UV and stim Flashcards
0
Q
physiological effects of UV (5)
(Indications for UVA, UVB, and UVC)
A
- created inflammatory response in skin which releases histamines =>used in wound care because increases bf (UVB/C)
- increases production of vit B (pro-vit B => vit D) (UVB/C)
- stimulates new cell production in basal layer (UVA/B) 4. enhance immune response (UVA/B) (esophylactic effect = enhanced production of WBC)
- UVC sterilizes- kills bacteria
1
Q
ultra violet basics (5)
A
- 180-400nm (18000-4000A)
- UVA (3200-4000) UVB (2900-3200) UVC (1800-2900) (fastest = shortest wavelength)
- photochemical modality
- 15s to 2-3m treatment time
- lamps or small hand held devices
2
Q
clinical application of uv (5)
A
- wounds
- acne
- psoriasis
- osteoporosis
- MED test (minimal erythemial dosage)
3
Q
contraindications/ precautions of UV (7)
A
- photosensitive meds/ foods (strawberry, shellfish, alcohol)
- exacerbation of some medical conditions (lupus, idd, hyperthyroidism)
- acute skin conditions (dermatitis, cellulitis)
- medical instability/ poor tolerance
- fever
- other forms of radiation
- protect eyes/ other areas
4
Q
LASER (3)
A
- 6-10,000 A
- Light Amplification by Stimulated Emission of Radiation
- cold later = photochemical modality, low level
5
Q
production of therapeutic light (2)
A
- atomic excitation
- as e- move to lower E level, light is released = laser light
6
Q
laser light vs. regular light (3)
A
LASER light is… 1. monochomatic (all same wavelength)
- collimated (all parallel)- waves in same phase… contributes to it being
- coherent (doesnt diverge)
7
Q
ranges of light on the EM spectrum (short vs. long wavelengths) (5)
A
- shorter wavelength = visible red (620-695 nm)
- less depth of penetration 1cm so
- used for superficial wounds and trigger points
- longer wavelength = infrared (760-1000nm)
- deeper penetration - 5cm
8
Q
light sources (4)
(types)
A
- laser diode - high power, very focused
- super luminous diode (SLD)- med power, mod focused
- light emitting diode (LED)- low power, scattered- less likely to have physiological effects
- cluster probes (combinations)
9
Q
treatment parameters of laser (5)
A
- wavelength nm
- power mw (set these two into machine)
- continous or pulsed (usually 90% duty cycle)
- energy density = dosage (J/cm2) J= e x time
- treatment duration (min)
10
Q
power considerations (laser) (3)
(2- how to increase or decrease)
A
- typically preset (higher powers in new devices decrease treatment time)
- higher power increase penetration
- decrease power by pulsing
11
Q
figuring out treatment time given area and protocol- dosage is given in J/cm2
A
dosage =J/cm2 = (watt x time)/area divide dosage/ area = treatment time
12
Q
energy density = dosage (4)
A
- measured J/cm2
- decribes energy delivered/ unit area of energy falling on surface
- acceleration of tissue healing dose = 1 x 10-6
- optimal dose response continues to be studied
13
Q
LLLT physiological effects (5)
A
- light (photons) applied to tissue -> 2. absorption in mitochondria -> 3. increased ATP synthesis -> 4. increased protein synthesis and cell proliferation -> 5. tissue repair and pain control
14
Q
contraindications for laser (6)
A
- active cancerous tissue
- eyes
- photophobia or abnormally sensitive to light
- pretreatment with photosensitivity enhancers
- direct over fetus or uterine area
- direct over thyroid gland
15
Q
e-stim indications (5)
A
- pain
- muscle weakness
- edema
- wound healing
- diagnostic purposes
16
Q
transcutaneous e-stim works by triggering action potential. to do this we need: (3)
A
- sufficient intensity (amplitude)
- duration (width of pulse)
- speed of rise
17
Q
order of fibers e-stim works on and why (3)
A
- sensory (first tingle) -these have the widest diameter and most mylenated so they are excited quickest
- motor - this is what you see when u see affected when u see contractions; not actual muscle contractions skip over if you put on bony prominence
- pain (recruited painful nerve fibers)
18
Q
pulse intensity duration curve (2)
A
- PW vs. PI
- shows better discrimination the narrower the pulse width (makes it easer to just trigger sensory)
19
Q
electricity definition
A
- electricity is flow of e-
20
Q
amplitude basics (6)
A
- amplitude is the # of e-
factors that affect amplitude:
- height of pulse
- voltage - increase in voltage increases potential difference btwn point A & B => driving force for current 4. proportional relationship
- resistance (ohms)- how well a particular environment conducts the flow (healthy tissue has less resistance than necrotic tissue) 6. inverse relationship
21
Q
3 types of electrical current
A
- direct
- alternating
- pulsified
22
Q
direct current (2)
A
- flows in long pulse (1s or greater) in 1 direction
- can be very irritating *be careful*
23
Q
alternating current (3)
A
- continous flow in 2 directions (switches polarities)
- short pulse width (ms)
- less irritating
24
