Modalities Flashcards
Acetic acid
Polarity:
Use:
negative
calcification
What are the 4 positive ions for ionto therapy?
lidocaine
magnesium
zinc oxide
copper
What are the 4 negative ions for ionto therapy?
ISAD
Acetic acid
Iodine
Dexamethasone
Salicylates
Ion for muscle spasms
Calcium chloride (negative)
Magnesium sulfate (positive)
Magnesium sulfate ion
Polarity:
Use:
positive
muscle spasms
Copper sulfate ion
Polarity:
Use:
positive
fungal infections (athletes foot)
Dexamethasone
Polarity:
Use:
negative
inflammation
Iodine
Polarity:
Use:
negative
Adhesive capsulitis, softening scars
Zinc oxide
Polarity:
Use:
positive
bacteriocidal, used for dermal ulcer
Spacing of electrodes: farther apart =
deeper current
Paraffin bath temperature
125-127 F
Contrast bath temperature
104 F (hot) to 59 F (cold)
Hot 3-4 mins/cold 1 min
Weight for mechanical cervical traction
no more than 30 lbs
Weight for mechanical lumbar traction
25-65 lb
Position for herniated disk lumbar traction
prone w/o pillow under hips
Position for stenosis lumbar traction
90/90
Salicylate
Polarity:
Use:
negative
pain
Normal US head speed
4 cm/sec
Ultrasound coverage area
No more than 2-3x the size of the US head
“Non thermal” US - needs to be set to what parameters
20% or lower duty cycle + low intensity (.5-.75)
allows heat produced during the on time to be dispersed more during off time ➔ no net increase in temperature
Minimum % body weight for lumbar traction to overcome friction
25%
Lumbar traction parameters for separation
60-120 lbs/50% body weight for NO LONGER THAN 25 mins
Cervical traction parameters for separation
20-30 lbs (7%) body weight to cause separation
INITIAL lumbar traction parameters
30-40 lbs
to decrease spasm and determine patient tolerance
INITIAL cervical traction parameters
8-10 lbs
Do not exceed % with cervical traction
7
Do not exceed % with lumbar traction
50
Neck angle with cervical traction
0-5 degrees for upper cervical
10-20 for mid cervical
20 to 30 for lower cervical
Optimal duty cycle for mechanical traction
3:1
3 on to 1 off
Supine positioning for lumbar traction
foraminal stenosis
Prone positioning for lumbar traction
posterior herniated disc
Only times DC is used
Wound healing and ionto
Polarity for wound healing - infected, non healing wound
Negative
Heat transfer: convection
liquid or gas moves past a body part
ex. whirlpool, fluidotherapy
Heat transfer: evaporation
vapocoolant spray
Heat transfer: conversion
transfer of heat via energy
ex. ultrasound, diathermy
Heat transfer: conduction
heat packs
parrafin
ex. transfer of heat between physical contact
Physiological effects of cold
vasoconstriction
increases blood viscosity
increases muscle strength (short term)
decreases metabolic rate
decreases connective tissue extensibility
decreases HR/RR(think divers response)
Physiological effects of heat
increases capillary permeability
vasodilation to tissues
decreases muscle spasm
increases tissue extensibility
increases pain threshold
increases respiratory rate
Spasticity - use heat or cold
cold
Cold compression unit should be set between …. degrees
50-59
“CBAN” for cold application
Phases go:
Cold
Burning
Aching
Numb
Physiological effects of heat
increases capillary permeability
increase oxygen uptake and metabolism
vasodilation to tissues
increases tissue extensibility
increases pain threshold
decreases muscle spasm
Skin temp during cold application should remain above
59 degrees
Physiological effects of heat
increases capillary permeability
vasodilation to tissues
decreases muscle spasm
increases tissue extensibility
increases pain threshold
Physiological effects of heat
increases capillary permeability
vasodilation to tissues
decreases muscle spasm
increases tissue extensibility
increases pain threshold
Copper sulfate ion
Polarity:
Use:
Lidocaine
Polarity:
Use:
positive
pain
Phonophoresis parameters
3 MHz
20% duty cycle
.5-.75 W/Cm
2-3x ERA
Contraindications for ultrasound
malignancy
over pregnant uterus (other areas are ok)
joint cement
plastic
pacemaker
thrombophlebitis
sensory deficits
epiphyseal plates in children
infection
Precautions for US
Acute inflammation
Epiphyseal
Fractures
Metal implants
Does 100% duty cycle (continuous US) always provide thermal effects
not all the time, with a lower intensity (.5 W/cm) you could achieve non-thermal
Goals of mechanical traction
decrease disc protrusion
decrease pain
increase joint mobility
increase muscle relaxation
promote blood flow
Cervical traction parameters for muscle stretch
11-15 lbs
Required space between electrodes
at least one electrode width of space between
Maximum ionto intensity
4mA
Normal ionto dosage in mA/mins
40-80 mA/mins
ex.
