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Therapeutic Modalities > Therapeutic Modalities > Flashcards

Therapeutic Modalities Flashcards

1
Q

Physiological effects of general heat application include what?

A

Decreased: BP, muscle activity, blood to internal organs, blood flow to resting muscle, stroke volume
Increased: Cardiac output, metabolic rate, pulse rate, respiratory rate, vasodilation

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2
Q

Passive physical agents should only be used when?

A

To facilitate active treatment

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3
Q

Hot packs should be heated in water at what temperature?

A

165º-170º F

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4
Q

Hot pack treatment time is typically what?

A

20-30 minutes

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5
Q

Discuss the physiological effects of general cold application

A

Increased: blood flow to internal organs, cardiac output, stroke volume, arterial blood pressure, shivering
Decreased: metabolic rate, pulse rate, respiratory rate, venous blood pressure

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6
Q

Whirlpool should not be used in what situation?

A

Wound care

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7
Q

Discuss cold pack treatment parameters

A
  • Treatment temperature: packs maintained at 0-10º F
  • Treatment time: 10-20 minutes
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8
Q

Ultrasound: what frequency is associated with the depth of superficial (1-2.5 cm) versus deep tissues (6 cm)?

A

3 mHz = superficial
1 mHz = deeper

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9
Q

A PT is performing US on a patient when the patient suddenly experiences a strong aching sensation in the region. What is the most likely cause of this?

A

overheating of the periosteal tissue

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10
Q

Ultrasound: The sound head should be what size compared to the treatment area?

A

ERA = 1/2 the size of the treatment area

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11
Q

What percentage of a patient’s body weight is recommended for traction of the cervical and lumbar spine when the goal is joint distraction?

A

Cervical: 7% of BW or 20-30 lbs
Lumbar: 50% of BW

Start lower to reduce risk of reaction: 30-40lbs for lumbar and 8-10lbs for cervical

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12
Q

What percentage of a patient’s body weight is recommended for traction of the cervical and lumbar spine when the goal is reduction of disk protrusion?

A

Cervical: 12-15 lbs
Lumbar: 60-120 lbs or up to 50% BW

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13
Q

What percentage of a patient’s body weight is recommended for traction of the cervical and lumbar spine when the goal is soft-tissue stretching?

A

Cervical: 12-15 lbs
Lumbar: 25% BW

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14
Q

What percentage of a patient’s body weight is recommended for traction of the cervical and lumbar spine when the goal is muscle relaxation?

A

Cervical: 12-15
Lumbar: 25% BW
–> Can be either intermittent or continuous

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15
Q

What percentage of a patient’s body weight is recommended for traction of the cervical and lumbar spine when the goal is joint mobilization?

A

Lower forces; intermittent
Cervical: 12-15?
Lumbar: 25% BW?

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16
Q

A PT chooses to implement cervical traction for a patient with chronic neck pain associated with mobility deficits. Upon application of traction, the patient’s symptoms completely resolve. What should the PT do next?

A

Immediately cease traction & refer patient back to referring provider; immediate complete relief of pain indicates severe nerve injury that needs to be addressed medically.

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17
Q

Mechanical intermittent cervical traction for the treatment of chronic neck pain with mobility deficits and neck pain with radicular symptoms has what level of evidence?

A

Grade B- Level II (Neck Pain CPG)

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18
Q

Mechanical lumbar traction has what level of evidence?

A

Conflicting evidence; Grade D-Level IV; CPG suggests traction is not effective for treating acute or subacute nonspecific low back pain but may provide some benefits for some patients with signs of nerve root impingement

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19
Q

Indications for intermittent mechanical compression include what?

A

Amputation
Decrease edema
post mastectomy lymphedema
DVT prevention
stasis ulcer healing
venous insufficiency
subacute injures such as ankle sprains w/ traumatic edema

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20
Q

Precautions for intermittent mechanical compression include what?

A

impaired sensation
malignancy
uncontrolled hypertension
recent skin graft
dermatologic infection

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21
Q

Contraindications for intermittent mechanical compression include what?

