Unit 1

Question 1

T/F: Physical agents are a stand alone treatment.

Answer 1

False

Question 2

What are the 3 major types of physical agents?

Answer 2

Thermal
Electromagnetic
Mechanical

Question 3

What thermal modalities are considered deep heat?

Answer 3

Ultrasound
Diathermy

Question 4

Which modalities are considered mechanical?

Answer 4

Compression
Traction
Hydrotherapy
Ultrasound - sound waves

Question 5

Why are modalities applied to hemorrhagic conditions contraindicated?

Answer 5

May disrupt platelet plug formation and cause uncontrolled bleeding

Question 6

What are the 3 phases of tissue healing?

Answer 6

Inflammation, proliferation, remodeling

Question 7

How long does the inflammation phase last?

Answer 7

0 hrs to 2 weeks – peaks at 2-3 hours

Question 8

How long does the proliferation phase last?

Answer 8

4-22 days – peaks at 2-3 weeks

Question 9

How long does the remodeling phase last?

Answer 9

Few days to 2 years

Question 10

What are the 3 stages of healing?

Answer 10

Acute, subacute, chronic

Question 11

How long does the acute phase last?

Answer 11

Onset to 7-10 days

Question 12

How long does the subacute phase last?

Answer 12

10 days to 6 weeks

Question 13

How long does the chronic phase last?

Answer 13

6 weeks to months/years

Question 14

What are the 5 cardinal signs of inflammation?

Answer 14

Pain, redness, swelling, heat, loss of function

Question 15

Why is it important to control inflammation early?

Answer 15

Inflammation inhibits muscle function

Question 16

What is the treatment goal of the acute phase?

Answer 16

Protection

PRICEM
Protection, rest, ice, compression, elevation, manual therapy, early motion

Question 17

What occurs during the subacute/proliferation phase?

Answer 17

Capillary growth and granulation tissue formation
Fibroblast proliferation with collagen synthesis
Increased macrophage and mast cell activities
Development of wound tensile strength
Characterized by decrease in pain and swelling, and increase in mobility

Question 18

What are the treatment goals of the subacute phase?

Answer 18

Controlled motion
Increase mobility within a safe range
Promote healing through gradual and progressively applied forces to healing tissue

Question 19

What are the treatment goals of the chronic phase?

Answer 19

Return to function:
Progressive strengthening & endurance exercises
Maximize independence

Question 20

What modalities should be used during the acute stage of healing?

Answer 20

Cryotherapy
Compression
E-STIM
Pulsed US (non-thermal)
Iontophoresis

Question 21

What modalities should be used during the subacute and chronic stages of healing?

Answer 21

Thermotherapy
US
E-STIM
Iontophoresis
Diathermy

Question 22

What is the safe & effective thermal therapy temperature range?

Answer 22

104-113 degrees Fahrenheit

Question 23

What are examples of superficial heat modalities?

Answer 23

Moist hot packs
Paraffin wax
Fluidotherapy
Warm whirlpool
Air activated heat wraps
Electric heating pads

Question 24

How is the level of oxygen available for tissue repair increased with thermal therapy?

Answer 24

Through vasodilation- more oxygenated blood flow to the area

Question 25

T/F: Exercise & superficial heat together have a greater effect than used in isolation.

Answer 25

True

Question 26

What are the neuromuscular effects of heat?

Answer 26

Elevate pain threshold Break the pain-spasm-pain cycle Alter nerve conduction velocity Change muscle spindle firing rate Pain relief Decrease muscle tone, guarding, and spasm Reduce DOMS

Question 27

What are the connective tissue effects of heat?

Answer 27

Increased elasticity & muscle flexibility Decreased viscosity & joint stiffness Improve ROM

Question 28

T/F: Adipose tissue cannot increase risk for burns with superficial heat.

Answer 28

False -- adipose tissue acts as an insulator

Question 29

Which tissues have the greatest temperature change with heat?

Answer 29

Skin & subcutaneous tissue 6-8 mins

Question 30

How long does it take for muscle to reach peak value with heat exposure?

Answer 30

15-30 mins

Question 31

What is conduction?

Answer 31

Direct transfer of heat from one object to another in direct contact

Question 32

What is convection?

Answer 32

Heat transfer occurs as movement of molecules in liquid or gas form encounter an object or body tissue and transfers energy

Question 33

What is radiation?

