Midterm Flashcards
What is the goal for a modalities during the inflammatory stage?
-Reduce blood flow and decrease cellular metabolism to lessen the formation of edema
What is the goal of a modality during the proliferation stage?
-enhance blood flow and cellular activity
What is the goal of a modality during the maturation phase?
-facilitate collagen maturation and organization
What type of pain receptors respond to high intensity mechanical and thermal stimuli and conduct the signal very quickly to create a withdrawl response?
-A delta fibers
what pain receptors condunt more slowly, and are related to dull or achy pains?
-C fibers
What type of neurons are nociceptor specific?
-High threshhold fibers
What type of neurons receive input from nociceptors and other afferent fibers?
-Wide dynamic
What is increased responsiveness to noxious stimuli and non-noxious stimuli, increased receptive field and decreased activation threshold?
-Central sensitization
What is the most commonly used theory to explain pain inhibition using modalities?
-The Gate control theory
What does the gate control theory propose?
-that stimulation of large diameter A beta fibers activate local inhibitory circuits in the dorsal horn of the SC, thereby preventing nociceptive input from reaching the brain
What two modalities are thought to stimulate A beta fibers?
-ESTIM and superficial heat
What does central inhibition propose?
-the pain is modulated by the activation of descending inhibitory pathways projecting into the spinal cord
When applying a modality to a patient in the acute stage what position should they be in?
-The most comfortable position (loose pack)
What is the transfer of heat by the direct interaction of the molecules?
-conduction
How can you facilitate conduction?
-add pressure
What is the transfer of heat caused by the movement of air of water molecules?
-convection
What is the transfer of heat due to the evaporation of liquid into a gas?
-Evaporation
What is the transfer of heat via electromagnetic waves?
-thermal radiation
As the temperature gradient increases, what happens to the cooling effect?
-it increases
What is the main effect of cryotherapy?
-it decreases blood flow
How does cryotherapy cause blood flow to decrease?
-it causes vasoconstriction of cutaneous blood floow and reduces vasodilating transmitters
At what tempurate will there be a reflexive cyclical vasodilation/constriction response?
-50 degrees
Lower tissue tempuratures also decrease what?
-metabolic rate and oxygen demand (prevent hypoxia_
What does cryotherapy do to nerve conduction?
-slows it
How does cryotherapy decrease spacticity?
-it results in a reflexive decrease in gamma-motor neuron activity, and decreases muscle spindle discharge
What effect does cryotherapy have on strength?
-it decreases it after only 10 minutes of cold exposure (MMT grades my not be reliable)
What effect does cryoptherapy have on joint proprioception?
-it decreases it (be aware of activity after)
What temperatures should a conventional cold pack be?
-below 32 degrees
How long can you apply a cold pack?
-twenty to thirty minutes
What type of cryotherapy is good to use on small areas?
-ice massage
how long should you apply an ice massage?
-10 minutes
What temperature should whirlpools be if used on a distal extremity?
-50-65 degrees
What temperature should a whirlpool be is used on the whole body?
-65 to 80 degrees
How long should an ice bath/whirl pool be applied?
-10 to 20 minutes
What is the order of sensations a patient will feel with cryotherapy?
-CBAN (cold, burning, aching, numbness)
How does compression improve edema?
-It increases the tissue hydrostatic gradient that is thought to favor edema
50% pull and 50% overlap of an elastic wrap can create pressures of what?
-40 to 50 mmHg
Intermittent compression devices create pressures of what?
-30 to 75 mmHg
what pressure is neccesary to be above capillary pressure and encourage the absorption of edema?
-30 mmHg
What is the main reason to use superficial heat as a modality?
-to increase tissue extinsibility
What temps should be used for vigorous heating?
-104 to 113 deg
applying heat to a large amount of tissue can cause what systemic effects?
-increased HR, BP and pulmonary alterations
What type of heat particulary notes cutaneous vasodilation?
-moist heat
What does superficial heat block pain?
-by the gate control theory, and alter nerve conduction
What should the temperature range be for MHP?
-158 to 167
What type of superficial heat therapy can be used to to descencitize hypersensitive skin?
-fluidotherapy
What increases tissue temperature more than MHP, paraffin or warm whirl pool?
-fluidotherapy
What type of cervical traction is most commonly used?
-intermittent
What amount of flexion should the patient be place in to apply traction to c1-c2?
-0-5 degrees
What amount of flexion should the patient be place in to apply traction to c3-c4?
-10-20 deg
What amount of flexion should the patient be place in to apply traction to c5-c7?
-25 to 30 deg
What poundage should be used on traction for c1-c2?
-10 lbs
What poundage should be used on traction for c3-c3?
-10 to 15 lbs
What poundage should be used on traction for c5 to c7?
-15-20 lbs
Cervical static traction may be better used to treat what?
-HNP or muscle spasm
To treat HNP or muscle spasm with traction, what should the parameters be?
-static for 5-8 minutes
To treat cervical stenosis, DDD or facet dysfunction with traction, what parameters should you use?
-intermittent for 10-20 minutes (on/off: 20/20)
How long should you ask the patient to remain flat on the table after the treatment?
