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MODALITIES > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

acute phase lasts

A

0-4 days

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2
Q

fibroblastic repair phase lasts

A

2 days - 6 weeks

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3
Q

maturation remodeling phase lasts

A

3 weeks - 2 years

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4
Q

sx of fibroblastic repair phase

A

not really red anymore, but tender and the scar formation is starting

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5
Q

what is Wolf’s law

A

px dictates progress

tissue responds to the demands being placed upon it

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6
Q

chronic is considered

A

more than 6 months

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7
Q

what are the light touch mechanoreceptors

A

meisners

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8
Q

what are the deep touch mechanoreceptors

A

pacinian

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9
Q

what order neurons do modalities act on

A

1st

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10
Q

1st order neurons run from

A

body to SC

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11
Q

the 1st order neurons send sensations to the

A

dorsal horn

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12
Q

proprioceptive fibers

A

Aa

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13
Q

touch/vibration fibers

A

Abeta

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14
Q

Aa and Abeta are

A

large and fast fibers

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15
Q

what 3 chemicals are released in any cell damage

A

substance P
prostaglandins
leukotrines

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16
Q

the 3 chemicals released in any cell damage do what

A

make nocioceptors sensitive and decrease depolarization threshold = increases pain and sensitivity

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17
Q

of the 4 main fiber types, which are the smallest/slowest

A 
A delta (delta is bigger than C so it may also be considered large)
C
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18
Q

most 2nd order neurons end in the (specific location)

A

thalamus (they run from SC to brain)

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19
Q

explain gate control theory

A

ascending Abeta fibers bloc impulses at the spinal cord of Adelta and C fibers (essentially, large fibers bloc the small ones)

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20
Q

examples of modalities that are gate control

A

TENS, massage

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21
Q

explain the decending px control theory

A

low freq (motor level) current causes intense stimulation of small diameter fibers. This releases enkephalins which supressess substance P and blocks px at the spinal level.

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22
Q

ex of descending px control theory

A

motor level TENS

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23
Q

explain endogenous opiod theory

A

stimulation of smaller fibers release opiods resulting in prolonged analgesia

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24
Q

ex of endogenous opiod

A

noxious level TENS

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25
Q

what is different about endogenous opiod theory

A

you have to leave this type of modality on longer bc it takes longer to kick in

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26
Q

what pps would you set for acute level for TENS

A

80-150

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27
Q

what pps would you set for sub acute level TENS

A

you want a motor response so 20-70pps (this stimulates smaller fibers)

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28
Q

what pps would you set for noxious level TENS

A

1-10 pps

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29
Q

which of the fibers require the least amt of electrical current in order to have an effect

A

Abeta (stimulating these - like the tingling with high pps TENS) occurs quickly. To reach A delta or C, it requires more current or duration

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30
Q

what does rheobase mean

A

the intensity of a current that is required to cause an observable response

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31
Q

what does chronoxie mean

A

the duration required for a current twice the intensity of rheobase to cause excitation

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32
Q

what modalities stimulate large fibers

A

high pps TENS, massage, balms

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33
Q

types of ESTIM currents

A

monophasic - direct current (only on 1 side of line)
biphasic -AC - above and below line
pulsed current - there is a break btwn

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34
Q

diathermy and lasers are ex of

A

Electromagnetic energies

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35
Q

what is the type of energy that has the longest wavelength and penetrates the deepest

A

radiation

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36
Q

explain the relationship btwn wavelength and freq

A

there is an inverse relationship btwn WL and freq

the higher the freq the shorter the WL

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37
Q

energy itself is directly proportional to

A

freq

so the higher the freq, the higher the energy

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38
Q

freq is what

A

number of waves per sec

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39
Q

if the amt of energy is insufficient, no change occurs (essentially, not using enough energy does nothing) is what law

A

arndt shultz principle

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40
Q

there is an inverse relationship between the energy absorbed and the penetration into the layers of tissue is what law (ex: with US, shorter freq with longer WL goes deep, but longer freq with shorter WL goes superficial)

A

Law of Grotthus draper

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41
Q

radient engergy is better absorbed if the source is at a right angle is what law

A

cosine

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42
Q

cosine law is indicative of

A

diathermy

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43
Q

intensity of radiation at a surface is inversley related to the square of DISTANCE from the source of the energy

