FINAL Flashcards
What modalist is US?
Deep Heating Modality
What US is good for?
Musculoskeletal Pain Soft Tissue Injury Arthritis Bursitis Frozen Shoulder Tenosynovitis Scare Management
What does US do with electrical energy?
Transfroms into acusting energy
What is Reverse Piezoelectic Effect?
Crystal inside the sound head due to electrical current expands and contracts. Generating sound waves in the range from 800,000-3,000,000Hz
What kind of wave is US producing?
Longitudinal Wave
What is Cavitation?
Formation of and collapse of gas vapor-filled cavities in liquids and occurs in relation to the compression and rarefaction cycles of ultrasound.
Based on the tissue the US waves can be?
Transmitted
Absorbed
Reflect-bone interface
Refracted-bone/periosteum interface
True of Fales. Does air causes total reflection of ultrasound?
True
What is Summation Effect?
Reflection of the waves traveling towards the sound head of US.
Beam Nonuniformity Ratio (BNR) what is that, what number is best?
It’s Maximum intensity of the transducer to the average intensity produced across the face of the transducer
Lower the BNR better
BNR 5 is excellent.
What are hots spots on transduces?
The highest peak in intensity due to the formation of the stone.
What are the effects of US thermal on tissue?
Heating deep tissue using kinetic energy
Causing vibration of the molecules that cause the heat
What are the effects of US nonthermal on tissue?
Effects are the result of acoustic streaming at the cellular membrane with stable cavitation.
What are a clinical indication for the use of theraml US
Facilitate tissue healing by; Increasing blood flow increasing metabolic rate Increasing tissue permeability Increasing viscoelasticity of connective tissue for stretching. Decreases pain Decreasing chronic inflammation
What is the best time to do AROM or PROM when it comes to US treatment?
During the treatment or 3-5 minutes past
To increase heat with US we can do either?
Increase the amplitude w/cm2
increase the wave to continuous wave
increase treatment time.
Thermal setting on US is the best to use when?
During chronic conditions
The Mechanic/non-thermal is the best to use when?
The acute phase of recovery
What are a clinical indication for the use of Mechanical/nontheraml US?
increase phagocytic activity
increased fibroblasts with enhanced protein synthesis
Decrease inflammation in the treatment area
Increase granulation tissue
Increase angiogenesis
1MHz wil provide ?
Deeper penetration of US from 2.5 to 5cm
3MHz will provide?
More superficial penetration of US from 1cm to 2.5cm
Ultrasound duty cycles for thermal?
80% to 100%
US duty cycles for nonthermal?
20%-30%
What is Convection?
Transfer of heat by a fluid movement from one place to another. Whirlpool, fluid therapy.
(transfers of temperature based on the constant movement of a medium over the surface).
What is Conduction?
The direct transfer of temperature example hot packs.
What is Evaporation?
Coolant sprays or sweating
What is Conversion?
One form of energy to another such as US
What is radiation?
Think ‘heating lamb
Movement of radiant energy through the air to a surface
What methods of transfer of heat/cold do we have?
Convection Conduction Evaporation Conversion Radiation
Clinical rationale for Hot application?
Decreased pain Decrease stiffness Increase ROM Increase tendon gliding Increase viscosity of synovium Enhance healing Promote relaxation
Clinical Rationale for Cold application?
Decrease pain Decrease acute and subacute inflammation Decrease edema Chronic pain Myofascial trigger points Muscle guarding Bursitis Spasticity.
HEAT will increase?>
Blood flow - vasodilation, capillary permeability, and histamine
Cell metabolism
Delivering O2
Muscle contraction velocity
HEAT will decrease?
Pain with analgesic effect on free nerve ending
Fluid viscosity
Muscles spasms
Heating effect of superficial heat don’t go deeper then?
2cm
Superficial Heat: Increase temperature of the tissue 1-2 cm
At 1 cm the tissue increased by….. degrees?
Tissue deeper than 2 can increase by ….. degrees?
6
2
The therapeutic effect achieved when subacute tissue reaches an elevated temperature of?
104 to 133 degrees F
Hydropcollatory Machine /Hot Pack
A most common cause of injury
Hydrocollatory is kept at 165 to 175
Hot pack reaches 104-133
Paraffin
Wax is heated to 118-135. 126 perfect Delivers circumferential heat to small joints Dip 8 to 10 times Good for softening the skin
Fluid therapy
105-118 degrees
Treatment time around 20 minutes
Fine particles suspended in a hot air stream
Whirlpool/hydrotherapy
10-20 minutes of treatment Good for active mobilization Gravity elimination Commonly used for wound debridement. The temperature depends on the treatment goal.
Cryotherapy increases?
ROM secondary to a reduction in pain, edema
Cryotherapy decreases?
Inflammation
Edema
Pain
Muscle Spasm
Indication for Cryotherapy?
Acute trauma 24 yo 72 hours muscle soreness edema arthritic exacerbation acute tendonitis/bursitis hematoma
What are precautions for Superficial thermal modalities
Open wounds Pregnancy Advanced age Menses Impaired cognition Previous experience with the physical agent Peripheral vascular disease Metastases
Interactive Reasoning?
Person Perspective - Getting to know the person through understanding the impact the hand condition has had on the person’s life.
Narrative Reasoning?
Consider the person’s occupational story, taking into consideration activities, habits, and roles
Pragmatic Reasoning?
Consider practical factors, such as payment, demonstration, equipment availability, and expected discharge environment
Conditional Reasoning?
Reflect on the person’s whole condition, taking into consideration the person’s life before the condition happened. Environment Physical, social, and cooperation of the person.
Procedural Reasoning?
