FINAL EXAM Flashcards
electrical modality used for pain control muscle spasm edema and strengthening
high volt modalities
low volt is ____ and high volt is ____
150v
150-500v
high volt modality machine are: (3 characteristics)
unidirectional
monophasic
interrupted
Direct current
high volt machine generates electromotive force up to
500 volts
physiological effects of high voltage
endogenous opioids
improved lymph drainage
decrease muscle spasm
local circulatory increase
Ardnt-Schultz Law
physiologic effects of energy absorption are concentration dependent
law of grothus and draper
energy is either absorbed superficial or transmitted to deeper layers
therapeutic effects of high volt
similar to IFC, russian, biphasic
same uses as medium frequency modalities
recommended frequencies of high voltage
pain reduction 70-110 pps
muscle spasm: 70-110 pps
muscle reeduction: 15 pps
edema <10pps
Contraindications for high voltage
neoplasia
sensory issue
Not over head
pacemakers
pregnancy
circulatory problems
metal in the area
polarity and effects
positive–>
negative –>
Positive: analgesia, vasoconstriction, germicidal
Negative: trigger pts, vasodilation, adhesions, muscle re-ed
what is Iontophoresis?
utilizing polarity of direct current to introduce chemicals into superficial tissues
Iontophoresis is done by:
using gauze soaked in a chemical covered by an electrode
what is the depth of iontophoresis?
1-2mm
.5ma/cm2
what is Phonophoresis?
ultrasound waves are used to drive substances through skin
substance is mixed into the coupling medium
what are some charactersitics of phonophoresis treatment?
1mhz
5-10min
1 w/cm2
contraindications to phonophoresis
broken skin
allergy
decreased sensation
malignancy
pregnancy
what is the acronym for Transcutaneous electrical nerve stimulation?
TENS
what is the purpose of TENS?
sensory stimulation for pain control but muscle contraction can occur
TENS parameters consist of:
alternating current
variation of faradic/square waveforms
70-150pps
width; 40-500 microseconds
low frequency tens typically have
longer widths
placement of TENS pads
dermatomes, nerve pathways, acupuncture points for pain control
muscle belly for contraction
indications for TENS
acute pain
chronic-if used daily
neuropathy-overplexus if used daily
obstetrical- depends on position of fetus in labor
contraindications of TENS
metal
poor sensation
local skin lesion
rash in the area
treatment protocol of TENS
high and low frequency in one session
30-45min
Mild SLS to Strong SLS
main goal of treatment of biofeedback is to train a patient to
perceive physical or biomechanical changes without the use of measuring instruments
intrinsic feedback is defined as:
cutaneous, vestibular, proprioceptive input sent to CNS
extrinsic feedback is defined as:
verbal, mechanical cues that a movement or function can be changed
(outside of the patient)
electrical biofeedback is defined as:
therapeutic procedure that uses electronic or electromechanical instruments to accurately measure, process, and feedback reinforcing via auditory or visual
effects of biofeedback are achieved via:
achieved by active work on patients part or by influencing physiological mechanisms
what are the 6 effects of biofeedback?
decrease spasm
decrease HR/RR
decrease BP
increase strength
decrease pain
decrease depression
what are 6 advantages of biofeedback?
small changes can be seen quicker
immediate identification of results
illustrates progress of rehab for patient
reduces stress from lack of improvement
identifying training problems
scientific approach to rehab
what are 4 types of biofeedback instruments?
peripheral skin temp
finger photo-transmission unit
skin conductance activity
electromyographic activity
what are 4 disadvantages of biofeedback?
rely on extrinsic input from device over internal
weaning off device if dependent
instrument makes activity exercise like as opposed to free flowing
mechanical failure
instruments in biofeedback do not:
measure the physiologic event directly, but an aspect correlated with it
(muscle contraction strength is not measure with EMG)
what are 4 devices used to measure forms of biofeedback?
sphygmomanometer
thermometer
EKG
EEG
what are some devices or tests that do not measure biofeedback?
lab studies
scales
height
imaging
what is EMG biofeedback?
nerve impulse reaches muscle and is sensed by the electrode
gives either visual (graph, oscilloscope) or auditory feedback (beep)
the sound in ultrasound is produced by what?
piezoelectric effect
rapid expansion and contraction of the crystal as AC passes
soundwaves of ultrasound are either:
1mhz -deep
3mhz- superficial
what is the audible range for human hearing?
