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AT 552: Modalities > Modalities E-Stim and Cryo > Flashcards

Modalities E-Stim and Cryo Flashcards

1
Q

Muscle Re-Education

A
  • 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)
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2
Q

Evidence for NMES

A
  • Can increase isokinetic strength = 65 degrees/sec

- Only use NMES when pt is struggling to contract on own (literature supports voluntary contraction is better)

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3
Q

Muscle Re-Education Parameters (Russian)

A 
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
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4
Q

E-Stim for Muscle Spasm

A

-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

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5
Q

Muscle Spasm Parameters

A 
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
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6
Q

E-Stim for Edema Reduction

A
  • Muscle contractions aide by manually forcing fluids from extremities to heart
  • Primary way: Motor-Level Stim
  • Use reciprocal contractions “milking” effect
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7
Q

Motor-Level Edema Parameters

A 
Gentle: 1-10 pps
No signs of pain: 30-50 pps
Intensity: Visible contraction
Agonist Contract: 5-10 sec
Antagonist Contract: 5-10 sec
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8
Q

High Volt Pulsed Current (HVPC)

A

-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

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9
Q

Russian E-Stim

A
  • 10/50/10: 10 sec on/50 sec off/ 10 minutes

- Preferential for type II muscle fiber recruitment

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10
Q

Russian Parameters

A 
Carrier Freq: 2500 Hz
Amp: muscle contract
Freq: 30-60 pps
Burst Duty cyle: 50%
On/off duty cyle: 1:5
time: 10 minutes
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11
Q

Biphasic Parameters

A 
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
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12
Q
  1. Conduction
A

=Heat loss or gain through DIRECT contact

  • Temp change dependent on:
    1. Temp difference
    2. duration
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13
Q
  1. Convection
A

=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
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14
Q
  1. Radiation
A

=EMISSION of energy

-May be emitted from a source then absorbed by body

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15
Q
  1. Conversion
A

=CHANGING from one energy to another

-i.e. ultrasound- converts acoustic energy to thermal energy

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16
Q
  1. Evaporation
A

=Thermal energy must be removed to undergo a PHASE CHANGE from liquid to gas
-i.e. Vapo-Coolant sprays

17
Q

Cryotherapy

A
  • 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
18
Q

Heat Transfer

A
  • Cold modalities work by removing the heat in the tissue
  • Hot to Cold always
  • One object must have higher temp than other
19
Q

Factors Influencing Depth and Duration of Treatment

A
  • Adipose tissue is the primary limiting factor affecting the depth of penetration
  • Thinner pt = shorter tx time
  • External insulator(towel) = longer tx time
20
Q

Primary Rationale Use of Cryotherapy

A

= 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

21
Q

Local Effects of Cold Modalities: Cellular Response

A

= Decrease cell metabolism leads to decrease need for O2

22
Q

Local Effects of Cold Modalities: Blood and Fluid dynamics

A
  • Vasoconstriction
  • Decrease blood flow to area
  • Decrease hydrostatic pressure
  • Decrease capillary permeability
23
Q

Local Effects of Cold Modalities: Nerve Conduction

A
  • Decrease afferent nerve conduction

- Decrease threshold of afferent nerve endings

24
Q

Local Effects of Cold Modalities: Inflammation

A
  • Decrease inflammation
  • Decrease release of inflammatory mediators
  • Decrease prostaglandin synthesis
  • Decrease capillary permeability
25
Q

Local Effects of Cold Modalities: Muscle spasm

A
  • Decrease sensitivity of muscle spindle

- Breaks pain-spasm-pain cycle

26
Q

Pain Control through Cold Therapy

A
  • Stimulates large Abeta nerve fibers
  • Reduces nerve conduction velocity and amplitude
  • Reduces muscle spasm
  • Controls edema
  • Gate control theory
27
Q

Indications for Cryotherapy

A
  • 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
28
Q

Contraindications for Cryotherapy

A
  • 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
29
Q

POLICE

A
  • Protection
  • Optimal
  • Loading
  • Ice
  • Compression
  • Elevation
30
Q

Reusable Cold Packs

A 
=Silica, water, and antifreeze
Advantage: cost effective
Disadvantages: risk of frostbite
-Poor conformation to body
-Doesn't undergo phase change
31
Q

Instant Cold Packs

A

=2 chemicals separated by barrier
Advantages: portable, quick to use
Disadvantages: one-time use, looses cooling quickly, chemicals are caustic to skin

32
Q

Cold Compression Therapy Units

A

-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

33
Q

Ice Massage

A

Advantages: convient self-tx, cost and time effective
Disadvantages: only small areas, and no compression
time: 5-10 minutes

34
Q

Col Whirlpool

A

= uses Convection for large areas
Indications: Decreased ROM, subacute or chronic, peripheral vascular disease
Contraindications: Acute conditions, postural support

35
Q

Whirlpool parts

A

Primary turbine regulates water and air:

  1. Water turbulence valve
  2. Water aeration valve
  3. Aeration outlet
  4. Water outlet
  5. Water intake
36
Q

Cold Water Immersion

A

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

37
Q

Cryostretch

A

= 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

AT 552: Modalities (6 decks)

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