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PHTY207 > Wk 11: EPA > Flashcards

Wk 11: EPA Flashcards

1
Q

ELECTRICAL STIMULATION - INTERFERENTIAL and portable sensory TENS what is it?

A

stimulation of sensory nerves

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2
Q

current classification of electrical stimulation

A
  1. low frequency currents = 1000 Hz/less (portable TENS)
  2. medium frequency current (interferential) = 2000 - 10 000 Hz
  3. High Frequency current = megahertz
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3
Q

What is an interference current (IFT)?

A
  • 2 different medium frequency (cross over on each other) currents superimposed in the tissues at the same time
  • currents interfere with each other and a new current results (beat or treatment frequency)
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4
Q

Physiological action of interferential currents?

A
  1. stimulates sensory nerves (descending exogenous opioids)
  2. activates the Pain-Gate Mechanism
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5
Q

what sensory nerves are stimulated in IFT?

A
  • A-beta nerve fibres (touch and pressure)
  • A-delta fibres (pain receptors)
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6
Q

what does the Pain-Gate mechanism alter?

A

neurotransmitter content
- effects on neuropathic pain
- acute pain guidelines

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7
Q

basically, IFT, you put electrodes peripherally to…

A

stimulate the nerves / alter pain mechanisms / alter central pathways of the body

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8
Q

what shape are the IFT currents set up in?

A

clover shaped

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9
Q

technique used for IFT currents?

A

Quadripolar technique
* Uses four electrodes-two pairs
* Electrodes placed diagonally opposed
* Currents cross each other in the tissue

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10
Q

IFT therapeutic uses

A
  • CLBP (chronic lower back pain)
  • Swelling
  • Pain reduction and management
  • Chronic pain (TENS)
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11
Q

knee OA EBP

A

short term pain relief = good; long term= no change

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12
Q

chronic LBP EBP

A

reduction in pain intensity & disability in the short term

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13
Q

what is the frequency you apply IFT for the acute pain settings (pain gate)?

A

80-150 Mhz / 8-100 MHz

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14
Q

what is the setup you apply IFT for the acute pain settings (pain gate)?

A

quadripolar/ bipolar

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15
Q

what is the intensity you apply IFT for the acute pain settings (pain gate)?

A

mild sensation

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16
Q

what is the time you apply IFT for the acute pain settings (pain gate)?

A

10-15 mins

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17
Q

what is the frequency you apply IFT for the chronic pain settings (endogenous opioids)?

A

0-25 Hz

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18
Q

what is the set up you apply IFT for the chronic pain settings (endogenous opioids)?

A

quadripolar

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19
Q

what is the intensity you apply IFT for the chronic pain settings (endogenous opioids)?

A

strong sensation

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20
Q

what is the time you apply IFT for the chronic pain settings (endogenous opioids)?

A

30-45 mins +

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21
Q

What does TENS stand for?

A

Transcutaneous Electrical Nerve Stimulation

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22
Q

how is the current applied in TENS?

A

across the skin

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23
Q

Physiological action (2)

A
  1. stimulation of sensory nerves (descending exogenous opoioids)
  2. activates the pain - gate mechanism (chronic pain)
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24
Q

do we cross the pads over?

A

no - not creating an interfering current

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25
Q

what is the setup application of TENS?

A

bipolar (low frequency)

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26
Q

where is the TENS applied?

A

over area of pain (dermatomal distribution)

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27
Q

TENS
smaller the elctrode =…

A

more concentrated current

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28
Q

TENS frequency dosage

A

40-150 Hz

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29
Q

TENS time applied?

A

30-60 mins, 1-2 x daily

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30
Q

what do you watch for with TENS?

