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NPTE > Therapeutic interventions > Flashcards

Therapeutic interventions Flashcards

1
Q

Describe the following characteristics of Type IIx muscle fibers:
1. motor neuron size
2. conduction velocity and contraction speed/relaxation
3. force production
4. fatigue resistance
5. color
6. myoglobin content and blood supply
7. capillary density
8. mitochondrial density

A
  1. motor neuron size - Large
  2. conduction velocity and contraction speed/relaxation - Fast
  3. force production - High
  4. fatigue resistance - low
  5. color - white
  6. myoglobin content and blood supply - low
  7. capillary density - low
  8. mitochondrial density - low
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2
Q

Describe the following characteristics of Type IIa muscle fibers:
1. motor neuron size
2. conduction velocity and contraction speed/relaxation
3. force production
4. fatigue resistance
5. color
6. myoglobin content and blood supply
7. capillary density
8. mitochondrial density

A
  1. motor neuron size - large
  2. conduction velocity and contraction speed/relaxation - fast
  3. force production - moderate
  4. fatigue resistance - moderate
  5. color - red/white
  6. myoglobin content and blood supply - low
  7. capillary density - moderate
  8. mitochondrial density - moderate
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3
Q

Describe the following characteristics of Type I muscle fibers:
1. motor neuron size
2. conduction velocity and contraction speed/relaxation
3. force production
4. fatigue resistance
5. color
6. myoglobin content and blood supply
7. capillary density
8. mitochondrial density

A
  1. motor neuron size - small
  2. conduction velocity and contraction speed/relaxation- slow
  3. force production - low
  4. fatigue resistance - high
  5. color - red
  6. myoglobin content and blood supply - high
  7. capillary density - high
  8. mitochondrial density - high
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4
Q

What influences muscle fiber types distribution?

A

genetics

Cannot be changed via normal exercise

  • specific training can modify metabolic characteristics of all fiber types
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5
Q

What is the order of recruitment for muscle fibers?

A
  1. Type I
  2. Type IIa
  3. Type IIx
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6
Q

What is the appropriate intensity for novice to intermediate exercisers to improve strength as described by FITT-VP?

A

60-70%

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7
Q

What is the appropriate intensity for Experienced exercisers to improve strength as described by FITT-VP?

A

Gradually increases to > 80%

1 RM

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8
Q

What is the appropriate intensity for older individuals beginning exercise to improve strength as described by FITT-VP?

A

40-50%

1 RM

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9
Q

What is the appropriate intensity for sedentary individuals beginning a resistance exercise program as described by FITT-VP?

A

40-50%

1 RM

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10
Q

According to FITT-VP, what intensity is best for improving endurance?

A

< 50%

1 RM

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11
Q

According to FITT-VP, what intensity is best for older adults who want to improve power?

A

20-50%

1 RM

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12
Q

How many reps are recommended for most adults when improving strength and power?

A

8-12

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13
Q

How many reps are recommended for improving strength in those who are middle-aged and older starting a resistance program?

A

10-15

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14
Q

How many reps are recommended for improving endurance?

A

15-25

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15
Q

What are the effects of Valsalva maneuver on intrathoracic pressure, HR, return of blood to the heart, venous pressure, and cardiac workload?

A
  1. Increases intrathoracic pressure
  2. Slows HR
  3. Decreases return of blood to the heart
  4. increases venous pressure
  5. increases cardiac workload
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16
Q

When does the most rapid recovery occur after exercise?

A

Within the first minute

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17
Q

When can DOMS begin?

A

12-24 hours after vigorous exercise

Peaks at 24-48 hrs after exercise

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18
Q

How long can muscle tenderness and stiffness caused by DOMS last?

A

5-7 days

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19
Q

Describe isometric exercise.

A

Muscle contracts without length change

Contractions should be held for > 6 seconds for adaptive muscle changes

Manual resistance

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20
Q

Describe isotonic exercise

A

Isotonic exercises are those that put a consistent tension on the muscles while moving them through a full range of motion.

Machines

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21
Q

Describe isokinetic exercise.

A

Dynamic, speed control for muscle length changes; resistance is accommodating and variable.

Push-ups, squats, Rowing

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22
Q

Does OKC or CKC exercises prepare a patient for functional WB activities?

A

CKC

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23
Q

Do OKC or CKC exercises stimulate mechanoreceptors?

A

CKC

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24
Q

What is Karoven’s formula used to predict?

A

HR reserve

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25
Q

What is ventilation?