A

acute inflammation
trauma/fracture
acute DVT
thrombophlebitis
obstructed lymph/venous return
arterial insufficiency/disease
acute pulmonary edema
renal impairment
cancer
loss of protective sensation
edema in cardiac or renal impairment
impaired cognition
infection in treatment area
hypoproteinemia
Very old or very young patients

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22
Q

Motor points in healthy innervated muscles are typically located near _____, while in denervated muscles it is usually closer to _________.

A

usually over the muscle belly

over the muscle distally toward the insertion

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23
Q

Goals and indications for electrical stimulation include what?

A

Pain modulation
Decrease muscle spasms
Impaired ROM
Muscle reeducation
Disuse atrophy
Soft-tissue repair (wound healing)
Edema reduction
Spasticity (to reduce hypertonicity)
Denervated muscle (controversial)

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24
Q

Precautions of electrical stimulation use include what?

A

Cardiac disease
Impaired mentation
Impaired sensation
malignant tumors
Open wounds/skin irritation
iontophoresis in the same spot as another physical agent
bleeding disorders
menstruating uterus
Pregnancy: during labor & delivery

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25
Q

Contraindications for the use of electrical stimulation include what?

A
  • Pacemakers or electrical devices like insulin pumps
  • Unstable arrhythmias
  • Suspected epilepsy or seizure disorder
  • Over: carotid sinus, eyes, phrenic nerve, urinary bladder stimulator, pharyngeal/laryngeal muscles, abdomen/low back in pregnancy
  • across Head or chest
  • uncontrolled bleeding or infection areas
  • thrombosis or thrombophlebitis
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26
Q

Discuss the physics principles behind iontophoresis

A

Like charges repel like charges
unlike charges attract unlike charges

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27
Q

What type of current and what is the maximal intensity associated with iontophoresis?

A

Direct current
4-5 mA

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28
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Analgesia

A

Ion(polarity): lidocaine (+), xylocaine (+), salicylate (-)
Source: lidocaine, xylocaine, sodium salicylate

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29
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Calcium deposits

A

Ion(polarity): acetate (-)
Source: acetic acid

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30
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Dermal ulcers

A

Ion(polarity): zinc (+)
Source: zinc oxide

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31
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Edema reduction

A

Ion (polarity): hyaluronidase (+)
Source: Wydase

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32
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Fungal infections

A

Ion (polarity): Copper (+)
Source: copper sulfate

33
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Hyperhidrosis

A

Ion (polarity): Water (+/-)
Source: tap water

34
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Muscle spasm

A

Ion (polarity): calcium (+), magnesium (+)
Source: calcium chloride, magnesium sulfate

35
Q

Discuss the associated ion, polarity, and source for the following iontophoresis indication:

Musculoskeletal inflammatory conditions

A

Ion (polarity): dexamethasone (-), hydrocortisone (+)
Source: dexamethasone phosphate, hydrocortisone sodium succinate

36
Q

The negative pole is the _____, while the positive pole is the _______.

A

Cathode
Anode

37
Q

Functional Electrical Stimulation: electrode placement for shoulder subluxation for a patient following a CVA

A

Bipolar (two electrodes), one on posterior delt and the other on supraspinatus

38
Q

Discuss the indications for the following modality:
Cryotherapy

A
  • Inflammation or pain
  • Acute edema
  • Muscle guarding or temporary spasticity reduction
  • Muscle facilitation
39
Q

Treatment times for cryotherapy? thermotherapy?

A

Cryotherapy: 10-20 minutes
Ice massage: 5-10 min
Thermotherapy: 20-30 minutes

40
Q

Discuss the precautions for the following modality:
Cryotherapy

A
  • Superficial nerves or open wounds
  • Uncontrolled hypertension
  • Altered sensation or mentation
  • Vulnerable patient populations (e.g. people w/ dementia, infants)
41
Q

Discuss the contraindications for the following modality:
Cryotherapy

A
  • Colder hypersensitivity or intolerance
  • Compromised circulation
  • Cryoglobulinemia
  • Paroxysmal cold hemoglobinuria
  • Raynaud’s disease
  • Regenerating nerves
42
Q

