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Modalities > Midterm > Flashcards

Midterm Flashcards

1
Q

What is a physical agent?

A

Describes a type of energy

AKA physical modality, biophysical agent, modality

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2
Q

What are the three categories for PAs?

A

Thermal
Mechanical
Electromagnetic

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3
Q

What is a mechanical agent?

A

Applied force to increase or decrease pressure within the body

IE. Hydortherapy, traction, compression, and ultrasound

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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

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5
Q

What are the effects of PAs?

A
  • Reduce inflammation
  • Accelerate tissue healing
  • Relieve pain
  • Alter collagen extensibility
  • Modify muscle tone
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6
Q

What physical agents can be used at an initial injury?

A
  • Static compression and cryotherapy

- Hydrotherapy (wound clean up)

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7
Q

What are contraindicated PAs at initial injury?

A
  • Exercise
  • Intermittent traction
  • Motor level ES
  • Thermotherapy
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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
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9
Q

What are contraindicated agents during chronic inflammation?

A

Cryotherapy

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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
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11
Q

What PAs are contraindicated during the remodeling stage?

A

Immobilization

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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
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13
Q

What PAs are contraindicated with acute pain?

A

Thermotherapy, load exercise, and motor ES

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14
Q

What PAs can be used with referred pain?

A

-ES, cryotherapy, and thermotherapy to control pain

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15
Q

What PAs can be used with spinal radicular pain?

A

Traction to decrease nerve root inflammation and compression

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16
Q

What PAs can be used for pain caused by malignancy?

A

ES, cryotherapy, and superficial thermotherapy to control pain

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17
Q

What PAs can be used for Mm weakness?

A

Water exercise, motor ES, EMG, and biofeedback to increase Mm strength

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18
Q

What PAs are contraindicated for Mm weakness?

A

Immobilization

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19
Q

What PAs can be used at rest and motion?

A

ES, cryotherapy, thermotherapy, spinal traction, EMG biofeedback to control pain

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20
Q

What PAs are contraindicated for rest and motion?

A

Exercise

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21
Q

What PAs can be used with motion only?

A

ES, cryotherapy, thermotherapy to control pain and promote tissue healing

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22
Q

What PAs are contraindicated with motion only?

A

Exercise into pain

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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

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24
Q

What PA is contraindicated with soft tissue shortening?

A

Prolonged cryotherapy

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25
Q

What PAs are used for bone block?

A
  • None to remove block

- Exercise, thermotherapy, brief ice massage and stretch for compensation

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26
Q

What PA is contraindicated for bony block?

A

Stretching blocked joint

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27
Q

What are the general contraindications for PAs?

A
  • Pregnancy
  • Malignancy
  • Pacemaker or implanted electrical device
  • Impaired sensation and/or mentation
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28
Q

What do you do before using a PA on a patient?

A
  • Check MD referral
  • Check medical dx
  • Check necessary precautions
  • Look at POC
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29
Q

What to do when choosing a PA

A
  • Look at goals and effect of treatment
  • Contraindications and precautions
  • Evidence of PA
  • Cost, convenience, and availability
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30
Q

What is exteroceptive sensation testing?

A
  • Assess light touch
  • Superficial pain (sharp/dull)
  • Temp
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31
Q

What is proprioceptive sensation testing?

A
  • Vibration
  • Proprioception - move part then ask
  • Kinesthesia - ask while moving part
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32
Q

What is combined sensation testing?

A
  • 2 point discrimination test - Poking with two points - point where pt cannot distinguish the two different points anymore
  • Tactile localization
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33
Q

What is the spinocerebellar tract?

A
  • Ascending pathway
  • PROPRIOCEPTION from skeletal Mm to cerebellum of same side
  • DO NOT CROSS
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34
Q

What is the dorsal column tract?

A
  • Discriminates TOUCH sensation through thalamus to somatosensory cortex
  • CROSS IN MEDULLA
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35
Q

What is the spinothalamic tract?

A
  • Carries nondiscriminate sensations (pain, temp, pressure) through thalamus to primary somatosensory cortex
  • CROSS at spinal cord before ascending
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36
Q

What is the neurosensory assessment?

