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508 midterm 2 > Modalities > Flashcards

Modalities Flashcards

1
Q

what are therapeutic modalities

A

the application of any physical agent applies to produce therapeutic changes to biologic tissues

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2
Q

what do physical agent modalities include

A

terminal, acoustic, electromagnetic, electrical, or mechanical energy

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3
Q

what is the purpose of physical modalities

A

stimulate the tissue in ways that are not possible with voluntary pt activity or manual therapy

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4
Q

Types of Physical Modalities

A

1) superficial heat and cold
2) intermittent pneumatic compression
3) traction
4) hydrotherapy

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5
Q

Purpose of electrotherapy’s

A

1) to promote muscle contractions (neuromuscular electrical stimulation (NMES))
2) to modulate pain (Transcutaneous Electrical Nerve Stimulation (TENS))
3) to promote edema reduction and wound healing

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6
Q

mechanical modalities

A

1) hydrotherapy
2) intermittent pneumatic compression
3) mechanical traction

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7
Q

what can manual traction be used for

A

1) lumbar for disc herniation, sciatica, DDD, or DJD
2) cervical
3) continuous
4) intermittent

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8
Q

what is intermittent pneumatic compression

A

the application of external mechanical pressure to the body for therapeutic purposes

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9
Q

Indications for Intermittent Pneumatic Compression

A

1) traumatic edema
2) stump reduction following limb amputation
3) wound healing
4) prevention of DVT
5) venous stasis ulcers
6) lymphedema

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10
Q

Contraindications for Pneumatic Compression

A

1) acute pulmonary edema: dont want more fluid to lungs
2) congestive heart failure: dont want to overload a weak heart
3) uncontrolled hypertension
4) acute or resent DVTS: dont want to dislodge
5) infection: dont want to spread infection around the body

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11
Q

typical protocols for intermittent pneumatic compression

A

1) continuous with very low intermittent pressure
2) maximal pressure must be below diastolic for 15-30 mins
3) want to avoid swelling in other areas, stiffness, numbness, SOB or other cardio plum issues

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12
Q

modalities that are often applied in combination

A
  • mechanical traction with moist heat
  • ice or heat packs with TENS
  • ultrasound following whirlpool
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13
Q

heating agents transfer energy

A

to the body

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14
Q

cooling agents transfer energy

A

away from the body

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15
Q

Conduction

A

direct contact between two objects that have different temperatures. hot molecules will collide with slow molecules until speed of molecules equalize

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16
Q

examples of conduction

A

hot and cold packs

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17
Q

convection

A

there is a medium present. heat is transfered from the circulating medium to the tissue

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18
Q

examples of convection

A

whirlpool and fluidotherapy

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19
Q

conversion

A

converts non-terminal form of energy to heat. does not require direct contact and the amount of energy depends on how much power the energy source provides

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20
Q

examples of conversion

A

ultrasound, diathermy

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21
Q

radiation

A

direct transfer of energy from a material with a greater temperature. No medium and no contact

22
Q

example of radiation

A

infrared lamp

23
Q

evaporation

A

material that absorbs energy and changes it from a liquid to a gas or vapor. Historically known as travell’s sprey and stretch

24
Q

examples of evaporation produces

A

vapocoolant sprays, sweating, flouromethane spray

25
Q

Therapeutic heat indications

A

1) general muscle relaxation, calming affect to diminish muscle tone and guarding
2) pain control
3) increase ROM and decrease joint stiffness
4) Increase muscle extensibility and decrease muscle spasm
5) promote healing by increasing circulation, increasing O2 and increasing metabolic rate.

26
Q

cardiac and neurological effect of vigorous heat

A
  • vasodilation
  • increases Oxygen hemoglobin dissociation
  • neuromuscular affects such as increases nerve conduction velocity and firing rate; and increases pain threshold
27
Q

what are the affects of vasodilation

A
  • increases capillary pressure and flow, clearance of metabolites and tissue oxygenation. Can be both local and systemic
28
Q

Contraindications of Therapeutic Heat

A

1) acute injury of inflammation
2) recent or potential hemorrhage
3) blood clot
4) impaired cognition
5) malignancy
6) infrared irradiation of the eyes

29
Q

adverse effects of superficial heat

A

burns, fainting (not keeping up with blood flow), bleeding, skin and eye damage from infrared

29
Q

precautions of therapeutic heat

A

1) pregnancy (especially during 1st trimester)
2) impaired circulation
3) poor thermal regulation
4) Edema
5) cardiac insufficiency
6) metal in the area
7) paraffin over an open wound
8) where topical counterirritants have recently been used

29
Q

methods of application of superficial heat

A
  • moist heat
  • electric heating pads
  • whirlpool
  • paraffin
  • infrared
30
Q

what is a hot pack

A
  • a canvas or nylod case filled with hydrophilic silicate (sand)
  • Stored in a thermostatically controlled water cabinet
  • water temperature between 70 and 75 C
  • placed in 6-12 layers of terrycloth, and places in contact with the pts body part for 15-20 mins.
31
Q

superficial heat

A

is governed primarily by temperature achieved and the tissues affected
- mild heat and vigorous heating

32
Q

mild heat

A
  • less then 40 degrees C(104F)
  • acts as an counterirritant, overall relaxation and decreased muscle tone
33
Q

vigorous heating

A
  • 40-45 degrees C (105-113 F)
  • this will have a more systematic response and will effect blood flow
  • Cannot heat over 45 C or damage to the skin will occur
34
Q

Changes in muscle strength after heating

A

strength decreases after 30 mins of heating, however it will increase for the next 2 hours to greater then pretreatment.

35
Q

Changes in muscle length after heating

A
  • increased tissue extensibility can lead to permanent elongation when combined with stretch
  • best to stretch lightly for longer duration, to apply stretch after heating and to maintain stretch during a cooling period, to maximize length gain and minimize tissue damage.
  • expect 3-6% length gaines with some loss following 24 hours.
36
Q

what is decreased by adding heat

A

pain, muscle spasms, and joint stiffness

37
Q

what is increased by adding heat

A

blood flow, edema formation, nerve conduction velocity, metabolic rate and collagen extensibility

38
Q

methods for applying cold

A

1) ice pack
2) ice massage
3) ice bath
4) flouromethane spray

39
Q

indications for therapeutic cold

A
  • acute and sub-acute musculoskeletal trauma and inflammation
  • hemodynamic effects of vasoconstriction, control of acute inflammatory mechanisms
  • pain control
40
Q

Hemodynamic effects of cooling

A
  • decreased blood flow
  • vasoconstriction due to decreased vasodilator releases, direct effect of smooth muscle contraction and increases sympathetic activation
  • increased blood viscosity results in decreased blood flow
41
Q

Tissue cooling temperatures

A
  • at 15 C (59F) tissue damage can occur
  • frost bite and tissue death can occur at -4 - -10 C or (39-14F)
  • serious cold applications should be no longer then 10 - 15 mins.
42
Q

Home cold pack

A

1 part rubbing alcohol 3 parts water. apply to skin in pillowcase

43
Q

how long to do ice massage

A

8-10 mins
want skin to be salmon pink at the end
allergic reactions can occur so be careful

44
Q

stages of sensations with cold therapy

A

1: cold 1-3 mins
2: burning 3-5 mins
3: aching 5-7 mins
4: numbness 7+ mins

45
Q

neuromuscular effects of cold therapy

A
  • temorary decrease in spasticity
  • decreased in nerve sensitivity and irritability
  • decreases reflex
  • can be use with UMN patients to work on improving voluntary control
46
Q

indications for cold therapy

A
  • inflammation control
  • edema control
  • pain control
  • modifications of spasticity (UMN pts)
  • facilitation of strength
47
Q

why is inflammation control on indication for cold therapy

A

cold has been shown to reduce edema, lower WBC, decrease analgesic intake, increased pain threshold, reduced muscle soreness and spasm

48
Q

contraindications with cold therapy

A
  • cold hypersensitivity
    -cold intolerance
    -cryoglobulinemia
    -paroxysmal cold cryoglobinuria
    -Raynaud’s disease or phenomenon
  • over regulation of the peripheral nerve
  • over an area with circulation compromise or peripheral vascular disease
  • pts would avoid activities that would otherwise aggravate their condition for 1-2 hrs after cold because analgesia may mask pain.
49
Q

precautions with cold therapy

A
  • superficial main branch of nerve (may cause neurapraxia or axomotmesis ex. peroneal nerve at the knee >1hr.
  • open wound
  • hypertension: due to change in hemodynamic
  • poor sensation or cognition
  • very young or very old pts.
50
Q

adverse effects of cold therapy

A
  • tissue death
    -frostbite
  • nerve damage
  • unwanted vasodilation: due to rebound effect that can cause throbbing pain

508 midterm 2 (7 decks)

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