Discuss the indications for the following modality:
Thermotherapy

A
  • Pain or muscle spasm
  • Increase soft tissue extensibility
  • Decrease joint stiffness
  • Increase circulation or metabolism
43
Q

Discuss the precautions for the following modality:
Thermotherapy

A
  • ACute injury
  • Impaired circulation
  • Vulnerable populations (e.g. unable to communicate)
  • Edema
  • Implants (metal)
  • open wounds
  • Topical agents
44
Q

Discuss the contraindications for the following modality:
Thermotherapy

A
  • At risk of hemmorhage
  • DVT
  • Impaired sensation/mentation
  • Irradiation eyes or reproductive organs
  • Pregnancy (full body/could affect fetus specifically)
  • Thrombophlebitis
  • Malignant tumors
45
Q

Discuss the indications for the following modality:
Hydrotherapy

A
  • Superficial heating or cooling
  • Water exercise
  • Pain or edema control
  • Wound care (removal of necrotic tissue only)
46
Q

Discuss the precautions for the following modality:
Hydrotherapy

A
  • Local immersion: decreased temp sensation, impaired cognition, recent skin graft

Full-body immersion: (hot water); local immersion + poor thermoregulation, cardiovascular meds, urinary incontinence, aqua phobia, respiratory issues

47
Q

Discuss the contraindications for the following modality:
Hydrotherapy

A
  • Local: maceration, bleeding
  • Full-body: unstable cardiac disorder, bowel incontinence, severe epilepsy, suicidal, cross-contamination potential, pregnancy
48
Q

Application and treatment parameters:
Hot pack

A
  • 165º-170º water
  • 6-8 layers of towels
  • Peak heat within 5 minutes, check for adverse effects
  • Treatment time: 20-30 min
49
Q

Application and treatment parameters:
Paraffin bath

A
  • self-sanitizing 175º-180º
  • Treatment time: 15-20 min
  • Unlikely
50
Q

Application and treatment parameters:
Hydrotherapy

A

Temperature varies:
Exercise in water: Tepid; 79º-92º
Open wounds: neutral; 92º-96º
Thermal: 96º+ –> cardiac & nervous system stress
Treatment time: 20 minutes

51
Q

Application and treatment parameters:
Nonimmersion irrigation devices

A
  • Tx in enclosed area
  • PPE
  • Sterile, warm saline used
  • pressure: 4-15 psi
  • Avoid granulating tissue & use in body cavity
  • Tx time: 5-15 minutes 1 x/day
52
Q

Application and treatment parameters:
Cold/ice packs

A
  • Wrap pack in contact layer
  • Freezer temp: 0º F-10º F
  • Tx time: 10-20 min
53
Q

Application and treatment parameters:
Ice massage

A
  • Area no > 4 x 6 inches
  • 2 inch/second pace
  • Not over bony areas or superficial nerves
  • Tx time: 5-10 min or until analgesia
54
Q

Application and treatment parameters:
Cold hydrotherapy

A
  • Temp: 32º-79º F
  • Tx time: 20 min
55
Q

Application and treatment parameters:
cold compression

A
  • Inspect limb, elevate
  • Temp: 50º-59º F
  • Intermittent or continuous compression
  • Tx time: 15 min
56
Q

Application and treatment parameters:
Ultrasound (direct contact)

A
  • Sound head size: ERA 1/2 of tx area
  • Tx intensity: 0.5-2.5 W/cm^2 depending on tx goal; lower for acute conditions/thin tissue, higher for chronic conditions/thick tissue
  • Tx time: 3-10 min; dependent on size/intensity/frequency/etc.
57
Q

Application and treatment parameters:
Phonophoresis

A
  • Use of US to drive meds through skin to deeper tissues
  • local analgesics & anti-inflammatories are usually used
  • Mode: puled 20%
  • Tx time: 5-10 min
  • 0.5-0.75 W/cm^2
  • Evidence does not support phonophoresis for pain or inflammation!!!!
58
Q

