Exam 3: compression, SWD, light, UV, Stim Flashcards
1
Q
Compression: def
A
application of mechanical force that increases external pressure on the body
2
Q
Goal of compression
A
To improve fluid balance
3
Q
3 clinical uses of compression
A
1-decrease edema
2- prevent DVT
3- limb and scar reshaping
4
Q
(compressions) edema can lead to what…
A
restricted ROM, functional impairments, pain, disfiguration, itching, pigment changes, ulceration, infection, amputation
5
Q
effect of compression on hydrostatic pressure
A
increases hydrostatic pressure in the interstitial spaces. this limits the outflow of blood due to injury or dysfunction. improves circulation
6
Q
Intermittent vs static compression
A
IM may be more effective at removing fluid.
- compression moves fluid, relaxation allows refilling
7
Q
sequential compression
A
milking of fluid from distal to prox?
8
Q
effects of compression on shape and size of limb
A
- limits shape and size
- acts as second skin
- extensibility of garment gives differing effects (limb shaping vs burn)
- controls hypertrophic scaring (increases temp - collagenase)
- acts as an insulator and increases temp of tissue
9
Q
Indications for compression
A
- acute injury
- edema (medical origin, venous insufficiency, lymphedema)
- prevents DVT
- venous stasis ulcers
- controls hypertrophic scarring
10
Q
Compression and acute injury
A
- used as PRICE
- limits vascular leakage
- prevents 2ndary tissue damage
- speeds inflam phase
- ace wraps (distal to prox and figure 8)
- longer “on” time!
11
Q
Edema is the presence of….
*also where does it flow?, rich in?, common pathologies
A
presence of abnormal amounts of fluid in the extracellular space
- fluid is collected by lymphatics and returned to subclavian vein
- lymphatic fluid rich in protein, water, macrophages
- pathologies - venous insufficiency, lymphatic dysfunction, acute inflam, CHF, liver failure, renal dysfunction etc..
12
Q
(compression) medical system dysfunction
A
possibly due to :
- cardiac
- kidney
- electrolyte imbalance
- vascular disorder
- tumor
***origin will determine if compression is indicated
13
Q
Venous insufficiency and pressure at R atrium and ankle and what happens with gastroc contraction
A
- low pressure system
- R atrium = 4.6 mmHg
- increases .77 per cm below that
- ankles around 90 mmHg
- gastroc/soleus complex provide 200 mmHg compression *** main factor in pumping!!
- relax it falls to 10-30 mmHg
- in supine 20-25 mmHg
14
Q
purpose of valves
A
- prevent backwards flow of blood
- lack of activity or dysfunction leads to edema
- bedrest, prolonged sitting, sedentary lifestyle
15
Q
Phlebitis
A
- most common cause of insufficiency
- thickening of walls increase hydrostatic pressure (HP)
- damage to valves allows backflow increasing HP
- exacerbated by gravity
16
Q
Lymphedema (primary and secondary)
A
- lymphatic channels prevents lymph from building up in intestinal spaces (high conc of protein)
- Primary = congenital disorders
- secondary = due to other disease or dycfunction (flow blocked or insufficiency due to preg, inflam, radiation, trauma, surgery, tumor, etc.)
17
Q
DVT cause and stuff
A
- when circulation is poor or inflammation of vein
- slow allows it to coagulate and form thrombus
- most common after surgery, immobilization, HF or stroke
- can cause PE
- use TED hose or TEDs (16-18 mmHg)
18
Q
Residual limb shaping with compression
A
- static compression
- shown to reduce limb size in half the time
- Mech (reduces edema, reduces stretching of soft tissue, shapes limb)
19
Q
Hypertrophic scarring and compression
A
- these scars are not pliable, have raised edges, and loss identity of skin
- poor cosmetics, limit rom and function
- mech (Shapes and acts as mold, decrease edema, improve collagen orientation, limit o2 helping collagenase)
- begins once new epithelium formed and continues for 8-12 months
20
Q
Applying compression bandage
A
- figure 8
- avoid circumferential wrapping
- distal to prox
- mod compression without impairing circulation
- differing amounts of elasticity available
21
Q
Resting vs working pressure
A
Resting = exerted by elastic bandages Working = produced by muscles working against more inelastic bandages
22
Q
Intermittent and/or sequential pneumatic pumps (application tech)
A
- typically in clinic and followed with wrapping
- done for hours per day or week ( 20 mins to 8 hrs a day)
- controversial for lymphedema
23
Q
IMC (intermittent?) parameters application tech
A
- 3 on: 1 off
- chronic = 15:5 sec
- acute = 45: 15 sec
- UE (30-60), LE (40 -80)
- for 2-3 hours
- never exceeded diastolic BP
- acute wants longer times to decrease on going edema
- chronic wants shorter times to create “pumping”
24
Q
Adverse effects of compression
A
- aggravates injury
- aggravates underlying medical patho
- undesired changes in BP
25
can SWD produce depolarization and muscle contractions?
