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PT > PT9111 - Modalities > Flashcards

PT9111 - Modalities Flashcards

1
Q

What is a therapeutic modality?

A

A clinical tool that is designed to stimulate a specific body tissue to perform its normal function

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2
Q

What are the four effects of therapeutic modalities?

A
  1. Modify the stages of tissue repair
  2. Relieve pain
  3. Alter collagen extensibility
  4. Modify muscle function
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3
Q

What are the stages of tissue repair?

A
  1. Hemostasis
  2. Inflammation
  3. Proliferation
  4. Maturation (remodeling)
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4
Q

What is the time course and function of hemostasis?

A

Time course: within seconds of injury
Function: To stop bleeding (fibrin clot and vasoconstriction)

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5
Q

What is the time course and function of inflammation?

A

Time course: 1-3 days port injury optimally (can be up to 3 weeks)
Function: Natural debridement by identifying/removing foreign material

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6
Q

What are examples of inflammation mediators?

A
  1. Mast cells (constriction and dilation)
  2. Leukocytes (phagocytosis)
  3. Prostaglandins (sensitize pain receptors; attract leukocytes; increase vascular permeability)
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7
Q

What are the cardinal signs of inflammation?

A
  1. Red (rubor)
  2. Hot (calor)
  3. Swollen (tumor)
  4. Pain (dolor)
  5. Loss of function
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8
Q

Why do we see the cardinal signs of inflammation?

A

Redness, swelling, temperature: vasodilation, fluid leakage into extracellular space, impaired lymphatic drainage
Pain: mechanical distention resulting in pressure on soft tissue; chemical irritation of specific nerve receptors

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9
Q

What is the time course and function of proliferation?

A

Time course: 3-4 days post-injury lasting approx. 3 weeks
Function: formation of granulation tissue

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10
Q

What is the time course and function of maturation?

A

Time course: 3 weeks to up to 3 years
Function: Increase scar strength (through continual collagen changes; increase number of cross links, orientation of collagen fibers along mechanical force)

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11
Q

How can physical agents modify pain?

A
  1. Modulate pain transmission at the level of the spinal cord
  2. Alter nerve conduction rate alone a particular nerve
  3. Alter neurotransmitters (central or peripheral)
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12
Q

What can happen after 3 weeks of immobilization?

A

-67.5% reduction in normal ROM
-intermolecular cross links leading to contracture

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13
Q

How can physical agents alter muscle tone?

A
  1. Altering nerve conduction velocity or sensitivity
  2. Altering biomechanical properties of muscle
  3. Reducing pain
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14
Q

What are the two types of physical agents?

A
  1. Electromagnetic spectrum (radiant energy)
  2. Acoustic spectrum (sounds waves)
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15
Q

What is radiation?

A

The process by which energy in various forms travels through space and it is energy that is transmitted without the movement of mass.

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16
Q

What are four common characteristics of electromagnetic radiations?

A
  1. They can be produced with sufficiently intense electrical of chemical forces applied to any material
  2. They all travel through space at an equal velocity
  3. The direction of travel is always a straight line
  4. They can be reflected, absorbed, or transmitted dependent on the medium that they strike.
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17
Q

What is the Ardnt-Schultz Principle?

A

No reactions or change can occur in the body tissues if the amount of energy absorbed is insufficient to stimulate the absorbing tissues.

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18
Q

What is the Law of Grotthus-Draper?

A

If the energy is not absorbed by superficial tissues, it will penetrate to deeper tissues.

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19
Q

What is the cosine law?

A

Radiant energy is more easily transmitted to deeper tissues if the source of radiation is at a right angle to the area being radiated. When further from the right angle, more energy is reflected.

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20
Q

What is the inverse square law?

A

The intensity of the radiation striking a material varies inversely with the square of the distance from the source.
Ex. doubling the distance results in one quarter of the light hitting the subject.

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21
Q

What are the 5 heat transference mechanisms?

A
  1. Conduction
  2. Convection
  3. Radiation
  4. Evaporation
  5. Conversion
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22
Q

What is conduction? What are some examples of conduction?

A

Heat transfer by direct collision between molecules of different temperatures.
Hot & cold packs, paraffin bath, ice massage.

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23
Q

What is thermal conductivity?

A

The rate at which a material transfers heat by conduction.
Metal > Water > Air

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24
Q

What is convection? What is an example?

A

Heat transfer by the movement of air or water around or past the body.
Whirlpool

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25
Q

What is radiation in regard to heat transfer? What is an example?

A

Transfer of hear through air from a warmer source to a cooler source (non-contact).
Laser.

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26
Q

What is conversion? What is an example?

A

Heat transfer by conversion of a non-thermal form of energy into thermal energy.
Ultrasound.

27
Q

What is the haemodynamic response to cryotherapy?

A

-Initial decrease in blood flow (smooth muscle contraction, increased blood viscosity, decrease vasodilators, SNS activation)
-Vasoconstriction results in a reduction in hydrostatic pressure and decreased blood flow (mitigates edema)
-Later increase in blood flow and potentially hunting response

28
Q

What is the hunting response?

A

Response to extreme cold. Lasts 4-6 minutes followed by vasoconstriction lasting 15-30 mins. Redness of skin due to concentration of oxyhemoglobin.

29
Q

What is the metabolic response to cryotherapy?

