Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Non-Systems > Modalities > Flashcards

Modalities Flashcards

1
Q

Mechanical Tx-Subacute vs. Acute

A

For Subacute & Chronic Joint Inflammation - Traction reduces pressure on the inflamed joint surfaces - Intermittent traction is GREAT! What about Acute joint inflammation? - Avoid intermittent traction, however, after 72 hours, use static traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What else is it used for?

A

What is it used for? • Hypertonicity (You want to INHIBIT the Overactive muscle) • Neck pain / Headaches • Upper Trapezius Hypertonicity • Spasticity • Gastrocnemius •

Hypotonicity (You want to ACTIVATE the Inhibitied muscle) • ACL reconstruction • Quadriceps weakness • Upper/lower Crossed Syndrome • Abdominal weakness • Mid Trapezius weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the settings for biofeedback?

A

Sensitivity = The ability to detect muscle electrical activity through the skin •

The higher the sensitivity, the more muscle activity you will detect •

The lower the sensitivity, the less muscle activity you will detect •

For Example • If I want to detect electrical activity in a quad muscle that is inhibited, should I increase or decrease the sensitivity? INCREASE IT so you can detect the signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Gain?

A

Gain • Unit of measure on the biofeedback unit that determines the ability to detect muscle electrical activity through the skin • Inversely proportional to your sensitivity***

Tester beware!! • If your answer choice has, “Sensitivity (Gain) will be increased, • base your decision on sensitivity and not gain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you determine electrode distance?

A

Consider: • Cross-Talk • When unwanted electrical signals from an adjacent muscle(s) are detected • Decreases the reliability of your results and decreases the effectiveness of your treatment.

Your options are: Wide Electrode Placement • The wider the electrode placement the more muscle fibers you will pick up and the*** greater the risk for cross talk ***• Wide electrode placement is a good option when working with • Inhibited muscles with poor activation

Narrow Electrode Placement: The narrower the electrode placement the less muscle fibers that will be detected and the less the risk for cross talk • Narrow electrode placement is a good option when working with • Small muscles • Hypertonic muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to determine electrode pad size?

A

• NPTE Options: Large or Small • The bigger the pads the greater the likelihood of cross talk. • First consider the size of the muscle (GENERALLY SPEAKING) • Second, don’t overthink it • Pick the electrode based on muscle size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you decide the starting point for treatment?

A

• Principles • “The starting point” • When trying to assess “very active” muscles, closer electrode placements are recommended. • In contrast, when the volitional activity of muscle is decreased, wider electrode placements recommended in order to monitor a larger muscle volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

For example…

A

If I have a patient with a weak, low activating, rectus femoris • Do I want to facilitate or Inhibit the muscle? • Facilitate • What is the size of the tissue? • Large tissue • What electrode placement is needed? • Wide electrode placement to start and narrow to finish • What electrode size is most appropriate? • Normal to Large • What is the appropriate level of sensitivity to start, high or low? • High sensitivity to start and low sensitivity to finish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nerve Conduction Velocity Testing is

A

Normal value=50-60 m/s

Increased latency=increased delay=parasthesias

This is testing sensory signals going to the spinal cord (sensory Afferent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is EMG?

A

is a diagnostic procedure that evaluates the health condition of muscles and the nerve cells that control them

EMG translates signals sent by motor neurons into numbers and graphs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who is it for?

A

When a patient presents with signs and symptoms consistent with neural compromise:

  1. Parasthesias
  2. Myotomal weakness
  3. Paralysis
  4. Muscle twitching

How is it performed?

  1. Insertion
  2. Rest- what the muscle is doing at rest
  3. Minimal activation- what the muscle is doing with easy movements
  4. Maximal activation-ask the patient for maximum contraction of the muscle(recruitment)

…It will send signals to show whether the muscles are normally/partially/completely denervated.

*Can also measure if the muscle is reinervating.

*Or if condition is neuropathic or myopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Findings for EMG-Insertion

A

Upon insertion, a brief burst of activity will occur=Normal

ABNORMAL and SEVERE denervation is increased or sustained activity

ABSENT or DECREASED activity is chronic denervation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Findings for EMG-Rest

A

Normal=

  • Electrical silence
  • Miniature end plate potentials
  • End plate spikes
  • Motor Unit Potentials
  • Abnormal (Active Denervation)=
  • Positive sharp waves (PSW)
  • Fibrillations
  • Fasciculations from Entrapments (CTS) or Anterior horn cell disease
  • Abnormal=
  • Myotonic discharges from Muscular dystrophy
  • Complex repetitive discharges from Chronic neuropathies
  • Myokymic discharges from Chronic neuropathies and Bell’s Palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Findings for EMG-Minimal Activation

A
  • Normal=Tri or biphasic waves
  • Abnormal findings=

Polyphasic potentials

>/= 5 waves

  • Means denervation of the nerve
  • Nascent polyphasic potentials
  • Early attempts to reinnervate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Findings for EMG-Maximal Activation

A
  • Normal=Interference pattern
  • Filling the screen with waves
  • No baseline present
  • Abnormal=
  • Neuropathic recruitment
  • Myopathic recruitment=Muscular Dystrophy
  • Abnormal
  • Decreased recruitment from=
  • Pain
  • Secondary gain
  • Symptom magnification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Iontophoresis-Concepts

A

Like charges repel! Cathode (-) is negatively charged!

