Test 2 Flashcards
Starting with cryotherapy
N
Conduction
Direct contact
Examples of conduction
Ice massage
Cold pack
Ice bath
Cold water
Convection
Air or water particles move across the body part causing cooling
Example of convection
Cold whirlpool
Evaporation example
Vapocoolant spray
Cryotherapy
Application of cold for therapeutic purposes
Cryokinetics
Combination of cold and exercise
CIVD-cold induced vasodilation aka?
Hunting response (hunting-Lewis response)
Cold induced vasodilation
Increased tissue temperature during cold therapy approx. 15 minutes into treatment then alternates. But never above baseline
Goals of cryotherapy
- relieve of decrease pain
- decrease blood flow and metabolism
- protect injured tissue
- decrease muscle spasm
Contraindications to cryotherapy
- impaired cold sensation
- cold-induced urticaria (allergy)
- Raynaud’s disease
- cryoglobulinemia
- paroxysmal cold hemoglobinuria
- open wounds
- peripheral vascular disease
- confused/unreliable patients
Cryoglobinemia
- abnormal clumping of plasma proteins stimulated by cold application
- leads to skin discoloration and dyspnea
- associated with multiple myeloma
What is cryoglobinemia associated with
Multiple myeloma Walden storm macroglobulinemia Chronic liver disease Infections Coexistence connective-tissue diseases like SLE, Sjogren syndrome
Aka for cold induced hemoglobinuria and info
Paroxysmal cold hemoglobinuria
- cold activates antibody to to RBCs causing lysis and excess hemoglobin is excreted in the urine
- dark urine and back pain
Acute disease MC in young child ex: URI
Chronic disease MC in elderly ex: neoplastic or infectious
Risks of cryotherapy
Impaired circulation Thoracic area in patients with CAD HTN patients Cardio disorders (take BP before, after, during) Superficial peripheral nerves Hemiplegic Very young/old Obesity( increased risk of frostbite)
How does ultrasound work (type of waves)
Uses sound waves at high frequencies to heat muscles, tendons, ligaments etc.
What is the Mc deep heating modality
Ultrasound
How does ultrasound work
Electrical current passed through a crystal causing it to vibrate. Vibration generates sound waves
What type/thickness of crystal used in ultrasound
Quartz, lead etc. very thin. 2-3mm
Frequency of ultrasound
~1 million HZ (1MHz-3.3Mhz)
What is duty cycle
Time sound is delivered by divided by total treatment time
100% continuous
50%/20% are Mc pulsed duty cycles
When it continuous ultrasound used
Tissue healing
When is pulsed ultrasound used
Mechanical/non-thermal effects
Piezoelectric effect
Mechanical deformation of a crystal causes and electrical current to form
Reverse piezoelectric effect (indirect)
Alternating current is passed through a crystal resulting in fast contraction and expansion of the crystal
—> produces high frequency sound waves
*requires high voltages
Near field aka and distance
5cm into tissues
Treatment area
Fresnel zone
Far field and aka for ultrasound
Fraunhofer zone
2ndary Tex affect
Deeper than 5cm/tissue
Spatial peak intensity
Peak intensity of max intensity
Watts/cm2
Spatial average intensity
Average intensity
Isp x duty cycle
ERA (effective radiating area)
Area of the sound head that produces sound energy (smaller than ultrasound head)
*ideally only a bit smaller
Beam nonuniformity ratio (BNR)
Amount of variability of the beam
Ratio between the peak intensity of the ultrasound mean divided by the average intensity sound beam
Used to compare quality between machines
What is ideal BNR (beam nonuniformity ratio)
1:1 within the range of 2:1-8:1 acceptable
**peak intensity: avg intensity
A lower BNR means what
more uniform the intensity of the sound wave
Benefits of lower BNR
Eliminate hot spot
Higher dosage without discomfort
Greatest comfort/safety
PAMBNR (peak area of the maximum beam nonuniformity ratio)
Area of sound head covered by peak intensity
Large: larger area of sound head; less uniform heating
Small: small area
Why is gel used in ultrasound
It prevents reflection of sound waves by air bc air is a poor conductor
More watts during ultrasound causes what
More heating NOT greater penetration
In ultrasound what does frequency affect
Depth
Time required to cause increase in tissue temperature
High and low frequency for ultrasound effects and indications
High: 3.3MHz- absorbed more rapidly affects superficial tissues
Low: 1.1MHz-absorbed slower and affects deeper
Continuous US
More sound energy delivered and absorbed so treated tissue healing
Scattering affect with ultrasound
When US encounters a boundary between tissues energy scatters by reflection or refraction
Reflection
Reversal of direction of ultrasound wave at soft-tissue-bone interface and leads to increased heating
**tissues close to bone receive increased dose
Refraction
Change of ultrasound wave from a straight path when passing obliquely from one medium to another
Lead to concentrations of US at point of refraction ex: tendon joints bone
Effects of ultrasound
-tissue healing due to increase in metabolic activity and blood flow
Increase in 1, 2-3 and 4 C effects with ultrasound
1- increased metabolic activity
2-3: reduction of muscle spasm, increased blood flow, reduced chronic inflammation
4: alters viscoelastic properties of collagen
Relationship with ultrasound and treatment time and tissue healing
Longer time needed when lower intensity used
Therapeutic effect of ultrasound
- increase extensibility of collagen of tendons/j-capsule and synthesis
- increased blood flow
- increased cell metabolism
- decreased joint stiffness and muscle spasm
- enhanced tendon, lig, and muscle healing
Non thermal effects of ultrasound
Pulsed ultrasound
- stimulation of fibroblast activity
- increased blood flow
- increased proteins associated with injury repair
Through acoustical streaming and stable cavitation
Acoustical streaming
Movement of fluids along cell membranes due to mechanical pressure exerted by sound waves
Movement is in direction of sound waves
-increased cell membrane permeability
Cavitation
Formation of gas filled bubbles from pressure changes in tissue fluids
Stable vs. unstable cavitation
Stable: rhythmic expansion and contraction of bubbles during repeated pressure changes over many acoustic cycles
Unstable: collapse of gas bubbles that may cause tissue damage. Associated with low frequency, high intensity ultrasound (not therapeutic)
Contraindications of ultrasound
Malignancy Hemorrhage Ischemia Thrombus Infection Gonads Eye Pelvic abd, lumbar/pregnant Eye Spinal cord after laminectomy Plastic and cemented implants (metal ok) Near/over electronic implant Unknown etiology
Risks of ultrasound
Bony prominence (use indirect/smaller head) Epiphyseal plate
What intensity not to exceed in ultrasound
8.0 W/cm2
Treatment area of ultrasound
2-3x of the size of ERA
Phonophoresis
Aka sonophoresis
Uses energy to drive medication into tissue
Medication doesn’t require charge
Ultrasound and E-stim (combo)
Useful potentially for: Trigger point Epicondylitis Superficial pain areas Decrease adhesions
Ultrasound head becomes the treated electrode when used with dispersal pad
**premod is used for pain relief in combo with mechanical pulsed/continuous US
Low intensity pulsed US use?
