Chapter 12 Therapeutic Modalities Flashcards

Question

How does cryotherapy lead to relaxation of muscle spasm and breaking of the pain-spasm cycle?

Answer 1

inhibition of nerves and muscle spindle activity

Answer 2

cold burning aching numbness

Answer 3

Use of cold treatments before exercise Alternates several bouts of cold using ice massage, ice packs, ice immersion or iced towels with active exercise Injured body part numbed by applying cold for 10-20 minutes, individual performs exercise Numbness wears off – reapply for 3-5 minutes Exercise bout 3-4x each session

Answer 4

Flaked ice or small cubes, molded to the body’s contours and held in place by a compressive wrap, elevated above the heart to minimize swelling and pooling of fluids in the interstitial tissue spaces Ice machine – expensive

Answer 5

Contain silica gel enclosed in a strong vinyl or plastic case Come in a variety of sizes to conform to the body’s natural contours Used with compression and elevation Wet towel/cloth places between the pack and the skin  can cause frostbite 15-20 minutes

Answer 6

Use static, external compression and cold application to decrease blood flow t0 an extremity, to assist in venous return, to decrease edema and to increase effective depth of cold penetration Pain and recovery time decreased

Answer 7

Convenient to carry in AT kit Disposed of after a single use, can conform to a body part Each bag contains two chemicals separated by a plastic barrier – barrier, the chemicals mix, producing cold Short duration of cold application, using pack once Liquid substance comes is an alkaline pH which can burn the skin 15-20 minutes

Answer 8

Performed over small area (muscle belly, tendon, bursa, trigger point) Produces significant cooling of the skin and a large reactive hyperemia (increase in BF) Useful for its analgesic effect in relieving pain that may inhibit stretching of a muscle Water frozen cup – 10 cm x 15 cm using small overlapping circles for 5-10 mins

Answer 9

Reduce temperature quickly over the entire surface of a distal extremity Bucket immersion 4-10 degrees C, 10-15.6 degrees C whirlpool cools tissues Pain is relieved  part is removed from the water and functional movement patterns are performed Treatment 10-15 mins

Answer 10

Acute or chronic pain Acute or chronic muscle spasm/guarding Acute inflammation or injury Postsurgical pain and edema Neuralgia Superficial first-degree burns Used with exercises to: facilitate mobilization, relieve pain, decrease muscle spasticity

Answer 11

Decreased cold sensitivity/hypersensitivity Cold allergy/cold-induced urticaria Circulatory/sensory impairment Raynaud’s Advanced diabetes Hypertension Uncovered open wounds Cardiac or respiratory disorders Nerve palsy Arthritis Lupus

Answer 12

Used during the second phase of rehabilitation to increase blood flow and to promote healing in the injured area

Answer 13

Used during inflammatory stage  overwhelm injured blood and lymphatic vessels leading to increases hemorrhage and edema

Answer 14

Goals – increase circulation and cellular metabolism, produce analgesic/sedative effect, resolve pain and muscle guarding spasms, increase extensibility of connective tissue

Answer 15

Vasodilation and increased circulation result in an influx of oxygen and nutrients to the area to promote healing of damaged tissue, debris/waste removed from injury site

Answer 16

Superficial heating – transfer of heat through conduction, convection and radiation  warm whirlpool/immersion, heat packs, paraffin baths, Fluidotherapy, infrared lamps

Answer 17

Penetrating thermotherapy – ultrasound, phonophoresis, diathermy

Answer 18

Vigorous heating effects – 40-45 degree C tissue increase Tissue damage can occur above this range, below is insufficient Greatest degree of elevated temperature occurs in the skin and subcutaneous tissues within 0.5 of skin surface Adequate circulation  temperature increases to its maximum within 6-8 minutes of exposure Muscle temperature at depths of 1-2 cm increases to a lesser degree requires a longer duration of exposure Peak temperature reached  plateau effect

Answer 19

Combine warm or hot water with a hydro massaging effect to increase superficial skin temperature Whirlpools – analgesic agents that relax muscle spasms, relieve joint pain and stiffness, provide mechanical debridement, facilitate ROM exercises after prolonged immobilization Immersion greater than 20-30 minutes can dehydrate the individual, leading to dizziness and high core temperature

