Therapeutic Modalities: Physical Agents Flashcards
What physiological values are increased with general heat application? (5)
Cardiac output Metabolic rate Pulse rate Respiratory rate Vasodilation
What physiological values are decreased with general heat application? (5)
Blood pressure Stroke volume Muscle activity Blood to internal organs Blood flow to resting muscle
List 6 contraindications for the use of superficial heating agents.
- Acute and early subacute traumatic and inflammatory conditions
- Decreased circulation , sensation and mentation
- DVT
- Malignant tumors
- Tendency toward hemorrhage or edema
- Very young and very old patients
What is a hot pack?
A canvas pack filled with silica gel, heated by immersion in water between 165 F and 170 F degrees.
A hot pack transmits heat via ______.
Conduction
Hot packs reach peak temperature within _____. The patient is at greatest risk for ____ during this time.
First 5 minutes
Burns
How often should the therapist check the patient’s skin when the patient is using a hot pack? How long is the treatment time for a hot pack?
Check the skin every 5 minutes
Treatment time: 20 minutes
What is hydrotherapy or whirlpool?
Partial or total immersion baths in which water is directed against or around the affected part
Describe the different treatment temperatures used during hydrotherapy. (3)
- Tepid/non-thermal 79-92 degrees = exercise in water
- Neutral 92-96 degrees = temperature for open wounds
- Thermal 96-104 degrees = causes stress on cardiopulmonary and nervous system, increases tissue mobility
What is the treatment time for hydrotherapy?
20 minutes
List 2 indications for the use of hydrotherapy.
Subacute and chronic musculoskeletal conditions
List 2 contraindications of local immersion hydrotherapy.
Maceration
Bleeding
List 5 contraindications for full body immersion hydrotherapy.
- Unstable cardiac disorder
- Bowel incontinence
- Epilepsy
- Suicidal ideation
- Potential for cross contamination
What physiological values are decreased with cryotherapy? (4)
Metabolic rate
Pulse rate
Respiratory rate
Venous blood pressure
What physiological values are increased with cryotherapy? (4)
Blood flow to internal organs
Cardiac output
Stroke volume
Arterial blood pressure (shivering when core temperature drops)
List 4 adverse physiological effects of cold due to hypersensitivity.
- Cold urticaria: erythema of the skin with wheal formation, associated with severe itching due to histamine reaction
- Facial flush
- Puffiness of the eyelids
- Anaphylaxis with syncope
List 7 contraindications to cryotherapy.
- Cold hypersensitivity (urticaria)
- Cold intolerance
- Cryoglobulinemia
- Raynaud’s disease
- Impaired temperature sensation
- Peripheral vascular disease
- Over regenerating peripheral nerves
What is the typical treatment time for a cold pack or ice pack?
10-20 minutes
Ice massage should not be performed over _____ or _____.
Bony areas
Superficial nerves
What is the typical treatment time when using ice massage?
5-10 minutes or until analgesia occurs
What should be done to the muscle when applying vapocoolant spray?
The muscle should be passively stretched before and during application
What are 2 indications for the use of vapocoolant spray? What is the typical treatment time?
Indications: Myofascial referred pain, trigger points
Treatment time: 10-15 minutes
What physical agent combines cryotherapy and compression?
Cold compression units
Treatment time: 15 minutes
Continuous ultrasound is applied to achieve _____.
Thermal effects
What is a ‘hot spot’ and how can its effect be reduced?
A hot spot is a high level of energy in the center of the US beam relative to the surrounding areas.
It can be reduced by moving the sound head or using pulsed US.
______ is typically the measurement used to document ultrasound. How is it calculated?
Intensity
Total power (Watts)/ area (cm^2) of the transducer head
What is the beam non-uniformity ration (BNR)?
The ratio of spatial peak intensity to spatial average intensity.
BNR should be between 2:1 and 6:1
The lower the BNR the more uniform the _____ and the less risk of _____.
More uniform ENERGY DISTRIBUTION
Less risk of TISSUE INJURY
What is a duty cycle? What duty cycle is considered to be pulsed ultrasound?
The fraction of time the US energy is on over one pulse period (time on + time off)
Duty cycle of less than or equal to 50% is considered pulsed US.
Absorption of ultrasound is highest in tissues with high ______ and ______ content.
COLLAGEN and PROTEIN content
i.e. Muscles, tendons, ligaments, capsules
Describe ultrasound frequencies.
3 MHz = used for tissues 1-2.5 cm deep
1 MHz = used for tissues up to 6 cm deep
What intensity is used for 1MHz versus 3MHz frequencies?
1 MHz = 1.5-2.0 W/cm^2
3 MHz = 0.5-1 W/cm^2
List 5 indications for the use of ultrasound.
- Modulate pain
- Increase connective tissue extensibility
- Reduce or eliminate soft tissue inflammation
- Accelerate rate of tissue healing
- Eliminate muscle spasm
List 8 contraindications to use of ultrasound.
- Impaired circulation, sensation, or mentation
- Malignant tumors
- Over or near thrombophlebitis
- Over joint cement or plastic components
- Over vital organs or exposed spinal cord
- Over cardiac pacemaker
- Over abdomen, low back, pelvis or uterus during pregnancy
- High dose US to be avoided over epiphyseal plates
When using direct ultrasound, do not cover an area greater than _____ the size of the effective radiating area (ERA) per ____ minutes of treatment.
2 to 3 times the size of the ERA
5-10 minutes
How far should the transducer be held from the skin when performing water immersion (indirect contact) ultrasound?
1 cm from the surface of the skin
What is phonophoresis? List the parameters of use.
The use if ultrasound to drive medication through the skin into the deeper tissues (i.e. lidocaine and dexamethasone)
Mode: pulsed 20%
Treatment time: 5-10 minutes
Intensity: 0.5-0.75 w/cm^2