A
  • 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
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37
Q

What PA were used by ancient Romans and Greeks?

A
  • Heat and water
  • Ancient baths
  • Epsom salt
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38
Q

What were electrical torpedo fish used for?

A
  • HA

- Arthritis

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39
Q

Which PAs are not used as frequently anymore?

A
  • Infrared
  • Sunlight
  • Diathermy
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40
Q

What occupations use PAs?

A 
PT/PTA
OT/OTA
AT-C
Physiatrists
Chiro
Acupuncturists
Pt
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41
Q

What is the ultimate goal of inflammation and repair?

A
  • Restore fxn
  • Replace damaged tissue
  • Promote regeneration of normal tissue
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42
Q

What are the “signs” of inflammation?

A
  • Heat
  • Redness
  • Swelling
  • Pain
  • Loss of function
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43
Q

What are the three phases of inflammation and healing?

A
  • Inflammation
  • Proliferation
  • Maturation
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44
Q

What is the inflammation phase?

A

Prepares wound for healing

Days 1-6

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45
Q

What is the proliferation phase?

A

Rebuilds damaged structures and strengthens the would

Days 3-20

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46
Q

What is the maturation phase?

A

Modifies scar tissue into mature form

Day 9 onward

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47
Q

What are the 4 responses during the inflammation phase?

A
  • Vascular
  • Hemostatic
  • Cellular
  • Immune
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48
Q

What happens during the vascular response?

A

-Swelling and redness

Steps

  • Transient constriction
  • Vasodilation = hyperemia
  • Leukocyte migration
  • Increase vascular permeability
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49
Q

What type of cells are involved during vasodilation of the vascular response?

A
  • Platelets
  • Neutrophils
  • Macrophages
  • Humoral factors (metabolites, hormones, and mediator substances)
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50
Q

What is the purpose of vasodilation?

A
  • Dilate the “good” cells to clean up
  • Increase permeability
  • Lasts about an hour
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51
Q

What triggers vasodilation?

A
  • Histamine (attract leukocytes)
  • Hageman factor (clotting)
  • Bradykinin (increase permeability)
  • Prostaglandins (increase permeability)
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52
Q

What controls inflammation?

A

-Humoral and neural mediators - IE. platelets and neutrophils to start aggregation and coagulation

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53
Q

What replaces the neutrophils after 2 days?

A

Macrophages - help shift to proliferation phase

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54
Q

What happens during the hemostatic response?

A
  • Controls blood loss
  • Platelets release fibrin which turns to fibroblasts that cross link with collagen to close the wound

Create lattice

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55
Q

What happens during the cellular response?

A

Delivery of leukocytes

  • Neutrophils (phagocytosis)
  • Basophils
  • Eosinophils
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56
Q

What happens during the immune response?

A

T-lymphocytes come in

  • Make aby
  • Inhibit bacteria and viruses

Complement system

  • Plasma proteins
  • Form membrane attack complex
  • Attract more leukocytes
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57
Q

What occurs during the proliferation phase?

A
  • Wound is covered and strengthened

- Involves 4 simultaneous processes

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58
Q

What are the simultaneous processes that occur during the proliferation phase?

A
  • Epithelialization
  • Collagen production
  • Wound contraction
  • Neovascularization
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59
Q

What is epithelialization?

A

Making epithelial cells

Increased wound thickness = increased time to heal

Provide protective barrier to prevent infection and loss of fluids

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60
Q

What is collagen production?

A

Produce granulated tissue (Type III collagen)

Fibroblasts make collagen

Align perpendicular to capillaries

Cross link between collagen molecules = tensile strength to injured area

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61
Q

What is neovascularization?

A

Making new blood vessels

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62
Q

What is the purpose of collage production?

A

Increase strength

Facilitate movement of other cells to facilitate wound healing

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63
Q

What is the purpose of increased granulation tissue?

A
  • Decrease fibrin clot to form a more permanent structure

- Increase fibroblastic activity

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64
Q

When does the type 3 collagen turn to type 1?

