Final Exam Flashcards
What are the stages of the Pain Cycle?
- Pain
- Guarding
- Muscle spasm and inflammation
- Restricted mobility
- Muscle weakness
- Loss of normal function
- Anger, Frustration, and helplessness
What are Nociceptors?
Pain receptors
Which fibers do the Nociceptors activate and what are their characteristics?
- A-delta Fibers
- Myelinated (faster transmission)
- Evoke sharp, pricking sensation
- C-Fibers
- Unmyelinated (slower transmission)
- Longer lasting
- Evoke burning sensation that is poorly localized
What are the characteristics of A-beta Fibers?
- More myelinated than A-delta fibers (very fast transmission)
- Carries impulses related to touch
What is the Gate Theory?
A-beta fibers are able to send impluses activated by light/warm touch up to the dorsal horn of the spinal cord faster than the A-delta and C-fibers can send impulses of pain. In turn, the touch impulses “close the gate” at the dorsal horn so that the pain impulses cannot get through and travel to the brain.
What is Endogenous Opiate Liberation?
The systemic release of endogenous opiates (such as endorphans, enkephelans, serotonin, and dopamine) which block the perception of pain at the dorsal horn of the spinal cord. These opiates can be stimulated by things like pain, exercise, acupuncture, meditation, laughter, relaxation, or muscle twitching (which we can acheive with E-stim)
What are the Pros and cons of Biphasic Current?
- More comfortable for the pt.
- Can use Bipolar, dual bipolar, and Quadrapolar configuration
- Does not allow you to “sweep” to prevent accomidation
What are the Pros and Cons of HVPC?
- Allows you to “sweep” to prevent accomidation
- Can use buildup of Sodium Hydroxide to treat wounds or edema
- Cannot adjust pulse duration for comfort of pt.
- Cannot use quadrapolar configuration
What does a Biphasic Current mean?
The current alternates directions so that their is no buildup of Sodium Hydroxide
What current does HVPC use and what does that mean?
Monophasic current, which means the current only runs in one direction, causing a build up of Sodium Hydroxide (but not very much since HVPC is pulsed)
How do you set up electrode configuration for HVPC when the goal is sensory analgesia?
1 or 2 small pads on or around area of pain hooked up to active electrode (which is usually the negative electrode), and 1 large pad anywhere on the body hooked up to the dispersive electrode.
What are the parameters for Sensory Analgesia with a biphasic current and HVPC?
Frequency: 80-120 pps
Duty Cycle: (Biphasic: 60-200 uSec) (HVPC: Fixed)
Amplitude: Strong Comfortable Tingle
Tx Time: 20’ initially (can progress to 1hr)
What are the parameters for Endogenous Opiate Liberation with a biphasic current and HVPC?
Frequency: 1-10
Duty Cycle: (Biphasic: 60-200 uSec) (HVPC: Fixed)
Amplitude: Comfortable/Visible Muscle Twitch
Tx Time: 30’ initially (up to 45 mins)
What does HVPC stand for?
High Volt Pulsed Current
What does IFC stand for?
Interferential Current
What are the Pros and Cons of IFC?
- It is the deepest penetrating current
- Good for joints
- Can use static to pinpoint pain or dynamic to treat pain in a general area
- Must use a quadripolar configuration unless using the Premod current
- When using the static option, the electrodes must be placed correctly to create a horizontal or vertical vector line
- Can only use IFC for Sensory Analgesia
What are the parameters for IFC?
Frequency: 80-150 bps
Duration: Fixed
Amplitude: Strong Comfortable Tingle
Tx Time: 20’
What are the general Contraindications for E-Stim?
- Demand cardiac pacemaker or unstable arrhythmia
- Placement of electrodes over corotid sinus
- Areas where venous or arterial thrombus or thrombophlebitis is present
- Pregnancy (Pelvis, abdomen, trunk, and low back). Estim may be used for pain during labor and delivery
- Malignancies in the area to be treated
- Very disoriented patients
- Directly over superficial metal implants
- Pain or condition of unknown etiology
- Active bleeding in area to be treated
What are the Contraindications specific to IFC?
- Do not place electrodes trans-thoracic
- Monitor conductivity of electrodes since they dry out quickly with IFC
What are the Contraindications for Ultrasound?
Cancer
Pacemaker
Pregnancy (near abdomin or low back)
-Not over:
-Spincal Cord
-Eyes
-Arthroplasty (plastic)
-Thrombus/DVT
-Reproductive OrgansWhat are the Indications for Ultrasound?
- Joint Contractures
- Sub-acute and chronic: bursitis, tendonitits, myositis
- Pain from muscle guarding, trigger points, and neuroma
- Warts
- Wound healing
What are the Parameters for Ultrasound?