40 mA/min treatment would take 20 mins at 2mA/10 mins at 4mA(max) intensity
Gate control therory of pain
presynaptic inhibition of C fibers (dull pain) and A-delta fibers (sharp pain) via activation of larger diameter (alpha A and B - motor, sensory)
this activates the substantia gelatinosa
Conventional TENS parameters and usage
mainly for ACUTE pain via gate control theory
80-120 pps
50-100 ms
tends tp relieve pain quick, but short lived
low intensity to only stimulate sensory
pps
frequency of individual contractions - the higher this number, the more “tingly” it feels
Acupuncture-like TENS parameters and usage
For CHRONIC pain control via endogenous Opiate Release due to muscle contraction
1-5 pps
150-300 ms
tends to take longer to relieve pain, but has more lasting effects
high intensity to stimulate muscle contraction
Russian ESTIM optimal duty cycle
1:5
With ESTIM, what ratio for on/off (duty cycle) should be used for muscle spasms
1:1 (goal is fatigue the muscles out)
this differs from strength which is typically 1:3 or 1: 5
-gives more time for rest between contractions
Polarity for wound healing - healthy, healing wound
positive
HVPC parameters
50-200 pps
20-100 ms
For simplicity about 100 pps 100 Ms
twin peak monophasic current
If proliferating wound, use positive on wound, negative proximally
Layers of towel for hot pack
6-8
PT should check hot pack within
5 mins
greatest risk for burn
Temperature of water for aquatic therapy
80-92 degrees
psi for wound irrigation
4-15 psi
Normal BNR
3:1 to 5:1
perfect beam would be 1:1
acceptable is less than 8:1
Attenuation
reduction of energy as it passes from the US heat through to the tissues via absorption, reflexion, refraction
Periosteal pain with ultrasound
sudden strong bone ache caused by overheat too quick
if this happens, stop treatment and apply more gel or decrease intensity
Considerations for water application of US
keep head 1 cm from body part
wipe off air bubbles that form
For intermittent pneumatic pump, why do you check BP?
this determines their pressure setting
Pps needed for tetany
20-30
Noxious stimulus TENS
highest intensity
long duration 250-1000ms
30-60 sec long
NMES targets Type 1/2 muscle fibers
Type 2
Fatigue more quickly
NMES parameters
35-50 pps
200-700 ms
Typically, shorter or longer pulse durations are more comfortable for the patient
shorter for shorter muscles
longer for longer muscles
Cold pack should be applied directly to the skin T/F
False; use a wet towel to dissipate the initial cooling effects
CPM cycles per minute
2
Large electrode vs small electrode
Large:
decreased density and impedance
increased current flow
Small:
increased density and impedance
decreased current flow
If patient reports hot spot with US what are your immediate actions?
FIrst, move the soundhead away from the hotspot and continue treatment - see if it is still hot
Second, turn down intensity