20-20,000hz
provide some characteristcs of 1 mhz vs 3mhz ultrasound penetration:
1mhz= 2-5cm
3mhz= 3mhz- 1-2cm
what is the duty cycles of ultrasound?
20% acute
50% subacute
cont- chronic
what is the intensity of ultrasound?
.5-1w/cm2 thin acute
1-1.5 acute thin
1-1.5w/cm2 chronic thin
1.5-2w/cm2 chronic thick
continuous ultrasound has a ____ effect
thermic effect 100% duty cycle
what are some benefits of ultrasound?
histamine release to enhance inflammation
increase temp
soften collagen
decrease pain
what are some contraindications of ultrasound?
vascular insufficiency
over reproductive organs
over eyes
over gravid uterus
near pacemaker
over tumor
over joint replacements or open GP
ultrasound frequency should not exceed _______
14 days
can be 6-8 days
what are some thermal effects of ultrasound?
collagen extensibility
decrease joint stiffness
reduction of muscle spasm
increase blood flow
1mhz and 1.5w/cm2- .2C increase
3mhz and 1.5w/cm2 - .6c per minute increase temp
ultrasound can cause non-thermal effects like:
cavitation
-stable and unstable cavitation
acoustic streaming-increase membrane permeability
sound travels faster in ______ (water or air)
water than air so a coupling medium is needed for ultrasound
for bladder and underwater ultrasound, intensity is changed in which way:
increase .5w/cm2
immersion, the head is held .5-1.0cm away
what is combination therapy?
using ultrasound and electrical stim through transducer head
with regards to combo therapy, the dispersal electrode of combo must be:
4x area of transducer head
the treatment area of ultrasound must not be:
> 2-3x transducer head
what are some diathermy adverse effects?
patients with implanted brain stimulators died after receiving diathermy
following treatment for scoliosis and oral surgery as well
what are 3 types of diathermy?
short wave
microwave
ultrasound
diathermy is a form of:
deep heat that is conversion since the energy is converted within the tissue
what are some diathermy effects?
high frequency electromagnetic energy 10-100million hz
dense tissue becomes warmer than less dense
diathermy is not used often because:
it cannot be precisely controlled or prescribed
diathermy must take place on a table free of what material?
metal
what are the parameters for medical shortwave diathermy?
13.56mhz-strong magnetic field
27.12mhz strong electrical field
wavelengths between 3-30m long most commonly 12 meters
what are some Types of short wave diathermy?
inductor, induction field, induction coil
condenser type
pad electrodes
coil electrodes
continuous vs pulsed shortwave diathermy
explain the physiologic effects of short wave diathermy:
no contractions
thermal effect causes:
muscle relaxation
vasodilation
increased metabolism
increased enzymatic activity
increased lymph drainage
increased phagocytosis
decreased joint stiffness
vibration releases histamine
what are some endocrine changes of short wave diathermy?
marked increase in production of blood glucose
increased visceral circulation
influences circulation more than hot pack, infrared, IFC
what are some physiologic effects of pulsed short wavediathermy?
similar to pulsed ultrasound
repolarized damaged cells and restores sodium pump
pearl chain effect of WBC and RBC line up in a row along vessel walls
MSK indications for shortwave or microwave diathermy
subacute or chronic phase due to heating element:
sprain/strain
myalgia
osteoarthritis
trigger points
tenosynovitis
visceral conditions for short wave diathermy
COPD via bloodflow
bronchitis via increased blood flow
PMS via muscle relaxation
cystitis
via increased blood flow
colic via muscle relaxation
constipation
hemorrhoids
contraindications of shortwave and microwave diathermy
acute inflammation
ANY ACUTE CONDITION
edema
metallic implants
malignancy
open GP
poor blood supply
pregnancy
Contact lenses
IUD
vascular problems
no watches or jewelry bc of heat and magnetic fields
what are some treatment set ups with diathermy?
lay of towel is used to absorb sweat
no moisture can be in region treated
intensity is set to a comfortable warmth
10 minutes-15min
what is microwave diathermy?
