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PTH 500 applied phys > Exam 3: compression, SWD, light, UV, Stim > Flashcards

Exam 3: compression, SWD, light, UV, Stim Flashcards

1
Q

Compression: def

A

application of mechanical force that increases external pressure on the body

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2
Q

Goal of compression

A

To improve fluid balance

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3
Q

3 clinical uses of compression

A

1-decrease edema
2- prevent DVT
3- limb and scar reshaping

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4
Q

(compressions) edema can lead to what…

A

restricted ROM, functional impairments, pain, disfiguration, itching, pigment changes, ulceration, infection, amputation

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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

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6
Q

Intermittent vs static compression

A

IM may be more effective at removing fluid.

- compression moves fluid, relaxation allows refilling

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7
Q

sequential compression

A

milking of fluid from distal to prox?

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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
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9
Q

Indications for compression

A
  • acute injury
  • edema (medical origin, venous insufficiency, lymphedema)
  • prevents DVT
  • venous stasis ulcers
  • controls hypertrophic scarring
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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!
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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..
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12
Q

(compression) medical system dysfunction

A

possibly due to :

  • cardiac
  • kidney
  • electrolyte imbalance
  • vascular disorder
  • tumor

***origin will determine if compression is indicated

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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
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14
Q

purpose of valves

A
  • prevent backwards flow of blood
  • lack of activity or dysfunction leads to edema
  • bedrest, prolonged sitting, sedentary lifestyle
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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
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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.)
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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)
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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)
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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
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20
Q

Applying compression bandage

A
  • figure 8
  • avoid circumferential wrapping
  • distal to prox
  • mod compression without impairing circulation
  • differing amounts of elasticity available
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21
Q

Resting vs working pressure

A 
Resting = exerted by elastic bandages
Working = produced by muscles working against more inelastic bandages
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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
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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”
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24
Q

Adverse effects of compression

A
  • aggravates injury
  • aggravates underlying medical patho
  • undesired changes in BP
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25
Q

can SWD produce depolarization and muscle contractions?

A

No

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26
Q

SWD and thermal stuff

A
  • inc tissue temp
  • inc blood flow (vasodilation)
  • inc venous and lymphatic flow
  • inc metabolism
  • changes in physical properties
  • relaxation
  • analgesia (pain)
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27
Q

pulsed SWD also known as?? (3)

A
  • Pulsed electromagnetic ENERGY
  • Pulsed electromagnetic ENERGY TREATMENT
  • Pulsed electromagnetic FIELD
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28
Q

SWD non thermal

A
  • injuries and wounds
  • changes cell membrane funct
    - ion binding
    - activates fibroblasts
    - inc macrophage activity
    - ATP and protein synthesis
    - pain reduction
  • corrects cell dysfunction
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29
Q

SWD condensor (capacitive) vs induction

A

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
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30
Q

SWD vs ultrasound (draper)

A

SWD produces the same mag and depth of muscle heating as 1MHz US

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31
Q

Tissue heating and types
(inductive heats -
capacitive, microwave, US

A

inductive best with muscle
capacitive best with fat
microwave best with muscle
US best with muscle

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32
Q

SWD treatment setup

A
  • 1 layer of toweling
  • Plates (equal distance)
  • drum (put over toweling, greatest directly below)
  • keep movement to min.
  • 20 mins
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33
Q

Capacitor electrodes distance and stuff

A
  • closer to skin the hotter
  • closer together = more surface heat
  • parts of body low in subcutaneous fat best treated
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34
Q

Capacitor electrodes: electrical field and stuff

A
  • 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
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35
Q

Dipole heating of Capacitor (condenser) SWD

A
  • 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
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36
Q

Capacitor (Pad electrodes)

A
  • 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

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37
Q

SWD indication

A
  • wont tolerate pressure
  • area where fat is thick and need to heat deep
  • treating large area!
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38
Q

Mettler Auto-therm SWD machine (silver)