A

Volume of air breathed each minute.

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26
Q

How many Liters of air are breathed each minute (Minute ventilation)?

A

approx. 6L

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27
Q

How do you calculate minute ventilation?

A

RR x Tidal volume

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28
Q

(true/false) Exercise can reverse any damage to pulmonary tissue

A

False

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29
Q

At altitudes of >6,000 ft, there can be a (increase/decrease) in performance with aerobic activities.

A

decrease

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30
Q

Why at altitudes of >6,000 ft (1,829 m) is there a decrease in aerobic activity performance?

A

PPO2 is reduced resulting in poor oxygenation of hemoglobin

Hypoxia at altitude can result in immediate compensatory hyperventilation and increased HR

–> Hyperventilation = decreased CO2 = increase in alkaline body fluids

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31
Q

How long does it take to acclimate to altitude starting at 7,545 ft (2,300 m)?

–> How much additional time is added when altitude increases by 1,968 ft (600m)?

A

a. 2 weeks
b. 1 week for every additional 600 m

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32
Q

What happens to plasma volume and total red blood cell count with increasing altitude?

A

Plasma Volume: Decreased

Total RBC count: Increased –> increased hemoglobin = improved oxygenation

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33
Q

VO2 max (increases/decreases) starting at 1,500 m.

A

decreases - continues to decrease by 2% for every 300 m increase.

Bottom line: decreased endurance performance

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34
Q

(true/False) training at altitude provides improvement in performance at sea level.

A

FALSE

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35
Q

(true/false) Dehydration is common when training in altitude.

A

True - air is dry and cool

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36
Q

What adaptive changes with sarcomeres are made to contractile tissues when consistently stretching?

A

increase in number of sarcomeres

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37
Q

What do muscle spindles monitor?

A

Velocity and length changes in muscle

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38
Q

What does the golgi tendon organ (GTO) do?

A

inhibits contraction of the muscle when excessive tension develops - inhibits the alpha motor neuron activity/monosynaptic stretch reflex

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39
Q

When can adhesions of muscle occur?

A

When the muscle is immobilized in a shortened position for an extended period of time

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40
Q

What causes an irreversible contracture?

A

When normal soft tissue is replaced by an excessive amount of non-extensible tissue such as bone or fibrotic tissue

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41
Q

Heat (increases/decreases) GTO sensitivity.

A

increases

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42
Q

When improving stability, those with hyperkinetic movement disorders should start with (small/large) range movements.

A

Large range

progress to small range and then holding steady

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43
Q

Are CKC or OKC exercises better for enhancing postural stabilization?

A

CKC

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44
Q

Aquatic therapy (decreases/increases) peripheral blood flow.

A

increases - counteracts effusion and edema

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45
Q

At what water temperature do most patients have difficulty maintaining core temperature?

A

77 degrees

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46
Q

What structure(s) of the body exhibit the greatest temperature change?

A

skin

rises rapidly

subcutaneous tissue rises less rapidly and does not show a large change

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47
Q

What structure(s) of the body exhibit the least change in temperature?

A

muscles and joints

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48
Q

Regarding thermotherapy, what do structures > 3cm under the surface require?

A

shortwave diathermy or ultrasound

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49
Q

What are contraindications for use of superficial thermotherapy?

A
  1. acute/subacute traumatic and inflammatory conditions
  2. decreased circulation and sensation
  3. DVT
  4. impaired cognitive function
  5. risk of hemorrhage or edema
  6. malignant tumors
  7. irradiation to eyes or reproductive organs
  8. pregnancy (full-body heat)
  9. thrombophlebitis
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50
Q

What changes occur to the following when using general heat application?

Cardiac output
metabolic rate
muscle activity
blood flow to internal organs and resting muscles
HR
RR
BP
Stroke volume

A
  • Cardiac output: increased
  • metabolic rate: increased
  • muscle activity: decreased
  • blood flow to internal organs and resting muscles: decreased
  • HR: increased
  • RR: increased
  • BP: decreased
  • Stroke volume: decreased
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51
Q

Capillary permeability and pressure (decrease/increase) with localized heat application

A

increase

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52
Q

What precautions must you consider before using thermotherapy?

A
  • acute injury
  • edema
  • metal implants
  • open wounds
  • topical agents
  • cognitive status
  • pregnancy
  • cardiac insufficiency/impaired circulation
  • impaired thermoregulation
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53
Q

What temperature should water be when storing hot packs?

