Final Flashcards
1
Q
What effects does spinal traction have?
A
- Jt distraction
- Reduction of disc protrusion
- Soft tissue stretch
- Mm relaxation
- Jt mobs
2
Q
How does traction treat a herniated disc?
A
Sucks the bulge back in
3
Q
How does traction work for soft tissue stretching?
A
Low load, static stretch
4
Q
How much force is required for lumbar joint distraction?
A
50% of BW
5
Q
How much force is required for cervical joint distraction?
A
7% of BW
6
Q
How much force is required for lumbar disc protrusion?
A
60-120 lbs
30-60% BW
7
Q
How much force is required for cervical disc protrusion?
A
15-30 lbs
8
Q
How does traction create muscle relaxation?
A
- Reduction of pressure on pain sensitive structures
- Stimulate Golgi tendons to inhibit alpha neuron firing
9
Q
How does traction create joint mobilization?
A
- High force or repetitive intermittent traction
- Mobilize multiple jt at once
- Manual techniques more localized
10
Q
What are clinical indications of traction?
A
- Disc bulge/herniation
- Nerve root impingement
- Jt hypomobility
- Subacute jt inflammation
- Mm spasm
11
Q
Should you use intermittent traction during the acute inflammatory phase?
A
No - may cause further injury
12
Q
What does static/low-load intermittent traction do for a muscle spasm?
A
May interrupt pain-spasm-pain cycle nd inhibit alpha neuron firing by depression of GTO
13
Q
What does higher load traction do for a muscle spasm?
A
May reduce the underlying cause of pain
14
Q
What should pt expect to feel with traction?
A
- Moderate pull
- No increase in symptoms
- Sx should not travel more
- Keep pain free
15
Q
What are some safety indications for traction?
A
- Empty bladder prior to traction
- Avoid heavy meals to tx
16
Q
Where is laxity when hips are flexed from 45-60 degrees?
A
L5-S1 segments
17
Q
Where is the laxity when hips are flexed from 60-75 degrees?
A
L4-L5
18
Q
Where is the laxity when hips are flexed from 75-90 degrees?
A
L3-L4
19
Q
Where is the laxity when hips are flexed to 90 degrees?
A
Posterior intervertebral space
20
Q
Why is the prone position used?
A
- Excessive lumbar and pelvic flexion
- Lying supine increases pain or symptoms
21
Q
How do you maximize the lumbar traction angle of pull?
A
- Should occur perpendicular to surface
- Supine/prone with hips and knees straight with lordosis for disc protrusion
- Supine with knees and hips at 90 degrees with kyphosis may be beneficial in lateral stenosis secondy to spondylosis
- Unilateral traction can be used in cases of lateral protrusion or unilateral foraminal stenosis
- Ant angle of pull = increase lordosis
- Post angle of pull = increase lumbar kyphosis
22
Q
What is the optimal angle of pull for lumbar traction?
A
- Comes from trial and error
- Depends on pt pathology
- Most text states around 30 degrees
23
Q
Where does the cradle go on cervical traction?
A
Under the occiput
24
Q
What are indications of cervical traction?
A
OA
Cerv radiculopathy
Disc herniation
Tension HA
25
T/F upper cervical requires less force than lower cervical spine?
True
26
What is the poundage for elongation of the cervical spine?
8-10 pounds
27
What poundage should cervical traction NOT exceed?
30 lbs
28
When should you adjust the cervical force?
When pt sx are moderately decreased - increase by 3-5 lbs
Decrease if peripheralization
29
What is the angle of pull for cervical traction?
- 0 degrees at the atlanto-occipital jt
- Max post elongation = 25-35 degrees of flex
- Neutral spine for disc probs b/c ligamentum flavum is more lax
- Flex spine - separate posterior structures
- Ext spine - separate ant structures
- Target upper C-spine - 0-5 degrees
- Target mid C-spine - 10-20 degrees
- Target lower C-spine - 25-35 degrees
30
Positional traction to maximally open facets?
Forward flex, contralateral flex, and ipsilateral rotation
31
Positional traction to maximally open foramen?
Forward flexion, contralateral side flexion and contralateral rotation
32
What are the three waveforms for ES?
- Direct current
- Alternating current
- Pulsed current
33
What is direct current and what is it used for?
- Electric current moves in a constant direction
- Unidirectional flow of charged particles
- Used in ionto and for denervated muscles
- Not used often b/c may be uncomfortable
34
What is alternating current and what is it used for?
- Continuous, bidirectional flow of charged particles
- Flow of electric charge periodically reverses direction
- Same as power outlets
- Used for pain control and muscle contraction
35
What is a pulsed current and what is it used for?
- Interrupted flow of charged particles
| - Used for pain control, tissue healing, and muscle contraction
36
What is monophasic pulsed current?
- Pulsed current that only flows in one direction
- Most commonly used for tissue healing and acute edema
- High voltage current
- Used if you want polar effects
37
What is a biphasic pulsed current?
