Week 4: Ultrasound and More Flashcards

1
Q

Ultrasound contraindications

A

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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2
Q

How far can ultrasound reach under the skin?

A

5cm

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3
Q

What is attenuation?

A

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

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4
Q

As you increase _______, absorption of Ultrasound increases

A

frequency

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5
Q

Ultrasound passes through ___________ and is absorbed into ___________

A

passes through high water content

absorbed into high protein content (tendons)

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6
Q

Ultrasound penetration and absorption are ______ related

A

inversely

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7
Q

In what order do tissues absorb ultrasound?

A

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

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8
Q

What absorbs more ultrasound muscle or nerves?

A

muscle

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9
Q

What absorbs the most ultra sound?

What absorbs the least?

A

Most: bones

Least: blood

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10
Q

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

A

To prevent hot spots, and prevent reflection from the air

(air reflects 99% of ultrasound)

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11
Q

How does ultrasound work?

A

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

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12
Q

What is the ERA of an ultra sound?

What is the general rule for treatment area?

A

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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13
Q

What is collimation?

What gives you more?

A

The focus on the ultrasound beam

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

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14
Q

What is BNR for ultrasound?

A

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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15
Q

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

A

Duty cycle for non-thermal effects

continious for thermal effects

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16
Q

What frequency of ultrasound do you use for Deep tissues?

For superficial tissues?

A

Deep- 1MHz

Superficial- 3MHz

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17
Q

How is intensity measured for ultrasound?

A

W/cm^2 (power unit per area)

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18
Q

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

A

treatment time

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19
Q

What is nonthermal ultrasound for?

Mild thermal?

Moderate?

Vigorous?

A

Acute injury/edema

Subacute/hematoma

Chronic inflammation/trigger point

Collagen Stretch

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20
Q

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

A

T

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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21
Q

How long is the typical ultrasound treatment time?

A

5-10 minutes

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22
Q

How much heat change is considered mild?

Moderate?

Vigorous?

A

Mild - 1 C

Moderate - 2 C

VIgorous - 4 C

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23
Q

Ultrasound caution: tissue damage at __C

Continue only if ______

_____effect

A

45C

There is improvement

Placebo Effect

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24
Q

What is the delivery of medication using ultrasound called?

A

Phonophoresis

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25
Q

What is ultraviolent light therapy used for?

A

Chronic ulcer/wounds

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26
Q

What are contraindications to ultraviolent light?

A

Areas receiving radiation

Diabetes

herpes

Pellagra

Photosensitive medication

Skin Cancer

SLE

TB

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27
Q

What is laser therapy used for?

A

Using Infared and visible light

For wounds

Tendon/ligament injury

arthritis

edema reduction

soft tissue injury

scar

triggerpoin t

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28
Q

How much depth can laser therapy have?

What kind of light penetrates the deepest?

How does it help wound healing?

A

2cm

Red and near-infrared

Increase ATP synthesis
proliferation of immune cells
increased blodflow
may modulate pain

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29
Q

What are contraindications to laser therapy

A

Cancer

Thyroid Dx

Pregnant

Over Eyes

Epilepsy

30
Q

What is relevant info included in the documentation of modality use

A

Body part

Modality

patient position

duration

parameters

patient response

skin effects

outcome measure

31
Q

Are monophasic currents AC or DC?

A

DC (Direct Current)

32
Q

What are the advantage of Pulsed Monophasic currents (HVPC)

A

“comfortable”

Short pulse duration = low risk of chemical burn

33
Q

What is the advantage of continuous monophasic currents

A

Unidirectional flow

Accumulation of ions

(used for delivering medicine)

34
Q

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

A

Russian

35
Q

HVPC duty cycle as per treatment goals:

NMR:

Muscle Pump:

Reduce atrophy/strenghten:

ROM:

A

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

36
Q

Does HVPC use modulation?

What are you looking for when you use HVPC?

A

No

Muscle Contraction

37
Q

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

A

Move through gravity resisted range, 25%+ of MVIC

3x10 repetitions x2 a day

38
Q

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

A

60% of MVIC, 3x10 repititons

Pt works w/ e-stim against resistance

39
Q

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

A

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

40
Q

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

A

Cathode, swich electrode every 1-3 days.

The cathode has antibacterial properties

41
Q

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

A

alkaline

acidic

42
Q

What settings should you use for iontophoresis?

A

Intensity: 3-5mA

Current density: 0.1 to 0.5

time: 10-20 mins

43
Q

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

A

add saline to opposite electrode that the medicine goes into

44
Q

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

Where does positive go?

A

negative electrode

On the positive electrode

45
Q

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

A

check skin for chemical burn

46
Q

What should iontophoresis feel like?

A

tingling/prickling sensation

47
Q

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?

A

By changing the current to 4mA

40mA = 4mA x 10

48
Q

Calcium medications have what charge?

Dexamethosone has what charge?

Lidocaine?

A

Positive

Negative

Positive

49
Q

Which electrode will calcium and lidocaine medication go on?

A

Postitive

50
Q

Which electrode will dexamethosone go on?

A

negative

51
Q

Iontophoresis contraindications

A

Same as Estim +

Impaired skin sensation

allergy to medication

denuded areas of recent scar

cut/bruises

metal in or near treatment site

52
Q

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

A

8-14 hours

53
Q

How should we educate patients for iontophoresis at home?

A

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

54
Q

Which electrode usually causes a burn during iontophoresis?

A

An alkaline reaction burn at the cathode

maybe also due to poor contact or too much resistance

55
Q

How to minimize burns using iontophoresis?

A

Decrease current density

inspect skin

ensure proper filling of meds

ensure good contact w/ skin

ask about allergies

56
Q

What is biofeedback?

A

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

57
Q

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

A

might detect other muscles

58
Q

How to set the sensitivity for biofeedback?

A

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

59
Q

What is pressure-sensitive biofeedback?

A

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

60
Q

Criteria for selection of biofeedback use for patients

A

Patients need good vision/hearing/communication

good comprehension of simple commands

good motor planning

no profound sensory or proprioception loss

61
Q

What penetrates deeper, cooling or heat?

(ice packs or hot packs)

A

cooling

62
Q

Thermotherapy contraindications

A

Acute/subacute injury

Decreased circulation

Decreased sensation

DVT

Impaired cognition

Malignant tumors

Tendancy toward hemorrhage or edema

very young or elderly

63
Q

thermotherapy PRECAUTIONS (not contras)

A

Cardiac insuffiency

edema

impaired circulation

impaired thermoregulation

pregnancy

topical counterirritants recently applied

demyleinated nerves

open wounds

64
Q

What is the normal temp of a hydrocollator?

A

160-170F

65
Q

Is erythema bad after applying a hot pack

A

No

But wheals, welts, and molted skin are bad

66
Q

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

A

Every 5 minutes

67
Q

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

A

6-8

Note: terry cloth cover counts as 4

68
Q

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

A

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

69
Q

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

A

Cold
Burning
Aching
Numbness

70
Q

What should a patient do immediately after receiving thermal therapy?

A

Exercise