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Ther. Int. Exam 2 > Traction, Heat, Cold... > Flashcards

Traction, Heat, Cold... Flashcards

1
Q

Define physical agent?

A

Consist of energy and materials applied to patients to assist in rehab (heat, cold, US…)

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2
Q

What is the difference between Thermal, Mechanical, and Electromagnetic agents?

A

Thermal- transfer energy to increase or decrease tissue temperature, Mechanical- apply force to increase/decrease pressure in the body, Electromagnetic- apply energy in the form of electromagnetic radiation or electrical current

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3
Q

Physiological effects with cryotherapy?

A

Decreased circulation, metabolic rate, tissue extensibility and pain

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4
Q

Physiological effects with thermotherapy?

A

Increase in circulation, metabolic rate, and tissue extensibility. Decrease in pain.

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5
Q

CI of traction?

A

Movement is contraindicated, acute injury, hypertension, peripheralization of symptoms, and joint instability

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6
Q

Precautions of traction?

A

Spinal structural disease, severe pain resolved, Disorientation, Displaced annular fragment, Medial disc protrusion, Pregnancy (belt is hazardous), Pt cant tolerate position, and claustraphobia

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7
Q

Define joint distraction

A

separation of two articular surfaces perpendicular to the plane of articulation–> reducing compression and widens the vertebral foramen

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8
Q

Increased tension of what ligament will reduce disc protrusion, by pushing posteriorly displacing the disc anteriorly?

A

Posterior Longitudinal Ligament (PLL)

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9
Q

Indications for Spinal traction

A
  1. Disc bulge/ Herniation 2. Impingement 3. Joint HYPOmobility 4. Subacute joint inflammation 5. Paraspinal muscle spasm
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10
Q

How will the patient be positioned during traction for a disc bulge/herniation? Impingement?

A

Bulge- prone

Impingement- supine

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11
Q

During traction, is a patient is in increased flexion what part of the spine is being treated?

A

Upper lumbar, Lower cervical

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12
Q

During traction, is a patient is in increased extension/ neutral what part of the spine is being treated?

A

Lower lumbar, Upper Cervical

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13
Q

Traction for paraspinal muscle spasm, what type of traction should be used to interrupt the pain spasm pain cycle –> inhibiting the alpha motor neuron firing (decreasing pain)

A

Static or Low-load intermittent traction

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14
Q

Traction for paraspinal muscle spasm, what type of traction should be used to reduce protective paraspinal muscles?

A

High load traction

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15
Q

What are the cervical traction clinical prediction rules?

A
  1. Peripheralization w/ C4-C7 mobility test
  2. (+) should abduction test
  3. > 54 years old
  4. (+) ULTTA
  5. (+) Neck distraction test
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16
Q

What are the lumbar traction prediction rules?

A
  1. (+) crossed SLR
  2. Peripheralization w/ extension
  3. Age 18-60 w/ pain radiating below buttocks in last 24 hours
  4. ODI> 19%
  5. Signs of nerve root compression
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17
Q

What are adverse effects of traction?

A

Excessive force can increase the pt’s symptoms, with cervical traction pt can experience lumbar pain or radiculopathy

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18
Q

How do you document traction?

A
  1. Type of traction 5. Type of halter
  2. Patient position 6. Treatment duration
  3. Maximum force 7. Parameters
  4. Area treated 8. Patient response
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19
Q

Define specific heat

A

the amount of energy required to raise the temperature (higher the specific heat= more energy to heat up)

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20
Q

Define conduction and give an example

A

an energy exchange by direct collision between the molecules of 2 materials at a different temperature
Ex: hot pack, paraffin, cold pack, ice)

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21
Q

Define convection and give an example

A

heat transferred by direct contact between a circulating medium with another material of a different temperature
Ex: whirlpool or blood circulating

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22
Q

Which transfers more heat convection or conduction?

A

Convection

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23
Q

Define conversion and provide an example

A

converts a nonthermal form of energy into heat (mechanical, electrical, or chemical)
Ex: Ultrasound

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24
Q

Conversions heat transfer is dependent upon? Does it require direct contact?

