Final Exam Flashcards
1
Q
Kinesio Tape Theory
A
KT is applied unstretched over manually stretched skin above the injured muscle to form convolutions which lift the skin
Convolutions facilitate the body’s natural healing process by increasing interstitial space resulting in decreased pressure and irritation on neural, sensory, and lymphatic structures which results in decreased pain, decreased swelling, and more free drainage of the lymphatic system
2
Q
Reasons to use Kineso Tape
A
Decreased muscle strength
- Facilitation muscle contraction
- Stabilize joint
- Promote active range of motion through spring assistance
Hypertonicity
- Inhibits muscle contraction
Muscle overuse or myalgia
- Promote recovery of inflammed, swollen or stiff muscles by increasing space between skin and muscle and promote flow of lymphatic tissue and decrease compression of pain receptors
Swelling/edema
- Tape is positioned to recoil and promote drainage toward healthy lymph node
- Increase space between skin and muscle to improve flow of lymphatic tissue
Pain
Reduce muscle fatigue
Scar tissue
Asymmetrical posture/movement
Sensory stimulation
Hypermobility
Hematoma/bruising
3
Q
Athletic tape
A
Used for acute injuries and injury prevention
Several layers of tape are rolled around affected area to restrict movement of affected muscle and joints
Applies significant pressure and compression to skin, joint, and muscle which may lead to an obstruction of flow of bodily fluids
Generally applied immediately before sports activity and removed immediately after
Requires pre-tape or spray adhesive
Contains latex
4
Q
McConnell Taping
A
Provides bracing or strapping with extremely rigid cotton mesh tape
Requires pre-tape
Poor adhesive quality when wet and has limited wear time
5
Q
Qualities of Kinesio Tape
A
100% cotton and latex free
Safe for pediatric and geriatrics
Heat sensitive adhesive
Breathable and flexible material
Can be kept on for up to five days
6
Q
Benefits of Kinesio Tape
A
Facilitate body’s natural healing process
Improves lymphatic flow
Provides support and stability to muscles and joints without restricting the body’s range of motion
Enhances muscular and joint function
Reduce muscle fatigue
Restore epidermal tissue homeostasis
Can be worn for 3-5 days without re-application
7
Q
Radiation
A
Light beam irradiates 1-3 inches below the skin to interrupt the DNA molecule so it is unable to replicate
Keloid scarring occurs below skin
8
Q
Side effects of radiation
A
Effects of radiation are present more than two years post treatment
- Rash
- Hair loss
- Fibrosis
- Decreased ROM
- Partial thickness burns
- Fatigue
- Infertility
- Heart disease
- Secondary cancers
9
Q
Chemotherapy
A
Using toxic drugs to interfere with synthesis or function of nucleic acid to kill cancer and health cells
Reoccurrence of cancer may occur since treatment will not affect 5% of cells in dominant phase)
10
Q
Side effects of chemotherapy
A
Hair loss
Fatigue
Weight gain/loss
Lean muscle mass loss
Cardiotoxicity
Myelosuppression
Fatigue
Chemo induced peripheral neuropathy
Cogntive changes
11
Q
Other possible side effects of chemo and radiation
A
Flu-life symptoms
Pain
GI problems
Skin changes
Weight changes
Anemia
Risk for infection
12
Q
Oncology pain
A
70% report cancer pain
Bone pain
Tumor pain
Pain secondary to treatment
13
Q
Cachexia
A
Weight loss of 5% of pre-illness weight
Primarily caused by tumor draining metabolic energy
14
Q
Osteolytic
A
Pertaining to bone being eaten away
15
Q
Osteoblastic
A
Pertaining to osteoblasts becoming more active and bone becoming like chalk
16
Q
Superior vena cava syndrome
A
Occurs when tumor compresses superior vena cava or may be due to radiation
Results in facial/arm edema, headache, vein distention on chest, plethora (redness in face), dizziness
Precautions
- Monitor vitals at all times
- Avoid activities that will increase intracranial pressure
- Work on mobility, safety, and ADL training
17
Q
Pleural effusion
A
Excess fluid in pleural space due to tumor or obstruction of lymph flow or pulmonary vein
Results in cough, dull chest pain, dyspnea, labored breathing
Intervention
- Energy conservation
- Mobility/ADL training
- Breathing/relaxation exercise
- Increase comfort
- Elevate HOB
- Monitor for edema in lower extremities
18
Q
Ranges of platelet count
A
Normal range: 150,000-450,000 per cubic mm
Low range is below 50,000
19
Q
Side effects of low platelet count
A
Easy bruising
Bleed longer with injuries
Gum and/or nose bleeds
Bleeding in stomach, throat, intestinal tract, bleed into muscles and or joints
20
Q
Intervention when platelet count is less than 10,000
A
Walk in room with assistance
ADLs, safety, basic active or active assistance exercises
Look for signs of bleeding or bruising
21
Q
Intervention when platelet count is from 11,000-50,000
A
Walk in room or hallway, complete ADLs, and educate on safety
Stationary bicycle/ergometer with no resistance
Increase exercise effort and time slowly
22
Q
Intervention when platelet count is over 50,000
A
