Mechanical agents + EPA Pt. 1 Flashcards
1
Q
Effects of traction
A
- Separation of vertebral bodies
- increased IVF diameter
- mobilization of the z joints (distraction and gliding)
- flattening of spinal curves
- mechanoreceptor stimulation/pain inhibition
- decreased muscle spasm
- mobilization of muscle and CT
- improved circulation (blood and lymph)
2
Q
Types of traction
A
- manual
- mechanical
- traction using gravity
- traction by positioning
- autotraction
3
Q
Indications for traction
A
- joint dysfunction (hypomobility)
- degeneration (associated hypomobility)
- nerve root compression or disc pathology
- pain (effect on mechanoreceptor)
4
Q
Contraindications for traction - include additional for cervical
A
- acute
- patient can’t tolerate the traction position
- bad response to manual traction
- recent surgery
- underlying hypermobility or instability
- malignancy
- SSX of spinal cord or cauda equina compression
- vascular compromise
additional for cervical: s&s VBI, TMJ dysfunction, RA, down syndrome, cervical myelopathy, glaucoma,
5
Q
Precautions for traction
A
- pregnancy
- respiratory problems
- osteoporosis
- spondylolisthesis
- hypermobility/instability
- claustrophobia
- extremely restricted ROM
- little improvement with rest
6
Q
What do you need to check/clear prior to traction
A
- VBI
- NEUR TEST
- NEUROMOBILITY AND CONDUCTION
- STABILITY
7
Q
What forces are required for traction
A
usually 10-20 % of body weight,
8
Q
Important considerations when prescribing compression garmets
A
- make sure proper fit
- instruct patient to put on properly
- ensure pressure is greater distal then proximal
- education on signs of too much pressure (cold, swelling, pain, capillary refill on toes 2-3 seconds normal?)
- instructed them to look for any wrinkles in garment to prevent pressure areas
9
Q
What is the main source of heat gain
A
metabolism (also absorption of radiation from environment, etc.)
10
Q
What is the main source of heat loss
A
radiation (also exhalation, evaporation of sweat, urine)
11
Q
Benefits of heat
A
- provides pain relief
- reduces muscle spasm and joint stiffness
- promotes relaxation
- increases blood flow
- facilitates fine movement
- increases ROM and exercise tolerance in some patients
12
Q
What temp is needed for therapeutic effect with heat
A
elevate tissues to 40-45deg
13
Q
Benefits of cold
A
- decreases swelling after injury/surgery, chronic edema and joint effusions
- decreases muscle spasm/spasticity
- mild cooling enhances muscular isometric contraction and endurance
- decrease pain
14
Q
4 forms of heat transfer
A
- Radiation
- Convection
- Conduction
- Conversion
15
Q
What thermal agent uses radiation
A
infra-red
16
Q
What is radiation
A
heat energy to electromagnetic radiation
17
Q
What is convection? What thermal agent uses this
A
movement of molecules in liquids or gases, ie. whirlpoo
18
Q
What is conduction? What thermal agent uses this
A
physical contact, ie. hot packs/paraffin wax/contrast baths
19
Q
What is conversion? what thermal agent uses this?
A
chemical/electrical energy produces heat, ie. US/diathermy
20
Q
Thermal agents have the greater effects at what tissue depth?
A
1-2mm
21
Q
After 1-2 mm of tissue depth what is the change possible via external heating
A
1c
22
Q
How can you heat tissues deeper than 1-2mm
A
if you want deeper you have to wait 20-25 mins and you need short wave diathermy or prolonged thermal US
23
Q
What must you do before using thermal agents
A
test sensation (hot and cold)
24
Q
What is the application of paraffin
A
(lower heat capacity, usually kept between 42- 52°): dip hands 6 times, will transmit heat as it cools/solidifies, wrap in wax paper with glove, leave for 15 min
25
What is the application of hot packs
use 1-2 cm or 4-6 towel between skin and hot pack, takes ~8 min for skin to reach max temp, do an objective and subjective test at 10 min, 15-20 mins duration, never lie on a hot pack
26
What is the application of contrast baths
Increases blood flow to skin and provides considerable sensory stim (no real temp change), tubs at 38-44° and 10-18°, ratio hot:cold = 4:2, 5:3, 3:1, etc. repeat 3-4x, 20-30 mins total
27
What is the application of whirlpool
mechanical stimulation + thermoreceptors (gating), can help with wound debridement
28
Contraindications to thermal agens
- acute inflammation
- skin conditions (dermatitis)
- altered thermal sensation
- hemorrhagic disease
- malignancies
- gonads
- open wounds
- unreliable patient
29
What is an important step for all cryotherapy
Check cap refill
30
Application of cold packs
don’t lie on, chip ice better then gel pack for cooling, 15 mins
31
Application of local immersion
15-20mins
32
Application of ice towel
Replace every 2-3 mins, repeat up to 20 mins
33
Application of ice massage
Use on small area, decrease local pain (5-10mins)
34
How often do you check for an allergic reaction to cold
after 1 min then again after 5 minutes
35
Dangers with cold therapy
- Ice burn
- peripheral nerve damage
- frostbite
- reduced peripheral blood supply (can further damage tissue)
- cold sensitivity (Reynaud’s, cold urticaria)
36
What is EMG feedback used for? what does it measure?