pulsatile current (3)
1. most common
2. 1 or 2 directions, but not continous monophasic or biphasic (symmetrical or a-symmetrical)
3. narrowest pulse width (microseconds)
25
4 setting on e-stim machine
1. intensity
2. frequency
3. duration
4. modulation
26
pulse intensity
1. height of pulse = amplitude (can change from subsensory -\> sensory -\> motor)
27
3 placements for electrodes
1. electrical accupuncture
2. motor point
3. trigger point
28
electrical accupuncture (2)
1. strong, most sensation at given intensity
2. pre-determined
29
motor point (2)
1. strongest motor response at given intensity
2. usually muscle belly, we are exciting nerve, not muscle
30
trigger point (3)
1. strongest painful stim at given intnsity
2. deep palpation for find point
31
contraindications of e-stim (8)
1. pt fear/ aprehension
2. active cancerous tissue
3. near carotid sinus/ ant neck/ uterine
4. no moor near recently sutured skin, tendon, broken bone
5. open wound/ acitve bleeding
6. implantable devices
7. joint replacement
8. history of siezures
32
hyperstimulation of TENS (4)
1. intensity = noxious but tolerable
2. 30-60s x2 to promote seretonin release
3. continous wide width
4. unipolar technique at trigger points
33
cortical re-org (5)
1. after stroke a pt goes thru cortical re-organization, other areas in brain get turned on
2. critical pd of spontaneous recovery (when cortical re-org happens)
3. teaches with: repetetion/variety
4. make sure to give verbal feedback and positive experiences
5. maintains ROM and minimizes atrophy
34
FES
1. functional electric stim (part of NMES)
eg- stim in shoe that activated when no pressure on heel
35
rheobase chronaxie
1. rheobase test= intensity required to produce minimal visible contraction (MVC) when using pulse width of 300msec
2. chronaximeter - machine that is locked in at 300ms, keep increasing intensity and record when you see contraction (2-8miliamps is normal)
3. chronaxie = pulse width required to produce minimal visibel contraction at 2x rheobase intensity (so when machine is on chronaxie setting whatever the pulse intensity x2 and adjust pulse width to see min vc)
(\< 1milisecond is normal, nerve damage increases this to 80/90ms)
4. full R/D get response, absolute R/D no response
36
strength/ duration curve (2)
1. use chronaximeter- set PW, measure PI needed for min vc
2. deinnervated = shift up because need more intensity and to the right because muscle less excitable
37
iontophoresis (3)
1. introduction of ions (medicine) thru skin
2. works on the basis of like repels like \*\* direct current\*
3. minimal depth of penetration- just getting them in and let meds diffuse
38
instrument for intophoresis (5)
1. phoressor, or dupel
2. dosage = intensity \* duration (40-80mA)
1mA\*60min = 2mA\*30min = 3mA\*20 min
3. highest dosage is 4mA
4. redness is okay and to be expected
5. negative pad is larger to spread out current density and electrode you are not using put 6 inches away
39
medications for iontophoresis
1. Mg
2. iodine
3. hydrocortisone
4. dexamethasone
5. lydocane
6. salicylates
7. acetate
1. Mg (+) = analgesic and vasodilator (bath salts)
2. iodine(-)= helps loosen scar tissue, comes as ointment
3. hydrocortisone (+)= steroidal antiinflammatory (inhibits prostoglandins), comes as ointment/cream at 1% or 10%
4. dexamethasone (+)= steroidal antiinflammatory (inhibits prostoglandins), coes as solution
5. lydocane (+)= numbing agent, ointment called xylocane
6. Salicylates (-)= - non-steroidal= asprin, comes as cream
7. acetate (-)= breaks down Ca deposits
40
3 phases of healing
1. inflammatory phase
2. proliferation phase
3. maturation phase
41
2 theories for estim for wound healing
1. stimulate 3 phases of healing
2. wound itself has differnt electrical potential than surrounding tissue
42
EMG biofeedback (2)
1. using external cues (auditory or visual) to help shape physiological response
2. goal is to either recruit or disrecruit muscles
43
reasons to increase EMG activity (3)
1. someone has weakness
2. paralysis- starting to make neural connections (stroke)
3. incontinence
44
reasons to decrease EMG activity (4)
1. spaciticity/hypertonicity
2. muscle tension (anxiety/ promote relaxation)
3. eliminate substitution patterns
4. neuro pt to disrecruit muscles (kids with CP)
45
3 electrodes for biofeedback
1. active electrode = on belly of muscle near motor point
2. reference electrode = distal (to active)
measuring potential difference
3. ground electrode = btwn active reference or slightly to the side (eliminates outside electrical interference)
46
biofeedback machine parts
1. pre-amplifier- electrodes send signals back to amplifier to increase these signals
2. then machine converts signals -\> visuals or auditory
47
EMG documentation (6)
1. placement of electrodes
2. pt position
3. sensitivity setings
4. # EMG activity generated
5. how long mainted recruitment/ disrecruitment
6. how pt responded
