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s3 - clinical practice 2 > Week 4- Spinal Traction, Compression Therapy > Flashcards

Week 4- Spinal Traction, Compression Therapy Flashcards

1
Q

SPINAL TRACTION

A

SPINAL TRACTION

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2
Q

What is spinal traction?

A

Applying distraction forces to the spine to separate articular surfaces between vertebral bodies and elongate the spine.

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3
Q

What are the 6 spinal traction methods?

A
  • Manual
  • Mechanical
  • Pneumatic
  • Positional
  • Gravity assisted
  • Inversion
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4
Q

The Goals and Indications of Spinal Traction are to Decrease:

  • ______ stiffness (hypomobility)
  • __________ blocking
  • Muscle spasm
  • Disc __________
  • Discogenic pain
  • Joint pain
  • Nerve ______ impingement
A
  • Joint
  • Meniscoid
  • protrusion
  • root
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5
Q

The indications for traction generally may be indicated for:

  • ________ or ________ spine pain with radiculopathy
  • Patients who have a reduction of symptoms with ________ traction
A
  • cervical or lumbar

- manual

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6
Q

Contraindications for Traction include:

  • Acute ________, ________, and inflammation
  • Spondylolisthesis
  • Fracture
  • Increased ___________ with traction
  • Increased nerve root ________ with traction
  • Joint ______mobility or instability
  • Pregnancy (lumbar traction)
  • Patients who have received surgical stabilization or decompression, spine implants, or prosthetic discs
A
  • strains, sprains
  • peripherilization
  • symptoms
  • hypermobility
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7
Q

Precautions for Traction include:

  • Claustrophobia
  • Hiatal ______
  • Impaired _______
  • Any disease or condition that can compromise the structure of the spine (RA, steroid use, tumor, osteoporosis)
A
  • hernia

- cognition

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8
Q

Spinal traction is a joint distraction that separates the facet joints and opens up the __________ foramen to relieve pressure on the __________ foramen and decrease compressive forces on __________.

A
  • intervertebral
  • nerve root
  • facets
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9
Q

For spinal traction to cause joint distraction, the lumbar region requires a minimum of __% of the patient’s body weight to cause separation while the cervical region needs __% of the body weight to result in separation.

A
  • 50%

- 7% or 20-30lbs

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10
Q

Spinal traction also causes a reduction of disc protrusion in what 2 ways?

A
  1. ) Separating the vertebral bodies leads to decreased intradiscal pressure creating a suction like effect on the nucleus pulposus.
  2. ) Surrounding ligamentous structures are taut which also helps to push disc centrally.
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11
Q

For spinal traction to reduce disc protrusion, the lumbar region requires up to __% (__-__lbs) of the patient’s body weight to reduce disc protrusion while the cervical region requires __-__lbs.

A
  • 50% (60-120lbs)

- 12-15lbs

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12
Q

Spinal traction can also cause ____-tissue stretching on the surrounding spinal muscles, ligaments, tendons, and discs. In order to get soft-tissue stretching, do we need to achieve joint seperation?

A
  • soft-tissue stretching

- No

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13
Q

For spinal traction to stretch soft-tissue, the lumbar region requires __% of the patient’s body weight while the cervical region requires __-__lbs.

A
  • 25%

- 12-15lbs

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14
Q

Spinal traction can also cause _______ relaxation by interrupting the pain-muscle spasm cycle by stimulating ___________ through the motion of intermittent traction and by inhibiting neuron firing with static traction.

A
  • muscle

- mechanoreceptors

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15
Q

For spinal traction to stretch muscle relaxation, the lumbar region requires __% of the patient’s body weight while the cervical region requires __-__lbs.

A
  • 25%

- 12-15lbs

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16
Q

What are the 3 variables for cervical traction?

A
  1. ) Static or intermittent
  2. ) Angle of traction (greater flexion= lower C spine)
  3. ) Dosage (amount of tension, duration of traction, cycle duration)
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17
Q
  • Cervical traction force should not exceed __-__ lbs and we should start light.
  • The force is also determined by the goals and patient tolerance. In the acute phase; disc protrusion, elongation of soft-tissue, and muscle spasm is done with __-__lbs of force while joint distraction is done with __-__lbs of force.
A
  • 30-40lbs
  • 10-15lbs
  • 20-30lbs
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18
Q

Cervical traction treatment time is between __-__min for acute conditions and disc protrusions and __-__min for other conditions.

A
  • 5-10min

- 15-30min

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19
Q

Cervical traction duty cycle:

  • Static traction is done with disc ___________ or when symptoms are aggravated by motion.
  • Intermittent traction is done with disc protrusion at a : ratio (hold:rest); or for joint distraction/mobility at a : ratio (hold:rest).
A

-protrusion

  • 3:1
  • 1:1
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20
Q

What should we watch out for post-traction?

