interventions midterm Flashcards
what to document for modalities?
clearance
reasoning
pt position
modality used
placement
time
pain before and after
objective measures before and after
skin assessments before and after
education provided
exact parameters of modality
three pillars of evidence based practice
best research evidence
clinical expertise
pt values and preferences
superficial heating agents:
therapeutic use of heat for pain control
deep heating agents:
energy conversion into heat as it passes through body tissues
what are the hemodynamic effects of cold?
vasoconstriction after 15-20 min
cold induced vasodilation (sympathetic inhibition)
what are the metabolic effects of cold?
decreased metabolic rate
what are the neuromuscular effects of cold?
decreased nerve conduction velocity
increased pain threshold
what are the muscle strength effects of cold?
decreased motor nerve conduction velocity
increases strength after 5 min, decrease after 30
what are the effects of cold on spasticity?
decreased
what are the uses of cryo?
inflammation control
edema control
pain control
muscle tone: can reduce spasticity
swelling in relation to TKA
inhibits quads
greater the knee swelling, greater the loss in strength
what is cryokinetics?
combo of cryotherapy and exercise
goal: numb injured part and then work through ROM
what is cryostretch?
application of cooling agent prior to stretching
allows for greater ROM and reduced muscle spasm
proven improvement in PROM knee extension
what are the contraindications of cryotherapy?
cold hypersensitivity
cold intolerance
cryoglobulinemia
paroxysmal cold hemoglobinuria
raynaud’s
over-regenerating peripheral nerves
over an area with circulatory compromise
what are the precautions of cryotherapy?
over the superficial main branch of a nerve
over an open wound
hypertension
poor sensation
very young or very old
what are the adverse effects of cryotherapy?
tissue death - caused by prolonged vasoconstriction
temp or permanent nerve damage
what is cryo proven to help?
DOMS
RPE
describe cold packs
filled with gel, semisolid state to conform to body
should be between 0-5 C (32-41F)
units need to be -5 C (-25F)
cold pack instructions
inspect skin
remove clothing/jewelry
elevate if swollen
apply pack over a moist cold towel
leave on for 20 min
inspect skin after
describe ice packs
mad of crushed ice in plastic bag
more aggressive than cold packs
more insulation needed
slush recipe = 4 cups water and 1 cup rubbing alcohol
how long should cold be applied?
20 min for pain
30 min for spasticity
what are the advantages to cold/ice packs?
easy to use
inexpensive
short use of clinician’s time
low level of skill
mod to large coverage
applied to elevated limb
what are the disadvantages to cold/ice packs?
must be removed to visualize area
may not tolerate weight - do not lay on top of
may not be good on small areas
long duration of treatment compared to ice cup
describe an ice massage
freezing small paper cups of water, edge peeled back
must stay in contact with pt’s skin
10-15 cm area
5-10 min
advantages to ice cups
well observed
small and irregular areas
short duration
inexpensive
elevated limb
disadvantages to ice cups
too time consuming for large areas
active participation from clinician
messy
describe controlled cold compression units
pump water and air into sleeve around limb
better than ice or compression alone
what is the temp of water for controlled cold compression units?
50-77 deg
(NPTE question)
describe the game ready machine
40-60 deg
no to low compression for first 24-48 hrs
mod to high compression after first 48 hrs
describe cryo cuff
cold + compression
flows via gravity - elevated 15-28 in above sleeve
provides mild cooling below intensity of others
advantages of controlled cold compression units
allows simultaneous cold and compression
temp and compression are controlled
larger joints
disadvantages of controlled cold compression units
area cannot be visualized
expensive
describe vapocoolant sprays
stretch is action, spray is distraction
advantages of vapocoolant
brief duration of cooling
vary localized
disadvantages of vapocoolant
limited use
other means of applying cryo
describe cooled whirlpools
cute and subacute conditions
agitation and aeration
10-30 min
describe a cold bath
immersion of distal extremities
55-64 deg
15-20 min
describe contrast baths
alternate cold and heat
hot bath - 104-106 F for 3-4 min
cold bath 50-60 F for 1 min
repeat for 25-30 min
indications for contrast baths
arthritis of small joints
MSK sprains/strains
CPRS
limb desensitization
what is whole body cryotherapy?
