Modalities Flashcards
Convection
Gain or loss of heat from air or water moving in a constant motion across the body
Thermal agent is in motion
Capable of transferring large amounts of heat
Modalities using convection
Fluidotherapy
Whirlpool
Conversion
Heating from a nonthermal energy being absorbed into tissue and transforming into heat
Rate is determined by power of energy source
Does not require direct contact, but does need a coupling agent
Modalities using conversion
Diathermy
US
Radiation
Direct transfer of heat from a radiation source of higher temp to one of cooler temp
A temp difference must occur without direct contact
Rate is influenced by: intensity and size of energy source, target area, angle of radiation, distance between
Modalities that use radiation
Infrared
Last
UV
Conduction
Gain or loss of heat from direct contact of two materials of different temperatures
Conducted from higher temp material to lower
Continues until two materials are equal
Rate accelerates with large temp difference, height thermal conductivity.
Modalities using conduction
Hot pack Cold pack Ice massage Cryo cuff Paraffin
Cryotherapy therapeutic effects
Decreased blood flow Decreased edema Decreased local temp Decreased metabolic rate Decreased nerve conduction Decreased tone Increased pain threshold
Cryotherapy contraindications
Cold intolerance Infection Over an area of compromised circulation Over regenerating peripheral nerves Peripheral vascular disease Raynaud's phenomenon
Therapeutic effects of heat
Decreased muscle spasm Decreased tone Increased blood flow Increased capillary permeability Increased ROM Increased local tissue temp Increased metabolic rate Increased nerve conduction Increased pain threshold
Contraindications of heat
Acute trauma Arterial disease Bleeding or hemorrhage Over an area of compromised circulation Over an area of malignancy Peripheral vascular disease Thrombophlebitis
Indications for US
Acute and chronic conditions Calcium deposits Chronic inflammation Delayed soft tissue healing Dermal ulcers Contractures Muscle spasms Trigger points Pain Scar tissue Tissue regeneration
Contraindications for US
Decreased sensation Decreased circulation/vascular insufficiency DVT Infection Malignancy Thrombophlebitis
Thermal Effects of US
Acceleration of metabolic rate Modulation of pain Decreased muscle spasm Decreased joint stiffness Increased circulation Increased soft tissue extensibility
Nonthermal effects of US
Increased membrane permeability
Increased intracellular calcium
Facilitates tissue repair
1 MHz
Deeper tissues
3 MHz
Superficial tissues
Continuous ultrasound
Thermal effects
Pulsed ultrasound
Nonthermal effects
Water temp of 32 to 79°F
Acute inflammation of distal extremities
Water temp of 79 to 92°F
Exercise
Water temp of 92 to 96°F
Wound care, spasticity
Water temp of 96 to 98°F
Treatment of burns
Water temp of 99 to 104°F
Pain management
Water temp of 104 to 110°F
Chronic RA, OA, increased range of motion
Therapeutic effects of traction
Decreased disk protrusion decreased pain Increase joint mobility Increase muscle relaxation Increased soft tissue elasticity Promote arterial, the venous, and lymphatic flow
Indications for traction
Disc herniation Joint hypomobility Muscle guarding Muscle spasm Narrowing of intervertebral foramen Osteophyte formation Nerve root impingement Sub acute pain Subacute joint inflammation
Contraindications for traction
Acute inflammation Aortic aneurysm Osteoporosis Dislocation, fracture, subluxation Hiatal hernia
Lumbar traction position
Supine=flexed spine, greater separation of posterior structures (facet joints, intervertebral foramen). Spinal stenosis
Prone=extended position of the fine, greater separation of anterior structures (disc spaces)
Disc herniation
Lumbar Traction Forces
Max of 30lbs for initial treatment
25% of BW to stretch soft tissue, treat spasm, and disc protrusion
50% for actual separation of vertebrae
Cervical traction flexion
Upper cervical spine : 0-5 degrees
Mid cervical spine: 10-20 degrees
Lower cervical spine: 25-35 degrees
Cervical traction forces
Up to 10 lbs for initial treatment
7-10% of BW (11-15 lbs) for stretch, treat spasm, disc protrusion
13-20% of BW (20-30lbs) for joint distraction
Should not exceed 30 lbs
Therapeutic effects of electrotherapy
Decreased edema Decreased pain Decrease spasm Increase local circulation Increase range of motion Eliminate disuse atrophy facilitate wound healing and bone repair Muscle reeducation and strengthening
Contraindications for electrotherapy
Cardiac arrhythmia or pacemaker Malignancy Osteomyelitis Patient with bladder stimulator Phlebitis Seizure disorders
Indications for electrotherapy
Bells palsy Decreased range of motion Facial neuropathy Fracture Idiopathic scoliosis Joint effusion Muscle atrophy, spasm, weakness Wound Pain Stress incontinence Shoulder subluxation
Small electrodes
Increased current density and impedance
Decreased current flow
Large electrodes
Decreased current density and impedance
Increased current flow
Proximity of electrodes
Closer together, superficial tissues
Farther apart, deeper tissues
Bipolar technique
To active electrodes over target area
Electrodes equal in size
Used for weakness, neuromuscular facilitation, spasms, range of motion
Amplitude
Measured as intensity or voltage
Maximum positive or negative point from zero
Must be large enough to exceed threshold for nerve nerve or muscle
Frequency
The number of pulses per second
Affect the number of action potentials during stimulation
NMES
Used for skeletal muscle activity
Amplitude dependent on strength of contraction
High pulse duration
As pulse duration shortened greater amplitude required for same contraction
Frequency of 35 to 50 pulses per second
Tetanic contraction
TENS
Used for acute and chronic pain
Pain relief through gate control theory
Conventional TENS
Short duration, high-frequency, low amplitude
50 to 100, 30 to 150, Sensory response
Mild tingling
Pain relief is brief and only when current is generated
Acupuncture like TENS
Long duration, low-frequency, moderate amplitude
100 to 300, 2 to 4, muscle twitching
Uncomfortable, burning
Pain relief for several hours after
IFC
Pain relief, increased circulation, muscle stimulation
Intersection of currents, producing higher amplitude in same phase and lower amplitude in opposite phases
Iontophoresis
Like charges repel
Dosage=amplitude x time
Decrease chance of burn by increasing cathode size, decreasing current density, increasing space between electrodes
Monopolar technique
Active electrode over target area, disburse of electrode away from target area
Active electrode smaller than dispersive
Used for wounds, iontophoresis, edema
Fibrillations
LMN disease
Positive sharp wave
Denervated muscle disorders at rest
Fasiculations
Irritation/degeneration of anterior horn cell
Nerve root compression
Muscle spasms
Repetitive discharges
Myopathies
Lesion of anterior horn cell and peripheral nerves
Biofeedback
High sensitivity=small amount of electrical activity
Low sensitivity=large amounts of electrical activity
Muscle relaxation
High sensitivity
Electrodes close together initially
With improvement farther apart and increased sensitivity
Decrease in feedback is positive
Muscle reeducation
Low sensitivity
Increase in feedback is positive