Answer 33

Conversion of heat energy to electromagnetic radiation. Rarely used in rehab

Question 34

What is the general time frame to leave heat on a patient?

Answer 34

10-30 mins

Question 35

What temp is the hydrocollator controlled at for moist heat packs?

Answer 35

158-167 deg F

Question 36

How many towel layers should be used between the hot pack and the pt?

Answer 36

6-8 but if the pt is lying on top of the hot pack, additional layers should be applied

Question 37

How often should you check the pt's skin when using a moist hot pack?

Answer 37

Before, 5 min in, and after treatment

Question 38

What is the melting point for Paraffin Wax?

Answer 38

129 deg F

Question 39

Which pt populations benefit from the use of Paraffin Wax?

Answer 39

RA Stable, non-fragile scars & skin grafts Scleroderma

Question 40

Which treatment duration is appropriate for the given heating agent? a) Air-activated heat wrap for acute back pain, 4 to 8 hours b) Moist hot pack to increase blood flow in subacute thigh strain, no less than 45 minutes c) Fluidotherapy to achieve “vigorous” heating of the hand, 5 minutes d) Paraffin bath “dip and re immerse” to increase collagen extensibility, 3 minutes after creating wax glove

Answer 40

a) Air-activated heat wrap for acute back pain, 4 to 8 hours

Question 41

What temp is maintained for air-activated heat wraps?

Answer 41

104 deg F

Question 42

What are the indications for heat therapy?

Answer 42

Reduce pain, muscle spasm, & stiffness Improve ROM & tissue healing

Question 43

What are the contraindications to thermotherapy?

Answer 43

Areas lacking intact thermal sensation Areas of vascular insufficiency Hemorrhage Malignant cancer Acute inflammation Infection Over heat rubs

Question 44

What is the difference between wet and dry heat?

Answer 44

Wet heat can elevate temp to a slightly deeper level Dry heat elevates skin surface temp to a greater degree

Question 45

When would you use deep heat?

Answer 45

During remodeling phase, for contractures, to heat deep into a joint

Question 46

What are the 3 modes of energy transfer to remove heat with cooling agents?

Answer 46

Conduction Convection Evaporation

Question 47

T/F: Tissues with higher water content have better thermal conductivity than adipose.

Answer 47

True

Question 48

Why should thermal conductivity be considered when cooling areas of poor/altered circulation?

Answer 48

Vasoconstriction decreases blood flow even more

Question 49

What is the order of best to worst conductors for human tissues?

Answer 49

Bone > Ligaments/tendons/fascia > Muscle > Adipose

Question 50

Why is ice the most effective type of cold therapy?

Answer 50

It goes through a phase change from solid to liquid which causes greater heat extraction

Question 51

T/F: It takes a cooled area longer than a heated area to return to resting value.

Answer 51

True

Question 52

What is evaporation?

Answer 52

Heat energy is removed as a molecule changes from a liquid to a gas, causing a cooling effect

Question 53

What are some positive effects of cold therapy?

Answer 53

Decreases bleeding Reduces inflammation Elevates the pain threshold Reduces muscle spasm

Question 54

What are some negative effects of cold therapy?

Answer 54

Affects muscle performance Increase joint stiffness Increased tissue viscosity and decreased elasticity

Question 55

How can cold cause vasodilation?

Answer 55

Cold for long periods of time can cause increased blood viscosity as the body switches from vasoconstriction to vasodilation

Question 56

What is cryotherapy's effect on peripheral nerves?

Answer 56

Decreases conduction velocity and synaptic activity of peripheral nerves which raises pain tolerance/threshold and affects muscle performance

Question 57

What are some muscular performance effects of cryotherapy?

Answer 57

Decreased muscle strength and proprioception

Question 58

T/F: Cryotherapy can reduce spasticity.

Answer 58

True

Question 59

What are the clinical indications for cryotherapy?

Answer 59

Decrease swelling Reduce pain Facilitate muscle relaxation Limit secondary hypoxic tissue injury

Question 60

What are the parameters for intermittent cooling?

Answer 60

20 min on, 10 min off & 10 min on (2x)

Question 61

What are the contraindications to cold therapy?

Answer 61

Cold urticaria (hives) Cyroglobulinemia (abnormal blood proteins) Raynaud's phenomenon Paroxysmal cold hemoglobinuria Over nerve regeneration Over compromised circulation Cold intolerance Over an area of peripheral vascular disease