Laser, SWD, HBO, EMG Flashcards
What is an HBO?
hyperbaric oxygen chamber
used to increase oxygen in blood plasma which makes it more readily available for wound healing
What is purpose of HBO?
increases oxygen gradient, may reduce bacterial growth as more O2 radicals are present
enchances all phases of proliferation, may reduce edema by bringing interstitial fluid out
more O2 delivery to tissue, improve antibiotic uptake
What are indications for HBO?
gas gangrene, peripheral ischemia, crush injury or skin graft, DM wagner 3,4,5, OM, thermal burns
Contraindications?
pneumothorax, COPD, claustrophobia, pregancy, severe arterial insufficnecy,current chemo
What is method for HBO?
patient in chamber at 1.5-2.5 ATM
tx time: 90-120 mins
frequency: 2x/day- 3/xweek
tx length- 10-60 sessions
When will health team know if working?
if 50% decrease of would isnt noted after 10 sessions likely not going to respond to rx
What does laser stand for?
light amplification by stimulated emissions of radiation
What is laser thrapy?
no heating of tissue is cold laser like LLLT, basically non thermal effects of US x 10
How does laser work?
photobiomodulation: use of light to modify biological processes
cell absorbs photon produce by laser and turns it into ATP which increases protein synthesis in mitochondria
What are three characteristics a laser must have?
- coherent
- monochromatic
- collimated
What does it mean for a laser to be coherent?
light waves are closely packed uniform lines
What does it mean for laser to be collimated?
all waves are parallel
How can tissues affect tissue repaid and wound healing?
cell repair through increased ATP, increased RNA that is pro-collagen
increased O2 and cell proliferation
How can laser help with vasodialation?
increased vasodialtion which will decrease ischemia and promote perfusion, decreased prostaglandin , decreased neutrophil migration
How can laser help with pain?
increased endorphins, decrease bradykinin, supresses c fiber afferents, decrease sensory and motor nerve conduction
What tyoe of laser do PT normally use?
class 3B, medium power level, less than 500 mW power
ex: LLLT
Roughly how deep will a laser light go?
5 cm deep
What are contraindications?
direct eye exposure, pregnancy, cancer, active bleeding (menstration or blood thinners), open growth plates
What are other precautions?
decreased sensation, recent steriod injection (will spread injection and we want it localized), photosensitivity meds
What are 4 key parameters to determine dosage and penetration?
wavelength- bigger the deeper
energy- j/cm2
power (mW)
continuous or pulsed
What power settings are needed for different tissue depth?
100 mw for superficial less than 1 cm
200 for medium 1-2 cm
300 mW for deeper greater than 2 cm
What are indications for LLLT?
wound healing, epicondylitis, fibromyalgia, carpal tunnel, neck pain, TMJ, LBP, shoulder pain
What is short wave diathermy?
produces deep heating 3-5 cm via conversion of electromagnetic energy into thermal energy
How does it work physiologically?
passes through tissue to cause molecular vibration which results in deep heating and superficial heating
What are two advantages of short wave diathermy?
capable of heating large areas (roughly size of cereal bowl)
causes both thermal and non thermal affects
What are thermal uses for SWD?
deep heat, increase blood flow, cell metab, tissue extensibility, muscular relaxation
What are non thermal uses of SWD?
edema reduction, lymphedema reduction, superficial wound healing, treeatment of venous ulcers
What are contraindications?
ischemic areas, metal, perspiration, tendency to bleed, pace maker, PT and pts who are pregnant should avoid
What are precuations?
dont let sweat near treatment site, thick fat can increase heating, operator should remain 2-3 feet away from energy source
What are two types of SWD generators?
- induction field 1 electrode
2. capacitive 2 electrodes
What type of tissue is mainly heated with inductive SWD?
muscle due to electrolytes
How does capacitive SWB work?
two electrodes on each side on leg for example to create an electrical circuit
What type of tissue is heated more with capicitive?
sueprficial skin and fat but muscle is heated some by conduction from adipose
How does SWD affect inflammation?
assists of removal of cell debris and toxins
How does SWD help wound healing?
by vasodialating you increase blood flow, capillary filtration, cap pressure and oxygen perfusion
non thermal can increase rate of phagocytosis, ATP increase
What is an EMG?
examines integrity of neuromuscular system including UMN, LMN and muscle fibers or delineated components of motor unit
study of motor unit activity
What does an EMG allow providers to see?
- can identify location of impairment
- can NOT identify cause of impairment
- can identify severity of impairment
What types of things can stimulate a nerve or muscle response in an EMG?
electric stim, needle provocation, voluntary activation
What type of pt can benefit from an EMG?
pts who have numbness, tingling, pain involving PNS, weakness in PNS
done for PNS not CNS
What are two diff type of nerve injuries?
- segmental demyelination- issue can be identified immedietly
- axon degeneration- takes 21 days after injury to identify
How long does it take for a nerve to heal?
1 mm a day
What is an abnormal velocity finding with EMG?
increase in latency reflects a decrease in conduction velocity
What is an abnormal amplitude response?
lower the amplitude will mean less motor units working
What is an abnormal duration response?
long duration can signal certain demyelinating disorders
What other factors can affect an EMG?
UE faster than LE, age slower in 7 y/o, heigher- longer limbs slower velocity, temp- cooler is slower
What is neurapraxia?
mild local conduction block, feels like arm fell asleep
axons intact but local demyelination
weeks to recover
What is axonotmesis?
more severe, disruption of axonal continuity
recovery is possible but could take several months, connective sheath must be intact
What is neurotmesis?
most severe
axonal degeneration and connective sheath damage
likely no recovery
What should happen on an EMG upon insertion?
normal- brief spike
PND- increased or prolonged
myopathic process- brief or increased
What should happen on EMG with spontaneuous activity?
normal- none
PND- present
MP- usually none
What should happen on EMG with minimal motor unit activation?
normal- normal activity
PND- increase duration, large sharp amplitude
MP- decrease duration small amp
How to treat denervated muscle?
use estim to decrease amount of atrophy
What would be parameters?
pulse duration- greater than 50 msec
frequency- 1-5 pps
on off ratio 1/5
do 3x/day for 5-20 reps
place one probe of muscle belly and other proximally
will get a worm like contraction
What are laser parameters for inflammation?
dosage- 2-5 j/cm2
frequency- 5000 hz
application- over area of inflammation
Acute pain?
6 j/cm2
continuous
over painful area
Chronic pain?
12 j/cm2, cont., over pain area
acute soft tissue injury?
4-8 j/cm2, under 100 hz, over lesion
Chronic soft tissue injury?
12 j/cm2, cont, over lesion
Tendinitis/Bursitis?
2-10 j/cm2, 5000 hz, over inflamed tissue
Trigger points?
5-12 j/cm2, cont. over TP
Acute wounds?
8 j/cm2, 700 Hz, in or around wound bed/periwound
Chronic wound?
1-6 j/cm2, cont. in and around wound bed/ periwound
