Exam 1- Physical agents- EMR Flashcards
what are physical agents
energy and material applied to a patient in their rehab
what can physical agents be used for
treat inflammation
pain management
tissue healing
muscle activation
alters collagen extensibility
decrease muscle spasicity
what is the role of modalities in PT
used in conjunction with other skilled therapeutic or educational interventions, not as the sole intervention
what are types of thermal agents
deep heating agents
superficial heating agents
cooling agents
what are types of mechanical agents
traction
compression
water
sound
what are types of electromagnetic agents
electromagnetic fields
electrical currents
what are thermal agents
transfer energy to a patient to increase or decrease tissue temperature
what are mechanical agents
apply force to increase or decrease pressure on the body
what are electromagnetic agents
apply energy in the form of electromagnetic radiation or electrical currents
what can change the effect of electromagnetic agents
variation of frequency and intensity change its effects and depth of penetration
what domain of the ICF model do modalities directly effect
body functions and structure
when does the inflammation phase occur
1-6 days post injury
when does the proliferation phase occur
3-20 days
when does the maturation phase occur
9 days on
what is the inflammation phase
immediate protective response that attempts to destroy, dilute, or isolate cells that are faulty
what are the cardinal signs of inflammation
heat
swelling
redness
pain
loss of function
what is the purpose of the inflammatory phase
clot formation
remove damage tissue
recruit endothelial cells and fibroblasts
what happens with the initial reaction to protect a wound in the body
clot formation
vasodilation caused by histamines- redness and increase temp
chemotaxis
what are the general goals for therapist during the inflammatory phase
decrease swelling and pain
improve A/PROM
which modalities are recommended during the inflammatory phase
cryotherapy
compression
what is the purpose of the proliferative phase
cover the wound and impart strength to the injury site
what happens during the proliferative pahse
epithelization
collagen production
wound contraction
neovascularization
what is the marker that suggests shift between healing phases
acute neutrophil cells are replaced by long term macrophages correlating the change between inflammatory to proliferative
what are the goals during the proliferative phase
improve ROM
decrease pain and swelling
increase circulation
protect wound
promote appropriate alignment of collagen fibers
what is the purpose for maturation phase
restoration of prior function
what are the general goals for therapist during maturation phase
return to activity
increase ROM, strength, circulation
decrease pain
what phase does chronic inflammation fall into
maturation phase
what can chronic inflammation lead to and why
increase scar tissue and adhesion formation due to increased fibrotic tissue and collagen production
how can chronic inflammation stay in the maturation phase
repeated trauma
immune response to a foreign body
what factors affect healing process
local- where on the body
external- movement
systemic- individual
mental/emotional stress
what are the considerations for tendons/ligaments in the inflammatory phase
PRICE
what are the considerations for tendons/ligaments in the proliferation phase
ligaments - immobilization
tendons - early controlled forces
all for organized collagen alignment
what are the considerations for tendons/ligaments in the maturation phase
physiological loading important
recover full
normal tissue strength = 40-50 week post
what are the differences between adolescent and adult cartilage healing
adolescent cartilage has a capacity to heal where as adults have limited ability
what are the clinical indications for cryotherapy
control inflammation, pain, edema
reduce spasticity
what are the affects for cryotherapy with pain control
10-15 min of cryotherapy can control pain for 1-2 hours
what are the neuro physiological effects of cryotherapy
blocks pain receptors
decreases nerve velocity on A delta fibers
what are the hemodynamic physiological effects of cryotherapy
vasoconstriction
what is the difference between cold packs and ice packs
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.