A

“Rebound Effect”

-Have patient relax for 5 minutes after treatment

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21
Q

Post-traction we should also record outcomes:

  • _______ symptoms
  • __________ of symptoms
  • ______ ROM/strength
  • improved ability to perform ___s
  • Improved reflexes/sensation
A
  • decrease
  • centralization
  • increase
  • ADLs
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22
Q

Research shows that cervical traction:

  • ________ pressure within the intervertebral foramen and ______ in dimensions of the intervertebral foramen.
  • _______ in intervertebral disc space w/ almost 30lbs while C spine was in neutral of in flexion.
  • Area of disc herniation ______ and disc space increased.
A
  • decrease, increase
  • increase
  • reduced
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23
Q

What are the 5 variables for lumbar traction?

A
  1. ) Supine or Prone Positioning
  2. ) Positioning of LE
  3. ) Static or intermittent
  4. ) Angle of traction
  5. ) Dosage (amount of tension, duration of traction, cycle duration)
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24
Q

Clinical considerations for lumbar traction:

  • limited evidence
  • lack of agreement of _________
  • ______ vs. _____ position during traction
  • legs extended or in hip flexion if in supine
A
  • parameters

- supine vs prone

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25
Q

In regards to lumbar traction, when the hips are flexed to 45-60 degrees we are increasing the space of __/__. When the hips are flexed to 75-90 degrees we are increasing the space of the _____ lumbar region.

A
  • L5/S1

- upper

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26
Q

For lumbar traction, where is the thoracic harness and the lower harness placed?

A
  • Thoracic- Placed inferior to the widest lateral dimension of the rib cage. 2 straps attached to end of table
  • Lower- Placed at or just below the iliac crests but superior to the greater trochanters. 2 straps attached to metal V shaped rod attaching to mechanical unit.
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27
Q

Lumbar traction force for:

  • Acute phase-__-__lbs
  • Disc protrusion, spasm, elongation of soft tissues-__% of BW
  • Joint distraction- __% of BW
A
  • 30-40lbs
  • 25%
  • 50%
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28
Q

Lumbar traction treatment time is between __-__min for herniated disc and __-__min for other conditions.

A
  • 5-10min

- 10-30min

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29
Q

What should we watch out for post-traction?

A

“Rebound Effect”

-Have patient relax for 5 minutes after treatment

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30
Q

Post-traction we should also record outcomes:

  • _______ symptoms
  • __________ of symptoms
  • ______ ROM/strength
  • improved ability to perform ___s
  • Improved reflexes/sensation
A
  • decrease
  • centralization
  • increase
  • ADLs
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31
Q

Research shows that lumbar traction:

  • _____ difference in muscle activity with continuous vs. intermittent traction.
  • Substantially greater reduction of the total area of herniated disc material vs. use of “_____________”.
  • Improvement with straight leg raise when lumbar traction was used with __ and __% of body weight.
A
  • No
  • other modalities
  • 30% and 60%
32
Q

Home Traction (Cervical):

  • Pneumatic pump with gauge quantifying ______
  • Adjustable head rest, similar positioning
  • Sustained traction

Home Traction (Lumbar):

  • Pneumatic pump, harness to stabilize
  • Less tension produced than clinical unit
  • Positioning of floor required
A

-tension

33
Q

How do we know if cervical or lumbar traction worked?

A

Test re-test

34
Q

COMPRESSION

A

COMPRESSION

35
Q
  • Homeostasis is maintained through ________ and ________ pressure inside and outside the vessels.
  • In normal circumstances, hydrostatic is greater than osmotic, forcing small amounts of fluid into ___________. Normal leakage is returned via the _________ system.
A
  • hydrostatic and osmotic
  • interstitium
  • lymphatic
36
Q
  • In the case of edema, excess fluid is in the __________ tissue spaces of the body.
  • What can cause a fluid overload?
A
  • extra-cellular

- venous insufficiency or lymphatic abnormalities

37
Q

Abnormalities = Interstitial Edema:

  • Unregulated ____
  • Plasma ________ imbalance
  • __________ flow obstruction
  • _________ insufficiency
A
  • BP
  • protein
  • lymphatic
  • venous
38
Q

Localized edema is associated with conditions such as ________ insufficiency, _________ blockage, prolonged dependency, localized _________. It tends to occur in ________ areas of the body.

A
  • venous
  • lymphatic
  • inflammation
  • discrete
39
Q

Systemic or general edema is associated with __________ conditions such as CHF, hypoalbuminemia, kidney dysfunction. It is typically more _____ and non-discerning edematous pattern.

A
  • systemic

- broad

40
Q

Consequences of Edema:

  • Decreased ______
  • __________ limitations
  • Decreased ___________ input
  • Pain
  • Increased collagen leading to ________
  • Ultimately may lead to contracture, increased risk of infection, amputation
A
  • ROM
  • functional
  • somatosensory
  • fibrosis
41
Q

What are 3 ways to assess edema?

