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Therapeutic Modalities: Physical Agent Modalities and Splinting > FINAL > Flashcards

FINAL Flashcards

1
Q

What modalist is US?

A

Deep Heating Modality

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2
Q

What US is good for?

A 
Musculoskeletal
Pain
Soft Tissue Injury
Arthritis 
Bursitis 
Frozen Shoulder 
Tenosynovitis 
Scare Management
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3
Q

What does US do with electrical energy?

A

Transfroms into acusting energy

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4
Q

What is Reverse Piezoelectic Effect?

A

Crystal inside the sound head due to electrical current expands and contracts. Generating sound waves in the range from 800,000-3,000,000Hz

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5
Q

What kind of wave is US producing?

A

Longitudinal Wave

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6
Q

What is Cavitation?

A

Formation of and collapse of gas vapor-filled cavities in liquids and occurs in relation to the compression and rarefaction cycles of ultrasound.

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7
Q

Based on the tissue the US waves can be?

A

Transmitted
Absorbed
Reflect-bone interface
Refracted-bone/periosteum interface

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8
Q

True of Fales. Does air causes total reflection of ultrasound?

A

True

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9
Q

What is Summation Effect?

A

Reflection of the waves traveling towards the sound head of US.

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10
Q

Beam Nonuniformity Ratio (BNR) what is that, what number is best?

A

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.

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11
Q

What are hots spots on transduces?

A

The highest peak in intensity due to the formation of the stone.

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12
Q

What are the effects of US thermal on tissue?

A

Heating deep tissue using kinetic energy

Causing vibration of the molecules that cause the heat

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13
Q

What are the effects of US nonthermal on tissue?

A

Effects are the result of acoustic streaming at the cellular membrane with stable cavitation.

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14
Q

What are a clinical indication for the use of theraml US

A 
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
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15
Q

What is the best time to do AROM or PROM when it comes to US treatment?

A

During the treatment or 3-5 minutes past

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16
Q

To increase heat with US we can do either?

A

Increase the amplitude w/cm2
increase the wave to continuous wave
increase treatment time.

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17
Q

Thermal setting on US is the best to use when?

A

During chronic conditions

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18
Q

The Mechanic/non-thermal is the best to use when?

A

The acute phase of recovery

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19
Q

What are a clinical indication for the use of Mechanical/nontheraml US?

A

increase phagocytic activity
increased fibroblasts with enhanced protein synthesis
Decrease inflammation in the treatment area
Increase granulation tissue
Increase angiogenesis

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20
Q

1MHz wil provide ?

A

Deeper penetration of US from 2.5 to 5cm

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21
Q

3MHz will provide?

A

More superficial penetration of US from 1cm to 2.5cm

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22
Q

Ultrasound duty cycles for thermal?

A

80% to 100%

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23
Q

US duty cycles for nonthermal?

A

20%-30%

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24
Q

What is Convection?

A

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).

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25
Q

What is Conduction?

A

The direct transfer of temperature example hot packs.

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26
Q

What is Evaporation?

A

Coolant sprays or sweating

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27
Q

What is Conversion?

A

One form of energy to another such as US

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28
Q

What is radiation?

A

Think ‘heating lamb

Movement of radiant energy through the air to a surface

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29
Q

What methods of transfer of heat/cold do we have?

A 
Convection 
Conduction 
Evaporation 
Conversion 
Radiation
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30
Q

Clinical rationale for Hot application?

A 
Decreased pain 
Decrease stiffness 
Increase ROM
Increase tendon gliding 
Increase viscosity of synovium 
Enhance healing 
Promote relaxation
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31
Q

Clinical Rationale for Cold application?

A 
Decrease pain 
Decrease acute and subacute inflammation 
Decrease edema
Chronic pain 
Myofascial trigger points 
Muscle guarding 
Bursitis 
Spasticity.
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32
Q

HEAT will increase?>

A

Blood flow - vasodilation, capillary permeability, and histamine
Cell metabolism
Delivering O2
Muscle contraction velocity

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33
Q

HEAT will decrease?

