Final Exam Flashcards
1
Q
What’s an Articular Orthosis?
A
Most common, crosses at least one joint “Use three-point pressure systems to affect a joint or joints by immobilizing, mobilizing, restricting or transmitting torque.
2
Q
What’s a Nonarticular Orthosis?
A
Does not cross joint, Uses two-point pressure force to stabilize or immobilize a both segment (should be included in the name of a orthosis)
3
Q
Orthosis: Define Location
A
Location: Anatomical area included in the orthosis (ex. Articular orthosis- include joint name (PIP jt), Nonarticular include name of long bone (humerus, radius)
4
Q
Orthosis: Define Direction
A
Position of joint for articular orthosis (what the orthosis is meant to do – at rest, mobilization force, or motion that you are restricting) such as - flexion, extension, opposition. (Small finger PIP flexion orthosis)
5
Q
Orthosis: What’s the purpose of Mobilization?
A
Designed to move or mobilize primary of secondary joints
6
Q
Orthosis: What’s the purpose of Immobilization?
A
Designed to immobilize primary of secondary joints
7
Q
Orthosis: What’s the purpose of Restriction?
A
- Limit specific ROM of a joint
8
Q
Orthosis: What’s the purpose of Torque transmission?
A
Transfer motion to another location (exercise orthosis)
9
Q
Orthosis: What is identified in the type?
A
identifies the number of secondary joints (or levels) included in orthosis (if orthosis only includes primary joints, then this = 0)
**Only joint levels are counted not the number of individual joints so if 4 MCP joints at the MCP joint level are included in the orthosis. When referring to MCPs, a ‘1’ is used regardless of how many MCPs are included
10
Q
Orthosis: What are primary joints?
A
Primary joints are the joints that are the primary focus of the orthosis
11
Q
Orthosis: How is theTotal number of joints indicated ?
A
The total number of joints included in orthosis follows type indication. Example: An elbow orthosis that includes the wrist and MCPs as secondary joints would be referred to as Elbow flexion immobilization orthosis type 2 (3)
Not commonly used in general practice
12
Q
Orthotic Design Classifications (Define each/what does it do)
- Static
- Dropout-
- Dynamic
- Static-progressive
A
Static- Holds position
Serial Static- Remolding of a static orthosis as motion increases
Dropout- Allows motion in one direction, while blocking the other motion
Dynamic- Applies an elastic tension force
Static-progressive- Use of inelastic components, allows pt to adjust tension
13
Q
Describe Static Orthosis
A
Rigid, no moving parts
Use to support after injury
Used to proctect healing tissue
Used to prevent motion
14
Q
Describe Serial Static Orthosis
A
Rigid device used to increase ROM
Fabricated to allow for ROM gains
15
Q
Describe Static Progressive Orthosis
A
Component pieces included to increase ROM
16
Q
Describe Drop out Orthosis
A
Allows motion in one direction, while blocking the other motion
17
Q
Describe Dynamic Orthosis
A
Rigid orthosis with moving parts that help mobilize soft tissue of jts. Used to resolve stiffness Gain ROM Provide muscle substitution Control mobilizing forces
18
Q
What’s kind of Material is most common in OT fabrication?
A
Low-temperature thermoplastic material is the most common material used by OTs for orthotic fabrication.
**Neoprene, cast material, tapes and straps can also be used (alone or in combination with thermoplastic).
19
Q
Orthosis: What’s is the temp of the water Thermoplastic Material is heated in?
A
Heated in water at 135 – 180 degrees F.
20
Q
Anatomy of the forearm and hand
Where are the following located?
-Transverse Arch
Longitudinal Arch
Proximal Transverse Arch
A
Transverse Arch -
Comprised of the heads of the metacarpals
It is always oblique
Longtiduinal Arch -
Follows the lines of the metacarpal and carpal bones alone a slightly oblique line along the third finger
Proximal Transverse Arch -
Comprised of the carpal bones and the annular ligament
21
Q
What are the 6 Creases of the hand?
