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NCE Prep > Modalities > Flashcards

Modalities Flashcards

1
Q

What is the physical stress theory?

A 
none/low = cell death
low = atrophy
normal = maintenance
moderate = hypertrophy
high = injury
extreme = cell death
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2
Q

What is the physical stress equation?

A

exposure (magnitude) + duration + direction = stress placed on tissues

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3
Q

What is a therapeutic modality?

A

A stress placed upon the body to elicit an involuntary physiological response (correct form of energy + proper stage of healing = regeneration)

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4
Q

What occurs during primary trauma? What are you trying to avoid? What are you trying to elicit?

A

Primary trauma = cell death, inflammation & hemorrhage edema
Avoid = hypoxia, blood flow congestion, enzymatic injury, pain, spasm, atrophy
elicit = phagocytosis, blood clotting, revascularization, wound contraction, wound healing

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5
Q

When does secondary injury start?

A

30 mins after primary injury

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6
Q

What is the difference between swelling and edema?

A 
swelling = fluid build up & increased capillary permeability (fluid leaves capillaries and enters tissue)
edema = fluid and protein build up in interstitial space (can obstruct venous and lymphatic return)
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7
Q

What layers must ice go through?

A

skin, adipose tissue, fascia, muscle

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8
Q

What causes a greater depth of cryo penetration?

A

longer duration and larger treatment area

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9
Q

How does re-warming occur?

A

Deeper tissues are re-warmed by blood (increased cell metabolism) and skin temp is increased by blood & air

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10
Q

How long does intramuscular temperatures continue to decrease after removal of a cold modality? How long does intramuscular temp remain elevated after a heat modality?

A

30 mins for both

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11
Q

A 10 degree temp decrease of the skin causes a ___ degree temp decrease at a joint?

A

6.5 degrees

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12
Q

At what temperatures do certain events happen during cryotherapy (decreased blood flow, decreased cell metabolism etc.)?

A
  • BF decreases instantly and levels out at 13 mins
  • CSA of lymph vessels decrease at 15 degrees C
  • Cell metabolism decreases at 10-15 degrees C
  • Nerve changes occur at a skin temp of 5 degrees C
  • P decreases and numbness occurs at 14.4 degrees C and P returns at 15.6 degrees C (approx 18-21 mins of ice application)
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13
Q

Does ice affect proprioception? If yes, for how long?

A

Yes, it affects proprioception for 5-10 mins after removal (decreased nerve conduction velocity and decreased perception of P)

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14
Q

What injuries could result from cold and compression application?

A

frostbite or cold-induced neuropathy

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15
Q

How does cold produce its effects physiologically (decreased P, edema formation etc.)?

A

blood = vasoconstriction, increased blood viscosity, decreased blood flow
edema = decreased cell metabolism, decreased secondary hypoxic injury (requires compression & elevation to remove edema)
pain = decreased nerve conduction velocity, decreased inflam/swelling (removes chemical and metabolic P triggers)
muscle spasm = decreased stretch reflex, decreased sensitivity of muscle spindles, decreased threshold of afferent nerve endings

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16
Q

How much does cold slow down a motor vs sensory nerve?

A

motor = 1.5m/sec
sensory = 2.6m/sec
(1 degree C intramuscular drop)

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17
Q

What is the law of Grotthus-Draper?

A

If energy is absorbed by one tissue layer it can’t be transmitted to deeper layers

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18
Q

What is Fouriers law?

A

The greater the temperature difference the faster the exchange of energy

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19
Q

Explain and provide an example of conduction, convection, conversion, radiation and evaporation

A
  • conduction - transfer of heat by touching of two surfaces ex. ice pack
  • convection - transfer of heat through the use of a medium (air/water) ex. whirlpool
  • conversion - transfer of heat by changing one form of energy to another ex. ultrasound
  • radiation - transfer of heat without the use of a medium ex. laser
  • evaporation - heat is absorbed as the liquid turns into a gas ex. vapocoolant spray
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20
Q

What is the temperature for cold modalities versus thermal modalities?

