NBS Flashcards
What are contraindications to all modalities?
Hemorrhage
Infection w/ suppuration
Malignancy (except TENS)
The therapeutic application of forces & substances that induce a physiological response & use &/or allow the body’s natural processes to return to a more normal state of health
Physiotherapy
What are contraindications to all heating modalities?
Diabetes Mellitus Encapsulated Swelling Active TB Decrease thermal sensations Edema Abdomen or low back during pregnancy Acute conditions
What stage of injury/healing is up to the 1st 72 hours?
Acute
Stage of injury/healing that is 72 hours or early phases of ds. Swelling is limited but debris & discoloration prevents healing. Pump, (alternating vasodilation & vasoconstriction) is beneficial
Subacute
Stage of injury/healing that is 2 wks longer than anticipated
Chronic
What are contraindications for all electrical modalities?
Brain Eyes Heart Carotid Sinuses Pacemaker Anesthesia (Except high volt) Pregnancy - low back (except TENS) Open wounds
Tx of acute conditions uses the acronym PRICES. What does it stand for?
Protect Rest Ice Compression Elevate Support
What type of EMS freq. reverses charge?
Ultra Low, <1Hz, (MENS)
What is the Hz range for low freq. EMS?
1-150 Hz (Contraction)
What is the Hz range for med. freq. EMS?
1,000-10,000 Hz (Depth)
What is the Hz range for high freq. EMS?
1 million Hz (Heating)
What EMS modalities are considered low freq.?
HVG LVG Sine Faradic Interference (IF & RS) TENS
What EMS modalities are considered med. freq.?
IF (4,000Hz)
RS (2,000Hz)
What types of high freq. EMS modalities cause superficial heat?
IR
UV
What types of high freq. EMS modalities cause deep heat?
MWD
SWD
US
Which type of wave form is symmetrical?
Sine
Which type of wave form is asymmetrical (sporadic)?
Faradic
Which type of wave form is composed of two sine waves?
Interferential
Which type of wave form has a twin, pulsed peak (“M” spiked peak)?
High Volt
How are pad size and mA related?
1mA per sq in. of pad size
What are the 3 types of pad placement?
Monopolar (dispersal pad & active pads)
Bipolar (small muscle group, dispersal & active pads are equal size)
Quadripolar (Crisscross pattern)
Continuous EMS is used for what?
Pain
Surge EMS is used for what?
Exercise
Pulsed/tetanizing EMS is used for what?
Fatigue/spasm
Modulation settings in EMS help to avoid what?
Accommodation
What low freq. pps setting do you use to release endorphins?
1-20pps
What low freq. pps setting do you use to release enkephalins?
70-150pps
What low freq. pps setting do you use for edema?
3-5pps
What low freq. pps setting do you use for exercise?
15-25pps
What low freq. pps setting do you use to fatique?
~50pps
This is when one object produces electromagnetic property in another
Electro-induction
Measurement of charge?
Coulomb
This is assoc. w/ pulse width, interpulse width, & freq.
Waveform
Magnitude/depth of an electric charge
Amplitude
Electricity that flows (number of electrons)
Current
This increases or decreases volts
Transformer
Ability to store up electrical energy
Capacitance (Ohm)
Property of substance to oppose current. Measured in Ohms.
Resistance
Difference in force b/w two objects. Measured in Volts.
EMF (Electromagnetic force)
- greater the charge = increase EMF
- greater the distance = decrease EMF
Slows down (dampens) electric charge.
Impedance
The time necessary for contraction when the rheobase is doubled
Chronaxie
The minimum volts necessary to excite a nerve
Rheobase (threshold)
Type of EMS you should assoc. w/ “paralyzed muscle”, “weak muscle”, or “research”
Faradic
Galvanic & Faradic current are compared to determine extent of damage & prognosis of nerve damage to muscle.
Reaction of Degeneration (R.D. Factor)
Best method of muscle testing
EMG (Electromyography)
Best method of nerve testing
NCV (Nerve Conduction Velocity)
Principle that states the energy of modality has to be absorbed by body to stimulate physiological response
Arndt - Schultz Principle
Law that notes the inverse relationship b/w penetration & absorption of energy (US)
Law of Grotthus-Draper
What are effects of cryotherapy?
Vasoconstriction
Anesthesia
Pumping Reaction
What does CBAN stand for?
Cold
Burn
Ache
Numb
After “about 20 mins” of cryotherapy, what reaction occurs?