A

The power of the energy source

NO direct contact is required

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25
Q

Define radiation and provide an example

A

A direct transfer of energy without the need for an intervening medium or contact
Ex: Infrared lamps

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26
Q

Define evaporation and provide an example

A

energy is absorbed to change a liquid into a gas or vapor (humidity impairs evaporation)
Ex: Vapocoolant or sweat

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27
Q

Cryotherapy nueromuscular effects

A

Decreased nerve conduction velocity, spasticity, and metabolic rate. INCREASED pain threshold. Facilitation of muscle contraction and altered muscle strength

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28
Q

Indications for Cryotherapy

A

Inflammation, Edema, Pain, spasticity, MS symptom management

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29
Q

CI for Cryotherapy

A

Cold intolerance and hypersensitivity, Cryoglobulinemia, Paroxysmal cold hemoglobinuria, Raynaud’s, Regenerating peripheral nerves, and poor circulation

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30
Q

Precautions for Cryotherapy

A

Hypertension, impaired sensation and mentation, very young/old, superficial branch of a nerve, and open wound

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31
Q

Adverse reactions to cold

A

Tissue death/ damage (

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32
Q

Describe patient experience with cryotherapy

A 
Intense cold
Burning
Aching
Analgesia- loss of pain
Numbness
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33
Q

How do you document for cryotherapy

A
  1. Area treated
  2. Type of cooling agent
  3. Time
  4. Patient position
  5. Patient response
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34
Q

Indications for Thermotherapy

A

Pain, Decreased ROM/ Joint stiffness, healing, and Psoriasis

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35
Q

Adverse reactions to thermotherapy

A

Burns, fainting, bleeding, skin or eye damage from IR

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36
Q

Thermotherapy CI

A

Hemorrhage, Impaired sensation and mentation, thrombophlebitis, malignant tumor

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37
Q

Thermotherapy Precautions

A

Acute injury, cardiac insufficiency, Edema, Metal, open wound, over topical irritant, Demyelinated nerves, pregnancy, impaired circulation, and poor thermal regulation

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38
Q

How many layers are required for thermotherapy

A

6-8

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39
Q

What is paraffin heated too

A

126-134 degrees

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40
Q

Documentation for thermotherapy

A
  1. Area treated
  2. Type of heating agent
  3. Patient position
  4. Time
  5. Patient response
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41
Q

How does diathermy differ from hot packs and ultrasound

A

Heats deeper and larger areas

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42
Q

What are the three types of diathermy?

A

Inductive coils- shortwave (20-30 mHz)
Capacitive plates- shortwave
Magnetron- microwave (2-300 Hz)

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43
Q

Describe inductive coils? What type of structures do they treat?

A

Heating produced by the creation of a magnetic field (wrapped around the extremity)
Used mainly for deep structures but superficial as well

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44
Q

Describe capacitive plates? What type of structures do they treat?

A

High frequency alternating electrical current flow from one plate to another
Used for Superficial tissue

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45
Q

Describe Magnetron? What type of structures do they treat?

A

used when only a small area of tissue is involved

Used for superficial tissue

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46
Q

Benefits of using Diathermy?

A

Heat large areas and deep tissue at the same time

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47
Q

Diathermy CI

A

Metal, malignancy, Growing epiphysis, eyes, and testes

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48
Q

Diathermy Precautions

A

Obesity, copper IUD, and Magnetic components in area

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49
Q

What type of waves are used in US

A

Sound waves >20,000 Hz

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50
Q

Define intensity for US and the units

A

the power per unit area of the sound head, w/cm^2

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51
Q

Define frequency for US and the units

A

the number of compression cycles per unit of time (Hz), MHz

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52
Q

Define duty cycle for US and the units

A

The proportion of the total treatment time that the US is on, % or ratio

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53
Q

Define effective radiating area (ERA)

A

The area of the transducer from which the US energy radiates–> treatment area should be no bigger than 2x the head

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54
Q

Define Beam nonuniformity ratio (BNR)

A

The ratio of spatial peak intensity to the spatial average intensity (5:1 or 6:)

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55
Q

Describe parameters for thermal and nonthermal US

A

Thermal- continuous

Non-thermal- pulse less than .5 (50%)

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56
Q

When you have a frequency of 1 or 3.3 MHz what intensity will be used? Which one is deep?

A

Thermal: 1 MHz- 1.5-2 w/cm^2
3 MHz- .5- 1 w/cm^2
Non-thermal: .5-1
1=deep, 3=superficial

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57
Q

What are some non-thermal effects with US?

