Midterm Flashcards
1
Q
What is a physical agent?
A
Describes a type of energy
AKA physical modality, biophysical agent, modality
2
Q
What are the three categories for PAs?
A
Thermal
Mechanical
Electromagnetic
3
Q
What is a mechanical agent?
A
Applied force to increase or decrease pressure within the body
IE. Hydortherapy, traction, compression, and ultrasound
4
Q
What are electromagnetic agents?
A
Applied energy in the form of electromagnetic radiation or electrical current
IE. UV radiation, infrared radiation, laser, diathermy, electrical current
5
Q
What are the effects of PAs?
A
- Reduce inflammation
- Accelerate tissue healing
- Relieve pain
- Alter collagen extensibility
- Modify muscle tone
6
Q
What physical agents can be used at an initial injury?
A
- Static compression and cryotherapy
- Hydrotherapy (wound clean up)
7
Q
What are contraindicated PAs at initial injury?
A
- Exercise
- Intermittent traction
- Motor level ES
- Thermotherapy
8
Q
What PAs can be used with chronic inflammation?
A
- Thermotherapy, fluidotherapy, thermotherapy to prevent/decrease jt stiffness
- Thermotherapy, ES, and laser to control pain
- Thermotherapy, ES, hydrotherapy and compression to increase circulation
- Pulsed US and ES for progression to proliferation stage
9
Q
What are contraindicated agents during chronic inflammation?
A
Cryotherapy
10
Q
What are PAs that can be used during the remodeling stage?
A
- Motor ES and water exercise to regain/maintain strength
- Thermotherapy to regain/maintain flexibility
- Brief ice massage or compression to control scar tissue formation
11
Q
What PAs are contraindicated during the remodeling stage?
A
Immobilization
12
Q
What PAs are used with acute pain?
A
- Sensory ES, cryotherapy to control pain
- Cryotherapy to control inflammation
- Immobilization, EMG biofeedback, and low-load static traction to prevent aggravation of pain
13
Q
What PAs are contraindicated with acute pain?
A
Thermotherapy, load exercise, and motor ES
14
Q
What PAs can be used with referred pain?
A
-ES, cryotherapy, and thermotherapy to control pain
15
Q
What PAs can be used with spinal radicular pain?
A
Traction to decrease nerve root inflammation and compression
16
Q
What PAs can be used for pain caused by malignancy?
A
ES, cryotherapy, and superficial thermotherapy to control pain
17
Q
What PAs can be used for Mm weakness?
A
Water exercise, motor ES, EMG, and biofeedback to increase Mm strength
18
Q
What PAs are contraindicated for Mm weakness?
A
Immobilization
19
Q
What PAs can be used at rest and motion?
A
ES, cryotherapy, thermotherapy, spinal traction, EMG biofeedback to control pain
20
Q
What PAs are contraindicated for rest and motion?
A
Exercise
21
Q
What PAs can be used with motion only?
A
ES, cryotherapy, thermotherapy to control pain and promote tissue healing
22
Q
What PAs are contraindicated with motion only?
A
Exercise into pain
23
Q
What PAs are used with soft tissue shortening?
A
- Thermotherapy to increase tissue extensibility
- Therotherapy or brief ice massage with stretch to increase tissue length
24
Q
What PA is contraindicated with soft tissue shortening?
A
Prolonged cryotherapy
25
What PAs are used for bone block?
- None to remove block
| - Exercise, thermotherapy, brief ice massage and stretch for compensation
26
What PA is contraindicated for bony block?
Stretching blocked joint
27
What are the general contraindications for PAs?
- Pregnancy
- Malignancy
- Pacemaker or implanted electrical device
- Impaired sensation and/or mentation
28
What do you do before using a PA on a patient?
- Check MD referral
- Check medical dx
- Check necessary precautions
- Look at POC
29
What to do when choosing a PA
- Look at goals and effect of treatment
- Contraindications and precautions
- Evidence of PA
- Cost, convenience, and availability
30
What is exteroceptive sensation testing?
- Assess light touch
- Superficial pain (sharp/dull)
- Temp
31
What is proprioceptive sensation testing?
- Vibration
- Proprioception - move part then ask
- Kinesthesia - ask while moving part
32
What is combined sensation testing?
- 2 point discrimination test - Poking with two points - point where pt cannot distinguish the two different points anymore
- Tactile localization
33
What is the spinocerebellar tract?