Hunting-Lewis Reaction
What are the different tx temps?
Cold: 55-65 Cool: 65-80 Tepid: 80-92 Neutral: 92-96 Warm: 96-99 (therapeutic) Hot: 99-104 (therapeutic) Very Hot: 105-115
Transmission of heat in gases & liquids by circulation of heat particles. Baths (hot & cold), IR
Convection
Transmission of heat w/o the intervening medium getting warm. Lamps, MWD, IR, UV
Radiation
The transformation of electrical energy into heat or mechanical energy. US.
Conversion
The transfer of heat through a substance, often heating up a solid. Ice, hydrocollator, paraffin, IR
Conduction
What effect does cryotherapy have on circulation?
Vasoconstriction
Decreased blood flow (increase BP)
Decreased edema
What effect does cryotherapy have on metabolism?
It decreases it
What effect does cryotherapy have on connective tissue?
Increased viscosity
Decreased ability to stretch
What effect does cryotherapy have on pain?
Decreased, after an initial increase, numb (anesthesia)
What neuromuscular effects does cryotherapy cause?
Decreased spasticity, trigger points, MFS
Increased or decreased strength
Decreased skilled motor tasks
What are indications for cryotherapy?
Headaches (migraine) Urticaria (red wheals) Spasticity (trigger points) Sprain/strain Angiomas Warts & herpes
What are contraindications of cryotherapy?
Elderly & infants Hypersensitive to cold Vascular diseases (Raynaud's) High BP Chilblains & frostbite Tension headaches Spasm
What are the different types of cryotherapy?
Ice packs - conduction, moist towel layer
Blue ice - conduction, dry towel layer, reusable
Vapocoolant spray - fluori-methane/ethyl chloride
Ice massage - conduction, direct ice has deepest effect
Ice Immersion - convection
Cryokinetics - conduction, ice 1st, activity 2nd
Ice massage & passive ROM - conduction
What are the effects of infrared?
Vasodilation Perspire Decreased BP Increased blood & lymph flow Decreased spasm Phagocytosis
Redness or mottled skin is called what?
Erythema
Mottled skin in area habitually exposed or one prolonged exposure
Erythema Ab igne
What is the difference in distance b/w short wave IR vs. long wave IR?
Short wave = 14-18”
Long wave = direct contact w/ towel - layers
What are the different types of short wave IR?
- Luminous
- Wire bound around porcelain
- Sunlight - Heliotherapy
What are the different types of long wave IR?
Hydrocollators Heating pads Hot water bottle Baths Fluidotherapy
What is the difference in penetration b/w short wave IR vs long wave IR?
Short wave = 10mm
Long wave = 1-3mm
What is the difference in intensity b/w short wave IR vs. long wave IR?
Short wave = 150-1500 watts
Long wave = Varies
What is the difference in wavelength b/w shortwave IR vs. long wave IR?
Short wave = 7,200 - 15,000nm
Long wave = 15,000 - 150,000nm
What is the distance used when treating w/ a hydrocollator?
Six towel layers
What temp is used for hydrocollators?
150-170F
What temp is used for paraffin?
125-130F
What are indications for a contrast bath?
Subacute connective tissue injuries Bruises Early PVD's * Raynaud's * Buerger's Diabetes Mellitus
What are contraindications for a contrast bath?
Anesthesia
Advanced arterial compromise
Late PVD’s
What type of heat transmission does a hydrocollator use?
Conduction
What kind of heat transmission does a contrast bath use?
Convection
What kind of heat transmission does a whirlpool bath (hubbard tank) use?
Convection
What are 3 results of using a whirlpool bath?
Relax
Vasodilator
Debridement (burns & abrasions)*
Which modality can cause a burn & treat a burn?
IR
What is the temp of a whirlpool bath?
100-105F (varies, based on desired effect)
What kind of heat transmission does a sitz bath use?
Convection
How long do you tx w/ a sitz bath?
2-10mins (<20 mins)
What kind of heat transmission does a paraffin bath use?
Conduction
What temp do you use for a paraffin bath?
125-130F
How many times do you dip into a paraffin bath?
7-10 times
What is the ratio of paraffin to mineral oil in a paraffin bath mixture?
7:1 paraffin:mineral oil
What is another name for Fluidotherapy?
Dry whirlpool
What is used for to heat in fluidotherapy?
Solid cellulose
What kind of heat transmission does a fluidotherapy use?