Increase walking distance
Slowly introduce active exercises with low resistance
23
Q
Hemoglobin range
A
Normal range: 12-16 grams per deciliter
Low range is below 8
24
Q
Hematocrit range
A
Normal hematocrit 37%-52%
Low range is below 35%
25
Side effects of low hemoglobin or hematocrit
Fatigue and shortness of breath
Dizziness
Leg cramping
Headaches
Increase in heart rate and respiration rate
26
Intervention when hemoglobin is less than 8
Minimize activity
Save energy for daily activities such as bathing/dressing
27
Intervention when hemoglobin is between 8-12
Walk short distances
Use stationary bike/ergometer for 5-10 minutes with no resistance
28
Intervention when hemoglobin is more than 12
Walk in room or hallway
Stationary bike/ergometer
UE/LE/trunk exercise with no more than 5 pounds
Increase exercise effort and time slowly
29
Axillary web syndrome (cording)
Visible or palpable tight cords from axilla to medial arm that become more pronounced and painful in shoulder abduction
May extend to antecubital space and to base of thumb , more pronounced and pinaul with shoulder abduction
Caused by interruption of lymphatics in axilla usually due to a fibrin clot
30
Intervention for axillary web syndrome
Soft tissue work with gentle myofascial release
Scar tissue massage
AROM/AAROM of shoulder and elbow
31
Interventions for scar adhesions
May appear secondary to surgical intervention
Manual scar mobilization to soften scar tissue to provide desensitization, prevent adhesions of tissue, and improve lymph circulation
Myofascial release
ROM/manual stretching
32
Lymphedema
Swelling due to build up of lymph fluid
May occur secondary to surgical resection of lymph node, radiation damage, or scar tissue impeding lymphatic flow after surgery
Complete decongestive therapy is required
33
Complete decongestive therapy
Manual lymph drainage massage
- Mild superficial massage aimed to manually move lymph out of limb or body part
- Improve lymph production
- Improve lymph circulation
- Special strokes break down fibrotic tissue
- Promotes relaxation and analgesia
Compression with multi-layer bandaging and compression garments
- Reduces ultrafiltration
- Improves efficiency of muscle pumps
- Prevent accumulation of evacuated lymph fluid
- Helps break up accumulated scar and connective tissue
Client education
Meticulous skin care and infection prevention
Exercise
34
Adhesive capsulitis symptoms
Associated with diabetes and thyroid disorders, presents with diffuse shoulder pain, and restricted passive range of motion on examination
35
Iontophoresis mechanisms
Direct current is used
Charged drug is repelled by electrode with the same charge and pulled toward the elctrode with the opposite charge
36
Indications for iontophoresis
Treat musculoskeletal and inflammatory condtions
Decrease joint pain
Decrease inflammation
Local anesthesia
Carpal tunnel syndrome
Epicondylitis
Ulnar nerve inflammation
Elbow strain/sprain
Radiohumeral bursitis
Triceps tendonitis
Gleno-humeral bursitis
Reflex sympathetic dystrophy
Hand and wrist tendinitis/tenosynovitis
DeQuervain's disease
Hyperhydrosis
37
Iontophoresis adminsitration
Administer every other day
Patient should notice a decrease in pain or symptom after 4-6 treatments and acute inflammation should subside
Continue for 9 to 12 sessions if patient shows continuous improvement
Treatment should be stopped if patient is not getting at least 50% relief
38
Iontophoresis precautions
Attraction of positive ions at negative pole may cause alkaline reaction resulting in formation of bases
Acids and bases forming at electrodes may affect ability to deliver a drug due to changes in pH of medicated solution
Alkaline reactions will be more irritating to the skin
Ask if they have any known allergies to food or medications
Accumulation of electrodes under elctrodes may lead to electrochemical skin irritation and burns under the negative electrode
Use lower level of current when treatment electrode is negative
Be aware of possible drug interactions
39
Iontophoresis contraindications
Should not be applied over scratches, cuts, lacerations, or abrasions due to risk of discomfort and burns
Skin sensitivty reactions
Sensitivity to aspirin (salicylates)
Gastritis or activity stomach ulcer (hydrocortisone)
Asthma (mecholyl)
Sensitivity to metal (zinc, copper, magnesium)
Sensitivity to seafood (iodine)
40
Commonly used NSAIDs for inflammation
Dexamethasone is the gold standard
Glucocorticoid medications are used to treat acute and chronic inflammatory conditions such as tendinitis, bursitis, and lateral epicondylitis
41
Corticosteroids
Anti-inflammatory drug
Suppress immune response and reduce inflammation
Naturally produced by adrenal cortex
42
Glucocorticoids
Anti-inflammatory durg
Synthetically produces
Anti-inflammatory, metabolic, and immunosuppressant effects
Include
□ Beclomethasone
□ Betamethasone
□ Cortisone
□ Dexamethasone
□ Hydrocortisone
Methylprednisolone
43
Salicylates
Anti-inflammatory drug
Less costly and available without prescription
Ex.
