modalities Flashcards
lower pulse duration for electrical stim is more what for the patient?
comfortable
traction used for what patients?
nerve root impingement, disc herniation, muscle spasm, guarding, joint hypomobility, spinal ligament and other connective tissue contractures
contraindications for traction
acute inflammation, bone disease, fx, increased ain with traction or radicular sxs with traction, osteoporosis, lumbar traction for px,
static traction
patient’s symptoms are slightly exaggerated with mvmt.
intermittent traction
patient can’t tolerate static or want some joint mobility
lumbar traction
parameters
25% of patient’s BW: to stretch soft tissue and tx muscle spasm or disk protrusion
50% for actual separation of the vertebrae
time: 5-30 minutes. disk-related 10-30 minutes
can be static or intermittent
ex: intermittent: 20 minutes (1:2) on and off times 10s:20s
cervical traction
parameters
supine position is most effective but can also be in sitting position
-start with 8-10 lbs. mac is 22-25 lbs. (7-11% of BW)
Always complete your manual therapy before traction
TRUE
flexion traction biases what structures
posteriorly
extension traction biases what structures
anteriorly
traction
static and intermittent …always start with?
Always start with intermittent and then work your way up to static based on patient comfort
contraindications to massage
acute injury, arteriosclerosis, cancer, cellulitis, emobolus, infection, thrombus
tapotement
tapping, hacking, cupping, slacking
goal is to enhance circulation and stimulate peripheral nerve endings
friction
deep massage technique that penetrates into the depth of the muscle and attempts to loosen adhesions, reduce edema, relieve muscle spasm
ex: patellar tendon
petrissage
performed distal to proximal, aka kneading, loosens up adhesions, improve lymphatic return, facilitate removal of metabolic waste from the tx area
effleurage
light stroke that produces a reflexive response, performed at the beginning and at the end of massage, direct strokes to the heart,
indication to CPM
improve ROM that may be impaired secondary to surgical procedure. commonly used in the knee
contraindications to electrotherapy
cardiac arrhythmia cardiac pacemaker malignancy osteomyelitis over a pregnant uterus over carotid sinus patient with bladder stimulator phlebitis (vein inflammation) seizure disorders
direct current
constant flow of electrons from the positive electrode (anode) to the negative electrode (cathode)
most commonly used with iontophoresis
alternating current
polarity that continuously changes from positive to negative with the change in direction of current flow
alternating current is biphasic, symmetrical or asymmetrical and is categorized by the waveform sinusoidal in shape
ex: used as a burst or time-modulated
pulsatile current
non-continuous flow of direct or alternating current
either monophasic or biphasic
proper cleaning of the skin and electrode application will facilitate conductance limit impedance
TRUE, with soap and water
small electrodes
increase current density
increase impedance
decrease current flow
large electrodes
decrease current density
decrease impedance
increase current flow
best frequency for mm contraction
40-60 pps
need more frequency for tetany
direct current
iontophoresis, denervated nn, wound care
alternating current
pain control, mm contraction
pulsed current
pain control, mm contraction, wound care
NMES: muscle strengthening protocol current target tissue frequency pulse duration (large vs. small) on:off time intensity
alternating current
alpha motor neurons
35-80 hertz of frequency
300-400 (large) 150 (small)
1: 5 (min. of 6 seconds on) ex: 10 seconds ON, 50 seconds off
10-12 max isometric contractions or until fatigue
NMES: muscle re-ed/ROM /functional e-stim current target tissue frequency pulse duration (large vs. small) on:off time intensity
alternating current alpha motor neurons 35-80 hertz of frequency 300-400 (large) 150 (small) 1:3 (on/off time) tetany, until pt. can contract/quiver, can make it functional by asking them to do a task
NMES: spasticity reduction current target tissue frequency pulse duration (large vs. small) on:off time intensity
alternating current alpha motor 35-80 Hz 300-400 (large) 150 (small) 1:1 (On/Off) max isometric contraction, until muscle fatigue, quiver
EMG biofeedback used for?
mm reeducation regaining NM control isometric/isotonic control relaxation of mm spasm/tightness psychological relaxation (HAs and placed on tense mms)
EMG biofeedback
how does it work
uses electronic or electromechanical instruments to accurately measure, process, and give feedback via auditor or visual signals.
-need 2 active electrodes and 1 reference electrode
e-stim for pain control contraindications
pacemakers, pregnancy, if painful
pain control: Conventional TENS (sensory level) current target frequency pulse duration on: off time intensity tx duration theory?
alternating current (interferential) or pulsed current (TENS) alpha beta 80-150 hertz 20-50 us continuous pleasant tingling feeling 20 minutes gate control, effects last up to 30 minutes, wear off in 12 hours
pain control: inhibition of muscle spasm motor level current target frequency pulse duration on:off time intensity tx duration theory?
AC or pulsed alpha motor 2-10Hz 300-400 (large) 150 (small) continuous muscle twitch (not tetany) 20-30 minutes endogenous opioids
When do you need a median frequency generator?
When using interferential current or using Russian for strengthening
pain control: noxious stim current target frequency pulse duration on:off time intensity tx duration theory?
direct current
c-fiber
polarity is present (not desired)
NA for frequency
I millisecond to 1 second for pulse duration
first pleasant tingling, muscle twitch, sharp pain to dull pain
electrodes are placed on trigger points and painful points
tx duration: as short as possible
endogenous opioids, effects last for 6 hours, done before wound debridement to decrease sensitivity
edema control: current target frequency pulse duration on:off time polarity intensity tx duration theory?
HVPC alpha beta, smooth muscle 80-150 Hz continuous negative polarity (repels negative serum proteins to prevent them from breaking leaking from blood vessels) pleasant tingling for intensity 20-30 minutes effects smooth muscle, ANS lasts for 4-5 hours
iontophoresis is used for?
acute inflammation to a small superficial tendon or for scar tissue break down pain calcium deposits fungal infection hyperhidrosis inflammation ischemia keloids muscle spasm myositis ossificans plantar warts scar tissue wounds
dexamethasone phosphate
(-, used for inflammation)
lidocaine
(-) used for scar, adhesive capsulitis
acetic acid
(-) used for calcific deposits,
salicylates
(-) used for muscle and joint pain, plantar warts
hydrocortisone
(+) inflammation
iodine
(-) scar
dosage for ionotphoresis
amplitude x time=40-80 mA/min
amplitude for ionotphoresis
0.1-4.0 mA/min
if the drugs is (-) use cathode
if the drug is (+) use anode
TRUE
iontophoresis contraindications
drug allergies skin sensitivity open wound cardiac pacemkaers electrical implants use of ice or heat diabetes
