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Modalities > Midterm Important Slides > Flashcards

Midterm Important Slides Flashcards

1
Q

Hemodynamic effects of cryotherapy

A
  • Vasoconstriction
  • Increase in blood viscosity
  • Decrease in blood flow
  • Decrease in vasodilatation mediators
  • Decrease in edema formation
  • Decrease in metabolic activity (decrease in O2)
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2
Q

Neuromuscular effects of cryotherapy

A 
•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
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3
Q

Tissue extensibility with cryotherapy

A

•increase in joint stiffness and less elasticity

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4
Q

Hemodynamic effects of thermotherapy

A
  • 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
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5
Q

Neuromuscular effects of thermotherapy

A

•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

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6
Q

Tissue extensibility with Thermotherapy

A

Increase in tissue extensibility

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7
Q

What are some indications for Thermotherapy?

A 
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
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8
Q

What is a warning sign you must look for with heat application?

A

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

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9
Q

Thermotherapy Contraindications

A 
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
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10
Q

Thermotherapy precautions

A 
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
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11
Q

Hot pack application protocol

A 
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
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12
Q

Hot pack protocol once applied

A 
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
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13
Q

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).

A

decreased

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14
Q

Hot whirlpool protocol

A

•Remove all jewelry and inspect area to be treated
•
Explain aims of treatment
•
Test for heat and cold sensations
•
Contraindications –drugs (alcohol), seizure disorders, heart or circulatory problems
•
Permission from patient
•
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

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15
Q

When would you use Paraffin?

A 
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

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16
Q

If you had a dupuytren’s contracture what modality would you use?

A

Paraffin

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17
Q

Define therapeutic ultrasound

A

“Therapeutic ultrasound is a deep-penetrating agent that produces changes in tissue through thermal and non-thermal (mechanical) mechanisms.”

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18
Q

What is a P-wave?

A

P-wave (primary): compressional wave –molecules collide and bend forward and elastically rebound –travels through the material in the direction of the release

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19
Q

What is an S-wave?

A

S-wave (secondary): Sliding and rebounding against rigid material –in liquid a shear wave doesn’t transmit but in bone it does.

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20
Q

Are P-Waves longitudinal waves or transverse waves?

A

Longitudinal waves

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21
Q

Are S-waves longitudinal waves or transverse waves?

A

Transverse waves

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22
Q

With a higher frequency you will get a ____ rate of absorption

A

greater

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23
Q

Describe continuous ultrasound

A

Continuous waves which come out a constant speed and within an equal distance

Generates thermal effects as well as mechanical effects

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24
Q

Describe Pulsed ultrasound

A

Bursts of waves (interrupted at various rates)

Generates non-thermal effects only

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25
Q

Define Half –Value, Half Layer Rate

A

depth at which 50% of the ultrasonic energy has been absorbed by the tissue

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26
Q

Half value distance: What depth does effects occur at with a 3MHz sound head?

A

1.5cm

.8 to 3cm starkey

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27
Q

Half value distance: What depth do effects occur at with a 1MHz sound head?

A

5cm

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28
Q

Describe ERA

A

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

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29
Q

Does the 1.0 MHz and 3.0 MHz cause different bubble activities? If so, why?

A

?

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30
Q

Which of the coupling agents transmits the most ultrasonic energy and why?

A

?

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31
Q

What will you tell your patient they will feel before you apply this ultrasound?

A

?

32
Q

Describe BNR

A

Mass produced crytsals will always have microimperfections and this imperfections will cause random peaks in the sound waves

33
Q

What ratio of BNR is acceptable?

A

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

34
Q

To achieve a therapeutic effect, the tissue temperature has to be maintained at
__ to __ degrees for at least _ minutes.

A

40-45 degrees. 5 mins

35
Q

List the thermal effects of ultrasound

A 
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
36
Q

Ultrasounds greatest effects are noted on which types of tissue

A

tendon, ligament, cartilage

37
Q

What does ultrasound do in the inflammatory phase?

A

Stimulates release of histamine from mast cells

38
Q

What does ultrasound do in the proliferation phase?

A

Reduction in the size and production of scar tissue

39
Q

What does ultrasound do in the Remodeling phase?

