Modalities Flashcards
1
Q
cryotherapy
A
- refers to the local or general use of low temp in rehab
- generates therapeutic effects by influencing hemodynamics, metabolic, and neuromuscular processes
2
Q
Cryotherapy Therapeutic effects
A
- decr blood flow to the treatment area
- decreased edema
- decr local temp
- decr metabolic rate
- decr nerve conduction velocity
- decr tone
- incr pain threshold
3
Q
Indication for cryotherapy
A
- abnormal tone
- acute or chronic pain
- acute or subacute inflammation
- bursitis
- muscle spasm
- musculoskeletal trauma
- myofascial trigger points
- tendonitis
- tenosynovitis
4
Q
contraindications for cryotherapy
A
- cold intolerance
- cold urticaria
- cryoglobulinemia
- infection
- over an area of compromised circulation
- over regenerating peripheral nerves
- paroxysmal cold hemoglobinuria
- peripheral vascular disease
- Raynauds
- skin anesthesia
**ACCPRO
5
Q
Ice massage
A
- typically performed by freezing water in a paper cup and then applying the ice directly to the treatment area
- a wooden tongue depressor can be frozen in water to form an ice popsicle
- Ideal for small or contoured areas
- the ice should be applied using small, overlapping circles or strokes
- an area 10 cm by 15cm can be covered in 5-10 min
6
Q
Cold pack
A
- typically contains silica gel and is available in a variety of shapes and sizes
- the gel remains in a semisolid form even at relatively low temp, which allows the cold pack to conform to the contour of the body
- cold packs are typically stored in a specializes cooling unit at approx 25 degrees Fahrenheit
- should be applied over a moist, cold towel to increase the initial magnitude of cooling. a cold pack should be applied for approx. 20 minutes
7
Q
cold bath
A
- cold bath is commonly used for the immersion of the distal extremity
- unlike many other forms of cryotherapy, a cold bath allows for circumferential contact with the cooling agent
- in the presence of edema, therapists should be mindful of the influence of a gravity- dependent position on the involved extremity during treatment
- water temp from 55-64 deg F
- a whirlpool or container of water with crushed ice can be used
- body part should be immersed for 15-20 minutes to attain the desired therapeutic effects. the lower the temp selected, the shorter the duration of treatment
- the intervention is often used as a component of a HEP
8
Q
controlled cold compression unit
A
- circulates cooled water through a sleeve that is applied to an extremity
- the water can be maintained at temp ranging from 50-77 deg F.
- compression is applied intermittently by inflating the sleeve with air with the goal of controlling inflammation and reducing edema in the extremity
- In post-operative situations, the sleeve may be placed on the patient’s involved extremity immediately after surgery
- the combined use of cold and compression is more effective than cold or compression alone in controlling inflammation
9
Q
cryo cuff
A
- is a cold water circulating unit that combines the benefits of cold with compression
- the cryocuff consists of a nylon sleeve that is connected to a specialized gallon container via a plastic tube.
- most commonly used on the knee, however it is available for a number of other areas of the body including the shoulder and the ankle
- the device is commonly employed post-operatively with the gioal of decreasing pain and the need for analgesic medications
10
Q
vapocolant spray
A
- produces rapid cooling through evaporation, with temp changes occurring superficially in the epidermis
- use to treat trigger points
- when using spray and stretch, therapists should identify the trigger point and make three to four sweeps with the spray in the direction of the muscle fibers
- the spray in the direction of the muscle fibers
- the spray must be applied in one direction only and not in a back and forth motion
- the spray should be applied at a 30 deg angle at a distance of 12-18 from skin
- vapocoolant sprays produce a counter- irritant stimulus to the cutaneous thermal afferent nerves that overlay the muscles
11
Q
Ultrasound
A
- common deep heating agent that transfers heat through conversion and elevates tissue temp to depth up to 5 cm. the modality uses high freq acoustic mechanical vibrations to produce thermal and nonthermal effects
- US has a freq above 20,000 hertz
12
Q
indications for ultrasound
A
- acute and post acute conditions
- calcium deposits
- chronic inflammation
- delayed soft tissue healing
- dermal ulcers
- joint contracture
- muscle spasm
- myofascial trigger points
- pain
- plantar warts
- scar tissue
- tissue regeneration
13
Q
contraindications for ultrasounds
A
- acute and post acute conditions
- areas of active bleeding
- areas of decr temp sensation
- areas of decr circulation
- deep vein thrombosis
- infection
- malignancy
- over breast implants
- over carotid sinus or cervical ganglia
- over epiphyseal areas in young children
- over eyes, heart and genitalia
- over methyl methacrylate cement or plastic
- over pelvic, lumbar or abdominal areas in pregnant women
