Modalities Final Flashcards
1
Q
Ultraviolet is classified as a ____________ modality.
A
Photochemical
2
Q
Ultraviolet treatment time
A
15 seconds-3 minutes
3
Q
UVC frequency
A
1,800-2,900 A; fastest frequency, shortest wavelength
4
Q
UVB frequency
A
2,900-3,200 A
5
Q
UVA frequency
A
3,200-4,000 A (visible light is ~4000)
6
Q
Main applications of ultraviolet therapy
A
Wound care, psoriasis
7
Q
Which ultraviolet wavelengths create inflammatory response in the skin?
A
UVB and UVC
8
Q
Which wavelengths are best for enhanced production of vitamin D?
A
UVB/UVC
9
Q
Which UV wavelength is bacterocidal?
A
UVC
10
Q
Which UV wavelengths enhance the release of histamine?
A
UVB and UVC
11
Q
Which UV wavelengths have an esophylactic effect? What does esophylactic mean?
A
UVA and UVB; esophylactic means something about enhanced WBC production and improved immune response. Edit this card if you understand it better!
12
Q
What is the name of the test for UV light dosage? From this test, how is dosage determined?
A
Minimal erythemia dosage (MED) test for photosensitivity, uses paper with holes cut out; treatment time is when redness just begins.
13
Q
UV contraindications
A
photosensitive medications and food, exacerbation of a medical condition (Lupus, connective tissue disease, diabetes, hyperthyroid), acute skin conditions (dermatitis, cellulitis), medical instability, intolerance, fever, other forms of radiation (cancer treatment), always protect eyes, genitalia, and sensitive areas
14
Q
What does LASER stand for?
A
Light Amplification by Stimulated Emission of Radiation
15
Q
What is the wavelength of laser band?
A
6,000-10,000 A (from red to infrared)
16
Q
Indications for low level laser therapy
A
Scar reduction (increase cellular activity by enhancing the inflammatory response)
17
Q
Describe the characteristics of laser radiation
A
monochromatic, concentrated and coherent (non dispersed), collimated (all waves parallel and in same phase)
18
Q
Short wavelength (visible red) depth of penetration?
A
up to 1cm
19
Q
Use of short wavelength laser
A
skin wounds, superficial trigger points
20
Q
UVA and UVB stimulate new cells in which layer of skin?
A
Basilar layers are stimulated by UV radiation (skin cancer=uncontrolled cell division in this dermal layer)
21
Q
What is the rationale for using laser therapy on scar tissue?
A
Immune response enhances cellular activity
22
Q
LLLT physiological effects
A
absorption in mitochondria, increase in ATP synthesis, increase in protein synthesis and cell proliferation, allowing for tissue repair and pain control
23
Q
T/F: LLLT decreases NCV better than cryotherapy
A
FALSE!
24
Q
Define dosage for LLLT/cold laser
A
Dosage (j/cm2=power(W)xtime(sec)/A(cm2)
energy/area
25
appropriate dosage range for tissue healing
1.0-6.0 j/cm2
26
in laser therapy, how does power relate to penetration? how is tx time adjusted for power?
higher power enhances penetration; treatment time should be decreased if power is increased
27
Summarize findings regarding benefits of LLLT/cold laser based on the studies that were cited in lecture: LLLT for acute wound, soft tissue injury
Acute wounds: increased collagen formation, healing rate, decreased size of wound
Soft tissue injury: decreased pain, accelerated inflammatory response
Chronic soft tissue injury: decreased pain, accelerated inflammatory response
28
Is an MED test necessary for laser therapy?
NO!
29
T/F: LLLT could be used after vigorous treatment, such as deep friction massage for the treatment of soft tissue injury
TRUE!
30
General clinical guideline: treatment of superficial lesions using cold laser
600-700nm
31
What was a finding pertaining to the use of LLLT for trigger point?
Decreased pain, decreased trigger point activity, elevated beta endorphin levels, decrease in NCV
32
T/F: laser is applied similar to ultrasound, by moving the source continuously over the treatment area.
FALSE! Stationary technique, in contact with skin or within 1cm of skin
33
T/F: placing the laser source on the skin shunts blood away from the area, increasing penetration.
TRUE!
34
Contraindications of laser therapy
active cancerous tissue, acute infection, photophobia, photosensitivity, over thyroid gland, over fetus or uterus during pregnancy, over tattoos (prevents absorption, more power necessary to penetrate same depth), presence of other photosensitive mediation, direct eye contact
35
Grid technique
Laser: treatment area ~1cm2
36
In electrical stimulation, which is more excitable: nerve or muscle tissue?
NERVE!