A

Change in collagen fibre patterns giving rise to greater tissue elasticity

40
Q

Ultrasound contraindication (all)

A

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

41
Q

Ultrasound complication (major ones)

A

1) Specialized tissue
2) Cancer, Radiation
4) Pregnancy
6) Thrombosis
9) Laminectomy

42
Q

Ultrasound precautions

A 
Effused Joint

Bursitis

Epiphyseal plate

Arthritic Joints

Implants

Burns

Major Blood Vessels and Nerves

Therapist precautions
43
Q

List a few examples of Aims of Treatment for ultrasound

A

decreased pain

increase ROM

decreased swelling

44
Q

Ultrasound application protocol

A 
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
45
Q

Does the length of time of application make a difference to the dosage of ultrasound given?

A

?

46
Q

What frequency is best for a deep and superficial lesion?

A

?

47
Q

Is there any difference between the ultrasound intensity for a tendon, ligament or muscle?

A

?

48
Q

What happens when the ultrasound hits an air or bony interface?

A

?

49
Q

Is there an ideal position to place the patient during an ultrasound application?

A

?

50
Q

Does the temperature of the water make a difference to your dosage?

A

?

51
Q

Why do bubbles develop on the sound head and what do you do about them?

A

?

52
Q

Can your hand and the ultrasound head go into the water?

A

?

53
Q

How far away should the sound head be from the treatment area in water?

A

?

54
Q

What thermal modalities do superficial heating? Deep heating?

A

Superficial:
Hot pack
Hot whirl pool
Paraffin wax

Deep:
Ultrasound
Exercise
Microwave
Short diathermy
55
Q

Is ultrasound low, medium or high frequency

A

High

56
Q

Tissue propensities: Ultrasound

A 
Organized collagen 
(ligament, capsule, tendon, interfaces)
57
Q

Tissue propensities: Hydrocollator packs

A

Dermis

afferents for muscle relaxation

58
Q

Tissue propensities: Paraffin wax

A

Joints of the extremity

59
Q

Cryotherapy contraindications

A

For cold packs/ice immersion/ice massage

  1. Raynaud’s or vasospasticdiseases
  2. Cold allergy and/or Hypersensitivity
  3. Cardiac or respiratory disorders
  4. Compromised local circulation
  5. Uncovered open wounds
  6. Anesthetised skin
60
Q

Cryotherapy precautions

A

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

61
Q

Cryotherapy protocol:

A

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

62
Q

Cryotherapy protocol during application:

A

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

63
Q

Cold Pack / Ice Pack application protocol:

A

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

64
Q

Cold pack / ice pack protocol during application:

A

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

65
Q

Cryokinetics protocol:

A

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

66
Q

Cryostretch indications:

A

Any muscle with low-grade muscle spasm
Any first degree muscle strain
A stiff muscle, stiff from disuse (immobilized)

67
Q

Cryostretch contraindications:

A

Do not use on decreased ROM owing to connective tissue contractures

Do not use if the exercise or activity causes pain

68
Q

Cryostretch Protocol:

A

A complete cryostretchsession consists of:

  1. 10 –20 min ice application to initial numbness
  2. Three exercise bouts with numbness in between
  3. 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
69
Q

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.
•
What would your treatment today consist of? and
•
Wouldyou expect them to be able to return to play?

A
  1. 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)
70
Q

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.
•
When throughout the treatment program would you use ice in your treatment for today?

A

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

71
Q

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).
•
How could you use ice in treatment of this athlete?

A

what causes adhesive capsulitis?
lack of movement / inhibition - it is usually a secondary complication
Ex. immobility (sling etc.) after a different injury

72
Q

•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.
•
What mode of cryotherapy would you use for this athlete?

A

?

73
Q

General indications for heat therapy

A 
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
74
Q

How whirlpool contraindications:

A

Contraindications –
drugs (alcohol),
seizure disorders,
heart or circulatory problems

75
Q

Paraffin protocol:

A 
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
76
Q

Dip and wrap protocol

A

•Dip hand in paraffin as far as possible and remove
•
Wait briefly for the layer of paraffin to harden and become opaque
•
Re-dip the hand, with fingers apart
•
Repeat at least 6 times
•
Wrap the hand in plastic bag or wax paper and then in towel
•
Elevate the extremity
•
Leave the paraffin 10 –15 minutes or until it cools
•
When completed peel off the wax and discard or back in container
•
Check the skin and begin stretching exercises

Modalities (10 decks)

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