Treatment parameters Flashcards
Ultrasound parameters
- Mode - use a pulse of continuous to utilise healing effect and minimise heating
- Duty cycle is the percentage of time that US is generated ie 1:3 = 25%
- Mark:space ratio = ration of pulse length to the interval eg 1:3
- Acute 1:3 (25%) and 1:4 (20%)
- Subacute is 1:1 (50%) - Frequency
- 1Mhz-3Mhz
- Determines the depth of tissue penetration not intensity (3 for superficial)
- Intensity
- SAI of 3W/CM squared is a safe limit for therapeutic uses
- Acute = 0-0.5
- Chronic = 0.5-1
- If doing through water than add 20% (x by 1.20)
- Duration
- 30 sec acute - 2 min chronic per ERA
TENS parameters
Acute settings:
- Narrow pulse width 50-100
- High pulse rate 80-200
- Intensity is when patient feels tingles
Chronic settings:
- Wide pulse width 150-200
- Low pulse rate 1-10
- Intensity to tolerance (wanting to hit pain fibers)
Modes:
- Normal is for pain gaiting
- Modulated is for endogenous analgesia
- Burst is for both
IFTparameters
Acute Settings:
- Low intensity
- High frequency 80-150
- Short treatment time 10-20
- Sweep 6 sec up and 6 down
Chronic Setting:
- High intensity
- Low frequency 1-25
- Long treatment time 20-60
- Sweep 1 sec up and 1 down
- A little muscle contraction is ok with this
Common red flags
Red flags
- Circulatory insufficiency → diabetes
- Lack of thermal sensation
- Pace makers in electrical stimulation
- Thrombosis
- Superficial metal in electrical stim
Common yelow flags
Yellow flags
- Unable to communicate
- Sensory loss
- Skin irritation or open wounds (unless in area of application)
Stimulation parameters for shoulder subluxation
- Frequency = 30 Hz
- Pulse width = 200
- Stim time = 30 secs and 5 seconds off. Need to build up to this, i.e. start with 10 on and 2 off
- Ramp = 1 up and 1 down
- Intensity at level of contraction
- Dosage 1-2 times per day. 1 hour per day and work towards 6 per day.
HGVS parameters
- Frequency
- 35-50, 50-100 for larger muscles groups
- Cycle time
- Exercise parameters will determine this
- Sweep
- Continuous for motor, add for swelling
- Polarity
- Negative
- Ramp
- 2 seconds
- Amplitude
- Obtain muscle contraction
How does heat speed up the heeling process
Increases metabolic activity
Decreases fluid viscosity
Vasodilation
Increases fluid exchange across capillary walls
Physiological effects of heat packs and wax
Speeds up healing process
Increases collagen extensibility
Relieves pain
Reduces muscle spasm
Heals tissue via increased fluid exchange
Heat is targeting pain via neuromatrix therefore setup of patient is very important
When would you use a heat pack
‣ Tissue healing (sub-acute to chronic inflammatory phases)
‣ Relief of pain (most common use)
‣ Reduction of muscle spasm
‣ Sedative effect
‣ Increase joint ROM
‣ Prophylaxis of pressure sores
‣ Chronic oedema
‣ Precursor to other treatment (eg. stretching, joint mobilisation, massage)
Dosage of heat pack, time, layers
Time: 15—20 mins for
superficial heating
Layers: 1-2 cm or 6-8 layers
depending on the desired
heat intensity for specific
pathology
When would you use wax over a heat pack
When you need to apply a heat treatment to areas of non uniform surface
Dosage of wax
6-8 layers of wax, give time for cooling between
15-20 mins
Make sure to wrap grease paper and towel around to prevent heat loss
Physiological effects of cryotherapy
- Decreases local blood flow
‣ SKIN: initial vasoconstriction of cutaneous
vessels, then after 5-10 mins vasodilation
occurs (hunter reaction)
‣ MUSCLES: vasoconstriction after 5-8 mins for
superficial structures, >10mins for deeper - Decreases metabolic rate: enhances the
survival of local cells as they demand less
oxygen and slows down inflammation - Affects peripheral nervous system: slows
conduction velocity and can release
endorphins and enkephalins - Relieves pain, relaxes muscles, and reduces
muscle strength, coordination and motor
skills when applied >30 mins - Stimulates and facilitates muscle activation
when applied <10 mins.