No
26
SWD and thermal stuff
- inc tissue temp
- inc blood flow (vasodilation)
- inc venous and lymphatic flow
- inc metabolism
- changes in physical properties
- relaxation
- analgesia (pain)
27
pulsed SWD also known as?? (3)
- Pulsed electromagnetic ENERGY
- Pulsed electromagnetic ENERGY TREATMENT
- Pulsed electromagnetic FIELD
28
SWD non thermal
- injuries and wounds
- changes cell membrane funct
- ion binding
- activates fibroblasts
- inc macrophage activity
- ATP and protein synthesis
- pain reduction
- corrects cell dysfunction
29
SWD condensor (capacitive) vs induction
Condensor (capacitive)
- part of electrical circuit
- plates on both sides
- heats a greater area
- depth 2-5 cm and uneven
Induction
- in the electromagnetic field
- use drum or coil
- heats area under drum or coil
- greater depth up to 5 cm and even heat
30
SWD vs ultrasound (draper)
SWD produces the same mag and depth of muscle heating as 1MHz US
31
Tissue heating and types
(inductive heats -
capacitive, microwave, US
inductive best with muscle
capacitive best with fat
microwave best with muscle
US best with muscle
32
SWD treatment setup
- 1 layer of toweling
* Plates (equal distance)
* drum (put over toweling, greatest directly below)
- keep movement to min.
- 20 mins
33
Capacitor electrodes distance and stuff
- closer to skin the hotter
- closer together = more surface heat
- parts of body low in subcutaneous fat best treated
34
Capacitor electrodes: electrical field and stuff
- cause movement from one pole to another
- center has higher density
- patient is part of circuit (in a series arrangement)
- heating occurs by rapid rotation of dipoles
35
Dipole heating of Capacitor (condenser) SWD
- AC cycles causing dipoles ro align
- high number of dipoles (skin and muscle) require more energy - less heating
- low number of dipoles (fat) require less energy - rapid (over) heating
36
Capacitor (Pad electrodes)
- greater electrical field
- part of circuit
- must have uniform contact
- space is cross-sectional diameter of pads
- part to be treated should be in center
*** increase spacing increase depth and decreases circuit density
37
SWD indication
- wont tolerate pressure
- area where fat is thick and need to heat deep
- treating large area!
38
Mettler Auto-therm SWD machine (silver)
CSWD *continuous* = Peak power (Pp)
PSWD *pulsed* = Mean power (Mp)
Mean power = peak power (watts) * % of pulse on time (pulse width x freq/ 1 million)
39
Magnatherm heating SWD (dinosaur looking thing)
Dose 1 = lowest = no heat
Dose 2 = low = mild heat
Dose 3 = med = mod or pleasant heat
Dose 4 = high = vigorous
40
Rebound SWD
100% = 1-2 degrees C per 3-4 mins
< 35% = non thermal
**need to tune
41
Types of light therapy
- photo
- laser
- low level laser
- cold laser
- soft laser
- low energy laser
- infrared
42
(triangle slide thingy( at 600-950 nm light causes cellular photoreceptor stuff)
- wound healing
- tissue repair
- prevents tissue death
- dec inflam, pain, edema
- acute injuries
- chronic injuries
43
LASER stands for?
Light Amplification by Stimulated Emission of Radiation
44
Electromagnetic modality and level of heating
| UV, visible, IR
```
UV = superficial
Visible = medium
IR = deep
```
45
is laser light monochromatic?
YES. same wavelength and color
46
light therapy history
- einstein idea
- theodore maiman first produced 1960
- produced LASER
- work on high power
- edward mester used to try destroy tumors
- FDA cleared in 2002
47
Behavior of light
- wave and a photon
- gyrates at unique freq
- has electrical and magnetic properties
- visible and nonvisible
- variation in wavelength leads to different responses
- red and near IR thought to have therapeutic properties
48
High power vs low power
High power used to create thermal changes
cold laser uses less power and cause photochemical changes
( direct effect = absorption of photons..... indirect effect = chemical events that are caused by interaction of photons from laser and the tissue)
49
Laser classification
class - power - effect
```
1 = <500 = therapy
4 = 500mW = cutting laser. damage.