A

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)

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39
Q

Magnatherm heating SWD (dinosaur looking thing)

A

Dose 1 = lowest = no heat
Dose 2 = low = mild heat
Dose 3 = med = mod or pleasant heat
Dose 4 = high = vigorous

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40
Q

Rebound SWD

A

100% = 1-2 degrees C per 3-4 mins
< 35% = non thermal

**need to tune

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41
Q

Types of light therapy

A
  • photo
  • laser
  • low level laser
  • cold laser
  • soft laser
  • low energy laser
  • infrared
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42
Q

(triangle slide thingy( at 600-950 nm light causes cellular photoreceptor stuff)

A
  • wound healing
  • tissue repair
  • prevents tissue death
  • dec inflam, pain, edema
  • acute injuries
  • chronic injuries
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43
Q

LASER stands for?

A

Light Amplification by Stimulated Emission of Radiation

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44
Q

Electromagnetic modality and level of heating

UV, visible, IR

A 
UV = superficial
Visible = medium
IR = deep
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45
Q

is laser light monochromatic?

A

YES. same wavelength and color

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46
Q

light therapy history

A
  • einstein idea
  • theodore maiman first produced 1960
  • produced LASER
  • work on high power
  • edward mester used to try destroy tumors
  • FDA cleared in 2002
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47
Q

Behavior of light

A
  • 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
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48
Q

High power vs low power

A

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)

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49
Q

Laser classification

A

class - power - effect

1 = <500 = therapy
4 = 500mW = cutting laser. damage.
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50
Q

Light therapy characteristics

A

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
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51
Q

Advantages of light

A
  • safe
  • min side effects
  • non thermal
  • simple to use
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52
Q

Energy (J) = power (W) * time (s)

Energy density = energy / target area (cm2)

A

for ref..

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53
Q

Light: promoting ATP production

A
  • 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
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54
Q

Light: acute inflammation reduction

A

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
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55
Q

Light: pain reduction

A
  • 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
Q

Light: tissue healing

A

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
Q

Light: inhibit bacterial gorwth

A
  • red laser dose dependent bactericidal effect on S. aureas and P. aeruginosa
  • some wavelengths may help so make it worse?????
58
Q

Light parameters: visible red

A

(620-750 nm)

  • superficial penetration (up to 1 cm)
  • wound healing, superficial target sites
59
Q

Light parameters: Near Infrared

A

(750-1400nm)

  • moderate and deeper penetration
  • wide variety of musculoskeletal conditions
60
Q

Light parameters: visible blue

A

(450-495nm)

  • surface absorption
  • bactericidal effects (acne, MRSA)
61
Q

Light: Photostimulation

A
  • 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
Q

Light: photobioinhibition

A
  • 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
Q

Light parameters: total energy for….
acute
sub-acute
chronic

A

acute 1-20 J/cm2 (stim)
20-40 J/cm2 (stim)
40-60 J/cm2 (inhibit)

64
Q

UV: effects and depth depends on

A
  • 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
Q

UV: erythema production effects

A
  • dilation of superficial; blood vessels
  • histamine and prostaglandin release
  • Primarily UVB
  • excessive can cause burning, blistering, and cell damage (sun burn)
66
Q

UV tanning effects

A

protective response limiting depth of penetration (increased production and upward movement of melanin)

67
Q

UV epidermal hyperplasia

A
  • increased epidermal synthesis and turn over
  • results in higher intensity of subsequent treatments
  • takes place ~ 72 post exposure
68
Q

UV: vitamin D synthesis

A

UV irradiation is needed for conversion of ingested provitamin D to vitamin D

  • important for proper calcium absorption for mineralization
69
Q

UV: Psoriasis

A
  • 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
Q

UV: wound healing

A

lower evidence

-UVC better seen as a germicidal agent?

