Therapeutic Modalities Flashcards
longboy tank
a tank that allows for long sitting with water up to mid thoracic level
highboy tank
tank allows for water to be a chest height for large extremities; hips and knees to be submerged while flexed
hubbard tank and contraindications
full body immersion
unstable blood pressure and incontinence
- should not exceed 100*
how hot should a therapeutic pool be ?
79-97*
what should be the temperature for acute inflammation of distal extremities ?
Exercise?
wound care/ spasticity?
Cardiopul compromise and burns?
inflammation: 32-79*
exercise: 79-92*
wound care/ spacitisy: 92-96* (low 90s)
Cardiopul compromise and burns: 96-98* (high 90s)
how hot should water be for pn mgmt? chronic OA/RA and ROM ?
pn mgmt 99-104
chronic OA RA and ROM 104-110
What requires the hottest and lowest water temps?
Acute inflammation in distal extremity = lowest
Chronic OA/RA and ROM = highest
What are pool therapy advantages and considerations?
Advantages:
- decreased WB 2/2 buoyancy
- improved therapist handling
- better control over resistance
- decreased risk of falling
-therapist must remain with pt at all times to monitor vital signs and activity tolerance
Who is pool therapy recommended for ?
- arthritis
- MSK injury
- neuro deficits
- SCI
- CVA
- MS
- selected CV dx
Who is at an increased risk with hydrotherapy ?
hypotension ; increased risk for fainting
antihypertensive ie beta blockers
-Immersion of large body areas in warm or hot water can induce hypotension
what temps should be used for contrast bath ?
hot: 104-106 for 3-4 mins (low 100s)
cold: 50-60 degrees 1 min
25- 30 mins in total
what are the therapeutic effects of traction
decreased:
- disk protrusion
- pain
Increased:
- joint mobility
- relaxation
- soft tissue elasticity
- arterial, venous lymphatic flow
what are indications for traction
Disc herniation joint hypomobility muscle guarding muscle spasm narrowing of the intravertebral foramen Nerve root impingement osteophyte formation subacute joint inflammation/ pain contracture of spinal ligaments and connective tissue
what are contraindications for traction
Acute inflammation acute sprain or strain aortic aneurysm bone diseases cardiac/pulmonary problem movement contraindications or symptom exacerbation dislocation fracture Hiatal hernia radicular symptoms joint/bone infection Meningitis osteoporosis peripheralization of symptoms \+ Alar ligamentor vertebral artery test pregnancy advanced RA subluxation TMJ pain trauma without other med conditions ruled out tumors vascular condition vertebral joint instability
what does traction in supine result in? L and C spine
greater separation of the posterior structures including facets and intervertebral foramen
- traction most often applied in supine
- Supine spinal stenosis 2/2 increased opening of intervertebral opening
what does traction in extension result in ? L and C spine
greater separation of the anterior stxs
- positioned in extension
- separation of disk spaces
- application in prone allows application of modalities
- Prone: disk protrusions; disk can project anteriorly due to extension. Disk herniations most often occur and posterolateral direction
what is the procedure for lumbar traction
select pt position
apply traction harness
select parameters: static or intermittent, Force, duration
when is static traction indicated ? L spine
pt symptoms are slightly exaggerated by movement
when is intermittent traction indicated L spine
- pt cant tolerate static traction
- joint mobilization
- calls for relax time (off) and hold times (on)
- F during relax period is about 50% of the hold F period
what is the coefficient of friction and how is it calculated? what is it for a mattress ?
- constant friction force over 2 surfaces
- mattress on body = .5 (coefficient of friction)
- % of bodyweight below L3 (50%)x .5
- therefore 25% of the pts body weight is needed to overcome the force of friction on mattress
how many lbs should be applied at the first session (recommended) for the L spine ? C- spine?
30 - lumbar
10 - cervical
how much body weight should be used with traction for spasm, soft tissue or disk protrusion? L spine ? C-spine
lumbar: 25% of body weight
cervical: 7-10 % of BW or 11-15 lbs
how much body weight should be used with traction for actual separation of vertebrae in L spine ? C-spine?
L: 50% of bw
C: 13-20% or bw or 20-30 lbs
how long should traction be applied for disk related symptoms in L spine
10 - 30 mins
How would you target the upper, mid and lower cervical spine in traction
Upper: 0-5 flexion
Mid: 10-20 flexion
Lower: 25-35 flexion
when is intermittent traction indicated for cervical traction
- decrease pain
- increase ROM
traction in the c-spine should not exceed how many lbs?
30
how long should tx be for traction in the c-spine for disk related symps? other conditions?
