Mod. 1-3 Flashcards
What is a physiological justification for tx?
what is (physiologically)happening to the tissue
how intervention is working towards goal (on provider level)
What is clinical justification?
the impact on pt’s function (for reimbursement purposes)
convince pt why exercise is important
mode of energy using direct contact between agents (heat transferred from high to low)
conduction
mode of energy using direct contact with a circulating medium with different temperature material
convection
mode of energy with heat transfer when a liquid absorbs energy and changes to a vapor
evaporation
mode of energy transfer from high to low temp without medium or direct contact
radiation
5 cardinal signs of inflammation
heat, redness, edema, pain, loss of function
how long does inflammatory phase last
1-6 days
Name 3 stages of tissue healing
inflammation
proliferation
maturation/remodeling
what happens during proliferation phase of healing
granulation tissue forms
fibroblasts deposit collagen
angiogenesis (new blood vessel formation)
describe A-beta fibers
large, myelinated
fastest transmission
transmit non-noxious stimuli
gate control theory
describe A-delta fibers
small & myelinated
medium transmission of noxious stimuli
transmit “fast pain”/acute sensation
not blocked by opioids
describe C fibers
smallest, unmyelinated
transmit noxious stimuli (diffuse, chronic pain)
blocked with opioids
Ascending pathway: synapse area?
which NT released?
destination of relay signal?
substantia gelatinosa
substance P
thalamus in brain
pain type: ill-defined, diffuse; travel/expands to other areas
radiating
pain type: sensation originates from somewhere other than pain site
referred
pain type: sharp pain that travels along nerve pathway (usually from neck/spine)
radicular
pain type: musculoskeletal (tendons, joints, mm)
somatic
pain type: accompanied by s/s of neuro dysfunction (ex: pins, needles, tingle)
neuropathic
pain type: unlocalized, referred pain from receptors in vital organs
visceral
gate control theory: which nerve fiber blocks others?
interneuron stimulated to release what?
inhibits release of what?
A-beta fibers
enkaphalin
substance P
Name 4 pain scale types
visual analog scale
numeric rating scale
Wong-Baker faces
body diagrams
McGill questionairre (descriptor words)
how deep into tissues do superficial thermal agents affect?
2 cm
Name 3 indications for thermotherapy
abnormal tone
subacute/chronic pain
decreased ROM
myofascial trigger points
mm guarding & spasm
Name 3 physiological effects of thermotherapy
increased nerve conduction
vasodilation
inc. pain threshold (gate control)
inc. collagen extensibility
altered tissue extensibility
dec. muscle strength
inc. metabolic rate/activity
dec. neuron firing rate & mm spasm
Name 3 contraindications for thermotherapy
acute inflammation/injury
peripheral vascular disease
area of compromised circulation
arterial disease
bleeding/hemorrhage
thrombophlebitis
area of malignancy
Moist hot pack parameters: temp, tx time, layers
~160*
15-20 min
6-8 layers
Contrast bath parameters: temps, tx time
hot: ~105*
cold: ~ 55*
25-30 min
Paraffin bath dip-wrap parameters: temp, # dips, tx time
130*
6-10 dips
10-15min
paraffin bath parameters (dip immersion & paint): temp, dips/paint layers, tx time
~130*
6-10 dips/paint layers
20 min (submerge w/ unit off)
Name 3 cryotherapy indications
acute/subacute/chronic pain or inflammation
bursitis
abnormal tone
muscle spasm
myofascial trigger points
musculoskeletal trauma
tendonitis, tenosynovitis
contraindications for cryotherapy
cold intolerance
peripheral vascular disease
area of compromised circulation
infections
skin anesthesia (reduced sensation)
Raynaud’s disease
regenerating peripheral nerves
cold urticaria (hives)
(paroxysmal cold hemoglobinuria
cryoglobulinemia)
Name 3 physiological effects of cryotherapy
vasoconstriction
inc. blood viscosity
dec. nerve conduction velocity
inc. pain threshold (gate control)
altered muscle strength
dec. muscle spasm
dec. spasticity
dec. metabolic activity
facilitation of muscle contraction
Cold Pack Parameters: temp, tx time, layers
~25*
15-20 min
1 moist layer
Ice Massage Parameters: time, layers, area
5-10 min
direct contact to skin
smaller contoured, localized areas
Cold compression parameters: temp, pressure, tx time
~60*
max 60 mm Hg
15-20 min
cold immersion parameters: temp, tx time
60*
15-20 min
Vapocoolant spray parameters: sweep # & direction, inches from skin
2-5, distal to proximal
12-18 in from skin
inc. stretch each time
TENS indications
pain (acute, chronic)
Name 5 TENS & IFC contraindications
cardiac pacemaker
cardiac arrhythmia
over pregnant uterus
over carotid sinus (anterior neck)
malignancy
infection
phlebitis
seizure disorder
osteomyelitis
bladder stimulator
*no low rate TENS if mm contraction would disrupt acute healing
Physiological Effects of TENS
pain relief (gate control or endogenous opioid)
Conventional/High Rate TENS parameters:
frequency, pulse duration, amplitude, tx time, pain mechanism
30-150pps
50-100 us
to sensory response (acute pain)
as needed (max 24 hrs)
gate control
Acupuncture-like/Low-Rate TENS parameters:
frequency
pulse duration
amplitude
tx time
pain mechanism
2-10pps
100-300 us
to motor response (mm twitch)/chronic pain
20-30 min
endogenous opioid
name 3 IFC indications
pain (acute, chronic)
dec. circulation
edema
muscle spasm
muscle stimulation- for stress incontinence
physiological effects with IFC
pain relief (gate control, endogenous opioid)
inc. local blood flow
muscle stimulation
IFC Pain Control (Gate theory) Parameters: beat frequency, amplitude, tx time
80-200 Hz
sensory (low, tingling)
20-30 min
IFC Pain Control (endogenous opioid) Parameters: beat frequency, amplitude, tx time
0-10 Hz
muscle twitch
20-30 min
IFC Inc. Blood Flow/MM Stim. Parameters:
frequency, amplitude, tx time
10-20 or 25 Hz
muscle twitch
20-30 min
IFC quadripolar vs. bi-polar/pre-mod
quad: 2 channels, 4 electrodes in “X” criss-cross vector
pre-mod: 1 channel, 2 electrodes w/ oval vector (more diffuse)
IFC Fixed vs. sweep
fixed: keeps same beat frequency within machine
sweep: timed, fluctuation between 2 different (high/low) frequencies