A

165-170 degrees

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54
Q

At what temperature does paraffin wax self-sterilize?

A

175-180 degrees

55
Q

What method of heat transmission is used with hydrotherapy (whirlpool)?

A

convection

56
Q

What temperature is most appropriate for exercising in water?

A

79-92 degrees

57
Q

What temperature is most appropriate if a person has an open wound?

A

92-96 degrees

58
Q

What precautions must be considered before utilizing local immersion?

A
  • decreased temperature sensation
  • decreased cognition
  • recent skin graft
59
Q

What precautions must be considered before utilizing full body immersion for hydrotherapy (whirlpool)?

A
  • poor thermoregulation
  • impaired temperature sensation
  • cardiac medications
  • urinary incontinence
  • respiratory issues
  • fear of water
60
Q

What are contraindications for local immersion with hydrotherapy?

A
  • maceration
  • bleeding
61
Q

What are contraindications for full body immersion with hydrotherapy (whirlpool)?

A
  • unstable CVD
  • bowel incontinence
  • severe epilepsy
  • potential for cross contamination
  • pregnancy
  • suicidal ideations
62
Q

What is the appropriate treatment pressure when using nonimmersion irrigating devices?

A

4-15 psi

63
Q

What must you avoid if using nonimmersion irrigation devices?

A
  • granulating tissues
  • body cavities
64
Q

definition

erythema of the skin with wealing formations- associated with severe itching due to histamine reaction

A

cold uticaria

65
Q

What precautions should be considered before utilizing cryotherapy?

A
  • HTN
  • poor thermal regulation
  • open wounds
  • over superficial nerves
  • cognition status
66
Q

What changes occur to the following when using general cold application?

Cardiac output
metabolic rate
blood flow to internal organs and resting muscles
HR
RR
arterial BP
venous BP
Stroke volume

A
  • Cardiac output: increased
  • metabolic rate: decreased
  • blood flow to internal organs and resting muscles: increased
  • HR: decreased
  • RR: decreased
  • arterial BP: increased
  • venous BP: decreased
  • Stroke volume: increased
67
Q

What are contraindications for cryotherapy?

A
  • cold sensitivity/intolerance
  • PVD
  • raynaud’s
  • paroxysmal cold hemoglobinuria
  • compromised circulation
  • regenerating nerves
68
Q

What is continuous ultrasound used to achieve?

A

thermal effects

69
Q

(true/false) With US, the intensity is not uniformly distributed over the surface of the transducer

A

true

Why?
The energy is mechanically blocked by the adhesive bonding of the crystals within the transducer head and the pressure waves interfere with eachother as they radiate to different areas of the crystal

70
Q

definition

The total power (Watts) divided by the area of the transducer head

A

spatial avg. intensity

71
Q

definition

The ratio of spatial peak intensity to spatial avg. intensity.

A

beam nonuniformity ratio (BNR)

71
Q

The higher the BNR, the (less/more) uniform the energy distribution is and the (less/more) risk of tissue damage occurring.

A

Higher BNR =
more uniformed energy
less risk of tissue damage

72
Q

What is the ideal ratio of BNR?

A

between 2:1 and 6:1

73
Q

When is pulsed US applied?

A

When non-thermal effects are desired

ex: treatment of acute soft tissue injuries

74
Q

definition

The fraction of time the US energy is on over one pulse period (time on + time off)

A

duty cycle

75
Q

What duty cycle is considered as pulsed US?

A

20-50%

76
Q

definition

reduction of acoustal energy as it passes through soft tissue.

  • affected by refraction, absorption, and reflection
A

attenuation

77
Q

What US frequency causes greater heat production in superficial layers (1-2.5 cm deep)?

A

3 MHz

Why?
Greater attenuation (scattering) of sound waves within the superficial tissue

78
Q

What US frequency causes greater heat production in deeper layers (3-6 cm deep)?

A

1 MHz

Why?
Less attenuation (scattering) of the sound waves within the tissues causing more energy to penetrate deeper into the tissues

79
Q

What is the intensity of the following US frequency?

1 MHz

A

1.5 - 2.0 W/cm2

80
Q

What is the intensity of the following US frequency?

3 MHz

A

0.5 - 1.0 W/cm2

81
Q

definition

movement of fluids along the boundaries of cell membranes resulting from mechanical pressure waves

A

acoustic streaming

82
Q

What precautions should be considered before using US?

A
  • breast implants
  • acute inflammation
  • open epiphyses
  • healing fractures
  • over joint cement or plastic components
83
Q

What are the contraindications for ultrasound?

