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NPTE > therapeutic modalities > Flashcards

therapeutic modalities Flashcards

1
Q

ice massage timing

A
  • 10x15 cm covered in 5-10 minutes
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2
Q

cold pack application

A
  • 20 minutes - reduces temp of skin and subcutaneous tissues up to 2 cm in depth
  • can be applied every 1-2 hours for reduction of inflammation and pain
  • can be 30 minutes if for spasticity reduction

stored in 25 degrees F

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3
Q
A
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4
Q

cold bath

A
  • water 55-64 degrees F
  • 15-20 minutes
  • lower temperature = shorter duration of treatment
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5
Q

controlled cold compression unit

A
  • water 50-77 degrees F
  • intermittent compression
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6
Q

cryo cuff

A
  • cold water and compression
  • mostly knee and ankle
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7
Q

cryotherapy comparisons

A
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8
Q

vapocoolant spray

A
  • cooling through evaporation, temp changes superficially in epidermis
  • for trigger points
  • 30 degree angle 12-18 in from skin
  • torticollis, neck or LBP caused by muscle spasm, acute bursitis, HS tightness
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9
Q

superficial thermotherapy

A
  • local or general use of high temps in rehab with goal of increasing skin temp and superficial subcut tissue to depths of up to 2 cm
  • influences hemodynamic, metabolic, and NM processes
  • hot packs, warm water baths, infrared lamp, paraffin
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10
Q

hot packs

A
  • stored in water 158-167 degrees F
  • 15-20 minutes
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11
Q

fluidotherapy

A
  • convection, circulates warm air and small cellulose particles
  • 100-118degrees F, 15-20 minutes
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12
Q

infrared lamp

A
  • superficial heating of tissue through radiant heat
  • 780-1500 nm
  • absorbed within first few mm of tissue
  • 20 inches from source, 15-30 minutes
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13
Q

paraffin wax

A
  • superficial heating agent
  • 113-122 degrees
  • 6-10 dips
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14
Q

deep thermotherapy

A
  • local or general use of energy in rehab with goal of increasing tissue temp
  • heat depths 3-5 cm
  • influence mechanical, muscular, connective tissue, hemodynamic, metabolic, and NM processes
  • ultrasound and diathermy
  • relative changes in tissue temp influenced by intensity of heating agent, duration of exposure, and thermal conductivity of tissues
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15
Q

ultrasound

deep thermotherapy

A
  • transfers heat through conversion and elevates tissue temp to depths up to 5 cm
  • high frequency acoustic mechanical vibrations produce thermal and nonthermal effects
  • frequency above 20,000 Hz, therapeutic between 0.75 and 3 megahertz (MHz)
  • uses alternating electrical current, generated at same frequency as crystal resonance, to create mechanical vibration - converts electrical energy to acoustic energy and generates US at desired frequency
  • thermal effects: acceleration of metabolic rate, pain mod, reduction of muscle spasm, decr joint stiffness, alteration of nerve conduction velocity, increased circulation
  • nonthermal effects: increased cell and skin membrane permeability, increased intracellular Ca levels, tissue repair, normal cell function promotion
  • no unstable cavitation (bursts) w/ therapeutic ultrasound
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16
Q

ultrasound contraindications

A
  • acute and post-acute conditions
  • active bleeding
  • decr temp sensation
  • decr circulation
  • DVT
  • infection
  • malignancy
  • over breast implants
  • over carotid sinus or cervical ganglia
  • over epiphyseal areas in young children
  • over eyes, heart, genitalia
  • over cement or plastic
  • over pelvic, lumbar, or abdom areas in pregnant women
  • over pacemaker
  • thrombophlebitis
  • vascular insuff
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17
Q

contraindications for cold therapy

A
  • cold intolerance
  • cold urticaria
  • cryglobulinemia
  • infection
  • compromised circulation
  • regenerating peripheral nn
  • paroxysmal cold hemoglobulinuria
  • periph vasc disease
  • raynaud’s skin anesthesia
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18
Q

coupling agent in US goes on

A
  • both skin AND transducer
  • gels, gel pads, mineral oil, water, lotions
  • indirect coupling agents - when treatment area is excessively small, irregularly shaped, unable to tolerate direct P from transducer (water immersion in plastic or rubber bin)
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19
Q

in water immersion US, how far should transducer be from skin

A
  • 0.5-3.0 cm away
  • moved parallel to treatment surface
  • wipe away air bubbles on transducer and patient skin - interfere with transmittion
  • may need to increase intensity 50% when using underwater d/t energy absorption by water
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20
Q

