Exam 1 info

Question 1

What forms of energy are relevant to therapeutic modalities?

Answer 1

Electromagnetic, thermal, electrical, sound, mechanical

Question 2

What are the forms of electromagnetic energy modalities?

Answer 2

Shortwave diathermy, microwave diathermy, infrared lamps, UV therapy, low power laser

Question 3

Types of thermal modalities?

Answer 3

Thermotherapy, cryotherapy. These are conductive modalites.

Question 4

Types of electrical modalities?

Answer 4

Electrical stimulating currents, Biofeedback, iontophoresis

Question 5

Sound modalities?

Answer 5

Ultrasound, extracorporal shockwave therapy, phonophoresis

Question 6

Mechanical modalities?

Answer 6

Intermittent compression, traction, massage

Question 7

How is electromagnetic energy transmitted?

Answer 7

Photons. Travels at the speed of light

Question 8

What is wavelength

Answer 8

the distance between the peak of one wave and the peak of the next.

Question 9

What is frequency?

Answer 9

The number of wave oscillations or vibrations occurring in a particular unit of time (per sec = Hertz)

Question 10

How are wavelength and frequency related?

Answer 10

speed = wavelength x frequency

They are inversely related

Question 11

How is the energy and frequency of a photon related?

Answer 11

E = wavelength x frequency

They are directly proportional

Question 12

What penetrates more?

Answer 12

Longer wavelengths

Question 13

What is the importance of the Arndt Shultz principle?

Answer 13

no reactions or changes can occur in the body tissues if the amount of energy absorbed is insufficient to stimulate the absorbing tissues. The clinician should deliver sufficient energy to stimulate the tissues to perform normal function, but avoid too much energy due to risk of impairment or tissue damage.

Question 14

What happens when speed is constant?

Answer 14

a longer wavelength = a lower frequency and greater energy

Question 15

What is and what is the importance of the Law of Grotthus Draper?

Answer 15

There is an incerse relationship between the energy absorption by a tissue and penetration to a deeper layers. Relevance - Using ultrasound at a shorter frequency and longer wavelength means less energy is absorbed superficially and more energy penetrates to deeper tissue.

Question 16

What is and what is the importance of the cosine law

Answer 16

radiant energy is more easly tranmitted to deeper tissues if the source of the radiation is at a right angle to the area being radiated. Relevance - especially important for diathermy - modalities are most effective when at 90 angle

Question 17

What is and what is the importance of the inverse square law?

Answer 17

The intensity of radiation striking a surface is inversely related to the square of the distance from the source. Relevance - modalites are most effective when placed close to the body, infrared lamp will be four times greater when it is half the distance to the body.

Question 18

What can a low power laser help with?

Answer 18

While there are little to no thermal effects, there seems to be a clinical effect on soft tissue and fracture healing as well as pain management.

Question 19

What are some uses of electrical energy?

Answer 19

1) Cause pain modulation through stimulation of cutaneous sensory nerves, 2) produce muscle contraction and relaxation or tetany, depending on the type of current and frequency; 3) facilitate soft-tissue and bone healing through the use of subsensory microcurrencts; 4) produce a net movement of ions, thus eliciting a chemical change in the tissues.

Question 20

What are the three phases of the healing process?

Answer 20

Inflammatory response phase, fibroblastic-repair phase, maturation-remodeling phase

Question 21

What are signs and how long does the inflammatory-response stage last?

Answer 21

Redness, swelling, tenderness, increased temperature, loss of function. 0-4 days

Question 22

What are signs and how long does the fibroblastic-repair stage last?

Answer 22

Diminishing pain and tenderness, gradual return to function. Includes revascularization and scar formation. 2 days - 6 weeks

Question 23

What are signs and how long does the maturation-remodeling stage last?

Answer 23

Strong contracted scar develops, increasing strength and full return to function. Includes relaignment of collagen fibers. 3 weeks - 2 years (or longer)

Question 24

What are the chemical mediators of the inflammatory phase?

