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CP 2 > Spinal Traction and Compression Therapy > Flashcards

Spinal Traction and Compression Therapy Flashcards

1
Q

List several abnormalities that can result in interstitial edema

A
  1. unregulated BP
  2. plasma protein imbalance
  3. lymphatic flow obstruction
  4. venous insufficiency
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2
Q

what is a localized edema associated with?

A

conditions such as venous insufficiency, lymphatic blockage, prolonged dependency, and localized inflammation

these tend to occur in discrete areas of the body

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3
Q

what is a systemic edema associated with?

A

systemic conditions such as CHF, hypoalbumnemia, and kidney dysfunction

typcially this is a broader, and non-discerning edematous pattern

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4
Q

List some consequences of edema

A
  1. decreased ROM
  2. functional limitations
  3. decreased somatosensory input
  4. pain
  5. increased collagen leading to fibrosis
  6. ultimately may lead to contracture, increased risk of infection and amputation
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5
Q

what are the methods for assessing edema?

A
  1. Pitting edema scale
  2. volumetric measurement
  3. linear measurement
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6
Q

describe the pitting edema scale

A
  • 1+ = barely detectable depression when finger is depressed into skin
  • 2+ = slight indentation 15 secs to rebound
  • 3+ = deeper indentation 30 secs to rebound
  • 4+ = >30 secs to rebound
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7
Q

how is volumetric measurement of an edema performed?

A

measure water displaced in a marked volume container which will easily accomodate the extremity, partially filling the container with water and immersing the extremity to a known anatomical landmark

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8
Q

what are the 3 main ways edema is reduced?

A
  1. improved venous and lymphatic circulation
  2. physical barrier to limit the size and shape of tissue
  3. increase tissue temperature
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9
Q

List the goals/indications for compression therapy

A
  1. amputation/mold residual limb
  2. decrease chronic edema
  3. lymphedema management (often seen in cancer patients)
  4. stasis ulcer
  5. venous insufficiency
  6. subacute injuries
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10
Q

list some uses for compression therapy

A

generally used to improve fluid balance, increase venous and lymph return and thus reduce vascular or lymhatic edema

  • DVT prevention
  • shaping of residul limb following amputation
  • proven to facilitate healing in venous insufficiency wound ares
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11
Q

List the precautions for compression therapy

A
  1. decreased sensation
  2. malignancy
  3. uncontrolled hypertension
  4. over area of superficial peripheral nerve
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12
Q

list contraindications to compression therapy

A
  1. trauma/fracture
  2. acute DVT
  3. completely obstructed lymph or venous return
  4. arterial disease/insufficiency
  5. arterial revascularization
  6. acute pulmonary edema
  7. loss of sensation
  8. edema with cardiac or renal impairment
  9. impaired cognition
  10. infection in trx area
  11. hypoproteinemia (<2g/dL)
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13
Q

what is the difference between static and intermittent compression?

A
  • static - exerting a continuous or constant force
  • intermittent - exerting a varying force over time
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14
Q

with compression, do you want the greatest amount of compression proximal or distal? why?

A

greater compression distally and gradually decreasing proximally, this aids in circulation as it creates a pressure gradient

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15
Q

List several types of compression methods

A
  1. Bandages
    • conforming vs non-comforming
  2. Garments
    • stockings, gloves, masks
  3. Pumps
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16
Q

With bandages what is resting pressure versus working pressure?

A
  1. Resting pressure is applied when elastic properties of the bandage are stretched in application. This pressure remains whether the patient moves or remains still.
  2. Working pressure is produced by muscle activity or movement pushing against the restraining bandage.
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17
Q

What type of bandage is more likely to have high working pressure what type is likely to have high resting pressure?

A
  • Highly extensible bandages provide high resting pressures
  • Relative inelastic bandages provide high working pressures
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18
Q

what are the precautions for bandage use?

A
  1. Propensity to be discharging to facility unfamiliar with use of multi-layer dressing (will the new place know how to use the dressing?)
  2. Frail skin/bony prominences
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19
Q

what are contraindications for bandage use?

A
  1. Patients with arterial disease (ABI ≤ 0.8)
  2. Patient inability to remove bandage (physical or mental)
  3. Allergy to component
  4. Active wound infection at bandage site
  5. Active cellulitis at bandage site
20
Q

What is the ankle brachial index and why do we care about it with compression?

A

Measurement that compares the BP measured at the ankle and arm and reports it as a ratio. This tells us if the strength of the blood flowing from the body is equal/not equal at different levels

21
Q

List pros for garment use

A
  1. OTC and custom-fit available
  2. Last 4-9 months with proper care
  3. Provide graded compression
  4. Cosmetically acceptable
22
Q

what are cons for garment use?

A
  1. Can be difficult to don, especially with arthritic hands
  2. Costly and not universally covered item by 3rd party payers
23
Q

List precautions for using garments for compression?

A
  1. May be difficult to don, may require an assistant or assistive aid
  2. Not recommended for over open wounds
24
Q

list contraindications for using garments for compression

A
  1. Patients with arterial disease
  2. Allergy to component
25
Q

How do mechanical pumps help decrease edema?

A
  1. These decrease interstitial fluids by:
    • Increasing pressure in the interstitial spaces forcing the fluid to move into the lymphatic and venous systems
    • Maintaining a mechanical limit to the skin or surrounding tissue through a sleeve to limit the “leakage” of fluid into the interstitial spaces
    • Increasing local tissue temperature through insulative factors, allowing improved activity of temperature dependent enzymes (e.g. collagenase)
26
Q

what is the difference between dynamic and non-dynamic pumps?

