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Flashcards in Chapter 11 Modalities Deck (15):
1

TEN ESSENTIAL POINTS OF PRESCRIPTION OF MODALITIES
_________.
_________/_________.
_________.
_________.
_________ to be treated.
_________/settings/temperature range.
_________ of treatment.
_________ of treatment.
_________/_________ of treatment.
Date of _________.

TEN ESSENTIAL POINTS OF PRESCRIPTION OF MODALITIES
Diagnosis.
Impairments/disabilities.
Precautions.
Modality.
Area to be treated.
Intensity/settings/temperature range.
Frequency of treatment.
Duration of treatment.
Goals/objectives of treatment.
Date of reevaluation.

2

SELECTED MODALITIES
Heat – The therapeutic temperature range is _________° to _________° C. Heat should be maintained for _________ to _________ minutes. Superficial heat is considered to penetrate _________ to _________ cm; deep heat, _________ to _________ cm.

SELECTED MODALITIES
Heat – The therapeutic temperature range is 40° to 45° C. Heat should be maintained for 5 to 30 minutes. Superficial heat is considered to penetrate 1 to 2 cm; deep heat, 3.5 to 8 cm.

3

SELECTED MODALITIES
Conduction is transfer of heat by _________, for instance, paraffin baths and hot packs (e.g., Hydrocollator packs). Although paraffin bath temperatures are ≈ _________° to _________° C, poor heat conductivity allows tolerance.

SELECTED MODALITIES
Conduction is transfer of heat by contact, for instance, paraffin baths and hot packs (e.g., Hydrocollator packs). Although paraffin bath temperatures are ≈52° to 54° C, poor heat conductivity allows tolerance.

4

SELECTED MODALITIES
Convection involves the _________ of heat, e.g., _________, whirlpool, and moist air.

SELECTED MODALITIES
Convection involves the flow of heat, e.g., fluidotherapy, whirlpool, and moist air.

5

SELECTED MODALITIES
Examples of conversion (where _________ energy is converted to heat) include _________, _________, SWD, and MWD. Infrared has a _________-cm depth penetration. US penetrates _________ to _________ cm; the greatest heating is at the _________–_________ interface. US parameters include a frequency of _________ to _________ MHz; intensity of _________ to _________ W/cm2; treatment area of 100 cm2; and duration of 5 to 8 minutes. SWD penetrates 4 to 5 cm; fat is heated more than muscle; the most commonly used frequency is 27.12 MHz. MWD is rarely used. Penetration is not as deep as SWD; the 915 MHz frequency penetrates deeper than 2,450 MHz.

SELECTED MODALITIES
Examples of conversion (where nonthermal energy is converted to heat) include infrared, US, SWD, and MWD. Infrared has a 2-cm depth penetration. US penetrates 3.5 to 8 cm; the greatest heating is at the bone–tissue interface. US parameters include a frequency of 0.8 to 1.1 MHz; intensity of 0.5 to 4 W/cm2; treatment area of 100 cm2; and duration of 5 to 8 minutes. SWD penetrates 4 to 5 cm; fat is heated more than muscle; the most commonly used frequency is 27.12 MHz. MWD is rarely used. Penetration is not as deep as SWD; the 915 MHz frequency penetrates deeper than 2,450 MHz.

6

SELECTED MODALITIES
Contraindications to heat therapy include acute _________ or _________ dyscrasia, inflammation, malignancy, insensate skin, inability to respond to pain, atrophic skin, and ischemia. Contraindications for US also include treatment over fluid-filled cavities (e.g., eyes and uterus) or near a pacemaker, laminectomy site, or joint prostheses. SWD should not be used in children (immature epiphyses) and persons with metallic implants, contact lenses, or menstruating/pregnant uteri. MWD should not be used over the eyes due to the risk of developing cataracts.

SELECTED MODALITIES
Contraindications to heat therapy include acute hemorrhage or bleeding dyscrasia, inflammation, malignancy, insensate skin, inability to respond to pain, atrophic skin, and ischemia. Contraindications for US also include treatment over fluid-filled cavities (e.g., eyes and uterus) or near a pacemaker, laminectomy site, or joint prostheses. SWD should not be used in children (immature epiphyses) and persons with metallic implants, contact lenses, or menstruating/pregnant uteri. MWD should not be used over the eyes due to the risk of developing cataracts.

7

SELECTED MODALITIES
Cryotherapy – Cold, unlike heat, is limited to superficial applications only. The physiological effects of cold include hemodynamic _________ and slowing of NCV (via conduction _________, i.e., C and A-δ fibers). Group _________ firing rates are likewise decreased, reducing the muscle stretch reflex (and thereby reducing spasticity). Cold is contraindicated in the setting of ischemia, insensate skin, severe HTN, or cold sensitivity syndromes (i.e., Raynaud's syndrome, cryoglobulinemia, and cold allergy).

SELECTED MODALITIES
Cryotherapy – Cold, unlike heat, is limited to superficial applications only. The physiological effects of cold include hemodynamic vasoconstriction and slowing of NCV (via conduction block, i.e., C and A-δ fibers). Group Ia firing rates are likewise decreased, reducing the muscle stretch reflex (and thereby reducing spasticity). Cold is contraindicated in the setting of ischemia, insensate skin, severe HTN, or cold sensitivity syndromes (i.e., Raynaud's syndrome, cryoglobulinemia, and cold allergy).

8

Cervical traction – About _________ to _________ lbs of force is recommended for cervical traction (of this, about _________ lbs is used to overcome the effects of gravity, i.e., the weight of the head). The intervertebral space is greatest at _________° of flexion; _________ is not recommended due to vertebrobasilar insufficiency.