37
Describe characteristics of nerve fiber that contributes to its excitability
nerve diameter, degree of myelination
38
At a short pulse width, is intensity lower or higher than at a wide pulse width?
higher
39
At what pulse width (wide or narrow) is sensory discrimination the best, meaning there is more time between each phase?
Short pulse width allows for greater discrimination between sensory, motor and pain
40
Ohm's Law (intensity)
I=V/R
Intensity=voltage/resistance
unit: milliAmps (mA)
41
1mA=___A?
1mA=.001A
42
Direct current: define
current flows continuously in 1 direction, pulse width wide (i.e. greater than 1 second)
43
alternating current: define
current flows in 2 directions, each pulse is less than 1 second. measured in milliseconds
44
Pulsatile current: define
can be 1 or 2 directions, non continuous, microseconds; contain a pulse and an interpulse interval
45
pulse intensity
amplitude, height of pulse, dictates whether the stim is sensory, motor or painful to subject
46
pulse frequence
pulse rate (pps, bps, Hz)
47
pulse modulation
continuous, interrupted, ramped, duty cycle
48
how could pulse modulation be adjusted to avoid fatigue?
Increase off time, ramp the on time, avoid continuous modulation
49
unipolar technique
one small ("active") electrode, one large ("disperser"); active electrode concentrates current in a small area; practical-used under 1st metatarsal head for wound healing
50
T/F: ultrasound sound head can be used as an electrode
TRUE!
51
Describe how DC current can be dangerous to the skin
Salt water in body attracted to the positive and negative charges of a DC current; hydrogen and chloride ions form HCl; Na and OH form NAOH. NAOH is harmful and leads to skin reaction
52
electrical acupuncture point
area of strongest non-painful sensory stimulation at a given intensity
53
motor point
strongest motor response at a given intensity
54
trigger point
strongest painful sensation at a given intensity
55
list contraindications for estim
near carotid sinus, active cancerous tissue, active infection, blood clot, hemorrhaging, cognitive impairment, lack of sensation, sensitivity or fear
56
Can estim be used over recently sutured or unhealed tissue?
Yes, but avoid motor level intensity to avoid mechanical stress on healing tissue
57
What areas would you avoid putting stim directly over?
area of severe edema, over implanted device (e.g. pacemaker), over superficial metal implants, joint replacement, over the uterus during pregnancy, over open would (for protocol OTHER than wound healing)
58
In a lesion of the CNS, can peripheral nerves be e-stim-ed?
YES!
59
Describe the Gate Theory of Pain
Stimulating A fibers (dorsal/sensory horn) with non-noxious stimuli activates the SG, allowing for presynaptic inhibition at the T cell (a "gateway" to the SC and brain that would allow for a pain signal if the SG is not activated)
60
How is the Gate Theory of Pain applied in estim?
Use sensory-level intenstiy to stimulate non-noxious A fibers; Conventional TENS uses comfortable sensory stim at a high frequency and narrow pulse width (better sensory discrimination)
61
Treatment rationale for low frequency TENS
release of endogenous opiates
62
Electrode placement-low frequency TENS
electrical acupuncture points because they have less resistance
63
hyper stim TENS: rationale
use of noxious but tolerable stimulation to activate descending serotonergic pathways
64
Describe electrode placement for hyper stim TEnS
unipolar technique: small electrode on trigger point, large electrode out of the area
65
Treatment time for hyper stim TENS
30-60 sec.
66
Low frequency TENS: intensity
strong sensory local motor
67
hyper stim TENS intensity
noxious but tolerable
68
Conventional TENS intensity
comfortable sensory
69
2 factors that influence pulse intensity
resistance and voltage
70
bipolar technique
both electrodes active, same size
71
anode attracts...?
anions, because the anode is positively charged
72
cathode charge?
negative; attracts cations
73
Rationale for muscle strengthening e stim protocol?
Better overall recruitment of muscles (stim plus active contraction); more selective recruitment of type II fibers (axons have a wider diameter); synchronous contraction excites everything, and may provide a more demanding exercise stimulus
74
Muscle strengthening protocol: intensity
Strong motor, ~70% of max voluntary contraction
75
At what frequency does a pulse become tetanizing?
