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DPT 715: Modalities > Exam 1- Physical agents- EMR > Flashcards

Exam 1- Physical agents- EMR Flashcards

1
Q

what are physical agents

A

energy and material applied to a patient in their rehab

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2
Q

what can physical agents be used for

A

treat inflammation
pain management
tissue healing
muscle activation
alters collagen extensibility
decrease muscle spasicity

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3
Q

what is the role of modalities in PT

A

used in conjunction with other skilled therapeutic or educational interventions, not as the sole intervention

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4
Q

what are types of thermal agents

A

deep heating agents
superficial heating agents
cooling agents

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5
Q

what are types of mechanical agents

A

traction
compression
water
sound

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6
Q

what are types of electromagnetic agents

A

electromagnetic fields
electrical currents

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7
Q

what are thermal agents

A

transfer energy to a patient to increase or decrease tissue temperature

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8
Q

what are mechanical agents

A

apply force to increase or decrease pressure on the body

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9
Q

what are electromagnetic agents

A

apply energy in the form of electromagnetic radiation or electrical currents

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10
Q

what can change the effect of electromagnetic agents

A

variation of frequency and intensity change its effects and depth of penetration

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11
Q

what domain of the ICF model do modalities directly effect

A

body functions and structure

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12
Q

when does the inflammation phase occur

A

1-6 days post injury

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13
Q

when does the proliferation phase occur

A

3-20 days

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14
Q

when does the maturation phase occur

A

9 days on

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15
Q

what is the inflammation phase

A

immediate protective response that attempts to destroy, dilute, or isolate cells that are faulty

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16
Q

what are the cardinal signs of inflammation

A

heat
swelling
redness
pain
loss of function

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17
Q

what is the purpose of the inflammatory phase

A

clot formation
remove damage tissue
recruit endothelial cells and fibroblasts

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18
Q

what happens with the initial reaction to protect a wound in the body

A

clot formation
vasodilation caused by histamines- redness and increase temp
chemotaxis

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19
Q

what are the general goals for therapist during the inflammatory phase

A

decrease swelling and pain
improve A/PROM

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20
Q

which modalities are recommended during the inflammatory phase

A

cryotherapy
compression

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21
Q

what is the purpose of the proliferative phase

A

cover the wound and impart strength to the injury site

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22
Q

what happens during the proliferative pahse

A

epithelization
collagen production
wound contraction
neovascularization

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23
Q

what is the marker that suggests shift between healing phases

A

acute neutrophil cells are replaced by long term macrophages correlating the change between inflammatory to proliferative

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24
Q

what are the goals during the proliferative phase

A

improve ROM
decrease pain and swelling
increase circulation
protect wound
promote appropriate alignment of collagen fibers

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25
Q

what is the purpose for maturation phase

A

restoration of prior function

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26
Q

what are the general goals for therapist during maturation phase

A

return to activity
increase ROM, strength, circulation
decrease pain

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27
Q

what phase does chronic inflammation fall into

A

maturation phase

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28
Q

what can chronic inflammation lead to and why

A

increase scar tissue and adhesion formation due to increased fibrotic tissue and collagen production

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29
Q

how can chronic inflammation stay in the maturation phase

A

repeated trauma
immune response to a foreign body

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30
Q

what factors affect healing process

A

local- where on the body
external- movement
systemic- individual
mental/emotional stress

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31
Q

what are the considerations for tendons/ligaments in the inflammatory phase

A

PRICE

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32
Q

what are the considerations for tendons/ligaments in the proliferation phase

A

ligaments - immobilization
tendons - early controlled forces
all for organized collagen alignment

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33
Q

what are the considerations for tendons/ligaments in the maturation phase

A

physiological loading important
recover full
normal tissue strength = 40-50 week post

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34
Q

what are the differences between adolescent and adult cartilage healing

A

adolescent cartilage has a capacity to heal where as adults have limited ability

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35
Q

what are the clinical indications for cryotherapy

A

control inflammation, pain, edema
reduce spasticity

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36
Q

what are the affects for cryotherapy with pain control

A

10-15 min of cryotherapy can control pain for 1-2 hours

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37
Q

what are the neuro physiological effects of cryotherapy

A

blocks pain receptors
decreases nerve velocity on A delta fibers

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38
Q

what are the hemodynamic physiological effects of cryotherapy

A

vasoconstriction

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39
Q

what is the difference between cold packs and ice packs

A

cold packs are easily accessible, but do not transfer energy as fast as ice packs.

