Review Flashcards
Skin impedance __________ as the inter-electrode distance increases
Increases
(because there’s more skin between them duh)
Skin impedance ________ as the frequency increases
Decreases
What are the general settings of Conventional Tens?
Around 100 duration (75-150) and 100 frequency (80-125)
What are the general settings of acupuncture TENS?
LOW frequency (under 20)
HIGH Pulse Duration: 100-600
SEE A MUSCLE CONTRACTION
What are the general settings of noxious TENs
LOW frequency: 1-5
High pulse duration: 100-1000
What are the general settings of brief intense TENS?
high frequency: 100
High Duration: 100-600
Set on B instead of N
You want to see muscle fasciculations
What pain theory does conventional TENs use?
Gate Control
What theory does Acupuncture/low frequency TENs use?
Descending pain control theory
What theory does noxious level TENs use?
Endogenous opiate pain control theory
What theory does brief intense TENs use?
Peripheral and central analgeisa
What factor makes tendons heal slower than muscles?
Difference in blood supply
Tendon proliferation stage occurs when?
Tendon Remodeling begins and can last how long?
48 to 72 hours after injury
6-8 weeks and may continue for years
What is the first stage of a muscle injury, how long does it last?
Short term immobilization
2-5 days
What happens between week 2-3 of a muscle injury?
week 4-6?
2-3 Balance between tissue extensibility and protection from reinjury
4-6 Gentle AROM through full range NO RESISTANCE
After 6+ weeks of a muscle injury, how do you train it?
Warm up and endurance activities
How long are most tendon rehab programs?
6+ months sometimes 1-2 years
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?
3
PROM
What are the 4 phases of fracture repair?
Hematoma formation
Fibrocartilage callus formation
Bony Callus formation
bone remodeling
How long does fracture healing time take in:
Children
Adolescencts
Adults
Children 4-6 weeks
Adolescents 6-8 weeks
Adults 10-18 weeks
What areas generally heal faster from a fracture
UE > LE
Distal > Proximal
What is tissue capacitance?
Put the following in increasing order of capacitance:
A-Beta, C fiber, Muscle fiber, muscle tissue, A-Delta
The ability to store electricity?
Lowest to highest: A-Beta, A-Delta, C fiber, Muslce Fiber, Muscle
What tissue is the best conductor of electricity?
What tissue is the worst?
Best conductor: Blood
Good conductor: Muscle
Poor Conductors: Fat, Tendon
Bone: Poorest conductor
Skin: Insulator (Opposite of conduction)
During the acute phase, what E-stim will you use?
Conventional
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
During the acute phase
Sub acute
chronic
contracture
Which frequency of ultrasound goes the deepest?
How deep?
1MHz
5 cm
How much temp increase for nonthermal ultrasound?
Mild?
Moderate?
Vigorous?
0C
1C
2C
4C
Skin infection
Open wounds
Arteriosclerosis/thrombosis/cardiac decompensation
severe varicose veins
new tendon transplant
fracture
acute inflammation
Which modality are these contraindications for?
Massage
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?
ROM
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?
E - Stim
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?
Ultrasound
What is a motor point?
The spot of least impedence found by using the hot-finger technique
Usually somewhere in the middle of the muscle belly
NMES Parameters
vs
Strengthening Parameters
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
What is IFC and how do you set it up?
IFC is like TENs but with 2 interfering currents
You need to place the 2 channels in a cross pattern
What is the cathode?
What is the anode?
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
What is the sequence of soft tissue massage?
Skin Rolling
Light Effleurage
Deep Effleurage
Petrissage
Special Techniqus
Petrissage
Deep Effleurage
Light Effleurage
What soft tissue massage can be preformed acutely?
Skin Rolling
Light Effleurage
Deep Effleurage
Petrissage
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
Stretching
What kind of ROM should you do in the acute phase?
3-5 reps PROM within pain tolerance several times per day
How do you progress ROM in the subacute stage?
PROM -> AAROM -> AROM (gravity eliminated) -> AROM
10-15 reps w/ brief holds 3-5 seconds
2-3 times per day
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?
Thermotherapy
What are the reflexive effects of massage?
Decrease Autonomic nervous system response via
increased parasympathetic tone
Decreased HR and BP
vasodilation
GTO activation
Gate Control Theory
Release of endogenous opiates
What are the mechanical effects of massage?
- 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
The mechanical effects of massage should be done __________
AFTER the reflexive effects are used
(only once patient is relaxed)