- over a pacemaker
- thrombophlebitis
- vascular insufficiency
14
Q
Thermal effects of Ultrasound
A
- include acceleration of metabolic rate, modulation of pain, reduction of muscle spasm, decreased joint stiffness, alteration or nerve conduction velocity, incr circulation, and incr soft tissue extensibility
- the extent of the thermal effects is dependent on the intensity, durtaion, and freq selected
15
Q
Nonthermal effects of Ultrasound
A
- increased cell and skin membrane permeability, incr intracellular calcium levels, facilitation of tissue repair and promotion of normal cell function
- ## the nonthermal effects occur as a result of cavitation and acoustic microstreaming
16
Q
ultrasound intensity
A
- measures the quantity of energy delivered per unit area
17
Q
ultrasound FRequency
A
- is the primary detrminant in the depth of ultrasound penetration
- a freq setting of 1 MHz is used for deeper tissues while a setting of 3 MHz is used for more superficial tissues
18
Q
ultrasound duty cycle
A
- administered using a continuous or pulsed mode
- in cont, US intensity remains constant throughout the TX
- in pulsed mode, the US intensity is periodically interrupted
- the portion of TX time that US is generated during the entire TX is referred to as the duty cycle
19
Q
Continuous Ultrasound
A
- 100% duty cycle
- generates constant US waves producing thermal effects at higher intensities and nonthermal effects at lower intensities
20
Q
Pulsed Ultrasound
A
- with a duty cycle of 20% generates ultrasound 20% of the total treatment time (on time +off time)
- pulsed US results in a reduced avg hetaing of the tissues and is therefore used primarily for nonthermal effects
21
Q
US Duration
A
- an area two or three times the size of the transducer typically requires a duration of five minutes
22
Q
Advantages of US
A
- capable of reaching deeper tissues
- can produce thermal and nonthermal effects
- amount of energy delivered per unit area can be quantified
- covers small areas effectively
- short duration of TX
23
Q
Disadvantages of US
A
- may not maintain good contact on small or contoured areas causing uneven heating
- Pt may not tolerate direct contact with the US transducer
- Rate of tissue cooling is faster than other deep heating agents
24
Q
Electrotherapy Therapeutic Effects
A
- decr edema
- decr pain
- eliminate disuse atrophy
- facilitate bone repair
- facilitate wound healing
- improved ROM
- Incr local circulation
- muscle re-education
- muscle strengthening
- relaxation of muscle spasm
25
Indications for electrotherapy
- Bell's palsy
- decr ROM
- facial neuropathy
- fracture
- idiopathic scoliosis
- joint effusion
- labor and delivery
- muscle atrophy
- muscle spasm
- muscle weakness
- open wound/ulcer
- Pain
- stress incontinence
- shoulder subluxation
26
contraindication for electrotherapy
- cardiac arrhythmia
- cardiac pacemaker
- malignancy
- osteomyelitis
- over a pregnant uterus
- over carotid sinus
- Pt with a bladder stimulator
- Phlebitis
- seizure disorders
27
Therapeutic Currents
| - Direct Current
- constant flow of electrons from the anode to the cathode for a period of greater than one second without interruption
- polarity remains constant and is determined by the therapist based on TX goals
- direct current can be modulated for therapeutic use by interrupting the current flow after one second, reversing the polarity or gradually increasing or decr the amplitue
- clinically, direct current is most often used with iontophoresis
28
therapeutic currents
| -- alternating currents
- characterized by 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 characterized by a waveform that is sinusoidal in shape
- the freq of cycle of alternating current is measured in cycles per second or hertz
- alternating current is used most frequently in a modulated form as burst or time-modulated
29
therapeutic currents
| -- Pulsatile CUrrent
- characterized by the non-continuous flow of direct or alternating current
- a pulse is defined as a discrete electrical event separated from other pulses by a period of time in which no electrical activity exists
- most pulse waveforms are either monophasic or biohasic
- monophasic pulsed current has one phase for each pulse and therefore, the waveform is either positive or negative
- monophasic pulsed current produces a polarity effect since the current flows through the tissues in only one polarity for a given period of time
- Biphasic pulsed current has two phases, one which is positive and one which is negative
- Biphasic waveforms can be described as symmetric or asymmetric and balanced or unbalanced
30
Characteristics of electrical currents using Small electrodes
- incr current density
- inc impedance
- decr current flow
31
Characteristics of electrical currents using Large electrodes
- decr current density
- decr impedance
- incr current flow
32
Monopolar technique for Electrode Placement
- the stimulating or active electrode is placed over the target area
- a second dispersive electrode is placed at another site away from the target area
