Modalities Flashcards

Question

Cryotherapy indications and what it does

Answer 1

Analgesia: through decreased nerve conduction Slows the metabolic effect by decreasing edema and inflammation - Short term: increase tone - Long term: decrease tone Vasoconstrictor (15 min or less), decreases motor unit firing - decrease spasm Vasodilation (15 min or more)

Answer 2

Precautions: - effects can last several hours - rewarming takes at least 20 min - monitor closely - never longer than 20 min - side effects: itching, hives, whelps - can cause a temporary increase in BP Contraindications: - cold intolerant - open wounds - vascular repairs - raynaud's - PVD - avoid superficial nerves

Answer 3

Conduction - Icepacks Convection - Whirlpool - Ice massage Evaporation - Sweat - Fluori Methane spray

Answer 4

Cold-stinging/burning-aching-numb Cheap, easy to use at home Ice pack: 30-45º for15-20 min Ice massage: 5-10 min Cold immersion/whirlpool-35-75º for 15 min Ice towel: change out every 5-6 min Cold compression units: 50-70º for 15-20 min Fluori-menthane

Answer 5

Combination of warm (vasodilatation) and cold (vasoconstriction) Pain-Edema-Circulation (healing) Hot-100-110 degrees Cold 60-70 degrees

Answer 6

Edema removal Pain reduction Subacute or chromic inflammation Impaired circulation

Answer 7

Acute injuries Hypersensitivity to cold Open or infected wounds Contraindications related to heat and cold

Answer 8

0-27º C (30-60ºF) (not very uniform!) Water and ice 10-20 minutes (the colder, the shorter)

Answer 9

Upper extremity: 100-105º Lower extremity: 100-102º Total body: 95-98º

Answer 10

Those modalities that produce heat/effect greater than 3cm Electric modalities Radiation modalities Laser

Answer 11

Different from diagnostic or surgical Up to 5cm Works by converting electrical energy to ultrasonic energy - A crystal in the head vibrates to create the sound waves which in turn cause the muscle tissue to “vibrate” - Sound waves enter the body. The molecules in the way are pushed aside (back and forth by the alternating phases of the waves)-this is a one way, longitudinal wave. - The sound waves travel best through solids (bone and dense tissue), less through liquid (blood) - Impacts tissue by cavitation and acoustic streaming

Answer 12

A standard ultrasound unit: - A generator (the box): the power supply, an oscillator circuit transformer - Coaxial cables - Transducer: contains the crystal * New ones don’t break * Also called the head * Various sizes * The head should be approximately ½ the size of the treatment area

Answer 13

Effective Radiating Area Usually found on the tag How much of the head is actually producing waves The higher the better

Answer 14

Beam non-uniforming ration - The smaller the better(6:1 or less) - The waves are non uniform by nature, this is an indication of just how non uniform they are 1-6 W/cm2 - The peaks are what cause discomfort or hot spots - Anything above 8W/CM2 is dangerous

Answer 15

Increase tissue extensibility Increase blood flow Decrease pain (by way of increasing pain threshold) Increase enzymatic activity Increase metabolic rate Reduce spasms Stable cavitation (good) Cellular perm-fluid movement Unstable Cavitation-occurs when the gas bubble expand and collapse in the blood stream-causes pain and discomfort; occurs when intensity is too high

Answer 16

Increase cell permeability and diffusion Increase histamine, protein/collagen synthesis Decrease pain Increased cell permeability-due to cavitation Increased cell diffusion-acoustic streaming Increased tissue repair Micromassage, to decrease pain Increases phagocytic activity and the mobility of fibroblasts Vasoconstriction and dilation: edema Increase tissue repair by increasing histamines, granular activity and increasing phagocyte cells: due to acoustic streaming

Answer 17

Ultrasound (thermal or non thermal) is often said to “drive” meds, usually, anti-inflammatory, lidocaine or corticosteroids. It softens the stratum corneum and allows for enhanced absorption of a topical medication 1. Must be TOPICAL and intended to be used with US 2. Must be tested and approved with ultrasound

Answer 18

Acute injury if 100% Breast implants Blood clots Joint cement or prosthesis Pace makers Growth plate of children Unprotected nerve or spinal cord Eye Heart Pregnant uterus Testes Thrombosis Freshly repaired tendon or bone Infection or malignancy Organs

