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Modalities > Final > Flashcards

Final Flashcards

1
Q

What effects does spinal traction have?

A
  • Jt distraction
  • Reduction of disc protrusion
  • Soft tissue stretch
  • Mm relaxation
  • Jt mobs
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2
Q

How does traction treat a herniated disc?

A

Sucks the bulge back in

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3
Q

How does traction work for soft tissue stretching?

A

Low load, static stretch

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4
Q

How much force is required for lumbar joint distraction?

A

50% of BW

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5
Q

How much force is required for cervical joint distraction?

A

7% of BW

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6
Q

How much force is required for lumbar disc protrusion?

A

60-120 lbs

30-60% BW

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7
Q

How much force is required for cervical disc protrusion?

A

15-30 lbs

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8
Q

How does traction create muscle relaxation?

A
  • Reduction of pressure on pain sensitive structures

- Stimulate Golgi tendons to inhibit alpha neuron firing

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9
Q

How does traction create joint mobilization?

A
  • High force or repetitive intermittent traction
  • Mobilize multiple jt at once
  • Manual techniques more localized
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10
Q

What are clinical indications of traction?

A
  • Disc bulge/herniation
  • Nerve root impingement
  • Jt hypomobility
  • Subacute jt inflammation
  • Mm spasm
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11
Q

Should you use intermittent traction during the acute inflammatory phase?

A

No - may cause further injury

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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

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13
Q

What does higher load traction do for a muscle spasm?

A

May reduce the underlying cause of pain

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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
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15
Q

What are some safety indications for traction?

A
  • Empty bladder prior to traction

- Avoid heavy meals to tx

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16
Q

Where is laxity when hips are flexed from 45-60 degrees?

A

L5-S1 segments

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17
Q

Where is the laxity when hips are flexed from 60-75 degrees?

A

L4-L5

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18
Q

Where is the laxity when hips are flexed from 75-90 degrees?

A

L3-L4

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19
Q

Where is the laxity when hips are flexed to 90 degrees?

A

Posterior intervertebral space

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20
Q

Why is the prone position used?

A
  • Excessive lumbar and pelvic flexion

- Lying supine increases pain or symptoms

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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
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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
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23
Q

Where does the cradle go on cervical traction?

A

Under the occiput

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24
Q

What are indications of cervical traction?

A

OA
Cerv radiculopathy
Disc herniation
Tension HA

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25
Q

T/F upper cervical requires less force than lower cervical spine?

A

True

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26
Q

What is the poundage for elongation of the cervical spine?

A

8-10 pounds

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27
Q

What poundage should cervical traction NOT exceed?

A

30 lbs

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28
Q

When should you adjust the cervical force?

A

When pt sx are moderately decreased - increase by 3-5 lbs

Decrease if peripheralization

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29
Q

What is the angle of pull for cervical traction?

A
  • 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
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30
Q

Positional traction to maximally open facets?

A

Forward flex, contralateral flex, and ipsilateral rotation

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31
Q

Positional traction to maximally open foramen?

A

Forward flexion, contralateral side flexion and contralateral rotation

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32
Q

What are the three waveforms for ES?

A
  • Direct current
  • Alternating current
  • Pulsed current
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33
Q

What is direct current and what is it used for?

A
  • 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
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34
Q

What is alternating current and what is it used for?

A
  • Continuous, bidirectional flow of charged particles
  • Flow of electric charge periodically reverses direction
  • Same as power outlets
  • Used for pain control and muscle contraction
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35
Q

What is a pulsed current and what is it used for?

A
  • Interrupted flow of charged particles

- Used for pain control, tissue healing, and muscle contraction

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36
Q

What is monophasic pulsed current?

A
  • 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
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37
Q

What is a biphasic pulsed current?

A
  • Pulsed current that flows back and forth

- Most common ES for muscle contraction or pain

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38
Q

What is biphasic symmetrical?

A

-Usually used on larger muscles

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39
Q

What is biphasic asymmetrical?

A

-Usually used on smaller muscles or children

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40
Q

What is a balanced biphasic pulsed current?

A

-Zero change

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41
Q

What is an unbalanced biphasic pulsed current?

A

-Polar effects d/t net charge

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42
Q

What is frequency in ES?