A

Increase intracellular calcium and skin and cell membrane permeability. Promotes cell function

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58
Q

Adverse effects of US

A

Burns, blood cell statis, cross contamination/infection

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59
Q

Documentation for US

A
  1. Area treated
  2. Parameters
  3. Patient Position
  4. Time
  5. Patient tolerance
  6. If underwater
60
Q

Define electromagnetic radiation (EMR)

A

equals electric and magnetic fields that vary over time and are orientated perpendicular to each other

61
Q

Define Laser

A

a light amplification by stimulated emission radiation

62
Q

Define Light emitting diode (LED)

A

is a semiconductor diode light source

63
Q

Define Low-level laser therapy

A

equals application of laser light for therapeutic purposes (Cold laser, low-intensity, low power, or soft laser)

64
Q

Define light

A

EMR in the visible range of the electromagnetic spectrum

65
Q

What is the difference between polychromatic and monochromatic?

A

Poly- various wavelengths, broad area

Mono- single wavelength, laser light

66
Q

Why is light commonly used for inpatient PT, neuropathy, or pain in LE

A

Because the lasers stimulate nitric acid which causes vasodilation and provides a temporary relief.

67
Q

How many nm is visible light?

A

400-650 nm

68
Q

How many nm is infrared light?

A

650-1300 nm (2-4 cm deep)

69
Q

A longer wavelength will penetrate _____ structures.

A

Deeper

70
Q

What wavelength (nm) has the most therapeutic effect?

A

over 650 nm

71
Q

Define power in lights and lasers

A

rate of energy flow

72
Q

Effects of laser and light

A

Promote ATP production, Increase RNA production, collagen production, and vasodilation. Decrease bacteria growth. Modulates Inflammation

73
Q

Indications for laser and light

A

Soft tissue/ bone healing, Arthritis, Pain, Lymphedema, and neurological conditions

74
Q

Adverse reactions to laser and light therapy

A

Retinal damage, Rash, Burning sensation, Increased pain, tingling, erythema, and numbness

75
Q

Documentation for Laser and Light therapy

A
  1. Type of diode
  2. wavelength (nm)
  3. Power (mW/cm^2)
  4. Area treated
  5. Energy density (J/cm^2)
  6. Patient response
76
Q

How much energy density should be used for:

  1. Soft tissue
  2. Fractures
  3. Arthritis
  4. Lymphedema
  5. Neuropathy
  6. Inflammation-
A
  1. Soft tissue- 5-16 J/cm^2
  2. Fractures- 5-16
  3. Arthritis- Acute: 2-4, Chronic: 4-8
  4. Lymphedema: 1.5
  5. Neuropathy: 10-12
  6. Inflammation: Acute: 2-8, Chronic: 10-20
77
Q

What are the differences between monophasic PC and Biphasic PC?

A

Mono- one direction, positive polarity, used to promote tissue healing and acute edema (HVPC)
Biphasic- current flows back and forth during pulse, used for muscle contraction

78
Q

Anode attracts ____, and repels____ ions?

A

Negative, positive

79
Q

Cathode attracts____ and repels ____ions?

A

Positive, Negative

80
Q

Documentation for Estim?

A
  1. Area treated
  2. Patient position
  3. Parameters
  4. Electrode placement
  5. Duration
  6. Patient response
81
Q

What does TENS stand for?

A

Transcutaneous Electrical Nerve Stimulation

82
Q

What is the difference between Conventional (high) TENS and Low Tens?

A

High-: Acute, short duration with high freq. , NO muscle contraction , no long term effects (only while being stimulated)
Low: Chronic, Muscle contraction, repetitive stimulation of motor nerves, Long term effects, cannot be used over 45 min (DOS)

83
Q

For demyelinated nerves use a _____ approach.

A

Direct (NMES)

84
Q

ES for muscle contraction stimulates which muscle fibers FIRST?

A

Fast twitch- Type 2 fibers

85
Q

A physiological muscle contraction stimulates which muscle fiber FIRST?

A

Slow twitch- Type 1 fibers

86
Q

Characteristics of type 2 fibers

A

Fatigue quickly and atrophy quickly

87
Q

Define the overload principle

A

Increased pulse duration, amplitude, electrode size, and external resistance will lead to a higher load with higher force contraction that has greater strengthening

88
Q

When using Estim with stroke patients, antagonist contraction will _____agonist spasticity.

