therapeutic modalities Flashcards
1
Q
ice massage timing
A
- 10x15 cm covered in 5-10 minutes
2
Q
cold pack application
A
- 20 minutes - reduces temp of skin and subcutaneous tissues up to 2 cm in depth
- can be applied every 1-2 hours for reduction of inflammation and pain
- can be 30 minutes if for spasticity reduction
stored in 25 degrees F
3
Q
A
4
Q
cold bath
A
- water 55-64 degrees F
- 15-20 minutes
- lower temperature = shorter duration of treatment
5
Q
controlled cold compression unit
A
- water 50-77 degrees F
- intermittent compression
6
Q
cryo cuff
A
- cold water and compression
- mostly knee and ankle
7
Q
cryotherapy comparisons
A
8
Q
vapocoolant spray
A
- cooling through evaporation, temp changes superficially in epidermis
- for trigger points
- 30 degree angle 12-18 in from skin
- torticollis, neck or LBP caused by muscle spasm, acute bursitis, HS tightness
9
Q
superficial thermotherapy
A
- local or general use of high temps in rehab with goal of increasing skin temp and superficial subcut tissue to depths of up to 2 cm
- influences hemodynamic, metabolic, and NM processes
- hot packs, warm water baths, infrared lamp, paraffin
10
Q
hot packs
A
- stored in water 158-167 degrees F
- 15-20 minutes
11
Q
fluidotherapy
A
- convection, circulates warm air and small cellulose particles
- 100-118degrees F, 15-20 minutes
12
Q
infrared lamp
A
- superficial heating of tissue through radiant heat
- 780-1500 nm
- absorbed within first few mm of tissue
- 20 inches from source, 15-30 minutes
13
Q
paraffin wax
A
- superficial heating agent
- 113-122 degrees
- 6-10 dips
14
Q
deep thermotherapy
A
- local or general use of energy in rehab with goal of increasing tissue temp
- heat depths 3-5 cm
- influence mechanical, muscular, connective tissue, hemodynamic, metabolic, and NM processes
- ultrasound and diathermy
- relative changes in tissue temp influenced by intensity of heating agent, duration of exposure, and thermal conductivity of tissues
15
Q
ultrasound
deep thermotherapy
A
- transfers heat through conversion and elevates tissue temp to depths up to 5 cm
- high frequency acoustic mechanical vibrations produce thermal and nonthermal effects
- frequency above 20,000 Hz, therapeutic between 0.75 and 3 megahertz (MHz)
- uses alternating electrical current, generated at same frequency as crystal resonance, to create mechanical vibration - converts electrical energy to acoustic energy and generates US at desired frequency
- thermal effects: acceleration of metabolic rate, pain mod, reduction of muscle spasm, decr joint stiffness, alteration of nerve conduction velocity, increased circulation
- nonthermal effects: increased cell and skin membrane permeability, increased intracellular Ca levels, tissue repair, normal cell function promotion
- no unstable cavitation (bursts) w/ therapeutic ultrasound
16
Q
ultrasound contraindications
A
- acute and post-acute conditions
- active bleeding
- decr temp sensation
- decr circulation
- DVT
- infection
- malignancy
- over breast implants
- over carotid sinus or cervical ganglia
- over epiphyseal areas in young children
- over eyes, heart, genitalia
- over cement or plastic
- over pelvic, lumbar, or abdom areas in pregnant women
- over pacemaker
- thrombophlebitis
- vascular insuff
17
Q
contraindications for cold therapy
A
- cold intolerance
- cold urticaria
- cryglobulinemia
- infection
- compromised circulation
- regenerating peripheral nn
- paroxysmal cold hemoglobulinuria
- periph vasc disease
- raynaud’s skin anesthesia
18
Q
coupling agent in US goes on
A
- both skin AND transducer
- gels, gel pads, mineral oil, water, lotions
- indirect coupling agents - when treatment area is excessively small, irregularly shaped, unable to tolerate direct P from transducer (water immersion in plastic or rubber bin)
19
Q
in water immersion US, how far should transducer be from skin
A
- 0.5-3.0 cm away
- moved parallel to treatment surface
- wipe away air bubbles on transducer and patient skin - interfere with transmittion
- may need to increase intensity 50% when using underwater d/t energy absorption by water
20
Q
US transducer should be moved at rate of
A
4 cm/sec
21
Q
US intensity
A
- quantity of energy delivered per unit area
- effective radiation area (ERA): area of transducer that emits US energy, smaller than total size of transducer head
- spatial averaged intensity: W/cm^2
- spatial peak intensity: intensity of US beam at its highest point
