
edema
capsular tightness
muscular Contracture
Muscle tone is …
the amount of resistance you feel
in a muscle to passive stretch
A muscle of very low tone is called…
flaccid
A muscle of very high tone is called…
spastic, or rigid
Minimal Erythemal Dose (MED)
- The amount of ultraviolet exposure, measured in
time, that results in a slight redness of the skin
within 8 hours, but the redness is faded in 24
hours. - Usually start treatment with 50% of the MED
MED
minimal erythemal dose
UV-A
320-400 nm in wavelength. It penetrates
deeper into the dermis, and is linked to aging,
wrinkling, age spots, etc
UV-B
250-320 nm wavelength. It has a more
superficial effect, and is linked to sunburn and
melanoma
UV-C
250 nm, and is used for bacteriocidal
properties and tissue healing
Continuous ultrasound
continuous delivery of
ultrasound throughout the treatment period. On 100% of
the time
Pulsed ultrasound
delivery of ultrasound only
during a portion of treatment period. Decreases the
thermal effects
Duty cycle
proportion of time the ultrasound is on,
expressed as ratio, or percent (ie 20% duty cycle or 1:4 ratio
= usually 2 msec on, 8 msec off)
underwater US
Increase intensity by about 50%. If you would
use 1.0 w/cm2, increase to 1.5 w/cm2 to account
for attenuation of sound into water.
* Hold sound head about 1 inch away.
function of skin
- Temperature regulation
- Protection of underlying structures
- Helps with fluid balance, excretes fluid
- Provides sensation
1 edema
edema that is slight (roughly 2mm in depth) and
disappears rapidly.
2 edema
deeper (4mm) Indentation disappears within 15
seconds.
3 edema
deeper yet (6mm), and can last longer than a minute.
The extremity looks grossly swollen.
4 edema
the most severe with deep pitting (8mm or greater in
depth) that may last more than 2 minutes
Biomedical Pain Model
- Pain is caused by an underlying deviation from
normal function, such as occurs with a pathology or
injury. Greater symptoms indicate a greater
underlying pathology.
Assessing Edema
- Grade degree of pitting and location
- Measure girth (circumference)
- Volumetric displacement
gait theory
Pain signals are not free to reach the brain as soon as
they are generated. They must pass through certain
‘neurological gates’ at the spinal cord level. These gates
determine whether the pain signals should reach the
brain.
* Pain is felt when the gate is open
Endorphin Pain Theory/Opiate Pain Theory
- Opiate-like neurotransmitters are
found in the brain and spinal cord.
Chemically, these look like morphine.
Endorphins, enkephalins,
dynorphins, etc. - When the body encounters stress or
pain, they are released. Like going for
a long run: painful at first, but then
the runner’s high - These chemicals block neuro-
transmitters from C-fibers.
Neuromatrix Model
- Proposes that pain is a multidimensional
experience produced by characteristic
“neurosignature” patterns of nerve impulses
generated by a widely distributed neural
network in the brain
Assessing Pain
- Verbal 0-10 rating scale
- 10-cm visual analog scale
- Wong-Baker faces
- Pain questionnaire
- Body drawings
Sensation
Sensation involves feeling temperature, touch, vibration,
pressure, shape of objects
Therapeutic exercise is ____ a modality
NOT
for hot packs, hydrocollator water temp should be
160-165
indications for deep heat therapy
soft tissue shortening
pain control
bone fracture
inflammation
wounds
ultrasounds contrindications
Cancer
Pregnancy
Joint cement
Pacemaker
Blood clots
Over genital, carotid sinus, spinal cord
epiphyseal plates
breast implants
gate theory (essay question)
- Pain signals are not free to reach the brain as soon as
they are generated. They must pass through certain
‘neurological gates’ at the spinal cord level. These gates
determine whether the pain signals should reach the
brain. - Pain is felt when the gate is open, and allows the pain
signals to travel through, and it is less intense or not at
all perceived when the gate closes for the signals to pass
through
light and diathermy..
wavelength seems to determine therapeutic effect, the therapeutic range is….
660-880nm
—–880 for new growth, blood vessels, smaller blood vessel growth
——660 for collagen, new small blood vessel growth
therapeutic range for new growth, blood vessels, smaller blood vessel growth
880
therapeutic range for collagen, new small blood vessel growth
660