- Ascending pathway
- PROPRIOCEPTION from skeletal Mm to cerebellum of same side
- DO NOT CROSS
34
What is the dorsal column tract?
- Discriminates TOUCH sensation through thalamus to somatosensory cortex
- CROSS IN MEDULLA
35
What is the spinothalamic tract?
- Carries nondiscriminate sensations (pain, temp, pressure) through thalamus to primary somatosensory cortex
- CROSS at spinal cord before ascending
36
What is the neurosensory assessment?
- Light touch - Use cotton ball, brush, feather, etc
- Superficial pain - Sharp vs dull
- Temp - fill test tube with hot and cold water and alternate which water the patient feels
37
What PA were used by ancient Romans and Greeks?
- Heat and water
- Ancient baths
- Epsom salt
38
What were electrical torpedo fish used for?
- HA
| - Arthritis
39
Which PAs are not used as frequently anymore?
- Infrared
- Sunlight
- Diathermy
40
What occupations use PAs?
```
PT/PTA
OT/OTA
AT-C
Physiatrists
Chiro
Acupuncturists
Pt
```
41
What is the ultimate goal of inflammation and repair?
- Restore fxn
- Replace damaged tissue
- Promote regeneration of normal tissue
42
What are the "signs" of inflammation?
- Heat
- Redness
- Swelling
- Pain
- Loss of function
43
What are the three phases of inflammation and healing?
- Inflammation
- Proliferation
- Maturation
44
What is the inflammation phase?
Prepares wound for healing
Days 1-6
45
What is the proliferation phase?
Rebuilds damaged structures and strengthens the would
Days 3-20
46
What is the maturation phase?
Modifies scar tissue into mature form
Day 9 onward
47
What are the 4 responses during the inflammation phase?
- Vascular
- Hemostatic
- Cellular
- Immune
48
What happens during the vascular response?
-Swelling and redness
Steps
- Transient constriction
- Vasodilation = hyperemia
- Leukocyte migration
- Increase vascular permeability
49
What type of cells are involved during vasodilation of the vascular response?
- Platelets
- Neutrophils
- Macrophages
- Humoral factors (metabolites, hormones, and mediator substances)
50
What is the purpose of vasodilation?
- Dilate the "good" cells to clean up
- Increase permeability
- Lasts about an hour
51
What triggers vasodilation?
- Histamine (attract leukocytes)
- Hageman factor (clotting)
- Bradykinin (increase permeability)
- Prostaglandins (increase permeability)
52
What controls inflammation?
-Humoral and neural mediators - IE. platelets and neutrophils to start aggregation and coagulation
53
What replaces the neutrophils after 2 days?
Macrophages - help shift to proliferation phase
54
What happens during the hemostatic response?
- Controls blood loss
- Platelets release fibrin which turns to fibroblasts that cross link with collagen to close the wound
Create lattice
55
What happens during the cellular response?
Delivery of leukocytes
- Neutrophils (phagocytosis)
- Basophils
- Eosinophils
56
What happens during the immune response?
T-lymphocytes come in
- Make aby
- Inhibit bacteria and viruses
Complement system
- Plasma proteins
- Form membrane attack complex
- Attract more leukocytes
57
What occurs during the proliferation phase?
- Wound is covered and strengthened
| - Involves 4 simultaneous processes
58
What are the simultaneous processes that occur during the proliferation phase?
- Epithelialization
- Collagen production
- Wound contraction
- Neovascularization
59
What is epithelialization?
Making epithelial cells
Increased wound thickness = increased time to heal
Provide protective barrier to prevent infection and loss of fluids
60
What is collagen production?
Produce granulated tissue (Type III collagen)
Fibroblasts make collagen
Align perpendicular to capillaries
Cross link between collagen molecules = tensile strength to injured area
61
What is neovascularization?
Making new blood vessels
62
What is the purpose of collage production?
Increase strength
Facilitate movement of other cells to facilitate wound healing
63
What is the purpose of increased granulation tissue?
- Decrease fibrin clot to form a more permanent structure
| - Increase fibroblastic activity
64
When does the type 3 collagen turn to type 1?
Around day 12
Much stronger and more mature
65
What cells help contract the wound borders to close it?
Myofibroblasts
66
What is the definition of granulation tissue?
Newly formed capillaries, fibroblasts, and myofibroblasts
67
What is primary intention wound healing?
