Review

Question 1

Skin impedance __________ as the inter-electrode distance increases

Answer 1

Increases

(because there’s more skin between them duh)

Question 2

Skin impedance ________ as the frequency increases

Answer 2

Decreases

Question 3

What are the general settings of Conventional Tens?

Answer 3

Around 100 duration (75-150) and 100 frequency (80-125)

Question 4

What are the general settings of acupuncture TENS?

Answer 4

LOW frequency (under 20)

HIGH Pulse Duration: 100-600

SEE A MUSCLE CONTRACTION

Question 5

What are the general settings of noxious TENs

Answer 5

LOW frequency: 1-5

High pulse duration: 100-1000

Question 6

What are the general settings of brief intense TENS?

Answer 6

high frequency: 100

High Duration: 100-600

Set on B instead of N

You want to see muscle fasciculations

Question 7

What pain theory does conventional TENs use?

Answer 7

Gate Control

Question 8

What theory does Acupuncture/low frequency TENs use?

Answer 8

Descending pain control theory

Question 9

What theory does noxious level TENs use?

Answer 9

Endogenous opiate pain control theory

Question 10

What theory does brief intense TENs use?

Answer 10

Peripheral and central analgeisa

Question 11

What factor makes tendons heal slower than muscles?

Answer 11

Difference in blood supply

Question 12

Tendon proliferation stage occurs when?

Tendon Remodeling begins and can last how long?

Answer 12

48 to 72 hours after injury

6-8 weeks and may continue for years

Question 13

What is the first stage of a muscle injury, how long does it last?

Answer 13

Short term immobilization

2-5 days

Question 14

What happens between week 2-3 of a muscle injury?

week 4-6?

Answer 14

2-3 Balance between tissue extensibility and protection from reinjury

4-6 Gentle AROM through full range NO RESISTANCE

Question 15

After 6+ weeks of a muscle injury, how do you train it?

Answer 15

Warm up and endurance activities

Question 16

How long are most tendon rehab programs?

Answer 16

6+ months sometimes 1-2 years

Question 17

Tendons: Active tension across repair site within first ___________ results in poor outcomes

What should you do in the first 3 weeks of a tendon injury?

Answer 17

3

PROM

Question 18

What are the 4 phases of fracture repair?

Answer 18

Hematoma formation

Fibrocartilage callus formation

Bony Callus formation

bone remodeling

Question 19

How long does fracture healing time take in:

Children
Adolescencts
Adults

Answer 19

Children 4-6 weeks
Adolescents 6-8 weeks
Adults 10-18 weeks

Question 20

What areas generally heal faster from a fracture

Answer 20

UE > LE

Distal > Proximal

Question 21

What is tissue capacitance?

Put the following in increasing order of capacitance:
A-Beta, C fiber, Muscle fiber, muscle tissue, A-Delta

Answer 21

The ability to store electricity?

Lowest to highest: A-Beta, A-Delta, C fiber, Muslce Fiber, Muscle

Question 22

What tissue is the best conductor of electricity?

What tissue is the worst?

Answer 22

Best conductor: Blood

Good conductor: Muscle

Poor Conductors: Fat, Tendon

Bone: Poorest conductor

Skin: Insulator (Opposite of conduction)

Question 23

During the acute phase, what E-stim will you use?

Answer 23

Conventional

Question 24

When do you use non-thermal ultrasound?

When do you use mild thermal ultrasound?

When do you use moderate thermal

When do you use vigorous

Answer 24

During the acute phase

Sub acute

chronic

contracture

Question 25

Which frequency of ultrasound goes the deepest? How deep?

Answer 25

1MHz 5 cm

Question 26

How much temp increase for nonthermal ultrasound? Mild? Moderate? Vigorous?

Answer 26

0C 1C 2C 4C

Question 27

Skin infection Open wounds Arteriosclerosis/thrombosis/cardiac decompensation severe varicose veins new tendon transplant fracture acute inflammation Which modality are these contraindications for?

Answer 27

Massage

Question 28

should not be done when motion is disruptive to the healing process should not be done when patient’s response or condition is life threatening What modality are these contraindications for?

Answer 28

ROM

Question 29

Pace makers Stimulation near heart Area over carotid sinus Area with DVT or thrombsis Patients who are confused Patients w/ internal stimulator seizure disorders Infection Wounds,scars,lesions Malignancies pregnancy MSK problems where it would exacerbate the condition high level spinal cord injury What modality are these contraindications for?

Answer 29

E - Stim

Question 30

Bleeding Decreased sensation Decreased circulation or DVT Infection Malignancy Over implants Carotid sinus or cervical ganglia Growth plates in children over eyes, heart, genitalia over cement/plastic over pregnant woman areas over pace maker vascular problems What modality are these contraindications for?

Answer 30

Ultrasound

Question 31

What is a motor point?

Answer 31

The spot of least impedence found by using the hot-finger technique Usually somewhere in the middle of the muscle belly

Question 32

NMES Parameters vs Strengthening Parameters

Answer 32

NMES Duty cycle starts 1:5 and progresses -> 1:3 -> 1:1 Frequency: 35-55 (tetany range) Pulse Width 200-600 Goal is a comfortable muscle contraction. Strenghening Pulse width 200-600 Frequency: 50-85 (more than NMES) Duty Cycle: 1:5 (more time to rest between contractions) Goal is to have 60% Maximal Voluntary Isometric Contraction MVIC

Question 33

What is IFC and how do you set it up?

Answer 33

IFC is like TENs but with 2 interfering currents You need to place the 2 channels in a cross pattern

Question 34

What is the cathode? What is the anode?

Answer 34

**Cathode:** Negative End Alkaline Has the most electrons Replicates the natural pattern of electrical flow in body Active electrode for stimulating muscle contraction **Anode:** Positive Acidic

Question 35

What is the sequence of soft tissue massage?

Answer 35

Skin Rolling Light Effleurage Deep Effleurage Petrissage Special Techniqus Petrissage Deep Effleurage Light Effleurage

Question 36

What soft tissue massage can be preformed acutely?

Answer 36

Skin Rolling Light Effleurage Deep Effleurage Petrissage

Question 37

Bony Block Non-Union Fracture Acute Inflammation/Infection Sharp/Acute pain Hematoma/Tissue Trauama Hypermobility Hypomobility that provides stability What modality are these contraindications for

Answer 37

Stretching

Question 38

What kind of ROM should you do in the acute phase?

Answer 38

3-5 reps PROM within pain tolerance several times per day

Question 39

How do you progress ROM in the subacute stage?

Answer 39

PROM -> AAROM -> AROM (gravity eliminated) -> AROM 10-15 reps w/ brief holds 3-5 seconds 2-3 times per day

Question 40

Acute/subacute injury Decreased circulation Decreased sensation DVT Impaired cognition Malignant tumors Tendancy toward hemorrhage or edema very young or elderly What modality are these contraindications for?

Answer 40

Thermotherapy

Question 41

What are the reflexive effects of massage?

Answer 41

Decrease Autonomic nervous system response via increased parasympathetic tone Decreased HR and BP vasodilation GTO activation Gate Control Theory Release of endogenous opiates

Question 42

What are the mechanical effects of massage?

Answer 42

* Loosens adhesions, * Softens and loosens scar formation * Assists in realignment of collagen tissue * Relieves myofascial trigger points * Increase range of motion via stretching muscle, scar tissue, and decreasing neuromuscular excitability * Often combined with stretch of muscle

Question 43

The mechanical effects of massage should be done __________

Answer 43

AFTER the reflexive effects are used (only once patient is relaxed)