Modalities 2 Flashcards
1
Q
Conduction
A
- refers to the gain or loss of heat resulting from direct contact between two materials at different temp
- heat is conducted from a material of higher temp to one of lower temp. heat transfer cont. until the temp and speed of molecular movement of both materials become equal
-EX: hot pack, cold pack, paraffin, ice massage and cryo cuff
2
Q
Convection
A
- gain or loss of heat resulting from air or water moving in a constant motion across the body. Since the thermal agent is in motion and new parts of the agent are constantly coming into contact with the target area, heating by convection is capable of transferring large amounts of heat
- EX: fluidotherapy, hot whirlpool, cold whirlpool
3
Q
Conversion
A
- refers to heating that occurs when nonthermal energy is absorbed into tissue and transformed into heat
- the rate of heat transfer with conversion is determined by the power of the energy source
- Heat transfer does not require direct contact between the thermal agent and the target areas, however, it does require a medium that allows transmission of the particular type of energy
- In the case of US, the medium may be gel, lotion or water
- EX: diathermy and US
4
Q
Evaporation
A
- refers to the transfer of heat that occurs as a liquid absorbs energy and changes form into a vapor
- in the case of a vapocoolant spray, the liquid spray is applied to a patient’s body
- the vapocoolant spray is then heated by the warmer skin of the body, causing the liquid to change into vapor
5
Q
Radiation
A
- refers to the direct transfer of heat from a radiation energy source of higher temp to one of cooler temp
- in order for heating by radiation to occur, there must be a difference in temp between the energy source and the target area
- this difference must exist without the energy source being in direct contact with the target area
- the rate of heat transfer will be influenced by a number of factors including the intensity and size of the energy source, the target area, the angle of the radiation in relation to the target area, and the distance between the energy source and the target area
- Ex: infrared lamp, laser, UV light
6
Q
Hydrotherapy
THerapeutic Effects
A
- decr abnormal tone
- incr blood flow
- incr core temp
- Pain relief
- relaxation
- vasodilation
- wound debridement
7
Q
Hydrotherapy
indications
A
- arthritis
- burn care
- edema
- decr ROM
- desensitization of residual limb
- joint stiffness
- muscle spasm
- muscle strain
- Pain
- Sprain
- Wound care
8
Q
Hydrotherapy
- Contraindications
A
- advanced cardiovascular or pulmonary disease
- active bleeding
- diminished sensation
- gangrene
- impaired circulation
- incontinence
- maceration
- Peripheral vascular disease
- Renal infection
- Severe infection
- severe mental disorders
9
Q
Hydrotherapy
Treatment temp Guidelines
- 32-79deg F
A
Acute inflammation of distal extremities
10
Q
Hydrotherapy
Treatment temp Guidelines
- 79-92 deg F
A
exercise
11
Q
Hydrotherapy
Treatment temp Guidelines
- 92-96 deg F
A
Wound care, spasticity
12
Q
Hydrotherapy
Treatment temp Guidelines
- 96-98 deg F
A
Cardiopulmonary compromise, tx of burns
13
Q
Hydrotherapy
Treatment temp Guidelines
– 99-104 deg F
A
- pain management
14
Q
Hydrotherapy
Treatment temp Guidelines
– 104-110 deg F
A
Chronic rheumatoid or osteoarthritis, incr ROM
15
Q
extremity tank
A
- used for a distal upper or lower extremity
- approx dimensions for an extremity tank are a depth of 18-24 in, a length 28-32 in and a width of 15 in
16
Q
lowboy tank
A
- used for larger parts of the extremities and permits long sitting with water up to the midthoracic level
- approx dimensions are a depth of 18 in a length of 52-65 and a width of 24 in
17
Q
highboy tank
A
- used for larger parts of the extremities and the trunk
- this tank permits sitting in chest-high water with the hips and knees flexed
- approx dimensions for the highboy tank are a depth of 28 in, a length of 36-48 in and a width of 20-24 in
18
Q
hubbard tank
A
- used for full-body immersion
- approx dimensions for the Hubbard tank are a depth of four feet, a length of 8 feet and a width of 6 feet
- contraindications specific to full-body immersion include unstable BP and incontinence
- the temp should not exceed 100 deg F
19
Q
therapeutic pool
A
- used for exercising in a water medium
- the temp should range from 79-97 deg F depending on pt age, health status and goals
20
Q
Whirlpool
A
- consists of a tank that holds water with an attached motor,, called a turbine, that provides agitation and aeration to create the “whirlpool effect”
- water temp should be selected based on the patient’s diagnosis and goals.