10 mins or less
can extend up to 30 mins for other conditions
when should the therapist check in with the patient during traction for the initial tx?
first 5 mins
- check if symps worsen or peripheralize
- parameters should be modified or stopped if persistent
- pt should have bell or off switch
When is static compression indicated
- shape residual limbs
- control edema
- prevent abnormal scar formation
- ## decr. DVT
what bandage type offers the greatest resting pressure
long stretch bandage
60-70 mmhg
very little working pressure (P exerted with muscle contraction)
- often used in immobile patients
what bandage produces low pressure at rest and high working pressure
short stretch
- not effective in flaccid or inactive limbs
- mostly used in exercise
when are multilayered bandages used
venous stasis ulcers
high resting P via use of several bandages
when is a semiridgid bandage used? what is an example?
- venous ulcer bandage that is applied wet and dries
- unna boot
- zinc oxide impregnated gauze
what mmhg is used to prevent DVT
16-18
what mmhg is used to prevent scar tissue
20-30
what mmgh is used for edema control
30-40
when is intermittent compression with a pneumatic device used
reduce chronic or post sx edema
what should the inflation Pressure be for intermittent compression with a pneumatic device used
- Should not exceed diastolic or systolic volume. Greater than systolic will restrict arterial bloodflow.
- arterial capillary P is 30 mmhg, P less than this will not have effect
- **P should be btwn 30-80 **
what are compression indications
Edema hypertrophic scarring lymphedema new residual limb risk for DVT stasis ulcers
what are compression contraindications
Circulatory obstruction DVT heart failure infected area malignancy of area unstable or acute fracture pulmonary edema
What are indications for electrotherapy
Bell's palsy decreased range of motion facial neuropathy fracture idiopathic scoliosis joint effusion labor and delivery muscle atrophy/spasm/weakness open wound/ulcer pain stress incontinence shoulder subluxation
What are contraindications for electrotherapy
Cardiac arrhythmia cardiac pacemaker over carotid sinus patient with bladder stimulator over pregnant uterus malignancy osteomyelitis phlebitis seizure
what is current, voltage, and resistance
current: the flow of charge from 1 end to the other via electrons
voltage: electrical difference from + and - end
resistance: opposition of flow of ions through it
R = V/C
what is direct current ? which modality uses it?
- constant flow of ions from anode(-) to cathode (+) for at least 1 sec
- polarity remains constant
- ionto
what is alternating current ?
- polarity changes from + and -
- change in current flow from one direction to another
- measured in Hz; frequency of cycles per second
- Alternating current is biphasic and can look asymmetrical or symmetrical and a sinusoidal wave
what is pulsatile current ? which modality uses it?
non-continous flow of AC or DC current
either: monophasic or biphasic
monophasic each wave is (+) or (-) produces polarity effect. Each phase will be either (+) or (-). Clarity effect allows current to flow through tissue.
- (1 phase in 1 pulse)
biphasic 1 (+) and 1 (-) phase in same pulse (2 phases 1 pulse). Phases will alternate “above and below line”
what should be done to the skin before electrode placement
clean with soap and water
hair should be removed but not required
small electrodes
increased:
current density
impedance
Decreased: current flow
large electrodes
Decreased:
current density
impedance
increased: current flow
what is current density dependent of
size and distance apart from other electrode
- current is more concentrated under smaller E is 2 of unequal size are being used
- close in proximity, current is dense superfically
- far away in proximity, current is dense in deep tissue
what is monopolar technique
ionto and edema
1 active E is placed over target area (smaller), dispersive E is placed away from target area
what is bipolar technique
2 active E are placed on target area of = size
used in msk weakness, nueromsk facilitation, spasm ROM
what is amplitude
magnitude of current
peak amp= max (+) or (-) point
peak amp must be big enough to pass nerve or muscle cell threshold
rise time
the time it takes to rise from 0 to peak amplituse
phase duration
amount of time it take for one phase of a pulse
biphasic: 2 phases in a pulse
monophasic: 1 phase in a pulse
(pulse duration = complete a cycle.)
frequncy
how many pulses are in 1 sec
firing of fibers at faster rate, however same # of fibers are recruited
What are the parameters for NMES: amplitude, pulse duration and frequency, duty cycle tx time.
Amplitude: strong enough for contraction mindfull of strengthening or post sx
Pulse duration: high enough to overcome tissue capacitance
Frequency: prodice tetanic contraction
35-50
Ramp time: Based off 6-10 seconds on-time ramp should be 1 - 4 seconds
Duty cycle 6-10 secs on time, off time should b 5x longer
Time: 10-20 mins for 10-20 contractions at max
What is more comfortable for small muscles for pulse duration? large muscles?
small mus: short duration
large mus: long pulse duration
what happens when pulse duration is shorted?
a greater amplitude is required to produce the same strength of contraction
When administering NMES, will high frequencies produce stronger contractions?
no, but will lead to more fatigue
conventional tens
provides pain relief by placing Es over painful area and stimulating a sensory but not motor response via short duration, low amplitude and high frequency.
- brief pain relief while machine is on
Used for ADLs