Answer 19

Non-thermal: acute injury/tissue healing Mild thermal (1ºC): sub-acute injury/tissue healing Moderate thermal (2-3ºC): chronic inflammation, pain, trigger points Vigorous heating (4ºC+): stretch collagen

Answer 20

1. Duty cycle 2. Frequency 3. Intensity 4. Time: 5-8 minutes 5. Apply medium: US gel (96%) or lotion (90%) 6. Treat 7. Document

Answer 21

Amount of time the unit is heating Continuous: 100% - deep heat Pulsed: 10%, 20%, or 50%

Answer 22

1MHz: 3-5cm 3MHz: 1-2cm

Answer 23

0.1-0.5: acute 0.5-1.0: subacute 0.5: wound healing 1.0-2.0: chronic; increase blood/O2 flow; scar tissue remodeling

Answer 24

Trigger points and scar tissue 50% pulsed or less

Answer 25

Theragesic cream = 97% Lidex gel = 97% Biofreeze = 80% Eucerin Cream = 0% Hydrocortisone powder in US gel = 29%

Answer 26

Produces less heat than direct contact Place limb in water with the head Increase the intensity one level Increase the time by 2 minutes

Answer 27

For wounds Place wrap and then gel Use wound parameters

Answer 28

muscle contraction and pain releif

Answer 29

1MA (milli amp) = tingling sensation Most units we use are in this area (4MA-ionto is the highest) 16 MA = cannot release grasp - muscle contraction 50 MA = pain may pass out 100 MA (3 amps)= ventricular fibrillation – heart issues 6 A = myocardial contraction and infarction, burns, death

Answer 30

Sensation-sensory level response (TENS, Interferential) Skeletal-muscle contraction-motor level (NMES) Pain-noxious level response (endorphin theory) 2-3 hours of pain relief after, lots of pain during

Answer 31

Galvanic current came about – continuous flow of electricity. Noxious, can damage tissue and nerves Will contract a muscle with or without an intact nerve innervations, so we don’t use it

Answer 32

The current is not continuous More comfortable, doesn’t burn or damage tissue Will cause a contraction if the nerve innervation is intact

Answer 33

All therapeutic electric stimulators are TES Transcutaneous electrical stimulators They are indirect current (except iontophoresis) They go through the skin They must have an intact nerve innervation The majority are TENS (transcutaneous nerve stimulators) - but we associate TENS with pain relief

Answer 34

Electrotherapeutic - Electric biofeedback – myoelectric training - Neuromuscular electrical stim - Functional electric stim - Transcutaneous electrical stim - Electric stim for tissue repair - High volt, galvanic stim - Iontophoresis Mechanical - Vasopneumatic devices - Continuous passive motion (CPM)

Answer 35

Stimulation of innervated muscle to increase strength, ROM, decrease spasticity, disuse atrophy, and muscle reeducation

Answer 36

Use of transdermal e-stim for pain modulation

Answer 37

Use of e-stim as an orthotic substitute to perform functional movements or activities

Answer 38

Stimulation of nerves for pain modulation and to facilitate deeper physiological response

Answer 39

Direct current - continuous flow of particles in one direction - you set is at positive or negative (iontophoresis) Alternating - continuous bidirectional flow of particles * symmetrical or asymmetrical * balanced or unbalanced > the more balance, the more comfort

Answer 40

The "shape" pf the current - pulsed or alternating Different shapes feel different - Sine - Triangular - Rectangular

Answer 41

The length of time between the beginning and end of all phases in a single pulse Usually expressed in microseconds The longer the width/duration, the more time something can happen - Recruitment, pain - As pulse width increases the depth of the current increases Set it based on what you are doing - Sensory stimulation: 20-150 (gate control) 50 most common * Tens - Muscle stim: 200-300 microseconds (use 300)(endorphin) * NMES, some tens - Noxious: 600+

Answer 42

The number pulses per second (pps) or cycles per second (Hz) This determines the type of muscle contraction - Machines are usually preset at 35, 50 or 80 - The higher the more comfortable, but may fatigue quicker 1 - 20pps: twitch 25 - 50pps: muscle contraction 50 - 80pps: tetanic

Answer 43

NMES is just TENS turned all the way up Really isn’t it’s all about width and rate The lower the width, the higher the intensity will need to be Acute injury - low width, high frequency Chronic - high width, low frequency

