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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
what is the setup application of TENS?
bipolar (low frequency)
26
where is the TENS applied?
over area of pain (dermatomal distribution)
27
TENS smaller the elctrode =...
more concentrated current
28
TENS frequency dosage
40-150 Hz
29
TENS time applied?
30-60 mins, 1-2 x daily
30
what do you watch for with TENS?
skin irritation
31
therapeutic uses of TENS
* Acute pain management * Chronic pain management * Labour pain (over sacrum and L/sp)
32
TENS EBP
* 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
33
IFT vs TENS IFT
* Penetrates deeper into tissues * Covers larger surface area * Versatile delivery methods * Rapid alternating current- limited time for adverse reactions
34
IFT vs TENS TENS
* Smaller and more portable * Cheaper- more widely available * Can be self-operated * Longer application time * Can run parallel to pain pathway
35
ULTRASOUND Definition
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
how does the physiological adaptation occur?
soundwave is absorbed into the tissue
37
physiological action
- 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
what does acoustic streaming + caivtation do?
encourage the movement of fluid within the tissue that then stimulates cell activity & cell membrane permeability changes
39
application of US requirements
- 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
Thermal CUS effects:
* Increased tissue temperature * Hyperdynamic tissue metabolism * Increased local blood flow * Increased extensibility of collagen fibers * Reduced viscosity of fluid elements in the tissue
41
Non-Thermal mechanisms:
* Ultrasonic cavitation- increase cell exchange across cell membranes * Gas body activation * Mechanical stress or frequency resonance non thermal processes
42
Therapeutic uses of US
* 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
KNee OA EBP US
low strength evidence that decreases pain
44
CLBP US EBP
decrease in intensity of pain (VAS) – combined with other modalities
45
CC/ SP US EBP
not recommended as only therapy for chronic LBP or neck pain- adjunct
46
tendinopathy US EBP
no improvements in pain or function -not effective treatment for rotator cuff tendinopathy
47
US EBP
No or insufficient evidence to support use in shoulder MSK conditions, carpal tunnel syndrome or RA.
48
bone union US EBP
Reduction in time to bone union but no benefit to functional recovery
49
what aspects do you consider when giving a dosage?
- stage of healing e.g. acute/ inflammatory, subacute/ repair phase of healing, chronic / remodelling phase of healing - localised / diffuse
50
therapeutic application of US can be used at...
1 or 3 MHz
51
when is 3 MHz used?
superficial structure or bony areas
52
3 MHz absorbs...
3 x faster
53
3 MHz heats...
3 x faster
54
3 MHz reduces time by...
1/3 of that for 1MHz
55
when is 1MHz used ? (US)
deeper structures
56
how many watts do you add for 1MHz?
0.25W/cm2 per cm of depth (to 6cm)
57
LOW LEVEL LASER (LLL) what is LLLT? (low level laser therapy)
= Low Level Light Therapy = Photobiomodulation (PBM) is a low intensity light therapy.
58
what is the effect of LLLT?
photochemical not thermal.
59
how many classes of lasers are there for LLLT?
4
60
where is the LLLT light produced, on the light spectrum?
Light with a wavelength in the red to near infrared region of the spectrum (760nm–850nm)
61
what is the power density (irradiance) of the LLLT?
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
1st class of laser
laser used in CD players
63
2nd class of laser
used in laser pointers
64
3rd class of laser
used in low level therapy but also CD and DVD writerss
65
4th class of laser
surgical laser
66
physiological action of LLLT
Light wavelength penetrates tissues and absorbed in mitochondria
67
what does LLLT increase?
oxidation capacity
68
what does LLLT enhance?
- Enhanced cell proliferation of fibroblasts and growth factor - Enhances neovascularisation
69
what does LLLT increase?
collagen synthesis
70
LLLT affect after Rx?
neural block - decrease nociception at periphery
71
overall result of LLT?
reduction of inflammation, pain relief, accelerated tissue regeneration
72
4 clinical targets for LLLT?
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
LLLT EBP NSCLBP
low level laser effective in reducing pain when compared to placebo. No effect on function.
74
Lymphoedema post breast cancer Rx
Low to moderate evidence - low level laser therapy is associated with reduction in limb volume, improved function and reduced pain in women
75
Knee OA EBP LLT
Not supported by current evidence
76
Tendinopathy EBP LLLT
effective for improving pain and function in LE put not PT
77
what are the best penetrating wavelengths for LLLT?
760–850nm
78
suggested light density for LLLT?
5mW/cm2 at 5cm deep
79
power of LLLT?
- 1Watt and surface density is 5W/cm2
80
LLLT Rx times
per point are in the range of 30 seconds to 1 minute.
81
how many points are there for LLLT?
1-15 points, depending on area to be Rx
82
CLINICAL GUIDELINES, WARNINGS, CI'S, PRECAUTIONS NICE Guidelines (NSLBP)
- 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
NICE guidelines OA
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
APA standards Warning entails...
risk management, client communication/ consent, equipment safety/ maintenance and clinical best practice guidelines
85
CI's & precautions to EPA
* 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

PHTY207 (7 decks)

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