Thermal effects of ultrasound
‣ Increased metabolic activity
‣ Decreased fluid viscosity
‣ Vasodilation
‣ Increases collagen extensibility and aligns fibres
‣ Pain relief and reduction in muscle spasm
‣ Tissue healing
‣ Resolution of inflammation
Non thermal effects of ultrasound
‣ Cavitation
‣ Acoustic streaming
‣ Pain reduction
‣ Standing waves
‣ Micromassage
Contraindications of ultrasound
Pregnancy
Risk of dissemination
To eyes or testes
Exacerbation of existing
conditions
Over inbuilt stimulator (eg.
Pacemaker)
Unable to communicate
Circulatory insufficiency
Physiological effects of TENS
‣ TENS targets different pain inhibitory systems
depending on the settings applied
1. Pain Gating through stimulation of large
diameter sensory nerves Aβ
2. Endogenous Analgesia through stimulation
of small diameter afferent nerves Aδ or C
How can TENS have a physiological effect - explain physics
‣ Nerves transmit signals to the brain via
electrical pulses
‣ Nerves can be affected by externally applied
electrical current
‣ TENS creates a circuit that incorporates the
human body
‣ TENS uses low frequency, short duration,
pulsed current
‣ Pulse duration (µs) and pulse rate (Hz) are
adjustable
Physiological effects of IFT
IFT targets different pain inhibitory systems
depending on the settings applied
1. Pain Gating through stimulation of large
diameter sensory nerves Aβ
2. Endogenous Analgesia through stimulation of
small diameter afferent nerves Aδ or C
‣ Sweep used to reduce swelling (large) and avoid
accommodation
‣ Thought to penetrate deeper and cover a larger area
than TENS
Why does IFT use two pulses that are out of phase and medium frequency.
Medium frequency current can pass through skin
with less impedance.
‣ Interference current
‣ has low beat/modulation frequency which acts like
pulsed current
‣ however needs high intensity (amplitude) to
stimulate sensory nerves
‣ High intensity (amplitude) means more nerves are
recruited for stronger stimulation
How does FES cause a motor contraction
‣ Stimulates muscle activity via selectively
depolarising motor nerves to generate a
contraction of the muscle fibres
‣ Short duration current allows for stimulation of
motor nerves compared to sensory nerves or
nociceptors
‣ FES uses a higher frequency (35-50Hz)
‣ Causes all motor neurons to fire
simultaneously, therefore fatiguing faster
‣ Preferentially activates fast twitch fibres
which fatigue faster
‣ Requires an intact peripheral nervous system to
generate a contraction
What are the physio practice threshold (7)
- Physiotherapy practitioner
- Professional and ethical practitioner
- Communicator
- Reflective practitioner and self directed learning
- Collaborative practitioner
- Educator
- Manager/leader
What are the national health service standards (8)
- Clinical governance
- Continuous improvement of safety and quality of services
- Patient centred and effective
- Partnering with consumers
- Partnerships relate to planning, design and delivery of care
- Preventing and controlling infections
- Medication safety
- Comprehensive care
- Communicating for safety
- Blood management
- Recognising and responding to acute deterioration
How can telehealth help aboriginal peoples specifically
- Involvement of local health workers and other staff
- Familiar surroundings and increased comfort
- Reduced need for travel and time away from country
- Easier access to specialist services
- Education and training opportunities for all involved
- Compliments existing visiting outreach services well
Information before telehealth
How he an access video conferencing
Link to joint
Information about others being off the internet if it is unstable
Make sure to test microphone and video first
Emergency contact - first aid response plan
Cost of the session
Alternate communication means
Chipchase 6 aspects of student preparedness
Knowledge and understanding
Willingness
Professionalism
Communication and interaction
Personal attribute
Skills
Information to client prior to telehealth session
- Information about telehealth consultations (plain language)
- Information about out‐of‐pocket charges
- Induction / screening process with technology testing
- Informed consent procedures (all parties)
- Information about when, how long, who should be present, contact details of clinician,
technical support options - Provide written instructions on use of technology (e.g., connection process)
- Instruct participants what they need to bring to the session
Two commonly accepted mechanisms/theories by which EPAs may reduce pain
- Pain gaiting → stimulates A beta nerves fibers which will excitate an inhibitory interuon resulting in decreased pain transmission
- Descending inhibition → targets A delta and C fibers and triggers the release of endophines which will decrease pain signalling