Answer 20

Provide superficial heat, transferring energy to the individual’s skin by way of conduction Each underlying tissue layer is heated through conduction from the overlying tissue, reaching a slightly deeper tissue level than what occurs in a whirlpool Deeper tissues not significantly heated Promote soft-tissue healing, reduce pain and superficial muscle spasm while promoting general relaxation, improve tissue extensibility Most efficient way to warm up tissue  exercise Pack – canvas or nylon case filled with hydrophilic silicate or with sand Stored in hot water unit at a temperature of 70-75 degrees C Removed pack from water  wrap in commercial padded cover (6-8 layers of towel) 20-30 minutes Mild-to-moderate sensation of heat

Answer 21

Provide heat to contoured bony areas of the body (feet/hands/wrists) Used to treat subacute or chronic rheumatoid arthritis associated with joint stiffness and decreased ROM Paraffin and mineral oil mixture (6:1 or 7:1 ratio) heated to 45-54 degrees C, oil makes mixture more comfortable Dip into bath several times, wrap in plastic bag and towel to maintain heat and elevated for 15-20 minutes

Answer 22

Dry thermal modality that transfers its energy to soft tissue by forced convection Heat is transferred through the forced movements or agitation in the unit chamber of heated air  circulated around the treated body part Used to treat acute injuries – decrease pain/swelling, increase ROM and BF 46-51 degrees C Exercise can be performed during the treatment, heat distributed throughout the entire limb 15-20 mins

Answer 23

Subacute or chronic injuries to: - Reduce swelling, edema and ecchymosis - Reduce muscle spasm/guarding Subacute or chronic muscle spasm Increased blood flow to: - Increase ROM prior to activity - Resolve hematoma - Facilitate tissue healing - Relieve joint contractures - Fight infection

Answer 24

Acute inflammation or injuries Impaired or poor circulation Subacute or chronic pain Advanced arthritis Impaired or poor sensation Impaired thermal regulation Malignancy/neoplasms Thromboplebitis

Answer 25

High frequency acoustic (sound) waves to elicit thermal and non-thermal effects in deep tissue depths or 3 cm or more Transfer of energy takes places in the deeper structures without causing excessive heating of overlying superficial structures

Answer 26

converts electrical current to mechanical energy as it passes through a piezoelectric crystal (quartz, barium titanate, lead zirconate titanate) house in a transducer head

Answer 27

The vibration of the crystal results in organic molecules moving in longitudinal waves that move energy into the deep tissues to produce temperature increases (thermal effects) as well as mechanical and chemical alteraltions (non-thermal effects)

Answer 28

Increase collagen tissue extensibility Increase blood flow Increase sensory/motor neuron velocity Increase enzymatic activity Decrease muscle spasm Decrease joint stiffness Decrease inflammation Decrease pain (indirect)

Answer 29

Increase skin permeability Facilitating soft-tissue healing process

Answer 30

Produce collimated cylindrical beams, similar to light beam leaving a flashlight, width smaller than the diameter of the transducer head

Answer 31

portion of the transducer's surface area that actually produces the ultrasound soundwave

Answer 32

Frequency increases = divergence decreases 1 MHz soundhead – 3-5 cm deep 3 MHz soundhead – 2-3 cm deep Tissues with high protein (nerve and muscle) absorb US readily

Answer 33

Deflection (reflection or refraction) is greater at heterogeneous tissue interfaces especially at bone-muscle interface Creates standing waves that increase heat

Answer 34

absorption of sound increases

Answer 35

Higher frequency = more rapidly molecules are forced against this friction Absorption increases = less sound energy is available to move through the tissue

Answer 36

Continuous and pulsed

Answer 37

Sound intensity remains constant Continuous – produce thermal/non-thermal effects, used for deep, need increase temp

Answer 38

sound intensity is intermittently interrupted Duty cycle range form 5-50% Non-thermal effects, facilitate soft-tissue healing, no increase temp

Answer 39

Tendinitis, bursitis, muscle spasm Reabsorb calcium deposits Reduce joint contractures, pain, scar tissue

Answer 40

US waves cannot travel through air  need coupling agent between the transducer head and the skin to facilitate passage of waves Coupling gel applied to area  transducer head stroker over area in small continuous circles Rate of 4cm/second to prevent cavitation (gas bubble formation) Total area 2-3x area of transducer head Alternate method – underwater for irregular shaped areas Indirect – 0.5-3 cm between patient and soundhead Intensity increased by 0.5 W/cm2 to compensate for air/minerals in water

Answer 41

Deep tissue healing Acute inflammatory conditions (pulsed) Chronic inflammatory conditions (pulsed or continuous) Spasticity/muscle spasm Trigger areas Increase tissue extensibility of collagen tissue Joint adhesions/contractures Neuroma Post-acute myositis ossificans