- typically, the active electrode is smaller than the dispersive electrode
- this technique is used with wounds, iontophoresis and in the TX of edema
33
bipolar technique for electrode placement
- two active electrodes are placed over the target area
- typically the electrodes are equal in size
- this technique is used for muscle weakness, neuromuscular facilitation, spasms and ROM
34
Parameters of Electrical Stimulation
| Amplitude
- refers to the magnitude of current
- avg amplitude refers to the avg amount of current supplied over a period of time, while peak amplitude refers to the max positive or negative point from zero where the pulse is maintained
- the peak amplitude must be large enough to exceed the threshold for the nerve or muscle cell
- amplitude controls are often labeled intensity or voltage and can be expressed in volts, microvolts or millivolts
- the higher the amplitude, the greater the peak amplitude
35
Parameters of Electrical Stimulation
| Rise Time
- is the time it takes for the current to move from zero to the peak intensity within each phase
- fast rise times are necessary with low capacitance tissues, such as large motor nerves
- rise times are typically very short ranging from nanoseconds to milliseconds
- by observing the graphical representation of a given pulse generated from an oscilloscope, therapists can gain a general sense of the rise time
- for example, a sine wave would exhibit a more gradual increase in amplitude compared to a rectangular wave which has an almost instantaneous increase in amplitude
- decay time is the time it takes for the current to move from the peak intensity to zero
36
Parameters of Electrical Stimulation
| Phase duration
- amount of time it takes for one phase of a pulse
- the phase begins when the current departs from the zero line and ends as the current returns to the zero line
-
37
Parameters of Electrical Stimulation
| pulse duration
amount of time it takes for two phases of a pulse with biphasic current
38
Parameters of Electrical Stimulation
| Frequency
- determines the number of pulses delivered through each channel per second
- freq controls are often labeled as rate and are expressed in pulses per second or Hertz
- the freq affects the number of action potentials elicited during the stimulation
- although a higher freq causes them to fire at a more rapid rate
39
Parameters of Electrical Stimulation
| Current Modulation
- refers to any alteration in the amplitude, duration or freq of the current during a series of pulses or cycle
- common categories of modulation include bursts, interrupted pulses, and ramp
40
Neuromuscular Electrical Stimulation NMES
- technique used to facilitate skeletal muscle activity
- stimulation of an innervated muscle occurs when an electrical stimulus of appropriate intensity and duration is administered to the corresponding peripheral nerve
- NMES is a commonly used therapeutic technique to facilitate the return of controlled functional muscular activity or to maintain postural alignment until recovery occurs
- place electrodes over the muscle to be stimulated aligned in parallel
41
NMES
| current amplitude
- amount of current amplitude is dependent on the desired strength of the contraction
- EX, a PT wpuld want a much more forceful muscle contraction for a patient participating in general muscle strengthening than for a patient recovering from a recent surgery
42
NMES
| - Pulse duration
- the pulse duration should be high enough to overcome the relatively low capacitance of motor nerve fibers
- despite the low capacitance, the relative depth of the muscle fibers requires a high pulse duration
- Pt often find shorter pulse duration more comfortable when targeting smaller muscles and longer pulse duration more comfortable when treating larger muscles
- PT should recognize that as the pulse duration is shortened, a greater current amplitude will be required to produce the same strength of contraction
43
NMES
| - FRequency
- should be sufficient to produce a tetanic contraction
- a smooth tetanic contraction is usually produced at a freq of 35-50 pulses per second
- higher freq will not produce a stronger contraction, but instead will promote more rapid fatigue
44
NMES
| - Duty cycle
- must be used when applying NMES to provide the muscle with relaxation time and limit the influence of fatigue
- On time should range from 6-10 sec while off time should be approx 5x longer
- the PT may elect to decrease the length of the off time in subsequent sessions based on patient progress
45
NMES
| - Ramp time
- a ramp allows current amplitude to gradually incr to a preset maximum and then gradually decr
- ramping is commonly used to made the onset of stimulation more comfortable when performing muscle strengthening
- based on an on time of 6-10 seconds, a ramp up time of 1-4 sec would be recommended
46
NMES
| - TX time
- Patients should complete a minimum of 10 contractions and a maximum of 20 contractions
- based on typical on and off times, performing 10 contractions would take approx 10 min while 20 contractions would take 20 minutes.