A

inverse square law (essentially, we place modalities close to the body)

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44
Q

net movement of electrons is referred to as

A

electrical current

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45
Q

Rate of electron (electrical current) flow (mA or μΑ) (measure of intensity)

A

ampere

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46
Q
  • Cycles per second (HZ or pps) (wavelengths per sec) (pps –pulses per sec)
A

freq

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47
Q

Opposition to electron flow (ohm)

A

resistance

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48
Q

Voltage/Resistance
Current is directly proportional to voltage & inversely proportional to resistance (higher voltage higher current) (higher current lower resistance)

A

ohms law

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49
Q

what tissues are good conductors of ESTIM

A

fluid (water)

bone, tendon, fat, muscle not so good

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50
Q

iontophoresis is ___phasic

A

mono (DC) - ionto is the only DC

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51
Q

TENS is ____phasic

A

bi (AC)

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52
Q

IFC and Russian are ___phasic

A

pulsed

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53
Q

parameters we set in ESTIM

A

Frequency (Hz or PPS)
Intensity (usually pt tolerance)
Duration

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54
Q

when we change intensity on a machine (to pt tolerance) we are changing

A

amplitude

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55
Q

durations on estim

A 
Motor = 300-600 microseconds
Sensory = 75-150 microseconds
Noxious = 100-1000 microseconds
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56
Q

3 components of current density

A

electrode size
electrode spacing
electrode placement

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57
Q

explain electrode spacing

A

closer together = superficial current density, further apart = deeper current density)

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58
Q

explain electrode size

A

larger electrodes spread out current, decreasing density, smaller electrodes concentrate the current so smaller electrodes have higher current density

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59
Q

what is resting membrane potential

A

electrochemical gradient a cell maintains during the normal homeostatic environment

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60
Q

contraindications for estim

A

active CA, pregnancy, pace maker

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61
Q

when would tetany be a good option to use

A

foot drop - to achieve dorsiflexion

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62
Q

if your goal is muscle re-education you should always use ___ and___

A

estim and exercise

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63
Q

how to effectively use ex with estim for muscle re education

A 
Type of electrical stimulation? Noxious TENS (high volt machine)
Electrode placement? Trigger points
Frequency (pps)? 1-10
Pulse duration? 100-1000 microseconds
Intensity? To tolerance (noxious)
Treatment duration? 15-60 min
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64
Q

which is typically more comfortable, mono or biphasic

A

biphasic

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65
Q

which is more comfortable bigger or smaller pads

A

bigger- more dispersment

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66
Q

diff btwn bipolar and quadrapolar with IFC

A

bi - 2 electrodes

quad - 4 electrodes

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67
Q

explain monopolar TENS

A

electrodes use one or more small active electrodes over a treatment area and a large dispersive electrode placed somewhere else on the body (big pad little pad)

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68
Q

explain bipolar TENS

A

2 same size pads

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69
Q

amplitude is in

A

mA

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70
Q

parameterss for motor, mm re-ed

A

35-55pps,on:offrange from 1:1 to 1:4,10-15min

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71
Q

Muscles respond with individual twitch contractions to pulse rates of less than ___pps

A

50

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72
Q

at ___pps tetany will occur

A

50

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73
Q

motor response, you would not use what type of current

A

DC

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74
Q

type of modulation when AC or PC current flows for a short duration and then is off for a short time in a repetitive cycle.

A

burst

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75
Q

When 2 interfering biphasic waveforms with differing frequencies are delivered to 2 separate pairs of electrodes through separate channels within the same unit.

A

beat

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76
Q

Surging modulation. Amplitude increases gradually to some present maximum and may also decrease in intensity.

