modalities Flashcards
what type of estim for mm strengthening? wave form?
Pulse Frequency (pps)? Pulse Duration (µS)
Intensity/Duration?
NMES: Wave form = Alternating Current, Russian
PPS = 50-80 / 200-800
1:5 duty cycle
Duration = 10-20 strong contractions
Contraindications for Estim
pacemaker or implanted electronic devices
uncontrolled hyper- or hypotension
peripheral vascular disorders (for fear of releasing blood clots)
areas of neoplasm or infection
pregnancy
Must be able to provide clear feedback
Duty Cycle = ?
- percentage of on time to total time between pulses
? = number of electrical pulses delivered to the body in one second
Frequency - Also called pulses per second (pps), Hertz (Hz) with AC
Pulse frequency for high freq TENS for pain relief?
Wave form?
> 50; generally 80-110 pps
pulsed AC or DC
Low freq TENS to point of ??
PPS / Duration
visible muscle twitch
PPS <10 / duration > 150
Estim for Edema management (acute)
Edema Management (acute)
pulsed DC/monophasic pulsed to comfortable sensory threshold; just below motor response
20 mins minimum - hours OK
Tips for Estim success
informed consent, and checking for changes in the patient’s medical history since the last visit
Cleaning the patient’s skin with alcohol to remove oil and dirt before electrode application
Clipping excess body hair under electrodes
No HP during, CP ok
Use large nodes for large areas, smaller nodes for smaller areas
skin checks before and after application of any modality.
how many channels for tissue repair? (mono/bi/quad?)
One channel: active electrode in the treatment area and the dispersive is placed proximally to target area >12-18” away
For Ultrasound; best absorbing tissues are those with high collagen content = what tissues?
Vs what reflects?
– LIGAMENT, TENDON, FASCIA, JOINT CAPSULE, SCAR TISSUE = best
Bone/cartilage reflect!
Mode req for HEATING on US?
continuous US
During the inflammatory phase, US has a stimulating effect on what cells?
for tissues in which there is an inflammatory reaction, but in which there is no ‘repair’ to be achieved, the benefit of ultrasound is to promote the normal resolution of the inflammatory events
mast cells, platelets, white cells with phagocytic roles and macrophages
% bodyweight for mm spasm - traction? Lumbar
25% bodyweight
As per proper safety procedures and to reduce periosteum burning, it is recommended to move the ultrasound head at a rate of x cm/second
4
To prevent skin burning, ensure use of x-x towel layers between the patients skin and the hot pack/heat source
6-8, unless the hot pack is in a cover- the cover can be counted as 2-3 towels depending on its age and thickness
Appropriate temperatures of the water in the hydrocollator must be maintained at x° F as per the safety guidelines.
164
Dexamethasone is a ? charged solution
you would place the saline solution on the x electrode to ensure proper delivery of the medication. Dexamethasone would be placed in the x electrode.
dex = negative
saline = positive electrode
dex = negative electrode
Impaired sensation is considered a precaution, but not a contraindication. T/F?
T
Ice pack duration to achieve an effect in treating spasticity?
up to 30 minutes; checking the patient after 10-15 minutes to be sure there aren’t adverse effects.
____ traction for a ____ amount of time is indicated for acute phase of spinal injury
continuous traction for a short amount of time
estim settings for the inflammatory phase of healing or with infection present
waveform/polarity/ pps
Waveform: high volt pulsed current (HVPC);
Polarity: negative;
Pulse frequency: 60-125 pps
WHAT polarity is recommended when the goal is to enhance granulation tissue formation in the wound bed and when re-epithelialization is desired.
Negative
Application of ultrasound treatment for a chronic condition is best suited at the x setting.
continuous
The proper range for cervical traction is x-x degrees of cervical flexion
proper lbs/force for cervical traction?
20-30 deg
force of 20 pounds
Biphasic electrical stimulation with two electrodes placed on the motor points; 2 second ramp time and a duty cycle of 10 seconds on, 30 seconds off.
What goal is being met?
muscle reeducation.