A

Pain with analgesic effect on free nerve ending
Fluid viscosity
Muscles spasms

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34
Q

Heating effect of superficial heat don’t go deeper then?

A

2cm

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35
Q

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?

A

6

2

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36
Q

The therapeutic effect achieved when subacute tissue reaches an elevated temperature of?

A

104 to 133 degrees F

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37
Q

Hydropcollatory Machine /Hot Pack

A

A most common cause of injury
Hydrocollatory is kept at 165 to 175
Hot pack reaches 104-133

38
Q

Paraffin

A 
Wax is heated to 118-135.
126 perfect 
Delivers circumferential heat to small joints 
Dip 8 to 10 times 
Good for softening the skin
39
Q

Fluid therapy

A

105-118 degrees
Treatment time around 20 minutes
Fine particles suspended in a hot air stream

40
Q

Whirlpool/hydrotherapy

A 
10-20 minutes of treatment 
Good for active mobilization 
Gravity elimination 
Commonly used for wound debridement. 
The temperature depends on the treatment goal.
41
Q

Cryotherapy increases?

A

ROM secondary to a reduction in pain, edema

42
Q

Cryotherapy decreases?

A

Inflammation
Edema
Pain
Muscle Spasm

43
Q

Indication for Cryotherapy?

A 
Acute trauma 24 yo 72 hours
muscle soreness 
edema
arthritic exacerbation 
acute tendonitis/bursitis 
hematoma
44
Q

What are precautions for Superficial thermal modalities

A 
Open wounds 
Pregnancy
Advanced age
Menses
Impaired cognition 
Previous experience with the physical agent 
Peripheral vascular disease 
Metastases
45
Q

Interactive Reasoning?

A

Person Perspective - Getting to know the person through understanding the impact the hand condition has had on the person’s life.

46
Q

Narrative Reasoning?

A

Consider the person’s occupational story, taking into consideration activities, habits, and roles

47
Q

Pragmatic Reasoning?

A

Consider practical factors, such as payment, demonstration, equipment availability, and expected discharge environment

48
Q

Conditional Reasoning?

A

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.

49
Q

Procedural Reasoning?

A

Problem-solving the best orthotic approach, taking into consideration the person’s diagnostically-related performance areas, components, and context.

50
Q

Orthosis for Fractures Purpose:

A

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.

51
Q

Elbow Fractures Orthosis

A

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

52
Q

Wrist Fractures Orthosis

A

Distal Radious fracture most common
Volar or circumferential immobilization
Usually slight wrsit extension
Do not corss MPC-leave digits free to flex

53
Q

Digit Fracture orthosis

A

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

54
Q

TMC (CMC) OA orthosis ?

A

Short opponens/Short thumb spica

Dorsal and radial subluxation of 1st metacarpal adducts and loses extension leading to MCP hyperextension and IP flexion

55
Q

Swan Neck defomity orthosis management

A

PIP hyperextesnion, DIP flexion
Prevent further deformity
Stablize joint
Decrease pain

56
Q

Boutonnier deformity orthosis management

A

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.

57
Q

Radial Nerve Palsy position of the area?

A

Stabilize wrist

MCP extension assists done with elastic strapping.

58
Q

Median Nerve orthosis

A

Prevent thumb add contracture (web Space contracture)

Can be for nighttime,

59
Q

Ulnar Nerve orthosis

A

Prevent RF/SF from clawing

Put MP’s in flexion

60
Q

Trigger Finger Orthosis

A

MP extesnion

Ip’s free

61
Q

Long Opponens orthosis

A

Radial vs Palmar thumb position depending on dx
Thumb position
DeQuervains, Scaphoid fx

62
Q

Spasticity Orthosis

A 
Cone
Achieve balance length of intrinsic vs extrinsic
Adjust design as patient progresses
Skin checks 
Wearing schedule
63
Q

Hand and wrist immobilization position

A

wrist neutral to 20-30 degrees ext
MCPs 50 – 90 degrees flex (wide range- depends on presentation)
thumb partial opposition

64
Q

Flexor Tendon Repair Orthosis?