71
Q

UV: adverse effects

A
  • 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
Q

Signs of skin cancer (moles)

A
  • asymmetry
  • border (ragged or irregular)
  • color (multi)
  • diameter (bigger than a pencil eraser)
73
Q

UV applying

A
  • 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
Q

Suberythemal dose (SED)

A

-no change in skin redness in 24 hours

75
Q

Minimal erythemal dose (MED)

A

-small dose that gives redness in 8 hours and disappears in 24 hours

76
Q

First degree erythema

A
  • mild desquamation in 6 hours and lasts 1-3 days

- ~2.5 MED

77
Q

Second degree erythema

A
  • intense erythema, peeling, blistering, like sun burn

- ~ 5 MED

78
Q

third degree erythema

A
  • severe blistering, peeling and exudation

- ~10 MED

79
Q

E-Stim uses

A
  • muscle contraction
  • tissue healing
  • strengthening and re-education
  • pain control
  • delivers meds
80
Q

Absolute vs relative refractory

A

Absolute = no AP possible. during depolarization

Relative = needs a stronger than normal one

81
Q

Term: electrical current

A

movement or flow of charged particles

from high to low

82
Q

Term: Ampere

A

indicates rate of flow

1 amp = 1 coulomb / sec
1 coulomb = 6.25 x 10^18 electrons

83
Q

Term: voltage

A

electrical force capable of moving particles through a conductor

-Volts

84
Q

Term: resistance

A

a conductors opposition to electron flow

-Ohms (R)

85
Q

Term: impedance

A

total opposition to current flow

86
Q

Ohm’s law

A

V=IR

voltage = current flow * resistance

87
Q

Order of conductance (best to worst)

A

Blood -> muscle -> fat -> bone

88
Q

Term: watt

A

unit of electrical power

Watts = volts X amperes

89
Q

Term: polarity

A

property of having 2 oppositely charged conductors

Anode = positive (flow to)
cathode = negative (flow from)
90
Q

What are the 3 types of electrotherapeutic currents?

A 
Direct current (DC)
Alternating current (AC)
pulsed current (PC)
91
Q

Direct current wave type. what it is and uses

A

-continuous, unidirectional flow of charged particles

uses

  • stimulating denervated muscles
  • wound healing
  • iontophoresis
92
Q

Alternating current wave type. what?

A

-continuous bidirectional flow of charged particles

93
Q

Pulsed current wave type

A

-an interrupted flow of charged particles where current flows in a series of pulses

94
Q

Graphically waves indicate what 5 things?

A
  • shape
  • direction
  • freq
  • amplitue
  • duration

can be sinusoidal, square, rectangle, or spiked

95
Q

Mono vs bi vs polyphasic

A

each indiv. waveform is a pulse which contains phases

96
Q

Symmetrical vs balanced asymmetrical vs unbalanced asymmetrical

A
  • determines if there is a net charge.

- unbalanced asymmetrical leaves a net charge in the body

97
Q

Waveform freq represents what?

A

the number of pulses per second (Hz)

98
Q

Waveform amplitude represents what?

A

represents the intensity of the current (voltage)

- does not represent the amount of current delivered.

99
Q 
Terms: 
pulse duration
phase duration
interpulse interval
interphase interval
A

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
Q

Waveform on/off time

A

on time = time when pulses flow

off time = time btwn pulses (off)

101
Q

Ramp up vs ramp down and importance

A

Ramp up = 0 to max amplitude
ramp down = max amplitude to 0

*for patient comfort

102
Q

The electricity required to produce an AP depends on?

A

-amplitude and pulse duration

103
Q

Rheobase vs chronaxie

A

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
Q

What is the relationship btwn freq and pulse duration?

A

inverse

105
Q

What is accommodation?

A
  • nerves become less responsive to the stim
  • often occurs with a slow rate of current rise (K+ leaks)
  • most resistant shapes = square/rectangle
106
Q

How do you prevent accommodation?

A

Modulation!!

