Modality Basics Flashcards
Hydrotherapy Indications
Superficial cooling or heating Wound care (not in the whirl pool) Water exercise Pain control Edema control
Hydrotherapy Contraindications
Local:
Maceration around the wound; bleeding
Full body:
Cardiac instability, infectious conditions that may be spread by water, bowel/bladder incontinence, severe epilepsy, suicidal thoughts/tendencies
What temperature of hydrotherapy reduces inflammation?
Cold
32-79 deg F
What temperature is medium for exercise?
Hydrotherapy
Tepid water
79-92 deg F
What is neutral warmth (92-96 deg F) used for?
Hydrotherapy
Control tone for neurologically based hypertonicity
Circulatory, sensory, cardiac disorders
What is the purpose for the application of mild warmth (96-98 deg F) hydrotherapy?
Burns after epithelialization has begun
Promotes mobility, relaxation
What is the purpose of hot (99-104 deg F) hydrotherapy?
Pain control
Increase soft tissue extensibility
Large areas of immersion
What is the purpose of applying very hot (104-110) hydrotherapy?
Pain control
Increase soft tissue extensibility
Limited body area
OA/RA Nona cute stage
Documentation of Hydrotherapy
Type: (thermal, cryotherapy, whirlpool, bath)
Patient position and types of movement
Water temperature
Duration
Patient response
Fluid pressure or additives if applicable
What are the different types of superficial heat?
Hot packs Paraffin- wax bath Contrast bath Fluidotherapy Infrared lamps Whirlpool
What are the indications for using superficial heat?
Promotes soft tissue healing Promotes general relaxation Decrease joint stiffness Pain- decrease/ control May help to reduce the effects of skin conditions
What is the optimum dosage/ therapeutic range of superficial heat?
Tissue should be heated to 104-113 deg F
What are the methods of paraffin application?
Continuous immersion/ dip immersion
Dip immersion w/ wrapping
Paining/ brushing with wrapping
What are the contraindications of therapy?
Area of recent or potential hemorrhage Impaired sensation/ mentation Over malignant area/ tumor Thrombophlebitis Over abdominal, pelvic and low back areas of a pregnant woman Infrared - irradiation of the eyes
Thermotherapy Documentation
Area treated Heating agent type Treatment parameters (temp, power, insulation, distance) Patient positioning Response to intervention
Types of cryotherapy
Ice pack, cup Gel, chemical packs Cryopressure units Vapocoolant sprays Cryohydrotherapy Cooling suirs
What are the indications for cryotherapy?
Abnormal tone Acute or chronic pain Acute or subacute inflammation Bursitis Muscle spasm Musculoskeletal trauma Myofascial trigger points Tendonitis Tenosynovitis
What are the contraindications of cryotherapy
Cold allergy/hypersensitivity (cold urticaria) Cold intolerance Raynaud's disease Cryoglobulinemia Paroxysmal cold hemoglobinuria Over regenerating peripheral nerves Over areas of circulatory compromise Inability to discriminate cold
Cryotherapy Documentation
Area treated Cooling agent Treatment duration Patient positioning Response to intervention
What are the indications for ultrasound?
Soft tissue shortening Pain control Repair of soft tissue injuries Dermal ulcers/ plantar warts Tendon injuries Resorption of calcium deposits Bone fracture Carpal runner syndrome Anti-inflammatory
INCREASE EXTENSIBILITY OF COLLAGEN FIBERS (TENDONS, JOINT CAPSULES)
What are the effects of continuous ultrasound?
Thermal effects
Increasing tissue temperature
REDUCTION OF MUSCLE SPASM, PAIN MODULATION, INCREASED BLOOD FLOW, INCREASED METABOLIC RATE, INCREASED NERVE CONDUCTION VELOCITY
What are the effects of pulsed ultrasound?
Non-thermal effects
Acoustic streaming
Micro-streaming
Cavitation
INCREASE PROTEIN SYNTHESIS AND TISSUE REPAIR, INCREASE BLOOD FLOW AND BONE HEALING AND REPAIR OF NON UNION FRACTURES
Which ultrasound frequency penetrates tissue deeper?
1.0 MHz (2-5cm)
Vs 3.0 MHz (1-2 cm)
What are the two different modes of ultrasound delivery?
Continuous (thermal) and pulsed (non-thermal)
How do you chose a ultrasound duty cycle?
Thermal = 100% Non-Thermal = 20 %
What is the duration of ultrasound?
5-10 minutes
What are the parameters of phonophoresis?
Frequency- 3MHz
Pulse 20% duty cycle
0.5-0.75 W/cm2 intensity
5-10 minutes
What are ultrasound contraindications?
Malignancy Pelvis, abdomens and low back of pregnant woman CNS issue Joint cement Plastic components Pacemaker Thrombophlebitis Eyes and reproductive organs OPEN EPIPHYSEAL PLATES
Ultrasound documentation
Area treated Ultrasound frequency Ultrasound intensity Ultrasound duty cycle Treatment duration If underwater Response to intervention
What is the intensity range for therapeutic ultrasound?