exposing body to vapors that reach -200 - -300F
insufficient evidence
application process of cryo
eval and set goals
determine if appropriate
ask about contra and precautions
inspect area to be treated
assess sensation
select appropriate cooling agent
explain procedure and reason
apply
check on pt
assess outcome
document
what are the stages of sensation in cryo?
COLD
burning/tingling
achey/pain
numb
what does a POC include?
goals
optimal improvement
interventions to be used
plans for referral
what can modalities do as interventions?
modify healing process
reduce adverse effects like inflammation
improve function and achievement of goals
what are the goals of inflam response?
eliminate insult
replace tissue
promote regen of normal tissue
restoration of function
what happens in inflam phase?
immediate protective response
attempts to destroy dilute or isolate cells at fault
cryo and laser treats
what happens in proliferation phase?
rebuilds damaged structure
strengthens the wound
thermal US
what happens at maturation phase?
modifies scar tissue into mature form
scar tissue release, traction
what is the vascular response in inflam?
immediate vasoconstriction - 5-10 min
vasodilation - increase cellular permeability
what is the hemostatic response in inflam?
control blood loss from injury
platelets bind to exposed collagen
created fibrin lattice - temp plug
cellular and immune response in inflam
release RBCs, platelets, WBCs
phagocytosis
how can PT’s assist in inflam phase?
immediate inflam control
edema control
increase healing process
improve oxygenation
monitor healing process
intervention for inflam phase
education - PRICE
modalities - cryo, US, TENS
exercise - light, AROM
how do you treat tendonitis?
REST
what happens in proliferation phase?
epithelialization - primary
wound contraction - pulling edges together, secondary
describe collagen
main structural protein in EC space
2 roles in healing - strength and movement
what is granulation tissue?
contains capillaries, fibroblasts and myofibrils
initially weak 3 coll
by day 12, replace with 1 coll
by day 21 still only 20% of normal strength
describe maturation phase
restore prior function of tissue
break down initial coll and replace with new stronger
assess the scar
what is induction theory?
scar mimics characteristics of tissue
dense = highly cross linked
pliable = less cross linked
what is tension theory?
stresses determine final structure
scars need low load, long duration stretching
how can PT assist prolif/mat phases?
edema/inflam control
improve oxygen for angiogenesis
monitor wound
provide loading/strengthening
what interventions are used for prolif/mat phases?
education
modalities - cryo, deep heating, estim, iastm
exercise - improve oxygenation
manual - STM, IASTM
what are the potential outcomes of inflam process?
replacement of injured tissue with like tissue
healing of scar formation
formation of abscess
progression to chronic inflam
what are the two types of chronic inflam?
follows acute
due to immune response
what factors affect healing process?
local factors - type, size, location
external factors - modalities
systemic factors - age, disease, nutrition
NSAIDS and treatment
impair coll repair
have them take after treatment
healing of tendons
7-8 days
depends on vascular supply, duration of immob
healing of ligs
depends of types, size of defect, amount of load
capsular and extracap have adequate repair
healing of cartilage
limited ability
healing of bone
primary - internal fixation
secondary - cast/splint
inflam
soft callus
hard callus
remodeling
define conduction
heat transfer by direct contact
ex. hot pack
define convection
heat transfer by direct collision of circulating medium with another material
ex. whirlpool
define conversion
non thermal energy
ex. ultrasound
define radiation
without need for direct contact
ex. infrared heat lamps
hemodynamic effects of heat
vasodilation
increased blood flow
can increase edema
NM effects of heat
changes in nerve conduction
increased pain threshold
brief changes in mus strength
metabolic effects of heat
increased
altered tissue extensibility
increased collagen extensibility
what are the uses of superficial heat?