- Pulsed current that flows back and forth
| - Most common ES for muscle contraction or pain
38
What is biphasic symmetrical?
-Usually used on larger muscles
39
What is biphasic asymmetrical?
-Usually used on smaller muscles or children
40
What is a balanced biphasic pulsed current?
-Zero change
41
What is an unbalanced biphasic pulsed current?
-Polar effects d/t net charge
42
What is frequency in ES?
Waves per sec (Hz)
| Usually b/t 1000 and 10000 Hz
43
What is IFC?
-Produced by interference of two medium frequency ACs with slightly different frequencies.
44
Why is IFC used?
- Though to penetrate deeper
| - Used for pain
45
What is a premodulated current?
- Produced with a single circuit and 2 electrodes
- More amp through skin and larger, deeper tissues is not accomplished
- Similar to IFC, but only 2 electrodes and they don't overlap
46
What is Russian Stim?
- 2500 Hz - 10 ms long bursts with 50 bursts/sec with 10 ms interburst intervals
- Used on big muscle groups
- Neuromuscular stim
47
What are the parameters of direct current?
Amp
| Total tx time
48
What is pulse duration?
- How long each pulse lasts
- Beginning of 1st phase to end of the last
- Measured in microsec
49
What is shorter pulse duration used for?
Pain control
50
What is longer pulse duration used for?
Muscle contraction
51
What is phase duration?
- Duration of one phase
| - Monophasic phase = pulse duration
52
What is the interpulse interval?
The amt of time b/t pulses
53
What is amplitude of ES?
Magnitude of current or voltage
AKA intensity
54
What is ramp up in ES?
Amt of time it takes amp to go from zero to max during the on time
55
What is ramp down time in ES?
Amt of time it takes for current amp to decrease from max to zero
56
Why are ramp times used?
Help with pt comfort when ES is used for muscle contraction
| -Allows for accommodation
57
What are A-beta fibers?
Nonpainful sensations related to vibration, stretching, and mechanical pressure
58
What are A-delta fibers?
- Sharp, stabbing, or pricking
- Not blocked by opioids
- Quick onset
59
What are C-fibers?
- Dull, throbbing, aching, burning, tingling, or tapping
- Blocked by opioid
- Emotional component
- Slow onset, long-lasting, diffusely localized, accompanied by sweating, increased HR and BP, or nausea
60
What are the effects of electrical currents?
- Stim action potential in innervated nerves (NMES)
- Direct muscle depolarization (EMS)
- Ionic effects of electrical currents
61
What happens when ES produces AP in nerves?
-Electrical currents depolarize nerve membranes = produce AP
62
What is the strength-duration curve?
-Amt of electricity required to produce an action potential depends on the type of nerve
63
What stimulates sensory nerves?
Lower amp and shorter pulse duration
| 50-100 microsec (tingly)
64
What stimulates motor nerves?
Higher amp and longer pulses
| 150-350 microsec (contraction)
65
What stimulates pain C-fibers?
Higher amps and longer pulses
66
What happens when amp is greater than 10 ms?
Needed to activate muscle not nerves
67
What is a subthreshold on the strength duration curve?
When the current amp and pulse duration fall below the curve for a nerve time. This is when no response will occur
68
Does denervated muscle membrane accommodate?
No - slow rising stimulus can be used to produce contractions in denervated muscle
69
What is saltatory conduction?
Speed of propagation depends on the diameter of the nerve and if it is myelinated or not
The greater the diameter = faster the AP
70
What is direct muscle depolarization?
Deprive an organ or body part of nerve supply by surgically removing or cutting the nerve or by blocking nerve conduction with drugs
71
What is EMS?
Electrical muscle stim
- Denervated muscles contract in response to direct ES
- Causes muscle to depolarize
- Need greater than 10 ms
72
What are the effects of positive and negative electrodes?
- Negative attracts positive ions to repel the negative (cathode)
- Positive electrodes attract negative ions to repel the positive (anode)
73
What are the benefits/downfalls of smaller electrodes?
- Target small area
- More superficial
- Less comfortable
74
What are the benefits/downfalls of larger electrodes?
- Target larger area
- Thicker subcutaneous fat tissue
- More comfortable
- Require higher amps
75
Where should electrodes be placed?
- Smooth against skin
- Not over bony prominence's
- The greater the distance = the deeper the current travels
76
What type of muscle fibers does ES for muscle contraction target?
Type II
77
What is the overload principle? How does ES use it to strengthen muscle?
Increased pulse duration, amp, electrode size, external resistance = higher load = higher force contraction = greater strengthening
78
How does ES specificity increase muscle strength?
- Contractions to strengthen specific muscle fibers
- More effect on type II than type I
- Disuse atrophy is primarily type II
79
What is FES?
Integrate performance of functional activities
80
How do you use ES for stroke pt?
-Stimulate LE to improve gait, increase ankle DF, reduce agonist/antagonist co-contraction, and increase probability of going home
81
How do you use ES for SCI pt?