A

Around day 12

Much stronger and more mature

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65
Q

What cells help contract the wound borders to close it?

A

Myofibroblasts

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66
Q

What is the definition of granulation tissue?

A

Newly formed capillaries, fibroblasts, and myofibroblasts

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67
Q

What is primary intention wound healing?

A
  • Direct union
  • Minimal tissue loss
  • Closed with sutures
  • Without contraction
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68
Q

What is secondary intention wound healing?

A
  • Indirect union
  • Significant loss of tissue and/or bacterial contamination
  • Heals with wound contraction
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69
Q

What is delayed primary intention wound healing?

A

-Use of skin grafts/sutures later

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70
Q

What occurs during the maturation phase?

A
  • Restoration of tissue to its prior function

- Type 3 collagen turned to type 1

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71
Q

What is a keloid scar?

A

Extends beyond the original boundaries and invades surrounding tissue

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72
Q

What is a hypertrphic scar?

A

Maintains within the original boundaries, but is raised

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73
Q

Why do keloid and hypertrophic scars occur?

A

Collagen production is greater than lysis

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74
Q

What factors affect healing?

A

Local
External
Systemic

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75
Q

How well does cartilage heal?

A
  • Limited

- Lacks vascular supply and nerves

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76
Q

How well do tendons heal?

A

-Depends on type, extent of damage, vascular supply and duration of immobilization

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77
Q

What are the four stages of bone healing?

A
  • Inflammation
  • Soft callus
  • Hard callus
  • Bone remodeling
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78
Q

What is nociception?

A

Neural process of encoding a noxious stimuli

Process pain through PNS

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79
Q

What are the three dimensions of pain?

A
  • Sensory discriminative
  • Motivational affective
  • Cognitive evaluative
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80
Q

What is sensory discriminative pain?

A

Pain is felt and what it feels like

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81
Q

What is motivational affective pain?

A

How does the pt feel about the pain and what is the emotional connection

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82
Q

What is cognitive - evaluative pain?

A

What pt thinks cognitively about pain and expectations from pain

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83
Q

What are nociceptors?

A

Free nerve endings in almost all types of tissue

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84
Q

What is peripheral sensitization?

A

Release of chemicals that increase response of nerve endings to pain

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85
Q

What is central sensitization?

A

Transmission from PNS to CNS with CNS adapting info

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86
Q

What is primary hyperalgesia?

A

Increased sensitivity to noxious stimuli

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87
Q

What is secondary hyperalgesia?

A

Enlargement of receptor field

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88
Q

What is allodynia?

A

Pain in response to stimuli that do not normally cause pain

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89
Q

What is the mechanism of nociceptors?

A
  • 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
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90
Q

What are A-delta fibers?

A
  • 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
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91
Q

What are C fibers?

A
  • 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
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92
Q

What are A beta fibers?

A
  • Nonpainful sensations
  • Vibration, stretching, and mechanical pressure
  • Located in skin, bones, and joints
  • Can be abnormal
  • Why TENS is used
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93
Q

Central pathways of pain transmission?

A

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
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94
Q

What is the gate control theory?

A

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

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95
Q

What is the endogenous opioid system?

A

AKA endorphins

Endorphins control pain by binding to specific opioid receptors

C-fibers

Work when body is under emotional stress

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96
Q

What is central sensitization?

A

-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

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97
Q

What is the pain matrix?

A

Pain being distributed to primary/secondary motor/sensory motor cortexes, limbic system, thalamus, and prefrontal cortex

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98
Q

What responses does the pain matrix generate?

A
  • 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
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99
Q

What influence does the endocrine system have on pain?

A

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

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100
Q

What is acute pain?

A
  • Direct result of injury
  • Less than 30 day duration
  • Nociception, peripheral/central sensitization, and psych factors contribute to “sense of pain”
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101
Q

What is chronic pain?

A
  • Persists after initial injury

- Nociception, peripheral/central sensitization and psych factors have not been resolved

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102
Q

What is peripheral sensitization?

A
  • Increased sensitivity to an afferent nerve stimuli
  • Occurs after injury
  • Produce flare up from nociceptive response
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103
Q

What is somatization?