Answer 24

Histamine - re;eased frp, omkired ,ast ce;;s. caise vasodialation and increased cell permeability, leukocytes - responsible for marginalization, adhere to cell walls, “walling off”, cytokines - regulate leukocytes and attract them to the site of inflammation

Question 25

Name the series of events for clotting

Answer 25

Thromboplastin released, prothrombin, thrombin, fibrinogen, fibrin clot

Question 26

During chronic inflammation, what are neutrophils replaced with?

Answer 26

Macrophages, lymphocytes, fibroblasts, plasma cells

Question 27

What is the sequence of the inflammatory response?

Answer 27

Injury to the cell, chemical mediators liberated, vascular reaction, platelets and leukocytes adhere to vascular wall, phagocytosis, clot formation

Question 28

Describe a mature scar compared to normal tissue

Answer 28

devoid of physiological function, it will have less tensile strength, and is not as well vascularized.

Question 29

What are factors that impede healing

Answer 29

extent of injury, edema, hemorrhage, poor vascular supply, separation of tissue, muscle spasm, atrophy, corticosteriods, keloids and hypertrophic scars, infection, humidity climate and oxygen tension, health age and nurition

Question 30

What modalities are acceptable during the initial acute phase?

Answer 30

cryo, e-stim, intermittent compression, low power laser, ultrasound, rest

Question 31

What modalities are acceptable during the inflammatory phase?

Answer 31

cryo, e-stim, intermittent compression, low power laser, ultrasound, ROM

Question 32

What modalities are acceptable during the fibroblastic phase?

Answer 32

thermo, e-stim, low power laser, intermittent compression, ultrasound, ROM, strengthening

Question 33

What modalities are acceptable during the maturation phase?

Answer 33

ultrasound, e-stim, low powered laser, shortwave diathermy, microwave diathermy, ROM, strengthening, functional activities.

Question 34

What is Wolff's Law

Answer 34

Bone will erspond to physical demands placed on it, causing it to remodel or realign along lines of force - same response in soft tissue. Immobilization during inflammatory phase will facilitate healing by controlling inflammation Injured structures should be subjected to controlled mobilization and progressively increasing loads, particularly during the remodeling phase

Question 35

What are the indications for E-stim high voltage

Answer 35

Pain modulation, muscle reeducation, muscle pumping contractions, retard atrophy, muscle strengthening, increase ROM, fracture healing acute injury

Question 36

What are the indications for e-stim low voltage

Answer 36

wound healing, fracture healing, iontophoresis

Question 37

What are the indications for e-stim interferential

Answer 37

Pain modulation, muscle reeduation, muscle pumping contractions, fracture healing, increasing ROM

Question 38

What are the indications for e-stim Russian?

Answer 38

Muscle strengthening

Question 39

What are the indications for e-stim MENS

Answer 39

Fracture healing, wound healing

Question 40

What are the indications for shortwave and microwave diathermy?

Answer 40

Increase deep circulation, increase metabolic activity, reduce muscle guarding/spasm, reduce inflammation, facilitate wound healing, analgesia, increase tissue temperatures over a large area

Question 41

What are the indications for cyro?

Answer 41

Acute injury, vasoconstriction, anagesia, reduce inflammation, reduce muscle guarding/spasm

Question 42

What are the indications for thermo>?

Answer 42

Vasodialation, analgesia, reduce muscle guarding/spasm, reduce inflammation, increase metabolic activity, facilitate tissue healing,

Question 43

What are the indications for low power laser?

Answer 43

Pain modulation, facilitate wound healing

Question 44

What are the different types of pain?

Answer 44

Acute, chronic, referred, radiating, deep somatic

Question 45

What are examples of pain assessment techniques?

Answer 45

Visual analog scale, pain charts, MPQ, Activity Pattern indicators pain profile, numeric pain scales

Question 46

What are some cognitive influences on pain?

Answer 46

anxiety and fear, attention and motivation, depression, past pain experiences, cultural influences, grief, hostility, pain memory, substance abuse

Question 47

What happens for noiciception following cell injury?

