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Modalities > Exam 1 info > Flashcards

Exam 1 info Flashcards

1
Q

What forms of energy are relevant to therapeutic modalities?

A

Electromagnetic, thermal, electrical, sound, mechanical

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2
Q

What are the forms of electromagnetic energy modalities?

A

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

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3
Q

Types of thermal modalities?

A

Thermotherapy, cryotherapy. These are conductive modalites.

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4
Q

Types of electrical modalities?

A

Electrical stimulating currents, Biofeedback, iontophoresis

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5
Q

Sound modalities?

A

Ultrasound, extracorporal shockwave therapy, phonophoresis

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6
Q

Mechanical modalities?

A

Intermittent compression, traction, massage

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7
Q

How is electromagnetic energy transmitted?

A

Photons. Travels at the speed of light

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8
Q

What is wavelength

A

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

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9
Q

What is frequency?

A

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

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10
Q

How are wavelength and frequency related?

A

speed = wavelength x frequency

They are inversely related

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11
Q

How is the energy and frequency of a photon related?

A

E = wavelength x frequency

They are directly proportional

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12
Q

What penetrates more?

A

Longer wavelengths

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13
Q

What is the importance of the Arndt Shultz principle?

A

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.

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14
Q

What happens when speed is constant?

A

a longer wavelength = a lower frequency and greater energy

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15
Q

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

A

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.

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16
Q

What is and what is the importance of the cosine law

A

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

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17
Q

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

A

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.

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18
Q

What can a low power laser help with?

A

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.

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19
Q

What are some uses of electrical energy?

A

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.

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20
Q

What are the three phases of the healing process?

A

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

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21
Q

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

A

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

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22
Q

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

A

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

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23
Q

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

A

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

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24
Q

What are the chemical mediators of the inflammatory phase?

A

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

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25
Q

Name the series of events for clotting

A

Thromboplastin released, prothrombin, thrombin, fibrinogen, fibrin clot

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26
Q

During chronic inflammation, what are neutrophils replaced with?

A

Macrophages, lymphocytes, fibroblasts, plasma cells

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27
Q

What is the sequence of the inflammatory response?

A

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

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28
Q

Describe a mature scar compared to normal tissue

A

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

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29
Q

What are factors that impede healing

A

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

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30
Q

What modalities are acceptable during the initial acute phase?

A

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

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31
Q

What modalities are acceptable during the inflammatory phase?

A

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

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32
Q

What modalities are acceptable during the fibroblastic phase?

A

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

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33
Q

What modalities are acceptable during the maturation phase?

A

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

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34
Q

What is Wolff’s Law

A

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

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35
Q

What are the indications for E-stim high voltage

A

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

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36
Q

What are the indications for e-stim low voltage

A

wound healing, fracture healing, iontophoresis

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37
Q

What are the indications for e-stim interferential

A

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

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38
Q

What are the indications for e-stim Russian?

A

Muscle strengthening

39
Q

What are the indications for e-stim MENS

A

Fracture healing, wound healing

40
Q

What are the indications for shortwave and microwave diathermy?

A

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

41
Q

What are the indications for cyro?

A

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

42
Q

What are the indications for thermo>?

A

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

43
Q

What are the indications for low power laser?

A

Pain modulation, facilitate wound healing

44
Q

What are the different types of pain?

A

Acute, chronic, referred, radiating, deep somatic

45
Q

What are examples of pain assessment techniques?

A

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

46
Q

What are some cognitive influences on pain?

A

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

47
Q

What happens for noiciception following cell injury?

A

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)

48
Q

What is the gate control theory of pain?

A

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.)

49
Q

Desceding pain control

A

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.

50
Q

How can modalities be used in pain management?

A

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.

51
Q

Ampere

A

Rate of electron flow (mA or microamperes)

52
Q

Volt

A

Electromotive force applied to produce a flow of electrons

53
Q

Monophasic or DC current

A

Has an uninterrupted unidirectional flow of electrons toward the positive pole

54
Q

What are the types of electrical current?

A

Biphasic or AC, monophasic or DC, pulsatile or PC

55
Q

Ohm’s law

A

Current flow = Voltage/Resistance

Current is directly proportional to voltage and inversely proportional to resistance

56
Q

How does current flow through biological tissues

A

The higher water content = best conductor, so from insulator to conductor:

Bone - skin, fat, and tendons - Muscle - Blood

57
Q

Biophysical or alternating (AC)

A

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

58
Q

PC

A

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

59
Q

Series circuit

A

Electrons have only one possible route

60
Q

Parallel circuit

A

Electrons have many routes

61
Q

Types of waveform shapes

A

Sinusoidal, rectangular, square, spiked

62
Q

Frequency for noxious

A

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

63
Q

Frequency for motor

A

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)

64
Q

Frequency for sensory

A

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

65
Q

Duration for motor

A

300-600 microseconds

66
Q

Duration for sensory

A

75-150 microseconds

67
Q

Duration for noxious

A

100-1000 microseconds

68
Q

What are the types of current modulation?

A

Continuous, burst, beat, ramping

69
Q

What is the cathode

A

The negative electrode. Attracts positive ions

70
Q

What is the anode

A

The positive electrode. Attracts negative ions

71
Q

What are indication for e-stim?

A

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

72
Q

What are contraindications for e-stim?

A

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

73
Q

What are the three types of electrophysiologic testing?

A

Nerve conduction studies
Electromyography
Somatosensory evoked potentials

74
Q

What equipment is needed for electrophysiologic testing?

A

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

75
Q

What are two considerations for electrophysiological testing?

A

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.

76
Q

Describe Sensory nerve conduction studies

A

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

77
Q

What is Sensory nerve conduction velocity?

A

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

78
Q

How is the Sensory nerve conduction velocity tested?

A

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

79
Q

What are general NCVs

A

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

80
Q

What does a motor nerve conduction study assess?

A

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

81
Q

What parameters are measured in a motor nerve conduction study?

A

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

82
Q

Describe Iontophoresis

A

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

83
Q

What is a cathode, anode

A

Negative electrode, positive electrode

84
Q

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

A

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

85
Q

What is the “active” electrode?

A

The one used to carry the ion into the tissue

86
Q

How much does Ionto penetrate?

A

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

87
Q

What current type is used for ionto?

A

Continuous DC

88
Q

What are recommendations for intensity and duration for ionto?

A

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

89
Q

What is the dosage for ionto?

A

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

90
Q

What are indications for biofeedback?

A 
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
91
Q

Describe E-stim for wounds

A

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

92
Q

Describe US for wound care

A

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

93
Q

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

A

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)

Modalities (1 decks)

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