- Direct union
- Minimal tissue loss
- Closed with sutures
- Without contraction
68
What is secondary intention wound healing?
- Indirect union
- Significant loss of tissue and/or bacterial contamination
- Heals with wound contraction
69
What is delayed primary intention wound healing?
-Use of skin grafts/sutures later
70
What occurs during the maturation phase?
- Restoration of tissue to its prior function
| - Type 3 collagen turned to type 1
71
What is a keloid scar?
Extends beyond the original boundaries and invades surrounding tissue
72
What is a hypertrphic scar?
Maintains within the original boundaries, but is raised
73
Why do keloid and hypertrophic scars occur?
Collagen production is greater than lysis
74
What factors affect healing?
Local
External
Systemic
75
How well does cartilage heal?
- Limited
| - Lacks vascular supply and nerves
76
How well do tendons heal?
-Depends on type, extent of damage, vascular supply and duration of immobilization
77
What are the four stages of bone healing?
- Inflammation
- Soft callus
- Hard callus
- Bone remodeling
78
What is nociception?
Neural process of encoding a noxious stimuli
Process pain through PNS
79
What are the three dimensions of pain?
- Sensory discriminative
- Motivational affective
- Cognitive evaluative
80
What is sensory discriminative pain?
Pain is felt and what it feels like
81
What is motivational affective pain?
How does the pt feel about the pain and what is the emotional connection
82
What is cognitive - evaluative pain?
What pt thinks cognitively about pain and expectations from pain
83
What are nociceptors?
Free nerve endings in almost all types of tissue
84
What is peripheral sensitization?
Release of chemicals that increase response of nerve endings to pain
85
What is central sensitization?
Transmission from PNS to CNS with CNS adapting info
86
What is primary hyperalgesia?
Increased sensitivity to noxious stimuli
87
What is secondary hyperalgesia?
Enlargement of receptor field
88
What is allodynia?
Pain in response to stimuli that do not normally cause pain
89
What is the mechanism of nociceptors?
- Activated by thermal, mechanical, and chemical stimuli
- Release neuropeptides, glutamate, and cytokines - lower activation threshold = cause peripheral sensitzation
- When activated it produces action potentials --> afferent nerve --> SC --> brain
90
What are A-delta fibers?
- Primary afferent neurons
- Small and myelinated
- Respond to intense mechanical stimuli and hot/cold
- "Sharp, stabbing, or pricking"
- Not blocked by opioids
- No emotional involvement
91
What are C fibers?
- Small and unmyelinated
- "Dull, throbbing, aching, burning, tingling, tapping"
- Slow onset and long-lasting
- Accompanied by sweating, increased HR and BP, or nausea
- Emotionally difficult to tolerate
- Can be blocked by opioids
92
What are A beta fibers?
- Nonpainful sensations
- Vibration, stretching, and mechanical pressure
- Located in skin, bones, and joints
- Can be abnormal
- Why TENS is used
93
Central pathways of pain transmission?
Spinal cord
- Peripheral fibers project to dorsal horn of gray matter
- SC connects directly or via interneurons - subject to pain gating
Brain
- Conscious perception of pain emerges in cortex
- Cortical changes seen when pain is prolonged
94
What is the gate control theory?
Pain severity is determined by the balance of excitatory and inhibitory inputs in the SC
IE. A-beta and descending neurons inhibit - rubbing arm or TENS
95
What is the endogenous opioid system?
AKA endorphins
Endorphins control pain by binding to specific opioid receptors
C-fibers
Work when body is under emotional stress
96
What is central sensitization?
-Facilitate nociceptive impulses in CNS
Steps
- Facilitate synaptic transmission in SC
- Inhibit endogenous opioid system
- Alter processing of nociception in brain
Symptoms no longer reliably reflect state of tissue
97
What is the pain matrix?
Pain being distributed to primary/secondary motor/sensory motor cortexes, limbic system, thalamus, and prefrontal cortex
98
What responses does the pain matrix generate?
- Conscious perception of pain
- Physical action/motor response
- Activation of ANS, endocrine, and immune system
- Cognitive, emotional, social, and contextual factors can modify input
- Brain changes with different types of pain
- Different parts of the brain are activated with certain pain types
- Evaluate the importance of pain
99
What influence does the endocrine system have on pain?