Anode (+) is positively charged!

The active/delivery/treatment electrode has the medication. So if your medication is negatively charged, you use the cathode as the active electrode.

The inactive electrode is the reference/dispersive electrode.

Direct current is used for this!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Iontophoresis Conditions

A
  • Soft Tissue Inflammation (#1)
  • Calcific Tendonitis
  • Edema
  • Scar Tissue
  • Ischemic Skin Ulcers
  • Hyperhidrosis (Excess Sweating)
  • Gout
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Correct Ions for Each Conditions

A

Dexter Always Ignores Sally- Negative

Lazy Zebra Hilarious- Position

Hyperhydrosis- Alternating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Conductance of Ionto electrodes

A
  • Current Density (cD = cA/cSA)-higher CD hurts a patient
  • cA = current amplitude (mA)
  • cSA = conductive surface area (cm2)
  • Safe Current Density
  • 0.5 mA/cm2 for the cathode
  • 1.0 mA/ cm2 for the anode

*CATHODE MUST BE DOUBLE THE SIZE OF THE ANODE AT ALL TIMES…WHICH WILL MAKE THE CURRENT DENSITY LESS THAN THE ANODE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When patient starts to experience an electrical burn…

A
  1. Make sure the cathode is twice the surface area of the anode.
  2. The Active Electrode is placed directly over area of pain
  3. The Inactive Electrode is placed at a distance away from the active electrode
  4. The Inter-electrode distance=Further the distance, the deeper the current will go…The closer the distance, the more shallow the current will go
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dosing the medications

A
  • Dosage (mA*min) = Amplitude x duration)
  • Dosage Range
  • 20– 80 mA – min
  • Safe Amplitude range
  • 0.1 mA to 4 mA
  • Duration of application
  • Based upon amplitude
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Iontophoresis Contraindications

A
  • Trunk or heart of patient’s with pacemakers or implantable cardioverter defibrillators.
  • Pregnancy over certain sites such as the Abdomen, Hip/Pelvis, Lower back (but lateral epicondylitis ok)
  • Pregnant with prior miscarriage
  • Carotid Bodies
  • Phrenic Nerve
  • Active osteomyelitis
  • Cancer
  • Hemorrhage
  • Eyes or reproductive organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Iontophoresis for Wounds

A
  • High-volt pulsed current (e.g., twin-peak monophasic) remains the most commonly used and supported for wound healing. (recalcitrant stage III & stage IV ulcers)
  • Ischemic ulcers, pressure ulcers are the most commonly addressed wounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Procedure for Iontophoresis and Wounds

A

•Acute phase (Inflammation/Infection)=

Cathode is used during this period

Electrode is placed into the wound inside of saline-moistened sterilized gauze.

  • Proliferation phase (Epithelialization)=
  • Anode is used during this period
  • Electrode is placed into the wound inside of saline-moistened sterilized gauze.

***Dispersive or inactive electrode is placed on nearby skin 15-30 cm distant from the wound.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mechanical Traction-Prescription

A

Lumbar START: 25%/30lbs

LUMBAR END: 60%

Cervical START: (7-9lbs)

Cervical END: 7%/20-30lbs

*If don’t improve in 2-3 treatments, treatment should be reevaluated and changed.

26
Q

Lumbar Traction Contraindications

A
  1. Where motion is contraindicated: a. Unstable fracture b. Cord compression c. Immediately after spinal surgical procedure 2. Acute injury or inflammation (<72 hours) a. Post 72 hours static traction should be implemented Initially with progression to intermittent traction as tolerated
  2. Joint hypermobility or instability a. During pregnancy and post-partum b. C1-2 ligament laxity c. Patient with Rheumatoid Arthritis d. Congenital conditions (Marfans, Down Syndrome) 4. Peripheralization of symptoms with traction (worsening of symptoms)
  3. Uncontrolled hypertension a. Inversion should be avoided b. Blood pressure increases with only 10% traction force c. Always assess blood pressure in a patient with hypertension before and after treatment
  4. Displaced Annular Fragment a. Traction should not be used in this case
27
Q

If you have complete resolution of pain, what is best next step?