A
  • cardiac pacemakers
  • impaired circulation and sensation
  • malignant tumors, thrombophlebitis, or myositis ossificans
  • over reproductive organs and heart
  • over the abdomen, low back and uterus during pregnancy
  • recently irradiated tissue
84
Q

(Low/high) intensities of US should be considered with acute conditions

A

low intensities

85
Q

(Low/high) intensities of US should be considered with chronic conditions

A

high intensity

86
Q

What is the regular treatment time for US?

A

3-10 minutes

87
Q

definition

The use of US to drive medications through the skin into deeper tissues

A

phonophoresis

88
Q

(true/false) Evidence shows support to the use of phonophoresis to treat pain and inflammation

A

false

89
Q

What are the following parameters for phonophoresis?

Intensity
Mode
time

A

Intensity: 0.5-0.75 W/cm2

mode: pulsed 20%

time: 5-10 minutes

90
Q

For joint distraction in the lumbar region, a force of ___% of the patient’s body weight is required to cause separation

A

50%

Do not exceed

NOTE:
for initial treatment, lower traction force is recommended to decrease reactive muscle spasm and determine patient tolerance

91
Q

For joint distraction in the cervical region, a force of ___% of the patient’s body weight is required to cause separation

A

7%

do not exceed

NOTE:
for initial treatment, lower traction force is recommended to decrease reactive muscle spasm and determine patient tolerance

92
Q

What traction force is sufficient to receive the effects of soft-tissue stretching in the lumbar region?

A

25% of body weight

93
Q

What traction force is sufficient to receive the effects of soft-tissue stretching in the cervical region?

A

12-15 pounds

94
Q

(true/false) traction can be isolated to a particular joint segment

A

false

95
Q

What are the contraindications to using intermittent mechanical compression?

A
  • acute inflammation
  • trauma
  • Fx
  • acute DVT
  • thrombophlebbitis
  • obstructed lymph or venous return
  • arterial insufficiency and/or revascularization
  • acute pulmonary edema
  • cancer
  • impaired sensation
  • infection
  • ABI < 0.6
96
Q

What is the optimal inflation-deflation ratio for intermittent mechanical compression?

A

3:1

97
Q

What is the optimal inflation-deflation ratio for shaping a residual limb when using intermittent mechanical compression?

A

4:1

97
Q

What on/off cycle of intermittent mechanical compression should be used for edema?

A

On: 45-90 seconds
Off: 15-30 seconds

3:1

98
Q

What determines the setting of intermittent mechanical compression?

A

Patient’s BP

  • some say do not exceed DBP
  • some say to fall between the systolic and diastolic values
99
Q

What type of current is russian and IFC while using E-stim?

A

Polyphasic

100
Q

definition

E-stim mode that has intermittent cessation for >1 second during treatment

A

interrupted

101
Q

definition

E-stim mode that has a gradual increase and decrease in the current intensity over a period of time

A

surge

102
Q

definition

E-stim mode that has a time of period with gradual rise of the current intensity and maintained for a given amount of time … then abruptly or graduallly declines in intensity

A

ramped

103
Q

(true/false) both continuous and pulsed waveforms can be used for healing

A

true

104
Q

What E-stim parameters has the greatest amount of evidence for facilitating tissue healing?

A

High voltage pulsed monophasic current

105
Q

What E-stim parameters are typically used to achieve tetany for edema reduction?

A

pulsed monophasic
pulsed biphasic

Increase lymph and venous flow

106
Q

What does E-stim do to help reduce spasticity?

A

Reciprocal inhibition:
- Fatigue the agonist muscle(s)
- Stimulate antagonist muscle(s)

107
Q

What precautions should be considered with use of E-stim?

A
  • CVD
  • impaired sensation
  • malignancies
  • iontophoresis
  • hypotension / hypertension
  • bleeding disorders
  • menstrating uterus
  • pregnancy (during labor and delivery)
  • skin irritation
  • open wounds
108
Q

What are the contraindications for E-stim?

A
  • electronic devices (pacemakers, insulin pumps, etc)
  • unstable arrythmias
  • epilepsy/Sz disorders
  • over carotid sinus, eyes, phrenic nerve, urinary bladder stimulator, pharyngeal/laryngeal muscles
  • over abdomen or low back during pregnancy
  • infection
  • uncontrolled bleeding
  • superficial metal implants
  • thrombosis
109
Q

(true/false) electrodes that are too small can cause skin irritation and/or burns

A

true

Same with those that have uneven contact and/or have self-adhesive that no longer sticks

110
Q

(smaller/larger) electrodes produce a high current density and therefore a strong stimulus

A

smaller

Note:
With larger electrodes, the same intensity is perceived as less intense due to a decreased current density

111
Q

What modality is designed specifically to provide afferent stimulation for pain management?