US transducer should be moved at rate of

A

4 cm/sec

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21
Q

US intensity

A
  • quantity of energy delivered per unit area
  • effective radiation area (ERA): area of transducer that emits US energy, smaller than total size of transducer head
  • spatial averaged intensity: W/cm^2
  • spatial peak intensity: intensity of US beam at its highest point
  • beam nonuniformity ratio (BNR): ratio btw spatial peak intensity and spatial averaged intensity, higher crystal quality = lower BNR and less likelihood that patients experience hot spots and discomofrt during treatment, usuall 5:1 or 6:1
22
Q

US frequency

A
  • primary determinant in depth of US penetration
  • high frequency absorbs faster - affect more superficial tissues, lower frequencies affect deeper tissues
  • 1MHz for deeper tissues, 3 MHz for more superficial tissues
23
Q

US: _ MHz for deeper tissues, _ MHz for more superficial tissues

A
  • 1MHz for deeper tissues (up to 5 cm)
  • 3 MHz for more superficial tissues (1-2 cm)
24
Q

US duty cycle

A
  • portion of treatment that US is generated during entire treatment, continuous or pulsed
  • on time/(on time + off time)
  • continuous: US intensity remains constant through treatment (100% DC); thermal effects at higher intensity and nonthermal at lower intensity -> more effective at elevating tissue temperature
  • pulsed: US intensity periodically interrupted, reduced average heating of tissues, primarily for non thermal effects, 20% recommended
25
Q

US duration

A
  • an area 2-3x transducer takes ~5 mins
  • longer duration for lower intensities or lower frequencies or if therapeutic objective is higher tissue temps
  • US should not be used to treat areas larger than 4x the effective radiating area of transducer
26
Q

US number of treatments

A
  • usually 2-3x per week
  • for nonthermal effects can be 1x per day
  • should see response in 3 sessions
  • more than 14 US treatments in a single episode of care can reduce RBC and WBC counts
27
Q

phonophoresis

A
  • use of US for transdermal delivery of meds
  • anti-inflamm agents and analgesics
  • not likely to produce burns or damage skin
  • limited efficacy according to evidence
28
Q

diathermy

A
  • deep heating agent, converts high frequency electromagnetic E into therapeutic heat
  • continuous or pulsed modes - pulsed not for thermal effects
  • most common frequency is 27.12 MHz
  • capacitive plate method: superficial heating pattern, over low fat contant areas
  • inductive coil method: deeper heating pattern, over areas of high water content
  • 20 minutes for thermal effects, 30-60 minutes for nonthermal effects
  • bigger areas than US
29
Q

heating agents advantages and disadvantages

A
30
Q

ultraviolet light

A
  • absorbed 2 mm into skin, for skin disorders
31
Q

hydrotherapy

A
  • heat through conduction or convection, in pools
  • NOT for CV or pulm disease, bleeding, diminished sensation, gangrene, impaired circulation, incontinence, maceration, PVD, renal infection, mental disorders
  • wound care, weight unloading, reduction of edema
32
Q

therapeutic pool temperatures

A
33
Q

contrast bath

A
  • alternating hot and cold to decrease edema in distal extremity
  • hot (104-106) then cold (50-60) for 3-4 mins, total 25-30 minutes
34
Q

lumbar traction

A
  • max 30 pounds used for initial session
  • 50% of body weight required for actual separation of vertebrae, 25% for muscle spasm or disk prostrusion
  • 10 minutes for disks, up to 30
  • prone for disks, supine for greater separation of facets and foramen
35
Q

cervical traction

A
  • supine for posterior structure separation, prone for disk spaces
  • 0-5 degrees flexion for upper CS
  • 10-20 for mid CS
  • 25-35 for lower CS
  • 10 lbs for first session
  • 7-10% of pt body weight for soft tissue stretch, muscle spasm, disc protrusion
  • 13-20% for joint distraction
  • should not exceed 30 pounds
  • 10 minutes for disks, up to 30 for other
36
Q

compression bandages

static compression

A
  • increase ext P on body w/ resting pressure and working pressure
  • resting: when elastic bandage is on stretch, P when pt is active or at rest
  • working: produced by active muscle contracting against inelastic bandaged, only when pt is active
37
Q

types of compression bandages

A
  • long-stretch bandages: greatest resting P (60-70 mm Hg), extend up to 200% length, little working pressure - stretch when muscles expand; for immobile pts
  • short-stretch: low P at rest and high P when muscles expand, moderately effective when pt active or at rest - both resting and working pressure; during exercise, not effective in flaccid or inactive limb
  • multi-layered: moderate to high resting pressure w/ layers, common w/ venous stasis ulcers
  • semirigid: treated gauze applied to distal extremity - intially wet then hardens and dries; also venous stasis ulcers
38
Q