A

Experience and communicate psych distress from somatic symptoms and seek medical help

IE. hysteria

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104
Q

What is conversion disorder?

A

Pt suffers from neurological symptoms such as numbness, blindness, paralysis, or fits without definable organic cause

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105
Q

What is neuropathic pain?

A
  • Direct lesion
  • Burning quality
  • Accompanied with sx of neurologic dysfunction of paresthesias, itching, anesthesia, weakness
  • Treat underlying prob
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106
Q

What is central sensitization pain?

A
  • 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
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107
Q

What is psychosocial pain?

A

Psychological processes play a role in pain

Pain doesn’t always correlated with tissue damage

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108
Q

What is causing pain if sharp, shooting, and burning sensations are felt?

A

Nerve root

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109
Q

What is causing pain if cramping, dull, aching, and poorly localized pain is felt?

A

Muscle

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110
Q

What if pain is deep and intolerable? Where may this be?

A

Bone

111
Q

What if the pain is diffuse, throbbing, aching, superficial, and poorly localized? Where might the injury be?

A

Vascular

112
Q

How should pain be assessed?

A
  • VAS and NRS scales
  • Comparison with predefined stimulus
  • Semantic differential scale
  • Other measures - IE. pain logs, body diagrams, open-ended interviews, physical exam
113
Q

What is a semantic differential scale?

A

Word lists and categories to describe pain

114
Q

How do you document pain?

A

Location, quality, severity, and timing

Factors that make it worse or better

What setting it occurs in

115
Q

What is the definition of muscle tone?

A

Underlying tension in the muscle that is an “at the ready contaction”

116
Q

What is hypotonicity?

A
  • Abnormally low tone
  • Decrease resistance to stretch
  • IE. Down’s and polio
117
Q

What is hypertonicity?

A
  • Abnormally high tone

- Resist stretch regardless of velocity

118
Q

What is flaccidity?

A

Total absence of tone

119
Q

What is spasticity?

A

Velocity dependent resistance to stretch

120
Q

What is Clonus?

A

Rhythmic oscillations or beats of involuntary contraction

121
Q

What is athetosis?

A

Writhing movements

122
Q

What is chorea?

A

Jerky movements

123
Q

What is ballismus?

A

Throwing type movements

124
Q

What is tremor?

A

Low amp, high freq movements

125
Q

What are quantitative measures of tone?

A
  • Dynamometer
  • Isokinetic testing
  • Pendulum test
  • EMG
126
Q

What are qualitative measures of muscle tone?

A
  • Muscle stretch reflex test
  • Ashworth/Modified Ashworth
  • Tone scale
127
Q

What is grading tone scale?

A

4+ - sustained response (severe hypertonia)

3+ - exaggerated response (mild to mod hypertonia)

2+ - Normal response

1+ - decreased response (hypotonia)

0 - no response (flaccidity)

128
Q

What is the most accurate measure of muscle tone?

A

Midrange of muscle length

129
Q

What does heat do to tone?

A

Increase availability of ATP to myofilaments (increase circulation and change elasticity of CT)

130
Q

What does cold do to tone?

A

Change elasticity of CT

Decrease conduction of velocity

131
Q

What effect does E-stim have on tone?

A

Change muscle fiber neural stimulation

132
Q

What are the consequences of low muscle tone?

A
  • Poor posture
  • Diff moving
  • Alpha motor neuron damage
133
Q

What modalities can be used for alpha motor neuron damage?

A
  • E-stim
  • Hydrotherapy
  • Quick ice
  • Biofeedback
  • Light touch
  • Tapping
  • Resistive exercise
  • TherEx
  • Functional training
  • Orthotics
134
Q

What are consequences of high muscle tone?

A
  • 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
Q

What is specific heat?

A

The amount of energy required to raise temp of a unit of mass by one degree

136
Q

What is specific heat of the body from low to high?

A
  • Bone
  • Fat
  • Muscle
  • Skin
137
Q

What are the modes of heat transfer?

