Physical Agents Midterm Review Flashcards
1
Q
What do physical agents do?
A
Modify tissue inflammation and healing
Relieve pain
Alter collagen extensibility
Modify muscle tone/contracting ability
2
Q
deep heating thermal agents
A
ultrasound and diathermy
3
Q
superficial heating thermal agents
A
hot pack and paraffin
4
Q
superficial cooling agents
A
cold pack, ice massage
5
Q
mechanical agents
A
mechanical traction
compression (bandage, stockings)
water (whirlpool)
sound (ultrasound)
6
Q
electromagnetic fields
A
ultraviolet, laser
7
Q
electrical currents
A
TENS/IFC NMES/Russian High Volt Iontophoresis EMG
8
Q
steps in choosing a modality
A
goals and effects of treatment
contraindications and precautions
evidence for physical agent use
cost, convenience and availability
9
Q
characteristics of A-delta fibers
A
respond to intense mechanical stimulation and heat or cold
–short duration, sharp, stabbing, or pricking sensation
–small and myelinated
–4-30 m/s
–20% of pain afferents
–not blocked by opioids
10
Q
characteristics of C afferent fibers
A
longer duration, dull, throbbing, aching, burning, tingling, diffusely localized, accompanied by sweating, increased heart rate and blood pressure, and nausea –small and unmyelinated –0.5-2 m/s –80% of pain afferents –can be blocked by opioid medication
11
Q
characteristics of A- beta
A
non-painful sensation related to vibration, stretching, and mechanical pressure
carries epicritic information
12
Q
What is the neuromatrix pain theory?
A
Pain is a multidimensional experience produced by “neurosignature” patterns of nerve impulses
Neural network distributed throughout many areas of brain
Neuromatrix genetically determined, modified by sensory inputs
Neurosignature’s output pattern determined by multiple influences (not only somatic sensory)
13
Q
How long is the duration of pain relief for endogenous opioid system?
A
4-6 hours
14
Q
how long is the duration of pain relief for gate control?
A
as long as the stimulus is applied
15
Q
physiological effects of heat
A
Vasodilation
Increase metabolism
For every 10ºC rise in temp, there is 2-3x higher rate of metabolism
Pain relief
Decrease stiffness
Enhance extensibility
Requires elevation of tissue temp to 40-45ºC
Reduce muscle spasms/decreased strength
First 30 minutes after application of heat; returns to pre-tx levels after 2 hours
16
Q
What is the peak temp time for heat?
A
within 6-8 minutes it can penetrate about 0.5 cm
17
Q
What is the longer duration for penetrating 1-2 cm?
A
about 15-30 minutes
18
Q
What is the rise in temp for 3 cm?
A
about 1 degrees celsius
19
Q
Through what mechanism do hot packs work?
A
conduction
20
Q
how many layers of towels do you need for a hot pack?
A
6-10 layers
21
Q
When do you reach max results?
A
after 20 minues
22
Q
When should you check on the patient with heat?
A
after 5-6 minutes
23
Q
What should heat feel like?
A
warm towels fresh out of the dryer
24
Q
How does paraffin work?
A
conduction
mineral oil that alters the melting point and lowers specific heart to make higher temps more tolerable
126-130 degrees
25
What mechanism does cold use?
conduction. convection and evaporation
26
what is the ideal tissue temp for cold treatment?
15-25 degrees celcisus
| 55-77 degreesF
27
What is the order of sensation for application of cold?
1. cold
2. warm, burning
3. achy, tingling
4. numbness
28
How long should cold pack be applied?
15- 30 minutes
29
When is cold most effective?
5-10 minutes after an injury and can still be helpful up to 72 hours after injury
30
physiological effects of cold
Vasoconstriction
Decrease metabolism
Pain relief (decrease nerve conduction velocity)
Augment muscle contraction
31
What level do you need to reach for ice?
to go beyond numbness
32
Mechanism of ultrasound
reverse piezoelectric effect
33
what is the reverse piezoelectric effect?
Electrical current (AC current) applied to lead zirconate titanate crystal in sound head which is converted to mechanical energy
34
Relationship of frequency, absorption and penetration
the higher the frequency, the higher the absorption BUT less depth of penetration
35
What ratio is better for the beam of the ultrasound
a lower beam non-uniformity ratio (BNR) is better
36
If BNR = 5:1 and intensity is 0.5 W/cm2 what is the spatial peak intensity?