Answer 44

What you adjust to the patient’s comfort level Expressed in milliamps Typically, 35-80 but varies based on machines

Answer 45

Gradual increase of intensity to desired level About comfort and recruitment Usually, 2-5 seconds

Answer 46

Ratio of on and off 1:1 = rapid fatigue 1:4 = reduced fatigue time

Answer 47

Self sticking, reusable The smaller the electrode, the higher the current density Smaller electrodes can create the perception of increased intensity If they are wearing out, they can cause surface burns and tissue damage Not sticking - Sweat, dirt, hair, lotion - Dry skin

Answer 48

Monopolar - one active electrode (iontophoresis) - Treatment at site - Dispersive at a distance (6-12 inches) Bipolar or quadrupolar - Along belly or treatment site - Closer = superficial - Farther = deeper

Answer 49

If you are using more than one set of electrodes Synchronous - all at the same time Reciprocal - alternate one and off

Answer 50

Used to create a muscle contraction Frequently used with: - CVA to overcome reflexes and establish appropriate motor engrams - Spinal Cords: area of innervation - Musculoskeletal: Increase ROM, assist with atrophy or disuse, break through adhesions, and relieve pain or spasms

Answer 51

Symmetric, biphasic square waveforms are best tolerated - Asymmetric work well with smaller muscles, but there is a higher risk of burns and irritation Amplitude Intensity-set to pt tolerance up to 100mA. - The greater the intensity, the greater the muscle contraction Pulse duration: varies from .2-.4 based on pt comfort. Duty Cycle: varies, usually 25% or 1:4 Ramp: the time it takes to reach peak, 2-3

Answer 52

Treatment of disuse and atrophy Increasing or maintaining ROM Muscle re-education Orthotic substitution Other benefits - Pain relief - Edema reduction

Answer 53

Contraindications - Demand pacemakers - Pregnancy * On a foot or hand ok - Placement along anterior neck * Some are doing this with feeding Precautions - Know arrhythmia - Fresh incisions or tendon repairs - Insensate skin - T6 or above spinal cords

Answer 54

10Hz or less (usually 2-4 Hz) Also called acupuncture (means low pulse frequency that is constant) or burst (low pulse frequency that occurs in bursts of pulses instead of continuous individual pulses) Intensity (amplitude) is usually 1.5 to 5 x the perception threshold (the first sensation of paresthesia) Endorphin release theory More effective on thermal pain can take several hours to achieve analgesia Some studies show an effect for up to 12 hours Pulse duration: 150 or more

Answer 55

10Hz or greater (usually 80 Hz or more) Also called Conventional TENS - Often perceived a the most comfortable - Place to start Gate control theory-stimulation of large diameter afferents should inhibit the second order neurons from carrying pain impulses from the small diameter afferents Pulse duration (width) is short - less than 150 Amplitude (intensity) is comfortable

Answer 56

Chronic Pain PostOp Pain: decreased use of drugs Obstetrics Neuropathic pain Cardiac: reducing angina Pediatric Use Musculoskeletal Pain Esophageal distension and pain

Answer 57

No strong research Over or around painful area Over the dermatome Over acupuncture points Over trigger point

Answer 58

15 minutes to 4 hours, 1-6x a day "as needed"

Answer 59

One of the most common types of E-Stim Considered medium frequency-4000Hz modulated by a low frequency of 1-250 Hz Commonly used for: - Urinary incontinence - Osteoarthritis pin - Low back pain - TMJ Pain - Enhance bone healing - Decrease soft tissue pain - Decrease proliferation with palmer psoriasis - Improve vascular status in PVD-Increase blood flow - Migraines - Decrease hyperreflexia in MS

Answer 60

Lower abdomen of pelvis during pregnancy Over cervical region Over hemorrhagic area With an electric implant Over embolus or thrombosis Over malignancy With cardiopathies Excessive hair

Answer 61

The effects are quicker (15 minutes or less) for anagesic

Answer 62

Bipolar-two electrode Quadripolar Quadripolar with scan Stereodynamic

Answer 63

Mode: constant (80bps) or sweep (80-150bps) Time: typically, 20 minutes, can be more or less Typically, the machines are preset 4000 Hz-frequency Pulse duration-250 Think about moving while in it Mesh glove: CRPS

Answer 64

A method of transferring the ions of a specific medication into soft or hard tissue An electrically charged electrode will repel a similarly charged ion