Application and treatment parameters:
cervical traction

A
  • disk protrusion, soft tissue elongation= 10-15 lbs or 7%-10% BW
  • Joint distraction= 20-30 lbs
  • Tx time: 5-10 min (acute, disk); 15-30 for other
59
Q

Application and treatment parameters:
Lumbar traction

A
  • More hip flexion, higher up the lumbar spine
  • Acute: 30-40 lbs
  • disk protrusion, spasm; soft tissue elongation 25% BW
  • Joint distraction: 50lbs or 50% BW
    Tx time: 5-10 min herniated disk, 10-30 for other conditions
60
Q

Application and treatment parameters:
Intermittent mechanical compression

A
  • Screen BP first
  • Inflation:deflation ratio = 3:1
  • Residual limb shaping = 4:1 ratio
  • follow manufacturer instruction on BP setting
  • Tx time: condition-specific
61
Q

Application and treatment parameters:
ES for shoulder subluxation

A
  • Wave form: pulsed monophonic or biphasic
  • Electrode placement: bipolar, supraspinatus, posterior deltoid
  • Amplitude: titanic muscle contraction to patient’s tolerance
  • Pulse rate: 25-30 pps
  • Duration of treatment: 15-30 min, 3x daily, put to 6-7 hrs
  • On:off ratio = 1:3 (2:6 seconds) progressing to 12:1 (24:2 sec)
62
Q

Application and treatment parameters:
ES for dorsiflexion assist in gait training

A
  • Wave form: pulsed monophonic or biphasic
  • Pulse duration: 20-250 useconds
  • Mode: interrupted by foot switch
  • Placement: bipolar, peroneal nerve near head of fibula or anterior tibial muscle
  • Amplitude: titanic muscle contraction sufficient to decrease plantar flexion
  • Pulse rate: 25-30 pps
63
Q

Discuss the indications for the following modality:
Ultrasound

A
  • Decreased pain or muscle spasm
  • Increase connective tissue extensibility
  • Reduce inflammation
  • Accelerate rate of tissue healing (wound healing)
64
Q

Discuss the precautions associated with the following modality:
Ultrasound

A
  • Acute inflammation (avoid continuous US)
  • Breast implants
  • Over healing fractures
  • Directly over joint cement of plastic components (also considered contraindication)
65
Q

Discuss the contraindications associated with the following modality:
Ultrasound

A
  • Impaired circulation, cognition, or sensation
  • High dose thermal US should be avoided over unclosed epiphyseal plates
  • Over malignant tumors, thrombophlebitis, myositis ossificans
  • Recently irradiated tissue
  • Over & near cardiac pacemakers
  • Over abdomen/LB/pelvis in pregnancy
  • Recently irradiated tissue
66
Q

Discuss the indications associated with the following modality:
Traction

A
  • Cervical radiculopathy
  • Lumbar radiculopathy with radiating pain or paresthesia that does not have a directional preference
  • Chronic neck pain with mobility deficits
67
Q

Discuss the precautions associated with the following modality:
Traction

A
  • Significant structural disease of spine
  • Pressure form belt = hazard in pregnancy
  • Disc extrusion or sequestration
  • medial disk protrusion
  • Pain completely abolishes after treatment (check dermatome, myotome, reflexes)
  • Patient unable to tolerate positioning
  • Claustrophobia
  • Altered mentation
  • Cervical sling traction w/ TMJ symptoms
68
Q

Discuss the contraindications associated with the following modality:
Traction

A
  • When motion is contraindicated (i.e. post-op spine surgery)
  • joint hypermobility (RA, Marfans, high relaxin levels, etc.)
  • Concerns of C1-2 stability fracture
  • Peripheralization w/ traction
  • Uncontrolled HTN (for inverse traction)
  • Neuro findings worsen
69
Q

Discuss the indications associated with the following modality:
Compression

A
  • Edema
  • DVT prevention
  • Venous stasis ulcers
  • Residual limb shaping
  • Hypertrophic scar management
70
Q

Discuss the precautions associated with the following modality:
Compression

A
  • Neuropathy (monitor for ischemia)
  • Impaired mentation
  • Uncontrolled HTN
  • Potential compromise of superficial nerve
  • ABI= 0.5-0.8; pressure should not be > 27 mmHg for static devices; intermittent compression should be avoided
71
Q