Ice packs offer more aggressive cooling, but after 10 minutes is ineffective.

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40
Q

when is controlled cold compression more effective

A

directly post surgery to control post- op edema/inflammation

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41
Q

what are the pros and cons for ice cup massage

A

pros: cost effective, quick, control pressure, target specific area
cons: messy, water can cause infection

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42
Q

what are the pros and cons for ice water immersion

A

pros: full coverage of contact area (greater surface area)
cons: limited application site, tolerance

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43
Q

what is vapocoolant spray

A

reduce muscle spasms and desensitizing trigger points

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44
Q

what are contraindications for cyrotherapy

A

cold hypersensitivity
cold intolerance
cryoglobulinemia
Raynaud’s disease

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45
Q

what are precautions to cryotherapy

A

over superficial main branch of nerve
open wound
hypertension
patient with poor sensation or mentation

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46
Q

what is conduction

A

energy exchanged by direct contact of stationary materials at different temp

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47
Q

what is thermal conductivity

A

rate at which a material transfers heat by conduction

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48
Q

what are rules for safely conduction

A

greater temperature difference = greater rate of heat transfer

conducive agents aren’t directly on skin

remove metal

6-8 layers of towels

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49
Q

what is convection

A

direct contact between circulating medium and another material of a different temperature

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50
Q

what is conversion

A

a non thermal form of energy into heat
does not require direct contact
require an intervening material to help transmit the certain type of energy

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51
Q

what does the rate of transfer depend on for conversion

A

power of the energy source

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52
Q

how does ultrasound convert to heat

A

mechanical form of energy - sufficient intensity to a tissue absorbs sound waves

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53
Q

how does diathermy convert to heat

A

electromagnetic form of energy - rotation of polar molecules convert to heat by friction

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54
Q

what is specific heat

A

amount of energy required to increase the temperature of a material

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55
Q

when can cold induced vasodilation occur

A

cold applied for greater than 15 minutes or when tissue temp reaches less than 50 deg

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56
Q

what are the muscular effects of cryo

A

decreased spasticity
increase muscular strength

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57
Q

what are the metabolic affects of cryo

A

decrease rate of inflammation by decreasing the activity of cartilage degrading enzymes and level of histamines

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58
Q

how does cryotherapy control acute edema

A

reduce histamines
increase blood viscosity
decrease blood flow

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59
Q

what are the uses of thermotherapy

A

accelerates tissue healing
pain management
alters collagen extensibility

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60
Q

what are the hemodynamic effects with thermotherapy

A

increase blood flow
increase capillary permeability

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61
Q

what are the neuro effects with thermotherapy

A

increased nerve conduction velocity
change frequency of nerve firing rate
increased pain threshold

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62
Q

how does thermotherapy change the frequency of nerve firing rate

A

relaxes muscles during stretch and spasm
decreased firing rate in muscle spindle

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63
Q

what are the muscular effects of thermotherapy

A

altered muscle endurance and strength
decrease during the first 30 minutes

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64
Q

what are the metabolic effects of thermotherapy

A

increased metabolic rate
more oxygen for tissue repair
increase destructive processes

