Midterm Flashcards
What are the Indications for Heat modalities?
- Sub-acute or Chronic conditions
- OA
- Muscle Tension
- Muscle Guarding
- Muscle Injury
- Improve electrical conductivity of the skin before E-Stim
What are the Contraindications to Heat modalities?
- Active bleeding
- Cancer
- Sensory loss
- Confusion
- DVT
What are the different methods of heat exchange and examples of each method?
- Conduction: Hot Pack and Paraffin
- Convection: Fluidotherapy and Whirlpool
- Conversion: Diathermy and Ultrasound
- Radiation: Infrared Lamps
- Evaporation: Vapocoolant Spray
What are the Parameters for Moist Hot Packs?
- 6-8 dry towels or 2-3 covers
- Temp of unit should be 158-167 deg F
- Treatment time= 20 mins w/skin check @ 5 mins
What are the Parameters for Paraffin Bath?
- Temp of unit should be 125-134 deg F
- 6-10 dips, wrap in plastic and towel, elevate
- Treatment time 10-15 mins
What are the Parameters for Fluidotherapy?
- Temp of unit should be 100-118 deg F
- Treatment time= 20 mins w/skin check @ 5 mins
What are the Indications for Cold Modalities?
- Spasicity/increased muscle tone
- Acute injury and inflammation: sprain, strain, post-op
- Acute or chronic pain: RA, trigger points
- Small burns
- ROM deficits due to pain
- Edema
What are the Contraindications for Cold Modalites?
- Hypersensitivity to cold
- Arterial insufficiency or PVD
- Cold intolerance
- Regenerating nerve
What are the Parameters for Cold Packs?
- Use for acute inflammation for 48-72 hrs
- Can use dry or wet towel/sheet to cover
- Treatment time= 15-20 mins every hour
What are the Parameters for Ice Massage?
- Use small overlapping circles in treatment area
- Treatment time= 5-10 mins via CBAN sequence
What are the Parameters for Vapocoolant Spray?
- 2-5 sweeps 1 in. apart @ 4 in. per sec. speed
- Hold can 12-18 in. from skin, angled at 30 deg
- Muscle is on slight tension, follow with a stretch
- Treatment time= <5 mins
Why do you want to consider Diastolic BP when using the Game Ready Device and what are the pressure level settings?
- You do not want the pressure to increase more than the pt.s diastolic blood pressure
- High= 5-75 mmHg
- Medium= 5-50 mmHg
- Low= 5-15 mmHg
What are the Indications for Diathermy?
- Sub-acute & Chronic Inflammation
- ROM Deficits
- Sprain/strain
- Joint Pain
What are the Contraindications for Diathermy?
Always:
-Pregnancy
-Pacemaker
-Cancer
Thermal Level:
-Metal Implants
-Cancer
-Ephiphysis
-Eyes
-Testes
Non-thermal:
-Organ disease
-Pain & edema treatment exclusivelyWhat are the Methods for heat exchange in Diathermy?
Capacitive:
-Uses plates
-For more superficial purposes (more absorption in skin and fat
-Heats by electric field
-Electrical current flows from plate to plate
-Pt. becomes part of the circuit
Inductive:
-Uses Drum/coils
-Used for more deep purposes (more absorption in muscle
-Heats by magnetic field
-Electrical current creates a perpendicular magnetic field
-Eddy current induced into the tissue
There are also Thermal and Non-thermal (mechanical) modes
What are the Indications for Ultrasound?
Mechanical (Non-Thermal):
- Acute tissue repair - Sub-acute inflammation due to sprain, strain, bruising, tear, burns
Thermal:
- Acute muscle spasm - Sub-acute edema, fibrosis, contracture, adhesions, unresolved hematomas
What are the Contraindications for Ultrasound?
Always:
-Cancer
-Pacemaker
-Pregnancy (near abdomen, pelvis, or low back)
Do Not go over:
-Spinal Cord (CNS)
-Eyes
-Arthroplasty (Joint cement or plastic)
-Thrombus
-Reproductive OrgansWhat are the Parameters for Ultrasound?
- C/I
- Treatment Area
- Duty Cycle (Thermal/Non-thermal)
- Frequency (Depth)
- Intensity (How hot)
- Duration
- Size of sound head
- Type of medium (if using something other than gel)
What does Attenuation mean in regards to Ultrasound?
It is the decrease in intensity as the sound wave travels through tissue
-Attenuation is directly related to absorption
Tissues with High _______ content have higher attenuation and absorption.
Collagen
What type of tissue absorbs the highest amount of Ultrasound and what other types of tissues absorb a lot of US?
Highest= Bone
Other tissues= Cartilage and tendon/ligament
What type of tissue absorbs the least amount of Ultrasound and what other types of tissues absorb little US?
Lowest= Blood
Other tissues= Fat, Nerves, Muscle
If a traction table does not split, how much is the treatment table co-efficient of friction?
.50
If a traction table is able to split, how much is the split treatment table co-efficient of friction?
.15
What are the indications for traction?
- Stretch of facet joint capsule
- Increase intervertebral foramina space
- More space for spinal nerve root
- Decreased inflammation
- Decrease pain
- More space for spinal nerve root
- Muscle elongation
- Muscle relaxation
- Decreased nerve pressure
- Gate mechanism with intermittent traction
- Improve blood supply to discs and tissue
- Promote negative pressure on disc
What are the contraindications for traction?
