Modalities Flashcards
Chemical activity in cells and metabolic rate will increase ___ for each ___ rise in temperature.
2-3 times; 10 deg C
temperature after which tissue will burn
45-50 deg C
use of heat modality (3)
- increase interstitial fluid and cause mild edema
- decrease pain
- in combination with stretch
superficial heat (3)
heats tissue within 0.5 cm from the surface
- hot packs
- paraffin
- fluidotherapy
moist heat pack
kept in ~160 deg F water
usual multiple layers of towel or cover and towel
needs 30 to reheat when returning to water
check after 5 min
15-20 min
DO NOT LIE ON TOP OFF
paraffin (4)
superficial, moist heat most commonly used for distal extremity
- dip and wrap - elevate hand
- dip and reimmerse - rarely used
- paraffin ‘packs’
- cooled paraffin - used for closed skin grafts
fluidotherapy
dry heat
temp and agitation can be controlled
usually 115-117 deg F
allows patient to exercise while heating
contraindications/precautions for superficial heat (5)
- circulatory impairment
- cancer at site of heat application
- sensation impairment
- easy bleeding
- infection
home program options - heat (3)
- heating pad
- microwave gel pads
- rice socks
use of cold modality (4)
- used in acute stages of inflammation
- reduction of muscle spasms
- reduction of pain
- decrease swelling
cold modalities (2)
- cold packs
2. ice massage
precautions for cold modalities (2)
- patients with cold-sensitivity (ex. Raynaud’s)
2. patients with circulatory-compromised areas
documentation of temperature modalities (4)
- thermal agent used
- duration
- body area treated
- position
ultrasound
deep heating agent
water-based gel used as a couple
uses of ultrasound (6)
- joint contracture
- scar tissue
- tendinitis
- bursitis
- muscle spasms
- pain
ultrasound - frequency
of oscillations a molecule undergoes in 1 second
1.0 MHz, 2.0 MHz, 3.0 MHz are used in therapy
frequency determines the depth of penetration
ultrasound depth with 1 MHz frequency
2-5 cm
ultrasound depth with 3 MHz frequency
up to 2 cm
ultrasound tissues (3)
US is absorbed in tissue high in protein (collagen)
- tendon
- ligament
- joint capsule
ultrasound wave settings (2)
- pulsed waves
2. continuous waves
pulsed ultrasound
used when the desired effect is non-thermal such as acute soft tissue injuries
US - duty cycle
the percentage of time the power is on during one pulse period
continuous ultrasound
provides a thermal effect
ultrasound - intensity
the rate at which energy is delivered per unit area (strength of the beam)
w/cm^2
joints with superficial skin coverage are usually treated at 1.0 w/cm^2
ultrasound - moving technique
speed = ~4 cm/second (slow)
area covered = 2-3x size of the head for every 5 minutes
ultrasound - precautions (12)
- DVT
- hemorrhagic conditions
- reproductive organs
- infections
- malignancy
- skin disease
- active epiphysis
- over heart, eyes, anterior neck, carotid sinus
- care over metal
- impaired circulation/sensation
- over plastic or cement implants
- over electronic device
uses of electrotherapy modalities (3)
- pain modulation
- muscle re-education
- facilitate tissue healing
therapeutic currents - direct (DC)
unidirectional flow of charged particles
used in iontophoresis, wound healing, and stimulation of denervated muscle
electrode should be large enough to cover target area and disperse the current evenly
therapeutic currents- alternating (AC)
bidirectional flow of charged particles
IFC (interferential current) for pain modulation
more comfortable than DC
burst-modulated AC is used for muscle strengthening
therapeutic currents - pulsed
flow of charged particles, unidirectional or bidirectional, that is delivered in finite periods of time before the next electrical event
used for pain modulation or neuromuscular reeducation
electrotherapy parameters (4)
- amplitude
- pulse and phase duration
- frequency
- current modulators
amplitude
intensity
pulse duration
the time that elapses from the beginning of the pulse to the end of the pulse
phase duration
the time that elapses from the beginning of the phase to the end of the phase
electrotherapy - frequency
of pulses (pulsed current), beat (IFC), cycles (AC) that are delivered in 1 second
current modulators
ramp-up to gradually increase to peak amplitude or clinical response
electrotherapy contraindications (5)
- pacemakers or other implanted electrical devices
- over a pregnant uterus
- over carotid sinus
- over thoracic region of body
- within area of DVT
electrotherapy precautions (6)
- pain that is serving as a protective function
- area of infection, malignancy, PVD
- excessive adipose tissue may require higher current amplitudes
- decreased sensation
- damaged or fragile skin or open skin surface
- history of electrode reaction
NMES - current
pulsed or burst-modulated AC
NMES - frequency
between 30-80 pps
NMES - current modulators
2 second ramp up
1 second ramp down
NMES - amplitude
needs to be set high enough to allow a strong contraction
NMES - time on/off
between 1:3 and 1:12 depending on muscle fatigue
uses of UE joint mobilization (3)
- remodel connective tissue to improve joint extensibility/reduce stiffness
- reduce pain and encourage relaxation
- bathe the joint with synovial fluid, externally nourishing joint structures
joint mobilization contraindications (6)
- joint replacement arthroplasties
- any fracture adjacent to the joints which is not clinically healed
- acute inflammatory or septic arthritis
- bone disease (i.e. osteomyelitis)
- bacterial infection
- malignancy/neoplastic disease
joint mobilization precautions (8)
- RA and OA
- osteoporosis
- fracture (acceptable once PROM is indicated)
- hypermobility
- inability for patient to relax
- presence of protective muscle spasm
- joint effusion/inflammation
- general debilitation
indications for joint mobilizations (4)
- hypomobility
- when there is potential for joint limitation
- whenever PROM is indicated (EXCEPT replacement arthroplasty)
- to decrease pain
osteokinematics
bone movements produced by 2 adjacent bones (flex/ext)
arthrokinematics
articular movements produced by 2 adjacent joint surfaces (accessory motions - roll, spin, glide)
concave on convex
concave surface glides same direction the bone is moving
convex on concave
convex surface glides opposite direction the bone is moving
Grade I joint mob
loosening movement is an extremely small traction force
Grade II joint mob
tightening movement first takes up the slack in the surrounding tissues and then tightens the tissues
Grade III joint mob
stretching movement is applied after the slack has been taken up and all tissues become taut
