Test Two Flashcards
Photobiomodulation
Photochemical effect from absorption of photons of lights by cells
Photobiostimulation
Lower doses of laser
Photobioinhibition
Higher doses of laser
Chromophore
Molecules that accept energy from photons
Ex: cytochrome
Trigger biochemical reactions
Cellular mechanisms of LLLT
Change in Na-K channel
Increase intracellular Ca
Increased Ca affects nucleotides that modulate DNA/cell proliferation
Aka biostimulation
Photobiostimulation
Chaim of chemical reactions is triggered by exposure to light
Causes change in oxidation/reduction leading to increased ATP synthesis and Na-K pump increased permeability to calcium
Primary effects of photobiostimulation
Due to direct interaction of photons with cytochromes
Secondary effect of photobiostimulation
Induced by primary effects in the same cell the photons produced primary affects
Cell proliferation, protein synthesis, degranulation, GF secretion, NT modification
Tertiary effects of photobiostimulation
Indirect responses of distant cells to changes in other cells that had direct contact with photons
Primary, secondary and tertiary evens summate to produce what>
Photo therapeutic activity
LLLT used for what?
Pain management
Tendinopathy management
Wound management
What class are therapeutic lasers
IIIb
What lasers can damage eyes
3a/3b
Wavelength of therapeutic lasers 3b
5-500mW
Contraindications of LLLT
Cancer Pregnancy Eyes Active hemorrhage Open wounds unless with clear barrier Epileptic patients
Super pulsed laser for LLLT
Higher peak power with less thermal effect
- more direct energy to target tissues
- safer and better
Lower range of frequencies for LLLT are termed what
Biostimulatory
Arndt Schultz principle
Biological reactions are not only dictated by dose but at rate which energy is delivered
Under 500Hz: stimulators
Over 500Hz: inhibitory
Phototherapy
Use of artificial UV light for therapeutic purposes
Photochemical effect
Use of artificial UC light with a chemical photosensitizing agent for therapeutic purpose
Minimal erythema dose
Faint redness 24 hours after treatment for ultraviolet therapy
What’s another way you can measure dose for UV therapy
Fitzpatricks skin phototype
Established indications for UV therapy
Psoriasis
Atopic dermatitis
Vitiligo
My oasis fungoides
Contraindications of UV therapy
Eye Malignant skin Melanoma history SLE, porphyrias, Pellagra sarcoidosis, HSV active TB Kidney, cardiac or liver diseases Hyperthyroidism DM Acute eczema or dermatitis
Photosensitizing drugs
Antibacterial/microbial
-tetracycline, sulfonamides, griseofulvin
Thiazide diuretics
Other: phenothiazines, psoralens, sulfonylureas, diphenhydramine (Benadryl)-antihistamine
Conduction
Direct contact
Heat/cold applied directly to skin
- hydrocollator
- paraffin bath
Convection
Air/water particles move across part causing heating or cooling
- whirlpool
- fluidotherapy
Radiation
Transfer of heat from a warmer surface to a cooler through air or vacuum
-infrared lamp
Conversion
Heat generated from another energy form
- ultrasound
- diathermy
Effects of thermotherapy
Pain relief
Spasm reduction
Increased mobility
-decreased joint viscosity, decreased viscoelasticity of muscle, tendon, and ligaments
Conduction is what kind of heat
Moist heat
Convection is what type of heat
Dry heat
What type of thermotherapy good for myofascial pain
Shorter duration moist heat
Ex: hot pack/paraffin bath
What type of thermotherapy is good for low back pain
Long duration low level heat
What may be better than ibuprofen at creating analgesic effect
Thermotherapy!