A 
cold = 10-18 degrees C
heat = 40-45 degrees C
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21
Q

Which penetrates deeper and lasts longer, superficial cold or heat?

A

superficial cold

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22
Q

How much does exercise increase body temp and at what depth?

A

2.2 degrees C at 5cm

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23
Q

By what 4 methods is heat produced?

A
  1. transfer of thermal energy
  2. chemical action associated with cell metabolism
  3. mechanical action (therapeutic U/S)
  4. electrical or magnetic currents (diathermy)
24
Q

When should you use cold versus heat?

A 
cold = acute inflammation, before ROM exercises, after activity to decrease cell metabolism
heat = subacute/chronic inflammation, promote venous drainage, encourage tissue healing, reduce edema/ecchymosis, improve ROM before activity

*Patient preference

25
Q

What is the Q10 effect?

A

for every 10 degree C increase in temp, cell metabolism increases by 2-3x

26
Q

What increases BF more, moist heat or dry heat?

A 
moist heat (386% increase)
dry heat (282% increase)
27
Q

What is required to increase tissue elasticity?

A

increase tissue temp to 40-45 degrees C for 5 mins then stretch the tissue

28
Q

What is rebound vasoconstriction?

A

after 20 mins of heating the vessels with automatically constrict to protect the deeper structures

29
Q

How does adipose tissue affect heating/cooling?

A

Need to increase duration
20mm or less = 25 mins
20-30mm = 45 mins
30-40mm = 60 mins

30
Q

What is inside an ultrasound head and how does it create heat?

A

piezoelectric crystal that expands and contracts (+ve and -ve electric charges)

31
Q

What is the difference between longitudinal and transvers waves?

A 
longitudinal = molecules are displaced parallel to direction of sound, travels through solid and liquid media (soft tissue)
transverse = molecules are displaced perpendicular to sound waves, can only travel through solids (occurs when sound strikes bone)
32
Q

Explain reflection, refraction and absorption

A
  1. reflection - beam goes in opposite direction (at an angle) when it strikes a surface
  2. refraction - beam continues in the same direction but is bent (speeds up if dense to less dense and slows down if less dense to dense)
  3. absorption - energy is converted to heat in a layer and cannot move to deeper layers
33
Q

What is the effective radiating area (ERA)?

A

Small portion of transducer surface that produces ultrasonic energy

34
Q

What are the differences between 1mhz and 3 mhz?

A 
1mhz = low frequency, divergent, 5cm deep, slower absorption, retains heat 2x longer
3mhz = higher frequency, collimating, 2-3cm deep, faster absorption (3x), heat leaves faster
35
Q

What is the beam nonuniformity ratio (BNR)?

A

ratio of the highest intensity within the beam with the average intensity (8:1 is unsafe)

36
Q

What components of the body are highly reflective?

A

Bone
MTJ
Intermuscular interfaces
Air

37
Q

What is cavitation, acoustical streaming and microstreaming?

A

Occur to produce non-thermal U/S effects.
1.cavitation = ultrasound produces pressure in tissue fluids which creates gas bubbles that expand and contract
2.acoustical streaming = bulk flow of fluids in one direction
3. microstreaming = fluids move in one direction across a boundary and can change cell structure/function
cavitation + acoustical streaming = microstreaming (increases cell membrane permeability)

38
Q

What is the difference between direct current, alternating current and pulse current with examples

A

DC - uninterrupted flow of electrons from cathode to anode ex. iontophoresis
AC - uninterrupted flow of electrons is bidirectional (no true +ve or -ve) ex. IFC/TENS
Pulsed - flow of electrons is interrupted by periods of no electron flow (monophasic or biphasic) ex. NMES/Russian

39
Q

What 4 factors affect current flow (resistance to flow)?

A
  1. Conductor material (blood & nerves are better than skin and bone)
  2. Length of circuit (shorter = less resistance)
  3. CSA of circuit (larger CSA = less resistance)
  4. Temperature of skin (warmer temp = less resistance)
40
Q

What tissues are better suited to small pads vs large pads?