A
  1. Dynamic – varying pressure throughout surface being compressed, force is applied and released cyclically
  2. Non-dynamic – same pressure throughout surface being compressed, force is applied and released cyclically
27
Q

T/F: numbness, tingling, puslating and pain are expected when using pumps for compression therapy

A

FALSE

none of these should be felt during trx

28
Q

compression therapy:

list precautions for pumps

A
  1. CHF patients must be monitored closely for signs of intravascular fluid burden
  2. Impaired sensation or mentation
  3. Uncontrolled hypertension
  4. CA
  5. CVA
  6. Valve insufficiency
  7. Superficial peripheral nerves
  8. Requires barrier for patients with contact isolation precautions
  9. Never adjust pressure to greater than diastolic blood pressure
29
Q

compression therapy:

list contraindications for pumps

A
  1. DVT, thrombophlebitis
  2. Acute cardiac failure
  3. Obstructed lymphatic or venous flow
  4. Arterial disease
  5. Fracture
  6. Local infection
  7. Significant hypoproteinemia (protein levels < 2 g/dL)
  8. Suspected underlying syndrome which may be effected by compression (compartment syndrome)
30
Q

List the various methods utilized for performing spinal traction

A
  1. manual
  2. mechanical
  3. pneumatic
  4. positional
  5. gravity assisted
  6. inversion
31
Q

List the goals and indications for spinal traction

A
  1. Decrease:
    • Joint stiffness (hypomobility)
    • Meniscoids blocking
    • Muscle spasm
    • Disc protrusion
    • Discogenic pain
    • Joint pain
    • Nerve root impingement
32
Q

List precautions for spinal traction

A
  1. Claustrophobia
  2. Hiatal hernia
  3. Impaired cognition
  4. Any disease or condition that can compromise the structure of the spine (RA, prolonged steroid use, tumor, osteoporosis, etc.)
33
Q

list contraindications for spinal traction

A
  1. Acute strains, sprains, and inflammation
  2. Spondylolisthesis
  3. Fractures
  4. Increased peripheralization with traction
  5. Increased nerve root symptoms with traction
  6. Joint hypermobility or instability
  7. Pregnancy (lumbar traction)
  8. Patients who have received surgical stabilization or decompression, spine implants, or prosthetic discs
34
Q

What is the proposed biomechanical effect of traction for joint distraction?

A
  1. Separation of the facet joints occurs with sufficient force
  2. Opens up the intervertebral foramen
    1. Relieves pressure on nerve root
    2. Decreases compressive forces on facets
35
Q

What is the proposed biomechanical effect of traction for joint protrusions?

A
  1. Separation of vertebral bodies occurs at higher forces
    • Leads to decrease intradiscal pressure creating suction like effect on nucleus populous potentially drawing it back in centrally
  2. Surrounding ligamentous structure taut which also helps push disc in centrally
36
Q

What is the proposed biomechanical effect of traction for soft tissue stretching?

A

Surrounding spinal muscles, ligaments, tendons, and discs can be stretched thus decreasing pressure on facet, nerve roots, vertebral bodies and discs without achieving joint separation

37
Q

What is the proposed biomechanical effect of traction for muscle relaxation?

A

Traction can interrupt the pain-muscle spasm cycle by stimulation mechanoreceptors through the motion of intermittent traction and by inhibiting neuron firing with static traction.

38
Q

What are the variables you can alter with cervical traction?

A
  1. if it is static or intermittent
  2. Angle of traction
  3. Dosage
    1. Amount of tension
    2. Duration of traction
    3. Cycle (total cycle duration)
39
Q

what needs to occur in order to target the lower C-spine with traction?

A

more cervical flexion

40
Q

what parameters do you need to know in regard to cervical traction?

A
  1. it is based off of expert opinion
  2. do not exceed 30-40 lbs
  3. start light and with less time work your way up
41
Q

what type of outcomes should you record post-traction?

A

whether or not there were any change in symptoms such as:

  1. decrease in symptoms
  2. centralization of symptoms
  3. increase/decrese in ROM/strength
  4. improved ability to perform ADLs
  5. improved reflexes/sensation
42
Q

what is a rebound effect (concerning spinal traction) and how can you avoid it?

A

Following a period of traction, if the patient suddenly moves through the new ROM the joint may rapidly stiffen up and be worse than before. Avoid this by allowing the patient to slowly and incrementally move

43
Q

List variables that you can alter with lumbar traction

A
  1. if the pt is supine/prone
  2. positioning of LE
  3. if the traction is static or intermittent in application
  4. angle of traction
  5. dosage factors such as:
    • amount of tension
    • duration of traction
    • cycle (total cycle duration)
44
Q

how can you target higher in the lumbar spine when applying spinal traction?

A

more hip flexion

45
Q

list the parameters that you need to know for lumbar traction

A
  1. it is based off expert opinion
  2. generally you can work up to 50% of body weight
  3. start light and with less time work your way up
46
Q

how much weight is needed in cervical traction to target disc protrusions and soft tissue mobility?

A

12-15 lbs

47
Q

how much weight is needed in lumbar traction to achieve soft tissue stretching?

A

25% of patient’s body weight

CP 2 (13 decks)

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