A

skin irritation

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31
Q

therapeutic uses of TENS

A
  • Acute pain management
  • Chronic pain management
  • Labour pain (over sacrum and L/sp)
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32
Q

TENS EBP

A
  • Chronic pain- low to medium quality evidence
  • Acute MSK pain
  • Labour pain
    Overall conclusion- consider as a treatment option for chronic MSK and labour pain within other accepted treatment options
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33
Q

IFT vs TENS
IFT

A
  • Penetrates deeper into tissues
  • Covers larger surface area
  • Versatile delivery methods
  • Rapid alternating current- limited time for adverse reactions
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34
Q

IFT vs TENS
TENS

A
  • Smaller and more portable
  • Cheaper- more widely available
  • Can be self-operated
  • Longer application time
  • Can run parallel to pain pathway
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35
Q

ULTRASOUND
Definition

A

Acoustic vibrations propagated
in the form of longitudinal compression waves at frequencies too high to be detected by the human ear (transducer produces vibrations which are propogate as a compression wave)

36
Q

how does the physiological adaptation occur?

A

soundwave is absorbed into the tissue

37
Q

physiological action

A
  • as sound wave passes through tissue - produces gas filled bubbles (in fluid parts of tissue)
  • causes a process called cavitation (passes wave through)
  • gas bubbles grow and shrink in response
  • movement of wave through tissue = acoustic streatming
38
Q

what does acoustic streaming + caivtation do?

A

encourage the movement of fluid within the tissue that then stimulates cell activity & cell membrane permeability changes

39
Q

application of US requirements

A
  • Transducer head needs to be perpendicular to
    surface
  • Transducer head needs to be in constant motion (so we dont get standill wave)
  • Avoid superficial bony areas- risk of burn
  • Use sufficient coupling agent- gel, silicone sheet, water
  • Correct dosage parameters
40
Q

Thermal CUS effects:

A
  • Increased tissue temperature
  • Hyperdynamic tissue metabolism
  • Increased local blood flow
  • Increased extensibility of collagen fibers
  • Reduced viscosity of fluid elements in the tissue
41
Q

Non-Thermal mechanisms:

A
  • Ultrasonic cavitation- increase cell exchange across cell membranes
  • Gas body activation
  • Mechanical stress or frequency resonance non thermal processes
42
Q

Therapeutic uses of US

A
  • Facilitate soft tissue healing (? preferential Collagen fibres)
  • Facilitate bone healing (first 2/52 post injury)
  • Hasten resolution of inflammation
  • Pain relief
  • Increase flexibility (as an adjunct to STM, exs)
  • Reduce muscle spasm
  • (+/- wound healing)
43
Q

KNee OA EBP US

A

low strength evidence that decreases pain

44
Q

CLBP US EBP

A

decrease in intensity of pain (VAS) – combined with other modalities

45
Q

CC/ SP US EBP

A

not recommended as only therapy for chronic LBP or neck pain- adjunct

46
Q

tendinopathy US EBP

A

no improvements in pain or function -not effective treatment for
rotator cuff tendinopathy

47
Q

US EBP

A

No or insufficient evidence to support use in shoulder MSK conditions, carpal
tunnel syndrome or RA.

48
Q

bone union US EBP

A

Reduction in time to bone union but no benefit to functional recovery

49
Q

what aspects do you consider when giving a dosage?

A
  • stage of healing e.g. acute/ inflammatory, subacute/ repair phase of healing, chronic / remodelling phase of healing
  • localised / diffuse
50
Q

therapeutic application of US
can be used at…

A

1 or 3 MHz

51
Q

when is 3 MHz used?

A

superficial structure or bony areas

52
Q

3 MHz absorbs…

A

3 x faster

53
Q

3 MHz heats…

A

3 x faster

54
Q

3 MHz reduces time by…

A

1/3 of that for 1MHz

55
Q

when is 1MHz used ? (US)

A

deeper structures

56
Q

how many watts do you add for 1MHz?

A

0.25W/cm2 per cm of depth (to 6cm)

57
Q

LOW LEVEL LASER (LLL)
what is LLLT? (low level laser therapy)

A

= Low Level Light Therapy = Photobiomodulation (PBM) is a low intensity light therapy.

58
Q

what is the effect of LLLT?

A

photochemical not thermal.

59
Q

how many classes of lasers are there for LLLT?

A

4

60
Q

where is the LLLT light produced, on the light spectrum?

A

Light with a wavelength in the red to near infrared region of the spectrum
(760nm–850nm)

61
Q

what is the power density (irradiance) of the LLLT?