- Counteract disuse of mm atrophy by improving circulation, contract mm to assist in movement/grasps/respiration/etc
- Needs to have sufficient force for activity, not painful, controlled and repeated, and acceptable
82
ES for edema control?
- Contract limb muscles to compress circulatory and lymphatic vessels to promote flow of fluid
- Do not use if edema is caused by organ failure
83
How does ES retard atrophy and return fxn of denervated nerves?
- May retard or reverse loss of strength, atrophy, and fibrosis
- Improve in functional outcomes may not persist after stimulation of mm has stopped
84
How does TENS use gate-theory?
- Activate non-nociceptor A-beta fibers
| - Inhibit noxious signals to spinal level
85
What opioids are released with ES contraction for pain?
- Endorphins
| - Enkephalins
86
What is a burst mode TENS?
- Delivers stimulation in bursts
| - Same mechanism as low-rate TENS
87
What is modulated TENS?
-Pulse rate and width are automatically varied
88
What is a brief intense TENS?
- Deliver electrical pulses have long duration and high frequency
- Application is short and amp is higher than other modes
- Amp is high to paresthesia or motor response
- Used to minimize pain during therapeutic activities that may be painful
- Tx time = ~15 min
89
What is noxious TENS?
- High density current that is uncomfortable/painful
- Administers with probe applicator or electrodes
- Stimulates for 30-60 sec at acupuncture/trigger points
- Monophasic pulsed/biphasic pulsed
90
When is ES used on pressure ulcers?
Those that have not healed within 30 days
91
What is galvanotaxis?
ES used on chronic wounds to promote tissue healing by using currents to attract appropriate cell types to the area
- Negative electrode promotes healing of inflamed or infected wounds
- Positive electrode promotes healing of wound without inflammation
92
What do anodes attract?
Macrophages
Epidermal cells
Inactive neutrophils
93
What do cathodes attract?
```
Lymphocytes
Platelets
Mast cells
Keratinocytes
Neural progenitor cells
Fibroblasts
Activated neutrophils
```
94
What polarity is used during the inflammatory stage?
Negative
95
What polarity is used during the proliferation phase?
Positive
96
What is the dispersive electrode?
Completes the circuit
| Should be larger which will provide comfort
97
What is the active electrode?
Electrode for polarity
| Smaller and near/in the wound
98
How does negative charge help reduce edema?
- Retards formation of acute edema
| - Repels negatively charged serum proteins
99
What is ionto?
- Low-amp DC facilitates transdermal drugs (Dex - anti-inflammatory)
- Penetrate drug 3-20 mm
- Want charges to repel to propel drug into system
- Given to people who cannot take NSAIDs
100
What is biofeedback?
A measuring instrument that provides moment to moment info about biologic function
101
What is the goal of biofeedback?
Train the pt to perceive change in muscle contraction without the use of measurement tools in order to practice on their own
102
What is the physiological effect of biofeedback?
Provide feedback to user for volitional alterations of activity
- Neuromuscular facilitation
- Inhibition - mm spasm
- Coordination
103
How does biofeedback help in neuromuscular facilitation?
- Combat arthrogenic muscle inhibition (AMI) - normal function that is inhibited d/t pain
- Max voluntary isometric contraction - reduction of AMI increases muscle ability to generate force
104
How does biofeedback help with neuromuscular inhibition?
- Decrease tone
- Increase afferent inhibition of efferent signals
- Used for relaxation, postural training, and decrease excessive mm tone
105
How does biofeedback help with neuromuscular coordination?
-Improve timing and recruitment of mm activity
106
What is electromagnetic radiation (EMR)?
Composed of electric and magnetic fields that vary over time and orient perpendicular to each other
Light is close to visible
107
What is low-level laser therapy?
Use of laser light for therapeutic purpose
108
What kind of light is laser light?
Monochromaic, coherent, and directional
109
What kind of light is most light?
Polychromatic, various wavelengths
110
What is coherent light?
All waves are in phase with each other
111
What is the correlation of frequency and wavelength of EMR?
As freq increases, wavelength decreases
112
What is wavelength in EMR?
Peak to peak
113
What are EMR properties?
- Low frequency
- Intensity is greatest when energy output is high, radiation is close to pt, and beam is perpendicular
- Thermal or nonthermal effects
- Clinical effects determined by frequency and wavelength range of radiation
114
What is a light-emitting diode (LED)?
- Low intensity light
- Neither coherent or monochromatic
- Divergent
- Longer application time
115
What is a supraluminous diode (SLD)?
- Produce high-intensity, almost monochromatic
- Not coherent
- Shorter application time than LED
- Delivers to a wide area
116
What is power?
Rate of energy flow (mW or J)
117
What is power density?
The amount of power per unit area (J/cm2)
118
What is energy?
Power x time of application
J = Power (W) x Time (s)
119
What is power density?
Amount of power per unit of area = J/cm2