A

Reduce

89
Q

When using Estim with stroke patients, agonist contraction will _____agonist strength and control.

A

Increase

90
Q

What is the required pulse duration for denervated muscle with Estim?

A

> 10ms

91
Q

Where should the electrodes be placed?

A

One over a motor point of the muscles and the other over stimulated muscle aligned parallel to the muscle fibers
**2 inches apart

92
Q

Estim parameters for Pain:
High
Low
IFC

A

High- 100-150 pps, 50-80 ms, comfortable, modulation if available, time as needed
Low- 2-10 pps, 100-300ms, contraction, less than 45 min
IFC- 80-150 Hz, Time-15-30 min

93
Q

Estim parameters for muscle contraction:
Muscle reeducation
Muscle Spasm
Muscle Edema

A

Reeducation: 35-50 pps, 150-350 ms, 10-50% contraction, 1:5 0r 1:3 on:off, 1-4 secs ramp, 10-20 min.
Spasm- 35-50 pps, 150-350 ms, contraction, 2-5 secs on/off, 1-4 secs ramp, 10-30 min
Edema- 35-50 pps, 150-350 ms, contraction, 2-5 secs on/off, 1-4 secs ramp, 20 min

94
Q

Estim parameters for Healing:
Inflammatory phase
Proliferation phase

A

Inflamm.- HVPC, negative, 60-125 pps, 40-100 ms, comfortable, 45-60 min
Proliferation- HVPC, positive, 60-125 pps, 40-100 ms, comfortable, 45-60 min

95
Q

Estim parameters for Edema:
Inflammation
Lack of contraction

A

Inflammation- HVPC, negative, 100-120 pps, 40-100 ms, comfortable, 20-30 min
Lack of Contraction- Biphasic, 35-50 pps, 150-350 ms, contraction, 20-30 min

96
Q

What is the time limit for using Estim for muscle strengthening?

A

10-20 min

97
Q

Define galvontaxis

A

attracting or repelling appropriate cell types

98
Q

What is Iontophoresis?

A

Use of an electrical current to promote transdermal drug penetration

99
Q

Where should electrodes be placed for wound healing?

A

In or around wound

Polarity is determined by the electrode on or near the wound

100
Q

Negative polarity is used for what stage of healing?

A

Acute inflammation- will repel negatively charged serum proteins, therefore blocks their movement out of the blood vessels which decreases inflammation

101
Q

Positive polarity is used for what stage of healing?

A

Facilitate epithelization (chronic)

102
Q

What types of Edema can we treat?

A

Edema due to inflammation
- area will be red and warm
Edema due to lack of motion or muscle contraction
- Area will be cold, pale, and swollen
NOT SYSTEMIC EDEMA

103
Q

Parameters for Iontophoresis

A

Amount of electricity: 40-80 mA-min (will be on package)
Treatment time= Dose/ current amplitude
Amplitude: 1-4, 1 being the most comfortable but takes longer.

104
Q

What medications are commonly used with Iontophoresis?

A 
Acetic Acid (-): calcific deposits, myositis ossificans
Calcium Chloride (-): scar tissue, keloids, muscles spasms
Dexamethasone (-): Inflammation
Lidocaine (+): Analgesia, inflammation
105
Q

Documentation for Iontophorisis

A
  1. Area treated
  2. Patient position
  3. Parameters
  4. Electrode placement
  5. Treatment time
  6. Patient/ wound response
  7. Condition of skin
106
Q

Define compression

A

a mechanical force that increases external pressure on the body or body part

107
Q

How is fluid balance improved with compression?

A

By increasing the hydrostatic pressure in the interstitial space

108
Q

Indications for edema control

A

DVT prevention, venous stasis ulcers, residual limb shaping post-amputation, and to control hypertrophic scarring

109
Q

What causes edema?

A 
Imbalance between hydrostatic and osmotic pressure
Venous or lymphatic obstruction
Increased capillary permeability
Immobility
Pregnancy
Systemic failure
110
Q

How does compression reduce edema?