-4 to 5 minutes
What is the most notable reason to use lumbar traction?
-to treat HNP
What poundage should you use for lumbar traction?
-Start with 1/2 of the patient body weight and then go up to 1/3
What frequencies should you use to treat deeper structures with US?
-1 Mhz; treats up to 6 cm
What frequency should be used to treat more superficial structures with US?
-3 Mhz; treats up to 2.5 cm
How large can the treatment area be for US?
-4 to 5 times the size of the ERA
What are the most common diathermy devices?
-pulsed short wave diathermy
Pulsed short wave diathermy devices use what kind of frequencies?
-Low range/ Radio waves
electromagnetic waves pass through human tissue and interact with the tissues radiant energy and increases what three things?
-energy absorption, tissue temperature and local circulation
What does the Grotthuss Draper Law state?
-different wave lengths produce different effect and the extent of those effects is dependent on the amount of energy absorbed in the tissue. (deeper= more absorption)
What foes the inverse square law state?
-the intensity of waves varies inversely with the square distance of the source of radiant energy. (if distance is decreased by half, the intensity is increased by 4)
What does the cosine law state?
-The the max absorption occurs when the source is at a right angle with the absorbent tissue
What is the primary mechanism of action of which light therapy affects tissue with its non-thermal effects?
-photobiostimulation
What is temporal coherence?
-when the photons of light are moving in a wave like pattern in phase with eachother
What is spatial coherence?
-When reflecting mirror effects the light by focusing lenses to amplify light into a concentrated beam
What affect does light therapy have on inflammation?
-It increases it
How does light therapy increase inflammation?
-it increases vasodilation by increasing histamine and NO2 level, and increases profusion, and nutrient transport- over all increases healing
How does light therapy improve tissue repair?
-it stimulates the mitochondial chromophore, which increases respiratory chain activity, improve ATP synthesis, increases cellular repair and increases the production of mRNA for collagen
Light therapy increases when endogenous optiod that will decrease pain?
-beta endorphins
infrared light therapy decreases bradykin and kallikrein which are what?
-pro-inflammatory mediators and pain facilitators
What type of fibers does light therapy inhibit the depolarization of?
-C fibers
Low level laser therapy has a max output of 500 mW or less, this produces what type of effects?
-non-thermal (cold laser)
High intensity laser therapy can produce power greater than 500 mW, which creates what type of effect?
-Thermal heating effects
helium neon lasers have a smaller wave length, can penetrate how deep below the skin?
-0.5 cm (good for treating chronic skin wounds
infrared lasers, such as gallium arsenide produce longer wave lengths and experience less absorbtion and can penetrate how deep below the skin?
-2 to 4 cm
What type of pattern should you used for low level laser therapy to treat lager chronic skin wounds?
-Grid
When applying a high intensity laser what must you do?
-keep it moving to avoid burns
What 5 things can low level laser therapy be used to treat?
-Wound healing, epicondyltis, CTS, Fribromyalgia and myofascial pain, neck pain
What 3 things can high intensity laser therapy be helpful in treating?
-TMJ pain, LBP, shoulder pain
LED can have a power output of what?
-5 to 40 mW
Applications of infrared light for 30 minutes has been shown to increase what?
-plasma nitric oxide levels (increased vasodilation)
Infrared light can also produce what effect that an increase the level of ATP in cells?
-irradiate lymptocytes
SLED can produce power up to 90 mW which can have what effect on tissue?
-Superficial heating
What are the primary indications for LED and SLED therapy?
-similar to low level light therapy: pain relief of shoulder dysfunction, DJD and peripheral neuropathy
How far should the applicator be away from the skin with the capacitative method of diathermy?
-1 to 3 inches
What type of tissue heats faster with diathermy?
-adipose
What is the most clinical application of diathermy?
-to increase tissue temperature of deeper tissues
What is one disadvantage to diathermy that other forms of electromagnetic therapy can do?
-they cannot depolarize motor nerves
What affect will diathermy have on muscle strength?
-it will decrease it breifly and then increase it for 30 minutes
Inductive diathermy is more effective in treating what, than MHP?
-Pain from trigger points
Short wave diathermy has been shown to promote an analgesic effect on what condition?
-knee OA
Diathermy can be used increase healing in what?
-bone and soft tissue
The nonthermal effects of diathermy have been shown to increase what?
-fibroblasts and chondrocyte proliferation, and increase vascular perfusion
Diathermy can be used to treat what type of wounds?
-state III and IV ulcers
What type of response does dose I diathermy create?
-nonthermal
Dose II diathermy is associated with what sensation?
-mild heat
Dose III diathermy is shown to cause what type of sensation?
-Moderate heating
What does of diathermy is used for vigorous heating?
-Dose IV
What is the wattage for dose II diathermy?
-12
What is the wattage for dose III diathermy?
-24
What is the wattage for dose IV diathermy
-48
What can dose I diathermy be used to treat?
-acute injuries
What should dose II diathermy be used to treat?
-subacute injuries
What should dose III diathermy be used to treat?
-pain, muscle spasm, and chronic conditions
To increase tissue extensability, what dose diathermy should you use?
-IV