□ Aspirin
□ Choline magnesium trisalicylate
Choline salicylate
Sodium salicylate
44
Current density
As electrode size decreases, current density increases which leads to increased perception of stimulation and greater physiologic response
If current density is excessive, it will result in discomfort, skin burns, and potential tissue damaged
Maximum current of 4 milliamps for iontophoresis
45
Benefits of electrotherapeutic agents
Facilitate tissue healing
Improve muscle strength and endurance
Decrease edema
Modulate pain
Decrease the inflammatory process
Modify the healing process
46
Neuromuscular electrical stimulation (NMES)
Type of pulsed, alternating current used to stimulate a motor response by depolarizing intact peripheral nerves
NMES stimulates nerves that correspond to a targeted muscle or muscle group to contract tissue
Intact peripheral nerve and healthy muscle tissue is required for activation
47
TENS electrode placement
Most units have four electrodes in which two originate from each of the two channels
Place electrodes over or around painful site
Can also place over motor points, trigger points, or acupuncture points
Can be placed parallel to painful site, on either side of scar or surgical incision, crossed at the site of pain, bracketed or linear
Initial placement should be changed if outcome is less than expected or if the patient is experiencing pain or discomfort
48
Transcutaneous electrical nerve stimulation
Delivers pulsatile alternating current through the skin for pain relief by stimulating the opioid system
Decreases pain perception by decreasing conductivity and transmission of noxious impulses from small pain fibers
49
Iontophoresis
Delivering medication into tissue with direct electrical current
Charged drug is repelled by electrode with the same charge and pulled toward the elctrode with the opposite charge
50
Iontophoresis electrode placement
Delivery electrode has the medication on it and is positioned on the target area
Dispersive pad is placed over a major muscle at least 4 to 6 inches away from the delivery electrode
51
Peripheral sensitization
Damage to high-threshold nociceptors leads to hypersensitivity
Areas adjacent to those of the actual injury hurt as if injured
Tissues respond to stimuli that ordinarily do not produce pain such as touch, clothing, light pressure, or a hairbrush as if they are painful (allodynia)
52
Central sensitization for chronic pain
Developed hypersensitivity that causes pain due to repetitive stimulation of afferent C-pain fibers
- Frequent stimulation results in stronger fiber memory
Presents with pain hypersensitivity, tactile allodynia (intense pain from innocuous stimuli), pressure hyperalgesia, limiting movement, and decreased performance and functional independence
53
Sub-sensory level TENS (Microcurrent electrical neuromuscular stimulation (MENS) or sublimination stimulation)
Monophasic pulsed current intensity below threshold for nerve depolarization
Stimulation enhance cellular physiology and processes by moving ions in tissues at a low magnitude
Cutaneous sensation is not felt
Uses acupuncture points
Studies failed to demonstrate treatment is significantly more effective than placebo
Cranial electrotherapy stimulation
- Microcurrent, subthreshold
- Treats sleep disorders, depression, anxiety
54
Sensory level TENS (Conventional or high rate TENS)
Activates cutaneous tactile sensory fibers resulting in cutaneous paresthesia or tingling sensation without eliciting any motor response
Uses gate control mechanism and opiate-mediated pain control theory to decrease pain
Frequency is from 50-150 Hz
Amplitude is increased until the patient feels tingling and buzzling at a comfortable level
Long term effects are limited to no longer than one hour
55
Gate Control Theory of Pain
Pain stimuli is either allowed to pass or is blocked by a gate in the dorsal horn of the spinal cord
Anxiety, negative thoughts, poor past experiences, or depression can open the gate and increase perception of pain
Positive thoughts and relaxation can close the gate to decrease perception of pain
56
Opioid Mediated Theory of Pain
Theory that endogenous opioids are pain-mediating chemicals that are produced in the body and affect the CNS and PNS
57
Motor level TENS
High amplitude and low frequency
Amplitude: high enough to produce visible muscle contractions
Uses Gate control theory or opiate mediated pain control
Frequency: 1-4 Hertz (pps)
Pulse width: 150-250 microseconds