-alter amplitude, frequency, or duration

107
Q

where is current density highest with e-stim

A

-higher at the surface

108
Q

adverse effects of e-stim

A

Burns (more common with AC/DC)

-be aware of current density with electrode size and skin contact)

109
Q

How does electrode placement effect current depth?

A

farther apart = deeper current

closer together = more superficial

110
Q

What are the 3 types of TENS?

A
  • conventional TENS
  • Low rate TENS
  • burst mode TENS
111
Q

Conventional TENS info stuff

A
  • “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
Q

Conventional TENS: basic waveforms

A
  • pulsed biphasic
  • interferential current (IFC)
  • Premodulated

**parameters stay the same

113
Q

IFC (interferential current)
-type of conventional TENS

-why use it?

A
  • 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
Q

Premod current (type of conventional TENS)

A
  • 1 channel, 2 pads
  • 2 freq are combined within machine
  • modulates amplitude for accommodation stufff
115
Q

Pulsed biphasic ( conventional TENS)

A
  • most common
  • only needs 2 electrodes
  • may NOT get same beneficial effects as IFC
116
Q

Conventional TENS parameters

Freq
pulse duration
amplitude
time

A

Freq = 100-150 pps
pulse duration = 50-80 microsec
amplitude = tingling
time = as needed (24 hours even)

117
Q

low rate TENS. what does it do?

A
  • 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
Q

low rate TENS parameters

freq
pulse duration
amplitude
time

A

freq = 2-10 pps
pulse duration = 200-300 microsec
amplitude = visible contraction
time = 20-30 mins

119
Q

Burst mode TENS

A
  • delivers in “bursts” of pulses

- similar to low rate

120
Q

How can you use E-stim for tissue healing?

A

You attract or repel things to the area

  • help activate cells with the charge
  • promote circulation
  • modifies electrical potential
  • antimicrobial effects
121
Q

What is galvanotaxis?

A

the attraction of cells to an electrical charge

many cells that have a charge effect healing

122
Q

How does e-stim effect fibroblast activity?

A
  • increases Ca++ influx
  • exposes more insulin receptors
  • activated insulin receptors -> fibroblast activity
123
Q

E-stim and healing and VEGF

A

vascular endothelial growth factor release possibly promoted.
-it is a signal protein that promotes angiogenesis

-enhances microcirculation (O2 and nutrients)

124
Q

Normally skin is negatively charged. injury causes it to be positive. importance?

A
  • “current of injury”

- can use stim to attract things to the area!

125
Q

What types of waves have been found to promote antimicrobial activity?
AC/DC/Pulse

A

DC and pulse have

AC no

126
Q

Tissue healing parameters and e-stim

  • waveform
  • polarity
  • pulse freq
  • pulse duration
  • amplitude
  • time
A
  • 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
Q

How can e-stim be used for edema? on micro level

A
  • 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
Q

using e-stim for edema: muscles

A 
-muscle pumping!
use biphasic
freq = 30-50
duration 150-350 microsec
amp = contractions
time = 20-30 mins
129
Q

How does iontophoresis work?

A
  • like charges repel
  • local administration of drug
  • depth is 3-20 mm
130
Q

iontophoresis parameters.

Dexamethasone = negative
lidocaine = positive
A
  • 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
Q

Adverse effects of iontophoresis

A

under the negative side = NaOH (alkaline rxn - more pronounced)
under the positive side = HCl (acidic rxn)

132
Q

What is russian protocol?

A

bursts delivered at 10 msec with same time for rest. for denervated muscle????

133
Q

Physiologically what muscle type activates first?

Electrically?

A

Phys: slow twitch first (type 1)

electrically: fast twitch (type 2)

134
Q

what % MVIC is needed for strengthening in health muscle vs injured or weak

A

healthy = 50%

injured or weak = 10%

135
Q

when placing electrodes for muscle contraction you want to what??

A
  • have them parallel to the muscle fibers

- try to put over motor point!

PTH 500 applied phys (3 decks)

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