pain control
increased ROM
decreased joint stiffness
accelerated healing
infrared radiation for psoriasis
what are the contraindication of thermotherapy?
recent or potenial hemorrhage
thrombophlebitis
impaired sensation
impaired mental ability
malignant tumor
infrared irradiation of the eyes
what are the precautions for thermo?
acute injury or inflam
edema
pregnancy
impaired circulation
poor thermal regulation
cardiac insufficiency
metal in the area
open wound
where topicals have recently been applied
demyelinated nerves
what are the adverse effects of thermo?
burns - cell death
fainting
bleeding
skin and eye damage from infrared
does heat work?
pain was reduced with heat pack compared to stretching alone
superficial heat + foam roll was most effective
hot pack
made of gel
standard size: 12 x 12
double size: 24 x 24, used for low back, buttocks
cervical: 6 x 18
stored in water kept at 158-167 F
20 min treatment
how many layers does a hot pack need?
6-8
sleeve = 2
each additional towel = 1
min of sleeve + 4 towels
advantages to hot pack
easy to use
inexpensive
short use of clinicians time
low skill level
cover mod to large areas
safe
readily available
disad to hot pack
remove to view area
pt may not tolerate weight
not good for small or contoured areas
active motion not practical during treatments
moderately expensive cabinet
paraffin
wax
113-122 F
only on distal extremities
paraffin methods
dip wrap
dip immersion
paint
pre-paraffin application
remove all jewelry
inspect area for wounds/contraindication
thoroughly wash area
dip wrap application
fingers apart
do not move during
avoid touching sides/bottom of tank
wait briefly to dry
re dip
dip 6-10 times
wrap in plastic bag
wrap in towel
elevate
leave for 10-15 min
peel and discard
fluidotherapy
dry heating
convection
ground corn cobs
particles move like liquid
temp and agitation can be controlled
ad to fluidotherapy
can move to work ROM
minimal pressure
temp controlled and constant
easy
disad to fluidotherapy
expensive
limb in dependent position
may cause overheating
corn cob particles may spill
not applied to those with CORN allergies
infrared lamps
electromagnetic radiation
770nm to 10^6 nm, peak around 1000nm
remove all jewelry
all parties wear opaque goggles
20cm from heat source
perpendicular angle
darker tissue absorbs more than lighter
variables of IR
power
wavelength
distance from source
angle of incidence
absorption coefficient of tissue
ad of IR
no contact required
less in infection
not weight
area can be observed throghout
disad of IR
not easily localized
difficult to ensure consistent heating
billing/coding
hot/cold pack: 97010
paraffin: 97018
contrast bath: 97034
whirlpool therapy: 97022
IR: 97026
define attenuation
decreased signal intensity as ultrasound travels through tissues
air is a poor conductor, therefore need a medium
what are the two commonly used frequencies for US?
3.3 MHz for 1-2 cm depth
1 MHz for up to 5 cm
thermal US considerations
keep US head moving to avoid hot spots
pt’s report of warm to determine final intensity
how does nonthermal US work?
mechanical events
increases cell membrane permeability
two duty cycles for US
100% - continuous - thermal
20% - pulsed - nonthermal
what is the evidence for US?
there are gaps…
low evidence for knee OA
poor evidence for CTS
no evidence for LBP
no evidence for AC
what are the contraindications for US?
malignant tumor
pregnancy
CNS tissue
joint cement
plastic components
pacemaker - in area of
thromboplebitis
eyes
reproductive organs
what are the adverse effects of US?
burns - w/o mvmt
standing waves can cause blood cell stasis
cross-contamination
biggest take: KEEP SOUND HEAD MOVING
what intensity of US should I use?
