LECTURE 4: MODALITIES Flashcards
ultrasound indications
Acute and post-acute conditions (non-thermal effects)
● Calcium deposits
● Chronic inflammation
● Delayed soft tissue healing
● Dermal ulcers
● Joint contractures
● Muscle spasm
● Myofascial trigger points
● Pain
● Plantar warts
● Scar tissue
● Tissue regeneration
ultrasound contra indications
● Areas of active bleeding
● Areas of decreased temperature
sensation
● Areas of decreased circulation
● Deep vein thrombosis
● Infection
● Malignancy
● Over breast implants
● Over carotid sinus or cervical ganglia
● Over epiphyseal areas in young
children
● Over eyes, heart, and genitalia
Over methylmethacrylate cement area (TKR) or plastic
● Over pelvic, lumbar or abdominal areas in pregnant women
● Over pacemaker
● Thrombophlebitis
● Vascular insufficiency
ultrasound is a what?
Sound frequency (acoustic energy in waves) that is deep heat modality!!!! up to 5 cm
true or false: ultrasound can be thermal and nonthermal
true!
What is attenuation?
decrease in energy intensity bc some of ultrasound waves got bent due to reflection or refraction
This is why we use gel and sound head firmly against body part
US passes through _____ content, and is absorbed in ___tissues
passes through high water content, absorbed in high protein like tendon
frequency increases, absorbtion increases
small area, what sound head size?
smaller the transducer size, more contact with the skin
Treatment area should be what compared to effective radiating area
2-3x effective radiating area
Larger transducer and higher frequency = more
collimation (focus of the beam)
a higher BNR means
losing lot of energy/heat inside the unit
What are 4 parameters of ULTRASOUND
duty cycle (pulsed vs continuous)-miliseconds!!!! 5th of a sec
frequency
intensity
treatment time
ERA IS
The portion that produces the sound wave
○ Energy output is greatest at the center
○ Is is smaller than the transducer size
○ Treatment area = 2-3x ERA
What does
thermal: CONTINUOUS DUTY CYCLE
non-thermal: pulsed! 1 ms on/4 ms off duty cycle is 20%, 1/5th
nonthermal effects are what?
good for early inflammatory phase
cavitation and microstreaming!
good for 1st 2 weeks of tissue healing and for stable fractures!
does thermal effects have tissue healing properties?
not really, mainly warms up tissues!
ultrasound frequency is WHAT
depth!!!! 0.75-3 MHz
1 MHz frequency ultrasound settings:
DEEP TISSUES! goes up to 5 cm
-if cushioned
-if quads, hams, thicker areas
3 MHz ultrasound frequency
3 MHz: shallower depth (1-3 cm) for superficial tissues
nonthermal duty cycle is for
acute injury, edema, tissue healing (no temp increase!)
what do you do for documentation?
Body part to be treated
○ Modality used
○ Patient position
○ Treatment duration
○ Parameters
○ Patient response to treatment
○ Skin effects
○ Outcome measure
*communicate to other providers so they can let them do the same
WHAT IS HIGH VOLT PULSED CURRENT
does same numbers as russian!
paired monophasic wave
modulation: none
muscle contraction
CAN BE GOOD FOR WOUNDS, EDEMA**
iontophoresis is WHAT
continuous direct current to deliver medicine! Drives ions into body…. through skin/mucous membranes
iontophoresis cathode has a
alkaline effect
iontophoresis anode has a
acidic effect (+)
iontophoresis dosage of med
40 mA-min dose = 4 mA x 10 min
40 mA-min=2 mA x 20 min
amount of med is same, but what changes is INTENSITY and TIME
dexamethasone
polarity: negative
4 mg/mL
tendonitis!!! bursitis!!!!
lidocaine
polarity: pos
4% lidocain
for: trigeminal neuralgia
acetate
2-5% acetic acid for CALCIUM DEPOSITS (-)
iontophoresis indications
Analgesia
● Calcium deposits (bone spurs)
● Dermal ulcers
● Edema reduction
● Fungal infections
● Hyperhidrosis
● Muscle spasms
● Musculoskeletal inflammatory conditions- tendonitis
ionto contras
Those general rules for EStim
● Impaired skin sensation
● Allergy or sensitivity to medication
● Denuded area of recent scars
● Cuts, bruises, or broken skin
● Metal in or near treatment area
how can ionto burns happen?
Chemical: usually alkaline reaction at cathode
● Heat: high resistance to flow, poor contact
● Irritation/rash: allergy to medication
how can you minimize burns?
Decrease current density
● Inspect skin prior to application
● Ensure sufficient filling of medication
● Ensure good contact with skin
● Ask about allergy to medications
what is biofeedback?
Used to measure motor unit action potentials (MUAP) .
● Signals are detected, amplified, and converted to audiovisual signals
● Electronic or mechanical instrument used to help patient develop greater voluntary control via relaxation or neuromuscular re-education
NO SHOCKING
Biofeedback is for
muscle re-education! beeps loader with more contraction
EMG biofeedback is used in conjunction with patient’s ______to increase or decrease muscle activity towards a functional goal.
voluntary contractions/efforts!
what does biofeedback measure?
skin temp
skin conductance
vasoconstriction or pulse via phototransm
EMG activity
pressure
who do you use biofeedback on?
● Good vision, hearing, and communication abilities
● Good comprehension of simple commands and concentration
● Good motor planning skills
● No profound sensory or proprioceptive loss
how does heat transmission occur?
Conduction
● Convection
● Radiation
● Conversion
conduction works by
CONDUCTION OVEN
DIRECT CONTACT
cooling penetrates deeper than heat! does not go deep, less than 1 cm deep
Convection
body in contact with moving fluid (air or liquid)
● Hot or cold whirlpool
● Fluidotherapy
● Whole or partial body cryotherapy
radiation
Transfer of energy (not necessarily heat) to the body without physical contact.
-Laser
● UV light
● Infrared lamps
conversion
Energy changes from one type (i.e. sound, electromagnetic energy) into another (i.e. heat)
ultrasound is what? CONVERSION
US: Sound waves create vibration of molecules which produces heat
diathermy is what? CONVERSION
Dia: EM energy induces electrical fields and heat currents within the tissue.
factors affecting thermal transfer
Temperature difference between modality and tissue Treatment time
Exposure of body area to modality
Specific heat and mass of body and source
Type of heat transfer
* Conduction > Convection > Conversion > Radiation
thermotherapy indications
Modulate pain
● Increase connective tissue
extensibility
● Reduce or eliminate soft
tissue inflammation and
swelling
● Accelerate rate of tissue
healing
● Reduce or eliminate soft
tissue or joint restriction
● Reduce muscle spasm
thermotherapy contras
Acute and early subacute traumatic and inflammatory conditions
● Decreased circulation
● Decreased sensation
● DVT
● Impaired cognitive function
● Malignant tumors
● Tendency toward hemorrhage or edema
● Very young patients
● Elderly
thermotherapy precautions
Cardiac insufficiency
● Edema
● Impaired circulation
● Impaired thermoregulation
● Metal in treatment area
● Pregnancy
● Topical counterirritants recently
applied
● Demyelinated nerves
● Open wounds
what increases with heat?
CO
metabolic rate
pulse rate
RR
vasodilation
what decreases?
BP
mm activity
Blood flow to internal organs and blood flow to resting muscle
stroke volume
aquatic therapy is good for what arthritic condition?
RA
