Modalities Flashcards
ice massage
or an area of 10cm by 15cm: 5-10min; maintain skin temperature of 59deg to prevent frostbite
cold packs
25deg F, apply with a moist towel for 20min; for spasticity reduction treatment can extend past 30min, but you must do a skin check every 10min
cold bath
55-64deg F for 15-20min
what’s the term ‘spray and stretch’ refer to?
vapocoolant spray on triggger points - apply spray at a 30deg angle 12-18 in away from the skin
hot pack + amount of towels
decrease pain, increase tissue extensibility, reduce muscle spasm: ~160deg F, 6-8 layers of towel used; skin check after 5min - max surface temp reached within 6-8min - give them a bell! treatment time: 15-20min
fluidotherapy
cantainer with warm air and cellulose particles - ~110deg F for 15-20min
infrared
everyone wears goggles, device positioned 20in away from pt, treatment duration 15-30min and best used for soft tissue healing
paraffin
~120deg F; dip wrap = 10-15min, dip-reimmersion=20min, paint appliccation = 20min; 6-10 layers total
ultrasound: thermal effects
accelerate metabolic rate, modulate pain, reduce muscle spasm, dec joint stiffness, alter nerve conduction velocity, inc circulation
ultrasound: non thermal
increased permeability, promote tissue repair and normal function; cavitations
water immersion ultrasound
sound head should be 0.5-3cm away from skin - used for irregular shaped or small body parts
what is BNR what does it cause
beam non-uniformity ratio in ultrasound - a high BNR can cause hot spots/discomfort
ultrasound: 1MHz vs. 3MHz
1 = deeper - up to 5cm; 3 = shallow, 1-2cm
continuous ultrasound
duty cycle =100%, theram effects produced
pulsed ultrasound
duty cycle = 20%, nonthermal effects
what size area is TOO large to treat with ultrasound?
one that is 4x the size of the transducer
phonophoresis
ultrasound to deliver medication - anti inflammatories and analgesics; can be used with pulsed or continuous
two types of diathermy
capacitive plate - superficial over areas of low fat content; inductive coil - deeper used over areas of high water contnet; diathermy can be used on diameter up to 25x that of a typical US
what’s the number one thing to do before treating someone with heat or ice?
have them remove all their jewelry
diathermy
based on pt subjective of heat; dose I = no heat sensation, dose II = mild heat; dose III = mod heat, dose IV = vigorous heat that is below pain threshold. treatment ~20min, but can be 30-60min for nonthermal effects
archimedes’ principle
buoyance: there is an upward force on the body when immersed in water that is equal to the amount of water displaced
gravity of water
1.0
primary determinants of water motion
speed, viscosity, turbulence
what is a lowboy tank
hydrotherapy tank that is long enough to long sit - comes up to midthoracic region, used for larger parts of extremities
what is a highboy tank
hydrotherapy tank that allows chest high water with the hips and knees flexed - used for larger parts of the extremities and trunk
hubbard tank
hydrotherapy used for full body immersion; DO NOT USE if they have unstable BP or are incontinent
temperature guidelines: 32-79deg
acute inflammation
temperature guidelines: 79-92deg
exercise
temperature guidelines: 92-96deg
wound care, spasticity
temperature guidelines: 96-98deg
cardiopulm compromise, treatment of burns
temperature guidelines: 99-104deg
pain management
temperature guidelines: 104-110deg
chronic rheumatoid or osteoarthritis, increased ROM
who is at risk of being hypotensive during pool work?
those on beta blockers or anithypertensive meds
contrast bath
used for arthritis, sprains, strains, reflex sympathetic dystrophy and for desensitization: extremity dipped in hot water for 3-4min, then into cold water for 1 min. for 25-30min total
for traction, what percentage of the max force is used for the relax period?
50%
lumbar traction: max force for first session; force for soft tissue; force for vertebral separation; duration
max force 1st session: 30lbs; soft tissue: 25% BW; disc: 50% BW; 5-30min
when flexing the cervical seg for traction, what deg for which seg?
0-5= upper C spine; 10-20 = mid C spine; 25-35 = lower C spine
benefits of intermittent traction
tissue extensibility and pain control
cervical traction: max force for first session; force for soft tissue; force for vertebral separation; duration
first session: 10lbs; soft tissue: 7-10% BW; disk: 13-20% BW (do not exceed 30lbs); 5-30min total
long stretch vs. short stretch bandages
long stretch give little working pressure because they stretch so much, used for individuals who are immobile; short stretch give low resting pressure and high working pressure - do not use on a flaccid limb, pt must be able to ambulate
what type of compression garmets are used for venous stasis ulcers?
multi-layer or semi-ridgid bandages
level of compression to prevent DVT vs assist with scar management vs edema control
16-18mm vs/ 20-30mm vs 30-40mm
what must penumatic compression pump pressure get to to override arterial pressure? what’s norm for UE? LE? normal treatment time?
at least 30mm Hg; UE: 30-60mmHg; LE: 40-80mmHg; 30min to 4hours
what is the typical number of cycles per minute for CPM?
2 cycles/min
electrode placement: if one is bigger than the other, where is the current densest? ; electrodes closer vs. farther, where is the current most dense?
it will be denser around the smaller electrode; closer together does more superficial, with farther apart does deeper tissue
acetic acid
negative, calcific deposits & myositis ossificans
calcium choloride
negative, scar tissue, keloids, muscle spasms
copper sulfate
positive; fungal infections
dexamethasone
negative; inflammation
iodine
negative; scars & adhesive capsulitis
lidocaine
positive; analgesic, inflammation
magnesium sulfate
positive; muscle spasms, ischemia
salicylates
negative; muscle and joint pain, plantar warts
zinc oxide
positive; healing, dermal ulcers, wounds
positive ions go on which side vs. negative
positive go on anode (positive), negative go on cathode (negative) to repel
a normal relaxed muscle should do what?
nothing. electrical silence
what do spontaneous N potentials indicate
muscle or nerve damage
fibrillation potential
indicative of LMN disease
positive sharp wave
denervated muscle at rest, such as muscular dystrophy
fasciculation
degeneration of anterior horn cell, nerve root compression, or muscle spssm
repetitive discharges
myopathy, lesion of anterior horn cells and peropheral nerves
polyphasic potentials - what diseases can this indiciate
abnormal - myopathy, muscle or anterior horn involvement - guillain barre, myasthenia gravis, peripheral neuropathy, poliomyelitis
electrode N: lateral delt, biceps brachi
C5-6
electrode N: tricpes, flexior carpi radialis
C6-7
electrode N: extensor indicis
C7-8
electrode N: abductor pollicis brevis, first dorsal interossei
C8-T1
electrode N: vastus medialis
L2,3,4
electrode N: tib anterior
L4-5
electrode N: TFL
L4-5, S1
electrode N: peronous longus
L5-S1
electrode N: glut max, hamstrings
L5-S1,2
electrode N: gastroc
S1-2
effleurage
light touch at beginning/end of massage - can also be deep for a reflex response
petrissage
kneading, perform in a distal to proximal movement
tapotement
rapid alternating movements, tapping, etc to enhance circulation
NMES
frequency 35-50 pulse/sec, 6-10sec on, 60-100sec off, 1-4sec ramp = 10 contractions min, 20 contractions max
TENS
30-150pps, for nano seconds, for 20ish min; acupuncture = low pps, long duration, for ~45min, brief intense = high pps, long duration for ~15min, noxious = highest tolerated stimulus for up to 1sec, 30-60seconds for ea point