A
DIP & PIP creases: at IP joints
Distal palmer crease: landmark for distal edge of volar orthoses immobilizing the wrist
distal edge here allows for MCP flexion*
Proximal palmer crease: radial palmer landmark (extends more radial than distal crease) to mark distal edge of wrist immobilization orthoses to allow for MCP flexion (IF)
Thenar crease: orthoses meant to allow for thumb motion need to follow the edge of this crease
Distal wrist crease: represents mid-carpal joint
Proximal wrist crease: represents proximal carpal row, distal radius.
**Do not cover the crease of a joint if you want that joint to move
22
Q
Orothsis: What are the Three point pressure?
A
two linear forces directed in one direction, another (third) linear force directed in opposite direction(usually in the middle)-ensures stable fit of orthosis
“Three-point pressure system is created by a orthosis surface and properly placed straps”
23
Q
What are four ways which skin/soft tissue can be damaged by force or pressure?
A
Degree
Duration
Repetition
Direction
24
Q
What are 7 Orthosis Precautions?
A
Redness Pressure areas Numbness/tingling Shearing Edema Pain Skin breakdown Changes in temperature
25
Orthoses for Diagnosis:
| What's the purpose of a orthosis for fractures?
Purpose:
Protection/Immobilization of healing bone and tissue
Used both conservatively or post-operatively
Often placed in orthosis after cast removal support for weak structures s/p cast removal
Pain and edema management
Over reliance on orthosis can cause stiffness and atrophy
26
Orthoses for Diagnosis: What type of orthosis would you fabricate for the following?
Humerus Fx
Elbow Fx:
Wrist Fx
Digit Fx
Humerus Fx: circumferential orthosis
Elbow Fx: usually posterior orthosis; short immobilization period
Wrist Fx: DRF most common; Volar or circumferential immobilization; Do not cross DPC
Digit Fx: custom orthosis for common conservative immobilization; stabilize proximal and distal to fx; adjust as edema decreases and ROM increases
27
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Arthritis?
```
Arthritis Orthoses:
Stability
Protect joint
Pain management
Correct deformity
Prevent deformity
```
28
Orthoses for Diagnosis:
| What's the purpose of a orthosis for TMC (CMC) OA?
```
TMC (CMC) OA:
Short opponens/Short thumb spica
May variations to patterns
Prefab/Custom designs
Dorsal & radial subluxation of 1st metacarpal adducts & loses extension leading to MCP hyperextension and IP flexion
```
29
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Swan Neck and Boutonniere Deformity?
Boutonniere- (PIP flexion, DIP hyperextension)
Immobilization: PIP in full extension, MCP and DIP free (Pt needs to exercise DIP AROM with PIP in ext
orthotic wear for 6 – 8 weeks full time if flexion contracture present joint not passively correctable) need to get extension of PIP back (try static progressive or serial casting first)
Relative motion orthosis
Swan Neck (PIP hyperextension, DIP flexion)
Prevent further deformity
Stabilize joint
Decrease pain
30
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Radial nerve palsy?
Radial nerve palsy: stabilize wrist; MCP extension assist
31
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Median nerve palsy?
Median nerve palsy: prevent thumb adduction contracture (web space contracture)
32
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Ulnar nerve?
prevent RF/SF from clawing; put MPs in flexion
33
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Trigger Finger Orthosis?
MP extension; IPs free
34
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Long Opponens?
Long Opponens: Radial vs palmar; thumb position; DeQuervains, scaphoid fx
35
Orthoses for Diagnosis:
| What's the purpose of a orthosis for Resting hand orthosis?
wrist neutral to 10 degrees; 5-10 degrees of UD, MCPs at 35-45 degrees flexion, IPs 0 to slight flexion
36
Orthoses for Diagnosis:
Spasticity
Cone
Achieve balanced length of intrinsics vs extrinsics
Hand & wrist immobilization:
wrist neutral to 20-30 degrees ext
MCPs 50 – 90 degrees flex (wide range- depends on presentation)
thumb partial opposition
Adjust design as patient progresses/patient tolerance
No strong evidence for one design over another
SKIN CHECKS!!