- TX should ideally take place a minimum of three times per week
47
Transcutaneous Electrical Nerve Stimulation
| TENS
- widely used for acute and chronic pain management
- main therapeutic effects of TENS include pain relief through the gate control theory of pain or the endogenous opiate pain control theory
- TENS units are portable and indicated for home use
48
Conventional TENS
- delivery of electrical pulses having short duration and high freq with low current amplitude
- Current amp should be sufficient to generate sensory response, but should be below the motor threshold
- Pain relief i usually brief and only occurs when the current is being generated
- used to relief pain during activities of daily living
49
Parameters for conventional TENS
- amplitude: Sufficient for a sensory response
- Pulse freq: High (30-150 pps)
- Pulse Duration: (short (50-100 pps)
- Treatment Time: Variable based on the duration of the activity
50
acupuncture like TENS
- delivery of electrical pulses that have long duration and low freq with moderate current amplitude
- the current amplitude should be sufficient to generate muscle twitching
- majority of pt report stimulus as uncomfortable or burning
- pain relief can last for several hours after stimulation
- most often used for pt requiring longer lasting pain relief
- not often used during ADLs since the muscle twitching can interfere with functional tasks
- TX is usually 20-45 minutes
51
Parameters for acupuncture-like TENS
- Amplitude: sufficient to produce muscle twitching
- Pulse freq: low (2-4 pps)
- Pulse Duration: Long (100-300 u sec)
- Treatment Time: 20-5 minutes
52
Brief intense TENS
- by delivery of electrical pulses having long duration and high freq with moderate current amplitude
- referred to as brief intense TENS since the applictaion is higher than some of teh other presented modes
- amp should be sufficient for strong paresthesia or a motor response
- Brief intense TENS is often used to minimize pain during therapeutic activities that may be painful
- TX time usually 15 minutes
53
Parameters for Brief intense TENS
- amplitude: sufficient for strong paresthesia or a motor response
- Pulse freq: high (60-200 pps)
- Pulse Duration: Long (150-500 usec)
- Treatment Time: 15 minutes
54
Noxious TENS
- characterized by high density current that is described by patients as uncomfortable or painful
- this mode of TENS is administered with a small probe type applicator or electrode
- stimulation is delivered in 30-60 second intervals to motor, acupuncture or trigger points
- noxious level stimulation should be applied to pt only after the therapist has thoroughly explained the expected sensation
55
Parameters of Noxious TENS
- amplitude: Highest tolerated stimulus
- Pulse freq: High or Low
- Pulse Duration: Long (250 usec up to 1 sec)
- Treatment Time: 30-60 sec for each point
56
Iontophoreses
- process by which ions are introduced into the body through the skin by means of continuous direct electrical stimulation
- based on the theory that like charges repel and ions in a solution of similar charge will move away from the electrical source and into the body
- the rate if ion delivery is determined by the concentration of teh ion, the pH of the solution, the current density and teh duration of the tx
57
ionto indications
- pain
- calcium deposits
- fungal infection
- hyperhidrosis
- inflammation
- ischemia
- keloids
- muscle spasm
- myositis ossificans
- plantar warts
- scar tissue
- wounds
58
ionto contra
- drug allergies
| - skin sensitivity reactions to specific ions
59
Ionto parameters
amt of electricity used when performing ionto is measured in milliamp minutes
- dosage ranges from 40-80 mA-min with ionto
- current amp should be adjusted to be comfortable for the pt
- current amp range from 1.0-4.0 mA