Responds to stress by secreting epi, NE, and cortisol
Constant release can lead to immunosuppression, osteoporosis, depression, altered sleep, slow healing and tissue degeneration, and pain
100
What is acute pain?
- Direct result of injury
- Less than 30 day duration
- Nociception, peripheral/central sensitization, and psych factors contribute to "sense of pain"
101
What is chronic pain?
- Persists after initial injury
| - Nociception, peripheral/central sensitization and psych factors have not been resolved
102
What is peripheral sensitization?
- Increased sensitivity to an afferent nerve stimuli
- Occurs after injury
- Produce flare up from nociceptive response
103
What is somatization?
Experience and communicate psych distress from somatic symptoms and seek medical help
IE. hysteria
104
What is conversion disorder?
Pt suffers from neurological symptoms such as numbness, blindness, paralysis, or fits without definable organic cause
105
What is neuropathic pain?
- Direct lesion
- Burning quality
- Accompanied with sx of neurologic dysfunction of paresthesias, itching, anesthesia, weakness
- Treat underlying prob
106
What is central sensitization pain?
- No clear origin
- Worsened by cold
- Associated with sleep disorders, impaired physical and mental fxn, phantom swelling or stiffness, depression
- IE. fibromyalgia, OA, RA, TMJ, whiplash, LBP, pelvic pain
107
What is psychosocial pain?
Psychological processes play a role in pain
Pain doesn't always correlated with tissue damage
108
What is causing pain if sharp, shooting, and burning sensations are felt?
Nerve root
109
What is causing pain if cramping, dull, aching, and poorly localized pain is felt?
Muscle
110
What if pain is deep and intolerable? Where may this be?
Bone
111
What if the pain is diffuse, throbbing, aching, superficial, and poorly localized? Where might the injury be?
Vascular
112
How should pain be assessed?
- VAS and NRS scales
- Comparison with predefined stimulus
- Semantic differential scale
- Other measures - IE. pain logs, body diagrams, open-ended interviews, physical exam
113
What is a semantic differential scale?
Word lists and categories to describe pain
114
How do you document pain?
Location, quality, severity, and timing
Factors that make it worse or better
What setting it occurs in
115
What is the definition of muscle tone?
Underlying tension in the muscle that is an "at the ready contaction"
116
What is hypotonicity?
- Abnormally low tone
- Decrease resistance to stretch
- IE. Down's and polio
117
What is hypertonicity?
- Abnormally high tone
| - Resist stretch regardless of velocity
118
What is flaccidity?
Total absence of tone
119
What is spasticity?
Velocity dependent resistance to stretch
120
What is Clonus?
Rhythmic oscillations or beats of involuntary contraction
121
What is athetosis?
Writhing movements
122
What is chorea?
Jerky movements
123
What is ballismus?
Throwing type movements
124
What is tremor?
Low amp, high freq movements
125
What are quantitative measures of tone?
- Dynamometer
- Isokinetic testing
- Pendulum test
- EMG
126
What are qualitative measures of muscle tone?
- Muscle stretch reflex test
- Ashworth/Modified Ashworth
- Tone scale
127
What is grading tone scale?
4+ - sustained response (severe hypertonia)
3+ - exaggerated response (mild to mod hypertonia)
2+ - Normal response
1+ - decreased response (hypotonia)
0 - no response (flaccidity)
128
What is the most accurate measure of muscle tone?
Midrange of muscle length
129
What does heat do to tone?
Increase availability of ATP to myofilaments (increase circulation and change elasticity of CT)
130
What does cold do to tone?
Change elasticity of CT
Decrease conduction of velocity
131
What effect does E-stim have on tone?
Change muscle fiber neural stimulation
132
What are the consequences of low muscle tone?
- Poor posture
- Diff moving
- Alpha motor neuron damage
133
What modalities can be used for alpha motor neuron damage?
- E-stim
- Hydrotherapy
- Quick ice
- Biofeedback
- Light touch
- Tapping
- Resistive exercise
- TherEx
- Functional training
- Orthotics
134
What are consequences of high muscle tone?
- High excitatory input to alpha motor neuron
- Effects include muscle spasms, contractures, abnormal posture, difficulty with ADLs
- Aggravated by pain, cold, stress
- SCI
- Cerebral lesions
135
What is specific heat?
The amount of energy required to raise temp of a unit of mass by one degree
136
What is specific heat of the body from low to high?