Convection
What are indications for fluidotherapy?
Chronic arthritis Amputees Strains To increase ROM RSDS aka CRPS (only tx for RSDS) Dystonia Open wounds (Unless diabetic)
What does LASER stand for?
Light amplification by stimulated emission of radiation
What wavelength does a cold laser use?
630-1200nm (absorbs best into body rather than skin surface)
What type of gas does a cold laser use?
Neon helium gases
What are irreversible effects of cold lasers?
Protein coagulation*
Thermolysis
Evaporation
Treating w/ UV for too long can cause what?
Erythema ab igne
What are contraindications of UV?
H.I.M. Vascular diseases Suppurative lesions Hemorrhage Tetracycline (competes w/ Ca++ absorption) SLE
What skin conditions can UV treat?
Fungal Herpes zoster (vesicles) Burns Psoriasis Carbuncles Wounds Decubitus ulcers
Erythema caused by UV is related to what 3 things?
- Pt sensitivity
- Intensity vs distance (inverse square law)
- Angle of radiation (cosine law)
What is the tx protocol for UV?
Start at MED. As pt. tolerance increases, increase duration by 15sec/tx to a max of 3 mins. When max time is reached, decrease distance by 2” per tx, approaching no closer than 18”
What distance do you start tx w/ a UV lamp?
30-36”
What are the different types of UV devices?
- Hot quartz (Mercury-helium gases, Kromayer lamp)
- Cold quartz (Neon & mercury, orificial)
- Wood’s lamp aka black light
Type of UV device that filters UV light through nickel oxide glass used to dx fungal infections (tinea)
Wood’s Lamp aka Black Light
How far must a diathermy unit be from any other electrical device?
10ft
How far must a diathermy tx on an individual be from hearing aids, bridge work, etc?
4ft
Generally speaking, how does SWD tx?
Outside in (general)
Generally speaking, how does MWD tx?
Inside out (local)
What are some indications for SWD?
Bronchitis
PID
Otitis media
What are some indications for MWD?
Otitis externa
Neuritis
What is a major contraindication for both SWD & MWD?
Metal
How much space do you use to get 100% heat from SWD?
2” (towel)
What are the 3 types of SWD?
Induction
Condensor
Butterfly
What is the wavelength for SWD?
11 meters
What is the freq. of SWD?
27.12 megacycles
What type of tissue does SWD heat first?
Fat
What distance do you use when treating w/ MWD?
1-7” (Air space)
What is the wavelength of MWD?
2-12cm
What is the freq. of MWD?
2450 megacycles
What type of tissue does MWD heat first?
Muscle
What are some contraindications for US?
Over spinal cord
Over epiphyseal growth plates (look at the age in questions)
Laminectomy
In LVG, what effects does the positive pole (anode) have?
"Anode acts like ice" Vasoconstricts Produces acid reaction in skin Repeals alkaline Attracts oxygen Repels hydrogen Causes ischemia Hardens tissue Pain relief Astringent
What are the M/C solution mixtures used w/ LVG?
2% solution mixtures
What substances are used under the positive pole (anode) in LVG?
"Repels Metals" *Magnesium - edema, IVD, DJD, arthritis, neuritis, PNE *Calcium - adhesions, capsulitis *Copper - fungus *Zinc - ulcers, gyn., derm Histamine - PVD, spasm Hyaluronidase - post trauma swelling Potassium - sprains Xylocaine - painful ROM Hydrocortisone - DJD, PNE
What substances are used under the negative pole (cathode) in LVG?
"Repels non-metals" *Salicylate - pain, inflammation, arthritis *Iodine - scars, adhesions Chloride - adhesions & scars *Acetate - calcium deposits, bursitis Niacin - PVD, arthritis PABA - Scleroderma Novocaine/alcohol - strains Hesperidin - ecchymosis
What intensity is used for LVG?
1-5mA
What are indications for HVG?
Acute & subacute injuries to reduce edema
Analgesia & spasms reduce muscle atrophy
Cast, disuse atrophy
What settings do you use in EMS for edema? muscle exercise? fatigue? endorphin production? enkephalin production?
Edema - 3-5pps Muscle exercise - 15-25pps Fatigue - ~50pps Endorphin production - 1-20pps Enkephalin production - 80-150pps
What are the 3 modes of HVG?