2. 5 W/cm2
| 0. 5 * 5= 2.5
37
What is attenuation?
the decrease in energy due to absorption, reflection and refraction
it is inversely related to penetration
38
how much does absorption account for attenuation?
absorption accounts for half of attenuation
39
Tissues with higher attenuation show a...
BIGGER temperature rise
40
Tissues with higher collagen content have....
HIGHER attenuation
41
as the frequency of US increases,what happens to attenuation?
attenuation INCREASES
42
What is the type of tissue with the highest attenuation?
BONE
| because it is collagen rich
43
What type of tissue has the lowest attenuation?
nerves with 0 attenuation
| blood fat and muscle are also the lowestq
44
What are the effects is the duty cycle is 100%
both thermal and mechanical
45
What is the duty cycle for mechanical only?
20%
46
How deep does a frequency of 1 MHz go?
up to 5 cm deep
47
How deep does a frequency of 3 MHz go?
up to 1-2 cm deep
it is absorbed quicker
(higher MHz= higher absorption)
therefore it doesn't go as deep
48
What intensity should you use with 1 MHz?
1.5- 2 W/cm2
49
What intensity should you use with 3 MHz?
0.5 W/cm2
50
What intensity should you use for non-thermal?
0.5- 1 W/cm2
51
What should the size of the treatment area be?
2-3 times the size head for 5-10 minutes
52
What is ultrasound used for?
```
soft tissue shortening, prolonged inflammation delayed tissue healing
pain control
patient preference
tendon and ligament injuries
dermal ulcers
carpal tunnel syndrome
one fractures
resorption of calcium deposits
```
53
What effect of ultrasound do you want with prolonged inflammation/delayed tissue healing?
NONthermal (20% duty cycle)
54
What are the precautions for ultrasound?
acute inflammation
epiphyseal plates
fractures
breast implants
55
What are the contraindications for ultrasound?
```
malignancy
pregnancy
joint cement
plastic
pacemaker
thromophelbiits
over the eyes/reproductive organs
```
56
What are the precautions for heat?
```
areas of decreased sensation and circulation
poor thermal regulation
pregnancy
cardiac insuffienciency
metal in the area
scars and new skin
```
57
What are the contraindications?
areas of arterial insufficiency or arterial disease
areas prone to bleeding
acute inflammation
impaired cognitive function
58
When is paraffin indicated?
arthritis
chronic orthopedic conditions
joint stiffness, contractures
scleroderma
59
what are the precautions for paraffin?
small scratches or scar tissue
60
what are the contraindications for paraffin?
open wounds
draining lesions
rashes and infections
water on skin (should be completely dry)
61
What is dipping?
a thick "glove" should be applied;
| abbout 6-10 layers
62
What is immersion?
more vigorous
| once 1 layer "glove" has been formed allow time to harden before placing back into tank
63
What to know for the board exam about cold treatment
- thought to be most effective 5-10 min after injury but can still be helpful for up to 72 hours after injury
- controls inflammation via vasoconstriction and decreased permeability of vessels
- decreases pain by numbing the area
- prevents secondary hypoxic ischemia
64
precautions for cold
```
previous frostbite
abnormal skin sensation
hypertensive patient because cold causes vasoconstriction
decreased cognition
very old or very young
```
65
contraindications for cold
Raynauds
cold intolerance or hypersensitivity
comprised local circulation (arterial PVD)
66
What should you do before the first treatment of ice?
check sensitivity using an ice massage for a couple of minutes
67
What will happen if someone is hypersensitive to the cold?
the skin will blanch and has a leather texture and an elevated surface
68
How cold should a cold bath or whirlpool be?
13- 18 degrees C
| 55-65 degrees F
69
What is the joint distraction mechanism of spinal traction used for?
for stretching facet joint capsules
70
What occurs from traction?
stretching facet joint capsule)
Simulate mechanoreceptors, decrease joint pain (gentle oscillations)
Increase inferior-superior dimensions of intervertebral foramina → increase space for nerve root
Decrease intradiscal pressure → helps with small disc bulges/protrusions
Gradually elongate soft tissue
Muscle relaxation
71
When would you perform manual traction?
to determine whether traction is appropriate
| also allows traction to be applied in various positions
72
What is continuous traction used for?
mainly to decrease pressure from muscles and other soft tissues
but typically no longer used with LBP because found to be less effective than exercise
73
effects of static/sustained traction
muscle relaxation
soft tissue stretch
seperation of joint surfaces
74
what are the effects of intermittent traction
seperation
stretch
relaxation
mobilization of joints
75
What are the indications for traction?