Wearing schedule
37
Orthoses for Diagnosis: Flexor Tendon Repair Orthosis
Dorsal Blocking Orthosis (most common) Wrist 0-20, MP 50-60, IP’s 0
Kleinert (active extension up to block, passive flexion via outrigger)
Immobilization (children, cognitive limitations)
38
Orthoses for Diagnosis: Flexor Tendon Protocols
Advanced Practice
Vary by surgeon/type of repair/strength of repair/zone of injury/
Immobilization
Early passive mobilization
Early active mobilization
Early active tenodesis program
Duran/Modified Duran
Klienert
Combinations of different protocols
Varying opinions on wrist position in orthosis
Place and Hold (passive digit flex.) vs. Scratch down technique (low tension active flexion of IPs)
39
Orthoses for Diagnosis: Work of flexion = Drag and Resistance
Decrease swelling
PROM for joint stiffness
Wrist position when doing active exercise (wrist neutral, wrist ext)
Speed of exercises- Go slow
If pt motion looks awesome SLOW DOWN, patient looks stiff progress slowly
40
Orthoses for Diagnosis:
1) TENDON REPAIR NEEDS TO BE ________
2) If left immobile, scar tissue can_____________?
3) Tendon rehab aims to ________
4) An immobilization orthosis is the best choice! (T/F?)
1) TENDON REPAIR NEEDS TO BE IMMOBILIZED FOR SUTURED AREA TO HEAL. TO MUCH MOTION OR STRESS CAN LEAD TO PULL A ON THE SUTURES CAUSING A LAG OR RUPTURED REPAIR
2) WHEN LEFT IMMOBILE, SCAR TISSUE CAN SETTLE IN, AND THE TENDON SCARS DOWN.
3) TENDON REHAB AIMS TO STRIKE A BALANCE – NOT SO MUCH TENSION ON THE TENDON TO LEAD TO RUPTURE, BUT ENOUGH PROTECTED AND RESTRICTED MOTION TO PREVENT SCARRING.
4) THERE ARE VARIOUS THEORIES AND APPROACHES IN ORDER TO ACCOMPLISH THIS, WHICH LEADS TO VARIOUS TYPES OF ORTHOSES (STATIC AND MOBILIZATION)NEEDED AT DIFFERENT STAGES OF THE HEALING PROCESS.
41
Relative Motion Orthosis
What dx can you use this for?
Digit position?
Relative motion orthosis
Extensor Quadriga’ is possible due to common muscle & interconnections
Provide active redirection of force to encourage improved P & AROM of digit ext, or, flexion (Colditz, 2014)
What dx can you use this for?
Extensor tendon 4-7 (can not be used if all tendons ruptured)
Sagittal band
Digit position?
MP in 15-20 degrees of ext
42
Mobilization Orthosis
| Purposes:
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
43
What are the 3 types of Mobilization Orthosis?
Serial static: a static orthosis holding tissue at end range; can be adjusted over time to accommodate
Static progressive: inelastic components provide torque force to hold joint close to end range
Dynamic: elastic components provide stretch
44
E-stim – Transcutaneous Electrical Nerve Stimulation (TENS): Basic Definition
Electrotherapeutic modality
45
E-stim – Transcutaneous Electrical Nerve Stimulation (TENS): Therapeutic Benefit / Indicated For
1. Pain Control
(usual electrode placement over the painful area)
- Gate Control Theory of Pain
- Endorphin Release Theory
(additional electrode placement over acupuncture points for motor TENS)
46
E-stim – Transcutaneous Electrical Nerve Stimulation (TENS):Parameters/Settings
Sensory Level Stimulation
Motor Level Stimulation
**look @ wrksheet for more info on each**
47
E-stim – Transcutaneous Electrical Nerve Stimulation (TENS):
Contraindications
General Guidelines
1. Areas of not intact skin (just shaved- cuts, psoriasis, wounds, infections)
2. Cancerous Lesions
3. Epilepsy, Seizures