Continuous Mode - beneficial for edema, pain, & neuritis
Reciprocal Mode - permits alternating contracture of agonist & antagonist, limits accommodation
Surge on/off - used when re-education & exercise is desired
What is the primary effect of MENS?
tissue healing
Immediately after trauma, noxious stimulation lowers nerve thresholds
Primary Hyperalgesia
W/i hours of trauma, chemicals diffuse to surrounding tissues causing hypersensitivity
Secondary Hyperalgesia
Nerve pain fiber that is well localized, often first pain (protopathic), stings or burns
A-delta
Nerve pain fiber that causes diffuse, second pain, & visceral pain (epicritic), achy or throbbing
C-fiber
Type of nerve fiber that is large, myelinated mechanoreceptors. Responds to light touch & can interrupt nociception in dorsal horn
A-beta
Small regions of metabolic distress, caused by the combination of increased energy demand & impairment of oxygen & energy supply. This is probably d/t a local restriction of circulation.
Trigger points
What is biofeedback used for?
Used to modulate autonomic functions
What are indications for biofeedback?
Hypertension Migraines Stress ADD Incontinence
Cervical brace used for emergency transport?
Philadelphia collar (hard collar)
Brace used for scoliosis
Milwaukee/Risser Jacket (Boston brace used on juveniles)
Brace used for a spondylolisthesis, L/S disc
Lumbosacral corset (Boston brace)
Brace used for SI dysfunctions
Sacroiliac girdle (Williams)
Brace used for hip lesions?
Intertrochanteric belt/girdle
How many effleurage strokes per min?
12
What is the purpose of the effleurage stroke?
To sedate
What is the purpose of the Petrissage stroke?
For spasm
What is the purpose of the Tapotement stroke?
For congestion
What is the purpose of the Friction stroke?
Break adhesions
What is the purpose of the Vibration stroke?
For congestion
What is the purpose of the Deep Pressure stroke?
Adhesions, trigger points
What is low velocity vibratory therapy used for?
Congestion
What is the minimal & maximum amount of weight used in cervical traction?
Min = 10lbs Max = 30-50lbs
What position do you use for traction of C3-C6?
Flexion at 20-28degs
What is the starting tx dose for cervical traction?
Begin at 5% of body weight, increase 2lbs max each tx
What is the starting tx dose for lumbar traction?
Begin at 25% of body weight & increase 5lbs max w/ each tx
What is the minimum & maximum amount of weight used for lumbar traction?
Min = 25% of body weight Max = 50% of body weight or 120lbs
What are the different types of traction?
Continuous
Intermittent - imbibition
Inversion - Lumbars (contra - high BP)
Positional - Decrease pressure best
Over the door - Csp, face door w/ 28degs of Csp flex.
Axial - don’t use w/ osteoporosis, Paget’s, Mets (weak bone)
Rotational - don’t use w/ facet trophism
Hydrotherapy traction - water belts, wings & buoys
What are 3 reliable LBP questionnaires?
Oswestry
Roland-Morris
Quebec
What area examples of ADL charts?
Copenhagen - neck
Croft - shoulder
Harris - hip
Breathing exercises & posture used for COPD’s, aging, & AS
Breugger’s
Administered to pt’s w/ peripheral vascular disease
Buerger - Allen’s
The Harvard step test is used to test for what?
Endurance
Flexion exercises for the low back. Pt is instructed to do sit-ups w/ knees flexed, hands in front of the chest, while the head & shoulders are lifted off of the table. The position is held for 5mins. Purpose is to help decrease lordosis by strengthening the abdominal muscles. Benefits spondylolisthesis, facet syndrome, increased lumbosacral angle, hyperlordosis
William’s exercises
Modified McKenzie exercises are used for what?
Benefits acute discs & spinal stenosis. Flexion exercises
Extension exercises for low back. Purpose is to help increase lordosis by strengthening the paraspinals. Benefits chronic disc & acute lumbar antalgia to “centralize” pain & get pt to neutral position
McKenzie’s
LBP (core) exercises. Includes side bridge, bird dog, & abdominals
McGill’s
Exercises for the pelvic floor musculature. Benefits incontinence
Kegel’s
Strengthens the shoulder girdle while eliminating the use of the supraspinatus muscle
Codman’s/Pendular
Use fingers to crawl up the wall for shoulder ROM
Wall walking
This type of exercise is focused on position & breathing mechanics. Benefits spinal stability & balance.
Yoga
What is the terrible triad composed of?
Medial meniscus
ACL
MCL
What sign is assoc. w/ a PCL tear?
Sag sign