A

Assess patient’s LE sensation and reflexes to double check you didn’t affect any nerves permanently.

28
Q

Patient Position-Lumbar

A

Supine w/ Flexion - Hits the posterior spinal elements (facet joints and intervertebral foramina) - Great for lumbar stenosis or facet joint dysfunction - Prone - Neutral or extended - Hits the anterior elements (disc spaces) - Best for disc protrusions or herniations

29
Q

Recommended Lumbar Parameters

A

Acute Phase (…after 72 hours) - 30-45 lbs - Static traction method - 5-10 minute duration

Joint distraction AFTER acute phase- 50lbs (50% BW) - Intermittent traction 15s on / 15s off) - 20-30 minute duration

*Most effective is the 50% BW

30
Q
A
31
Q

Recommended Lumbar Parameters-Muscle Spasms

A

25% is good enough for muscle spasms.

Muscle Spasms - 25% of patient body weight - Intermittent 5s on / 5s off - 20-30 minute duration

Disc problems / Stretching soft tissues - 25% of patient body weight - 60s on /20s off - 20-30 minute duration

32
Q

When patient improves with LUMBAR traction, how do you increase dosage?

A
  • If the patient has improvement a moderate improvement in symptoms with traction
  • Traction force can be increased by 5-15 lbs on the next session - Traction should initially start at 30-45 lbs (25% BW) and not exceed 60% BW
  • When intermittent traction is being used, the relaxed force should be approximate 50% less than the maximum force or less.
33
Q

Position with Cervical Traction

A
  • Supine Position w/ cervical flexion - Hits the posterior spinal elements (facet joints and intervertebral foramina) - Great for cervical stenosis or facet joint dysfunction - Great for hitting the lower cervical spine - Supine Position w/ cervical extension or neutral - Hits the anterior spinal elements (disc) - Great for protrusions and discal problems - Great for hitting upper cervical spine
34
Q

Sitting position…

A

Sitting Position with flexion, neutral or extension - Similar effect to traction performed in supine position. - Pros: can be used for patient who cannot tolerate supine positioning

35
Q

Recommended Cervical Parameters

A

Acute Phase (…after 72 hours) - 7 - 9 lbs - Static traction method - 5 - 10 minute duration Joint distraction - 20 - 29 lbs (7% BW) - Intermittent traction 15s on / 15s off) - 20 - 30 minute duration

36
Q

Cervical Parameters

A

Muscle Spasms - 11 - 15 lbs - Intermittent 5s on / 5s off - 20-30 minute duration Disc problems / Stretching soft tissues - 11 - 15 lbs - 60s on / 20s off - 20-30 minute duration

37
Q

If a patient improves with cervical traction, how should you increase dosage?

A

Traction force can be increased by 3 - 5 lbs on the next session

38
Q

What is Russian STIM?

A

It is also called NMES. Its primary purpose is to strengthen weakened muscles after injury or disease.

Muscle force can be increased by increasing cross-sectional area (which takes 6-8 weeks), and/or non-muscle mass adaptations.

39
Q

What are some non-muscle mass adaptations?

A
  1. Increasing number of muscle fibers being recruited.
  2. As frequency of muscle contraction increases, force generation increases
  3. As the synchronicity of muscle fibers increase, the force generation increases.
40
Q

Russian ESTIM indications…

A

Post-surgical weakness can be improved by NMES. Examples include: TKA, ACL, SCI, CVA, MS.

This can combat Reflexive Inhibition- when the nerve tells the muscle not to move because it is trying to protect that area.

41
Q

Russian ESTIM Contraindications…

A

LMN conditions because it can actually decrease sensitivity between neuromuscular junction.

42
Q

What kind of waveform is NMES/Russian?

A

Biphasic burst modulated alternating current.

Less risk for chemical burn, goes between positive and negative waveforms.

Sends the current pulse and phases in bursts

43
Q

NMES parameters

A

Pulse duration: 200-600 microsec Frequency: 20 – 100 p.p.s Amplitude: as strong as tolerated >/= 50% MVC Carrier Frequency: 1000 – 2,500 Hz Duty Cycle: 10 – 50%

44
Q

NMES Prescription

A

Frequency: 3-5x/week – 4-8 weeks Intensity: >/= %50 MVC Time: 10 sec on/50 sec off x ~ 10 repetitions or up to 1hr a day) Type: Strengthening

***YOU WANT AS MUCH FORCE STIMULATION AS POSSIBLE with adequate rest time.

45
Q

What is ramp up/down time?

A

Time it takes to ramp UP to peak force production. Ramp time is often used for patient comfort Shorter ramp times are recommended so that the muscle can be activated for sufficient periods Ramp-up ( 1 – 5 seconds) Ramp down (1 - 2 seconds)

*So if a patient complains about pain, you INCREASE ramp up time

46
Q

Electrode size and placement?

