Midterm Important Slides Flashcards
Hemodynamic effects of cryotherapy
- Vasoconstriction
- Increase in blood viscosity
- Decrease in blood flow
- Decrease in vasodilatation mediators
- Decrease in edema formation
- Decrease in metabolic activity (decrease in O2)
Neuromuscular effects of cryotherapy
•decrease in nerve conduction •increase in pain threshold •altered muscular strength •decrease in spasticity •facilitation of muscular contraction •gate control for pain •decrease in muscle spasm DECREASE IN PAIN
Tissue extensibility with cryotherapy
•increase in joint stiffness and less elasticity
Hemodynamic effects of thermotherapy
- Vasodilatation
- Increasein rate of blood flow
- Local increase with superficial heat
- Systemically with deep heat
- increase in metabolic rate
- increase in enzyme activity which accelerates healing process
Neuromuscular effects of thermotherapy
•increase in nerve conduction velocity
•decrease in conduction latency (both sensory and motor)
•decrease in firing rate of muscle spindle and gamma efferent
•increase firingfrom Golgi tendon
•decrease in muscle spasm
•increase pain threshold –gate control
•decrease muscle strength initially, then increase two hrslater
DECREASE IN PAIN
Tissue extensibility with Thermotherapy
Increase in tissue extensibility
What are some indications for Thermotherapy?
Demolition phase to Return to sport Reduction of pain Decreased range of motion Hematoma resolution Reduction of joint restrictions or contractures Reduction of muscle spasm
What is a warning sign you must look for with heat application?
Mottling
Mottling of the skin is a warning that the tissue temperatures are raising to a dangerous level
Ghost white areas and beet-red blotches
Thermotherapy Contraindications
Acute injury or inflammation Recent or potential hemorrhage Impaired circulation Impaired mentation Thrombophlebitis With deep heating modalities, should not be applied over area of malignancy With IR laser irradiation of the eyes
Thermotherapy precautions
Pregnancy Impaired circulation Poor thermal regulation Edema Cardiac insufficiency Metal in the area Over an open wound Over areas where topical counterirritants have recently been applied
Hot pack application protocol
Remove jewelry Check area with hot and cold test tubes Explain aims with modality and get permission to apply Contraindications Inspect skin for circulatory problems
Wrap the hot pack in 6 –8 layers of towels (roughly 1” or 2.54cm) Hot pack covers can substitute Need more towels if patient complains of feeling too warm Place the hot pack over the lesion site Towel over top to hold heat in Secure hot pack in place
Hot pack protocol once applied
Provide patient with means to reach you if the pack becomes too hot Use more towels if too hot Timer set at 20 minutes Check skin after 5 minutes May need to replace the pack throughout the treatment After 20 minutes remove the pack and inspect the skin Begin ROM or other rehabilitation
With a hot whirlpool temperature of water depends on amount of body part immersed (temperature of the water is ______ as the total body area immersed increases).
decreased
Hot whirlpool protocol
•Remove all jewelry and inspect area to be treated
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Explain aims of treatment
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Test for heat and cold sensations
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Contraindications –drugs (alcohol), seizure disorders, heart or circulatory problems
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Permission from patient
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Ensure temperature of whirlpool, depth of water, ground fault circuit interrupter and treatment areaPosition the patient comfortably in front of the whirlpool
Protect the toes or fingers with a cover
Have them immerse the treatment area allowing them a few minutes to acclimatize to the temperature
Turn the turbine on to activate the water agitation
Instruct the patient on ROM exercises they will complete during the treatment
Set a timer for 20 minutes
After 5 minutes, check the limb to ensure normal response to heating
When would you use Paraffin?
RA, OA of hands and feet Finger or toe joint sprains or fractures Contractures or restriction in range of motion in hands and feet.
Dupuytren’s contracture *****scenario on every practical
systemic disorder that occurs in the hands its a contracture phenomena
parrafin works great on contracture phenoman because it heats in nicely allows the tissue to become more mobile and the therapist to work on it
If you had a dupuytren’s contracture what modality would you use?
Paraffin
Define therapeutic ultrasound
“Therapeutic ultrasound is a deep-penetrating agent that produces changes in tissue through thermal and non-thermal (mechanical) mechanisms.”
What is a P-wave?
P-wave (primary): compressional wave –molecules collide and bend forward and elastically rebound –travels through the material in the direction of the release
What is an S-wave?
S-wave (secondary): Sliding and rebounding against rigid material –in liquid a shear wave doesn’t transmit but in bone it does.
Are P-Waves longitudinal waves or transverse waves?
Longitudinal waves
Are S-waves longitudinal waves or transverse waves?
Transverse waves
With a higher frequency you will get a ____ rate of absorption
greater
Describe continuous ultrasound
Continuous waves which come out a constant speed and within an equal distance
Generates thermal effects as well as mechanical effects
Describe Pulsed ultrasound
Bursts of waves (interrupted at various rates)
Generates non-thermal effects only
Define Half –Value, Half Layer Rate
depth at which 50% of the ultrasonic energy has been absorbed by the tissue
Half value distance: What depth does effects occur at with a 3MHz sound head?