- Bone
- Fat
- Muscle
- Skin
137
What are the modes of heat transfer?
- Conduction
- Convection
- Conversion
- Radiation
- Evaporation
138
What is conduction?
Exchange of energy by direct collision of molecules at diff temp
Requires direct contact
IE. Hot pack, paraffin, ice pack
139
What is thermal conductivity?
Rate at which the material transfers heat by conduction
(Area of contact x thermal conductivity x temp diff)/tissue thickness
140
What are conduction principles?
The greater the temp diff b/t heat and cool agent and body part the faster the heat transfer rate
The larger the area = the greater heat transfer
141
How many layers should you have with thermotherapy?
6-8 layers
142
What is convection?
Heat transfer by direct contact b/t circulating medium with another material of diff temp
IE. Whirlpools, fluidotherapy, blood circulating
Transfer more heat in the same time as conduction
Used to cool via vasodilation to decrease risk of burns
143
What is conversion?
Converts nonthermal form of energy to heat
IE. US, diathermy, and chemical
Temp is not important
Does not require direct contact - transferred through friction or vibration
Heat depends on power of energy source
144
What is radiation?
Direct transfer of energy without the need to intervene with medium or contact
IE. Infrared lamp
Rate of temp change depends on :
- Intensity
- Relative size of radiation source and tx area
- Distance and angle of radiation to tx area
145
What is evaporation?
Absorbed energy to change a liquid into a gas or vapor
Humidity impairs evaporation
IE. body sweat
146
What effects does heat have?
- Hemodynamic - blood movement (vasodilation) - reduce smooth muscle contraction
- Neuromuscular - change nerve conduction velocity and firing rate (Alpha motor neurons), increase pain threshold (gate control mechanism), and change muscle strength - reduce muscle spasm and contraction
- Metabolic - endothermic chem rxn
- Altered tissue extensibility
147
What happens to muscle strength in the first 30 min of heat application?
Decrease strength and endurance
148
What happens to muscle strength in the 30 min after heat and for the next 2 hours?
Strength gradually recovers and becomes greater
149
When is greater extensibility achieved with heat?
5-10 min
150
Why do we use superficial heat?
- Pain control
- Increase ROM
- Accelerate healing
151
How does heat decrease pain?
- Activate gate theory via thermoreceptors
- Improve healing
- Decrease mm spasm
- Decrease ischemia by increasing blood flow
- Alter nerve conduction
- Perception of comfort and relaxation
152
What should occur with heat for best results?
Heat - followed by exercise
153
How does heat increase ROM?
Increase tissue extensibility
Add heat for 5-10 min with low-load prolonged stretch
154
What are contraindications of thermotherapy?
- Recent/potential hemorrhage
- Thrombophelbitis
- Impaired sensation/mentation
- Malignant tumor
- IR radiation of eyes
155
What are precautions of thermotherapy?
- Acute injury/inflamm
- Pregnancy
- Impaired circulation
- Poor thermal regulation
- Edema
- Cardiac insufficiency
- metal in area
- Over open wound
- Topical counterirritants
- Demyelinated nerves
156
What are the adverse effects of heat?
- Burns
- Fainting
- Bleeding
- Skin/eye damage
157
How long does it take to heat up a new hot pack?
Two hours
158
How long does it take to reheat the hot pack after one use?
30 min
159
What temp should hydrocullator be at?
158-167 degrees F
160
What temp should paraffin be kept at?
Between 126-134 degrees F
161
How many times do you dip your hands in paraffin?
5-10
162
How long should paraffin stay on?
10-15 min
163
What temp should the two contrast baths be?
Warm water between 100-111 degrees F
Cold water between 10-18 degrees F
164
How long should you immerse in each bath?
3-10 min in warm and 1-3 in cold
165
How many times do you repeat the contrast bath at once?
5-6 times for 25-30 min
End with warm and inspect
166
What is fluidotherapy?
Convection dry heating
Portals for UE and LE
Can do exercise throughout
167
What temp should fluidotherapy be at?
Between 100-118 degrees F
168
How long should a fluidotherapy tx be?
20 min
169
Why is cryotherapy used?
- Inflammation control
- Edema control
- Pain control
- Modification of spasticity - prolonged ice
- MS symptom management
- Facilitation of movement
- Cryokinetics and cryostretch
170
What are the hemodynamic effects of cryotherapy?