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65
Q

how is soft tissue altered with heating

A

increase stretch
decrease risk of tearing issue

66
Q

what is superficial heating agents used for

A

scar tissue and superficial tendons

67
Q

what is deep heating agents used for

A

large deep muscles or deeper tendons

68
Q

what are the clinical uses of superficial heat

A

increase ROM
decrease jt stiffness
superficial m relaxation

69
Q

what modalities can decrease jt stiffness

A

warm paraffin
warm water bath
infrared lamp

70
Q

how can thermo help with accelerated healing

A

increasing circulation and enzymatic activity rate

71
Q

what are contraindications of thermotherapy

A

acute trauma, MSK, inflammatory conditions
DVT
recent or potential hemorrhage
impaired sensation
impaired cognition
malignancy

72
Q

what are the precautions of thermotherapy

A

pregnancy
poor circulation or thermal regulation
edema
metal
open wound

73
Q

what are the adverse effects of thermotherapy

A

burns
fainting
bleeding

74
Q

what is the application of hot pack

A

6-8 layers of protection
treatment time 20-30 minutes
check skin before and after treatment

75
Q

what is the application of dip wrap paraffin

A

dip 5-10 times, then wrap hand in a plastic bag and a towel to insulate heat
10-15 minutes

76
Q

what are the thermal effects of ultrasound

A

continuous ultrasound penetrates more deeply
greater effect with tissues high in collagen (tendons, ligaments, jt capsule, fascia)

77
Q

what are the non thermal effects of ultrasound

A

pulsed ultrasound promotes tissue repair in all phases of wound healing

78
Q

how do we choose frequency for ultrasound

A

depth of target tissue
1= deeper
3= superficial

79
Q

what are the number of treatments needed for results with ultrasound

A

1-3 treatments effect should be detectable

80
Q

what are the parameters of 1 MHz frequency

A

1.5 to 2.5 W/cm2
5-10 minutes (8 minute rule)

81
Q

what are the parameters of 3 MHz frequency

A

.5 to 1.0 W/cm2
5-10 minutes (8 minute rule)

82
Q

what are the parameters for cleaning the ultrasound

A

clean tranducer head before and after
clean skin before

83
Q

how do you set up SWD

A

select SWD setting
select edit
change mode to continuous, adjust power to desired watts

84
Q

how do you set up SWT

A

choose clinical protocol
select body region
select treatment goal
dose and treatment parameters

85
Q

what are the dosage levels for diathermy

A

1-lowest level = nonthermal, 0 watts
2-low level= mild heat, 12 watts
3-medium level = moderate heat, 24 watts
4-heavy level = vigorous heat, 48 watts

86
Q

what is cavitation

A

alternating compression and expansion of gas bubbles in tissue fluids caused by mechanical pressure
makes cell membrane more permeable

87
Q

what is microstreaming

A

eddying that occurs around any vibrating object

88
Q

what is acoustic streaming

A

movement of fluids along boundaries of cell membrane resulting from mechanical pressure waves

89
Q

what does acoustic streaming produce

A

alterations in cell membrane activity, increased wall permeability, and increased intracellular calcium

90
Q

what are the nonthermal effects of ultrasound

A

increase intracellular calcium levels
increase skin and cell membrane permeability
mast cell degranulation
promote macrophage degranulation
promote protein synthesis by fibroblast
accelerate healing and reduce inflammation

91
Q

what are the clinical uses for ultrasound

A

soft tissue shortening (continuous)
tendon and ligament healing
bone fractures
jt inflammation (pulsed)
phonophoresis

92
Q

how much should tissue increase in temperature with ultrasound for soft tissue shortening treatment

A

3-8 deg C

93
Q

how might ultrasound be used for pain control

A

stimulate thermal receptors
increase soft tissue extensibility
change nerve conduction through temp
modulation of inflammation (non thermal)

94
Q

what duty cycle should be used for ultrasound to treat pain control

A

continuous duty cycle

95
Q

what parameters should be used for ultrasound to treat soft tissue healing and inflammation

A

may use indirect (water immersion) or peri wound technique
pulsed duty cycle 20%
3 MHz - .5-1.0 intensity for 3-10 min
3x/wk for 6-16 wks

96
Q

what parameters should be used for ultrasound to treat tendon inflammation in the acute phase