higher frequency
shorter wavelength and less penetration compared to short wave
“deep heat”
good for low fat or water content areas
parameters of microwave diathermy:
2.5billion hz
12cm wavelength
superficial penetration
strong magnetic field is absorbed subcutaneously
what is magnetron?
electrons flow through iron structure on microwave diathermy
depends on velocity and force
what is director?
small structure focuses the microwave diathermy onto a small area of the body
heat of diathermy is ___
conversion as it is converted in the body
the director of microwave diathermy should be
90 degree to the area being treated at all times
LASER stands for:
light amplification of stimulated emissions of radiation
provide visible light characteristics:
400-800nm
infrared and microwave are above 800nm
UV light has the following wave characteristic:
> 400nm with x rays and gamma rays
frequency is defined as what?
number of wavelengths/cycles per one second
how does the energy source of lasers work?
stimulates atoms to move to high energy level and creates a population inversion (more excited atoms)
lasing medium is responsible for:
wavelength and color of the light
may be a solid liquid or gas
resonating cavity is defined as:
chamber for lasers that is capped with a 100% impermeable mirror and 80-99% impermeable mirror on the other end
light reflects back and forth until is has enough energy to leave the chamber
what does the term monochromatic mean?
one wavelength
what does the term coherent mean?
light waves are continuous and unbroken
what does the term collimated mean?
light runs parrallel and does not diverge
how would you describe laser qualities in 3 terms?
monochromatic
coherent
collimated
longer wavelength lasers are able to:
penetrate deeper than shorter ones
what are the FDA laser power guidlines?
1mw for continuous
.5mw pulsed
what are some indications for laser?
facilitate wound healing
reduce pain
increase tensile strength of scar tissue
decrease scar tissue
decrease inflammation
increase fx healing
what are some contraindications for laser?
not over gravid uterus
no over malignancy
not over eyes
not over thyroid
what is UVA?
long UV wavelength not commonly used and close to visible light
what is UVB?
medium wavelength
Sunburn
what is UVC?
short wavelength bactericidal (most common)
what are UVA and UVB?
near UV
UVC is also known as:
far UV
what are some ultraviolet therapy processes?
2-3mm penetration
10% reaches dermis
palms of soles and hands of feed- no UV reaches dermis due to callous
absorption causes leathery skin (epidermal hyperplasia)
what are some physiologic effects of UV therapy?
erythema
pigmentation UVA/UVB
thickened skin
edema
increase fibroblast activity
increase RBC numbers
stimulates Vit D production
bactericide
what is the term photokeratitis?
what does this lead to pathology wise?
inflammation of the eye from UV light
conjunctivitis
photophobia
tearing
ocular spasm
what are some types of UV lamps?
carbon arc
mercury arc (most common)
high pressure type (hot quartz)
fluorescent UV (Blacklight)
what are some indications of UV therapy?
acne
psoriasis
sinusitis
osteomalacia
sterilization
herpes zoster
folliculitis
septic wounds
pityriasis rosea
pressure sores
what are some precautions for UV?
cover eyes
fair skin
cannot contact metal
older and younger people with thin skin
what are some contraindications of UV?
lupus
pregnancy
pellagra
acute exzema
herpes
diabetes
hyperthyroidism
chicken pox
acute psoriasis
what is the minimum erythemal dose?
exposure time needed to create erythema 24 hours after exposure
treatment should never exceed 10x MED
what are physiological reasons to utilize traction?
seperates joint surfaces
promotes gliding of joints
decrease spasm
decrease congestion
stretches adhesions
wha tare some contraindications for traction?
acute trauma
cancer
cardiovascular disorders
joint instability
uncontrolled HTN
osteoporosis
pregnancy
____ must be done with traction
tolerance testing must be done before treatment begins
vibration therapy is ____ and _____
stimulative <3min
sedative >3min
what are some indications for vibration therapy?
adhesions
trigger points
congestion
joint swelling
circulatory stasis
what are some contraindications for vibration therapy?
acute inflammation
heart disease
hyper anxiety states
damaged organs
over eyes
thrombophlebitis
What are the three Stages of healing?