Answer 47

Release of 3 chmicals (substance P, prostaglandins, & leukotrienes) that sensitize nociceptors in/around area by lowering the depolarization threshold. THis results in primary hyperalgesia (enhanced pain response) the secondary hyperalgesia (hypersensitivity)

Question 48

What is the gate control theory of pain?

Answer 48

Stimulation from ascending alpha beta afferents results in blocking impulses at the spinal cord level of pain messages carried along alpha delta and c fibers. Non-nociceptive alpha beta fibers inhibit the effects of the alpha delta and c fibers "closing the gate." This trhory is the basis for many modalities that provide sensory stimulation as a method of pain relief (massage, application of most heat, etc.)

Question 49

Desceding pain control

Answer 49

Stimulation of descending pathways in the dorsolateral tract of the spinal cord by c fiber input results in a blocking of impulses carried along the A delta and C fibers. Influence from the thalamus stimulates the periaqueductal gray, the raphe nucleus, and the pons to inhibit the transmission of pain through ascending tracts.

Question 50

How can modalities be used in pain management?

Answer 50

1) Simulate large-diameter afferent fibers (TENS, massage, analgesic balms) 2) Decrease pain fiber transmission velocity (Cold, ultrasound) 3) Stimulate small-diameter afferent fibers and descedning pain control mechanisms (deep massage, TENS) 4) simulate a release of B-endorphin and dynorphin through prolonged small-diameter fiber stimulation.

Question 51

Ampere

Answer 51

Rate of electron flow (mA or microamperes)

Question 52

Volt

Answer 52

Electromotive force applied to produce a flow of electrons

Question 53

Monophasic or DC current

Answer 53

Has an uninterrupted unidirectional flow of electrons toward the positive pole

Question 54

What are the types of electrical current?

Answer 54

Biphasic or AC, monophasic or DC, pulsatile or PC

Question 55

Ohm's law

Answer 55

Current flow = Voltage/Resistance | Current is directly proportional to voltage and inversely proportional to resistance

Question 56

How does current flow through biological tissues

Answer 56

The higher water content = best conductor, so from insulator to conductor: Bone - skin, fat, and tendons - Muscle - Blood

Question 57

Biophysical or alternating (AC)

Answer 57

Continuous flow of electrons is bidirectional, constantly changing direction, reversing polarity (TENS)

Question 58

PC

Answer 58

Three or more pulses grouped together, unidirectional or bidirectional. (IFC, Russian)

Question 59

Series circuit

Answer 59

Electrons have only one possible route

Question 60

Parallel circuit

Answer 60

Electrons have many routes

Question 61

Types of waveform shapes

Answer 61

Sinusoidal, rectangular, square, spiked

Question 62

Frequency for noxious

Answer 62

1-10 pps (noxious level TENS or IFC, pain control via endogenous opiates)

Question 63

Frequency for motor

Answer 63

20-70 (high volt & Russian, low frequency/motor level TENS, pain control via descending pathways, muscle pumping, muscle reeducation, muscle strengthening, contraction at 20-40, tetany at 40-70)

Question 64

Frequency for sensory

Answer 64

80-125/150 (conventional TENS, IFC; pain control via gate control theory)

Question 65

Duration for motor

Answer 65

300-600 microseconds

Question 66

Duration for sensory

Answer 66

75-150 microseconds

Question 67

Duration for noxious

Answer 67

100-1000 microseconds

Question 68

What are the types of current modulation?

Answer 68

Continuous, burst, beat, ramping

Question 69

What is the cathode

Answer 69

The negative electrode. Attracts positive ions

Question 70

What is the anode

Answer 70

The positive electrode. Attracts negative ions

Question 71

What are indication for e-stim?

Answer 71

Modulating acute, postacute, and chronic pain muscle contraction, stimulating contraction of generated muscle reeducation, retarding atrophy, muscle strengthening, increasing TOM, Decreasing edema, Decreasing muscle spasm, Decrease muscle guarding, Stimulating the healing process, Wound healing, fracture healing, tendon healing, ligament healing, stimulating nerve regeneration, stimulating peripheral nervous system function, Changing membrane permeability, synthesizing protein, stimulating fibroblasts and osteoblasts, regenerating tissue, increasing circulation through muscle pumping contraction

Question 72

What are contraindications for e-stim?