when is controlled cold compression more effective
directly post surgery to control post- op edema/inflammation
what are the pros and cons for ice cup massage
pros: cost effective, quick, control pressure, target specific area
cons: messy, water can cause infection
what are the pros and cons for ice water immersion
pros: full coverage of contact area (greater surface area)
cons: limited application site, tolerance
what is vapocoolant spray
reduce muscle spasms and desensitizing trigger points
what are contraindications for cyrotherapy
cold hypersensitivity
cold intolerance
cryoglobulinemia
Raynaud’s disease
what are precautions to cryotherapy
over superficial main branch of nerve
open wound
hypertension
patient with poor sensation or mentation
what is conduction
energy exchanged by direct contact of stationary materials at different temp
what is thermal conductivity
rate at which a material transfers heat by conduction
what are rules for safely conduction
greater temperature difference = greater rate of heat transfer
conducive agents aren’t directly on skin
remove metal
6-8 layers of towels
what is convection
direct contact between circulating medium and another material of a different temperature
what is conversion
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
what does the rate of transfer depend on for conversion
power of the energy source
how does ultrasound convert to heat
mechanical form of energy - sufficient intensity to a tissue absorbs sound waves
how does diathermy convert to heat
electromagnetic form of energy - rotation of polar molecules convert to heat by friction
what is specific heat
amount of energy required to increase the temperature of a material
when can cold induced vasodilation occur
cold applied for greater than 15 minutes or when tissue temp reaches less than 50 deg
what are the muscular effects of cryo
decreased spasticity
increase muscular strength
what are the metabolic affects of cryo
decrease rate of inflammation by decreasing the activity of cartilage degrading enzymes and level of histamines
how does cryotherapy control acute edema
reduce histamines
increase blood viscosity
decrease blood flow
what are the uses of thermotherapy
accelerates tissue healing
pain management
alters collagen extensibility
what are the hemodynamic effects with thermotherapy
increase blood flow
increase capillary permeability
what are the neuro effects with thermotherapy
increased nerve conduction velocity
change frequency of nerve firing rate
increased pain threshold
how does thermotherapy change the frequency of nerve firing rate
relaxes muscles during stretch and spasm
decreased firing rate in muscle spindle
what are the muscular effects of thermotherapy
altered muscle endurance and strength
decrease during the first 30 minutes
what are the metabolic effects of thermotherapy
increased metabolic rate
more oxygen for tissue repair
increase destructive processes
how is soft tissue altered with heating
increase stretch
decrease risk of tearing issue
what is superficial heating agents used for
scar tissue and superficial tendons
what is deep heating agents used for
large deep muscles or deeper tendons
what are the clinical uses of superficial heat
increase ROM
decrease jt stiffness
superficial m relaxation
what modalities can decrease jt stiffness
warm paraffin
warm water bath
infrared lamp
how can thermo help with accelerated healing
increasing circulation and enzymatic activity rate
what are contraindications of thermotherapy
acute trauma, MSK, inflammatory conditions
DVT
recent or potential hemorrhage
impaired sensation
impaired cognition
malignancy
what are the precautions of thermotherapy
pregnancy
poor circulation or thermal regulation
edema
metal
open wound
what are the adverse effects of thermotherapy
burns
fainting
bleeding
what is the application of hot pack
6-8 layers of protection
treatment time 20-30 minutes
check skin before and after treatment
what is the application of dip wrap paraffin
dip 5-10 times, then wrap hand in a plastic bag and a towel to insulate heat
10-15 minutes
what are the thermal effects of ultrasound
continuous ultrasound penetrates more deeply
greater effect with tissues high in collagen (tendons, ligaments, jt capsule, fascia)
what are the non thermal effects of ultrasound
pulsed ultrasound promotes tissue repair in all phases of wound healing
how do we choose frequency for ultrasound
depth of target tissue
1= deeper
3= superficial
what are the number of treatments needed for results with ultrasound
1-3 treatments effect should be detectable
what are the parameters of 1 MHz frequency
1.5 to 2.5 W/cm2
5-10 minutes (8 minute rule)