Initial decrease of blood flow
171
What are the neuromuscular effects of cryotherapy?
- Decrease nerve conduction (after 20 min of cooling and reverses within 15 min)
- Increase pain threshold
- Alter mm strength
- Decrease spasticity
- Reduce MS sx
- Facilitate movement/mm contraction
172
What are the metabolic effects of cryotherapy?
Decrease metabolic rate
173
What is the Hunting response?
Alternating between vasoconstriction and vasodilation
174
What is CIVD?
Cold induced vasodilation
175
What happens to muscle strength with 5 min of ice massage?
Increase strength right away
176
What happens to mm strength when ice is applied for 20 min or more?
Decrease strength initially, but increases an hour later
177
How long does it take for cryotherapy to decrease spasticity?
10-30 min
178
What does prolonged cooling do?
Decrease gamma motor neuron activity
Decrease GTO
Decrease force of mm contraction
179
What does quick ice do?
Facilitate alpha motor neurons to contract mm
Sweep 2-3 times to stimulate neurons
Lasts a short period of time
180
What are indications of cryotherapy?
- Inflammation control
- Edema control
- Pain control
- Modify spasticity
- MS sx management
- Facilitation
- Cryokinetics and cryostretch
181
How often can you use cryotherapy for inflammation?
15-20 minutes every 1 hour
182
Which pain fiber does cryotherapy block?
A-delta
183
How long should cryotherapy be applied for clonus?
10-30 min
184
How long should cryotherapy be used for spasticity?
Up to 30 minutes
Effects last up to an hour
185
What are contraindications of cryotherapy?
- Cold hypersensitivity
- Cold intolerance
- Cryoglobulinemia
- Paroxysmal cold hemoglobinuria
- Raynaud's
- Over regenerating nerves
- Over area of circulatory compromise or PVD
186
What are cryotherapy precautions?
- Over superficial main branch of nerve
- Over open wound
- HTN
- Poor sensation/mentation
- Very young or very old pt
187
What are adverse effects of cryotherapy?
Tissue damage/death
188
What temp should freezer be for cold packs?
23 degrees F
189
How long should it be cooled between uses?
30 min
190
How long is cryotherapy applied for for inflamm/edema?
10-20 min
191
How long is ice massage applied for?
5-10 min
192
What is temp of cold compression?
50-70 degees F
193
How long is cold compression applied for?
15 min
194
What is vapocoolant spray used for?
Trigger points
195
How should vapocoolant be applied?
2-5 parallel sweeps of .5-1 inch apart x 4 in/sec
Hold away from skin at 12-18 in at 30 degree angle
196
What are the effects of external compression?
- Improve venous and lymphatic circulation
- Limit shape and size of tissue
- Increase tissue temp
197
How is fluid balance maintained with compression?
Improved by increased hydrostatic pressure in interstitial space`
198
What are consequences of edema?
- Restricted ROM
- Pain
- Disfigurement
- Infection
- Ulceration
- Amputation
- Itching
- Grown skin pigmentation
- Functional impairment
199
How many layers of compression is effective for venous stasis ulcers?
2 to 4 layers
200
What are contraindications of compression?
- Heart failure/pulm edema
- Recent or acute DVT or PE
- Obstructed lymphatic/venous return
- Severe PAD
- Acute local skin infection
- Significant hypoproteinemia
- Acute trauma/fx
- Arterial revascularization
201
What are precautions of compression?
- Impaired sensation/mentation
- Uncontrolled HTN
- Cancer
- Stroke/significant CV insufficiency
- Superficial peripheral nerves
202
What are adverse effects of compression?
- Aggravate condition causing edema
- Impaired circulation with excessive pressure
- Monitor closely
203
What pressure should compression garments be at for anti-embolism?
16-18 mmHg
204
What pressure should compression garments be at for scar tissue?
20-30 mmHg
205
What pressure should compression garments be for edema?
30 mmHg
206
What types of tissue does US heat?
High collagen
- Tendons
- Ligaments
- Fascia
- Joint capsule
207
What type of heat transfer is US?
Conversion
208
What is US attenuation?
Decrease in intensity
209
How do sound waves enter the body?
Absorption
Reflection
Refraction
210
What is absorption coefficient?
Increase in heat causes an increase in collagen and frequency
211
What are piezoelectric properties?
Ability for the crystal to expand and contract
212
What is intensity of US?