4. Eyes, Mouth, Neck (Carotid Area), Pacemaker, Genitals, Cranium (transcranial application)
5. 1st Trimester of Pregnancy (over uterus)
6. Cardiac arrhythmias- see pacemaker
(Near Site of Heart Problems- including hyper and hypotensive)
48
E-stim – Transcutaneous Electrical Nerve Stimulation (TENS):
Precautions
General Guidelines
1. Decreased Sensation (useless treatment for sensory TENS)
2. Impaired Cognition/ Language (unable to communicate)
3. Heart problems (distal to heart) see contraindications
4. Peripheral Vascular Diseases (PVDs)
5. Pathology of the nerve that includes the myelin sheath
6. Neuromuscular Junction pathology (myasthenia gravis)
49
E-stim – Neuromuscular Electrical Stimulation (NMES): Basic Definition
Electrotherapeutic modality
50
E-stim – Neuromuscular Electrical Stimulation (NMES:) Therapeutic Benefit / Indicated For
Muscle re-education, restoration/strengthening, and motor use post CVA (avoiding learned non-use)
Parameters for Muscle Re-Education
1: 1 or 1:2 is aggressive strengthening for a healthy muscle
1: 3 is a typical rehabilitation duty cycle for muscle re-education post stroke
1: 5 is for a very deconditioned muscle
Treatment time guidelines:
10- 20 repetitions of the muscle contraction = 10- 20 minutes
51
E-stim – Neuromuscular Electrical Stimulation (NMES): Parameters/Settings
On : Off - Duty Cycle for Training of a muscle post-stroke: See prior column
Isometric Contraction/Tetany: 25-35 Hz/ pulses/second
Fatigue the Neuromuscular Junction to Decrease Muscle Spasms: 80-100 Hz/ pulses/second
Pulse Width: 200- 300 microseconds
Set Ramp between 3-5 seconds (patients preference)
52
E-stim – Neuromuscular Electrical Stimulation (NMES): Contraindications
General Guidelines
1. Areas of not intact skin (just shaved- cuts, psoriasis, wounds, infections)
2. Cancerous Lesions
3. Epilepsy, Seizures
4. Eyes, Mouth, Neck (Carotid Area), Pacemaker, Genitals, Cranium (transcranial application)
5. 1st Trimester of Pregnancy (over uterus)
6. Cardiac arrhythmias- see pacemaker
(Near Site of Heart Problems- hyper and hypotensive)
53
E-stim – Neuromuscular Electrical Stimulation (NMES):
| Precautions
1. Unstable Fracture (motor TENS – could displace fracture)
2. Impaired Cognition/ Language (unable to communicate)
3. Heart problems (distal to heart) see contraindications
4. Peripheral Vascular Diseases (PVDs)
5. Pathology of the nerve that includes the myelin sheath
6. Neuromuscular Junction pathology (myasthenia gravis)
7. Recent Surgical Procedure/application at site- disrupt wound healing with muscle activity
8. Acute Inflammation (motor TENS)
54
Ultrasound Basic Definition
Energy Conversion from Ultrasound waves to acoustic and thermal effects in the tissues.
Parameters can be set for
Non-Thermal &
Thermal
Effects
Mainly used for
Musculoskeletal dysfunction / soft tissue injuries
Ultrasound waves Attenuation – based on tissue collagen protein content.
Transmits easily through
Blood/ Fat
Some of the sound wave energy absorbed:
Muscle, Tendon, Ligament, Joint Capsule, Nerve Root (dura), Scar Tissue, Connective Tissue
Sound Wave Reflected at Bone interface
55
Ultrasound Basic Definition
Energy Conversion from Ultrasound waves to acoustic and thermal effects in the tissues.
Parameters can be set for
Non-Thermal &
Thermal
Effects
Mainly used for
Musculoskeletal dysfunction / soft tissue injuries
Ultrasound waves Attenuation – based on tissue collagen protein content.
