Practical Exam Flashcards
Traction Contraindications
- Structural fault due to tumor or infection.
- Of cervical spine in patients with vascular compromise (stretching an artery the diameter decreases in size, limits blood flow).
- Where movement is contraindicated (Such as a fracture).
- Of cervical spine in patients with Rheumatoid Arthritis
- Of cervical spine in patient with a major neck injury until fracture of the odontoid process has been ruled out. (Or transverse/alnar ligament laxity via motor vehicle accident)
Traction Precautions
- Acute Strains (careful if inflammation is present).
- Pregnancy (even menstrual cycle, hormones can make you more lax).
- Osteoporosis (a disease in which the bones become very fragile and likely to fracture).
- Hiatal Hernia using pelvic traction (hiatal hernia is a condition in which part of the stomach stick upward into the chest, through and opening in the diaphragm.
- Claustrophobic patients or other safety concerns
Cold Contraindications
- Severe coronary artery disease
- Severe hypertension
- Some Rheumatoid conditions (Scleroderma, systemic Lupus, Erythamatosa (SLE)
- Patients with cold hypersensitivity
(Cold uticaria - hives, itching and sweating with cold)
(Cold hemoglobinuria-hemoglobin in urine with cold) - Vasospastic disorders (Raynaud’s disease)
Cold Precautions
- Paralyzed patients (lack of central heat control)
- Coma Patients
- Any cold on skin > 1 hour
- Ice over superficial nerves (ex. peroneal nerve)
Heat Contraindications
- Severe cardiac disease
- Over malignancy
- Sepsis
Heat Precautions
- With insensitive patient (diabetes)
2. With spinal cord injured patients
Ultrasound (Non-Thermal) Indications
- Cavitation may break down calcium deposits (aka calcifications)
- Affects nerve conduction velocity, possibly altering pain perception
- Phonophoresis to drive chemicals through the skin (Increase the rate of healing)
Ultrasound Contraindications
- Where heat is not indicated (When using thermal effects such as:
Severe Cardiac Disorder
Malignancy
Sepsis - Hemophiliac patients
- Over deep vein thrombosis (sudden death, clot breaks free and ca get stuck in unwanted areas like the brain, heart, lungs)
- Over Neoplasm (a new growth, never provide heat to a new growth, it will only speed up the process)
- Over the pregnant uterus
- Over the eyes (like an egg cause changes in proteins)
- Over the heart
- Near a pacemaker (lump under the left side of the skin).
- Over growth plates (mainly in adolescents, if you heat over a growth plate you can cause the plate to close prematurely).
Ultrasound Precautions
- Over a healing fracture
- Over the spinal cord (don’t go back and forth, lift up head after your done with one side, then move to the other).
- Over metal implants ( diathermy and metal is no bueno. Metal is a great conductor of sound so it heats up quickly, also use caution when US over a cemented joint).
Pool Therapy Contraindications
- Open wounds that cant be adequately covered
- Incontinence
- Pts with isolation precautions
- Uncontrollable seizures
- Severe Cardiac Disease
Pool Therapy Precautions
- Multiple Sclerosis
- Possible infection sites such as ostomies, G-tubes etc..
- Pts with orthostatic hypotension.
Contrast Bath Contraindications
- Cardiovascular Problems
- Peripheral Vascular Disease (arterial sclerosis)
- Tendency Toward Hemmorage
Contrast Bath Precautions
- Loss of Sensation
- Pregnancy
- Hypersensitivity to temperature.
Massage Contraindications
For this course:
- Severe Distress (severe pain, febrile state)
- Systemic Edema
- Acute Conditions (0-48 hrs, minimum)
- Over Recent Surgery
- Increased Circulation is not Desired
- Contagious Skin Conditions
- Over Foreign Bodies or Sharp Bony Prominence
- Over Areas of Active Bone Growth
- Over Areas of Decreased Sensation
- Tuberculosis Diagnosis
- Over the Pregnant Abdomen
Electrotherapy Contraindications
- Demand type Cardiac Pacemaker
- Cardiac Arrhythmia
- Over the Carotid Artery
- Hypersensitive Patients
- Pregnancy
Electrotherapy Precautions
- Check Equipment
- Change intensities slowly
- Always turn down intensity before changing other
parameter controls. - Avoid concentration of current (Skin cuts, creases in electrode pads, poor contact of electrodes)
- Avoid dispersal of current (gel dispersal outside of electrode area)
Traction Controls
- Treatment Time
- Force
- Duty Cycle
- Direction of Pull
Traction Treatment Time
For Disc Problems:
3-5 minutes for first treatment. Then progress to 8-10 minutes.
For all other problems:
Treat for 15-20 minutes
Traction Force
For Cervical Spine:
10% to 20% of the patients body weight (to 35 # MAX). you must add the weight of the head if they are in the sitting position.
For Lumbar Spine:
25% to 50% of the patients body weight, additional force may need to be applied to accommodate for the friction if the table doesn’t slide.
Traction Duty Cycle
For Disc problems 60 seconds ON and 20 seconds OFF
For all other problems, 20-30 seconds ON and 10 seconds OFF
Direction of Pull Transverse Axis
Disc Problems - Direction of pull should be as straight as possible.
Muscle and Facet Problems - Pull with 25 to 30 degrees of flexion.