```
disc bulge
DDD
nerve root compression/impingement
stenosis
radiculopathy
spondylolisthesis
degenerative joint disease
spondylosis (spinal arthritis)
joint hypo mobility
compression fracture
```
76
What are the precautions for traction?
```
hypermobility
acute phase of healing
pregnancy due to increased ligamentous laxity
swelling
traction anxiety
cardiac/respiratory insuffciency
complete reduction of symptoms
```
77
Contraindications of traction
```
joint instability
RA
tumors
acute sprain/strain
acute inflammation
peripherilization
uncontrolled HTN
TMJ (no cervical traction)
fractures
hernia
```
78
What occurs in the evaluation process for traction?
```
subjective questioning
palpation
instability testing of C1-C2!!!!!- transverse and alar ligaments
vertebral artery testing
neuro screeening
cluster items for cervical radiculopathy
```
79
What is the positioning for cervical traction
supine or sitting
for upper= neutral
for lower= flexed
for OA= flexed to 2 degrees
80
What are the four variables for cervical radiculopathy testing?
-spurling test
-cervical distraction test that would reduce UE symptoms
-ULTT
cervical rotation to the involved side is
81
What is recommended for vertebral artery testing?
```
Good hx
Thorough exam
Slow, progressive increase of tx ROM and velocity
Pre-manipulative hold (10-15 seconds)
Constant monitoring of neuro status
```
82
what should you do for future sessions of traction?
increase TIME before increasing force
83
what are the parameters for cervical traction?
begin force 8-10 lbs
| do not exceed 30 lbs
84
What are the time parameters for traction?
acute-static
muscle spasm - 5on/5off
disc- 60 on/20 off
joint 15 on/15 off
85
Where is it vulnerable to external compression
at the vertebral foramen of C6
within the foramen transversarium between C2 and C6
at the level of C1 and C2
86
What position is best for the upper L spine and facet joint problems?
supine
87
what position is best for the LOWER L spine and posterior disc problems?
prone
88
What is the classification for lumbar traction?
Leg symptoms
-pain numbness distal to knee
signs of nerve root compression
- pos. SLR that reduces symptoms
89
parameters for lumbar traction
begin 25-50 lbs
| about 1/4 BW is required
90
What should you do if there is complete pain relief from traction
assess indicators of nerve conduction
91
if the pain is worsened?
STOP because there could be interruption of nerve conduction otherwise decrease by 50%
92
If pt responds well to treatment what should you do?
increased the TIME first in future visits
93
if pt. responds poorly what should you do?
decrease the force by 50%
94
if pt. experiences partial relief what should you do?
maintain level
95
what is diathermy?
same as ultrasound except larger treatment area
| used thermal and non-thermal
96
precautions for diathermy
keep away from electronic or magnetic equipment
97
what is hydrotherapy?
high specific heat and thermal conductivity
| heat transfer via conduction and convection
98
what effects does hydrotherapy have?
```
cleansing effects
cardiovascular effects
-enhanced venous return
-increased CO
respiratory effects
renal effects
-increased blood flow and volume
psychological effects
-relaxing
```
99
What temperature has the purpose of pain control?
99-110
100
What temperature is medium for exercise?
79-92
101
what temp. is used for burns and eptheliazation?
96-98
102
what temp. is used for open wounds and controlling tone?
92 - 96
103
what temp is used to reduce inflammation?
32 to 79
104
What are lasers used for?
```
soft tissue and bone healing
arthritis
lymphedema
neurological conditions
pain control
```
105
What do you have to do to lower the frequency?
get a longer wavelength which will essentially penetrate deeper
106
What is the intensity of radiation proportional to?
the inverse square of distance
107
What is fluidotherapy?
a dry heating agent that transfers heat via convection
| you can perform AROM while being heated at the same time
108
what is the use of high volt pulsed current?
to treat edema caused by inflammation or lack of motion
also soft tissue healing
used local to the area of swelling; not a muscle
109
when is the active electrode NEGATIVE?
when we want to repel proteins and attract positively charged chemicals to prevent infection
ex: pitting edema
110
when is the active electrode POSITIVE?
for later healing it is placed over the affected area to promote further healing
111
HVPC parameter for tissue healing with inflammation
60-125 Hz
40-100 usec
tingling
negative polarity
112
HVPC parameter for proliferation
60-125 Hz
40-100 usec
tingling
Positive polarity
113
HVPC parameter for edema control
100-120 Hz
40-100 usec
tingling
negative polarity
