Week 4: Ultrasound and More Flashcards by Alexander Lee

Ultrasound contraindications

Bleeding

Decreased sensation

Decreased circulation or DVT

Infection

Malignancy

Over implants

Carotid sinus or cervical ganglia

Growth plates in children

over eyes, heart, genitalia

over cement/plastic

over pregnant woman areas

over pace maker

vascular problems

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How far can ultrasound reach under the skin?

5cm

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What is attenuation?

The decrease in ultrasound intensity as it travels due to absorption/reflection/refraction

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As you increase _______, absorption of Ultrasound increases

frequency

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Ultrasound passes through ___________ and is absorbed into ___________

passes through high water content

absorbed into high protein content (tendons)

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Ultrasound penetration and absorption are ______ related

inversely

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In what order do tissues absorb ultrasound?

LOW - Blood -> Fat -> Nerve -> Muscle -> Skin -> Tendon -> Cartilage/Bone - HIGH

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What absorbs more ultrasound muscle or nerves?

muscle

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What absorbs the most ultra sound?

What absorbs the least?

Most: bones

Least: blood

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Why must you keep an ultrasound moving and keep it level to the skin w/ coupling gel

To prevent hot spots, and prevent reflection from the air

(air reflects 99% of ultrasound)

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How does ultrasound work?

Piezoelectric crystals expand and contract w/ AC electric current, causing sound waves

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What is the ERA of an ultra sound?

What is the general rule for treatment area?

Effective radiating area, the part that produces the sound waves note: slightly smaller than the actual transducer size, energy output is greatest at the center

Treatment area should be 2-3 times the ERA

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What is collimation?

What gives you more?

The focus on the ultrasound beam

As per the slides: A larger transducer with a higher frequency

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What is BNR for ultrasound?

Beam nonuniformity

the peak intensity compared to the average intensity, usually set as a ratio. Lower is better. 1:1 is ideal but not possible. Aim for 2:1 or 3:1

Better BNR = Less risk for hotspots

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When should you set ultrasound to a duty cycle (1:5 / 20%) vs havingit continous

Duty cycle for non-thermal effects

continious for thermal effects

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What frequency of ultrasound do you use for Deep tissues?

For superficial tissues?

Deep- 1MHz

Superficial- 3MHz

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How is intensity measured for ultrasound?

W/cm^2 (power unit per area)

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When you increase intensity or frequency on ultrasound, you decrease ____________

treatment time

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What is nonthermal ultrasound for?

Mild thermal?

Moderate?

Vigorous?

Acute injury/edema

Subacute/hematoma

Chronic inflammation/trigger point

Collagen Stretch

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T or F: Water can be used as a medium to apply ultrasound

Best for oddly shaped surfaces like the malleoli of the feet

note: use increased intensity as water cannot transmit as well as the gel

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How long is the typical ultrasound treatment time?

5-10 minutes

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How much heat change is considered mild?

Moderate?

Vigorous?

Mild - 1 C

Moderate - 2 C

VIgorous - 4 C

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Ultrasound caution: tissue damage at __C

Continue only if ______

_____effect

45C

There is improvement

Placebo Effect

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What is the delivery of medication using ultrasound called?

Phonophoresis

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What is ultraviolent light therapy used for?

Chronic ulcer/wounds

What are contraindications to ultraviolent light?

Areas receiving radiation Diabetes herpes Pellagra Photosensitive medication Skin Cancer SLE TB

What is laser therapy used for?

Using Infared and visible light For wounds Tendon/ligament injury arthritis edema reduction soft tissue injury scar triggerpoin t

How much depth can laser therapy have? What kind of light penetrates the deepest? How does it help wound healing?

2cm Red and near-infrared Increase ATP synthesis proliferation of immune cells increased blodflow may modulate pain

What are contraindications to laser therapy

Cancer Thyroid Dx Pregnant Over Eyes Epilepsy

What is relevant info included in the documentation of modality use

Body part Modality patient position duration parameters patient response skin effects outcome measure

Are monophasic currents AC or DC?

DC (Direct Current)

What are the advantage of Pulsed Monophasic currents (HVPC)

"comfortable" Short pulse duration = low risk of chemical burn

What is the advantage of continuous monophasic currents

Unidirectional flow Accumulation of ions (used for delivering medicine)

What is better for muscle training, russian current or HVPC?

Russian

HVPC duty cycle as per treatment goals: NMR: Muscle Pump: Reduce atrophy/strenghten: ROM:

NMR: 1:5 -> 1:3 -> 1:1 Muscle Pump: 1:1 Reduce atrophy/strengthen: 1:5 ROM: 1:1 or 1:5 depending on fatigue

Does HVPC use modulation? What are you looking for when you use HVPC?