A

-decreased metabolic rate (controls acute inflammation via decrease in pro-inflammatory cytokines, macrophage infiltration and histamine decrease)

30
Q

What is the neuromuscular response to cryotherapy?

A

-decreased nerve conduction velocity
-increased pain threshold (gate control)
-facilitation of muscle contraction

31
Q

What are some indications for cryotherapy?

A

-Inflammatory control
-Pain control
-Spasticity
-MS
-Facilitation of neuromuscular activity

32
Q

What are some contraindications for cryotherapy?

A

-Vasospastic pathologies (Ex. Raynauds, thoracic outlet syndrome, carpal tunnel)
-Cold hypersensitivity or intolerance
-Over regenerating nerves
-Cryoglobulinemia (ischemia) and haemoglobulinemia (Hb breakup due to cold)

33
Q

What are some precautions for cryotherapy?

A

-Over a superficial main branch of a nerve
-Over an open wound
-Hypertension (may induce arrhythmia)
-Poor sensation
-Altered mental state or poor communication skills
-Very young or very old

34
Q

What are some safety considerations for cryotherapy?

A

-Frostbite
-Exercise
-Superficial nerve injury
-Sensation

35
Q

How long should you wait between cryotherapy sessions?

A

2 hours

36
Q

What are the three responses to thermotherapy?

A
  1. Haemodynamic
  2. Neuromuscular
  3. Metabolic
37
Q

What is the haemodynamic response to thermotherapy?

A

-Vasodilation

38
Q

What is the neuromuscular response to therapy?

A

-increase nerve conduction velocity (2 m/s per 1C)
-decrease firing rate of muscle spindle
-increase firing rate of GTO (autogenic inhibition at a quicker rate)
-increased pain threshold (gate control)
-decrease in strength

39
Q

What is the metabolic response to thermotherapy?

A

Increased metabolic rate
-shift oxygen-hemoglobin dissociation curve to the right (increase oxygen uptake)

40
Q

What are indications for thermotherapy?

A

-Pain control
-Decrease joint stiffness
-Accelerate healing
-Increase tissue extensibility
-Psoriasis
-Dermal ulcers

41
Q

What are contraindications of thermotherapy?

A

-Impaired sensation
-acute injury or inflammation
-over area of recent or potential hemorrhage
-blood clot (DVT)
-malignancy
-infection

42
Q

What are some precautions for thermotherapy?

A

-Poor circulation or thermal regulation
-Edema
-Hypertension
-Metal
-Altered mental state or poor communication
-Open wound
-Topical counterirritants have been applied
-pregnancy

43
Q

What is electrical current? What is it measured in?

A

The flow of electrons from one area to another.
Measured in Amperes (A)

44
Q

What is voltage?

A

The magnitude of potential difference between the high and low concentration areas of electrons

45
Q

What is Ohm’s Law?

A

The rate of current (I) is directly proportional to the strength of the driving force (V) and inversely proportional to the resistance (R)

46
Q

What is resistance? What is it measured in?

A

Resistance refers to how easily material give up electrons. Conductance is inversely related to resistance.
Ohms

47
Q

What is medical ionization?

A

-Cathode results in basic reaction (NaOH)
-Anode results in acidic reaction (HCl)

48
Q

What is wave pulse, phase, and cycle?

A

-Pulse: singe waveform, may have one or more phases
-Phases: portion of pulse which rises above or below baseline and returns to baseline
-Cycle: two phases that each return to baseline (AC)

49
Q

What is amplitude?

A

Magnitude of electromotive force driving electrons. Measured in V or A.

50
Q

Is amplitude synonymous with amount of electricity delivered to the tissues?

A

No.

51
Q

What is wave frequency?

A

Number of pulses or cycles per second. Measured in Hz

52
Q

What frequency is necessary for tetanic contraction?

A

> 50 Hz

53
Q

What are contraindications for electrotherapy?

A

-pacemaker or known arrhythmia
-over carotid sinus
-blood clot/DVT
-impaired sensation
-poor communication
-altered mental state
-over fetal areas in pregnant women
-Severe peripheral vascular disease
-superficial metal implants
-cancer

54
Q

What are precautions for electrotherapy?

A
  • Palliative/terminal cancer
    -Skin irritations or open wounds
55
Q

What is TENS? What does it do?

A

Transcutaneous electrical nerve stimulation.
Elicit sensory analgesia or endogenous opiate liberation.

56
Q

What is the duration and frequency for conventional TENS?

A

Duration: Short pulses (50-100us)
Frequency: High (80-100pps)

57
Q

What is the duration and frequency of Acupuncture-like TENS?

A

Duration: Long pulses (150-200 us)
Frequency: Low (2-10 pps)

58
Q

What is IFC?

A

Interferential current.
Transcutaneous application of two separate medium frequency alternating currents

59
Q

What is medium frequency?

A

1000-100 000 Hz
(TENS is 0-1000Hz)

60
Q

What is the relationship between frequency and resistance?

A

Inverse (increase frequency, decrease resistance)

61
Q

What is beat frequency?

A

Difference between two currents. Meant to act as TENS in deeper tissues.

62
Q

What is frequency sweep?

A

When beat frequency is altered over time by setting the sweep between two prefixed beat frequencies. Accommodation.

63
Q

Can you put IFC over spinal nerve roots?

A

Yes; shows functional disability improvements.

PT (3 decks)

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