A

Waves per sec (Hz)

Usually b/t 1000 and 10000 Hz

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43
Q

What is IFC?

A

-Produced by interference of two medium frequency ACs with slightly different frequencies.

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44
Q

Why is IFC used?

A
  • Though to penetrate deeper

- Used for pain

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45
Q

What is a premodulated current?

A
  • 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
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46
Q

What is Russian Stim?

A
  • 2500 Hz - 10 ms long bursts with 50 bursts/sec with 10 ms interburst intervals
  • Used on big muscle groups
  • Neuromuscular stim
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47
Q

What are the parameters of direct current?

A

Amp

Total tx time

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48
Q

What is pulse duration?

A
  • How long each pulse lasts
  • Beginning of 1st phase to end of the last
  • Measured in microsec
49
Q

What is shorter pulse duration used for?

A

Pain control

50
Q

What is longer pulse duration used for?

A

Muscle contraction

51
Q

What is phase duration?

A
  • Duration of one phase

- Monophasic phase = pulse duration

52
Q

What is the interpulse interval?

A

The amt of time b/t pulses

53
Q

What is amplitude of ES?

A

Magnitude of current or voltage

AKA intensity

54
Q

What is ramp up in ES?

A

Amt of time it takes amp to go from zero to max during the on time

55
Q

What is ramp down time in ES?

A

Amt of time it takes for current amp to decrease from max to zero

56
Q

Why are ramp times used?

A

Help with pt comfort when ES is used for muscle contraction

-Allows for accommodation

57
Q

What are A-beta fibers?

A

Nonpainful sensations related to vibration, stretching, and mechanical pressure

58
Q

What are A-delta fibers?

A
  • Sharp, stabbing, or pricking
  • Not blocked by opioids
  • Quick onset
59
Q

What are C-fibers?

A
  • 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
Q

What are the effects of electrical currents?

A
  • Stim action potential in innervated nerves (NMES)
  • Direct muscle depolarization (EMS)
  • Ionic effects of electrical currents
61
Q

What happens when ES produces AP in nerves?

A

-Electrical currents depolarize nerve membranes = produce AP

62
Q

What is the strength-duration curve?

A

-Amt of electricity required to produce an action potential depends on the type of nerve

63
Q

What stimulates sensory nerves?

A

Lower amp and shorter pulse duration

50-100 microsec (tingly)

64
Q

What stimulates motor nerves?

A

Higher amp and longer pulses

150-350 microsec (contraction)

65
Q

What stimulates pain C-fibers?

A

Higher amps and longer pulses

66
Q

What happens when amp is greater than 10 ms?

A

Needed to activate muscle not nerves

67
Q

What is a subthreshold on the strength duration curve?

A

When the current amp and pulse duration fall below the curve for a nerve time. This is when no response will occur

68
Q

Does denervated muscle membrane accommodate?

A

No - slow rising stimulus can be used to produce contractions in denervated muscle

69
Q

What is saltatory conduction?

A

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
Q

What is direct muscle depolarization?

A

Deprive an organ or body part of nerve supply by surgically removing or cutting the nerve or by blocking nerve conduction with drugs

71
Q

What is EMS?

A

Electrical muscle stim

  • Denervated muscles contract in response to direct ES
  • Causes muscle to depolarize
  • Need greater than 10 ms
72
Q

What are the effects of positive and negative electrodes?

A
  • Negative attracts positive ions to repel the negative (cathode)
  • Positive electrodes attract negative ions to repel the positive (anode)
73
Q

What are the benefits/downfalls of smaller electrodes?

A
  • Target small area
  • More superficial
  • Less comfortable
74
Q

What are the benefits/downfalls of larger electrodes?

A
  • Target larger area
  • Thicker subcutaneous fat tissue
  • More comfortable
  • Require higher amps
75
Q

Where should electrodes be placed?

A
  • Smooth against skin
  • Not over bony prominence’s
  • The greater the distance = the deeper the current travels
76
Q

What type of muscle fibers does ES for muscle contraction target?

A

Type II

77
Q

What is the overload principle? How does ES use it to strengthen muscle?

A

Increased pulse duration, amp, electrode size, external resistance = higher load = higher force contraction = greater strengthening

78
Q

How does ES specificity increase muscle strength?