A

TENS

112
Q

What is the most common TENS mode?

A

High rate TENS

(“conventional TENS”)

113
Q

(true/false) high rate TENS can be applied during the chronic phase of pain but not the acute phase

A

FALSE

Can be applied during both acute and chronic phases of pain

114
Q

Does high rate TENS have a temporary or long-lasting duration of pain relief?

A

temporary

115
Q

Strong low rate TENS can be applied during what phases of pain?

Acupuncture-like TENS

A

chronic

116
Q

What TENS settings have long-lasting pain relief (60+ minutes)?

A
  1. acupuncture-like (strong low rate)
  2. brief intense TENS
  3. hyperstimulation (point stimulation)
117
Q

What TENS setting is used to provide rapid-onset, short-term pain relief during painful procedures?

ex: debridement, deep friction massage, etc)

A

Brief intense TENS

118
Q

What type of TENS combines characteristics of both high and low-rate TENS?

A

burst-mode

119
Q

What type of TENS is used as a method of modulating the parameters of other TENS modes to prevent neural or perceptual haituation due to consistent E-stim?

A

modulation mode TENS

120
Q

What is high-voltage pulsed current stimulation used for?

A
  1. inflammation phase: promotes granulation
  2. proliferation phase: reduce wound size through capillary regrowth and fibroblastic activity
  3. epithelialization phase: stimulates epidermal proliferation
121
Q

What are the following parameters for conventional (high rate) TENS?

Amplitude
Pulse rate
Pulse duration
mode
treatment duration
duration of pain relief

A

Amplitude: comfortable tingling sensation with no muscle response

Pulse rate: 80-110 pps

Pulse duration: 50-100 msec

mode: continuous

treatment duration: 20-60 minutes

duration of pain relief: temporary

122
Q

What are the parameters of Russian Stim when following a strengthening protocol?

Amplitude
Pulse rate
Pulse duration
mode
- ramp
- duty cycle

A

Amplitude: tetanic muscle contraction

Pulse rate: 50-70 pps

Pulse duration: 150-200 msec (50% duty cycle)

mode:
- ramp: 1-5 seconds based on patient tolerance
- duty cycle: 1:5

123
Q

description

electronic instrument used to measure motor unit action potentials generated my active muscles

  • signals are detected, amplified, and converted into audiovisual signals that are used to reinforce voluntary control
A

EMG biofeedback

124
Q

When using iontophoresis, what ion(s) are commonly used for pain reduction? Are each of them of positive or negative polarity?

A
  1. lidocaine (positive)
  2. xylocaine (positive)
  3. salicylate (Negative)
125
Q

When using iontophoresis, what ion(s) are commonly used for calcium deposits and myositis ossificans? Are each of them of positive or negative polarity?

A

acetate / acetic acid (negative)

126
Q

When using iontophoresis, what ion(s) are commonly used for wound healing and dermal ulcers? Are each of them of positive or negative polarity?

A

Zinc / zinc oxide (positive)

127
Q

When using iontophoresis, what ion(s) are commonly used for edema reduction? Are each of them of positive or negative polarity?

A

hyaluronidase / wydase (positive)

128
Q

When using iontophoresis, what ion(s) are commonly used for fungal infections? Are each of them of positive or negative polarity?

A

copper / copper sulfate (positive)

129
Q

When using iontophoresis, what ion(s) are commonly used for hyperhidrosis? Are each of them of positive or negative polarity?

A

Water (postive and negative)

130
Q

When using iontophoresis, what ion(s) are commonly used for muscle spasms? Are each of them of positive or negative polarity?

A
  • calcium / calcium chloride (positive)
  • magnesium / magnesium sulfate (positive)
131
Q

When using iontophoresis, what ion(s) are commonly used for MSK inflammatory conditions? Are each of them of positive or negative polarity?

A
  • dexamethasone (negative)
  • hydrocortisone (positive)
132
Q

When using iontophoresis, what ion(s) are commonly used for scars and adhesive capsulitis? Are each of them of positive or negative polarity?

A

iodine (negative)

NPTE (20 decks)

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