Discuss the contraindications associated with the following modality:
Compression

A
  • underlying cause unknown
  • active infection or malignancy
  • Mechanical intermittent compression is avoided w/ active DVT, PE thrombophlebitis, edema from CP pathology, or severe PAD
  • ABI < 0.6 = avoid static compression
  • Significant hypoproteinemia
  • situations where limb movement is avoided
72
Q

Electrical stimulation application & treatment parameters for the following condition:
Weakness/strengthen

A
  • Type: NMES
  • Current: pulsed biphasic , pulsed monophonic, burst modulated AC (russian stimulation)
  • Frequency: tetany (smooth muscle contraction > 25-30 pps)
  • Pulse duration: 300-500 usec is common; russian stim present
  • Amplitude: visible muscle contraction
  • Treatment variables: 10 seconds on: 50 seconds on; ramp for comfort; 15 min tx, 10-15 contractions, 3 sessions/week
73
Q

Electrical stimulation application & treatment parameters for the following condition:
Endurance/prevent shoulder subluxation post-CVA

A
  • Type: NMES/FES
  • Current: pulsed current
  • Frequency: > tetany
  • Pulse duration: 300-500 usec is common; russian stim present
  • Amplitude: submaximal
  • Treatment variables: progress to longer on & shorter off times (1:1 or greater)
74
Q

Electrical stimulation application & treatment parameters for the following condition:
Muscle reeducation (facilitation)/orthotic substitution

A
  • Type: FES
  • Current: pulsed current
  • Frequency: tetany
  • Pulse duration: 300-500 usec is common; russian stim present
  • Amplitude: intensity enough to accomplish task
  • Treatment variables: often hand/foot switches used to match on/off times w/ task requirements
75
Q

Electrical stimulation application & treatment parameters for the following condition:
Muscle spasm

A
  • Type: NMES
  • Current: pulsed current or russian
  • Frequency: > tetany; higher frequency = greater fatigue)
  • Pulse duration: 300-500 usec is common; russian stim present
  • Amplitude: maximal tolerated
  • Treatment variables: attempting to fatigue spasm; on time = continuous; 10-15 min tx time
76
Q

Electrical stimulation application & treatment parameters for the following condition:
Pain/acute

A
  • Type: TENS
  • Current: pulsed current of IFC
  • Frequency: 80-110 pps
  • Pulse duration: 50-100 usec
  • Amplitude: sensory level stimulation
  • Treatment variables: conventional TENS; continuous for 20-60 min
77
Q

Electrical stimulation application & treatment parameters for the following condition:
Pain/chronic

A
  • Type: TENS
  • Current: pulsed current or IFC
  • Frequency: 1-5 pps
  • Pulse duration: 150-300 usec
  • Amplitude: motor level response that causes a comfortable rhythmic muscle contraction
  • Treatment variables: Low-rate TENS; continuous for 30-40 min
78
Q

Electrical stimulation application & treatment parameters for the following condition:
Inflammation reduction/medication delivery

A
  • Type: ionto
  • Current: DC
  • Frequency: N/A
  • Pulse duration: N/A
  • Amplitude:
    1-4 mA (clinical models)
    Dosage based on mA/min
    Dose= current (mA) x duration (minute)
    Typical dose= 40-80 mA/min
  • Treatment variables: conventional TENS; continuous for 20-60 min
  • Current density should not exceed 0.5 mA for cathode and 1.0 mA for anode
79
Q

Electrical stimulation application & treatment parameters for the following condition:
Wound healing

A

HVPC
- Pulsed monophasic
- Frequency = 30-130 pps
- Duration: dependent on waveform, could be present
- amplitude: sensory level stimulation

DC
- direct current
- Frequency: NA
- Duration: NA
- Amplitude: 200-1000 microamperes = < 1000 microA or < 1mA

Treatment length: 1-4 hrs/day; 5-7 days/week

Therapeutic Modalities (1 decks)

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