A
  • Conduction
  • Convection
  • Conversion
  • Radiation
  • Evaporation
138
Q

What is conduction?

A

Exchange of energy by direct collision of molecules at diff temp

Requires direct contact
IE. Hot pack, paraffin, ice pack

139
Q

What is thermal conductivity?

A

Rate at which the material transfers heat by conduction

(Area of contact x thermal conductivity x temp diff)/tissue thickness

140
Q

What are conduction principles?

A

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
Q

How many layers should you have with thermotherapy?

A

6-8 layers

142
Q

What is convection?

A

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
Q

What is conversion?

A

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
Q

What is radiation?

A

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
Q

What is evaporation?

A

Absorbed energy to change a liquid into a gas or vapor

Humidity impairs evaporation

IE. body sweat

146
Q

What effects does heat have?

A
  • 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
Q

What happens to muscle strength in the first 30 min of heat application?

A

Decrease strength and endurance

148
Q

What happens to muscle strength in the 30 min after heat and for the next 2 hours?

A

Strength gradually recovers and becomes greater

149
Q

When is greater extensibility achieved with heat?

A

5-10 min

150
Q

Why do we use superficial heat?

A
  • Pain control
  • Increase ROM
  • Accelerate healing
151
Q

How does heat decrease pain?

A
  • 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
Q

What should occur with heat for best results?

A

Heat - followed by exercise

153
Q

How does heat increase ROM?

A

Increase tissue extensibility

Add heat for 5-10 min with low-load prolonged stretch

154
Q

What are contraindications of thermotherapy?

A
  • Recent/potential hemorrhage
  • Thrombophelbitis
  • Impaired sensation/mentation
  • Malignant tumor
  • IR radiation of eyes
155
Q

What are precautions of thermotherapy?

A
  • Acute injury/inflamm
  • Pregnancy
  • Impaired circulation
  • Poor thermal regulation
  • Edema
  • Cardiac insufficiency
  • metal in area
  • Over open wound
  • Topical counterirritants
  • Demyelinated nerves
156
Q

What are the adverse effects of heat?

A
  • Burns
  • Fainting
  • Bleeding
  • Skin/eye damage
157
Q

How long does it take to heat up a new hot pack?

A

Two hours

158
Q

How long does it take to reheat the hot pack after one use?

A

30 min

159
Q

What temp should hydrocullator be at?

A

158-167 degrees F

160
Q

What temp should paraffin be kept at?

A

Between 126-134 degrees F

161
Q

How many times do you dip your hands in paraffin?

A

5-10

162
Q

How long should paraffin stay on?

A

10-15 min

163
Q

What temp should the two contrast baths be?

A

Warm water between 100-111 degrees F

Cold water between 10-18 degrees F

164
Q

How long should you immerse in each bath?

A

3-10 min in warm and 1-3 in cold

165
Q

How many times do you repeat the contrast bath at once?

A

5-6 times for 25-30 min

End with warm and inspect

166
Q

What is fluidotherapy?

A

Convection dry heating

Portals for UE and LE

Can do exercise throughout

167
Q

What temp should fluidotherapy be at?

A

Between 100-118 degrees F

168
Q

How long should a fluidotherapy tx be?

A

20 min

169
Q

Why is cryotherapy used?

A
  • Inflammation control
  • Edema control
  • Pain control
  • Modification of spasticity - prolonged ice
  • MS symptom management
  • Facilitation of movement
  • Cryokinetics and cryostretch
170
Q

What are the hemodynamic effects of cryotherapy?

A

Initial decrease of blood flow

171
Q

What are the neuromuscular effects of cryotherapy?

A
  • 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
Q

What are the metabolic effects of cryotherapy?

A

Decrease metabolic rate

173
Q

What is the Hunting response?

A

Alternating between vasoconstriction and vasodilation

174
Q

What is CIVD?

A

Cold induced vasodilation

175
Q

What happens to muscle strength with 5 min of ice massage?

A

Increase strength right away

176
Q

What happens to mm strength when ice is applied for 20 min or more?

A

Decrease strength initially, but increases an hour later

177
Q

How long does it take for cryotherapy to decrease spasticity?