```
50
Light therapy characteristics
at 600-1300nm optimized for tissue penetration to 1mm-4cm
- near IR is deepest 30-40 mm
- Red - 5-10mm
* ** longer wavelength -> lower freq -> deeper penetration
* deeper effects thought to occur from resultant chemical reactions
51
Advantages of light
- safe
- min side effects
- non thermal
- simple to use
52
Energy (J) = power (W) * time (s)
Energy density = energy / target area (cm2)
for ref..
53
Light: promoting ATP production
- light penetrates skin
- transforms into biochemical energy (photons)
- photons absorbed by chromophores
- cellular mitochondria generates ATP and NO
- fuels physiologic response restoring normal cell function
54
Light: acute inflammation reduction
LLLT (low level light therapy???) mediates both symptoms and underlying inflam process
- increased cell ATP production
- dec neutrophils
- accel macrophage activity including fibroblast prolif.
- vasodilation via prostaglandin, histamine, NO, and serotonin facilitating repair and debris removal
- enhanced lymphocyte activation
- increased angiogenesis
55
Light: pain reduction
- combination of local and systemic effects
- utilizing enzymatic, chemical and physical interventions
- inc beta endorphins
- block C fiber afferants
- inc NO production
- inc nerve cell AP
- nerve cell regen
- dec bradykinin
- inc ACh
- ion channel normalization
56
Light: tissue healing
thought to improve open surface wounds and tissue injuries
- enhance leukocyte infiltration
- inc macrophage activity
- inc neovascularization
- inc fibroblast activity
- early epithelialization
- inc growth factor
- enhance cell proliferation and differentiation
- greater wound tensile strength
- 4-16 J/cm2
57
Light: inhibit bacterial gorwth
- red laser dose dependent bactericidal effect on S. aureas and P. aeruginosa
- some wavelengths may help so make it worse?????
58
Light parameters: visible red
(620-750 nm)
- superficial penetration (up to 1 cm)
- wound healing, superficial target sites
59
Light parameters: Near Infrared
(750-1400nm)
- moderate and deeper penetration
- wide variety of musculoskeletal conditions
60
Light parameters: visible blue
(450-495nm)
- surface absorption
- bactericidal effects (acne, MRSA)
61
Light: Photostimulation
- chain of chemical rxns is triggered by exposure to light
- cell is provided with more energy
- cell is in optimum condition to play its part in healing process
62
Light: photobioinhibition
- chain of chemical rxns are blocked or delayed due to exposure to light
- higher dose causes hyperactivity of Ca/ATP-ase pump and exhaust ATP reserve. causes cell to explode.
63
Light parameters: total energy for....
acute
sub-acute
chronic
acute 1-20 J/cm2 (stim)
20-40 J/cm2 (stim)
40-60 J/cm2 (inhibit)
64
UV: effects and depth depends on
- freq
- wavelength (UVA = several mm, UVB and C = superficial epidermis)
- size of irridated
- thickness and pigment of skin
- duration
- intensity (distance, power, and angulation)
65
UV: erythema production effects
- dilation of superficial; blood vessels
- histamine and prostaglandin release
- Primarily UVB
- excessive can cause burning, blistering, and cell damage (sun burn)
66
UV tanning effects
protective response limiting depth of penetration (increased production and upward movement of melanin)
67
UV epidermal hyperplasia
- increased epidermal synthesis and turn over
- results in higher intensity of subsequent treatments
- takes place ~ 72 post exposure
68
UV: vitamin D synthesis
UV irradiation is needed for conversion of ingested provitamin D to vitamin D
* important for proper calcium absorption for mineralization
69
UV: Psoriasis
- uncommon benign autoimmune chronic inflam condition causing increased rate skin cell production
- bright red plaques with silver scales (dead skin)
- common on knees, elbows and scalp
*UV thought to inactivate cell division and inhibit DNA synthesis (most responsive to PUVA)
** initial dose 50% - 2.5x MED
70
UV: wound healing
lower evidence
| -UVC better seen as a germicidal agent?