thermal, superficial: .5
thermal, deep: 1.5-2
nonthermal: .5-1
start at lowest and increase
when should I increase intensity for US?
when pts feel nothing
define effective radiating area (ERA)
area of the crystals that produce energy
treat area that is 4x size of sound head
define beam nonuniformity ratio (BNR)
ratio between spatial-peak intensity and spatial average intensity
lower: more favorable - less hot spots
higher: must move faster
what coupling agent do we use for US?
direct coupling agent
gel
apply prior to turning on
thermal vs nonthermal: impairments treated
ther: pain
non: delayed tissue healing, CHRONIC
considerations for US
ST shortening
pain control
dermal ulcers
surgical skin incisions
tendon and lig injuries
resorption of calcium deposits/calcific tendonitis
bone fractures
what is phonophoresis?
application of topical med via US
nonthermal, 20%, 3.3, 0.5-0.75
limited evidence
application of US
explain treatment and reason
comfortable position pt
inspect skin
set up machine
place gel
start moving head
if need to pause, press stop FIRST then take head off
after done, wipe gel and inspect skin
in EM radiation, when is intensity greater?
energy output high
closer to pt
perpendicular to skin
what are the 4 clinical uses of EMR?
IR radiation: superficial heating
UV radiation: erythema, tanning, epidermal hyperplasia
shortwave and microwave radiation: heat deep tissues, decrease pain, decrease edema, facilitate tissue healing
low-intensity laser: promote healing, control pain and inflam
what are the physiological effects of EMR?
alter cellular function
promote active transport and ATP use
what is the arndt-shulz law?
minimal stimulus needed to initiate biological process
too strong may be inhibitory
if you see “diode” what should you think?
LASER
what are the 2 types of laser?
high power: hot, surgical
low-level laser therapy: cold or soft
what class of laser is used in PT?
3B
what are the effects of laser?
stim ATP and RNA production
alter synthesis of cytokines
inhibit bacterial growth
promote vasodilation
alters nerve conduction velocity and regen
initiates reactions at cell membrane
what are the clinical applications of laser?
acute or chronic pain
fibromyalgia
OA, DJD, spondy
MVA, whiplash
meniscal tears
contraindications for laser
malignancy
direct to eyes
within 4-6 months of radiotherapy
hemorrhaging regions
over endocrine glands
precautions for laser
low back or abdo during pregnancy
epiphyseal plates in children
impaired sensation
impaired mentation
photophobia
abnormally high sensitivity to light
pretreatment with one or more photosensitizers
adverse effects of lasers and light
transient thingling
mild erythema
skin rash
burning sensation
adverse effects from irradiation of the eyes
protocol for laser
clear of contras
clean skin
everyone wear eyewear
applicator perp to skin
so not move during application
apply with firm pressure if not contraindicated
laser techniques
gridding - imaginary grid
scanning - no contact
wanding - oscillatory
what to doc with laser
type of diode
wavelength
power
area of body treated
energy density
pts reaction to treatment
what are the 3 bands of UV?
UVA: 320-400nm, non ionizing
UVB: 290-320nm, produces most erythema
UVC: less than 290nm, ionizing
effects of UV radiation
erythema
tanning
epidermal hyperplasia
vitamin D synthesis
bactericidal
suppression of immune system with low doses
activation of immune with high doses
wound healing
skin conditions that laser works for
psoriasis
scleroderma
eczema
atopic dermatitis
cutaneous T-cell lymphoma
vitiligo
palmaplantar pustulosis
what UV is used in PT?
UVB
contras for UV
eyes
skin cancer
pulmonar TB
cardiac, kidney, liver disease
systematic lupus erythematosus
fever
precautions for UV
photo meds
photo supplements
photosensitivity
recent x-ray therapy
no dose repeated until effects of previous disappeared
adverse reactions of UV
burning
premature aging of skin
carcinogenesis
eye damage
how to determine UV dose?