Cervical traction – About 25 to 30 lbs of force is recommended for cervical traction (of this, about 10 lbs is used to overcome the effects of gravity, i.e., the weight of the head). The intervertebral space is greatest at 30° of flexion; extension is not recommended due to vertebrobasilar insufficiency.

9

Lumbar traction – A force of _________% of the body weight is needed to overcome the effects of friction when lying supine with the hips and knees flexed. An additional _________% of body weight is needed to achieve vertebral separation. A split lumbar traction table can essentially eliminate the frictional component. Although often prescribed for back pain (e.g., herniated disks and radiculopathy), the efficacy of this modality is not clear.

Lumbar traction – A force of 26% of the body weight is needed to overcome the effects of friction when lying supine with the hips and knees flexed. An additional 25% of body weight is needed to achieve vertebral separation. A split lumbar traction table can essentially eliminate the frictional component. Although often prescribed for back pain (e.g., herniated disks and radiculopathy), the efficacy of this modality is not clear.

10

General contraindications for spinal traction include ligamentous instability, _________, _________, bone malignancy, spinal cord tumor, severe osteoporosis, and untreated HTN. Contraindications specific to C-spine traction include vertebrobasilar artery insufficiency, rheumatoid arthritis, midline herniated disk, and acute torticollis. Contraindications specific to L-spine traction include restrictive lung disease, pregnancy, active peptic ulcers, aortic aneurysm, gross hemorrhoids, and cauda equina syndrome.

General contraindications for spinal traction include ligamentous instability, osteomyelitis, discitis, bone malignancy, spinal cord tumor, severe osteoporosis, and untreated HTN. Contraindications specific to C-spine traction include vertebrobasilar artery insufficiency, rheumatoid arthritis, midline herniated disk, and acute torticollis. Contraindications specific to L-spine traction include restrictive lung disease, pregnancy, active peptic ulcers, aortic aneurysm, gross hemorrhoids, and cauda equina syndrome.

11

TENS
Several theories explaining the mechanism of action of TENS exist. In the “_________ theory” introduced by Melzack and Wall, stimulation of _________ myelinated fibers (A-β and A-γ) excites _________ in the _________ _________, which in turn exerts an inhibitory influence on _________ V, where the small unmyelinated A-δ and C pain fibers synapse with spinal neurons.
“Conventional” or high-frequency (50 to 100 Hz) TENS uses barely perceptible, low-amplitude, short-duration signals. Periodic adjustments to the pulse width and frequency may be necessary due to accommodations to the settings. “Acupuncturelike” TENS uses larger amplitude, low-frequency (1 to 4 Hz) signals that may be uncomfortable. β-Endorphin release may play a role in the analgesic effects. Contraindications to TENS include using near pacemakers (controversial), gravid uteri, and carotid sinuses.

TENS
Several theories explaining the mechanism of action of TENS exist. In the “gate theory” introduced by Melzack and Wall, stimulation of large myelinated fibers (A-β and A-γ) excites interneurons in the substantia gelatinosa, which in turn exerts an inhibitory influence on lamina V, where the small unmyelinated A-δ and C pain fibers synapse with spinal neurons.
“Conventional” or high-frequency (50 to 100 Hz) TENS uses barely perceptible, low-amplitude, short-duration signals. Periodic adjustments to the pulse width and frequency may be necessary due to accommodations to the settings. “Acupuncturelike” TENS uses larger amplitude, low-frequency (1 to 4 Hz) signals that may be uncomfortable. β-Endorphin release may play a role in the analgesic effects. Contraindications to TENS include using near pacemakers (controversial), gravid uteri, and carotid sinuses.

12

Massage
Classic Western techniques include _________ (stroking), _________ (kneading), _________ (percussion), and _________ (tapotement + petrissage + deep tissue massage). Deep friction massage is used to break up adhesions in chronic muscle injuries. Myofascial release attempts to release soft tissue entrapped in tight fascia through the prolonged application of light pressure in specific directions. Eastern techniques include acupres-sure and Shiatsu massage.

Massage
Classic Western techniques include effleurage (stroking), petrissage (kneading), tapotement (percussion), and Swedish (tapotement + petrissage + deep tissue massage). Deep friction massage is used to break up adhesions in chronic muscle injuries. Myofascial release attempts to release soft tissue entrapped in tight fascia through the prolonged application of light pressure in specific directions. Eastern techniques include acupres-sure and Shiatsu massage.

13

Absolute contraindications to massage include _________, _________, _________ plaques, and infected tissues. Relative contraindications include incompletely healed scar tissue, anticoagulation, calcified soft tissues, and skin grafts.

Absolute contraindications to massage include malignancy, DVT, atherosclerotic plaques, and infected tissues. Relative contraindications include incompletely healed scar tissue, anticoagulation, calcified soft tissues, and skin grafts.

14

Phonophoresis – Topical medications (e.g., _________ and _________) are mixed with an acoustic coupling medium, which are then driven into the tissue by US. Common uses include osteoarthritis, bursitis, capsulitis, tendonitis, strains, contractures, scar tissue, and neuromas.

Phonophoresis – Topical medications (e.g., steroids and anesthetics) are mixed with an acoustic coupling medium, which are then driven into the tissue by US. Common uses include osteoarthritis, bursitis, capsulitis, tendonitis, strains, contractures, scar tissue, and neuromas.

15

Iontophoresis – _________ _________ are used to drive medications across biological membranes into the symptomatic areas, while theoretically avoiding the systemic side effects of the medications.

Iontophoresis – Electrical currents are used to drive medications across biological membranes into the symptomatic areas, while theoretically avoiding the systemic side effects of the medications.