Modalities

Question 1

Ultrasound

Answer 1

1. Continuous: applied to achieve thermal effects
2. Pulsed US: when non thermal characteristics are desired
3. Duty cycle (on + off time)- the fraction of time the US energy is on over one pulse period
   -3 MHz: greater heat production in superficial layers. (Used for tissues 1-2.5 cm deep)
   -1MHz: increased heat production used to penetrate deeper tissues (6 cm deep)

Question 2

Precautions/ contraindications for Cryotherapy?

Answer 2

-Precautions: HTN, poor thermal regulation, impaired sensation, open wound, over superficial nerve, very young or old, cognitive changes
-Contraindications: cold hypersensitivity (urticaria), cold intolerance, cryoglobulinemia (more common with chronic liver diseases, rheumatic diseases, multiple myeloma), peripheral vascular disease, Raynaud’s disease

Question 3

What is the procedure for cryotherapy?

Answer 3

1. Cold packs: (silica gel) cover with towel, keep refrigerator at 0-10 degrees, treatment time: 10-20 minutes
2. Ice packs 10-20 minutes
3. Ice massage: 5-10 minutes
   Cold hydrotherapy: 32-79 degrees, 20 minute treatment time, indications: acute edema, inflammation
4. Cold compression units: apply hygienic sleeve, then compression sleeve, elevate limb, 50-59 degrees, 15 minutes

Question 4

What are the different types of thermal therapy?

Answer 4

-paraffin bath
-Hot pack
-Contrast bath

Question 5

Hot pack?

Answer 5

Trx temp: 165-170 degrees
Trx time: 20-30 minutes
-**6-8 layers of toweling
-Hot packs heat in the first 5 minutes and pt is at greatest risk of burns during this time

Question 6

Paraffin bath?

Answer 6

Trx temp: 125-127 degrees
Trx time: 15-20 minutes
-Used on wrist, hands or feet

Question 7

Contrast bath?

Answer 7

Immerse involved limb in 100-111 degree water for 4 minutes
-Then immerse involved limb in 55-65 degrees water for 1 minute

Question 8

What are the contraindications for thermal therapy?

Answer 8

-Acute MSK trauma, arterial disease, bleeding or hemorrhage, over an area of compromised circulation, over an area of malignancy, PVD, thrombophlebitis

Question 9

What are the negative ions for iontophoresis?

Answer 9

Salicylate, Acetate, Dexamethasone, Iodine
Analgesic: salicylate
Calcium deposit: acetate
MSK inflammation: dexamethasone
Sclerotic scars: iodine
See FF modalities for full chart

Question 10

What is intermittent mechanical compression?

Answer 10

Pneumatic device that applies external pressure to extremity through inflatable sleeve
-Cold can be applied simultaneously through sleeve
-External pressure on the extremity increases the pressure in the interstitial fluids, forcing the fluids to move into the lymphatic and venous return systems which reduces the fluid volume in the extremity

Question 11

What is the procedure for intermittent mechanical compression?

Answer 11

-Check pt’s BP
-Set the inflation/deflation ratio to ~3/1, generally for edema reduction, 45-90 seconds on 15/30 seconds off
-Some recommend to never exceed the patients diastolic BP
-Numbness, tingling, pulse or p! Should not be felt by the patient during the treatment
-Trx: usually an hour everyday