compression garments

A
  • 16-18 mmHg prevent DVT
  • 20-30 mmHg for scar tissue control
  • 30-40 mmHg for edema control
  • should be fit when level of edema is minimal
  • usually last 6 months
39
Q

intermittent pneumatic compression pump

A
  • UE 30-60 mmHg
  • LE 40-80 mmHg
  • 30 minutes - 4 hours based on diagnosis, 3x per week to 4x per day
  • can be used in combo with other modalities
40
Q

therapeutic electrotherapy currents

A
  • direct: constant flow of electrons from anode (+) to cathode (-) for more than 1 s without interuption
  • alternating: polarity continuously changes from (+) to (-) w/ change in direction of current flow, biphasic, symmetrical, or asymmetrical, sinusoid shape
  • pulsatile: non-cont flow of direct or alternating current, discrete separated from other pulses by period of time w/ no activity, monophasic is all positive - one phase for each pulse, biphasic is + and - and has two pahses for each pulse
41
Q

characteristics of electrical current based on electrode size

A
  • small electrodes: increased current density, increased impedance, decreased current flow
  • large electrodes: decreased density, decreased impedance, increased current flow
  • closer electrodes: more dense current in superficial tissue
  • farther apart: more dense in deeper tissues
42
Q

monopolar or bipolar electrode placement

A
  • monopolar: small stimulating or active over target site, larger dispersive placed away from target site; for wounds, iontophoresis, and edema
  • bipolar: two same size elctrodes over target; for muscle weakness, NM facilitation, spasms, ROM
43
Q

e stim parameters

A
  • amplitude: amount of current supplied over time, must be large enough to exceed threshold for cells
  • rise time: time it takes for current to mvoe from 0 to peak intensity within phase
  • phase duration: amount of time it takes for one phase of a pulse
  • frequency: number of pulses delivered per second
44
Q

NMES

A
  • facilitate skeletal muscle activity for return of controlled muscular activity
  • electrodes in parallel along direction of m fibers > 2 in apart
  • higher current amplitude for more foreceful contraction
  • pulse duration: shorter for smaller muscles
  • frequency: tetanic contraction, 35-50 pulses/sec, higher frequencies promote more rapid fatigue
  • duty cycle: 6-10 s on, off time should be 5x longer
  • ramp time: 1-4s
  • treatment: 10-20 contractions -> 10-20 minutes, 3x per week
45
Q

transcutaneous electrical nerve stimulation (TENS)

A
  • pain management
46
Q

interferential current

A
  • 2 medium frequency alternating waveforms that are biphasic through 2 sets of electrodes
  • pain relief, increased circulation, muscle stimulation
  • bipolar delivery produces oval shape
  • quadripolar delivery produces 4 leaf clover shape, can have automatic vector scan
47
Q

iontophoreis

A
  • 40-80 mA-min
  • 10-20 minutes
48
Q

electromyography

A
  • evaluating motor units (naterior horn cell and its axon, NM junctions, and m fibers innervated by the unit)
  • indwelling electrodes (intramuscular EMG) - for small or deep muscles, when there is need to record single motor unit potential
  • surface electrodes (biofeedback): used to monitor larger muscle groups
49
Q

abnormal potentials w/ EMG

A
  • SPONTANEOUS
  • fibrillation potentials: indicated of LMN disease
  • positive sharp wave: denervated m disorders at rest, primary m disease like MD
  • fasciculations: irritation or degeneration of ant horn cell, nerve root compression or muscle spasms
  • repetitive discharge: myopathies, lesion of ant horn cells and periph nn
  • VOLUNTARY
  • polyphasic potentials: myopathiesm muscle or peripheral nn involvement
50
Q

EMG biofeedback

A
  • gives info about the electrical activity but does not measure muscle contraction
  • allows pts to make small changes in performance and receive immediate feedback
  • muscle relaxation: high sensitivity setting w/ active electrodes intiailly positioned close to each other - place further apart and more sensitive as patient improves relaxation; 10-15 minutes
  • muscle re-education: begin max muscle contraction, set at low sensitivity so pt can perform reps at 2/3 max contraction - isometric contractions 6-10 seconds; 5-10 minutes
51
Q

massage

A
  • centrifugal - from center of body out
  • centripetal - from extremities toward center of body
  • effleurage: light stroke that produces reflexive response - at beginning and end of massage; should be toward heart
  • friction: small circular motions over trigger point or muscle spasm to loose edema, adhesions, relieve spasm
  • petrissage: kneading, muscle squeezed and rolled to loosen adhesions, improve lymphatic return; distal to proximal
  • tapotement: rapid alterntaing movements like tapping, hacking, cupping, slapping - enhance circulation and stimulate peripheral nerve endings
  • vibration: rapid shaking motion causing vibration to treatment; for relaxation

NPTE (32 decks)

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