- Tx time ranges from 10-30 min
- exercises can be performed during whirlpool tx as indicated
- tank should be thoroughly clean after each use with a disinfectant and antibacterial agent
21
Q
contrast bath
A
- Utilizes alternating heat and cold in order to decr edema in a distal extremity
- the alternating vasodilation and vasoconstriction is theorized to allow the benefits of heat, such as decr pain and incr flexibility while avoiding the risk of incr edema
- provides good contact over irregularly shaped area, allows for movement during tx and assists with pain management
- ## limitations include potential intolerance to cold, dependent positioning, and a lack of credible research supporting the efficacy of contrast baths
22
Q
Procedure for contrast bath
A
- tx should begin with the pt’s distal extremity immersed in the hot bath with the temp between 104-106 deg F for 3-4 minutes
- the pt should then place the distal extremity into the cold bath with a temp between 50-60 deg F for one minute
- the pt should then repeat this hot/cold sequence for 25- 30 minutes
- The degree of temp increase desired often determines whether the tx ends in the hot or cold water
23
Q
Massage
- Therapeutic Effects
A
- altered pain transmission
- decr anxiety and tension
- decr muscle atrophy
- decr muscle spasm
- facilitate healing
- improved circulation
- increased lymphatic circulation
- loosen adhesion
- reduction of edema
- relaxation
- removal of metabolic waste
- stimulate reflexive effects
24
Q
Massage Indications
A
- adhesion
- bursitis
- decr ROM
- edema
- intermittent claudication
- lactic acid excess
- migraine or HA
- muscle spasm and cramping
- pain
- Raynaud’s syndrome
- Scar tissue
- tendonitis
- trigger point
25
Massage Contraindications
- acute injury
- arteriosclerosis
- Cancer
- cellulitis
- embolus
- infection
- thrombus
26
Massage
| - Effleurage
- massage technique that is characterized by a light stroke that produces a reflexive response
- the technique is performed at the beginning and end of a massage to allow the patient to relax
- strokes should be directed towards the heart
- effleurage can also be applied as a deep stroke to produce both a mechanical and a reflexive response
27
Massage
| - Friction
- massage technique that incorporates small circular motions over a trigger point or muscle spasm
- this is a deep massage technique that penetrates into the depth of a muscle and attempts to reduce edema, loosen adhesions and relieve muscle spasm
- friction massage is used freq with chronic inflammation or with overuse injuries
28
Massage
| - Petrissage
- is a massage technique described as kneading, where the muscle is squeezed and rolled under the therapist's hands
- the goal of petrissage is to loosen adhesions, improve lymphatic return, and facilitate removal of metabolic waste from the tx area
- Petrissage should be performed in a distal to proximal sequence
- Petrissage can be performed with two hands over larger muscle groups or with as few as two fingers over smaller muscles
29
Massage
| - tapotement
- massage technique that provides a stimulation through rapid alternating movements such as tapping, hacking, cupping, and slapping
- the primary purpose of tapotement is to enhance circulation and stimulate peripheral nerve endings
30
Massage
| - vibration
- massage technique that places the therapist's hands or fingers firmly over an area and utilizes a rapid, shaking motion that causes vibration to the treatment are
- the therapist initiates this motion from the forearm while maintaining firm contact on the tx area
- vibration is used primarily for relaxation
31
Massage Parameters
| Direction
- the general movement pattern of the massage stroke
- direction can be described as centrifugal or centripetal
- centrifugal is moving from the center of the body out
- centripetal is moving in from the extremities toward the center of the body
32
Massage Parameters
| - Duration
- The length of time a massage technique is performed
- duration is highly variable depending on the characteristics of the massage technique, established therapeutic objectives and patient tolerance
33
Massage Parameters
| - Frequency
- the rate at which the massage technique repeats itself in a given time frame
- the variety of massage techniques are repeated several times prior to transitioning to a different technique
34
Massage Parameters
| - Pressure
- the relative amount of compressive stress applied to the body. Pressure is usually described by terms such as light,moderate, deep or variable
35
Massage Parameters
| - Rhythm
- the relative regularity of the massage technique