A
  • Contractions to strengthen specific muscle fibers
  • More effect on type II than type I
  • Disuse atrophy is primarily type II
79
Q

What is FES?

A

Integrate performance of functional activities

80
Q

How do you use ES for stroke pt?

A

-Stimulate LE to improve gait, increase ankle DF, reduce agonist/antagonist co-contraction, and increase probability of going home

81
Q

How do you use ES for SCI pt?

A
  • 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
Q

ES for edema control?

A
  • 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
Q

How does ES retard atrophy and return fxn of denervated nerves?

A
  • May retard or reverse loss of strength, atrophy, and fibrosis
  • Improve in functional outcomes may not persist after stimulation of mm has stopped
84
Q

How does TENS use gate-theory?

A
  • Activate non-nociceptor A-beta fibers

- Inhibit noxious signals to spinal level

85
Q

What opioids are released with ES contraction for pain?

A
  • Endorphins

- Enkephalins

86
Q

What is a burst mode TENS?

A
  • Delivers stimulation in bursts

- Same mechanism as low-rate TENS

87
Q

What is modulated TENS?

A

-Pulse rate and width are automatically varied

88
Q

What is a brief intense TENS?

A
  • 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
Q

What is noxious TENS?

A
  • 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
Q

When is ES used on pressure ulcers?

A

Those that have not healed within 30 days

91
Q

What is galvanotaxis?

A

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
Q

What do anodes attract?

A

Macrophages
Epidermal cells
Inactive neutrophils

93
Q

What do cathodes attract?

A 
Lymphocytes
Platelets
Mast cells
Keratinocytes
Neural progenitor cells
Fibroblasts
Activated neutrophils
94
Q

What polarity is used during the inflammatory stage?

A

Negative

95
Q

What polarity is used during the proliferation phase?

A

Positive

96
Q

What is the dispersive electrode?

A

Completes the circuit

Should be larger which will provide comfort

97
Q

What is the active electrode?

A

Electrode for polarity

Smaller and near/in the wound

98
Q

How does negative charge help reduce edema?

A
  • Retards formation of acute edema

- Repels negatively charged serum proteins

99
Q

What is ionto?

A
  • 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
Q

What is biofeedback?

A

A measuring instrument that provides moment to moment info about biologic function

101
Q

What is the goal of biofeedback?

A

Train the pt to perceive change in muscle contraction without the use of measurement tools in order to practice on their own

102
Q

What is the physiological effect of biofeedback?

A

Provide feedback to user for volitional alterations of activity

  • Neuromuscular facilitation
  • Inhibition - mm spasm
  • Coordination
103
Q

How does biofeedback help in neuromuscular facilitation?

A
  • 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
Q

How does biofeedback help with neuromuscular inhibition?

A
  • Decrease tone
  • Increase afferent inhibition of efferent signals
  • Used for relaxation, postural training, and decrease excessive mm tone
105
Q

How does biofeedback help with neuromuscular coordination?

A

-Improve timing and recruitment of mm activity

106
Q

What is electromagnetic radiation (EMR)?

A

Composed of electric and magnetic fields that vary over time and orient perpendicular to each other

Light is close to visible

107
Q

What is low-level laser therapy?

A

Use of laser light for therapeutic purpose

108
Q

What kind of light is laser light?

A

Monochromaic, coherent, and directional

109
Q

What kind of light is most light?

A

Polychromatic, various wavelengths

110
Q

What is coherent light?

A

All waves are in phase with each other

111
Q

What is the correlation of frequency and wavelength of EMR?

A

As freq increases, wavelength decreases

112
Q

What is wavelength in EMR?

A

Peak to peak

113
Q

What are EMR properties?

A
  • 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
Q

What is a light-emitting diode (LED)?

A
  • Low intensity light
  • Neither coherent or monochromatic
  • Divergent
  • Longer application time
115
Q

What is a supraluminous diode (SLD)?

A
  • Produce high-intensity, almost monochromatic
  • Not coherent
  • Shorter application time than LED
  • Delivers to a wide area
116
Q

What is power?

A

Rate of energy flow (mW or J)

117
Q

What is power density?

A

The amount of power per unit area (J/cm2)

118
Q

What is energy?

A

Power x time of application

J = Power (W) x Time (s)

119
Q

What is power density?

A

Amount of power per unit of area = J/cm2

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