A

small pads = superficial nerves and decreased adipose tissue

large pads = deep nerves and increased adipose tissue

41
Q

What 3 things can change how a nerve responds to electrical stim?

A
  1. Depth of nerve
  2. Diameter of nerve
  3. Phase duration of current
42
Q

Name the nerves from superficial to deep

A

sensory nerves
motor nerves
pain fibres
muscle fibres

43
Q

Why do motor nerves fire before pain fibres?

A

because P fibres have a smaller diameter so they take longer to depolarize

44
Q

What is the difference between a normal muscle contraction and an electrically induced muscle contraction?

A

normal contraction =

  • small –> large fibres
  • contractions and recruitment are asynchronous to decrease fatigue
  • GTO protect muscle from tension
  • slow to fatigue

Electrically induced =

  • large –>small fibres
  • contraction and recruitment are synchronous
  • GTO can not protect against tension
  • quick to fatigue
45
Q

What pps is required to reach tetany?

A

30-40pps

46
Q

Can you get DOMS from electrical stim?

A

Yes

47
Q

Can you increase strength on the opposite side of electrical stim? If yes, by how much? Why would you do this?

A

yes, by 10%

to delay atrophy or assist in re-education

48
Q

What are the goals of electrical stim with parameters?

A
  1. Decrease Edema =
    - 30-50 pps
    - electrode proximal to edema
    - 5-10s on 5-10s off
    - ramp = 0.5s- none
    - elevate body part and relax
    - 10-20 mins daily
  2. Muscle spasm
    - 50-70pps
    - on muscle group in spasm
    - 10s on 10s off
    - 1-2s ramp
    - pt tries to relax
    - 10-20 mins daily
  3. Strength/re-ed
    - 50-70pps
    - electrode on muscle
    - 10:50 (re-ed), 10:30 (strength)
    - 2-3s ramp
    - contract with on cycle
    - 10-20 mins daily
49
Q

What 4 things/domains contribute to how we interpret pain?

A
  1. evaluative- previous P experience
  2. sensory - nature of P stimulus
  3. affective - mental/emotional state
  4. misc - how everything combines into a feeling
50
Q

How fast does a nerve fire?

A

33mph

51
Q

What is the gate control theory?

A

Block painful stimulus from reaching the brain = pain relief

  • stimulate A-beta fibres to reach the spinal cord first (only one sensation at a time can go up)
  • A-beta = larger fibre, stimulates the SG and prevent P signal from going up
52
Q

What is the opiate theory?

A

Allow painful stimulus to reach brain so that the body will release endogenous opiates
A-delta = large pain fibre (sharp/stinging)
C-fibres = small pain fibre (dull/aching)
Small fibres inhibit the SG and allow the pain signal to go up (releases enkephalin from pituitary to decrease P)

53
Q

What else besides P relief can IFC do in a meh way?

A

edema reduction, decrease muscle spasm and bone stimulation

54
Q

What are contras for cold application?

A 
open wounds
sensory deficit
cold allergy
cold sensitivity
PVD
thrombosis
advanced diabetes
Raynaud's
Lupus
Hemogolbinemia
cold-induced miocardial ischemia
55
Q

What are contras for heat application?

A 
acute inflammation
sensory deficit
infection
cancer
PVD
advanced arthritis
thrombophlebitis
impaired circulation
poor thermal regulation
DVT
Pregnancy
56
Q

What are contras for U/S application?

A 
Same as heat for thermal, as well as
unstable fracture
pacemaker
metal implants
joint replacements
organs
breast implants
eyes, heart, skull, carotid sinus, genitals
57
Q

What are contras for electrical stim application?

A 
seizures
metal implants
psychological impairments
pacemaker
sensory deficits
infection
blood clots
pregnancy
cancer
unstable fracture
arterial disease
cardiac disability

NCE Prep (1 decks)

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