- a massage technique applied at regular consistent intervals would be considered rhythmic
- if the technique was applied at inconsistent intervals, it would be considered non-rhythmic
36
Massage Parameters speed
- general rate the PT's hands move
| - speed is usually described as slow, moderate, fast or variable
37
Superficial Thermotherapy
| - Therapeutic Effects
- Decr muscle spasm
- decr tone
- incr blood flow to the tx area
- incr capillary permeability
- incr collagen extensibility
- incr local temp
- incr metabolic rate
- incr muscle elasticity
- incr nerve conduction velocity
- incr pain threshold
38
Superficial Thermotherapy
| - indications
- abnormal tone
- decr ROM
- muscle guarding
- muscle spasm
- myofascial trigger points
- subacute or chronic inflammatory conditions
39
Superficial Thermotherapy
| - contraindications
- acute musculoskeletal trauma
- arterial disease
- bleeding or hemorrhage
- over an area of compromised circulation
- over an area of malignancy
- peripheral vascular disease
- thrombophlebitis
40
Hot pack
- stored in water between 158-167 deg F
- the water is housed in a thermostatically controlled container that maintains the water at a relatively constant temp
- application requires 6 to 8 layers of towels between the hot pack and skin
- Pt should feel a mild to moderate heating sensation from the hot pack
- skin check for excessive redness, blistering or other signs of a burn are required after 5 minutes
- hot packs require approx 15-20 minutes to achieve the desired effects
41
Fluidotherapy
- container that circulates warm air and small cellulose particles
- the superficial heating modality generates dry heat through forced convection
- the extremity is placed into the container and a protective shield is applied to prevent the escape of the cellulose particles
- direct contact between the skin and the cellulose is desired since this will maximize heat transfer
- temp should be set 100-118deg F. teh maximum temp rise during tx occurs after approx 15 min
- Tx time is usually 15-20 min
42
infrared lamp
- produces superficial heating of tissue through radiant heat
- the majority of infrared radiation is absorbed within the first few mm of human tissue
- The amt of tissue temp incr is directly proportional to the amt of radiation that penetrates the tissue
- Pt should be positioned approx 20 in from the source to produce a comfortable level of warmth.
- optimal absorption occurs when the infrared radiation strikes perpendicular to the target area
- Tx duration is generally 15-30 minutes and is influenced by the distance from the lamp
43
Paraffin
- commonly used heating source for the distal extremities.
- can provide a more even distribution of heat to areas, such as the fingers and toes.
- paraffin's low specific heat enhances a pt's ability to tolerate heat from paraffin compared to heat from water at the same temp
- paraffin cannot be applied to areas with open wounds or infected
- temp should be maintained between 113 and 122 deg F
44
Paraffin dip-wrap
- required to maintain a static position as the distal extremity dips into the paraffin bath and is removed
- after waiting briefly for the paraffin to harden, the extremity should be redipped 6-10 times and then immediately placed into a plastic bag
- a towel should be wrapped around the bag to slow the paraffin cooling
- the paraffin should be left in place for 10-15 min
45
Traction
| -Therapeutic Effects
- decr disk protrusion
- decr pain
- incr joint mobility
- incr muscle relaxation
- incr soft tissue elasticity
- promote arterial, venous, and lymphatic flow
46
Traction
| - indication
- disk herniation
- joint hypomobility
- muscle guarding
- muscle spasm
- narrowing of the intervertebral foramen
- nerve root impingement
- osteophyte formation
- spinal ligament and other connective tissue contractures
- subacute joint inflammation
- subacute pain
47
Traction
| - contraindications
- acute inflammation
- acute sprain or strain
- aortic aneurysm
- bone diseases
- cardiac or pulmonary problems
- conditions where movement significantly increases symptoms
- conditions where movement is contraindicated
- dislocation
- fracture
- hiatal hernia
- incr pain or radicular symptoms with traction
- infections in bones or joints
- meningitis
- osteoporosis
- peripheralization of symptoms
- positive alar ligament test
- positive vertebral artery test
- pregnancy
- RA = advanced
- sublaxation
- TMJ pain or dysfunction
- Trauma- if diagnostic tests have not ruled out other medical conditions
- Tumors
- Vascular conditions
- vertebral joint instability