Transmits easily through
Blood/ Fat
Some of the sound wave energy absorbed:
Muscle, Tendon, Ligament, Joint Capsule, Nerve Root (dura), Scar Tissue, Connective Tissue
Sound Wave Reflected at Bone interface
56
Ultrasound Parameters/Settings
```
Frequency:
Amplitude:
Thermal:
Non-Thermal:
Duty Cycle:
Sound Head size:
Speed to move the Sound Head:
```
Frequency:
1 MHz= up to 5 cm depth of penetration based on tissues
3 MHz= 1-2.5 cm depth of penetration based on tissues
```
Amplitude: Height of the wave - Range based on tissue under the sound head (bone)
Thermal:
1.0 Wt/CM- 1.5 Wt/Cm
Non-Thermal:
0.3 Wt/Cm- 0.7 Wt/Cm
```
Duty Cycle:
Thermal: 80%- 100%
Non-thermal: 30%- 50 %
Sound Head size:
5 cm sound head (treatment area is 2.5 times size of sound head)
1 cm sound head (treatment area is 2.5 times the size of the sound head)
Speed to move the Sound Head: 4cm/second
“row-row- row your boat”
Duration of Treatment:
Guidelines based on moderate heating effect
5 cm sound head – 10- 12 minutes
1 cm sound head- 5-7 minutes
57
Ultrasound
Contraindications
General Guidelines
1. Burning the bone/ periosteum interface with summation(reflected and refracted wave) of a standing ultrasound wave
2. Metal implants or joint replacements (deeper setting and heating effect)
3. Open wounds- using ultrasound gel is not sterile
4. Over the eyes, heart, uterus, genitals
5. NOT over pregnant uterus
6. Abnormal Growth- Cancerous lesions
7. Lack of sensation- inability to communicate discomfort
8. Thrombus (blood clot)
9. Pacemaker (over site)
10. Adverse prior
experience with ultrasound
11. Epiphyseal Plate children
58
Ultrasound Precautions
| General Guidelines
Pain with pressure of the ultrasound head
59
Iontophoresis Basic Definition
Electrotherapeutic modality that delivers medication/chemical substances transdermal
Medication spreads via: passive diffusion (after it is passed through the top/superficial layer of skin via sweat glands and hair follicles, sebaceous glands.
60
Iontophoresis Therapeutic Benefit / Indicated For
Based on the Medication Used
Typically treats inflammatory conditions
Modify scar tissue
Manipulate the healing process
61
Iontophoresis Parameters/Settings
Usual dosage?
Electrical current range?
Doasge goal?
2 types of application, what are they?
Usual Dosage: 40 mA/minute with 1.5 mLof medication with a passive diffusion depth of 12mm
Electrical Current Range = .5-4 Milliamps
Dosage Goal = 40 mA/min – 80 mA/min
2 types of application
1. Ionto-patch- patient wears a Band-Aid type patch with medication on one side and embedded small battery that pushes the medication through the skin (4- 14 hours)
2. Clinic Unit- Patient has iontophoresis done at the therapy office
(10- 30 minutes)
62
Iontophoresis
Contraindications
General Guidelines
Same as TENS/ NMES contraindications
Additional Contraindications:
· Documented allergy/sensitivity to medication
63
Cryotherapy (Cold)
| Basic Definition and identify the 3 types
A superficial modality that withdraws heat from tissues
Types:
1. Ice massage (small area- quick results)
2. Ice pack (larger area- effectiveness based on the quality of the ice pack 10- 15 minutes)
3. Ice bath
(may not be tolerated by patient 1- 2 minutes usual time frame)
64
Cryotherapy (Cold) Therapeutic Benefit / Indicated For
Acute Inflammation (RICE principle)
Myofascial trigger points
Muscle guarding
Arthritic exacerbation
Decreases pain, muscle spasm, edema, soreness, and acute/subacute inflammation/trauma
Chronic Pain (secondary to muscle spasm)
Bursitis & Tendonitis
Spasticity
Increases ROM (associated with swelling)
Subjective “numbness” = decreased nerve conduction velocity
65
Cryotherapy (Cold) Parameters/Settings
Effects a Tissue Depth of: 1-2 cm
How Long Does it Take for a Tissue to rewarm? 20 minutes
Therapeutic Benefit Lasts: a few hours
66
Cryotherapy (Cold) Contraindications
| General Guidelines
- An unreliable pt. (responds communicates inconsistently)
- Poor circulation in the treatment area
- Absence of sensation in the treatment area, including scars
- Frostbite in treatment area
- Raynaud’s and other conditions sensitive to cold
- Undressed or infected wounds
67
Cryotherapy (Cold) Precautions
| General Guidelines
Open Wounds
· Advanced Age (decreased insulation/subcutaneous fat)
· Impaired cognition
· Previous negative experience with the physical agent
· PVD/compromised circulation to the area
· Metastases
· Monitor boney prominences
68
Superficial
| Thermotherapy (Heat) Basic Definition
A superficial thermal agent designed to increase the temperature of the skin and subcutaneous tissue to 1-2 cm
At 1 cm = 6 degrees temperature increase
At 2 cm= 2 degrees temperature increase
69
Superficial
| Thermotherapy (Heat) Therapeutic Benefit / Indicated For
Increases Blood Flow to the area
- Vasodilation, capillary permeability with additional histamine release
Increased Cell metabolism, O2 consumption
Decrease pain and stiffness- Promote relaxation (counteract guarding)
Increase A/PROM, tendon gliding, viscosity of synovium
```
· Muscle spasms
· Subcutaneous adhesions
· Contractures
· Neuromas
· Arthritis
· Trauma
· Wounds
· Sympathetic Nervous System Disorders
· Subacute and chronic inflammation
· Tendinosis/tendinopathy
Spasticity
```
70
```
Superficial
Thermotherapy (Heat) Parameters/Settings
Therapeutic effect?
