Mod 2 PAMS Flashcards
What are the correct parameters and electrode placement for relief of acute pain TENS sensory
Place electrodes over the painful area, Frequency 80- 150 Hz, 20- 100 microseconds duration/ pulse width, time 20 minutes to hours
Marge has tolerated the pain relief e-stim very well, so you decide to try NMES for muscle re-ed. Pick the correct parameters for muscle re-ed.
Place electrodes over the muscle belly of the middle deltoid and anterior deltoid, Frequency 25-35 Hz, 200- 300 microseconds duration/ pulse width, Duty cycle 1:3 for weak muscles
What verbal instruction should you give Marge when the NMES unit is working. Marge is sitting with her right arm/ elbow supported on a table.
“Marge try to contract the muscle in your shoulder when the electricity is on. Work to lift your arm out in front like you are giving a big person a hug”
What would happen if an electrode fell off during treatment?
The patient would stop feeling the electricity, because you need a positive and a negative pole (2 electrodes) for electrical current
If a patient did not “feel” the electricity with turning up the intensity/ amplitude to 10 milliamps after you set up the pads and set the parameters; would you do?
Turn the intensity knob to zero and recheck the connections
What affect would a hot pack have on the E-stim unit (InTENSity)? (How does blood flow affect the electricity)
Increases the intensity of the electricity. Blood is a good conductor of electricity and therefore decreased the impedance
When turning off an e-stim unit, what controls need to be turned to zero and why?
Intensity Knob/ Amplitude/ Milliamps
Can you perform TENS on a person who just shaved that area?
No, clip don’t shave
Your patient has a whiplash injury and wants to apply the TENS to the front of their neck by the sternocleidomastoid. Is this safe?
No, it’s not safe because electrical stimulation over the carotid arteries can change pressure on the Baroreceptors and decrease blood pressure
Your CVA patient wants to use NMES for grip strength, but has limited sensation in that hand. Can you use NMES?
Yes, sensation is only needed for TENS sensory stimulation pain relief
Complete this statement: there are 4 general categories of physical agents; they include
Superficial thermal agents
Deep thermal agents
Electrotherapeutic agents
Mechanical Devices
The exclusive use of PAMs as a therapeutic intervention without direct application to occupational performance is not considered occupational therapy. This statement is ______
true; PAMs are always integrated into a broader occupational therapy program.
Regulatory agencies that govern the oversight of PAMs education include_____________.
Local, state, and national level; examples include AOTA standards and state licensing boards
Direct Current (DC)
Direct Current (aka Galvanic Current) can travel from both a negative and a positive poles (electrodes) based on the desired result
Alternating Current (AC)
Alternating Current is any type of current that is characterized by a continuous change in the direction of the electrical flow; meaning the polarity of the electrodes change from positive to negative
Interferential Current
When the two current cross paths and interfere with each other; the resulting wave form is the desired for the clinical need.
True or False: Body tissues including Bone and Fat are poor Conductors of Electricity (high impedance). Surface electrodes applied close to areas of bone and fat do not travel as deep because of the high impedance.
True
True or False: High water content will decrease the amount of impedance and increased conductivity. Tissues that have high water content are muscle and nerve.
True
True or False: Applying a hot pack in the same (body) area as the electrical stimulation (electrodes) will increase the blood flow in the area and decrease the impedance of electricity to the tissues.
True
True or False: Skin has the greatest resistive element to the flow of electrical current since it contains very little water, specifically a callous.
True
Your patient has a rash from poison ivy in the same area that an you would like to place an electrode for a TENS unit (pain relief). Is it safe to put the electrodes over the rash while performing functional motions?
NO, Breaks in skin integrity are contraindicated because electricity follows the least restrictive path.
Ultrasound waves have similar characteristics to Electrical Waves. However, ultrasound waves are measure as_____________.
Longitudinal Waves
Attenuation is the reduction of the amplitude of the ultrasound beam as it travels. As the sound wave travels through the body it actually loses energy. What frequency allows the sound wave to travel deeper into the tissue?
Low frequency
Ultrasound travels through the body tissues at different speeds. Acoustic Impedance is defined as the amount of resistance encountered as an ultrasound beam passes through tissue. The denser the tissue the more resistance. What tissue has the highest acoustic impedance?
Bone (Ex: Lateral Epicondyle)
Ultrasound waves can be transmitted (travels through), absorbed (heats up the tissue), reflected back towards the transducer (incident and off angle reflection), and refracted (scatter).What is the interface that almost all sound waves are reflected back towards the transducer?
Fat: bone
A shear wave can adversely affect the outer covering of the bone. How do therapists avoid a standing or shear wave that can occur at the bone?
Keep moving the ultrasound head to avoid a summation effect of the original wave and the reflected wave
True or False: As a general rule, the higher the intensity (amplitude of the wave) the more heating that will occur in the tissue.
True
What are the 10 variables that may affect the Dosage of Ultrasound Delivered to the Target Tissue
- Ultrasound frequency
- Wavelength
- Intensity
- Effective radiating area of the transducer
- BNR
- Continuous or pulsed administration
- Coupling medium used
- Composition and structure of the targeted tissue
- Movement and angle of the transducer
- Frequency and duration of the application
Your patient has a diagnosed rotator cuff tendonitis. She is 3 months pregnant. Can you perform ultrasound on her shoulder?
Yes
Your patient has a distal radius fracture with an open reduction internal fixation. Can you perform ultrasound on the area to improve stretching / ROM?
NO
Your patient a 10 year old boy that recently fractured his proximal humerus mountain bike riding and is referred for increasing ROM at the glenohumeral joint. Can you perform ultrasound on his arm/ shoulder?
NO (Bone ossification not completed until 13 years of age)
What is the frequency band for therapeutic ultrasound?
800,000 Hz to 3,000,000 Hz
Ultrasound has a physiological effect on body tissues. What two settings can Ultrasound be programmed to perform?
Ultrasound can be programmed to heat the tissues “thermal effect” and not heat tissues “mechanical effect”
What are the 6 Clinical Effects of Thermal Ultrasound?
- Increased tissue extensibility of collagen fibers of tendons and joint capsules
- Decrease pain
- Decrease joint stiffness
- Increase blood flow
- Decrease muscle spasm
- Decrease chronic inflammation
Ultrasound is commonly used as an adjunct treatment to stretching out tissue. What is the therapeutic window (window of opportunity to stretch) after the application of Ultrasound?
The treated tissue stays heated for approximately 8-10 minutes
What is Conduction?
ConDuction is Direct contact of one surface with another surface and the resulting transfer of heat. (example hot packs)
What is Convection?
Convection is the conveyance of heat by the movement of heated particles over a body part (example is whirlpool and fluidotherapy)
What is a safer form of heat transfer? (Meaning if you were concerned about burning a patient; which one would be less likely to cause a burn)
Convection
Your patient has diabetes type 2 and peripheral neuropathy with decreased sensation in their feet and hands. Outpatient referral for status post flexor tendon repair (zone 2) fourteen days ago; increase passive range of motion. Can you use a hot pack with several layers of towels (6) to the area before passive ROM?
NO
Your patient is a 75 year old female with osteoarthritis in her hands; otherwise she is healthy. What applies to your patients advanced age needs and heat modalities?
Even if the patient has intact sensation and is reliable, they may have little subcutaneous fat / fragile skin.
What is an absolute prerequisite before applying Superficial Heat or Cold to a hand with scarring?
Check for sensation of the scar, both soft touch and temperature