A

10-30 min

178
Q

What does prolonged cooling do?

A

Decrease gamma motor neuron activity

Decrease GTO

Decrease force of mm contraction

179
Q

What does quick ice do?

A

Facilitate alpha motor neurons to contract mm

Sweep 2-3 times to stimulate neurons

Lasts a short period of time

180
Q

What are indications of cryotherapy?

A
  • Inflammation control
  • Edema control
  • Pain control
  • Modify spasticity
  • MS sx management
  • Facilitation
  • Cryokinetics and cryostretch
181
Q

How often can you use cryotherapy for inflammation?

A

15-20 minutes every 1 hour

182
Q

Which pain fiber does cryotherapy block?

A

A-delta

183
Q

How long should cryotherapy be applied for clonus?

A

10-30 min

184
Q

How long should cryotherapy be used for spasticity?

A

Up to 30 minutes

Effects last up to an hour

185
Q

What are contraindications of cryotherapy?

A
  • Cold hypersensitivity
  • Cold intolerance
  • Cryoglobulinemia
  • Paroxysmal cold hemoglobinuria
  • Raynaud’s
  • Over regenerating nerves
  • Over area of circulatory compromise or PVD
186
Q

What are cryotherapy precautions?

A
  • Over superficial main branch of nerve
  • Over open wound
  • HTN
  • Poor sensation/mentation
  • Very young or very old pt
187
Q

What are adverse effects of cryotherapy?

A

Tissue damage/death

188
Q

What temp should freezer be for cold packs?

A

23 degrees F

189
Q

How long should it be cooled between uses?

A

30 min

190
Q

How long is cryotherapy applied for for inflamm/edema?

A

10-20 min

191
Q

How long is ice massage applied for?

A

5-10 min

192
Q

What is temp of cold compression?

A

50-70 degees F

193
Q

How long is cold compression applied for?

A

15 min

194
Q

What is vapocoolant spray used for?

A

Trigger points

195
Q

How should vapocoolant be applied?

A

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
Q

What are the effects of external compression?

A
  • Improve venous and lymphatic circulation
  • Limit shape and size of tissue
  • Increase tissue temp
197
Q

How is fluid balance maintained with compression?

A

Improved by increased hydrostatic pressure in interstitial space`

198
Q

What are consequences of edema?

A
  • Restricted ROM
  • Pain
  • Disfigurement
  • Infection
  • Ulceration
  • Amputation
  • Itching
  • Grown skin pigmentation
  • Functional impairment
199
Q

How many layers of compression is effective for venous stasis ulcers?

A

2 to 4 layers

200
Q

What are contraindications of compression?

A
  • 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
Q

What are precautions of compression?

A
  • Impaired sensation/mentation
  • Uncontrolled HTN
  • Cancer
  • Stroke/significant CV insufficiency
  • Superficial peripheral nerves
202
Q

What are adverse effects of compression?

A
  • Aggravate condition causing edema
  • Impaired circulation with excessive pressure
  • Monitor closely
203
Q

What pressure should compression garments be at for anti-embolism?

A

16-18 mmHg

204
Q

What pressure should compression garments be at for scar tissue?

A

20-30 mmHg

205
Q

What pressure should compression garments be for edema?

A

30 mmHg

206
Q

What types of tissue does US heat?

A

High collagen

  • Tendons
  • Ligaments
  • Fascia
  • Joint capsule
207
Q

What type of heat transfer is US?

A

Conversion

208
Q

What is US attenuation?

A

Decrease in intensity

209
Q

How do sound waves enter the body?

A

Absorption
Reflection
Refraction

210
Q

What is absorption coefficient?

A

Increase in heat causes an increase in collagen and frequency

211
Q

What are piezoelectric properties?

A

Ability for the crystal to expand and contract

212
Q

What is intensity of US?

A

Power per unit area of the sound head

W/cm2

213
Q

What is frequency of US?

A

Number of compression/rarefaction cycles per unit of time

Hz = cycles per second

Typically = MHz

214
Q

What is duty cycle?