Power per unit area of the sound head
W/cm2
213
What is frequency of US?
Number of compression/rarefaction cycles per unit of time
Hz = cycles per second
Typically = MHz
214
What is duty cycle?
How often is the sound off or on
IE. Continuous or pulsed
215
When do you used pulsed US?
When you want healing effects
Non-thermal
216
When do you use continuous US?
Thermal
Increase extensibility to increase ROM, control pain, etc
217
What is the ERA?
Part of the transducer head that is just inside the border.
Treat 1 to 2 times the area of the ERA
218
What is beam nonuniformity ratio (BNR)?
The ratio of spatial peak intensity to spatial average intensity
219
How do you estimate the time given the ERA?
Treatment area is twice the ERA therefore treated 5-10 min
220
True or false: you should treat an area 4x the ERA?
False
221
What are the effects of thermal US?
Increase tissue temp affected by absorption coefficient, intensity, and freq
Because of increased temp
- Accelerate metabolic rate
- Reduce or control pain
- Reduce or control muscle spasm
- Alteration of nerve conduction velocity
- Increased circulation
- Increased soft tissue extensibility
222
What are the effects of nonthermal US?
- Cavitation
- Acoustic streaming
- Microstreaming
- Increase intracellular calcium levels
- Increase skin/cell permeability
- Promote normal function of cells
- Facilitate healing
223
How deep does 1 MHz reach?
Up to 5 cm
224
How deep does 3.3 MHz reach?
1-2 cm
225
How fast should you be moving the transducer?
2-8 cm/sec
~4 cm/sec
226
Which produces a higher temp? 3.3 MHz or 1 MHz?
3.3 MHz
227
What is cavitation?
Formation, growth, and pulsation of gas filled bubbles that expand and compress due to pressure changes caused by US
Stable vs Unstable
228
What is microstreaming with cavitation?
Eddying around gas bubbles setting them into oscillation
229
What is acoustic streaming?
Steady circular flow of cellular fluids induced by US
230
What are the clinical indications of US?
- Soft tissue shortening
- Pain control
- Soft tissue healing
- Tendon and ligament injuries
- Bone fractures
- Carpal tunnel syndrome
- Phonophoresis
231
How does US help soft tissue shortening?
- Must apply stretch with US
| - Use 1 MHz with capsules, tendons, and ligaments, but not muscle
232
How does US help pain control?
- Alter transmission perception
- Modify underlying condition
- Activate cutaneous thermal receptors
- Increase soft tissue extensibility
- Change nerve conduction
- Modulate inflammation
- Neuronal pain signaling
233
How does US help soft tissue healing?
- Benefit to pressure and venous ulcers
| - Needs to be non-thermal because you don't want to heat up a wound
234
Why may US be used for fractures?
May help with calcium reabsorption
Pain and improvement on ROM may be a result of decreased inflammation
235
What type of US would you use with carpal tunnel syndrome?
Pulsed
Thermal may cause overheating of the nerve conduction
236
What is phonophoresis and why might US be used?
- Transdermal delivery of medication
- US enhances delivery by travelling directly to the site, avoid gastric irritation, avoid 1st pass metabolism, and avoid trauma of injection
- Penetrates through by increasing permeability into the straatum corneum by cavitation
237
Why would we use phonophoresis or ionto?
Someone who cannot tolerate NSAIDs due to gastric probs
238
When should you avoid using phonophoresis?
When a patient is taking corticosteroids by mouth
239
What are contraindications of US?
- Malignant tumor
- Pregnancy
- CNS issues
- Joint cement
- Plastic component
- Pacemaker/cardiac device
- Thrombophlebitis
- Eyes
- Reproductive organs
240
What are the precautions of US?
- Acute inflammation
- Epiphyseal plates (need to make sure they are closed)
- Fractures (could cause pain)
- Breast implants
241
True or false: US can be done over metal?
True
242
What are the adverse effects of US?
- Burns
- Standing waves
- Cross-contamination
243
Why would someone use water immersion US?
-Pain is so extreme even blowing on it increases pain
244
What parameters should you use for soft tissue shortening?
- Thermal
- 100%
- 1-2 cm = 3 MHz = 0.5 W/cm2
- Greater than 5 cm = 1 MHz = 1.5-2.0 W/cm2
245
What parameters should you use for delayed tissue healing or prolonged inflammation?