Problem-solving the best orthotic approach, taking into consideration the person’s diagnostically-related performance areas, components, and context.
Orthosis for Fractures Purpose:
Protection/immobilization of healing bone and tissue
Used both conservatively and post-operatively
Often placed in orthosis after case removal due to weak structures
pain and edema management
Can creat Stiffness.
Elbow Fractures Orthosis
Usually posterior custom desgine at 90 or prefab locking hinge orthosis
Leave wrist free, unless radius and ulan need immobilization then include wrist in order to limit FA rotation
Shirt immobilization period due to elbow’s propensity for stifness 2 to 3 weeks
Wrist Fractures Orthosis
Distal Radious fracture most common
Volar or circumferential immobilization
Usually slight wrsit extension
Do not corss MPC-leave digits free to flex
Digit Fracture orthosis
Digits and metacarpal fixation
Custom orthosis common for immobilization
need to stabilize bone both proximal and distal to fx
Positioning may vary by MD
Requires adjustment as edema decreases and as ROM is allowed to progress
TMC (CMC) OA orthosis ?
Short opponens/Short thumb spica
Dorsal and radial subluxation of 1st metacarpal adducts and loses extension leading to MCP hyperextension and IP flexion
Swan Neck defomity orthosis management
PIP hyperextesnion, DIP flexion
Prevent further deformity
Stablize joint
Decrease pain
Boutonnier deformity orthosis management
PIP flexion, DIP hyperextesnion
Immobilization include PIP in full extesnion, MCP and DIP free
Orthostic wear for 6 - 8 weeks full time
Try static progressive or serial casting if flexion contracutre presist.
Radial Nerve Palsy position of the area?
Stabilize wrist
MCP extension assists done with elastic strapping.
Median Nerve orthosis
Prevent thumb add contracture (web Space contracture)
Can be for nighttime,
Ulnar Nerve orthosis
Prevent RF/SF from clawing
Put MP’s in flexion
Trigger Finger Orthosis
MP extesnion
Ip’s free
Long Opponens orthosis
Radial vs Palmar thumb position depending on dx
Thumb position
DeQuervains, Scaphoid fx
Spasticity Orthosis
Cone Achieve balance length of intrinsic vs extrinsic Adjust design as patient progresses Skin checks Wearing schedule
Hand and wrist immobilization position
wrist neutral to 20-30 degrees ext
MCPs 50 – 90 degrees flex (wide range- depends on presentation)
thumb partial opposition
Flexor Tendon Repair Orthosis?
Dorsal Blocking Orthosis (Most common) Wrist 0-20, MP 50-60, IPs 0
Immobilization (children, cognitive limitations)
Kleinert Splint what that?
Active extension up to block, passive flexion via outrigger.
Work of flexion = Drag, and Resistance.. what we need to do when we want to work with a patient with flexor tendon repair?
Decrease swelling
PROM for joint stiffness
Wrist position when doing an active exercise (wrist neutral, wrist ext)
Speed of exercise - Go slow.
Postop Duputyrens what orthosis is appropriate?
Extension orthosis/Pan Orthosis.
What is the purpose of mobilization orthosis?
Provide substitute motion for lost AROM
Provide low load prolonged stress to increase ROM
Active redirection to improve ROM
Allow for controlled motion s/p tendon repair.
What are the types of mobilization orthosis?
Serial Static
Static Progressive
Dynamic
Orthosis Precautions
Skin atrophy Insensate hand Vascular compromise Pain Edema Bony Prominence Patient's cognitive and cooperation level.
Articular Orthosis
Most common
Crosses at least one joint
Uses three-point pressure system to affect a joint or joints by immobilizing, mobilizing, restricting, or transmitting torque
Nonarticular Orthosis
Do not cross joint. Use two-point pressure force to stabilize or immobilize both segment
When it comes to articular orthosis and location
The anatomical area included in the orthosis ex. Articular orthosis- include a joint name (PIP jt)
When it comes to nonarticular orthosis and location
Include the name of a long bone (humerus, radius)
What is the purpose of mobilization orthosis?
Designed to move or mobilize primary of secondary joints
What is the purpose of Immobilization orthosis?
Designed to immobilize primary of secondary joints
What is the purpose of Restriction orthosis?
Limit specific ROM of a joint
What is the purpose of Torque Transmission?
Transfer motion to another location (exercise orthosis)
Orthosis Design Classification: Static
Holds position
Orthosis Design Classification: Serial Static
Remolding of a static orthosis as motion increases
Orthosis Design Classification: Dropout
Allows motion in one direction, while blocking the other motion
Orthosis Design Classification: Dynamic
Applies a elastic tension force
Orthosis Design Classification: Static- Progressive
Use of inelastic components
allows pt to adjust tension
Static Orthosis what do they do?
Rigid, no moving parts
Use to support after injury
Used to protect healing tissue
Used to prevent motion
Serial Static Orthosis what do they do?
Rigid device used to increase ROM
Fabricated to allow for ROM gains
Static progressive Orthosis what do they do?
Component pieces included to increase ROM
Drop Out Orthosis what do they do?
Allows motion in one direction, while blocking the other motion
Dynamic Orthosis what do they do?
Rigid orthosis with moving parts that help mobilize soft tissue of jts Used to resolve stiffness Gain ROM Provide muscle substitution Control mobilizing force
What temperature of the water should be…. in order to allow for the thermoplastic material to be moldable?
135-180 degrees
Clients’ consideration when providing orthosis?
Cognition Compliant Cost Ability to don/doff Functional status with an orthosis
Orthosis Precautions what are they?
Redness Pressure areas Numbness/tingling Shearing Edema Pain Skin breakdown Changes in temperature