A
  • Pitting Edema Scale
  • Volumetric Measurement
  • Linear Measurement
42
Q

What is the scale for Pitting Edema?

A
  • 1+ = Barely detectable depression when finger is depressed into the skin
  • 2+ = Slight indentation, 15s to rebound
  • 3+ = Deeper indentation, 30s to rebound
  • 4+ = >30 seconds to rebound
43
Q

How is assessing edema via volumetric measurement done?

A
  • Measure water displaced in a container by immersing the extremity to a known anatomical landmark.
  • The difference between measurements of the uninvolved vs the involved provides a comparison and a measure for documentation.
44
Q

What is a big caution when assessing edema via volumetric measurements?

A

Caution for patients with open wounds!

45
Q

What is the key when assessing edema via linear measurement?

A

Keep the way they are measured the same each time and compare involved to uninvolved.

46
Q

What are the 3 main ways edema can be reduced?

A
  1. ) Improved venous and lymphatic circulation
  2. ) Physical barrier to limit the size and shape of tissue
  3. ) Increased tissue temperature
47
Q

Compression Uses:

  • Generally utilized to improve fluid balance, increase venous and lymph return, thus reducing ______ or ________ edema
  • ____ prevention
  • Shaping of residual limb following ________
  • Proven to facilitate healing in venous insufficient wound areas
  • Manual _______/__________ techniques have supplanted use of mechanical compression in many instances
  • Some conditions may require the daily use of compression stockings to counteract effect of _________ on vascular and lymph systems
A
  • venous or lymphatic
  • DVT
  • amputation
  • massage/drainage
  • gravity
48
Q

Goals and Indications for Compression:

  • __________ to mold residual limb
  • Decrease _______ edema
  • ___________ management (often seen in Cancer patients)
  • ________ ulcer
  • _______ insufficiency
  • _______ injuries
A
  • Amputation
  • chronic
  • lymphedema
  • Stasis
  • Venous
  • Subacute
49
Q

Contraindications for Compression:

  • Trauma/______
  • Acute ____
  • Completely obstructed lymph or venous return
  • Arterial disease/insufficiency
  • Arterial _____________
  • Acute _________ edema
  • Loss of _________
  • Edema with cardiac or renal impairment
  • Impaired __________
  • Infection in treatment area
  • _____proteinemia (<2g/dL)
A
  • fracture
  • DVT
  • revascularization
  • pulmonary
  • sensation
  • cognition
  • hypoproteinemia
50
Q

Precautions for Compression:

  • Decreased _________
  • Malignancy
  • Uncontrolled __________
  • Over area of superficial peripheral nerve
A
  • sensation

- hypertension

51
Q

What are the 2 types of compression and what are they?

A

Static
-Exerting a continuous or constant force

Intermittent
-Exerting a varying force over time

52
Q

Intermittent compression is thought to provide improved outcomes through a milking mechanism from _______ to ____________.

A

distal to proximal

53
Q

What are 3 compression methods?

A
  1. ) Bandages
  2. ) Garments
  3. ) Pumps
54
Q

Despite the method utilized for compression, care must be exercised to provide greater compression forces in the _________ extremity and gradually decreasing _____________, aiding in circulatory return.

A
  • distal

- proximally

55
Q

In regards to bandages, what is the difference between resting and working pressure?

A
  • Resting pressure is applied when elastic properties of the bandage are stretched in application. This pressure remains whether the patient moves or remains still.
  • Working pressure is produced by muscle activity of movement pushing against the restraining bandage.
56
Q

Highly extensible bandages provide high ______ pressures when stretched with application, but typically provide very low ______ pressure.

A
  • resting

- working

57
Q

Relatively inelastic bandages provide low ________ pressure, but high _______ pressure.

A
  • resting

- working

58
Q

What are the pros and cons of highly extensible bandages?

A 
PROS
\+inexpensive
\+readily available
\+easily removed
\+patient/care giver can be trained to install

CONS

  • Correct and Incorrect Application
  • May slide down the extremity
  • Difficult to apply even tension
  • Quickly loose their elastic properties
  • Requires patient to be able to reach area to be wrapped/unwrapped if they do not have a caregiver to help
59
Q

What are the pros and cons of low stretch bandages?

A

PROS
+Higher working pressure generated, rather than resting pressure (less likely to impede circulation)
+Still relatively inexpensive
+Easily Removed
+Patient/Care Giver can be trained to install
+More fool-proof for application of compressive forces

CONS

  • Not as effective at removing edema as highly elastic bandages
  • Less comfortable to wear than highly elastic bandages
  • Correct and Incorrect Application
  • Requires patient to be able to reach area to be wrapped/unwrapped
  • Less readily available than highly elastic
60
Q

Semi-Rigid Bandages are applied every - days to the extremity after edema has been removed by other means.