A

ramping

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77
Q

____determines whether sensory or motor nerve will be stimulated,

A

amplitude

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78
Q

typical parameters for muscle strengthening motor NMES

A

70-85pps (tetany),
on:off1:5 or more (5-10 sec on, 50-120 sec off),
3 sets of 10 contractionsis common

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79
Q

typical parameters for muscle pumping for NMES

A

35-55pps,on:off 1:1 (5-10 sec on, 5-10 sec off)20-30 min

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80
Q

electrons have a ___ charge

A

neg

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81
Q

movement of electrons is

A

current

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82
Q

rate of electrons (intensity) is measured in

A

amperes

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83
Q

the amps we usually achieve are btwn

A

2-15 (before 2 they don’t feel, after 2 is pain)

84
Q

electrochemical gradient a cell maintains during the normal homeostatic environment is

A

resting membrane potential

85
Q

impulse reaches its effector organ (either another nerve cell or muscle), the impulse is trasnferred between the two at a motor endplate or synapse, a neurotransmitter substance is released

A

depolarization effect

86
Q

Introduction of ions into the body tissues through direct electrical current (no alternating, the electrons move one direction continuously)

A

iontophoresis

87
Q

movement of ions in a solution

A

electrophoresis

88
Q

negative electrode, electrode with greatest concentration of electrons

A

cathode

89
Q

positive electrode, electrode with lower concentrations of electrons

A

anode

90
Q

why do you need to know pos/neg with ionto

A

neg charged ions are replled from a neg electrode
pos charged will be repelled from a pos electrode
pos ion meds, apply to pos electrodes
Neg ion meds apply to neg electrode

91
Q

with ionto, which pad gets the meds

A

In iontophoresis, the “active” electrode is defined as the one used to carry the ion into the tissue (med on this one)

92
Q

factors to consider when doing ionto

A

The force that moves ions through the tissues is determined by strength of the electrical field and electrical impedance of tissues.
Skin & fat are poor conductors and offer greater resistance to current flow. Sweat glands decrease impedance. (so if patient sweats, resistance decreases which increases intensity)

93
Q

how deep does ionto go

A

Ionotophoresis is superficial (penetrating no more than 1.5 cm over a 12-24 hour period and only 1-3 mm during treatment)

94
Q

recommended amps for ionso

A

3-5 mA

95
Q

check skin every___ with ionto

A

3-5 min

96
Q

typical duration of ionto

A

10-20 min

97
Q

how to determine exact dose of ionto

A

min x mA = specific dose

98
Q

dexa is what polarity

A

neg

99
Q

dexa does what to BS

A

increases it

100
Q

russian is primarily used for

A

strenthening

101
Q

a delta fibers transmit

A

fast pain (acute) local

102
Q

c fibers transmit

A

chronic px

103
Q

the 2 NMES

A

HV

russian

104
Q

electromotive force applied to produce a flow of electrons (current)

A

volt

105
Q

which has higher density or concentration of current, large or small pads

A

small

106
Q

the 1-10 pps (noxious) is for what purpose

A

chronic px

107
Q

how many mA is sensation (before px)

A

2-15 (after 15 its pxful)

108
Q

how many mA is cardiac arrest

A

100

109
Q

for muscle re-ed. put pts limb in a ___position

A

isometric (ex for quads extend the leg to see if contracture occurs)

110
Q

time frame for muscle re -ed e stim

A

15 min

111
Q

for muscle pumping, electrodes are placed

A

proximal to the joint

112
Q

With US, is 1 MHz freq deeper or 3MHz

A

1 goes deeper (grothes draper law)

113
Q

US travels as a ___wave

A

longitudinal

114
Q

with US, velocity depends on what

A

the tissue density

denser= higher velocity

115
Q

sound waves travel through ____ but is absorbed in_____

A

sound travels through water but doesn’t absorb there, absorbs in muslce

116
Q

penetration and absorption of US are ____ related

A

inversely

117
Q

with US, absorption increases if ___ increases

A

freq

118
Q

3 tissue types that absorb US best

A

nerve is highest, then muscle, then fat

119
Q

what is piezoelectric effect

A

transducer of an US wand Contains a crystal (quartz or synthetic) that converts electrical energy to acoustic energy through mechanical deformation of the crystal. The crystal will expand and contract (piezoelectric effect), vibrating at a specific frequency & producing a sound wave

120
Q

What is ERA

A

in US, it is the effective radiating area (transducer head)

121
Q

how to determine US wand size

A

the tx area should only be 2-3 times larger than the head

122
Q

depth of penetration of US at 1MHz

A

2-5 cm

123
Q

depth of penetration of US at 3 MHz

A

1-2

124
Q

pulsed US is good to use when you want a ___effect

A

non thermal

125
Q

with US, pulse is same thing as

A

duty cycle (usually 20-50%)

126
Q

Formation of gas-filled bubbles that expand and compress, inducing pressure changes in tissue fluids.