- beam nonuniformity ratio (BNR): ratio btw spatial peak intensity and spatial averaged intensity, higher crystal quality = lower BNR and less likelihood that patients experience hot spots and discomofrt during treatment, usuall 5:1 or 6:1
22
Q
US frequency
A
- primary determinant in depth of US penetration
- high frequency absorbs faster - affect more superficial tissues, lower frequencies affect deeper tissues
- 1MHz for deeper tissues, 3 MHz for more superficial tissues
23
Q
US: _ MHz for deeper tissues, _ MHz for more superficial tissues
A
- 1MHz for deeper tissues (up to 5 cm)
- 3 MHz for more superficial tissues (1-2 cm)
24
Q
US duty cycle
A
- portion of treatment that US is generated during entire treatment, continuous or pulsed
- on time/(on time + off time)
- continuous: US intensity remains constant through treatment (100% DC); thermal effects at higher intensity and nonthermal at lower intensity -> more effective at elevating tissue temperature
- pulsed: US intensity periodically interrupted, reduced average heating of tissues, primarily for non thermal effects, 20% recommended
25
US duration
- an area 2-3x transducer takes ~5 mins
- longer duration for lower intensities or lower frequencies or if therapeutic objective is higher tissue temps
- US should not be used to treat areas larger than 4x the effective radiating area of transducer
26
US number of treatments
- usually 2-3x per week
- for nonthermal effects can be 1x per day
- should see response in 3 sessions
- more than 14 US treatments in a single episode of care can reduce RBC and WBC counts
27
phonophoresis
- use of US for transdermal delivery of meds
- anti-inflamm agents and analgesics
- not likely to produce burns or damage skin
- limited efficacy according to evidence
28
diathermy
- deep heating agent, converts high frequency electromagnetic E into therapeutic heat
- continuous or pulsed modes - pulsed not for thermal effects
- most common frequency is 27.12 MHz
- capacitive plate method: superficial heating pattern, over low fat contant areas
- inductive coil method: deeper heating pattern, over areas of high water content
- 20 minutes for thermal effects, 30-60 minutes for nonthermal effects
- bigger areas than US
29
heating agents advantages and disadvantages
30
ultraviolet light
- absorbed 2 mm into skin, for skin disorders
31
hydrotherapy
- heat through conduction or convection, in pools
- NOT for CV or pulm disease, bleeding, diminished sensation, gangrene, impaired circulation, incontinence, maceration, PVD, renal infection, mental disorders
- wound care, weight unloading, reduction of edema
32
therapeutic pool temperatures
33
contrast bath
- alternating hot and cold to decrease edema in distal extremity
- hot (104-106) then cold (50-60) for 3-4 mins, total 25-30 minutes
34
lumbar traction
- max 30 pounds used for initial session
- 50% of body weight required for actual separation of vertebrae, 25% for muscle spasm or disk prostrusion
- 10 minutes for disks, up to 30
- prone for disks, supine for greater separation of facets and foramen
35
cervical traction
- supine for posterior structure separation, prone for disk spaces
- 0-5 degrees flexion for upper CS
- 10-20 for mid CS
- 25-35 for lower CS
- 10 lbs for first session
- 7-10% of pt body weight for soft tissue stretch, muscle spasm, disc protrusion
- 13-20% for joint distraction
- should not exceed 30 pounds
- 10 minutes for disks, up to 30 for other
36
compression bandages
| static compression
- increase ext P on body w/ resting pressure and working pressure
- **resting**: when elastic bandage is on stretch, P when pt is active or at rest
- **working**: produced by active muscle contracting against inelastic bandaged, only when pt is active
37
types of compression bandages
- **long-stretch bandages**: greatest resting P (60-70 mm Hg), extend up to 200% length, little working pressure - stretch when muscles expand; for immobile pts
- **short-stretch**: low P at rest and high P when muscles expand, moderately effective when pt active or at rest - both resting and working pressure; during exercise, not effective in flaccid or inactive limb
- **multi-layered**: moderate to high resting pressure w/ layers, common w/ venous stasis ulcers
- **semirigid**: treated gauze applied to distal extremity - intially wet then hardens and dries; also venous stasis ulcers
38
compression garments
- 16-18 mmHg prevent DVT
- 20-30 mmHg for scar tissue control
- 30-40 mmHg for edema control
- should be fit when level of edema is minimal
- usually last 6 months
39
intermittent pneumatic compression pump
- UE 30-60 mmHg
- LE 40-80 mmHg