A

Size: Bigger electrodes for bigger muscles Bigger the electrode the lower the current density.

Placement: Depends on size and location of target muscle. For strength, we want to place the electrode to recruit as many MUs as possible. Placed over the proximal and distal motor points for optimal activation of the muscle.

*Distance does not matter for NMES. Just place at proximal and distal motor unit.

47
Q

IFC vs TENS

A

TENS is a method of activating nerve fibers to reduce pain.

IFC is TENS but is alternating current delivered in quadripolar arrangement.

48
Q

Acute Pain and chronic pain for ESTIM

A

Acute pain (0 – 3 months) Chronic pain (3 months – 6+ months)

*Specific to ESTIM

49
Q

What is the patho of ESTIM?

A

The pain theory. Gait theory: When you put pressure on a place of pain to Stimulate A-Beta Fibers & A – Alpha fiber to block slower demyelinated fibers called C- fibers. C-fibers carry nasty, nagging pain. This exists in the spinal cord.

Also, the descending pain inhibition. Which Causes pain in order to raid the body’s internal pharmacy (endogenous opioids)

50
Q

What is ESTIM?

A

Electrical stimulation. Which is electrotherapy that assists in pain modulation and muscle unit activation.

51
Q

What is interferential current?

A

• a popular alternating current modality that modulates (reduces) pain by stimulating A-Beta Fibers & A – Alpha fibers and/or nociceptors

It has an easy set-up • Good effect on pain levels • Less risk for skin irritation (because AC. DC will cause more pain)

52
Q

How are the electrodes placed?

A

Quadripolar perpendicular arrangement.

The signal goes from one pad to the other in an X pattern.

•Where the signals intersect is the area that is being treated. They cancel each other out leaving behind the difference called: • Beat frequency = 100 Hz or 100 pps

53
Q

What is Pre-Mod?

A

Bipolar arrangement • The signals are transmitted through ***2 electrodes*** instead of four • Why do you care for the NPTE? • IFC and Pre-mod are very similar • Description question • Same or similar answers (eliminate them both if the question isn’t asking about one or the other because they’re BOTH THE SAME THING)

54
Q

When should you use TENS unit?

A

Up to 1 hour at a time with a 30min break between each use.

55
Q

What is TENS?

A
  • TENS is a method of activating nerve fibers by delivering electrical impulses through the skin using surface electrodes in order to reduce pain.
  • When TENS is administered, the electrical stimulation can be varied by: • Frequency (Hz) or (pps) • Amplitude (mA) or (V) or (mv) • Pulse duration (msec)
56
Q

What are the measures of TENS?

A

Frequency is the number of pulses per second. How quickly it goes back and forth.

Amplitude is the magnitude/volume. Hi high/low you turn up or down the volume.

Pulse duration is how long one pulse lasts.

57
Q

What are the TENS settings for Acute Pain?

A

Conventional/Traditional High Frequency TENS. Trying to create a different sensation that blocks the pain.

Frequency= At minimum 50pps. Then 80-110pps.

Amplitude=Strongest possible without motor contraction or increasing pain.

Pulse Duration= 50-100 microseconds.

***THIS IS FOR ACUTE PAIN ONLYYYYY

58
Q

If the patient does not feel the tingling from TENS, what is the next step?

A

Switch unit over to modulated TENS. Which MODULATES according to adaptation. Pre-mod is different from Modulated.

59
Q

What is burst-train tens?

A

It is a combo of conventional and acupuncture-like. For CHRONIC PAIN**** that regular TENS isn’t working anymore

• Burst-Train TENS • Combo of conventional and acupuncture-like • High frequency of pulses delivered at a low frequency of bouts • Frequency = 100 pps, delivered at 1 - 5 pps • Amplitude = highest tolerated painful stimulus • Pulse Duration = 250+ microseconds

Acupuncture-like TENS • Low-Frequency/High-Intensity TENS • Frequency = Below 10pps, usually 1-4 pps • Amplitude = performed with intensity high enough to evoke visible muscle contractions • Pulse Duration = 200 microseconds

60
Q

What is the procedure for chronic pain/pre surgery?

A

• Brief-Intense TENS • High-Frequency/High-Intensity TENS • Frequency = 100 – 150 pps • Amplitude = highest tolerable intensity for a short period of time • Pulse Duration = 150 -250 microseconds **Clinical Note: used for only brief periods of <15 minutes

61
Q

Contraindications for TENS?

A

Pacemaker (C, Local, physician approval) Pregnancy (C, Local, abdomen, Low Back, Hips, Pelvis) Lack of normal sensation (C, local) Impaired Cognition (C) DVT (C) Malignant Tumors (C, local) Active Epiphysis (P)

Non-Systems (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions