Modalities

Question 1

ESTIM Parameters

Answer 1

Frequency (hz): number of pulses delivered through each channel per second
- low <5pps and high > 50pps

Phase duration (ms): amount of time it takes for one phase of a pulse
Pulse duration (ms): amount of time it takes for two phases of a pulse in biphasic current
-in monophasic currents, phase and pulse duration are the same
Amplitude (volts)

current:
1. direct (ionto)
2. alternating
3. pulsed (pain modulation)
- mono or biphasic

Question 2

TENS (pain modulation)

Answer 2

Conventional
- frequency: high (50-150 pps)
- pulse duration: short (50-100 microseconds)
- amplitude: low

Acupuncture
- frequency: low (2-4 pps)
- pulse duration: long (100-300 microseconds)
- amplitude: mod

Brief Intense
- frequency: high (60-120 pps)
- pulse duration: long (150-500 microseconds)
- amplitude: mod

Noxious
- frequency: high or low
- pulse duration: long (250 microseconds to 1 second)
- amplitude: high
- tx: 30-60 seconds per point

Question 3

NMES (muscle strengthening)

Answer 3

Amplitude: higher
Pulse duration: shorter needs a higher amp,
- shorter = more comfy for smaller muscles
- longer = more comfy for larger muscles
Frequency: 35-50 pps typical for a smooth tetanic contraction
- higher frequencies do not cause stronger contractions, just more rapid fatigue
Duty cycle: off time 5x longer than on time
- on time = 6-10 seconds
Ramp time: makes stimulation more comfortable
- 1-4 secs: recommended
Treatment: min 10 max 20 contractions
- min 3X/week

Question 4

Ultrasound

Answer 4

Deep heating agent
Uses high frequency above 20,000 Hz
Therapeutic US: 0.75-3 MHz
Alternating electrical current

Question 5

Iontophoresis Parameters

Answer 5

Continuous direct current
Dosage: 40-80 mA/min
- 4.0 mA for 10 mins
*lower amplitude and longer duration would reduce the risk of burns and irritation
Amplitude: 1-4.0 mA
Electrodes: smaller has higher current density
- increased distance = current density to sup. tissues decreases
*diminish risk of burns

Question 6

Principles of estim for wounds

Answer 6

High voltage pulsed current

Question 7

Cryotherapy

Answer 7

Decreases BF
Decreases edema
Decreases local temperature
Decreases metabolic rate
Decreases nerve conduction velocity
Increases pain threshold

Question 8

Thermotherapy

Answer 8

Decreases muscle spasm
Decreases tone
Increases BF
Increased muscle elasticity and collagen extensibility
Increased capillary permeability
Increased local temperature
Increases metabolic rate
Increases nerve conduction velocity
Increases pain threshold

Question 9

Paraffin

Answer 9

Commonly used for distal extremities
OA and RA
Decreases stiffness and pain in joints and muscles

Question 10

Hydrotherapy

Answer 10

Main therapeutic effects: wound care, unloading of weight, reduction of edema

Contraindications: advanced CVP disease, PVD, renal infection, impaired circulation, incontinence, severe infection, severe mental disorders

Lower temperature: acute inflammation
Higher temperature: exercise, wounds, spasticity, burns, pain, OA, RA

Question 11

Traction

Answer 11

Applies forces to the body to separate joint surfaces and decrease pressure

Flexed spine (supine): greater separation for posterior structures including facet joints
-ie for spinal stenosis
Extended spine (prone): greater separation of anterior structures including disk spaces
-ie for disk herniation

Static (if pt condition is slightly exaggerated by movement)
Intermittent (if pt cannot tolerate static)

*re evaluate pt symptoms after 3 sessions

Question 12

Traction Contraindications

Answer 12

OP
RA (advanced)
acute inflammation, sprains, strains
cardiac or pulmonary problems
bone diseases or infections
fracture, dislocation
positive alar ligament or vertebral artery test
pregnancy (lumbar)
meningitis
hiatal hernia
peripheralization

Question 13

Biofeedback

Answer 13

Use of instrumentation to bring specific events to conscious awareness

Can be utilized to receive information related to motor performance, kinesthetic performance, or physiological response

Allows patient to make small changes and receive immediate feedback

Electrical activity is most commonly presented as audio or visual feedback

Can be used for muscle relaxation or reeducation

place electrodes further apart on muscle belly if patient has lower control/muscle activation

place electrodes closer together if patient has adequate muscle control and is able to recruit more motor units

Question 14

Massage

Answer 14

Effleurage
Friction
Petrissage
Tapotment
Vibration

Question 15

Cervical Traction

Answer 15

Should not exceed 30 pounds
7-10% (11-15 pounds): stretch soft tissue or treat muscle spasm and disk protrusion
13-20% (20-30 pounds): joint separation

Question 16

Lumbar Traction

Answer 16

25% should be adequate for stretching soft tissue and treating muscle spasm or disk protrusion
50% is required for actual vertebral separation

Question 17

Ultrasound Parameters

Answer 17

Direct coupling agent: should be applied to treatment area and transducer before the power is turned on
Indirect coupling agent: often employed when the treatment area is excessively small, irregularly shaped, or unable to tolerate direct pressure from the transducer

Intensity:
Frequency: 1MHz - affects deeper tissues (up to 5cm), 3 MHz - affects superficial tissues (1-3cm)
Duty cycle: on time/on+off time
- continuous: more for thermal effects
- pulsed: more for non thermal effects
Duration: an area 2-3x the size of the transducer typically takes 5 mins
- longer durations may be needed when using lower intensities or lower frequencies or for higher tissue temps (therapeutic objective)
- US should not be areas 4-5x larger than ERA

Question 18

Compression Therapy

Answer 18

Long (high) stretch: best for immobile patient
-high resting pressure

Short (low) stretch: best for mobile patient
- high working pressure, low resting pressure

Multilayer: good for venous stasis ulcers, protection, absorption, and compression

Semirigid: wet to dry bandages, good for venous stasis ulcers, also improve ability to WB

Question 19

Intermittent Pneumatic Compression Pump

Answer 19

Primarily used to reduce chronic or post traumatic edema
Inflation pressure generally ranges from 30-80mmhg
Treatment of upper extremities: 30-40mmhg
Treatment of lower extremities: 40-80mmhg
Dosage: 30 mins to 4 hours, 3x/week to 4x/day

Question 20

Estim

Answer 20

Muscle strengthening
Pain mgmt
Muscle re-education
Stimulation of denervated muscle

Question 21

Iontophoresis Ions

Answer 21

Negative
- acetic acid: calcific deposits, myositis ossificans
- calcium chloride: scar tissue, keloids, muscle spasms
- dexamethasone: inflammation
- iodine: scars, adhesive capsulitis
- salicylates: muscle and joint pain, plantar warts

Positive:
- copper sulfate: fungal infection
- lidocaine: analgesia, inflammation
- magnesium sulfate: muscle spasms, ischemia
- zinc oxide: healing, dermal ulcers, wounds

Question 22

Iontophoresis Burns

Answer 22

Acidic reaction: HCL acid forming under positive anode
Alkaline reaction: sodium hydroxide forming under negative anode

Decrease risk of burns
- increase size of cathode in comparison to anode
- increase size between electrodes
- decrease current amplitude