Length of use?
Max heating benefit to tissues is lost after....mins?
```
Therapeutic Effect – when subcutaneous tissues reach 104 -113° F
Length of Use: 10-30 minutes
Maximum Heating Benefit to Tissues is Lost After: 10 minutes (stretching window)
71
Superficial
Thermotherapy (Heat)
Contraindications
General Guidelines
- An unreliable pt. (responds/ communicates inconsistently)
- Anticoagulant medications
- Metastasis in the tx area
- Absence of sensation in the treatment area, including scars
- Acute inflammation or hemorrhage
- Deep Vein Thrombosis
- Undressed or infected wounds
- Presence of superficial metal implants and jewelry
- Primary repair of a tendon or ligament (need to follow surgeons protocol)
- Acute Flare Up Rheumatoid Arthritis
72
Superficial
Thermotherapy (Heat) Precautions
General Guidelines
· Open Wounds
· Heat directly over the Uterus - pregnancy
· Advanced Age (decreased insulation/subcutaneous fat)
· Impaired cognition
· Previous negative experience with the physical agent
· PVD/compromised circulation to the area
· Metastases
· Monitor boney prominences
73
Hot Pack Basic Definition
A superficial heating agent
74
Hot Pack Therapeutic Benefit / Indicated For
*See thermotherapy
Increases Blood Flow to the area
- Vasodilation, capillary permeability with additional histamine release
Increased Cell metabolism, O2 consumption
Decrease pain and stiffness- Promote relaxation (counteract guarding)
Increase A/PROM, tendon gliding, viscosity of synovium
```
· Muscle spasms
· Subcutaneous adhesions
· Contractures
· Neuromas
· Arthritis
· Trauma
· Wounds
· Sympathetic Nervous System Disorders
· Subacute and chronic inflammation
· Tendinosis/tendinopathy
Spasticity
```
75
Hot Pack Parameters/Settings
Hydrocollator temp?
Hot Pack Temp?
Treatment time?
Reheating time?
Hydrocollator Temp:165-175° F; Optimal:168° F
Hot Pack Temp.: 104-113° F
Temperature over 114 degrees =cell death (burning)
Treatment Time: 10 minutes on average
Reheating Time: 30 minutes
Hot packs need to be inside a cover and there should be 4-6 layers of towels between the hot pack and the pt.
76
Hot Pack Contraindications
| General Guidelines
*See thermotherapy
- An unreliable pt. (responds/ communicates inconsistently)
- Anticoagulant medications
- Metastasis in the tx area
- Absence of sensation in the treatment area, including scars
- Acute inflammation or hemorrhage
- Deep Vein Thrombosis
- Undressed or infected wounds
- Presence of superficial metal implants and jewelry
- Primary repair of a tendon or ligament (need to follow surgeons protocol)
- Acute Flare Up Rheumatoid Arthritis
77
Hot Pack Precautions
| General Guidelines
*See thermotherapy
· Open Wounds
· Heat directly over the Uterus - pregnancy
· Advanced Age (decreased insulation/subcutaneous fat)
· Impaired cognition
· Previous negative experience with the physical agent
· PVD/compromised circulation to the area
· Metastases
· Monitor boney prominences
78
Fluidotherapy Basic Definition
A superficial heating agent that uses fine particles suspended in a hot air stream to treat distal extremities
“A dry whirlpool”
79
Fluidotherapy Therapeutic Benefit / Indicated For
Mid-distal UE is horizontal, not in a dependent position
Client can actively exercise during treatment
Good for desensitization and clients who are hesitant to move actively
80
Fluidotherapy Parameters/Settings
Treatment temp?