Frequency:
-1 MHz (deep tissues)
-3 MHz (superficial tissues)
Duty Cycle:
-20% (Nonthermal)
-Tissue healing
-Acute and sub-acute inflammation
-100%/Continuous (Thermal
-Decreased ROM (guarding or spasm)
-Fibrosis/Scar
-Adhesions
-Sub-acute edema
-Unresolved hematoma
Intensity:
-Tendon: .5-1 w/cm2
-Muscle: 1-1.5 w/cm2What are the Contraindications for Traction?
Symptoms worsen/peripheralize
Osteoporosis
Uncontrolled HTN
Recent Spinal Fracture
Joint Hypermobility
Acute inflammation or injury
Recent spinal surgery
Spinal cord pressure (bilateral rediculopathy)
What are the Indications for Traction?
- Reduce radicular signs and sx from:
- Disc protrusion, DDD/DJD/spondylosis, stenosis
- Reduce muscle spasm and guarding
- Reduce joint pain
- Increase ROM
What are the Parameters for Cervical Traction?
- Never extend the C-spine for Tx. The most / you’d want is neutral.
- Angle of pull:
- AO joint: 0 deg
- C2-C7: 25-35 deg
- Poundage of pull:
- Start @ 8-10# (7-9# if acute)
- Never more than 30#
- Disc herniation
- Static (Not as tolerated) or Long intermittent
- Facet/DDD/spasm
- Short intermittent
- Duration/Time:
- First Tx: 5-10’
- Disc: 5-10’ static; 20-30’ long intermittent
- Facet/DDD/muscle relaxation: 20-30’
What are the Parameters for Lumbar Traction?
- Angle of pull:
- Disc herniation: Anterior
- Facet/DDD/spasm: Posterior
- Poundage of pull:
- Start at 30-45#
- Never more than 60% of BW
- Disc herniation
- Static (Not as tolerated) or Long intermittent
- Facet/DDD/spasm
- Short intermittent
- Duration/Time:
- First Tx: 5-10’
- Disc: 5-10’ static; 20-30’ long intermittent
- Facet/DDD/muscle relaxation: 20-30’
What are the Effects of Traction?
- Alter intradiscal pressure
- Create negative pressure and promote nucleus material return
- Improve blood supply to posterior mm and to disc: osmosis brings about increased blood
- Increased intervertebral formina dimensions
- Elongate posterior muscle tissue
- Stretch the facet capsule
What is the Inverse Square Law in terms of Light Therapy?
Doubling the distance of a radiant light source will decrease the intensity to 25% of the original amount.
What is Ohm’s Law in terms of E-stim?
- The relationship between current, voltage, and resistance (impedance)
- I (current) = V (voltage)/R (resistance)
What are the Contraindications for TENS?
-Do not use while operating heavy machinery
What are the Contraindications for NMES?
-Where active motion is contraindicated
What are the Contraindications for E-stim for Tissue Repair?
- Wounds with osteomyelitis
- Over topical agents containing heavy metal ions
- Systemic infections
What are the Contraindications for Iontophoresis?
- Contraindications to the intended medication
- Malignancies in the area to be treated
- Anesthetic skin in the area to be treated
- Scars in the area to be treated
What are the Contraindications for Heat?
Bad Contraindications Someone Can’t Do
- active Bleeding
- Confusion
- Sensory loss
- Cancer
- DVT
What are the Contraindications for Cold?
HAIR
- Hypersensitivity to cold
- Arterial insufficiency or PVD
- cold Intolerance
- Regenerating nerve
What are the Contraindications for Diathermy?
General: -Pregnancy -Neural Stimulators -Electronic Devices -Pacemaker Thermal Level: -Metal implants -Malignancy -Epiphysis -Eyes -Testes Non-Thermal Level: -Deep tissues such as internal organs -Substitute for convetional therapy of edema/pain
What are the Contraindications for Intermittent External Compression?
Group 1: Arterial insufficiency
Arterial wound
Group 2: Thrombi/DVT/PE
CHF/Pulmonary edema
Group 3: Infections at the rx site
Acute fracture or trauma
Group 4: Obstructed lymph
HypoproteinemiaWhat are the Contraindications for LASER and Light?
- Active Bleeding
- Cancer
- Eyes
- Thyroid or glands
- Radiation Tx w/in past 6 months
- Uterus during pregnancy
What are the Contraindications for Ultraviolet?
- Lupus
- Eyes
- Pulmonary TB
- Cardiac, Kidney, Liver Disease
- Fever
- Skin CA
What are the Contraindications for EMG Biofeedback?
- Acute inflammatory conditions (up to 6 wks post-surgery)
- Pelvic floor feedback: pregnancy; bladder or vaginal infections
What are the Contraindications for Hydrotherapy?
Local Application:
-Bleeding
-Maceration
Full Body (Aquatics or large tank)
-Infections
-Cardiac Instability
-Incontinence
-Severe Epilepsy
-Suicidal
Full Body (Hot Water):
-Pregnancy
-Multiple Scerosis
-Thermoregulation Deficit