Direction of Pull Longitudinal Axis
(The patients head or trunk list to one side)
Disc Problems - Pull of the side needed to MAINTAIN the list.
Muscle and Facet Problems - Pull on the side to CORRECT the list. (Straighten the patient out)
Paraffin Bath Controls
Paraffin Bath temperature 125 - 130 F
Treatment time: 20 minutes
Application Techniques:
- Dip X 6 times and wrap in a bag /w towel
- Dip X 6 times and re-immerse
Hydrotherapy Controls
Temperature:
From cold to hot (55 -113F) depending on the desired effect.
Treatment Time: 20 minutes
Whirlpool size:
Depending on are toe be treated (low boy or tall boy).
Air Control:
High air decreases mass of fluid.
High air increases sensation of fluid.
Water Pressure :
High pressure moves water faster, improving convection.
High pressure may be painful on wound, so be cautious.
Turbine Height and Direction:
Consider whether treated are needs to be exposed to water force.
Standrad Temperature Classifications
Cold 55 - 65 F (13-18C)
Cool 65-80 F (18-27C)
Tepid 80-94 F (27-34C)
Warm 94-98 F (34-37C)
Hot 98-104 F (37-40C)
Very Hot 104-113 (40-45C)
Ice Packs, Ice Massage & Cryotherapy Controls
Treatment Time:
3-60 minutes (3-15 minutes for ice massage to numb. 20-30 minutes for typical treatment. Limit to 60 minutes to prevent frostbit).
Temperature:
Cold ice baths is 55-65 F
Ice Pack machines are 10-15 F
Insulation:
Wet towels wrapped around ice cool more quickly. Dry towels are better tolerated by patients who need to have an area cooled for several hours.
Contrast Bath Controls
Temperature:
Hot (105 -110F) water baths are alternated with COLD (55-65F)
Hot Pack Controls
Time 20 - 30 Minutes
Insulation: 6-8 layers of towels.
The foam cover = 4-6 Layers
Reheating the packs takes 30 mintues
Ultrasound Controls
- Frequency
- Beam Nonconformity Ratio (BNR)
- Duty Cycle
- Intensity
- Treatment Time
- Head Movement
- Alcohol Wipe Between Uses
Ultrasound Frequency
1 MHz penetrates to 5 cm (2 inches)
3 MHz penetrates to 1 cm (0.5 inches)
Ultrasound Intensity
Watts/cm^2
Maximum intensity is determined by the patient tolerance. Typical maximum intensity is 1.5 w/cm^2 but a machine with a poor BNR might be uncomfortable at that intensity. Alternatively, if a deep structure that is not near a bone is to be heated the patient may safely tolerate intensities above 1.5 w/cm^2
1 MHz
- Acute injury desire .1 - .2 w/cm^2
- Subacute injury desire .3 - .8 w/cm^2
- Chronic Injury use .9 - 1.5 w/cm^2
3 MHz
- Acute injury desire .1 - .2 w/cm^2
- Subacute injury desire .1 - .3 w/cm^2
- Chronic Injury use .3 - 1 w/cm^2
Ultrasound Intensity (Always consider depth)
If the injury is deeper than the surface, you will need to adjust your intensity for depth and loss of energy.
For 1 MHz, Intensity should be increase by .25/cm depth
For 3 MHz, Intensity should be increased by .4/cm depth.
Example: For 1 MHz at 4 cm, and desired acute intensity of .2 w/cm^2. The intensity should be set at
Desired + (Depth)(Ratio)(Desired)
.2 + (4 cm) (.25/cm) (.2)
.2 + ( 1 cm) (.2)
.2 + .2 = .4 w/cm^2
Effective Radiating Area
(ERA) is the area of the sound head which is producing an ultrasonic wave.
Ultrasound Treatment Time
As a rule of thumb, an 8-10 minute treatment of US can cover an area twice the are of the sound head size. If a larger are is covered, treat is segments, each twice the sound head size, with similar additional time.
Example: You want to treat an area of 24cm^2 and you have an 8.5 Head ERA, what is you treatment time. Well we know that a head with an 8.5 ERA can cover an area of 17 cm^2 for 8-10 min. But that wont cover the whole area so 24/17 = 1.41176 or 14 minute treatment time for 24cm^2
Ultrasound Movement Speed
Head movement speed is between 1-4 cm/sec.
1 cm/sec for a BNR of 3 or less.
4 cm/sec for a BNR greater than 3.
Ultrasound 1 MHz Intensity
Acute .1 to .2 w/cm^2
Subacute .3 - .8 w/cm^2
Chronic .9 - 1.5 w/cm^2
Ultrasound 3 MHz Intensity
Acute .03 w/cm^2
Subacute .3 w/cm^2
Chronic .3333 w/cm^2
I Think!
Beam Nonconformity Ratio
BNR rates the quality of the head, a 1:1 head is perfect and sound intensity is equal over ALL of the head. A BNR of 6:1 is the minimal acceptable.
BNR affects the ultrasound treatment in that the poorer the BNR the faster the sound head must be kept moving in order to avoid “hot spots”. With a low BNR, the sound head can be moved as slowly as 1cm/sec. With a high BNR you may need to move the sound head at 4 cm/sec.