- Non-thermal
- 20%
- 1-2 cm = 3 MHz = 0.5-1 W/cm2
- Greater than 5 cm = 1 MHz = 0.5-1.0 W/cm2
246
What is external application of hydrotherapy?
- Immerse the whole body/body par
- Spray/pour water
- Negative pressure therapy
247
Who used contrast baths back in the day to treat various diseases?
Hippocrates
248
What are physical properties of water?
- Solvent
- Resistance - viscosity
- Hydrostatic pressure
- Buoyancy - upward against gravity
- High specific heat and thermal conductivity
249
How is resistance applied in hydrotherapy?
- Viscosity
| - Increase pt resistance by walking faster or increasing speed of water pushing against pt
250
What is hydrostatic pressure?
Pressure exerted on the body by fluid
251
What is Pascal's law?
Fluid exerts equal pressure on all surfaces of the body at a certain depth
252
True or false: hydrostatic pressure increases as depth increases?
True
Works from proximal to distal
253
What are some benefits of hydrostatic pressure?
- Promote circulation and alleviate peripheral edema
- Increase venous return
- Support to brace unstable joints or weak muscles
254
What is buoyancy?
Upward thrust force on the body
255
What allows a body to float in water?
If density of immersed body is less than fluid
256
What allows a body to sink?
Density of immersed body is greater than the fluid
257
What are the physiologic effects of hydrotherapy?
- Cleansing
- Musculoskeletal
- CV
- Resp
- Renal
- Psych
258
What are the cleansing effects?
- Softens material
- Exert pressure
- Debride exudate or necrotic tissue
- Antimicrobial or surfactant additives
259
What are the MS effects?
- Buoyancy decrease WB
- Resistance provides force for strengthening
- Assist those who struggle at land-based exercise
- Increase Mm blood flow = more O2 = more effective muscle training
260
What are the CV effects?
Increase myocardial efficiency with someone immersed in water
261
?What are the resp effects
- Increase work of breating
- Humidity reduces exercise-induced asthma
- Monitor overload
262
What are the renal effects
| ?
Increased urine production
- Increase renal blood flow
- Increase central blood volume
- Decrease in ADH and aldosterone
Urinary and potassium excretion
-Benefits for patients with hypervolemia, HTN, and peripheral edema
Chronic kidney disease
- Improve kidney and cardiorespiratory function
- Decrease BP
263
What are the psychological effects?
- Relax (depending on the temp)
| - Good for adults and children
264
What are clinical indications for hydrotherapy?
- Wound care
- Edema control
- Water exercise
- Superficial heating or cooling
265
What should you consider when choosing hydrotherapy for wound care?
- Immersion vs nonimmersion
- +/- additives
- Pain with debridement of burns
- Negative pressure wound therapy (vacuum assisted)
266
How does hydrotherapy control edema?
- Hydrostatic pressure change
- Change in circulation and renal fxn
- Requires deep immersion
- Cold water may cause vasoconstriction and reduce perm
- Avoid hot water
- Remember contrast baths
267
What are the contraindications for immersive hydrotherapy?
Immersion
- Cardiac instability
- Confusion/impaired cognition
- Maceration
- Bleeding
- Infection to area being immersed
- Bowel incontinence
- Severe epilepsy
- Suicidal pt
268
What are the contraindications for negative pressure wound therapy?
- Necrotic tissue
- Untreated osteomyelitis
- Malignancy in wound
- Untreated malnutrition
- Exposed arteries, veins, nerves, anastomatic sites, or organs
- Nonenteric and unexplored fistulas
269
What are precautions for local immersion?
- Impaired thermal sensation
- Alcohol ingestion
- Limited strength, endurance, balance, or ROM
- Meds
- Urinary incontinence
- Fear of water
- Resp probs
270
What are precautions for full body in hot/very warm water?
- Pregnancy
- MS
- Poor thermal regulation
271
What are precautions for nonimmersion hydrotherapy?
- Maceration
- Recent skin graft
- May be ineffective
272
What are precautions for negative pressure wound therapy?
- Anticoagulant therapy
- Difficult homestasis
- Confusion or disorientation
273
What are adverse effects of hydrotherapy?
- Drowning
- Burning, fainting, bleeding
- Hyponatremia
- Infection
- Aggravation of edema
- Asthma exacerbation
274
What temp should exercise pool be at?
79-97 degrees F
