Modalities E-Stim and Cryo Flashcards
Muscle Re-Education
- Muscle inhibition after surgery
- Neuromuscular mechanism for contraction still intact
- CNS inhibition is the cause: Local swelling, Pain, atrophy
- Electrical impulses increase sensory input to muscle(pt feels sensation of contraction, pt voluntarily contracts)
Evidence for NMES
- Can increase isokinetic strength = 65 degrees/sec
- Only use NMES when pt is struggling to contract on own (literature supports voluntary contraction is better)
Muscle Re-Education Parameters (Russian)
Carrier Frequency: 2500-5000 Hz Freq: 30-60 pps Intensity: visible muscle contraction Ramp: 1:5(20%) at first, then 1:3(30%) then 1:2(50%) Time: 15-20 minutes *10 seconds on 50 Seconds off
E-Stim for Muscle Spasm
-Not a muscle cramp, but a low-grade contraction or tightness
-Goal: break the pain-spasm-pain cycle via involuntary tetanic contractions
- Increase local circulation
- Remove metabolic waste
- Mechanically stimulate muscle fibers
- Induce muscle fatigue
Contraindications = Acute injuries and local instability
Muscle Spasm Parameters
Pulse rate: 50-60 pps Intensity: visible contraction Duty cyle: 10 sec on/10 sec off Ramp: 1-2 sec on/1-2 sec off Time: 10-20 minutes No voluntary contractions necessary
E-Stim for Edema Reduction
- Muscle contractions aide by manually forcing fluids from extremities to heart
- Primary way: Motor-Level Stim
- Use reciprocal contractions “milking” effect
Motor-Level Edema Parameters
Gentle: 1-10 pps No signs of pain: 30-50 pps Intensity: Visible contraction Agonist Contract: 5-10 sec Antagonist Contract: 5-10 sec
High Volt Pulsed Current (HVPC)
-Monophasic Neg charge
-Decrease capillary permeability(WBC’s)
Freq: 120 pps
Intensity: Sensory only, no contraction
Polarity: cathode (-) over injured tissue
-Dispersive(+) pad over another body part
Time: 4x30 mins with 60 min rest intervals
Russian E-Stim
- 10/50/10: 10 sec on/50 sec off/ 10 minutes
- Preferential for type II muscle fiber recruitment
Russian Parameters
Carrier Freq: 2500 Hz Amp: muscle contract Freq: 30-60 pps Burst Duty cyle: 50% On/off duty cyle: 1:5 time: 10 minutes
Biphasic Parameters
Freq: 1-200 pps Phase Duration: 20-300 Micro seconds Intrapulse interval: 100 micro seconds Intensity: contraction Burst duty cycle: 40-50% On/Off duty cycle: 1:5, 1:3 Ramp: 1-3 seconds Note: Lower frequency = higher phase duration
- Conduction
=Heat loss or gain through DIRECT contact
- Temp change dependent on:
1. Temp difference
2. duration
- Convection
=Heat loss or gain through MVMT OF FLUID OR AIR between regions of unequal temp
- Temp change dependent on
1. Temp difference
2. Duration
3. Size of tx area
- Radiation
=EMISSION of energy
-May be emitted from a source then absorbed by body
- Conversion
=CHANGING from one energy to another
-i.e. ultrasound- converts acoustic energy to thermal energy
- Evaporation
=Thermal energy must be removed to undergo a PHASE CHANGE from liquid to gas
-i.e. Vapo-Coolant sprays
Cryotherapy
- Heat is REMOVED from body and absorbed by the cold modality
- Application of cold modalities that have a temp range btw 32-65 Degrees F
Heat Transfer
- Cold modalities work by removing the heat in the tissue
- Hot to Cold always
- One object must have higher temp than other
Factors Influencing Depth and Duration of Treatment
- Adipose tissue is the primary limiting factor affecting the depth of penetration
- Thinner pt = shorter tx time
- External insulator(towel) = longer tx time
Primary Rationale Use of Cryotherapy
= To decrease the metabolic rate of tissue: Reduce demands for O2 in tissue and limits secondary hypoxic injury
-Max temp for reduction of cell metabolism = 50-59 degrees F
Local Effects of Cold Modalities: Cellular Response
= Decrease cell metabolism leads to decrease need for O2
Local Effects of Cold Modalities: Blood and Fluid dynamics
- Vasoconstriction
- Decrease blood flow to area
- Decrease hydrostatic pressure
- Decrease capillary permeability
Local Effects of Cold Modalities: Nerve Conduction
- Decrease afferent nerve conduction
- Decrease threshold of afferent nerve endings
Local Effects of Cold Modalities: Inflammation
- Decrease inflammation
- Decrease release of inflammatory mediators
- Decrease prostaglandin synthesis
- Decrease capillary permeability
Local Effects of Cold Modalities: Muscle spasm
- Decrease sensitivity of muscle spindle
- Breaks pain-spasm-pain cycle
Pain Control through Cold Therapy
- Stimulates large Abeta nerve fibers
- Reduces nerve conduction velocity and amplitude
- Reduces muscle spasm
- Controls edema
- Gate control theory
Indications for Cryotherapy
- Acute injury or inflammation
- Acute or chronic pain
- Post-surgical pain
- Cyrokinetics(ice + ROM)
- Small, superficial burns
- Acute or chronic muscle spasm
- Neuralgia(nerve pain)
- Spasticity secondary to CNS disorders
Contraindications for Cryotherapy
- Cold allergy
- Cardiac/Respiratory involvment
- PVD/circulatroy insufficiency
- Wounds
- Anesthetic skin - lost sensation
- Advanced diabetes
- Raynaud’s phenomenon: blood vessels spasm
- Prolonged application on superficial nerves
POLICE
- Protection
- Optimal
- Loading
- Ice
- Compression
- Elevation
Reusable Cold Packs
=Silica, water, and antifreeze Advantage: cost effective Disadvantages: risk of frostbite -Poor conformation to body -Doesn't undergo phase change
Instant Cold Packs
=2 chemicals separated by barrier
Advantages: portable, quick to use
Disadvantages: one-time use, looses cooling quickly, chemicals are caustic to skin
Cold Compression Therapy Units
-Combines static external compression with cold application
-Less tissue cooling compared to ice pack
-Keep tx area elevated
-Provides 40mmHG circumferential compression
Advantages: PRICE, reusable, Circumferential compression
Disadvantages: initial investment, set-up/clean up, only for extremities
Ice Massage
Advantages: convient self-tx, cost and time effective
Disadvantages: only small areas, and no compression
time: 5-10 minutes
Col Whirlpool
= uses Convection for large areas
Indications: Decreased ROM, subacute or chronic, peripheral vascular disease
Contraindications: Acute conditions, postural support
Whirlpool parts
Primary turbine regulates water and air:
- Water turbulence valve
- Water aeration valve
- Aeration outlet
- Water outlet
- Water intake
Cold Water Immersion
Temp: 40-50 degree F
time: 10-15 mins
use: extremities
-have to move around so thermopane does not develop
Indications: acute/ inflammation, chronic, post surgical
Precautions: dependent position, nerve palsy, uncomfortable
Cryostretch
= Vaso-Coolant spray:
- Decreases skin temp and decreases pain
- AT adds gentle passive stretch to relieve spasm
- i.e. flouromethane spray
- Gate control theory - reduces intensity and speed of pain
Indications: Trigger point, muscle spasm, Decreased ROM, ACUTE pain
Contraindications: allergic, post surgical, open wounds, face and eyes