SOUR JARS
- Symptoms worsen/peripheralize
- Osteoporosis
- Uncontrolled hypertension
- Recent spinal fracture
- Joint hypermobility
- RA, Down syndrome, Marfan syndrome, pregnancy
- Acute inflammation/injury
- Recent spinal surgery
- Spinal cord pressure
What are the angles of pull for lumbar traction?
- Anterior
- Posterior
- Unilateral/Neutral
Which angle of pull do you want for traction when you are trying to creat a posterior pelvic tilt?
Posterior angle of pull
What are the only angles of pull appropriate for lumbar disc hernation pt.s during traction?
Anterior or neutral
What are the parameters for angle of pull for C-Spine Traction?
- AO joint = 0 deg
- C2-C7 = 25-35 deg
What are the parameters for poundage of C-Spine Traction?
- Begin with 8-10 lbs
- Progress to 20-30 lbs max
What are the parameters for poundage of L-Spine Traction?
- Begin with 25% of body weight (30-45 lbs)
- Progress to 60% of body weight max
For what reasons are Static or Intermittent Traction used for both C & L-Spine?
- Static:
- Best for disc herniation
- Intermittent:
- Long is best when static is not tolerated or for muscle elongation (60:20)
- Short is best for facet/DDD/DJD/spasm (1:1)
What are the parameters for time during both C & L-Spine Traction?
- First time: 5-10 mins
- Static: 5-10 mins
- Intermittent: 20-30 mins
What are the Traction Parameters to document?
- C-spine or L-Spine traction
- Pt. position
- Angle of pull
- Static/Intermittent
- Poundage
- Rx Time
What are the different types of Edema?
- Local edema
- General edema
- Lymphedema
Describe Local Edema
- Unilateral or bilateral
- Caused by trauma, infection, or obstruction
- Can happen post mastectomy
Describe General Edema
- Bilateral LEs, groin, abdomen, may be total body edema
- Systemic (relating to a system rather than a particular part
- Caused by chronic illness- cardiac disease, kidney failure, liver disease
Describe Lymphedema
- Painless edema of one or both UEs or LEs
- Caused by impairment of lymphatic drainage
What is the Role of Muscle Spindle in regards to Tone?
Stretching muscle facilitates/contraction in the agonist and inhibits the antagonist
What is the Role of GTO in regards to Tone?
Applying extra pressure to the tendon of an agonist will signal antagonist to contract and counteract agonist
What are the Roles of Cutaneous Receptors?
To detect Temperature, Pressure, Pain, Touch, and Texture
What are some techniques which can be applied to Cutaneous Receptors to increase Tone?
- Quick light touch
- Brushing
- Quick icing
What are some techniques which can be applied to Cutaneous Receptors to decrease Tone?
- Slow stroking
- Maintained holding
- Neutral warmth
- Prolonged icing
What are examples of Contractile vs. Noncontractile tissue?
- Contractile:
- Musculotendinous
- Noncontractile
- Skin
- Ligament
- Capsule
- Cartilage
- Disc
- Bursa
What are the Indications for ROM and Stretching?
- Contractures
- Adhesions
- Scar tissue
- Muscle soreness
- Muscular weakness
What are the Contraindications for ROM and Stretching?
- Bony block
- Infection
- Sharp pain
- Hypermobility
- Hematoma
- When tightness is beneficial
What are the 3 Healing Stages of a wound and when do they take place?
- Inflammation
- 1-10 days
- Fibroplastic/Proliferation
- Begins between day 3-20
- Remodeling
- From 3 weeks post injury to 3 years
Describe a Stage I wound
- Pressure Ulcer
- Non blanching erythema of intact skin
Describe a Stage II wound
- Epidermal Wound
- Partial thickness involving epidermis and/or dermis
Describe a Stage III wound
- Dermal Wound
- Full thickness involving dermis and to, but not through the fascia
Describe a Stage IV wound
- Dermal Wound
- Full thickness involving tissue necrosis or damage to muscle or bone
What is the Gate Theory?
- Lg diameter A beta fibers increase activity in dorsal horn of spinal column, close the gate, and decrease pain perception
- Sm diameter A delta & C fibers decrease activity in dorsal horn of spinal columc, open the gate, and increase pain perception
What is the Gate Mechanism?
Thermoreceptors (heat/cold), Mechanoreceptors (rubbing/E-stim) can reduce pain, therefore reducing spasm/musle tension
What are the different sensory fibers and how are they described?
-A-Delta Fibers:
-Nocioceptor
-Myelinated (faster transmission)
-Evoke sharp, pricking sensation
-C-Fibers:
-Nocioceptor
-Unmyelinated (slower transmission)
-Longer lasting
-Evoke burning sensation that is poorly localized
-A-Beta Fibers:
Non-Nocioceptor
What are the different Spinal Pathways and how are they described?
Ascending Pathways
- Spinothalamic:
- Impulses travel to thalamus and then to somatosensory cortex
- Responsible for sharp, discriminative, localized sensations
- Spinoreticulothalamic:
- Impulses travels to reticular formation to thalamus and limbic system
- Diffuse and visceral pain perception
Descending Pathways
- Motor tracts
- Endogenous opiates released from higher centers
- Examples: enkephalins, endorphins, serotonin, dopamine
- Stimulated by systemic pain, intense exercise, laughter, meditation, relaxation, acupuncture, E-stim