About 30-35 pps
76
Electrode placement for muscle strengthening
motor poitn
77
Uses for neuromuscular electric stimulation
muscle strengthening, neuromuscular facilitation, functional e-stim
78
Rationale for neuromuscular facilitation/activation NMES?
enhance cortical reorganization minimize atrophy, maintain ROM, prevent disuse
79
Electro osmosis rationale
use polarity to mobilize edema
80
Electro osmosis intensity
anything submotor
81
T/F: electro osmosis can be twitching or tetanic frequency
TRUE! 1pps twitches 50pps tetanizes
82
median nerve: cutaneous innervation in hand
digits 1,2,3 plus radial half of digit 4
83
ulnar nerve lesion: sensory innervation
ulnar, palmar aspect of forearm, to pinky and half marriage finger
84
ulnar nerve lesion motor loss if injury occurred at elbow
adductor pollicis and a lot of intrinsics will be weak (DAB, PAD), hypothenar eminence muscles weak, 4 and 5 lumbricals would be weak, FDP – 4 and 5 DIP flexion will be weak or absent
85
radial nerve damage sensory loss
dorsum of forearm and hand
86
radial nerve lesion motor impairment
wrist extensors, triceps depending on the level of injury
87
What type of waveform would you use to conduct an R/D test?
pulsatile or AC current
88
R/D test: unipolar or bipolar?
unipolar
89
R/D test: if muscle responds with PC, result is called
no R/D
90
what is partial R/D?
when a muscle responds to PC, but only weakly
91
if no response is observed with PC in an R/D test, what next?
use DC
92
Using DC current in an R/D test, the muscle is excitable. what is this result called?
full R/D
93
A muscle does not respond to a DC current. What is this called? what does this mean?
absolute R/D; muscle atrophy severe enough that there is enough fibrotic tissue to interfere with the electrical stimulation
94
T/F: nerve is more excitable to short duration currents
TRUE!
95
Using a DC current for an R/D test, what are the 2 possible outcomes (assuming the PC current produced no contraction?)
Full R/D: response with DC
| Absolute R/D: no contraction with DC
96
Using a PC current for an R/D test, what are the 2 possible outcomes?
No R/D: full contraction with PC
| Partial R/D: weak contraction with PC
97
What is rheobase intensity?
Intensity required to produce a minimal visible contraction at a pulse width of 300 millisec (very wide); normal: 2-8mA
98
Chronaxie setting
Twice the rheobase value (individual)
99
What is a chronaximeter?
Machine, has a rheobase setting which locks the pulse wide at 300msec. When rheobase intensity is determine (between about 2-8milliAmps) "chronaxie" setting doubles the rheobase intensity but brings the pulse width to 0. Bring up pulse duration (intensity locked at rheobase value) and observe MVC. In normal individuals, MVC will occur within 1 millisec.
100
On a strength duration curve (PI vs. PW), how is a deinnervated muscle slope different from a normally innervated muscle?
A denervated muscle slope is shifted UP and RIGHT, indicating that at any pulse width, greater intensity is needed and that wider pulse widths are necessary to excite muscle
101
What questions does chronaxie test answer?
What pulse width is required to elecit a contraction?
102
If chronaxie gets lower, peripheral nerve is...
regenerating!
103
What type of current is used in iontophoresis?
Direct current only!
104
Iontophoresis dosage
dosage=intensityxtime
ex) dosage=1mAx40min=40mAmin
(to avoid skin irritation, lower intensity and increase treatment time, same dosage)
105
charge of Mg, therapeutic effects
+POSITIVE+! vasodilator, analgesic, anti-spasmatic
106
charge of Iodine, therapeutic effects
-NEGATIVE-! loosens scar tissue
107
hydrocortisone: charge and therapeutic effect
+POSITIVE+! anti-inflammatory, inhibits prostaglandin production
108
Licocaine: charge, therapeutic effect
+POSITIVE+! numbing agent/anesthetic
109
Salicylate: charge and therapeutic effect
-NEGATIVE-! non-steroidal analgesic/anti-inflammatory
110
Acetate: charge, therapeutic effect
-NEGATIVE! breaks down calcium deposits, beneficial in acute stage
111
Iontophoresis rationale
use direct current to drive the ions of a medication into skin using polarity
112
Iontophoresis: does the medication go on the electrode with the like charge or the opposite charge?
Medication goes on the like charge electrode! Electrode will repel medication away from itself--through the skin
113
Iontophoresis intensity
Never exceed 4milliAmps!
114
Wound healing e-stim rationale
use polarity to stimulate cells through the inflammatory and proliferative phases of healing; add electrical potential to attract cells to area (chronic wounds)
115
Wound healing: type of current
unipolar: positive electrode over wound
116
Treatment time: wound healing estim
1-2 hours
117
define biofeedback
use of external cues (auditory/visual) to help shape a physiological response
118
T/F: EMG biofeedback can only be used when the goal is increasing muscle recruitment
FALSE!
119
what are the 3 electrode placements for EMG biofeedback?
active electrode: on muscle belly
reference electrode: distal to active
ground: somewhere in between or adjacent
120
what is the role of the ground electrode in EMG biofeedback?
eliminates noise in the environment
