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PCE - Treatment > Mechanical agents + EPA Pt. 1 > Flashcards

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)
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2
Q

Types of traction

A
  • manual
  • mechanical
  • traction using gravity
  • traction by positioning
  • autotraction
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3
Q

Indications for traction

A
  • joint dysfunction (hypomobility)
  • degeneration (associated hypomobility)
  • nerve root compression or disc pathology
  • pain (effect on mechanoreceptor)
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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,

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5
Q

Precautions for traction

A
  • pregnancy
  • respiratory problems
  • osteoporosis
  • spondylolisthesis
  • hypermobility/instability
  • claustrophobia
  • extremely restricted ROM
  • little improvement with rest
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6
Q

What do you need to check/clear prior to traction

A
  • VBI
  • NEUR TEST
  • NEUROMOBILITY AND CONDUCTION
  • STABILITY
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7
Q

What forces are required for traction

A

usually 10-20 % of body weight,

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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
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9
Q

What is the main source of heat gain

A

metabolism (also absorption of radiation from environment, etc.)

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10
Q

What is the main source of heat loss

A

radiation (also exhalation, evaporation of sweat, urine)

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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
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12
Q

What temp is needed for therapeutic effect with heat

A

elevate tissues to 40-45deg

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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
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14
Q

4 forms of heat transfer

A
  • Radiation
  • Convection
  • Conduction
  • Conversion
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15
Q

What thermal agent uses radiation

A

infra-red

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16
Q

What is radiation

A

heat energy to electromagnetic radiation

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17
Q

What is convection? What thermal agent uses this

A

movement of molecules in liquids or gases, ie. whirlpoo

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18
Q

What is conduction? What thermal agent uses this

A

physical contact, ie. hot packs/paraffin wax/contrast baths

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19
Q

What is conversion? what thermal agent uses this?

A

chemical/electrical energy produces heat, ie. US/diathermy

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20
Q

Thermal agents have the greater effects at what tissue depth?

A

1-2mm

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21
Q

After 1-2 mm of tissue depth what is the change possible via external heating

A

1c

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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

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23
Q

What must you do before using thermal agents

A

test sensation (hot and cold)

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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

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25
Q

What is the application of hot packs

A

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
Q

What is the application of contrast baths

A

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
Q

What is the application of whirlpool

A

mechanical stimulation + thermoreceptors (gating), can help with wound debridement

28
Q

Contraindications to thermal agens

A
  • acute inflammation
  • skin conditions (dermatitis)
  • altered thermal sensation
  • hemorrhagic disease
  • malignancies
  • gonads
  • open wounds
  • unreliable patient
29
Q

What is an important step for all cryotherapy

A

Check cap refill

30
Q

Application of cold packs

A

don’t lie on, chip ice better then gel pack for cooling, 15 mins

31
Q

Application of local immersion

A

15-20mins

32
Q

Application of ice towel

A

Replace every 2-3 mins, repeat up to 20 mins

33
Q

Application of ice massage

A

Use on small area, decrease local pain (5-10mins)

34
Q

How often do you check for an allergic reaction to cold

A

after 1 min then again after 5 minutes

35
Q

Dangers with cold therapy

A
  • Ice burn
  • peripheral nerve damage
  • frostbite
  • reduced peripheral blood supply (can further damage tissue)
  • cold sensitivity (Reynaud’s, cold urticaria)
36
Q

What is EMG feedback used for? what does it measure?

A

Nerve conduction testing – estimates velocity of depolarization along an alpha motor neuron

37
Q

What is the normal response of skeletal muscle when you insert the emg needle?

A

short burst of electrical activity

38
Q

Reduce insertional activity with needle insertion is seen in..

A

Fibrotic or severely atrophied muscle

39
Q

Increased insertional activity with needle insertion is seen in..

A

when a muscle is irritable

40
Q

What does abnormal EMG electrical activity at rest indicate

A

suggests neuropathy or myopathy

41
Q

What is abnormal EMG electrical activity at rest

A

fibrillation potentials (rapid, irregular contractions of muscles), positive sharp waves, or fasciculation potentials

42
Q

What is surface EMG used for

A

improve control over defective muscles or improve control over stressed muscles (ex: hemiplegia, SCI, spasticity, dystonia, recovering peripheral nerve injuries)

43
Q

Is emg a treatment?

A

no a tool

44
Q

What is TENS used for

A

Used for acute and chronic pain, muscle twitch, muscle strengthening and spasticity management

45
Q

What is the mechanism via which TENS can inhibit pain

A

segmental mechanism gating at spinal cord (conventional setting) OR extra-segmental mechanism (release of opioid and serotonin receptors)

46
Q

Conventional tens prescription? Indication?

A

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
Q

acupuncture like tens prescription? Indication?

A

10 Hz, 200 microseconds, intensity to muscle twitch, electrodes on motor point, treatment duration 40-60 min,

For prolonged pain management

48
Q

TENS contraindications

A
  • 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
Q

NMES use

A

Can be used for pain, produce muscle twitch, inc muscle strength, spasticity management

50
Q

NMES settings for pain

A

same as TENS

51
Q

NMES settings for edema management

A

over extraarticular edema, 5-10 Hz, 200 microseconds, motor intensity to twitch

52
Q

NMES settings for muscles strengthening

A

> 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
Q

NMES Contraindications

A
  • 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
Q

Interferential current use?

A

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
Q 
IFC: 
Low or high voltage?
Intensity?
Wave form?
Frequency?
Balanced-unbalanced?
symmetrical?asymmetrical?
Pulse duration?
Phase duration?
A 
Low voltage 
Medium intensity 
2 sinusoidal waves - alternating current 
4000 Hz 
Balanced 
Symmetrical 
250usec 
125usec
56
Q

IFC Motor Frequency

A

1-10Hz with strong but comfortable muscle twitch

40-60 mins

57
Q

IFC sensory (pain) Frequency

A

80-150Hz with strong but comfortable sensation

0-40 mins

58
Q

IFC Motor + sensory Frequency

A

1-150 Hz for both (but less effective for motor)

59
Q

IFC application

A 
quadripolar bracketing (bipolar if pre-modulated), warm/wet to decrease resistance, sweep to avoid accommodation 
o Can treat large, deep areas
60
Q

IFC Caution

A
  • 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
Q

IFC Contraindications

A

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
Q

IFC Precautions

A
  • active epiphyses in children
  • skin disease (ie. eczema, psoriasis)
  • impaired circulation
  • metal implants
  • fragile skin (use vacuum/suction cup application)

PCE - Treatment (6 decks)

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