Typical treatment time?
Treatment Temperature: 105-118° F
Typical Treatment Time: 20 minutes
Can adjust blower speed
81
Fluidotherapy Contraindications
| General Guidelines
- Recent DVT/hemorrhage
- Acute inflammation
- Blood thinning meds
- Conditions w/ easy bleeding
- Impaired sensation
- Infection
- Vascular insufficiency/cardiac disease
- Open wound
- Over known malignancy
- Skin graft/scar
82
Fluidotherapy Precautions
| General Guidelines
Edema in the UE
83
Paraffin Basic Definition
A superficial heating agent
Techniques used include glove/wrap, immersion, dip immersion, brush, and pouring
84
ParaffinTherapeutic Benefit / Indicated For
Can combine w/ passive stretch
Good for hand arthritis b/c decreases viscosity of synovium and delivers circumferential heat to small joints
Good for Scar Tissue Mobilization on the hand
85
Paraffin Parameters/Settings
Wax temp?
Optimal temp?
Wax Temperature:118-135° F
Optimal Temp.: 126° F
86
Paraffin
Contraindications
General Guidelines
- An unreliable pt. (responds/ communicates inconsistently)
- Anticoagulant medications
- Metastasis in the tx area
- Absence of sensation in the treatment area, including scars
- Acute inflammation or hemorrhage
- Deep Vein Thrombosis
- Undressed or infected wounds
- Presence of superficial metal implants and jewelry
- Primary repair of a tendon or ligament (need to follow surgeons protocol)
- Acute Flare Up Rheumatoid Arthritis
87
Paraffin Precautions
| General Guidelines
· Open Wounds
· Heat directly over the Uterus - pregnancy
· Advanced Age (decreased insulation/subcutaneous fat)
· Impaired cognition
· Previous negative experience with the physical agent
· PVD/compromised circulation to the area
· Metastases
· Monitor boney prominences
88
Whirlpool Basic Definition
Temperature Varies for clinical indications
89
Whirlpool Therapeutic Benefit / Indicated For
Client can actively exercise
Agitation acts as a gentle massage or gentle resistance to exercise against
Can clean and debride wounds
90
Whirlpool Parameters/Settings
water temp for small body parts?
water temp indicated very warm?
water temp indicated neutral best for wounds?
What body parts do you use a higher temp? lower temp?
Water Temp: 100-104° F (hot- use for small body parts)
Water Temp: 96- 100 F (very warm)
Water Temp: 92-96° F (Neutral Temp used for wounds)
**Smaller body parts use a higher temp.
**Larger body parts use a lower temp.
91
Whirlpool
Contraindications
General Guidelines
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92
Whirlpool Precautions
| General Guidelines
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93
Diathermy Basic Definition
A deep thermal agent that uses pulsed or continuous radio waves as conversion energy to heat tissues a depth of 2 to 5 cm
A high-frequency electric current that flows from one plate to the other through the pt.
Modulated Radiofrequency waves of 27.12 MHz
94
Diathermy Therapeutic Benefit / Indicated For
Larger treatment area
Musculoskeletal sprains, strains, and osteoarthritic conditions
Usually seen in long term care facilities
Needs to be in a separate room due to the contraindications
95
Diathermy Parameters/Settings
Continuous leads to a greater ______ effect?
Pulsed leads to a _____heating effect
Continuous leads to a greater heating effect
Pulsed leads to a decreased heating effect
Any setting over 5watts, check pt.’s sensation of hot/cold
96
Diathermy Contraindications
| General Guidelines
Conditions that would have an adverse effect w/ heating described above rows. Example: acute inflammation, decreased sensation, malignancy
Don’t apply over metal implants, pacemakers, implanted neural stimulators, metal orthopedic hardware
No jewelry, zippers, buttons
No eyes, brains, ears, reproductive organs
Keep unit away from other electrical devices
Do not apply to pregnant people or people around them
Don’t allow pt. to touch a bare metal object, including the metal diathermy cabinet
Don’t allow electrode to touch pt.
97
Diathermy Precautions
| General Guidelines
Patients have to stay still for the entire treatment