A

Increase extravascular hydrostatic pressure promotes circulation, and may move fluid proximally through vessels

111
Q

Parameters for pneumatic compression pumps

A

Inflation: Deflation time- 3:1
Inflation pressure should be UNDER diastolic BP (30-60 mmHg for UE, and 40-8- mmHg for LE)
Time: 1-4 hours, 3x a week 4x a day

112
Q

Compression documentation

A
  1. Type of compression
  2. Area treated
  3. Patient position
  4. Inflation:Deflation time
  5. Compression pressure
  6. Time
  7. Patient response
113
Q

Define UV

A

Is electromagnetic radiations with a frequency 7.5 x 1014 to >1015 Hz
Wavelength: 400 to

114
Q

What are UVA nm

A

320-400 nm

115
Q

What are UVB nm?

A

290-320 nm

116
Q

What are UVC nm?

A
117
Q

Lower wavelength will have ____ penetration

A

Deeper

118
Q

Factors that effect UV intensity?

A

Angle ( needs to be 90 degrees), Distance, power of the lamp, and skin pigmentation

119
Q

Effects of UV radiation?

A

Erythema production, tanning, epidermal hyperplasia (thickening of skin), Vitamin D synthesis, and bacteriocidal

120
Q

What is the primary clinical use for UV radiation?

A

Psoriasis

121
Q

Documentation for UV

A
  1. Medication used (psoralen)
  2. Area treated
  3. Type of UV radiation
  4. Lamp serial number
  5. Distance of lamp
  6. Time
  7. Patient response
122
Q

How is heat transferred?

A

Convection and conduction

123
Q

Specific heat of water is ___ that of air.

A

4x

124
Q

The Thermal conductivity of water is ___ that of air.

A

25x

125
Q

Water holds ___ the energy of air.

A

4x

126
Q

Water transfers heat ____ faster than air.

A

25x

127
Q

What is buoyancy?

A

The upward thrust against gravity

128
Q

Density of the human body is ___ than water.

A

Less

129
Q

What is hydrostatic pressure?

A

The pressure exerted by a fluid on a body immersed in the fluid.

130
Q

Physiological effects for hydrotherapy

A

Cleansing (wound care), musculoskeletal, cardiovascular (displaces venous blood proximally), respiratory, renal, and psychological

131
Q

Benefits of warm water? Cold water?

A

Warm- relax muscles, decreases pain

Cold- Decreased pain and inflammation

132
Q

Cardiovascular effects of hydrotherapy?

A 
Central blood volume increases by 60%
Cardiac Volume increases by 30%
Cardiac Output increases by 30%
Decreased HR response to exercise
Increases stroke volume
133
Q

Respiratory effects of hydrotherapy?

A

Increased pressure in chest walls
Increased circulation in the chest cavity
Decreased humidity( good for asthmatic)

134
Q

Renal effects of hydrotherapy?

A 
Increased urine production
Increased renal blood flow
Increased central blood volume
Decreased ADH and Aldosterone
Increase in K and Na which results in a decrease in edema
135
Q

Avoid ____ water with edema

A

Hot

136
Q

Hydrotherapy ______ wound healing

A

accelerates

137
Q

Whirpool temperature for inflammation

A

32-79 degrees Fahrenheit

138
Q

Whirpool temperature for exercise

A

79-92 degrees Fahrenheit

139
Q

Whirpool temperature for open wounds and control tone

A

92-96 degrees Fahrenheit

140
Q

Whirpool temperature for Burns (chronic)

A

96-98 degrees Fahrenheit

141
Q

Whirpool temperature for pain control & Increase soft tissue extensibility

A

99-110 degrees Fahrenheit

142
Q

Documentation for hydrotherapy

A
  1. Type of hydrotherapy
  2. Patient position or activity
  3. Water temp
  4. Duration
  5. Patient response
  6. Fluid pressure and water additive (if used)
143
Q

Estim CI

A 
Pacemaker
Pregnancy
Arrhythmia
Clot
Carotid sinus
144
Q

Estim Precautions

A

Cardiac disease
Impaired sensation/ mentation
Malignancy
Open wound

145
Q

Compression CI

A 
Heart failure
DVT
Obstructed  lymphatic/ venous return
PAD
Infection
Hypoproteinemia
Acute trauma/ fracture
146
Q

Compression precautions

A 
Impaired sensation/mentation
Hypertension
Cancer
Stroke
Superficial peripheral nerves

Ther. Int. Exam 2 (1 decks)

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