A

pulsed duty cycle 20%
3 MHz - .5-1.0 intensity for 3-10 minutes

97
Q

what parameters should be used for ultrasound to treat tendon inflammation in the subacute/chronic phase

A

continuous duty cycle
increase intensity as tolerated
combine with stretching assist in resolving chronic tendinitis

98
Q

what parameters should be used for ultrasound to treat bone fractures

A

pulsed duty cycle 20%
1.5 MHz - .15 intensity for 15-20 min/day

99
Q

what is phonophoresis

A

application of ultrasound with a topical drug as the medium

100
Q

what is the benefit of phonophoresis

A

higher initial drug concentration
avoids stomach issues
avoids initial metabolism
works with thermal/nonthermal effect of increased permeability of skin (caviation)

101
Q

what is the treatment of phonophoresis mainly used for

A

to deliver corticosteriods and local analgesics
used to treat tendinitis, CTS
6 treatments

102
Q

what parameters should be used for phonophoresis

A

medication gel - medium
pulsed duty cycle 20%
3 MHz - .5-1.0 intensity for 5-10 minutes
lower intensity for longer time

103
Q

what are the contraindications for ultrasound

A

tumor
pregnancy
CNS tissue if exposed by laminectomy above L2
over jt replacement
pacemaker
over the eyes
near reproductive organs

104
Q

what are the precautions for ultrasound

A

acute inflammation
epiphyseal plates
fx
breast implants

105
Q

what are adverse effects of ultrasound

A

burns
cross contamination

106
Q

what does heat produced by ultrasound depend on

A

absorption coefficient
energy delieverd

107
Q

what does energy delivered by use of ultrasound depend on

A

intensity
duty cycle

108
Q

what does absorption coefficient by use of ultrasound depend on

A

collagen
frequency

109
Q

after heat is delivered by ultrasound and absorbed, what does the remainder of attentuation due to

A

reflection and refraction

110
Q

what is attentuation

A

as ultrasound enters, it gradually decreases in intensity due to frequency and tissue

111
Q

what is wave transmission frequency for 3 MHz

A

increases with with wave frequency
less energy to deeper tissue
2-3 cm depth
absorb 3-4 x faster

112
Q

what is wave transmission frequency for 1 MHz

A

lower frequency penetrates deeper
up to 6 cm deep
absorption slower

113
Q

what is the reflected field

A

when 1 MHz reflects off bone and comes back to the skin

114
Q

what is beam nonuniformity ratio

A

peak/average

115
Q

what is spatial peak intensity

A

peak intensity of the ultrasound output over the area of the transducer
greatest in the center

116
Q

what is spatial average intensity

A

average intensity of the ultrasound output averaged over the on/off time of the pulse

117
Q

what is the ERA of ultrasound

A

effective radiating area
2x the sound head surface

118
Q

what is piezoelectric

A

change the shape in response to the electric current

119
Q

how does the piezoelectric work within the crystal

A

expand and contracts at same frequency of current
crystal expands as molecules in front are compressed and vice versa

120
Q

how does the piezoelectric crystal work

A

crystal converts electric energy to acoustic energy
crystal is mechanically deformed

121
Q

what is the advantage of ultrasound

A

depth of tissue penetration
2-5 cm deep

122
Q

what structures are ultrasound best used for with thermal

A

high collagen content: tendon, ligament, capsule, fascia

123
Q

what is therapeutic ultrasound

A

high frequency mechanical waves delivered by acoustic energy

124
Q

what is EMR

A

composed of electrical and magnetic fields that vary over time and are oriented perpendicular to one another

125
Q

what physical agents can deliver EMR

A

infrared radiation- superficial heating
microwave/shortwave = diathermy

126
Q

how are wavelength and frequency related with EMR

A

inversely proportional

127
Q

what is lower frequency EMR

A

nonionizing - cannot break molecular bonds, medically safe
shortwaves, microwaves, IR, visible light, UV