A

How often is the sound off or on

IE. Continuous or pulsed

215
Q

When do you used pulsed US?

A

When you want healing effects

Non-thermal

216
Q

When do you use continuous US?

A

Thermal

Increase extensibility to increase ROM, control pain, etc

217
Q

What is the ERA?

A

Part of the transducer head that is just inside the border.

Treat 1 to 2 times the area of the ERA

218
Q

What is beam nonuniformity ratio (BNR)?

A

The ratio of spatial peak intensity to spatial average intensity

219
Q

How do you estimate the time given the ERA?

A

Treatment area is twice the ERA therefore treated 5-10 min

220
Q

True or false: you should treat an area 4x the ERA?

A

False

221
Q

What are the effects of thermal US?

A

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
Q

What are the effects of nonthermal US?

A
  • Cavitation
  • Acoustic streaming
  • Microstreaming
  • Increase intracellular calcium levels
  • Increase skin/cell permeability
  • Promote normal function of cells
  • Facilitate healing
223
Q

How deep does 1 MHz reach?

A

Up to 5 cm

224
Q

How deep does 3.3 MHz reach?

A

1-2 cm

225
Q

How fast should you be moving the transducer?

A

2-8 cm/sec

~4 cm/sec

226
Q

Which produces a higher temp? 3.3 MHz or 1 MHz?

A

3.3 MHz

227
Q

What is cavitation?

A

Formation, growth, and pulsation of gas filled bubbles that expand and compress due to pressure changes caused by US

Stable vs Unstable

228
Q

What is microstreaming with cavitation?

A

Eddying around gas bubbles setting them into oscillation

229
Q

What is acoustic streaming?

A

Steady circular flow of cellular fluids induced by US

230
Q

What are the clinical indications of US?

A
  • Soft tissue shortening
  • Pain control
  • Soft tissue healing
  • Tendon and ligament injuries
  • Bone fractures
  • Carpal tunnel syndrome
  • Phonophoresis
231
Q

How does US help soft tissue shortening?

A
  • Must apply stretch with US

- Use 1 MHz with capsules, tendons, and ligaments, but not muscle

232
Q

How does US help pain control?

A
  • Alter transmission perception
  • Modify underlying condition
  • Activate cutaneous thermal receptors
  • Increase soft tissue extensibility
  • Change nerve conduction
  • Modulate inflammation
  • Neuronal pain signaling
233
Q

How does US help soft tissue healing?

A
  • Benefit to pressure and venous ulcers

- Needs to be non-thermal because you don’t want to heat up a wound

234
Q

Why may US be used for fractures?

A

May help with calcium reabsorption

Pain and improvement on ROM may be a result of decreased inflammation

235
Q

What type of US would you use with carpal tunnel syndrome?

A

Pulsed

Thermal may cause overheating of the nerve conduction

236
Q

What is phonophoresis and why might US be used?

A
  • 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
Q

Why would we use phonophoresis or ionto?

A

Someone who cannot tolerate NSAIDs due to gastric probs

238
Q

When should you avoid using phonophoresis?

A

When a patient is taking corticosteroids by mouth

239
Q

What are contraindications of US?

A
  • Malignant tumor
  • Pregnancy
  • CNS issues
  • Joint cement
  • Plastic component
  • Pacemaker/cardiac device
  • Thrombophlebitis
  • Eyes
  • Reproductive organs
240
Q

What are the precautions of US?

A
  • Acute inflammation
  • Epiphyseal plates (need to make sure they are closed)
  • Fractures (could cause pain)
  • Breast implants
241
Q

True or false: US can be done over metal?

A

True

242
Q

What are the adverse effects of US?

A
  • Burns
  • Standing waves
  • Cross-contamination
243
Q

Why would someone use water immersion US?

A

-Pain is so extreme even blowing on it increases pain

244
Q

What parameters should you use for soft tissue shortening?

A
  • Thermal
  • 100%
  • 1-2 cm = 3 MHz = 0.5 W/cm2
  • Greater than 5 cm = 1 MHz = 1.5-2.0 W/cm2
245
Q

What parameters should you use for delayed tissue healing or prolonged inflammation?