Intensity: increase until patient receives muscle contraction (30-60 miliamps)
Duration: 20-30 minutes once daily
Used for chronic pain
Goals is to selectively activate small diameter nerve fibers arising from muscles to induct a phasic muscle twitch
Avoid any joint movement contraindicated
Use for chronic pain, pain caused by damage to deep tissues, myofascial pain, and pain caused by muscle spasm
58
Noxious level TENS
Frequency is greater than 100 Hertz (pps)
Pulse width: 300-1000 microseconds
Amplitude: increased until pain is perceived
Impulses release endogenous opiates and inhibit release of substance P
High level of analgesia achieved, but effects short-lived and transitory
59
A-delta fibers
Myelinated pain fibers that carry sharp, well-localized pain signals
60
C-fibers
Unmyelinated pain fibers that carry poorly localized burning and aching sensation and are easily injured
61
Pain pathway
Afferent fibers
T-cells receive input from afferent fibers and assist in discriminating the type of pain
Brain
- Somatosensory cortex
-> Perceives pain as sharp, discriminative, localized to specific area
-> Is responsible for automatic reaction to pain
- Spinoreticulothalamic pathway
-> Terminates in thalamus/midbrain region
-> Perceives pain as diffuse, poorly localized somatic and visceral pain
- Frontal cortex
-> Defines perceptions and response to pain
-> Signals to release neurotransmitters which moderate and affect flow of afferent impulses
Descending inhibitory fibers in higher brain centers release neurotransmitters to affect flow of afferent impulses
62
Interferrential current Therapy
High frequency (1-100Hz) carrier waveform penetrates the skin more deeply than a regular TENS unit with less discomfort
Deeper tissues cancel out the carrier waveform resulting in TENS like signal deeper under the skin
63
Functional electrical stimulation
Uses pulsed current to stimulate peripheral nerves to allow clients to perform a functional activity
Ex. Wireless walking FES system helps with lifting leg or foot drop
64
Analgesia from cold
Absence of sensibility to pain leading to relief of pain without loss of consciousness
Occurs at approximately 80.6 degrees F in 10-20 minutes
Higher intensity application like ice massage require less time and should be discontinued with analgesia is reached
65
Target soft tissue temperature for thermotherapy
104-113 F
Below 104, therapeutic response will not be achieved
Above 113F, catabolism and cell death will occur; 116 F will burn skin
66
Penetration of superficial thermal agents
1-2 cm
67
Penetration of deep thermal agents
5 cm
68
PRICE protocol
Position
- Position to avoid further injury or instability
- Partially immobilize injured area
Rest
- Avoid activities that stress injured area to point of pain
- Allow gentle ROM and movement w/o pain
- Isometric exercises without pain facilitate healing
Ice
- Apply ice in cycles of 10 -15 minutes on and 1 to 2 hours off
- Protect skin and limit cold application to 10 to 15 minutes
Compression
- Apply compression wrap to provide support and decrease edema
Elevation
- Position extremity above level of heart to avoid increased hydrostatic pressure and swelling
69
Application of cold packs
Wrap cold pack in a thin towel or cover area with a paper towel
Bandage wraps or other elastic wraps can be used to hold cold pack in place
Monitor skin to prevent tissue damage
70
Application of ice massage
Use to anesthetize a relatively small area or disrupt pain cycle of a trigger point
Position patient comfortably and drape area with towel to catch melting ice
Move ice in small, rhythmic circles with direct contact on the skin
Numbness generally occurs within a 3 to 10 minute time frame
- Do not exceed 10 minutes
71
Hot pack application procedure
Remove hot pack from hydrocollator (158-168 F) and place in hot pack cover or 6-8 layers of dry Turkish towels
- Hot pack cover = 2 layers
Apply to body segment and secure
Start treatment timer for 20 minutes and advise to immediately indicate if hot pack feels to hot
At 5 minutes, check patient's status and assess for burning, blistering, or excessive redness
- Briefly apply a cold pack if there is overheating
At the end of 20 minutes, remove towels and hot pack, check patient's status, and check to see if treated area is slightly red and warm to touch
Place hot pack back in hydrocollator to reheat for 30-120 minutes
72
Advantages of hot pack
Body segment can be placed into sustained positional stretch to increase ROM
Easy to use and minimal maintenance