Indications for thermotherapy
Pain relief
Muscle spasm
RA
OA
Contraindications of thermotherapy
Impaired heat sensation Malignancy Thrombophlebitis Hemorrhage Pregnant Acute inflammation/conditions Confused patients
How many layers used with hydrocollator pack
Silicate gel
6-8 layers of terry cloth
Use of hydrotherapy
Cleansing and debridement of wounds
Temperature for whirlpool
86-100/30-38
For whirlpool, temperature of water must be ____ if size of treatment area is ___
Lower
Bigger
Temperature of paraffin bath
124-129 F (51-54C)
Indication for fluidotherapy
Chronic condition
Dry heat
Indication for infrared lamp
Skin conditions/sensitive skin with issues of pain, OA, RA, spasm
Inverse square law
Intensity varies with the inverse square of the distance between the bulb and the skin
Double distance = 1/4 heat
Cosine law-reflection
Intensity of heat decreases with change from perpendicular
What phase do you use contrast bath
Subacute
Able to transition from warm to cool etc.
NOT GOOD FOR SWELLING
Topical counterirritants
Menthols from peppermint
Methyl salicylate from wintergreen
Camphor
Capsaicin from hot peppers
Ex: biofreeze, icy hot etc
What are thought to inhibit pain (fibers?)
A-delta
C-afferent
Evaporation of alcohol and menthol
Decrease skin temp
Stimulate cold receptors that compete for spinal pathways in pain
Rubbing (massage) stimulates large what?
Myelinated mechanoreceptors
That thermotheraies can be used for chronic conditions
Hydrocollator pack (158-169F) Warm whirlpool Fluidotherapy
Temperatures of hydrocollator pack
158-169F
What thermotherapy used for joint stiffness of hands/feet in OA
Paraffin bath
Cryokinetics
Combo of cold and exercise
Cold induced vasodilation
Increase in tissue temperature approx. 15 min into treatment and then alternates
Hunting response
Indications of cryotherapy
Decrease pain
Decreased blood flow and metabolism
Protect injured tissue
Decrease spasm
Contraindications to cryotherapy
Impaired cold sensation Cold induced urticaria Raynauds Cryoglobulinemia Paroxysmal cold hemoglobinuria Open wound Peripheral vascular disease Confused patients
Cryoglibinemia
Abnormal clumping of plasma proteins stimulated by cold application
Skin discoloration/dyspnea
Associated with MM, macroglobulimea, C. Liver disease, hepatitis, SLE etc
Paroxysmal cold hemoglobinuria
Cold temperatures activates antibodies to RBCs causing lysis
Excess hemoglobin excreted causing dark urine andback pain
Acute MC young, Chronic MC in old
Obesity and cryotherapy relationship
Extra insulation can freeze skin before removing any heat
Stages of sensation in cryotherapy
CBAN
Cold, burn, ache, numb
What tests are done before cryotherapy
Ice cube test and nail bed test
Does compression increase cooling?
Yes
Do you apply ice bags directly to skin? Gel packs?
Ice: yes
Gel: no, single layer of wet towel to improve conduction and prevent frostbite, NO COMPRESSION WITH GEL
What are diasvantages to cold whirlpool
Cannot elevate part so not ideal fro acute situation
Thermopane
Whirlpool constant circulation prevents water water layer around body part
Ice massage best for what areas
Superficial and bony prominences and Tendon areas
Desensitize trigger points
Vapocoolant spray
Superficial rapid cooling through evaporation but no temperature change below dermis
Indications of vapocoolant spray
Trigger points
Muscle spasm
Decreased ROM
Effects of vapocoolant sprays
Increase tolderance to motion/stretch
Contraindications of Ethyl chloride/fluoromethane vapocoolany spray
Allergy Open wound Post surgical Eyes Other cold contraindications plus indications to passive stretch
What has the largest physiological response to cold
Skin
Rewaarming vs cooling time periods
Should have 2x rewarming period than that of cooling
Physiological responses to cryotherapy
Decreased nerve conduction velocity and bombard CNS with cold signals
Affect muscl spindle and GTO
Decrease efferent signals
Decreased pain interrupts
Vasoconstriction..decreased flow…edema
Decrease metabolism…less secondary injury
Strength of contraction decreased
Cryokinetic
Active exercise during or after cryotherapy.
Apply cold until numb, ROM exercise for 3-5min repeate up to 5x