Nerve conduction testing – estimates velocity of depolarization along an alpha motor neuron
37
What is the normal response of skeletal muscle when you insert the emg needle?
short burst of electrical activity
38
Reduce insertional activity with needle insertion is seen in..
Fibrotic or severely atrophied muscle
39
Increased insertional activity with needle insertion is seen in..
when a muscle is irritable
40
What does abnormal EMG electrical activity at rest indicate
suggests neuropathy or myopathy
41
What is abnormal EMG electrical activity at rest
fibrillation potentials (rapid, irregular contractions of muscles), positive sharp waves, or fasciculation potentials
42
What is surface EMG used for
improve control over defective muscles or improve control over stressed muscles (ex: hemiplegia, SCI, spasticity, dystonia, recovering peripheral nerve injuries)
43
Is emg a treatment?
no a tool
44
What is TENS used for
Used for acute and chronic pain, muscle twitch, muscle strengthening and spasticity management
45
What is the mechanism via which TENS can inhibit pain
segmental mechanism gating at spinal cord (conventional setting) OR extra-segmental mechanism (release of opioid and serotonin receptors)
46
Conventional tens prescription? Indication?
80-150 Hz, 60 microseconds, intensity to comfortable tingle (modulated) with electrodes over site of pain/bracketing, treatment duration 30 min,
For immediate pain management
47
acupuncture like tens prescription? Indication?
10 Hz, 200 microseconds, intensity to muscle twitch, electrodes on motor point, treatment duration 40-60 min,
For prolonged pain management
48
TENS contraindications
- Electronic devices
- low back or ab of pregnant woman
- malignancy
- DVT or thromboembolism
- infected tissue (TB)
- impaired sensory awareness
- cognitive or communication impairments
- cardiac disease or arrhythmias
49
NMES use
Can be used for pain, produce muscle twitch, inc muscle strength, spasticity management
50
NMES settings for pain
same as TENS
51
NMES settings for edema management
over extraarticular edema, 5-10 Hz, 200 microseconds, motor intensity to twitch
52
NMES settings for muscles strengthening
>35<65 Hz, intensity to tetany, rise and fall (usually nice to have a 2 sec ramp and 1 sec off with a 6 sec contraction = 9 sec total), on/off depending on strength of muscle (I: 1:5 III: 1:3 IV: 1:1) 12-15 contractions per second
53
NMES Contraindications
- electrical devices/implant
- pregnancy ANYWHERE
- active DVT or thromboembolism
- infected tissue
- chest with cardiac disease or arrhythmias or heart failure
- neck or over eyes
- impaired circulation
- unstable (recent surgery, osteoporosis, #)
- intercostal muscles, lower abdomen
54
Interferential current use?
Used for pain management via gating and/or endogenous opiate release, edema management via muscle twitch, increasing local blood flow, muscle stimulation for strengthening of pelvic floor
55
```
IFC:
Low or high voltage?
Intensity?
Wave form?
Frequency?
Balanced-unbalanced?
symmetrical?asymmetrical?
Pulse duration?
Phase duration?
```
```
Low voltage
Medium intensity
2 sinusoidal waves - alternating current
4000 Hz
Balanced
Symmetrical
250usec
125usec
```
56
IFC Motor Frequency
1-10Hz with strong but comfortable muscle twitch
| 40-60 mins
57
IFC sensory (pain) Frequency
80-150Hz with strong but comfortable sensation
| 0-40 mins
58
IFC Motor + sensory Frequency
1-150 Hz for both (but less effective for motor)
59
IFC application
```
quadripolar bracketing (bipolar if pre-modulated), warm/wet to decrease resistance, sweep to avoid accommodation
o Can treat large, deep areas
```
60
IFC Caution
- can output 50-90mA (other machines = much lower) – NO THORACIC APPLICATION OVER 50mA - Risk of ventricular fibrillation
- smaller electrodes increase current density and risk of burns
- superficial current flow and increased risk of burns if electrodes placed too close together
61
IFC Contraindications
o to the chest/thorax
o electronic devices (ie. pacemakers)
o regions of known or suspected malignancy
o low back or abdomen of pregnant women
o active DVT or thrombophlebitis
o actively bleeding tissues or untreated hemorrhagic disorders
o infected tissues, TB, or wounds with underlying osteomyelitis
o recently radiated tissue
o impaired sensory awareness
o to the neck or head (especially if known to have seizures)
o to areas near reproductive organs or genitalia (without specialized training)
o to areas near or over eyes
o damaged or at risk skin areas that would result in uneven conduction of current
o cognition or communication impairments (no feedback)
62
IFC Precautions
- active epiphyses in children
- skin disease (ie. eczema, psoriasis)
- impaired circulation
- metal implants
- fragile skin (use vacuum/suction cup application)