- 30 minutes - 4 hours based on diagnosis, 3x per week to 4x per day
- can be used in combo with other modalities
40
therapeutic electrotherapy currents
- **direct**: constant flow of electrons from anode (+) to cathode (-) for more than 1 s without interuption
- **alternating**: polarity continuously changes from (+) to (-) w/ change in direction of current flow, biphasic, symmetrical, or asymmetrical, sinusoid shape
- **pulsatile**: non-cont flow of direct or alternating current, discrete separated from other pulses by period of time w/ no activity, monophasic is all positive - one phase for each pulse, biphasic is + and - and has two pahses for each pulse
41
characteristics of electrical current based on electrode size
- small electrodes: increased current density, increased impedance, decreased current flow
- large electrodes: decreased density, decreased impedance, increased current flow
- closer electrodes: more dense current in superficial tissue
- farther apart: more dense in deeper tissues
42
monopolar or bipolar electrode placement
- monopolar: small stimulating or active over target site, larger dispersive placed away from target site; for wounds, iontophoresis, and edema
- bipolar: two same size elctrodes over target; for muscle weakness, NM facilitation, spasms, ROM
43
e stim parameters
- amplitude: amount of current supplied over time, must be large enough to exceed threshold for cells
- rise time: time it takes for current to mvoe from 0 to peak intensity within phase
- phase duration: amount of time it takes for one phase of a pulse
- frequency: number of pulses delivered per second
44
NMES
- facilitate skeletal muscle activity for return of controlled muscular activity
- electrodes in parallel along direction of m fibers > 2 in apart
- higher current amplitude for more foreceful contraction
- pulse duration: shorter for smaller muscles
- frequency: tetanic contraction, 35-50 pulses/sec, higher frequencies promote more rapid fatigue
- duty cycle: 6-10 s on, off time should be 5x longer
- ramp time: 1-4s
- treatment: 10-20 contractions -> 10-20 minutes, 3x per week
45
transcutaneous electrical nerve stimulation (TENS)
- pain management
46
interferential current
- 2 medium frequency alternating waveforms that are biphasic through 2 sets of electrodes
- pain relief, increased circulation, muscle stimulation
- bipolar delivery produces oval shape
- quadripolar delivery produces 4 leaf clover shape, can have automatic vector scan
47
iontophoreis
- 40-80 mA-min
- 10-20 minutes
48
electromyography
- evaluating motor units (naterior horn cell and its axon, NM junctions, and m fibers innervated by the unit)
- indwelling electrodes (intramuscular EMG) - for small or deep muscles, when there is need to record single motor unit potential
- surface electrodes (biofeedback): used to monitor larger muscle groups
49
abnormal potentials w/ EMG
- SPONTANEOUS
- fibrillation potentials: indicated of LMN disease
- positive sharp wave: denervated m disorders at rest, primary m disease like MD
- fasciculations: irritation or degeneration of ant horn cell, nerve root compression or muscle spasms
- repetitive discharge: myopathies, lesion of ant horn cells and periph nn
- VOLUNTARY
- polyphasic potentials: myopathiesm muscle or peripheral nn involvement
50
EMG biofeedback
- gives info about the electrical activity but does not measure muscle contraction
- allows pts to make small changes in performance and receive immediate feedback
- muscle relaxation: high sensitivity setting w/ active electrodes intiailly positioned close to each other - place further apart and more sensitive as patient improves relaxation; 10-15 minutes
- muscle re-education: begin max muscle contraction, set at low sensitivity so pt can perform reps at 2/3 max contraction - isometric contractions 6-10 seconds; 5-10 minutes
51
massage
- centrifugal - from center of body out
- centripetal - from extremities toward center of body
- effleurage: light stroke that produces reflexive response - at beginning and end of massage; should be toward heart
- friction: small circular motions over trigger point or muscle spasm to loose edema, adhesions, relieve spasm
- petrissage: kneading, muscle squeezed and rolled to loosen adhesions, improve lymphatic return; distal to proximal
- tapotement: rapid alterntaing movements like tapping, hacking, cupping, slapping - enhance circulation and stimulate peripheral nerve endings
- vibration: rapid shaking motion causing vibration to treatment; for relaxation
