Fringe

Question 1

Therapeutic LASER

Answer 1

• Light Amplification by Stimulated Emission of Radiation
  ~ Cold laser because of the low power
  used (<500 mW)
  ~ Emits photons into the tissues
  > Individual parts of a light wave
  > Zero mass
  > No electric charge

Question 2

Characteristics of LASER Light: Coherence

Answer 2

Photons emitted from a specific medium have some spacing relationships within the light wave

Question 3

Characteristics of LASER Light: Monochromatic

Answer 3

• Emitted light waves from a specific medium have a single defined wavelength
  ~ Emits light that’s only one color
  > Ambient light is composed of
  many wavelengths and colors

Question 4

Characteristics of LASER Light: Collimated

Answer 4

The light from a laser emerges in an extremely thin beam with very little divergence

Question 5

Class 3 LASER

Answer 5

• Due to low power, class 3 lasers don’t heat up tissues
  ~ Low Level Laser
  ~ Cold laser
  ~ Soft laser
  > Pts. may perceive an increase in
  temperature due to potential
  increased circulation

Question 6

Effects of LASER Tx: Photomodulation

Answer 6

• Light modifies biological processes by interacting with cellular photoreceptors
  ~ Effects determined by the amount of
  energy/photons absorbed
  > More photons = more effects

Question 7

Effects of LASER Tx: Wound/Tissue Healing

Answer 7

• Most evidence comes from wound healing studies.
  ~ Increases number and/or activity of
  fibroblasts.
  ~ Speeds conversion of fibroblasts to
  myofibroblasts.
  > Myofibroblasts help contract
  wound margins.

Question 8

Effects of LASER Tx: Pain

Answer 8

• Evidence that laser decreases pain, but no clear mechanism identified
  ~ Healing
  ~ Inhibition of nociceptor.

Question 9

Class 4 LASER

Answer 9

• Uses increased power (>500 mW)
• Heats superficial tissues
  ~ All effects of heat are in play
  ~ Uncertainty exists relative to
  photomodulation effects
• Can burn pt.

Question 10

Arndt-Schultz Law

Answer 10

• There’s an amount of energy that’s optimal
• Less than that will cause no effects and greater levels will be detrimental to tissues
• At a certain point Tx is no longer beneficial

Question 11

Dosage of Laser Tx

Answer 11

• Theoretically dosage should match the condition
  ~ Need enough photons in the area to
  make a change
• Power output of the units is often fixed so the way to alter dosage is by manipulating the Tx time

Question 12

LASER Indications

Answer 12

• Any condition that requires healing
• Pain

Question 13

LASER Contraindications

Answer 13

• Cancer
• Directly over eyes

Question 14

Bottom Line of LASER?

Answer 14

• If light doesn’t penetrate the desired tissues, there will be no beneficial effects
• Depth of penetration is a function of wavelength color
  ~ 600-1000 nm typically used

Question 15

Monochromatic Infrared Energy (MIRE)

Answer 15

• Application of near infrared light energy to the tissues.
  ~ Infrared
  > Light energy that can not be seen.
  > Produces heat energy.
  > Ex. Heat from a fire or light bulb.
  ~ Near Infrared
  > Light energy that can be seen.
  > Does produce heat, but very little.

Question 16

Effects of MIRE

Answer 16

• Appears to increase fibroblast activity
• Appears to increase nitric oxide levels in the tissues treated

Question 17

Effects of MIRE: Nitric Oxide Function

Answer 17

• Acts as a vasodilator = increased circulation
  ~ Nitric Oxide is produced by many
  tissues including blood vessels
  > Production of nitric oxide causes
  smooth muscle to relax

Question 18

MIRE Indications

Answer 18

• Sub Acute/Chronic conditions
• Any condition where increased circulation is needed
  ~ Wounds
  ~ Fracture
  ~ Diabetes
• Pain
• Spasm

Question 19

MIRE Contraindications

Answer 19

Acute conditions

Question 20

Longwave US

Answer 20

• Application of long wave length ultrasound = low frequency ultrasound.
• Typical US Frequencies
  ~ 1 MHz = 1000 kHz
  ~ 3 MHz = 3000 kHz
• Longwave Ultrasound Frequency
  ~ Very low
  > .045 MHz = 45 kHz
  • much deeper & much
  more divergence

Question 21

Longwave US Characteristics: Frequency and Intensity

Answer 21

• Frequency
  ~ As frequency increases:
  > Depth Decreases - due to
  greater absorption of
  superficial tissues.
  > Divergence Decreases
• Intensity
  ~ Very low
  > Measured in milliwatts mW.
  > Ex: 60 mW/cm2 = 06 W/cm2
• Does not heat up tissues

Question 22

Longwave US Effects

Answer 22

• Increases Cell Membrane Permeability
• Stimulates Fibroblast Activity
• Stimulates WBC Activity
• Stimulates Osteoblast Activity

Question 23

Microcurrent Electrical Stimulation

Answer 23

• Current applied at an intensity below sensory or motor levels (pt. doesn’t feel anything)
  ~ Current parameters are extremely
  variable between manuracturers.
  ~ 1/1000 the amperage of TENS, but
  much longer pulse duration.
  ~ Effects are not well understood.
  > Some studies do show
  improvement, but not greater
  than other available modalities.
  • Improvement shown in
  studies using electrodes
  implanted in the tissues.
  • Improvement shown with
  DC variety with negative pole.

Question 24

Microcurrent Electrical Stimulation: Theory/Effect of Injury

Answer 24

• Tissue trauma increases the cells resistance to electrical current.
• The body’s intrinsic bioelectrical currents take the path of least resistance around the site of trauma.
  ~ Results in diminished bioelectrical
  activity within the site disrupting cell
  homeostasis

Question 25

Microcurrent Electrical Stimulation: Thoery/Effect of Current

Answer 25

• Microcurrent re-establishes the body’s electrical balance and restores normal levels of resistance
• Restores Homeostasis
  ~ Allows cell’s ATP supply to be
  restored so cells can properly
  function and heal area.
  > Low intensity electrical current
  has been shown to increase
  ATP opposed to higher
  intensities which have been
  shown to decrease ATP.

Question 26

InterX

Answer 26

Delivers pulsed AC while measuring resistance in tissues to direct practitioner to specific area for treatment.

Question 27

Compex

Answer 27

Delivers AC. Presets deliver waveforms that are effective for sensory input (TENS) and muscle contraction (NMES)

Question 28

Hivamat

Answer 28

Deep tissue oscillation due to a pulsed electrostatic field.