71
UV: adverse effects
- burns
- premature skin aging
- actinic damage - AKs are PRECURSOR lesions to the squamous cell type of skin cancer. Pre-cancerous growths
- eye damage
- carcinogenesis-melanoma, squamous cell
- PUVA meds
72
Signs of skin cancer (moles)
- asymmetry
- border (ragged or irregular)
- color (multi)
- diameter (bigger than a pencil eraser)
73
UV applying
- determine patient sensitivity
- caries with pigment, age, prior UV and meds
- min erythema dose (MED)
- must use same lamp!
* **typical initial dose is .5-1 MED
* ** increase 10-40% for subsequent dose
74
Suberythemal dose (SED)
-no change in skin redness in 24 hours
75
Minimal erythemal dose (MED)
-small dose that gives redness in 8 hours and disappears in 24 hours
76
First degree erythema
- mild desquamation in 6 hours and lasts 1-3 days
| - ~2.5 MED
77
Second degree erythema
- intense erythema, peeling, blistering, like sun burn
| - ~ 5 MED
78
third degree erythema
- severe blistering, peeling and exudation
| - ~10 MED
79
E-Stim uses
- muscle contraction
- tissue healing
- strengthening and re-education
- pain control
- delivers meds
80
Absolute vs relative refractory
Absolute = no AP possible. during depolarization
Relative = needs a stronger than normal one
81
Term: electrical current
movement or flow of charged particles
| from high to low
82
Term: Ampere
indicates rate of flow
1 amp = 1 coulomb / sec
1 coulomb = 6.25 x 10^18 electrons
83
Term: voltage
electrical force capable of moving particles through a conductor
-Volts
84
Term: resistance
a conductors opposition to electron flow
-Ohms (R)
85
Term: impedance
total opposition to current flow
86
Ohm's law
V=IR
| voltage = current flow * resistance
87
Order of conductance (best to worst)
Blood -> muscle -> fat -> bone
88
Term: watt
unit of electrical power
Watts = volts X amperes
89
Term: polarity
property of having 2 oppositely charged conductors
```
Anode = positive (flow to)
cathode = negative (flow from)
```
90
What are the 3 types of electrotherapeutic currents?
```
Direct current (DC)
Alternating current (AC)
pulsed current (PC)
```
91
Direct current wave type. what it is and uses
-continuous, unidirectional flow of charged particles
uses
- stimulating denervated muscles
- wound healing
- iontophoresis
92
Alternating current wave type. what?
-continuous bidirectional flow of charged particles
93
Pulsed current wave type
-an interrupted flow of charged particles where current flows in a series of pulses
94
Graphically waves indicate what 5 things?
- shape
- direction
- freq
- amplitue
- duration
can be sinusoidal, square, rectangle, or spiked
95
Mono vs bi vs polyphasic
each indiv. waveform is a pulse which contains phases
96
Symmetrical vs balanced asymmetrical vs unbalanced asymmetrical
- determines if there is a net charge.
| - unbalanced asymmetrical leaves a net charge in the body
97
Waveform freq represents what?
the number of pulses per second (Hz)
98
Waveform amplitude represents what?
represents the intensity of the current (voltage)
| - does not represent the amount of current delivered.
99
```
Terms:
pulse duration
phase duration
interpulse interval
interphase interval
```
pulse duration = how long each pulse lasts (microsec)
phase duration = length of time for 1 phase
interpulse interval = time btwn pulses
interphase interval = time btwn phases
100
Waveform on/off time
on time = time when pulses flow
| off time = time btwn pulses (off)
101
Ramp up vs ramp down and importance
Ramp up = 0 to max amplitude
ramp down = max amplitude to 0
*for patient comfort
102
The electricity required to produce an AP depends on?
-amplitude and pulse duration
103
Rheobase vs chronaxie
rheo: min amplitude with a long pulse duration needed to produce an AP
Chron: min duration it takes to stim tissue at 2x rheobase intensity
104
What is the relationship btwn freq and pulse duration?
inverse
105
What is accommodation?
- nerves become less responsive to the stim
- often occurs with a slow rate of current rise (K+ leaks)
- most resistant shapes = square/rectangle
106
How do you prevent accommodation?
Modulation!!
| -alter amplitude, frequency, or duration
107
where is current density highest with e-stim
-higher at the surface
108
adverse effects of e-stim
Burns (more common with AC/DC)
| -be aware of current density with electrode size and skin contact)
109
How does electrode placement effect current depth?
farther apart = deeper current
| closer together = more superficial
110
What are the 3 types of TENS?