Answer 65

Used because it is: - Non-invasive - Site specific - Low risk of infection - Enhanced drug penetration to directed site Common uses - Pain relief-site specific, not general - Decrease inflammation - Treat calcifying tendonitis with frozen joints - Treat hyperhidrosis - Anesthetic for dental - Edema reduction - Scar tissue

Answer 66

Parameters will depend on the medication used, the drug must be approved for iontophoresis, and you MUST know the polarity. Remember, “electrically charged electrodes will repel similarly charged ions” If the medication is + you will use a + charge What if you use 2=lidocaine and dexamethasone??? Two treatments Black – negative Red or white - positive

Answer 67

Acetate (-)=dissolves calcium deposits Chlorine (-)=softening of tissue (scars) Dexamethasone (-)=reduces inflammation Glucocorticoid (-)=reduces inflammation Iodine (-)=softening of connective tissue (scars) Penicillin (-) kills bacteria Copper (+)=antiseptic and antifungal Glycoperronium bromide (+)=stops palmer sweating Hyaluronidase (+)=decreases edema Hydrocortisone (+)= reduces inflammation Lidocaine (+)= pain release Tap water (+ and-)=decreases sweating

Answer 68

The dosage is proportional to the current magnitude (A) used and the duration of the application (T) To calculate: A x T=Dosage For example: 30mA min of Dexamethasone can be delivered: - At 3 mA for 10 minutes or - At 1mA for 30 minutes or - At 2 mA for 15 minutes The magnitude is based on patient comfort

Answer 69

Produces electromagnetic energy at 27.12 million cycles per second. This is applied as a pulsed electromagnetic field to the tissue treated Can have thermal or non thermal effects The Drum produces a pulsed magnetic field into the tissue, causing sub thermal and thermal effects in high water content tissue (blood, muscle and joint synovium) 5cm

Answer 70

Increases blood flow and thereby healing Reduces pain Increases cell membrane permeability - decreasing edema Increases collagen production and encourages growth Increases tissue elasticity

Answer 71

Post trauma or surgery - Reduce pain - Reduce edema Pain associated with osteoarthritis - Reduces pain Improve tissue healing - Ligaments, cartilage, wounds, tendons and muscle - Absorption of hematomas - Diabetic sores

Answer 72

Position the client so they are comfortable, they need to be as still as possible during treatment Place shower cap over the drum Drape towel over exposed skin - To absorb sweat with thermal - Privacy and warmth Position drum over treatment area, but do not touch the towel or skin Set parameters - treat for 30 min

Answer 73

- 4% duty cycle * Pulse rate of 400 PPS * Pulse duration of 65 uSecs - 150 watts output power - Average power is 3.9 watts

Answer 74

10-33% duty cycle - Rate of 800 pps - Pulse duration 100-400 usec Average power is 10-48 watts, peak 150 watts Treatment duration 20 minutes - Use 1˚ to produce mild heat * For elderly or over boney area - Use 2˚ to produce moderate heat - Use 3˚ to produce vigorous heat Check frequently, should be warm, not hot

Answer 75

Mild - Elderly, arthritis - Boney area, distal radius Moderate to vigorous - Chronic low back pain - Increase blood flow - Increase extensibility of tendons, joint capsule * Increase AROM

Answer 76

Do not perform over carotid sinus, vagus nerve, or pharyngeal muscles Do not use over organs, heart, eyes, or testes Do not use overactive cancer - Exception for terminal patients for pain relief Do not use with fever, inflammation, or infection Do not use over pregnant abdomen Do not use over exposed spinal cord (laminectomy) Do not use overgrowth plates of children Do not use over metal (in clothing or internal) Do not use over or close to a DVT

Answer 77

The agent applied and the treatment parameters - Ultrasound * Frequency * Intensity * Duty cycle Site of application - Left epicondyle Treatment duration - 8 minutes Physiological response to the treatment - Unremarkable Subjective response to treatment- “feels better”

Answer 78

Taking ultrasound and converting it to heat

Answer 79

Stimulation of denervated muscle/nerve to facilitate healing and maintain viability

Answer 80

Use of E-stim for facilitating wound healing, decrease edema, and improve circulation

Answer 81

Stimulation of denervated muscle, facilitation of wound healing, edema reduction, and pain modulation