A

Dorsal Blocking Orthosis (Most common) Wrist 0-20, MP 50-60, IPs 0
Immobilization (children, cognitive limitations)

65
Q

Kleinert Splint what that?

A

Active extension up to block, passive flexion via outrigger.

66
Q

Work of flexion = Drag, and Resistance.. what we need to do when we want to work with a patient with flexor tendon repair?

A

Decrease swelling
PROM for joint stiffness
Wrist position when doing an active exercise (wrist neutral, wrist ext)
Speed of exercise - Go slow.

67
Q

Postop Duputyrens what orthosis is appropriate?

A

Extension orthosis/Pan Orthosis.

68
Q

What is the purpose of mobilization orthosis?

A

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.

69
Q

What are the types of mobilization orthosis?

A

Serial Static
Static Progressive
Dynamic

70
Q

Orthosis Precautions

A 
Skin atrophy 
Insensate hand 
Vascular compromise
Pain 
Edema 
Bony Prominence 
Patient's cognitive and cooperation level.
71
Q

Articular Orthosis

A

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

72
Q

Nonarticular Orthosis

A

Do not cross joint. Use two-point pressure force to stabilize or immobilize both segment

73
Q

When it comes to articular orthosis and location

A

The anatomical area included in the orthosis ex. Articular orthosis- include a joint name (PIP jt)

74
Q

When it comes to nonarticular orthosis and location

A

Include the name of a long bone (humerus, radius)

75
Q

What is the purpose of mobilization orthosis?

A

Designed to move or mobilize primary of secondary joints

76
Q

What is the purpose of Immobilization orthosis?

A

Designed to immobilize primary of secondary joints

77
Q

What is the purpose of Restriction orthosis?

A

Limit specific ROM of a joint

78
Q

What is the purpose of Torque Transmission?

A

Transfer motion to another location (exercise orthosis)

79
Q

Orthosis Design Classification: Static

A

Holds position

80
Q

Orthosis Design Classification: Serial Static

A

Remolding of a static orthosis as motion increases

81
Q

Orthosis Design Classification: Dropout

A

Allows motion in one direction, while blocking the other motion

82
Q

Orthosis Design Classification: Dynamic

A

Applies a elastic tension force

83
Q

Orthosis Design Classification: Static- Progressive

A

Use of inelastic components

allows pt to adjust tension

84
Q

Static Orthosis what do they do?

A

Rigid, no moving parts
Use to support after injury
Used to protect healing tissue
Used to prevent motion

85
Q

Serial Static Orthosis what do they do?

A

Rigid device used to increase ROM

Fabricated to allow for ROM gains

86
Q

Static progressive Orthosis what do they do?

A

Component pieces included to increase ROM

87
Q

Drop Out Orthosis what do they do?

A

Allows motion in one direction, while blocking the other motion

88
Q

Dynamic Orthosis what do they do?

A 
Rigid orthosis with moving parts that help mobilize soft tissue of jts
Used to resolve stiffness 
Gain ROM
Provide muscle substitution
Control mobilizing force
89
Q

What temperature of the water should be…. in order to allow for the thermoplastic material to be moldable?

A

135-180 degrees

90
Q

Clients’ consideration when providing orthosis?

A 
Cognition 
Compliant 
Cost 
Ability to don/doff
Functional status with an orthosis
91
Q

Orthosis Precautions what are they?

A 
Redness
Pressure areas 
Numbness/tingling
Shearing 
Edema 
Pain 
Skin breakdown
Changes in temperature

Therapeutic Modalities: Physical Agent Modalities and Splinting (2 decks)

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