what are the parameters of 3 MHz frequency
.5 to 1.0 W/cm2
5-10 minutes (8 minute rule)
what are the parameters for cleaning the ultrasound
clean tranducer head before and after
clean skin before
how do you set up SWD
select SWD setting
select edit
change mode to continuous, adjust power to desired watts
how do you set up SWT
choose clinical protocol
select body region
select treatment goal
dose and treatment parameters
what are the dosage levels for diathermy
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
what is cavitation
alternating compression and expansion of gas bubbles in tissue fluids caused by mechanical pressure
makes cell membrane more permeable
what is microstreaming
eddying that occurs around any vibrating object
what is acoustic streaming
movement of fluids along boundaries of cell membrane resulting from mechanical pressure waves
what does acoustic streaming produce
alterations in cell membrane activity, increased wall permeability, and increased intracellular calcium
what are the nonthermal effects of ultrasound
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
what are the clinical uses for ultrasound
soft tissue shortening (continuous)
tendon and ligament healing
bone fractures
jt inflammation (pulsed)
phonophoresis
how much should tissue increase in temperature with ultrasound for soft tissue shortening treatment
3-8 deg C
how might ultrasound be used for pain control
stimulate thermal receptors
increase soft tissue extensibility
change nerve conduction through temp
modulation of inflammation (non thermal)
what duty cycle should be used for ultrasound to treat pain control
continuous duty cycle
what parameters should be used for ultrasound to treat soft tissue healing and inflammation
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
what parameters should be used for ultrasound to treat tendon inflammation in the acute phase
pulsed duty cycle 20%
3 MHz - .5-1.0 intensity for 3-10 minutes
what parameters should be used for ultrasound to treat tendon inflammation in the subacute/chronic phase
continuous duty cycle
increase intensity as tolerated
combine with stretching assist in resolving chronic tendinitis
what parameters should be used for ultrasound to treat bone fractures
pulsed duty cycle 20%
1.5 MHz - .15 intensity for 15-20 min/day
what is phonophoresis
application of ultrasound with a topical drug as the medium
what is the benefit of phonophoresis
higher initial drug concentration
avoids stomach issues
avoids initial metabolism
works with thermal/nonthermal effect of increased permeability of skin (caviation)
what is the treatment of phonophoresis mainly used for
to deliver corticosteriods and local analgesics
used to treat tendinitis, CTS
6 treatments
what parameters should be used for phonophoresis
medication gel - medium
pulsed duty cycle 20%
3 MHz - .5-1.0 intensity for 5-10 minutes
lower intensity for longer time
what are the contraindications for ultrasound
tumor
pregnancy
CNS tissue if exposed by laminectomy above L2
over jt replacement
pacemaker
over the eyes
near reproductive organs
what are the precautions for ultrasound
acute inflammation
epiphyseal plates
fx
breast implants
what are adverse effects of ultrasound
burns
cross contamination
what does heat produced by ultrasound depend on
absorption coefficient
energy delieverd
what does energy delivered by use of ultrasound depend on
intensity
duty cycle
what does absorption coefficient by use of ultrasound depend on
collagen
frequency
after heat is delivered by ultrasound and absorbed, what does the remainder of attentuation due to
reflection and refraction
what is attentuation
as ultrasound enters, it gradually decreases in intensity due to frequency and tissue
what is wave transmission frequency for 3 MHz
increases with with wave frequency
less energy to deeper tissue
2-3 cm depth
absorb 3-4 x faster
what is wave transmission frequency for 1 MHz
lower frequency penetrates deeper
up to 6 cm deep
absorption slower
what is the reflected field
when 1 MHz reflects off bone and comes back to the skin
what is beam nonuniformity ratio
peak/average
what is spatial peak intensity
peak intensity of the ultrasound output over the area of the transducer
greatest in the center
what is spatial average intensity
average intensity of the ultrasound output averaged over the on/off time of the pulse
what is the ERA of ultrasound
effective radiating area
2x the sound head surface
what is piezoelectric
change the shape in response to the electric current
how does the piezoelectric work within the crystal
expand and contracts at same frequency of current
crystal expands as molecules in front are compressed and vice versa