- conventional TENS
- Low rate TENS
- burst mode TENS
111
Conventional TENS info stuff
- "tingling"
- aka high rate
- no muscle contraction
- focus on gate theory (activates A-beta)
- only helps when it is working (no long term)
- may be used up to 24 hours
- current needs to be modulated to limit accommodation
112
Conventional TENS: basic waveforms
- pulsed biphasic
- interferential current (IFC)
- Premodulated
**parameters stay the same
113
IFC (interferential current)
-type of conventional TENS
-why use it?
- use 4 pads
- 2 leads
- produces beats from interference of 2 waves
- original freq = carrier freq
- more comfortable (lower amp, deep tissue)
- delivers more total current
- large area
114
Premod current (type of conventional TENS)
- 1 channel, 2 pads
- 2 freq are combined within machine
- modulates amplitude for accommodation stufff
115
Pulsed biphasic ( conventional TENS)
- most common
- only needs 2 electrodes
- may NOT get same beneficial effects as IFC
116
Conventional TENS parameters
Freq
pulse duration
amplitude
time
Freq = 100-150 pps
pulse duration = 50-80 microsec
amplitude = tingling
time = as needed (24 hours even)
117
low rate TENS. what does it do?
- muscle contractions and stims A delta fibers
- endogenous opioids (long lasting)
- descending modulators of pain transmission (good for more chronic pain)
- low rate refers to freq.
118
low rate TENS parameters
freq
pulse duration
amplitude
time
freq = 2-10 pps
pulse duration = 200-300 microsec
amplitude = visible contraction
time = 20-30 mins
119
Burst mode TENS
- delivers in "bursts" of pulses
| - similar to low rate
120
How can you use E-stim for tissue healing?
You attract or repel things to the area
- help activate cells with the charge
- promote circulation
- modifies electrical potential
- antimicrobial effects
121
What is galvanotaxis?
the attraction of cells to an electrical charge
| many cells that have a charge effect healing
122
How does e-stim effect fibroblast activity?
- increases Ca++ influx
- exposes more insulin receptors
- activated insulin receptors -> fibroblast activity
123
E-stim and healing and VEGF
vascular endothelial growth factor release possibly promoted.
-it is a signal protein that promotes angiogenesis
-enhances microcirculation (O2 and nutrients)
124
Normally skin is negatively charged. injury causes it to be positive. importance?
- "current of injury"
| - can use stim to attract things to the area!
125
What types of waves have been found to promote antimicrobial activity?
AC/DC/Pulse
DC and pulse have
| AC no
126
Tissue healing parameters and e-stim
- waveform
- polarity
- pulse freq
- pulse duration
- amplitude
- time
- waveform = HVPC
- polarity = Depends on stage. negative for acute. positive for prolife and maturation
- pulse freq = 60 - 125 pps
- pulse duration = 40-100 microsec
- amplitude = comfy tingling
- time = 45-60 mins
127
How can e-stim be used for edema? on micro level
* do not use if edema is systemic in nature (CHF)
* **USE NEGATIVE HVPC! 20-30 mins
- repels negatively charged stuff blocking movement out of vessels?
- reduce blood flow by reducing vessel diameter?
- reduce pore size?
they not sure!
128
using e-stim for edema: muscles
```
-muscle pumping!
use biphasic
freq = 30-50
duration 150-350 microsec
amp = contractions
time = 20-30 mins
```
129
How does iontophoresis work?
- like charges repel
- local administration of drug
- depth is 3-20 mm
130
iontophoresis parameters.
```
Dexamethasone = negative
lidocaine = positive
```
- total electricity = 40 mA-min
- (current amp) max of 4 mA to reduce risk of burn
- polarity depends on drug
- time depends on current amp
131
Adverse effects of iontophoresis
under the negative side = NaOH (alkaline rxn - more pronounced)
under the positive side = HCl (acidic rxn)
132
What is russian protocol?
bursts delivered at 10 msec with same time for rest. for denervated muscle????
133
Physiologically what muscle type activates first?
Electrically?
Phys: slow twitch first (type 1)
electrically: fast twitch (type 2)
134
what % MVIC is needed for strengthening in health muscle vs injured or weak
healthy = 50%
injured or weak = 10%
135
when placing electrodes for muscle contraction you want to what??
- have them parallel to the muscle fibers
| - try to put over motor point!