Answer 72

Pacemakers, infection, malignancies, pregnancy, Musculoskeletal problems where muscle contraction would exacerbate the condition

Question 73

What are the three types of electrophysiologic testing?

Answer 73

Nerve conduction studies Electromyography Somatosensory evoked potentials

Question 74

What equipment is needed for electrophysiologic testing?

Answer 74

Electrodes, amplifier, oscilloscope (visual feedback), speakers (auditory feedback), testing unity This all helps to elicit an action potential and generate a record

Question 75

What are two considerations for electrophysiological testing?

Answer 75

Temperature: room temp should be around 25 deg C, limb temp should be 30-32 deg C Age: individuals over 50 or under 16 may have slower NCV than adults age 16-50.

Question 76

Describe Sensory nerve conduction studies

Answer 76

Examiner introduces an AP along a peripheral nerve and picks up that AP at a second site Stimulating electrode creates a single monophasic square wave, generating a SNAP SNAP parameters measured include amplitude, shape, latency, and NCV

Question 77

What is Sensory nerve conduction velocity?

Answer 77

Tests the speed of conduction over a specific segment of nerve.

Question 78

How is the Sensory nerve conduction velocity tested?

Answer 78

Examiner creates the setup then measures the distance between the stimulation and pickup sites (no predetermined distances)

Question 79

What are general NCVs

Answer 79

At least 50 m/s for the UE and at least 40 m/s for LE

Question 80

What does a motor nerve conduction study assess?

Answer 80

The combined function of the nerve, neuromuscular junction, and muscle fibers innervated by the available axons.

Question 81

What parameters are measured in a motor nerve conduction study?

Answer 81

Amplitude, rise time, duration, shape, NCV, latency compared with NCV

Question 82

Describe Iontophoresis

Answer 82

Transdermal iontophoresis delivers medication at a constant rate with a goal of keeping he effective plasma concentration of the medication within the "therapeutic window" for an extended time

Question 83

What is a cathode, anode

Answer 83

Negative electrode, positive electrode

Question 84

How do you decide what electrode to use with a solution?

Answer 84

Same ions repel, so that can be pushed into the skin

Question 85

What is the "active" electrode?

Answer 85

The one used to carry the ion into the tissue

Question 86

How much does Ionto penetrate?

Answer 86

1.5 cm over a 12-24 hour period and 1-3 mm during treatment

Question 87

What current type is used for ionto?

Answer 87

Continuous DC

Question 88

What are recommendations for intensity and duration for ionto?

Answer 88

Intensity: tingling (3-5mA) Duration: 10-20 min Be sure to check skin every 3-5 minutes to ensure no burning

Question 89

What is the dosage for ionto?

Answer 89

milliampere-minute. Typically 40, but can range 0-80

Question 90

What are indications for biofeedback?

Answer 90

``` Muscle reeducation Regaining neuromuscular control Increasing isometric contraction and isometric strength of a muscle Relaxation of muscle spasm Decreasing muscle guarding Pain reduction Psychological relaxation ```

Question 91

Describe E-stim for wounds

Answer 91

Monopolar setup Sterile active electrode placed over wound Wound bed packed with gauze soaked in an electroconductive material HVPC or microcurrent are commonly used

Question 92

Describe US for wound care

Answer 92

Stimulates of phagocytic activity of inflammatory cells May be "proinflammatory," stimulating and accelerating the inflammatory process Stimulate fibroblasts to synthesize and produce collagen May accelerate wound healing May be applied directly or indirectly to wounds With direct application, the wound is filled with sterile hydrogel & covered with a special dressing Indirect ultrasound may be applied to periulcer skin or through a water bath

Question 93

Describe some rules that can help you choose a modality for nonhealing wounds

Answer 93

E-stim - all stages of healing Ultrasound - recalcitrant wound with chronic inflammation and pronounced slough/fibrin Hydrotherapy - Used to soften eschar, cleanse the wound, and remove necrotic tissue (nonselective debridement)