0.1-3 W/cm2
When would you use higher intensities and when would you use lower intensities for ultrasound?
Higher intensities= continuous= chronic conditions and thick tissues
Lowe intensities= pulsed= acute conditions and thin tissue
What is the pulse duration of most TENS units?
50-400 microseconds
What is the pulse frequency of most TENS units?
1-200 Hz
Which is the pulse rate…
What are the effects of pulse frequency?
Muscle contraction:
Twitch 1-10 Hz; Tetanic 20-50 Hz
Analgesic:
Enkephalins 40-150 Hz; Serotonin 15-100 Hz; Beta endorphins 2-5 Hz
What is the intensity in most TENS units?
0-120 mA
Higher intensity the greater the penetration depth and greater number of fibers stimulated
What are the 3 levels of responses to TENS?
Sensory- low amplitude
Motor- increased amplitude and duration
Noxious- more intense with long duration
What are the electrical pulses of conventional TENS?
Short pulse duration (<150 microseconds)
High frequency (>80 Hz)
Current amplitude is sensory
ACUTE
What are the electrical pulses of Acupuncture-like TENS?
Long pulse duration (>150 microseconds)
Low frequency (<10 Hz)
Sensory and motor current amplitudes
CHRONIC
What are the electrical pulses of Brief-Intense TENS?
Long duration (>150 microseconds) High frequency (>80 Hz) Sensory- motor- noxious current amplitude
What are the electrical pulses of burst TENS?
Bursts of pulses instead of individual pulses
Low frequency (<10Hz)
Sensory- motor current amplitudes
What are contraindications for TENS?
Over pelvis, abdomen, trunk, and low back area during pregnancy
Over carotid sinus
Demand pacemaker or unstable arrhythmia
Venous/ arterial thrombosis or thrombophlebitis
What are some other contraindications of TENS?
Malignant tumor Epileptic patients Over metal implants, eyes or testicles Mucosal membranes Undiagnosed pain Implanted defibrillators Thoracic and cranial areas
TENS documentation
Area treated Patient positioning Parameters (frequency, duration, amplitude) Electrode placement Duration Response to intervention
What are the parameters of laser?
Wavelength (visible light 600-700nm, infrared light >700-1100 nm)
Power
Energy density
Light sources
When would an LED laser be used?
Most diffuse light Widest frequency range Low power individually BEST SUITED FOR TREATING LARGE, SUPERFICIAL AREAS Power- 1-5mW can be 30-40mW
When would SLD laser be used?
Less diffuse light Narrower wavelength Emit more power than LEDs BEST SUITED FOR SUPERFICIAL, MODERATELY DEEP AREAS BASED ON WAVELENGTH Power: 5-35 mW can be >90mW
When would Laser Diodes be used?
Provide single wavelength Very concentrated Best suited to treat small areas DELIVERS THE MOST DEEPEST LIGHT TO A SINGLE AREA OF TISSUE 5-500mW (power)
What are the clinical indications for lasers?
Soft tissue and bone healing Arthritis Lymphedema Neurological conditions Pain management
What are contraindications of laser?
Malignancy Direct irradiation of the eyes Within 4-6 month after radiotherapy Hemorrhaging regions Over the enterprise glands PRECAUTIONS: pregnant women and growth plates
Can laser be used for acute conditions?
Yes
It’s non-thermal
Can also be used for metal implants and pacemakers
Laser Documentation
Type of diode Wavelength (on machine) Power (on machine) Area of body treated Energy density (on machine) Position of patient Response to intervention
What are the two types of shortwave diathermy and what are they used for?
Continuous- heating deep tissues
Pulsed- thermal physiological effects: increased microvascular perfusion, altered cell membrane function and cellular activity
What are indications for short wave diathermy?
Heating joint capsule before stretching/ mobs Enhancement of soft tissue healing Musculoskeletal disorders (pain, muscle guarding, joint stiffness) Uneven or irregular treatment areas Bursitis degenerative joint disease Decreased collagen extensibility Peripheral nerve regeneration
What are the types of diathermy applicators in the United States?
Inductive coils, drum, garments
Capacitive plates
Where is the heat produced during diathermy?
Capacitive plates: produce more heat in the skin and superficial tissue
Inductive applicators: produce more heat in deeper structures
What is the duration of diathermy treatment?
Thermal- 15-20 minutes
Non-Therma 30-60 minutes
What are the doses for CSWD?
Dose 1- no sensation of heat
Dose 2- mild heating sensation
Dose 3- moderate (comfortable heating sensation)
Dose 4- vigorous heating that iss tolerable below the pain threshold
What are contraindications for diathermy?
Recent or potential hemorrhage
Thrombophlebitis
Impaired sensation/ mentation
Malignant tumor
Implanted or transcutaneous stimulators (pacemaker)
Pregnancy (pelvis, abdomen, low back)
CSWD- malignancy, eyes, testes, growth plates
PSWD- directly over deep tissue organs, closed loop plates and screws
Diathermy Documentation
Area treated Frequency range Average power or power setting Pulse rate Treatment duration Type of applicator Patient position and distance from applicator Response to intervention
