Modalities

Question 1

Indications of cryotherapy?

Answer 1

• active acute inflammatory response

- before ROM exercises, after physical activity

Question 2

Indications of thermotherapy?

Answer 2

• control inflammatory reaction in subacute or chronic stages
• encourage tissue healing
• promote venous drainage
• reduce edema and ecchymosis
• improve ROM before physical activity

Question 3

What is radiation?

Answer 3

heat transferred from one object to another

ex. shortwave diathermy, UV therapy

Question 4

What is conversion?

Answer 4

heat generated from another energy source (ex. sound, electricity, chemical agents)
ex. ultrasound

Question 5

What is evaporation?

Answer 5

heat transferred from a surface when liquid becomes a gas

ex. sweat, vapocoolant spray

Question 6

What is convection?

Answer 6

heat transferred through movement of fluid or gas

• factors that may influence the heating are temperature, speed of movement, and conductivity
  ex. whirlpool

Question 7

What is conduction?

Answer 7

heat transferred from direct contact between two objects

ex. moist heat pack, paraffin, ice pack

Question 8

What should the temperature range of cold modalities be?

Answer 8

0-18 degrees C

Question 9

What are the physiological effects of cryotherapy?

Answer 9

• vasoconstriction of arterioles and venules
• increases blood viscosity = reduces blood flow
• lowers metabolic rate = decreases ischemic injury, waste products, muscle fatigue, and increases muscular contraction
• reduction of new swelling
• decreases collagen elasticity
• decreases free nerve ending excitability = decreased pain perception

Question 10

Explain the Hunting Response.

Answer 10

phenomenon causing slight temperature increase during cooling

Question 11

Contraindications of cryotherapy?

Answer 11

• cold allergy
• Raynaud’s
• circulatory or sensory impairment
• advanced diabetes
• arthritis
• hypertension
• deep vein thrombosis
• hypo or hyper cold sensitivity
• uncovered open wounds
• nerve palsy
• cardio/respiratory disorders
• hemoglobinemia
• lupus

Question 12

What does CBAN stand for and how long is each portion?

Answer 12

C- Cold (0-3 mins)
B - Burning (2-7 mins)
A - Aching (2-7 mins)
N - Numbness (5-12 mins)
\+ Analgesia (18-21 mins)

Question 13

What is the cryokinetic cycle?

Answer 13

1. numb the area (12-20 min, following CBAN)
2. exercises within pain limits - must be PF, should be active, should focus on flexibility and strength, should progress as quickly as possible)
3. when numbness wears off, reapply for 3-5 mins
4. Repeat cycle 5 times

Question 14

What pain theory is used in thermotherapy?

Answer 14

Gate control theory

Question 15

What is the Piezoelectric effect?

Answer 15

expansion and contraction of crystals in an ultrasound head produces an oscillation voltage

Question 16

Explain what the frequency parameter of an ultrasound is.

Answer 16

1MHz - energy is absorbed by deeper tissues - 3-5cm

3MHz - energy is absorbed by superficial tissues - 1-2cm

Question 17

What does BNR stand for and what does it mean?

Answer 17

Beam Nonuniformity Ratio - the amount of variability of intensity in the beam
- lower BNR = more uniform

Question 18

What is ultrasound intensity?

Answer 18

amount of energy delivered to sound head in w/cm2

Question 19

Which sensory nerve fibres are large, slightly myelinated, fat, produce instant pain, withdrawal, and acute pain?

Answer 19

A-delta fibres

Question 20

Which sensory nerve fibers are slow, unmyelinated, produce throbbing, pressure, chronic pain?

Answer 20

C-Fibers

Question 21

Which sensory nerve fibers are large, myelinated, fast, and produce a nonpainful stimuli?

Answer 21

A-alpha and A-beta fibers

Question 22

Explain the Gate Control theory.

Answer 22

• only allows one sensation to pass through the brain at a time, acute
• stimulation of a-beta blocks the impulses at the spinal cord level of pain messages carried by a-delta and c-fibers
  ex. TENS, massage, cryotherapy

Question 23

Explain the Endorphin Release theory.

Answer 23

operates at supraspinal and spinal levels

• prolonged stimulation of a-delta and c-fibers trigger release of beta endorphins by the ant. pituitary
• beta endorphins bind to opiate binding sites in the nervous system and have long half-life (multiple hour analgesic effect)
• chronic pain

Question 24

What are the 3 types of currents?

Answer 24

1. Direct - uninterrupted, monophasic or galvantic
2. Alternating - uninterrupted, bidirectional, biphasic, ex. premod, IFC, TENS
3. Pulsed - interrupted by discrete periods of no electron flow, 3+ pulses grouped together, uni or bidirectional, ex. NMES, Russian, High Volt

Question 25

What is the All or None Law in regards to electrical stimulation in a kinetic tissue response?

Answer 25

• all muscle fibres in a motor unit contract in response to a single action potential in the nerve

Question 26

What are the contraindications of NMES?

Answer 26

• metal implants, pacemaker
• cancer
• pregnancy
• hx of seizures, epilepsy
• cardiac disability
• over ant cranium, thorax, chest
• circulation issues,
• altered sensation
• open wounds, blood clots

Question 27

Review NMES chart and biphasic vs russian waves!!

Answer 27

DO IT!!

Question 28

What are the contraindications of TENS and IFC?

Answer 28

• over anterior cervical area
• pacemaker, metal implants
• damaged skin
• hemorrhagic area
• altered sensations
• pregnancy
• epilepsy

Question 29

What does TENS stand for?

Answer 29

Transcutaneous Electrical Nerve Stimulation

Question 30

Review TENS low vs high frequency and chart.

Answer 30

If you do it you can have a snack.

Question 31

Review IFC guidelines!!

Answer 31

Again…. it’s for your own good.