1 sec ramp time and duty cycle of 10 seconds on, 10 seconds off
what goal is being met?
treatment of muscle spasms
x-phasic waveforms are most appropriate for wound healing.
Mono
Direct Current (DC) or Galvanic
features?
Continuous unidirectional flow of charged particles with a duration of at least 1 second.
One electrode is always the anode (+) and one is always the cathode (-) for the entire event.
There is a build-up of charge since it is moving in one direction causing a strong chemical effect on the tissue under the electrode
Alternating Current (AC)
features?
bidirectional flow of charged particles changing direction at least once per second.
Electrodes continuously changes polarity each cycle, therefore no build-up of charge under the electrodes
Often used in interferential or Russian commercial stimulators
Pulsed Current (pulsed)
features?
Can be unidirectional (like DC) or bidirectional (like AC)
Flow of charged particles stops periodically for less than 1 second before the next event
Pulses can occur individually or in a series
Considerations for Adposity and Estim?
adipose (fat) is a resistor, causing increased impedance
intensity required to reach MM may not be tolerated by the patient, rendering electrical stimulation an inappropriate modality for that patient
Electrical stimulation AND ultrasound would not be appropriate for the areas of the body with ?
little depth and little soft tissue between the skin and bone (knee joint, elbow joint, spine, etc.)
what modality can help to reduce scar tissue formation
ice massage
High voltage pulsed current is typically utilized in treatment of ?
pressure ulcers
x increases tissue extensibility which will help facilitate passive range of motion
heat
Traction in WHAT POSITION is the most effective position in which to perform spinal traction, as it facilitates relaxation of the low back musculature to allow for true traction
hooklying (knees raised)
What time range will allow a cold pack to have an effect on edema and pain?
10-20 minutes
Cryotherapy should be applied for no more than ?? minutes at a time and at least one hour between sessions.
20
The stages of cryotherapy are typically -
CBAAN
intense cold, burning, aching, analgesia, and numbness.
Effect of heat on mm strength?
superficial heat can decrease strength for a period of time (about 30 minutes) following a heat session
pairing an electrical stimulation with a functional activity = ?
eg; Estim to contraction during gait ex
FES
Function Electrical Stim
Conduction = direct contact heat transfer
examples?
Hp, CP, ice massage parrafin, cryocuff
whirlpool is an example of what kind of energy transfer?
Convection - gain or loss of heat d/t water moving in constant motion across body
Ultrasound and Diathermy utilize what mode of energy transfer?
Conversion - nonthermal energy (mechanical) is absorbed into tissue and transformed into heat
Radiation is heat transfer via what?
light/photons via temerpature differential at impact surface
What is an example of evaporation for theraputic modality?
vapocoolant spray
Theraputic effects of cold?
decrease edema, blood flow (vasoconstriction)
decrease nerve conduction, mm tone
increase pain threshold
Perform ice massage for how long?
5-10 mins max
stop if rash, wheals - red or dark pink OK
A cold bath req what temperature? How long to place body part?
55-65 deg
15-20 mins
Temperature for parrafin? how many dips? time to leave on hands in bag vs in bath?
110-120 deg
6-10 dips
leave in bag for 5-10 mins
leave in bath (off) after dips up to 20 mins
height for infrared lamp above target tissue? Towels?
20 in
towels masking nontargeted areas
Edema Management (subacute/chronic)
NMES; AC/Biphasic/Russian to tetanic muscle contraction
50% duty cycle/ 1:1 on off ratio
x 10-20 minutes
logic = mm pump of lymph, rhythmic assist of venous return
Copper Sulfate, Magnesium Sulfate, Zinc Oxide, and Lidocaine have what charge/polarity for iontophoresis?
POSITIVE
put it on the electrode that has the same electrical charge as the medication does so it will repel and push through the skin***
Where to put medication for ionto?
put it on the electrode that has the same electrical charge as the medication does so it will repel and push through the skin***
Dexamethasone, iodine, calcium chloride = what polarity?
NEGATIVE