Moderate to vigorous doses of heat that penetrates 1-2 cm
73
Disadvantages of hot packs
Skin cannot be observed
Patient may not be able to tolerate weight/heat
Weight can accelerate rate of transfer
May not allow AROM during heating
74
Paraffin Bath Procedures
Heat bath to more than 125 F
Have patient wash and dry body part
Hold hand with fingers slightly spread and dip hand into paraffin bath
Remove hand and hold it over paraffin mixture until hand stops dripping
Repeat process 10 times
After last dip, cover hand with plastic wrap and drape it with a paper towel
Set treatment timer for 20 minutes
Tell patient to inform if paraffin is too hot or uncomfortable
At 5 minutes, verbally check patient's status
At end of 20 minute session remove towel and plastic wrap and discard paraffin
Treated area should appear slightly red and be warm to the touch
75
Advantages of paraffin bath
Easy to apply, inexpensive
Efficient when treating small joints of distal extremities
Evenly applies moderate to vigorous heat that penetrates 1-2 cm to decrease stiffness and pain in joints, reduce pain in soft tissue, and improve range of motion
Mineral oil in mixture lubricates skin
Passive stretch can be sustained throughout heat application with Coban
Effective for rheumatoid arthritis when a moderate amount of heat is applied
76
Disadvantages of paraffin bath
§ Messy
§ Skin is not visible for inspection during procedure
Expensive to replace wax mixture
Danger of contamination
Need to clean bath
Vigorous doses of heat caFn be harmful for Rheumatoid arthritis
77
Fluidotherapy
Special chamber that suspends finely ground cellulose particles in warm air to provide heat, massage, and sensory stimulation
78
Whirlpool bath
Hydrotherapy process that uses forced air to agitate water in a tank to provide mild, moderate or vigorous dose of heat
Fill tub with water at desired temperature (100-104 F for heating and 90-100 F for open wounds)
79
Contrast baths
Immersing extremity in alternating tubs of hot and cold water causes extremity to cycle between vasodilation and vasoconstriction
- Extremity is held in hot water for 3 or 4 minutes (105-110 F) and then immediately immersed in cold water (50-60 F)
- If desired effect of treatment is to achieve state of vasoconstriction, then last bath will be cold water
- If state of vasodilation or relaxation is desired, then last bath will be warm water
80
Cryotherapy contraindiciations
Areas with impaired circulation
Peripheral vascular disease
Hypersensitivity to cold
Skin anesthesia
Open wounds or skin conditions
Infections
Hypertension
Impaired sensation or mentation
Patients with a history of frostbite or systematic cold injury
Those diagnosed with cold urticaria, cryoglobulinermia, or Raynaud's disease
81
Cryotherapy precautions
Exposure for longer than 20 minutes can lead to tissue damage or death
Extended application of cold may cause temporary or permanent nerve damage of changes in nerve conduction
When patient reports numbness, this indicates analgesia and removed protective sensation
- Caution from overuse or reinjury to area
Sensitivity to cold indicated by itching, hives, sweating, and development of wheals with reddened borders and blanched centers
Do not test for grip/pinch strength or fine motor manipulation after application of cold
82
Thermotherapy contraindications
Acute inflammation
Acute edema
Deep vein thrombophlebitis
Bleeding tendency
Infection
Primary repair of tendon or ligament
Advanced cardiac disease
Semicomatose or impaired mental status
Acute musculoskeletal conditions
Impaired circulation
Peripheral vascular disease
Skin anesthesia
Open wounds or skin conditions
Increase in hydrostatic pressure
83
Acoustic impedance
Resistance to wave energy by a medium
Greater impedance in tissues with more dense or heavy molecules
Fluid has elements have the lowest impedance values and acoustic absorption
Bone has the highest impedance value and highest acoustic absorption coefficient
Ultrasound waves continue through each tissue but is slightly refracted away from original position
Impendence levels from lowest to highest: fat, water, blood, muscle, bone
84
Resistance
Resistance to flow of particles
Fat and dry skin have high resistance
Muscle and clean and moist skin have low resistance
85
Pulse amplitude/intensity
Strength of current
Associated with depth of penetration
- Deeper penetration will result in more muscle fiber recruitment
Amplitude needs to be 25-50 miliamps to make the muscle contract
Amplitude of 75 miliamps will lead to cardiac arrest
Peak amplitude
- Maximum amount of voltage delivered in a single phase
86
Healing process
Typically takes 4 weeks
Inflammatory phase (time of injury - 7 days)
Proliferative phase (3 days - 3 weeks after injury)
Maturation/remodeling phase (2 weeks - 1 year or longer after injury)
87
Inflammatory Phase
Lasts from time of injury - 7 days
Leukocytes, neutrophils, and monocytes are sent to the injured area to decontaminate the wound
Blood vessels dilate in response to histamine release to provide increased blood supply for healing
Blood flow to area causes the area to become red, hot, swollen, and painful
Edema surrounds wound to bind edges together
Associated with red/blue/purple skin color, heat, swelling, pain, and potentially some loss in function
If too much inflammation occurs, excessive scar is produced
Neovascularization
- New circulatory loops fill wound creating highly pink to reddish wound color
- Immobilization is essential during this phase to permit vascular regrowth and prevent new breakdown
88
Proliferative phase
3 days - 3 weeks after injury
AKA epithelialization or granulation phase
Damaged area is filled with new connective tissue and covered with new epithelium
Granulation tissue fills in wound site, binding and protecting the area (granulation)
Epithelial cells migrate upward and repair the wounded area (epithelization)
Wound contraction results in decreased size of wound
Scabs form a temporary barrier and should not be disturbed
89
Maturation/remodeling phase
2 weeks - 1 year or longer after injury
Continued fibroblastic activity and collagen synthesis and lysis lead development of a scar with maximum tensile strength
Scar formed is dense, disorganized, and may appear rosier
Scar formation occurs when collagen synthesis exceeds collagen lysis
Hypertrophic scars
- Scars within the boundaries of the lesion
Keloid scars
- Scars that extend beyond the boundary of the wound and appear raised
90
Purposes of Neuromuscular Electrical Stimulation
Improve muscle strength without increasing cardiovascular output
Enhancing range of motion
- Provides regular stretching over an extended period of time
Inhibit spasticity or muscle spasms
- Reciprocal stimulation of agonist and antagonist pairs can reduce spasticity
- Stimulate spastic agonist to fatigue
Improves capillary density in muscles
- Improves local blood supply
- Facilitates microcirculation
Improve endurance
Muscle reeducation or neuromuscular facilitation
- Ask patient to try and assist the action of the stimulator with voluntary movement
Reduce pain due to increase in neurotransmitters and endogenous opiates
Temporarily correct shoulder spasticity/subluxation
- Can improve the resting position of joints
-Stimulation of posterior deltoid and supraspinatus as a substitute for traditional arm slings
Initiate orthotic substitution
Control edema
Enhance effect of botulinum toxin
- Botox can be more easily absorbed if muscles are active
- Take up occurs over first two days after injection
91
NMES precautions
Use lowest effective current on patients with impaired mentation or sensation
Monitor motor response and skin
Areas of skin irritation, damage, or skin lesion can cause decreased tissue impedance and increased current that may result in pain
Fractures
Pregnancy
Allergy or skin sensitivity
92
NMES contraindications
Lower back or uterus during first trimester of pregnancy
Metastases
Osteomyelitis
Thrombosis
Allergy to iontophoretically-delivered medication
Patients who are taking diuretics
Should not be applied to craniofacial or cervical region of patients who have a history of CVAs or seizures
Over phrenic nerves or bladder stimulators
Over carotid sinus
Near diathermy devices (minimum 9' clearance)
Over or near superficial metal pins, plates, or hardware
Patients with cancer, infection, tuberculosis, or active hemorrhage
Cardiac pacemakers
93
TENS contraindications
Demand-type cardiac pacemakers
Halter monitors
During labor and delivery
On trunk of abdomen or pregnant women
Directly over the eyes of individuals with epilepsy or malignancies
Patient with peripheral vascular diseaes or infection
Patients with decreased or absent sensation
In patients with undiagnosed pain
Over carotid sinus area or trans-cerebrally
Care should be taken for patient who are experiencing acute pain as the protective mechanism that indicates potential tissue damage may be affected
94
Iontophoresis precautions
Attraction of positive ions at negative pole may cause an alkaline reaction resulting in formation of bases
- Acids and bases forming at electrodes may affect ability to deliver a drug due to changes in pH of medicated solution
Alkaline (-) reactions will be more irritating to the skin
Ask if they have any known allergies to food or medications
Accumulation of electrodes under elctrodes may lead to electrochemical skin irritation and burns under the negative electrode
Use lower level of current when treatment electrode is negative
Be aware of possible drug interactions
95
Iontophoresis contraindications
Should not be applied over scratches, cuts, lacerations, or abrasions due to risk of discomfort and burns
Skin sensitivty reactions
Sensitivity to aspirin (salicylates)
Gastritis or activity stomach ulcer (hydrocortisone)
Asthma (mecholyl)
Sensitivity to metal (zinc, copper, magnesium)
Sensitivity to seafood (iodine)
96
Joint mobilization
Passive joint movement for increasing ROM or decreasing pain
Applied to joints and soft tissues at varying speeds and amplitudes
Force is light enough that patients can stop movement
97
Joint manipulation
Passive joint movement for increasing joint mobility
Incorporate a sudden, forceful thrust that is beyond the patient's control
Usually done by a chiropractor
98
Effects of joint mobilization
Stimulates mechanoreceptors to decrease pain
Stimulate nociceptive receptors to decrease muscle spasms and muscle guarding
Stimulate afferent nerves to increase awareness of joint position and motion
Distraction or small gliding movement causes synovial fluid movement
Improve nutrient exchange
Improve joint mobility of hypomobile joints
Loosen adhesions and thickened connective tissue
Maintains extensibility and tensile strength of articular tissues
99
Contraindications for joint mobilization
Inflammatory arthritis
Malignancy
Tuberculosis
Ligamentous rupture
Herniated discs with nerve compression
Bone disease
Neurological invovlement
Bone fracture
Congential bone deformities
Vascular disorders
Joint effusion (may use 1 or 2 mobilizations to relieve pain)
100
Joint mobilization precautions
Osteoarthritis
Pregnancy
Flu
Total joint replacement
Severe scoliosis
Poor general health patient's inability to relax
101
Joint mobilization treatment direction
Joint traction techniques are applied perpendicular to the treatment plane
Gliding techniques are applied parallel to the treatment plane
If gliding in the restricted direction is too painful, begin gliding mobilizations in the painless direction then progress to gliding in restricted direction when not as painful
102
Joint traction techniques
Pulling one articulating surface away from another, creating separation
Performed perpendicular to treatment plane
Used to decrease pain or reduce joint hypomobility
103
Instrument Assisted Soft Tissue Mobilization (IASTM)/Graston Technique
Soft tissue mobilization technique
Can cover larger areas
104
Augmented soft tissue manipulation (ASTYM)
Soft tissue mobilization technique
Form of IASTM
Addresses entire kinetic chain and reestablishes normal movement patterns
Guides healing to restore tissue to pre-injury levels
- Provides body with a stimulus to jump start healing
Focuses on cellular level (macrophage-mediated phagocytosis and remodeling and regeneration of degenerated and dysfunctional tissues)
Dosing
- 2x/week for most patients
- 2 days between treatment session
- Maximal results will result in 6-9 treatments
- Continue pattern until desired outcome is achieved
105
Goals of soft tissue mobilization
Break down adhesions or scar tissue
Improve ROM
Lengthen muscles and tendons
Reduce swelling and edema
Decrease pain
Restore functionality
Stimulate rehabilitation and recovery
Increased vascular response
Increased fibroblast proliferation
Remodeling of unorganized collagen fiber matrix following STM/IASTM application
106
Nonthermal ultrasound
Used for inflammatory or acute phase (time of injury - 7 days)
0.2 W/cm2
20% duty cycle
107
Mild heating ultrasound
Used for proliferative or subacute phase of healing (3 days - 3 weeks after injury)
0.2-0.8 W/cm2
50% duty cycle
108
Therapeutic heating ultrasound
Used during remodeling or chronic phase (2 weeks - 1 year)
0.8-2 W/cm2
100% duty cycle
109
Ultrasound frequency
Number of complete wave cycles generated each second
Influences amount of energy absorbed and determines tissue penetration depth
1MHz penetrates 5-7 cm
3 MHz penetrates 1-2 cm
110
Ultrasound duration
2 minutes per finger width
Maximum of 15 minutes or equivalent of 2x size of soundhead
Approximately 1 minute per treatment head area
111
Symmetrical waveform
Symmetrical intensity of positive and negative are equal
112
Balanced asymmetrical waveform
Intensity of positive and negative are equal but different shapes
113
Unbalanced asymmetrical waveform
Intensity and shapes are different for positive and negative
114
NMES pulse frequency
Number of pulses per second (pps) or Hertz (Hz)
15-25 Hz for weak patients (stroke, TBI, debilitated)
35 Hz for otherwise healthy patients (ortho)
50 Hz to fatigue spastic muscles
60+ Hz for TENS pain relief
115
NMES pulse duration (pulse width)
Length of time electrical flow is on for one cycle to take place
Measured in microseconds
Can determine which nerve fibers are preferentially recruited
20-100 microseconds
- Preferentially recruits sensory nerves
- Large diameter A-beta nerve fibers that are hyper stimulated to over-ride pain
200-400 microseconds
- Preferentially recruits motor nerves
- Recruits large diameter A-alpha motor nerves necessary for muscle contraction
400-1000 microseconds
- Preferentially recruits pain carrying nerve fibers
- Used in noxious electrotherapy protocols
- Concept of pain relieving pain
116
NMES Amplitude ramp
Gradual rise or fall in amplitude of a pulse train
Causes a gradual increase in the force of muscle contraction by progressive recruitment of motor units
2 second ramp up time is effective for non-spastic muscles
6-8 second ramp up time may be helpful for patients with mild to moderate muscle spasticity
117
NMES on/off cycle
Strengthening may require that you start at 1:3 time ratio and progress to 1:1 time ratio
- When patient is able to comfortably perform a 1:1 power treatment regimen, will be time to discontinue treatment
Musstrencle reeducation may require starting at 1:3 time ratio and progress to 1:5 time ratio
- When patient is able to perform movements during rest cycle, will be time to discontinue treatment
118
Trigger point
Electrically active and conduct nerve impulses more easily
119
NMES for muscle strengthening
Increase amplitude to about half of individuals maximum isometric muscle contration
Start at 1:3 time ratio and progress to 1:1 time ratio
When patient is able to comfortably perform a 1:1 power treatment regimen, will be time to discontinue treatment
120
NMES for neuromuscular reeducation
Use a goal directed activity along with NMES to increase motivation, proprioceptive and kinesthetic feedback, and increase neural plasticity
Start with patient achieving tetanic muscle contraction
Progress to muscle fasciculation to cue patient to contract muscle
Voluntary contraction + stimulated contraction results in better outcomes due to stimulating higher neurological centers that promote neuromuscular re-education
121
Roll
Occurs on incongruent surface when a series of points on a articulating surface comes into contact with a series of points on another surface
Usually occurs in combination of sliding or spinning
The more incongruent the joint surfaces are, the more rolling there is
Ex. Femoral condyles rolling on the tibial plateau
122
Slide
Occurs when a specific point of one surface comes into contact with a series of points on another
Surfaces are congruent
Glide occurs when a passive mobilization technique is used to produce the slide
The more congruent the surfaces are, the more sliding there is
123
Spin
Occurs when one bone rotates around a stationary longitudinal axis
Does not occur by itself during normal motion
Ex. Radial head at spinning in humeroradial joint during pronation/supination
124
Compression
Decreasing the space between two joints surfaces
Adds stability to joint
Normal reaction of a joint to muscle contraction
125
Distraction
Increasing the space between two joint surfaces
Often used in combination with joint mobilizations to increase stretch of capsule
126
Arthrokinematics
Movements of a joint
127
Indications for cryotherapy
Acute or subacute inflammation
Acute pain, strain, or pain
Acute swelling
Myofascial trigger points
Muscle guarding
Muscle spasm
Acute contusion
Bursitis
Tenosynovitis
Tendinitis
Delayed onset muscle soreness
Post exercise edema/pain
Arthritic exacerbations or flare-ups
Spasticity
Post exercise to maintain soft tissue elongation
128
Indications for thermotherapy
Subacute or chronic inflammation or pain
Subacute strain or sprain
Subacute edema removal or swelling
Decreased ROM
Myofascial trigger points
Muscle guarding
Muscle spasm
Subacute contusion
Infection