Inflammatory response
Fibroblastic repair (subacute)
Maturation-remodeling (chronic)
Explain the Inflammatory response stage
2-4 days after injury
Leukotaxin increases leukocytes along cell walls
Necrosin cleans area with phagocytosis
Explain the Fibroblastic Repair Phase
Begins 4 days after injury
Lasts up to 10 days
Granulation tissue infiltrates
6-7 days after injury fibroblasts lay down collagen haphazardly
Explain the Maturation-Remodeling Phase
Begins around day 7 and lasts for years
Haphazard collagen is realigned along movement patterns
Parallel to tensile forces
pain can outlive its purpose, when it does so, it is a _____ ______ in itself
Diseased state
sensory receptors
meissners-
pacinian-
merkels-
ruffini-
krauses-
free nerve-
meissners- light touch
pacinian- deep (fast)
merkels-deep pressure (slow)
ruffini- touch/tension, joint position
krauses- thermo
free nerve- chemical, thermal noxious stimulus
specific theory of pain is an indicator of what?
specific nerve fibers and endings carry noxious stimuli to the brain with ascending pathways
pathway determines nature of stimulus
Explain the summation pain theory
excessive stimulation of nerve fibers results in transmission of noxious stimulus
no anatomical basis for this theory
What is the pattern theory?
stimulus must match a certain pattern to be transmitted as pain or other sensations
stimulus must come in abnormal matter
What is the sensory interaction theory?
specialized system exists to control sensory input from large and small afferent fibers
summation is prevented from occuring
LIST all pain theories:
specific theory
summation theory
pattern theory
sensory theory
likely a combination of all to form pain pathways
What are 4 main causes of pain?
external causes (skin)
internal causes (no skin)
lesions of CNS (skin is involved)
non-physiological
What will 80pps/hz cause?
enkephalins to be released for short period of time
natural painkiller
What will 10pps/hz cause?
endorphins to be released
natural painkiller that lasts much longer than enkephalins
What is a rheobase?
minimal intensity needed to cause contraction
What is chronaxie?
minimum time it takes to cause contraction at 2x rheobase
What is the definition:
“decrease in sensitivity to and area that is exposed to prolonged stimulation or the same frequency”
wedensky inhibition
Describe ohms law:
amps (current) is directly proportional to the voltage and inversely proportional to the resistance
amps=volts/resistance
increase intensity and resistance will be lessened
What is the cosine law?
as the source of the energy moves away from the perpendicular its intensity lessens and absorption lessons cosine of 90degree
What is the inverse square law?
intensity of radiation is inversely proportional to the square of the distance from its source
a ____ frequency is formed due to the interactions of 2 frequencies:
beat frequency
cold pack procedure
1 towel layer
5 minutes and 60 minutes in between treatments
1/2 inch penetration
conduction heat transfer
superficial heat application
10-20min (15min)
check every 5 min
conduction heat
1/4-1/2 inch penetration
6-8 towel layers
paraffin bath procedure
20-30 min
conduction heat
1/4 inch penetration
6-10 dips
fluidotherapy procedure
cellulose particles
convection
110-125f
15-20 min
1/4 inch
russian or biphasic for edema
moderate muscle contraction
10/10 cycle
15 min
20-50hz
normal one channel
1.5-2 ramp
biphasic acute
15 min
80-150
mild sensory stim
normal, continuous
biphasic chronic
15 min
1-10hz
normal continuous
strong sensory stim
biphasic spasm
15 min
80-150hz
mild motor stim
normal, continuous
russian for muscle strengthening
(only one that can be done for strengthening)
35-50hz
30+ min
10/30(rehab)
10/50 for health people
strong motor stim
normal 1 channel
2 channels co-contract or reciprocal
IFC acute
80-150hz (high)
mild sensory stim
target/sweep
15 min
IFC chronic
15 min
1-10hz
strong sensory stim
target/sweep (2 channels)
pre-mod acute
15 min
high 80-150hz
1 channel
mild sensory stim
pre-mod chronic
15 min
low 1-10hz
1 channel
strong sensory stim
Dynatron microcurrent pads
20-30 min
.3hz frequency
50microamps intensity
should not feel it
dynatron microcurrent probes
.5hz-10hz
350-550ua
4-6 spots circle the dragon protocol (10 sec at each spot)
alphastim microcurrent probes
.5hz
350-550ua
4-6 spots at 10 seconds (circle the dragon)
positive polarity is used to treat ____ while negative treats _____
acute problems
chronic problems
alphastim transcranial
30+ min to 2 hrs
350-550ua
.5hz
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