No Muscle Contraction

When using HVPC to reduce atrophy, what intensity and volume should you use

Move through gravity resisted range, 25%+ of MVIC 3x10 repetitions x2 a day

When using HVPC for strengthening, what intensity should you use?

60% of MVIC, 3x10 repititons Pt works w/ e-stim against resistance

How do you use HVPC for edema control? (example: ankle sprain)

larger dispersive electrode is proximal Smaller active electrode on the site of swelling elevate the extremity Frequency: 120pps pulse duration: low note: not looking for muscle contraction, just voluntary

When using HVPC, which electrode do you put over the wound?

Cathode, swich electrode every 1-3 days. The cathode has antibacterial properties

the cathode has a ______ effect, the anode has a _______ effect

alkaline acidic

What settings should you use for iontophoresis?

Intensity: 3-5mA Current density: 0.1 to 0.5 time: 10-20 mins

How do you complete the circuit for an at-home iontophoresis unit?

add saline to opposite electrode that the medicine goes into

If a medicine is negatively charged, it must go on the _____ electrode to enter the skin Where does positive go?

negative electrode On the positive electrode

When using iontophoresis, what is important to do after the treatment?

check skin for chemical burn

What should iontophoresis feel like?

tingling/prickling sensation

Iontophoresis dose is expressed in mA-min meaning current x time) So if a 40 mA -min dose = 2mA current x 20 minutes. How do you deliver it twice as fast?

By changing the current to 4mA 40mA = 4mA x 10

Calcium medications have what charge? Dexamethosone has what charge? Lidocaine?

Positive Negative Positive

Which electrode will calcium and lidocaine medication go on?

Postitive

Which electrode will dexamethosone go on?

negative

Iontophoresis contraindications

Same as Estim + Impaired skin sensation allergy to medication denuded areas of recent scar cut/bruises metal in or near treatment site

When using iontophoresis at home, how long should the patient keep the electrode on?

8-14 hours

How should we educate patients for iontophoresis at home?

Instruct about sensation teach cleaning trim but dont shave dont overfill or compress pad once applied keep electrode on 8-14 hours take electrode off under running water may apply lotion after electrode removal

Which electrode usually causes a burn during iontophoresis?

An alkaline reaction burn at the cathode maybe also due to poor contact or too much resistance

How to minimize burns using iontophoresis?

Decrease current density inspect skin ensure proper filling of meds ensure good contact w/ skin ask about allergies

What is biofeedback?

NOT E-stim, but electrodes that measure current in muscle will beep when patient uses that muscle, more beeping = more use good for encouraging patients to use or not to use certain muscles example: u dont want them to use upper trap to shrug while lifting arm

What happens if you place electrodes too far apart when using biofeedback?

might detect other muscles

How to set the sensitivity for biofeedback?

Use the lowest level that does not elicit feedback at rest high sensitivity needed for relaxation training (theyre trying to reduce feedback to zero) Low sensitivity for NMR (attempting to increase the feedback) feedback = beeping

What is pressure-sensitive biofeedback?

NMR used to train specific muscles, uses a cuff that detects pressure, pressure changes when u contract muscle

Criteria for selection of biofeedback use for patients

Patients need good vision/hearing/communication good comprehension of simple commands good motor planning no profound sensory or proprioception loss

What penetrates deeper, cooling or heat? (ice packs or hot packs)

cooling

Thermotherapy contraindications

Acute/subacute injury Decreased circulation Decreased sensation DVT Impaired cognition Malignant tumors Tendancy toward hemorrhage or edema very young or elderly

thermotherapy PRECAUTIONS (not contras)

Cardiac insuffiency edema impaired circulation impaired thermoregulation pregnancy topical counterirritants recently applied demyleinated nerves open wounds

What is the normal temp of a hydrocollator?

160-170F

Is erythema bad after applying a hot pack

No But wheals, welts, and molted skin are bad

How often should you check a patients skin while on a hot pack

Every 5 minutes

How many layers of towel should you put between a patient and the hot pack

6-8 Note: terry cloth cover counts as 4

T or F, you should have lower back patients lay on the hot pack

F, don’t let them lay on the hot pack bc it increases heat transfer, risk of burns

What are the 4 normal sensations a patient should feel when doing cryotherapy (in order)

Cold Burning Aching Numbness

What should a patient do immediately after receiving thermal therapy?

Exercise