Stimulation of fracture healing
Noncontact low-frequency ultrasound (NCLFUS)
Would cleaning and debridement
Propels sterile saline across wound and stimulates healing
What phase is targeted with 100%/continuous with heat for ultrasound
Repair phase
What phase is targeting with 50%-pulsed-no heat with ultrasound
Acute phase
What settings are used with repair phase with ultrasound
Continuous (100%) with heat
What settings are used for acute phase for ultrasound
Pulsed (50%) no heat
Chronic tendonopathies such as lat. epicondylitis and Achilles tendonosis are painful with ischemic and fibrotic changes of the tendon that may benefit from what treatment?
Thermotherapy with US in combination with premod
Decrease pain and increase circulation
When is indirect/underwater ultrasound used
When the head won’t contact the skin flat
What is pulsed, no heat used with ultrasound
Goal of increase healing in an acute patient
When is continuous with heat for ultrasound used?
Goal of decrease muscle spasm, chronic pain, and increase healing
When is combo US and premod IF used
Chronic tendonosis, trigger points or acute or chronic pain
Depth of 1MHz and 3.3 MHz
1: 2-5cm
3. 3: 1-2cm
Types of diathermy
Shortwave (MC) and microwave
What is diathermy
High frequency electromagnetic energy
Arndt-schultz law
Dose vs response
Grotthuss-Draper law
Absorption vs therapeutic effect
Inverse square law
Dose vs divergence
1/4 as much heat with 2x the perpendicular distance
Indications of short wave diathermy
Osteoarthritis Neck/back pain Ankle pain Dermal wounds Other musculoskeletal injuries/pain
Contraindications (11) of short wave diathermy
Loss of sensation Electronic implants Surgically implanted metal Metal in contact with skin Cancerous areas Pregnant patients Hemorrhagic areas Ischemic areas Testes Eyes Open growth plates
Precautions with short wave diathermy
Prenant operator shouldn’t be around daily and remain 3 feet away Copper IUDs Other patients keep 10 foot distance Other EPA devices-10 feet Mentally confused
Types of electrodes with diathermy
Capacitive or inductive
Capacitive electrode with diathermy
Targets what?
Use for who?
Produces electrical field
Targets low electrolyte/water content tissues such as adipose
Use on things patients are areas with low subQ fat like: knee, foot, hand, shoulder
What areas should you use capacitance technique of diathermy
Low subQ fat—knee, foot, hand, shoulder
Induction electrode with diathermy
Targets
Use on who
Produce a magnetic field
Greatest absorption in high electrolyte and high dipole tissue such as deep muscle, tendon, joint
Use on patients with more subQ fat/obese patients
When should you use inductive technique for diathermy
Obese patients
Targets muscle, tendons, joints
Clinical goals of diathermy
Decrease pain
Increase joint mobility
Increase would healing
Application of diathermy
Test warm/cold sensation first
Remove jewelry
2-3cm layer towel between electrode and skin
DIATHERMY LOOK UP
- 4 LAWS
2. CONTINUOUS VS PULSED INDICATIONS
Light is transmitted as _____ and is packaged in “_____”
Waves
Photons
Giving up energy is called?
Spontaneous emission
Adding energy to electrons causes them to do what? The atom is in an ________ state. An excited atom will then do what? If that ______ interacts with another _____ _____ it will do what?
Move to higher orbit
Excited state
Excited atom releases a photon
If photons interacts with another excited atom, it will release another photon
Population inversion
Number of excited atoms outweighs the number at ground state
Pumping
Application of external source of power that causes population inversion
Explain steps in production of laser
Pumping of active medium Population inversion Spontaneous emission Stimulated emission Amplification
Coherence in laser
Same wavelength and all in phase
Light emitted in an organized fashion
Monochromatic
Single color
AKA same wavelength
Collimation in cold laser
Photons move in parallel fashion, they don’t diverge
What wavelength gives deeper penetration
Longer—lower frequency gives deeper penetration
As concentration of melanin or hemoglobin increase the depth of penetration of laser of the light _____?
Decreases