1.5cm
.8 to 3cm starkey
Half value distance: What depth do effects occur at with a 1MHz sound head?
5cm
Describe ERA
Effective Radiating Area
The area of the ultrasound head that produces mechanical waves, normally measured in cm2
Measured 5 mm from the face of the sound head, the ERA represents all areas producing more than 5% of the maximum power output of the transducer.
Always lesser area that the actual size of the transducer’s face
Does the 1.0 MHz and 3.0 MHz cause different bubble activities? If so, why?
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Which of the coupling agents transmits the most ultrasonic energy and why?
?
What will you tell your patient they will feel before you apply this ultrasound?
?
Describe BNR
Mass produced crytsals will always have microimperfections and this imperfections will cause random peaks in the sound waves
What ratio of BNR is acceptable?
8: 1 elsa personally wouldnt use it beyond a ratio of 6:1
8: 1 means 8 times the normal intensity
6: 1 *** referenced in starkey and elsas limit
To achieve a therapeutic effect, the tissue temperature has to be maintained at
__ to __ degrees for at least _ minutes.
40-45 degrees. 5 mins
List the thermal effects of ultrasound
Increase metabolic rate increase circulation decrease pain increase enzyme activity increase extensibility of tissue increase viscoelastic properties
Decrease joint adhesions, thus created an increase in joint range Increase tissue healing Increase collagen extensibility Muscle spasm reduced
Ultrasounds greatest effects are noted on which types of tissue
tendon, ligament, cartilage
What does ultrasound do in the inflammatory phase?
Stimulates release of histamine from mast cells
What does ultrasound do in the proliferation phase?
Reduction in the size and production of scar tissue
What does ultrasound do in the Remodeling phase?
Change in collagen fibre patterns giving rise to greater tissue elasticity
Ultrasound contraindication (all)
1) Specialized tissue
2) Cancer, Radiation
3) Infection
4) Viscera, Pregnancy
5) Cardiac Pacemaker
6) Thrombosis
7) Arteriosclerosis
8) Carotid Sinus, Stellate Ganglion
9) Laminectomy
Ultrasound complication (major ones)
1) Specialized tissue
2) Cancer, Radiation
4) Pregnancy
6) Thrombosis
9) Laminectomy
Ultrasound precautions
Effused Joint Bursitis Epiphyseal plate Arthritic Joints Implants Burns Major Blood Vessels and Nerves Therapist precautions
List a few examples of Aims of Treatment for ultrasound
decreased pain
increase ROM
decreased swelling
Ultrasound application protocol
1.Aim of Treatment –thermal or non-thermal 2.Determine depth of lesion –Frequency 3.Position the patient 4.Explain treatment and get permission to apply 5.Go thru contraindications
Does the length of time of application make a difference to the dosage of ultrasound given?
?
What frequency is best for a deep and superficial lesion?
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Is there any difference between the ultrasound intensity for a tendon, ligament or muscle?
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What happens when the ultrasound hits an air or bony interface?
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Is there an ideal position to place the patient during an ultrasound application?
?
Does the temperature of the water make a difference to your dosage?
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Why do bubbles develop on the sound head and what do you do about them?
?
Can your hand and the ultrasound head go into the water?
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How far away should the sound head be from the treatment area in water?
?
What thermal modalities do superficial heating? Deep heating?
Superficial:
Hot pack
Hot whirl pool
Paraffin wax
Deep: Ultrasound Exercise Microwave Short diathermy
Is ultrasound low, medium or high frequency
High
Tissue propensities: Ultrasound
Organized collagen (ligament, capsule, tendon, interfaces)
Tissue propensities: Hydrocollator packs
Dermis
afferents for muscle relaxation
Tissue propensities: Paraffin wax
Joints of the extremity
Cryotherapy contraindications
For cold packs/ice immersion/ice massage
- Raynaud’s or vasospasticdiseases
- Cold allergy and/or Hypersensitivity
- Cardiac or respiratory disorders
- Compromised local circulation
- Uncovered open wounds
- Anesthetised skin
Cryotherapy precautions
Diabetic, paralyzed, rheumatoid conditions or hypertensive diseases
Never apply longer than one hour continuously since this may cause frostbite
Caution when applying cold gel packs under a compressive dressing or directly over the skin –greater risk of frostbite
Cryotherapy protocol:
1.Assess the patient and determine best mode for cold application
2.Determine that cryotherapyis not contraindicated
3.Explain the aims with the ice application
why to apply, home program and how often to use it
4.Explain the sensations that the patient will feel –intense cold, burning, aching, analgesia and numbness
5.Get permission for application
Cryotherapy protocol during application:
Talk the patient through the painful part of the icing
Check the area 2 minutes in for adverse affects or skin mottling
Choose the appropriate treatment time for the application depending on pathology, agent, patient’s tolerance, depth of lesion, body part
Cold Pack / Ice Pack application protocol:
Remove all jewelry
Assess area, check contraindications, get permission
Place the ice in a bag –remove excessive air, tie a knot in the top of the bag
Wrap the cold pack or ice pack in a towel (Knight disagrees-directly on skin when ice pack)
Use damp towel or wet tensor
Apply tensor or wrap snugly but not too tight
The wrap must cover the entire injured area, even if the ice pack does not cover it fully
Position the patient comfortably
Elevate the injured part 6 –10 inches above the heart
Stabilize if necessary to ensure relaxation of the muscles
-sling for upper extremity
-Pillow or support under knee, pelvis etc
Record all ice applications in patient file
Cold pack / ice pack protocol during application:
Leave the pack in place for 10 –20 minutes
Check every 5 minutes for any signs of adverse effects
Provide the patient with a bell or other means to call for assistance
When the treatment is completed, remove the pack and inspect the treatment area for any signs of adverse effects
Reapply wrap or brace and continue elevation provided home advice
Repeat every 1 to 2 hours
Cryokinetics protocol:
Step 1 –Prepare the patient mentally: explain the stages they will go through during the cold phase –be prepared to talk the athlete through the first two minutes
Step 2 –Prepare the patient physically: ensure the toes are covered or protected and the athletic is in a comfortable position
Step 3 –Ensure all your necessary supplies are available and within reach, ie., towel, timer, exercise aids
Application: numb the area with ice immersion or CWP or Ice cup massage –can take up to 20 minutes, but not usually more
Patient’s sensation is more important than length of time –at the point of numb, start the next step
Exercise the area immediately –with very little assistance from surrounding structures that will warm the area too quickly.