128
Q

what is higher frequency EMR

A

ionizing- can break molecular bonds and inhibit cell division
very small doses for imaging
large doses to intentionally destroy tissue

129
Q

when is intensity of EMR greatest

A

energy output is high
radiation source is close to the patient
beam is perpendicular to skins surface

130
Q

what can physiological effects depend on with EMR

A

frequency/wavelength
intenisity

131
Q

what applicators can produce diathermy

A

inductive coil
capacitive plates
magnetron

132
Q

what tissues do inductive coil target

A

muscle

133
Q

what tissues do capacitive plates

A

fat

134
Q

what are the nonthermal effects of diathermy

A

modulates pain, edema, inflammation through altered cell membrane function and activity
increased microvascular perfusion
increased blood flow/circulation

135
Q

what are the advantages of SWD diathermy

A

can heat larger areas than US
can heat deeper than hot pack
can be used when direct contact of agent is contraindicated

136
Q

what are diathermy disadvantages

A

radiation
expensive

137
Q

what are the advantages of SWT diathermy

A

accelerates edema resolution
reduce pain after injury
accelerate soft tissue healing (wound care)

138
Q

what are the characteristics of laser light

A

monochromatic
coherent
directional

139
Q

what is low level laser therapy

A

low intensity cold laser - non thermal
low level light device visible red and IR range
used to promote healing
control pain and inflammation

140
Q

what is high intensity laser

A

hot laser
used for sx
cuts/destroys tissue
not for rehab

141
Q

what is a cluster probe

A

applicator with more than one diode or type of diode of various wavelength and power

142
Q

what is photodiodes

A

conductor of energy
laser diodes
LED
SLD

143
Q

what are the characteristics of laser photodiodes

A

monochromatic
coherent
directional
superficial penetration - 5mm
high intensity= hot laser
low intensity= cold laser

144
Q

what are the characteristics of the LED photodiode

A

polychromatic
noncoherent
nondirectional- diffuse spread of light, cover large area
deep penetration - 2-4 cm
longer application time

145
Q

what are the characteristics of the SLD photodiode

A

almost monochromatic
noncoherent
nondirectional- spreads more than laser and less than LED
deeper penetration- 2-4 cm
shorter application time

146
Q

what is the effect of wavelength in light therapy

A

depth of tissue penetration
longer wavelength=deep
shorter wavelength=superficial

147
Q

what wavelength penetrates the deepest

A

IR penetrates more deeply than visible redlight

148
Q

what photodiode penetrates the deepest

A

LED penetrates more deeply than laser

149
Q

what is power in light therapy

A

unit of light intensity, class 3B
hot laser= high intensity= high power
cold laser= low intensity= low power

150
Q

what is power density in therapy

A

irradiance- light intensity per unit area

151
Q

what is energy in light therapy

A

dose

152
Q

what is energy density on light therapy

A

fluence of treatment
preferred measure of dose

153
Q

what is chromophores

A

gives tissue its color by absorbing some wave lengths and reflecting others

154
Q

what are physiological effect of laser

A

stimulate mitochondria to produce more ATP
mRNA to promote fibroblasts increase collagen
vasodilation/circulation
inhibit bacterial/fungi growth
modulate inflammation
improve nerve conduction

155
Q

what are the clinical indications for laser

A

wound healing/fx
neurological conditions
MSK disorder
lymphedema
pain management

156
Q

what can a low dose be used for with laser

A

more acute or superficial conditions

157
Q

what can a high dose be used for with laser

A

chronic or deeper conditions

158
Q

what should we be aware of during treatment with laser

A

wear goggles
burns

159
Q

what are the laser contraindications

A

directly to eyes
within 4-6 months of radiotherapy
hemorrhagic lesions
locally endocrine glands
malignancy

160
Q

what are precautions of laser

A

pregnancy
epiphyseal plates
impaired sensation/mentation
photophobia
high sensitivity to light

161
Q

what needs to be done documented with laser

A

area of body treated
treatment dose/energy density

DPT 715: Modalities (2 decks)

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