4 holes
one at a time
30 sec
60 sec
120 sec
240 sec
dose response assessment for laser
subery - no change
minimal ery - appear in 8 hrs, disappear within 24 hrs
first deg - appear in 6 hrs, lasts for 1-3 days
second deg - appears within 2 hrs, sunburn
third deg - blistering
how to doc laser
psoralen?
area
type
serial number of lamp
distance from pt
duration
response
what is short wave diathermy?
application of shortwave or microwave to produce heat
what are the freq and wl for diathermy?
SW: 10-100 MHz, 3-30 m
MW: 300 MHz - 300 GHz, 1 mm - 1 m
what does how much energy absorbed depend on?
type of tissue
tissue perfusion
strength of mag field reaching tissue
2 types of diathermy coils
inductive coils - mag field, drums most common
capacitive plates - electrical field
magnetron
how much heat is received by body in diathermy?
closer the applicator, stronger mf
higher electrical conductive tissues
proposed benefits of diathermy
decreased edema in large areas
stim tissue healing in larger areas
decrease pain in larger areas
common uses for pulsed SWD
pain and edema control
wound healing
45 min treatments
advan of SWD
heat deeper
larger areas than US
not reflected by bone
little time for set up
disadvan of SWD
equipment not always avail
time needed for effective treat is long
contras for diathermy
pregnancy
implanted or other stimulators - 10ft away
contras for thermal diathermy
pacemaker
electronic devices
metal implants
over testes
cancer
contras for nonthermal diathermy
pacemakers
electronics
metal implants
not a sub for conventional therapy
precautions for dia
electronics or magnetic
obesity
copper bearing intrauterine contraceptive devices
precautions for NT dia
pregnancy
skeletal immaturity
therapist precautions for dia
stay 10 ft away
can damage fetus
application for dia
wooden table
towels for sweat
clear contras
postion and drape
check machine
single layer towel over treat area
apply
20-20 min
feedback from pt
turn off before removing towel
assess area
what are the 5 aquatic principles?
buoyancy - floating
resistance - res increases with speed
hydrostatic pressure - promotes circulation
specific heat - more mvmt increased heat
solvent
extremity tank
distal upper and lower extremity usage
10-24 gallons
hubbard
full body immersion
425 gallons
highboy tank
taller and thinner
sitting in chest high water with hips and knees flexed
10-24 G
lowboy tank
long sitting
90-105 G
temp of therapeutic pool
79-97 deg
temps for pools and their purpose
32-79 - acut inflam
79-92 - exercise
96-98 - cardiopulm compromise, burn treatments
99-104 - pain management
104-110 - chronic arthritis, increase ROM
what temp is a concern for MS pts?
88 and above
what are the effects of hydro?
cleansing
decres WB
increase venous circ, cardiac volume, Q
decreased vital capacity
increased work of breathing
diuresis
could be relaxing or invigorating
therapeutic effects of hydro
decrease abnormal tone
increase blood flow
increase core temp
pain relief
relaxation
vasodilation
strengthening
wound debridement
heat or cold superficial tissue
reduce fear of falling
indications for hydro
arthritis
burn care
edema
decreas ROM
desen of residual limb
joint stiffness
muscle spasm/spasticity
muscle strain
pain
sprain
wound care
contras for hydro
uncontrolled or unstable conditions
open wounds or bleeding
infected wounds
active infections
fever
precautions for hydro: partial immersion
maceration around wound
impaired thermal sensation in area
confusion or impaired cog
recent skin graft
precautions for hydro: full immersion
preg
MS
poor thermal reg
bowel incontinence
suicidal thoughts
confusion
alcohol ingestion
impaired strength, endurance, balance
medications that could effect cardio
urinary incontinence
fear of water
respiratory problems
adverse effects of hydro
drowning
burns
hyponatremia
infection
aggravation of edema
asthma exacerbation
electrical safety
falls outside of water