how does the piezoelectric crystal work
crystal converts electric energy to acoustic energy
crystal is mechanically deformed
what is the advantage of ultrasound
depth of tissue penetration
2-5 cm deep
what structures are ultrasound best used for with thermal
high collagen content: tendon, ligament, capsule, fascia
what is therapeutic ultrasound
high frequency mechanical waves delivered by acoustic energy
what is EMR
composed of electrical and magnetic fields that vary over time and are oriented perpendicular to one another
what physical agents can deliver EMR
infrared radiation- superficial heating
microwave/shortwave = diathermy
how are wavelength and frequency related with EMR
inversely proportional
what is lower frequency EMR
nonionizing - cannot break molecular bonds, medically safe
shortwaves, microwaves, IR, visible light, UV
what is higher frequency EMR
ionizing- can break molecular bonds and inhibit cell division
very small doses for imaging
large doses to intentionally destroy tissue
when is intensity of EMR greatest
energy output is high
radiation source is close to the patient
beam is perpendicular to skins surface
what can physiological effects depend on with EMR
frequency/wavelength
intenisity
what applicators can produce diathermy
inductive coil
capacitive plates
magnetron
what tissues do inductive coil target
muscle
what tissues do capacitive plates
fat
what are the nonthermal effects of diathermy
modulates pain, edema, inflammation through altered cell membrane function and activity
increased microvascular perfusion
increased blood flow/circulation
what are the advantages of SWD diathermy
can heat larger areas than US
can heat deeper than hot pack
can be used when direct contact of agent is contraindicated
what are diathermy disadvantages
radiation
expensive
what are the advantages of SWT diathermy
accelerates edema resolution
reduce pain after injury
accelerate soft tissue healing (wound care)
what are the characteristics of laser light
monochromatic
coherent
directional
what is low level laser therapy
low intensity cold laser - non thermal
low level light device visible red and IR range
used to promote healing
control pain and inflammation
what is high intensity laser
hot laser
used for sx
cuts/destroys tissue
not for rehab
what is a cluster probe
applicator with more than one diode or type of diode of various wavelength and power
what is photodiodes
conductor of energy
laser diodes
LED
SLD
what are the characteristics of laser photodiodes
monochromatic
coherent
directional
superficial penetration - 5mm
high intensity= hot laser
low intensity= cold laser
what are the characteristics of the LED photodiode
polychromatic
noncoherent
nondirectional- diffuse spread of light, cover large area
deep penetration - 2-4 cm
longer application time
what are the characteristics of the SLD photodiode
almost monochromatic
noncoherent
nondirectional- spreads more than laser and less than LED
deeper penetration- 2-4 cm
shorter application time
what is the effect of wavelength in light therapy
depth of tissue penetration
longer wavelength=deep
shorter wavelength=superficial
what wavelength penetrates the deepest
IR penetrates more deeply than visible redlight
what photodiode penetrates the deepest
LED penetrates more deeply than laser
what is power in light therapy
unit of light intensity, class 3B
hot laser= high intensity= high power
cold laser= low intensity= low power
what is power density in therapy
irradiance- light intensity per unit area
what is energy in light therapy
dose
what is energy density on light therapy
fluence of treatment
preferred measure of dose
what is chromophores
gives tissue its color by absorbing some wave lengths and reflecting others
what are physiological effect of laser
stimulate mitochondria to produce more ATP
mRNA to promote fibroblasts increase collagen
vasodilation/circulation
inhibit bacterial/fungi growth
modulate inflammation
improve nerve conduction
what are the clinical indications for laser
wound healing/fx
neurological conditions
MSK disorder
lymphedema
pain management
what can a low dose be used for with laser
more acute or superficial conditions
what can a high dose be used for with laser
chronic or deeper conditions
what should we be aware of during treatment with laser
wear goggles
burns
what are the laser contraindications
directly to eyes
within 4-6 months of radiotherapy
hemorrhagic lesions
locally endocrine glands
malignancy
what are precautions of laser
pregnancy
epiphyseal plates
impaired sensation/mentation
photophobia
high sensitivity to light
what needs to be done documented with laser
area of body treated
treatment dose/energy density
