Exam 3 Flashcards
Contraindications for electrotherapy
- Demand type cardiac pacemaker
- Cardiac arrhythmia
- Over the carotid artery
- Hypersensitive patients
- Pregnancy
Precautions for electrotherapy
- Check equipment: leads, power cord, electrodes
- Change intensities slowly
- Always turn down intensity before changing other parameter controls
- Avoid concentrations of current (skin cuts, creases in electrode pads, poor contact of electrodes)
- Avoid dispersal of current (gel smeared outside the electrode area)
Precautions for Iontophoresis
- electrode burn
2. adverse drug reaction
Two main types of drugs used for Iontophoresis
- Lidocaine (pain killer) +
2. Dexamethasone (anti-inflammatory) -
Other drugs used in Iontophoresis
- Magneisum + ( muscle relaxant, vasodilator)
- Calcium + ( spasmodic conditions, tics)
- Chlorine - (scar tissue, burns)
- Actate -
- Ringer’s solution +/- (decubitus lesions)
CPM Indications
- to reduce blood/fluid accumulation in and around joints following trauma/surgery
- maintain motion following injury or surgery
- prevent stiffness following injury or surgery
CPM Contraindications
- if ligaments are insufficient
- joint stability
- if fracture fixation has not been attained
CPM Precautions
- may increase wound drainage
- wound swelling could risk incision healing (swollen incision = milk extra fluid before beginning)
- do not have circumferential dressings in place when using CPM (can cause abrasions
- check position often to prevent pressure nerve palsies
CPM Treatment time
continuous except for bathroom breaks
CPM Length of Treatment
7-10 days, although may be used for 21-30 if needed
CPM Positioning
to maintain proper axes of motion
CPM arc of motion
establish per surgeon
TENS
transcutaneous electrical nerve stimulation
TENS waveform
- monophasic
- biphasic
- polyphasic
TENS amplitude
- large myelinated fibers requires less than small diameter unmyelinated fibers
- distant fibers more current than local fibers of the same size
TENS pulse duration
- 50-200
- brief for larger diameter myelinated fibers
- long for small unmyelinated fibers
TENS Frequency
1-150 Hz
- sensory fibers fire at higher frequency, pain fire at lower frequency
- bombards CNS with different frequency
- frequency and pulse width are related
- higher frequency correlates to smaller pulse width
TENS accommodation
- negative charge inside the cell
- slower change in voltage = balanced voltage which we don’t want
- vary frequency and intensity to minimize accommodation
TENS accommodation prevention
- increase voltage faster than the cell can equalize voltage
- units will have different modes
- burst
- modulation
- SMP
- continuous
TENS use
- electrode pads
- 2 channels
- lead wires
- batteries
- unit: TENS only, or combo units that have IFC, NMES, and TENS
Conventional TENS
Frequency: 40-100Hz Pulse Width: <200 Amplitude: between initial perception and discomfort Duration: indefinite Time: 2-4x/day, 10-30 mins each session Best for ACUTE pain Gate control
Low Frequency TENS
Frequency: 1-5Hz
Pulse Width: 300-400
Amplitude: produce a visible twitch w/in pain tolerance
Duration: 30-45 mins due to muscle fatigue
Time: 2-3x/day, at least 30 mins per time
Best for Chronic pain
endorphin action
- delayed yet long lasting relief
TENS hyperstimulation
pulsed biphasic
Frequency: maximum setting
Pulse: maximum setting
Amplitude: pain tolerance
Duration: 15 mins, followed by 2-3 min rest, can repeat 2-3 times
- used when wanting quick and long lasting relief but at a cost of painful application
TENS electrode placement
- bracket pain
- acupuncture points
- dermatome
- spinal cord levels
- skin irritation from pads
- areas of decreased sensation
TENS considerations
- pt. may reduce pain medications to monitor effectiveness
- not in our scope to change medication, has to be doc
- 32% placebo effect
- pain questionnaire
TENS contraindications
- Demand type cardiac pacemaker
- Cardiac arrhythmia
- Over the carotid artery
- Hypersensitive patients
- Pregnancy
TENS Precautions
- areas of decreased sensation have remote potential for burns
TENS Indications
- diseases that damage tissue (cancer, RA)
- pain is the only problem
- sympathetically maintained pain (edema, skin changes, temperature changes)
- myofacial pain
- pt. looking for secondary gain (psychosocial yellow flags), they get more from being in pain
Laser Contraindications
- don’t treat tumors or cancerous lesions
- pregnancy is a precaution for legal reasons
- don’t apply over thyroid gland due to selective uptake of energy by iodine
- do not treat bacterial infections
- pts. who are on immunosuppressant drugs
- if pt. starts to feel pain/weakness
- pt. who are taking medications (retain-a), warned to avoid bright sunlight
Laser Precautions
- do not look at the beam or allow pt. to do so
- have a “danger laser” sign at the treatment room door
- turn the laser off before removing it from the skin
- pt./PT should wear protective safety goggles
- do not treat until 2 weeks after steroid injection
- be careful over tattoos (dyes my become hot)
- use care w/children due to sensitive skin
Laser Pretest
safest to perform a skin test initially with 10-25 joules on the arm or leg
- wait 5 minutes and if no adverse reactions, pt. may be treated.
Laser Treatment Acute
treated 2-3 times per week
Laser Treatment Chronic (subacute)
treated 2 times/week initially and then decreased to 1 x per week
Laser Initial treatment power
- children 12 and younger should be started at 25J or less
- pt. w/serious systemic diseases or chronic woulds or pain should also be started at 25J or less
- healthy adults should be started at 50J or less
Laser Treatment Progression
each successive treatment should increase power no more than 50% of the previous treatment
Laser Maximum Dosage
Children: 50J
Adult: 200J
Laser signs of appropriate dosage
- warm/tingling sensation
- improvement in functional capacity
- decreased tenderness
Laser symptoms of Excessive treatment
- pt. fatigue, nausea or headache
- increased symptom severity
- muscle spasm in treated area
Laser calculation of treatment time
- based upon the pt. category (child, adult)
- which treatment and progression
- probe output
- 0.5in/sec = head speed
Laser History
- developed in the 1960s
- promotes healing
Laser wavelength
best range is 600-900nm
- below 600nm is dangerous for causing cell damage
- above 900nm the energy is absorbed so quickly that heating occurs which can damage
Laser penetration depth
in proper 600-900nm frequency range laser may penetrate to 3-6 cm