A

usually between 5W/cm2 and is applied to an injury or to a painful site for 30–60 seconds a few times a week for several
weeks

62
Q

1st class of laser

A

laser used in CD players

63
Q

2nd class of laser

A

used in laser pointers

64
Q

3rd class of laser

A

used in low level therapy but also CD and DVD writerss

65
Q

4th class of laser

A

surgical laser

66
Q

physiological action of LLLT

A

Light wavelength penetrates tissues and absorbed in mitochondria

67
Q

what does LLLT increase?

A

oxidation capacity

68
Q

what does LLLT enhance?

A
  • Enhanced cell proliferation of
    fibroblasts and growth factor
  • Enhances neovascularisation
69
Q

what does LLLT increase?

A

collagen synthesis

70
Q

LLLT affect after Rx?

A

neural block - decrease nociception at periphery

71
Q

overall result of LLT?

A

reduction of inflammation, pain relief, accelerated tissue regeneration

72
Q

4 clinical targets for LLLT?

A
  1. The site of injury to promote healing, remodeling and reduce inflammation.
  2. Lymph nodes to reduce edema and inflammation.
  3. Nerves to induce analgesia.
  4. Trigger points to reduce tenderness and relax contracted muscle fibers.
73
Q

LLLT EBP NSCLBP

A

low level laser effective in reducing pain when compared to placebo. No effect on
function.

74
Q

Lymphoedema post breast cancer Rx

A

Low to moderate evidence - low level laser therapy is associated with reduction in limb volume, improved function and reduced
pain in women

75
Q

Knee OA EBP LLT

A

Not supported by current evidence

76
Q

Tendinopathy EBP LLLT

A

effective for improving pain and function in LE put not PT

77
Q

what are the best penetrating wavelengths for LLLT?

A

760–850nm

78
Q

suggested light density for LLLT?

A

5mW/cm2 at 5cm deep

79
Q

power of LLLT?

A
  • 1Watt and surface density is 5W/cm2
80
Q

LLLT Rx times

A

per point are in the range of 30 seconds to 1 minute.

81
Q

how many points are there for LLLT?

A

1-15 points, depending on area to be Rx

82
Q

CLINICAL GUIDELINES, WARNINGS, CI’S, PRECAUTIONS
NICE Guidelines (NSLBP)

A
  • 1.2.9Do not offer ultrasound for managing low back pain with or without
    sciatica. [2016]
  • 1.2.10Do not offer percutaneous electrical nerve simulation (PENS) for
    managing low back pain with or without sciatica. [2016]
  • 1.2.11Do not offer transcutaneous electrical nerve simulation (TENS) for
    managing low back pain with or without sciatica. [2016]
  • 1.2.12Do not offer interferential therapy for managing low back pain with or
    without sciatica. [2016]
83
Q

NICE guidelines OA

A

1.3.9Do not offer any of the following electrotherapy treatments to people with
osteoarthritis because there is insufficient evidence of benefit:
- transcutaneous electrical nerve stimulation (TENS)
- ultrasound therapy
- interferential therapy
- laser therapy
- pulsed short-wave therapy
- neuromuscular electrical stimulation (NMES).

84
Q

APA standards Warning entails…

A

risk management, client communication/ consent, equipment safety/ maintenance and clinical best practice guidelines

85
Q

CI’s & precautions to EPA

A
  • Pregnancy
  • Circulatory insufficiency (varicose veins; DVTs)- US
  • Haemorrhagic conditions- US, laser, IFT/TENS
  • Inability to communicate –All EPA
  • Inability to detect heat- US
  • Infective disorders (spread;↑activity)- US
  • Metal implants (TKR, THR)- US
  • Recent radiotherapy- US, laser, IFT/TENS
  • Treatment over an inbuilt stimulator (e.g. cardiac pacemaker)- US, laser, IFT/TENS
  • Tumours, tuberculosis, osteomyelitis-US, laser, IFT/TENS
  • Treatment near eyes- laser (protective eyewear must be worn during Rx)
86
Q
A

PHTY207 (7 decks)

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