A

4-7 days

61
Q

What are the pros and cons of semi-rigid bandages?

A

PROS
+Useful for less compliant patients, as it remains in place for several days
+Eliminates daily dressing changes

CONS

  • Must be protected from environment (shower)
  • Long term applications allows for pressure areas if not correctly applied
  • Patient may be unable to remove easily if discomfort occurs
62
Q

Contraindications for Bandages:

  • Patients with ________ disease (ABI < 0.8)
  • Patient inability to remove bandage (physical or mental)
  • Allergy to component
  • Active wound _________ at bandage site
  • Active _________ at bandage site
A
  • arterial
  • infection
  • cellulitis
63
Q

Precautions for Bandages:

  • Propensity to be discharging to facility unfamiliar with use of multi-layer dressing
  • _____ skin / bony prominences
A

frail

64
Q

What is the ankle-brachial index?

A
  • Comparing BP at ankle compared to BP measured at arm.

- Low ABI can indicate narrowing or blockage of arteries in legs.

65
Q

Do patients need to be measured for garments?

A

Yes, some OTC are available.

66
Q

What are the pros and cons of garments?

A 
PROS
\+OTC and Custom-fit Available 
\+Last 4-9 months with proper care 
\+Provide Graded Compression 
\+Cosmetically Acceptable

CONS

  • Can be difficult to don, especially with arthritic hands
  • Costly and not universally covered item by 3rd party payers
67
Q

Contraindications for Garments:

  • Patients with ______ disease
  • _______ to component
A
  • arterial

- allergy

68
Q

Precautions to Garments:

  • May be difficult to ____
  • Not recommended for over open wounds
A

don

69
Q

Pumps are done via mechanical compression and decrease interstitial fluids in what ways?

A
  • Increase pressure in the interstitial spaces forcing the fluid to move into the lymphatic and venous systems allowing for circulation.
  • Maintain a mechanical limit to the skin or surrounding tissue through a sleeve to limit “leakage” of fluid into interstitial spaces
  • Increases local tissue temperature through insulative factors, allowing improved activity of temp dependent enzymes
70
Q

What are the 2 types of intermittent pneumatic pumps used?

A
  • Non-dynamic (aka static)

- Dynamic

71
Q

What is the difference between non-dynamic and dynamic pumps?

A

Non-dynamic
-Same pressure throughout surface being compressed, force applied and released cyclically.

Dynamic
-Varying pressure throughout surface being compressed, force applied and released cyclically.

72
Q

Non-dynamic pumps:

  • Utilized for ______ prophylaxis in sedentary patients
  • Should be utilized any time the patient is not __________
  • Must be removed for __________
  • Available for calf length or thigh length
  • Routine care in hospital for non-ambulatory
A
  • DVT
  • ambulating
  • ambulation
73
Q

Dynamic pumps:

  • Available in multi-chamber sleeve designs
  • Peak pressure first develops _______
  • Progresses ________ in wave action, decreasing pressure in each subsequent chamber
  • Completes wave then holds complete deflation cycle
  • Cycles every - secs
  • Many “best” protocols/guidelines exist (typically 3:1)
A
  • distally
  • proximally
  • 7-8secs
74
Q

Pumps General Guidelines:

  • Check patient’s ____
  • Set inflation and deflation ratio to ~: (generally for edema reduction, 45-90 seconds on/15-30 seconds off); to shape residual limb : often used
  • Patient’s blood pressure determines device settings
  • Treatment time varies depending on patient’s _______ and ________.
A
  • BP
  • 3:1, 4:1
  • tolerance and condition
75
Q

Should numbness, tingling, pulsating, or pain be felt during treatment?

A

No

76
Q

Contraindications for Pumps:

  • DVT, thrombophlebitis
  • Acute ________ failure
  • Obstructed _________ or ______ flow
  • __________ disease
  • Fracture
  • Local _________
  • Significant _____proteinemia- protein levels < 2 g/dl
  • Suspected underlying syndrome which may be effected by compression (compartment syndrome)
A
  • cardiac
  • lymphatic or venous
  • arterial
  • infection
  • hypoproteinemia
77
Q

Precautions for Pumps:

  • CHF patient must be monitored closely for signs of intravascular fluid burden
  • Impaired ________ or mentation
  • Uncontrolled _____tension
  • CA
  • CVA
  • Valve insufficiency
  • Superficial peripheral _______
  • Requires barrier for patients with Contact Isolation Precautions
  • Never adjust pressure to greater than ______
A
  • sensation
  • hypertension
  • nerves
  • DBP (diastolic)

s3 - clinical practice 2 (13 decks)

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