A
  • 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
Q

What is external application of hydrotherapy?

A
  • Immerse the whole body/body par
  • Spray/pour water
  • Negative pressure therapy
247
Q

Who used contrast baths back in the day to treat various diseases?

A

Hippocrates

248
Q

What are physical properties of water?

A
  • Solvent
  • Resistance - viscosity
  • Hydrostatic pressure
  • Buoyancy - upward against gravity
  • High specific heat and thermal conductivity
249
Q

How is resistance applied in hydrotherapy?

A
  • Viscosity

- Increase pt resistance by walking faster or increasing speed of water pushing against pt

250
Q

What is hydrostatic pressure?

A

Pressure exerted on the body by fluid

251
Q

What is Pascal’s law?

A

Fluid exerts equal pressure on all surfaces of the body at a certain depth

252
Q

True or false: hydrostatic pressure increases as depth increases?

A

True

Works from proximal to distal

253
Q

What are some benefits of hydrostatic pressure?

A
  • Promote circulation and alleviate peripheral edema
  • Increase venous return
  • Support to brace unstable joints or weak muscles
254
Q

What is buoyancy?

A

Upward thrust force on the body

255
Q

What allows a body to float in water?

A

If density of immersed body is less than fluid

256
Q

What allows a body to sink?

A

Density of immersed body is greater than the fluid

257
Q

What are the physiologic effects of hydrotherapy?

A
  • Cleansing
  • Musculoskeletal
  • CV
  • Resp
  • Renal
  • Psych
258
Q

What are the cleansing effects?

A
  • Softens material
  • Exert pressure
  • Debride exudate or necrotic tissue
  • Antimicrobial or surfactant additives
259
Q

What are the MS effects?

A
  • 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
Q

What are the CV effects?

A

Increase myocardial efficiency with someone immersed in water

261
Q

?What are the resp effects

A
  • Increase work of breating
  • Humidity reduces exercise-induced asthma
  • Monitor overload
262
Q

What are the renal effects

?

A

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
Q

What are the psychological effects?

A
  • Relax (depending on the temp)

- Good for adults and children

264
Q

What are clinical indications for hydrotherapy?

A
  • Wound care
  • Edema control
  • Water exercise
  • Superficial heating or cooling
265
Q

What should you consider when choosing hydrotherapy for wound care?

A
  • Immersion vs nonimmersion
  • +/- additives
  • Pain with debridement of burns
  • Negative pressure wound therapy (vacuum assisted)
266
Q

How does hydrotherapy control edema?

A
  • 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
Q

What are the contraindications for immersive hydrotherapy?

A

Immersion

  • Cardiac instability
  • Confusion/impaired cognition
  • Maceration
  • Bleeding
  • Infection to area being immersed
  • Bowel incontinence
  • Severe epilepsy
  • Suicidal pt
268
Q

What are the contraindications for negative pressure wound therapy?

A
  • Necrotic tissue
  • Untreated osteomyelitis
  • Malignancy in wound
  • Untreated malnutrition
  • Exposed arteries, veins, nerves, anastomatic sites, or organs
  • Nonenteric and unexplored fistulas
269
Q

What are precautions for local immersion?

A
  • Impaired thermal sensation
  • Alcohol ingestion
  • Limited strength, endurance, balance, or ROM
  • Meds
  • Urinary incontinence
  • Fear of water
  • Resp probs
270
Q

What are precautions for full body in hot/very warm water?

A
  • Pregnancy
  • MS
  • Poor thermal regulation
271
Q

What are precautions for nonimmersion hydrotherapy?

A
  • Maceration
  • Recent skin graft
  • May be ineffective
272
Q

What are precautions for negative pressure wound therapy?

A
  • Anticoagulant therapy
  • Difficult homestasis
  • Confusion or disorientation
273
Q

What are adverse effects of hydrotherapy?

A
  • Drowning
  • Burning, fainting, bleeding
  • Hyponatremia
  • Infection
  • Aggravation of edema
  • Asthma exacerbation
274
Q

What temp should exercise pool be at?

A

79-97 degrees F

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