Reapply the cold application –this time it will only take 5 –7 minutes, but again, just to numb
Repeat the exercise progressing to the next stage
Do at least 5 repetitions of ice-exercise
Cryostretch indications:
Any muscle with low-grade muscle spasm
Any first degree muscle strain
A stiff muscle, stiff from disuse (immobilized)
Cryostretch contraindications:
Do not use on decreased ROM owing to connective tissue contractures
Do not use if the exercise or activity causes pain
Cryostretch Protocol:
A complete cryostretchsession consists of:
- 10 –20 min ice application to initial numbness
- Three exercise bouts with numbness in between
- Each exercise bout consists of 65 sec sets of passive stretch and isometric contractions with a 20 sec rest between sets
Static stretch 20 sec Isometric contraction 5 sec Static stretch 10 sec Isometric contraction 5 sec Static stretch 10 sec Isometric contraction 5 sec Static Stretch 10 sec Rest in anatomical position 20 sec
A soccer player sustained a first degree inversion ankle sprain yesterday at practice. Swelling is not present and the joint is stable. The athlete would like to return to play in tomorrow’s game.
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What would your treatment today consist of? and
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Wouldyou expect them to be able to return to play?
- Ice immersion - how long? until numb 10-15mins rough estimate every person is different
come out of ice immersion and start working on ROM (cryokinetics)
An athlete has pain in their rectus femoris muscle after sustaining a contusion resulting in a hematoma. Range of motion is almost full (80%) and slight pain is felt but only with maximal resistance activities. The injury is now several days old and you would like to treat using ice.
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When throughout the treatment program would you use ice in your treatment for today?
pain is not an option with cryokinetics - if pain is felt while the tissue is numb you must pull back and end treatment for that day
don’t strengthen someone through the limited ROM - your goal for this day is to increase ROM
use cryostretch to increase ROM
and once you have a new ROM then you can strengthen it
collagen should not be iced and stretched. do not immediately stretch collagen after icing.
however you can heat collagen and then stretch afterwards
if you want to stretch a ligament or a capsule ice would not be the mode of choice
An athlete has muscle spasm and limited abduction range of motion in their shoulder which the doctor has indicated is a “frozen shoulder” (adhesive capsulitis).
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How could you use ice in treatment of this athlete?
what causes adhesive capsulitis?
lack of movement / inhibition - it is usually a secondary complication
Ex. immobility (sling etc.) after a different injury
•A swimmer has pain and tightness in the biceps tendon that started that day during a warm-up they were doing to get ready for a national championship race. The competition is later today and the athlete must compete.
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What mode of cryotherapy would you use for this athlete?
?
General indications for heat therapy
Demolition phase to Return to sport • Reduction of pain • Decreased range of motion • Hematoma resolution • Reduction of joint restrictions or contractures • Reduction of muscle spasm
How whirlpool contraindications:
Contraindications –
drugs (alcohol),
seizure disorders,
heart or circulatory problems
Paraffin protocol:
Remove all jewelry from the area to be treated • Test hot and cold sensation • Explain purpose of application • Get permission to apply • Avoid moving fingers in wax • Avoid touching the bottom or sides of tank
Dip and wrap protocol
•Dip hand in paraffin as far as possible and remove
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Wait briefly for the layer of paraffin to harden and become opaque
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Re-dip the hand, with fingers apart
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Repeat at least 6 times
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Wrap the hand in plastic bag or wax paper and then in towel
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Elevate the extremity
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Leave the paraffin 10 –15 minutes or until it cools
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When completed peel off the wax and discard or back in container
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Check the skin and begin stretching exercises