A

cavitation (happens with US)

127
Q

what is stable vs non stable cavitation

A

stable -regular, repeated pressure changes over many cycles

non stable - large violent bubbles over a few cycles

128
Q

therapeutic US only occurs with ___ cavitation

A

stable

129
Q

Unidirectional movement of fluids along the boundaries of cell membranes resulting from mechanical pressure wave in an ultrasonic field. Produces high-viscous stresses which can alter cell membrane structure & function.

A

acoustic microstreaming (occurs with US)

130
Q

non thermal US is usually done at what duty cycle

A

20%

131
Q

what is coupling

A

tranducer head of US should be parallel to skin and a gel should be used

132
Q

US duration

A

5-10 min

133
Q

degrees of temp increase with US

A 
1, 2, 4
mild, mod, vig
mild-subacute
mod-chronic
vig-scars
134
Q

intensity of US is in

A

W/cm2 (done by pt tolerance)

135
Q

how might you deal with boney areas for US

A

submersion or a bladder

136
Q

phonophoresis is typically done with

A

pulsed

137
Q

contraindications for US

A 
pregnancy
pacemaker
malignancy
epiphyseal areas in young children
total joint replacements
infection
138
Q

temp transfer (cryo and thermo) happens via

A

conduction

139
Q

US and diathermy are done via

A

conversion

140
Q

conductive modalities only go how deep

A

1cm (thermal)

141
Q

how does thermal modalities offer px control

A

Analgesia through hyperstimulation of large sensory fibers by heating or cooling inhibits pain fibers (gate control theory)

142
Q

what to do if you suspect your pt has frostbite after cryo

A

water submerge 100degrees and call dr

143
Q

what does EMG stand for

A

electromyography (needle)

144
Q

what does NCS stand for

A

nerve conduction study (electrodes)

145
Q

EMG and NCS evaluate the ___NS

A

Periph.

146
Q

only ___ tests CNS and PNS

A

SEP

somatosensory envoked potential

147
Q

for emg the room temp should be

A

25 c 77 f

148
Q

why do you have to check the skin with ionto every 3-5 min

A

Check the skin every 3-5 minutes; skin impedance decreases during treatment and intensity may need to be decreased to avoid burning

149
Q

Intense stimulation of Adelta and C fibers transmits pain to midbrain, pons, and medulla. This causes release of enkephalins through descending neurons, which suppresses the release of neurotransmitter substance P and blocks pain impulse at the spinal level.

A

descending px control theory

150
Q

examples of descending px control theory

A

low freq tens

151
Q

noxious tens and HV are what theory

A

end opiod

152
Q

what fibers get stimulated with the end opiod theory

A

Ad and C (which causes release of opiods)

153
Q

formula for ionto

A

min x mA = dose

154
Q

formula for US

A

degrees you want to achieve/degrees in box = time

155
Q

diathermy is ___freq (high or low)

A

high

156
Q

can’t have any what around diathermy

A

metals

157
Q

which diathermy can be cont or Pulsed

A

shortwave

158
Q

does diathermy create AP or depolarization

A

no (WL too short)

159
Q

PSWD

A

pulsed short wave diathermy (can help with ion imbalance)

160
Q

watts of diathremy

A

80-120

161
Q

type of diathermy that pt is in the circuit

A

capacitance

162
Q

explain resistance in capacitance

A

fatty areas are resistors in capacitance- they gather heat

163
Q

inductors, pts are not part of the

A

circuit

164
Q

low sub q tissue is best for ___ diathermy

A

capacitance (shortwave)

165
Q

which type of diathermy uses a coil and has eddy currents

A

inductor

166
Q

diathermy is best for what scenario

A

deep heat large area

167
Q

advantages of diathermy

A

heat lasts long and get a bigger area

168
Q

lazers are mono ___

A

chromic

169
Q

high power lazers are used for

A

cutting (surgery) or coagulation

170
Q

low power lazers are used for

A

wounds collagen or px

171
Q

weird side effect of lazer

A

syncope

172
Q

which of the electrophysiological type of studies applies stimulus

A

NCS

173
Q

EMG is what

A

no stimulus, just needle watching activity

174
Q

what (in an emg) might be the earliest indicator of a prob

A

latency

175
Q

ncv FOR UE and LE snap

A

General NCV = at least 50 m/s for for UE and at least 40 m/s for LE (tables available

176
Q

latency for motor nerves take longer for 3 reasons

A

1) the AP has to cross the NM junction,
(2) the AP has to spread across the muscle fiber,
(3) larger motor axons conduct more slowly than the largest sensory fibers.

177
Q

there is snap for sensory and ___ for motor

A

Compound motor unit action potential (cmap)

178
Q

cmap velocities

A

UE amplitudes are typically 5 mV or greater, LE CMAPS are typically 2 mV or greater

179
Q

sx that warrent emg study

A

sensory changes, weakness, atrophy, reflex changes, easy fatigue-ability.

180
Q

dennervated muscle looks ___phasic on emg

A

poly (should be bi)

181
Q

spontaneous contraction of a single muscle fiber (can only be seen via EMG

A

fibrilation

182
Q

pulsed diathermy effects

A

Mechanism for non-thermal effects may be repolarization of damaged cells or by creating a negatively charged cellular environment which reactivates the sodium pump and allows the cell to regain ionic balance

183
Q

short or micro diathermy goes deeper

A

micro

184
Q

microwave has strong___ and weak___

A

strong electric weak magnetic

185
Q

which reverses polarity, mono or biphasic

A

biphasic (mono phasic goes towards pos always)

186
Q

reading waves, if there is a space btwn that is

A

pulsed

187
Q

IFC and Russian are ___ waves

A

pulsed

188
Q

speed is ___ x ____

A

WL x Freq

189
Q

pulsed has to have ___ in a row

A

3

190
Q

all of the ——ines are the ____ in the inflammatory process

A

histamine, leukotriene, cytokines

are chemical mediators

191
Q

• Injured structures should be subjected to controlled mobilization and progressively increasing loads, particularly during the ____ phase

A

remodeling

192
Q

movement of ions

A

current

193
Q

pps for muscle re-ed AND pumping

A

35-55

194
Q

pps for muscle strengthening

A

70-85

195
Q

pulse duration is in

A

microseconds

100 or 300 (300 for motor)

196
Q

ions are ___ or ___ charged

A

neg or pos

197
Q

issues with ionto (contraindications)

A
  • Sensitivity to aspirin (salicylates)
  • Gastritis/stomach ulcer (hydrocortisone)
  • Asthma (mecholyl)
  • Sensitivity to metals (zinc, copper, magnesium)
  • Sensitivity to seafood (iodine)
198
Q

contraindications cryotherapy

A
  • Impaired circulation
  • Peripheral vascular disease
  • Hypersensitivity to cold
  • Skin anesthesia
  • Open wounds or skin conditions
  • Infection
199
Q

2 main reasons for thermotherapy

A

• Subacute & chronic inflammatory conditions*

200
Q

impaired circ is contra for

A

both thermo and cryo

201
Q

2 reasons for US

A

stimulate soft tissue repair and relieve px

202
Q

pulsed US is mainly for

A

soft tissue healing-modulate membrane permeability, alter cellular proliferation, and increase production in proteins associated with inflammation & injury repair.

203
Q

cavitation and acoustic microstreaming are ___ effects of US

A

nonthermal

204
Q

contraindications US

A
  • Acute or postacute conditions (thermal)
  • Decreased temperature sensation
  • Decreased circulation
  • Vascular insufficiency
  • Thrombophlebitis
  • Eyes
  • Reproductive organs
  • Pelvis immediately following menses
  • Pregnancy
  • Pacemaker
  • Malignancy
  • Epiphyseal areas in young children
  • Total joint replacements
  • Infection
205
Q

laser stands for

A

• Light amplification of stimulated emissions of radiation (LASER)

MODALITIES (1 decks)

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