Answer 42

Acute and post-acute hemorrhage Infection Thrombophlebitis Areas of impaired circulation/sensation Over stress fracture sites or osteoporosis Over suspected malignancy/cancer Over the pelvic or lumbar areas during menstruation or pregnancy Over epiphyseal growth plates Over the eyes, heart, skull, spine, genitals Over active sites of infection or sepsis Over an implanted pacemaker Over exposed metal that penetrates the skin

Answer 43

Mechanical effects of ultrasound are used to enhance percutaneous absorption of anti-inflammatory drugs and local analgesics through the skin to the underlying tissues High US intensities have been used to deliver these medications to depths of 5-6 cm

Answer 44

Uses electromagnetic energy from the nonionizing radio frequency part of the spectrum Duration of impulses is short, no ion movement

Answer 45

Two types of generators are used for heating One places two condenser plates on either side of the injured area, placing the patient in the electrical circuit Other method uses an induction coil wrapped around the body part that places the patient in an electromagnetic field

Answer 46

Heating is uneven High fluid content – absorb more energy and are heated to greater extent Continuous SWD – raise temperature to 37.5-44℃ in deeper tissue by introducing high-frequency electrical current with a power output of 8—120 W Pulse SWD – uses a timing circuit to electrically interrupt the 27.12 MHz waves and produce bursts or pulse trains

Answer 47

a measure of the force, or intensity, that drives the current Voltage causes ions to move, but actual movement is called the current Conductors – medium that facilitates movement of ions including water, blood and electrolyte solutions Resistors – medium that inhibit movement of the ions including skin, fat and lotion

Answer 48

Frequency – refers to the amplitude of waveform cycles per second or Hz with AC Low-frequency (< 15 pps) – muscles twitch Frequency increases (15-40 pps) – minimizes the relaxation phase of muscle contraction High-frequency (> 40 pps) – maximal contraction generate

Answer 49

length of time that current is flowing

Answer 50

quantity of an electrical current

Answer 51

direction of current flow

Answer 52

alternating or continuous flow

Answer 53

ratio of the amount of time that current is flowing to the amount of time it is not flowing

Answer 54

Electrical energy flows between two points Ions of similar charge repel each other, ions of dissimilar charge attract one another

Answer 55

Direct current (DC) – continuous, one-directional flow of ions and is used to modulate pain, elicit a muscle contraction or produce ion movement Alternating current (AC) – continuous, two-directional flow of ions used to modulate pain or elicit or elicit a muscle contraction One-directional – monophasic Two-directional – biphasic Polyphasic

Answer 56

Conventional TENS – biphasic generators with parameters that allow pain control via electrical pulses having short duration, high frequency and low-to-comfortable current amplitude

Answer 57

Acupuncture-like TENS – electrical pulses of long duration, low frequency and comfortable to tolerable current amplitude, low pulse frequency

Answer 58

electrical pulses of long duration, high frequency and comfortable to tolerable current amplitude

Answer 59

Uses a monophasic current with a twin-peak waveform, a relatively short pulse duration and a long interpulse interval and an amplitude range above 150 mV Activates sensory and type II motor nerves without stimulating pain fibers Re-educate muscle, increase joint mobility, promote dermal wound healing, decrease pain/edema/muscle spasm/atrophy

Answer 60

Designed to elicit a muscle contraction of moderately high intensity with little patient discomfort (?) Biphasic current with a duty cycle Reduce edema, pain and muscle spasm

Answer 61

Two separate generators and a quadripolar electrode arrangement to produce two simultaneous AC electrical currents acting on the tissues Current crosses at the midpoint Decrease pain, acute/chronic edema, muscle spasm

Answer 62

Delivers an electrical current to the body with 1/1000 the amperage of TENS but with a pulse duration that may be up to 2500x larger Not designed to stimulate peripheral nerves to elicit a muscle contraction, used to reduce acute/chronic pain, inflammation, edema, facilitate healing

Answer 63

Neuromuscular stimulation that uses AC, with frequencies ranging from 2000 to 10000 Hz Current generated in bursts with interburst intervals Designed to produce an isometric rather than an isotonic contraction Strength gains do not transfer across the entire joint Faradic Current – asymmetrical biphasic wave

Answer 64

Uses a DC monophasic waveform with a peak current amplitude of up to 5 mA The current drives charged molecules from certain medications such as anti-inflammatories, anesthetics, analgesics into damaged tissue Treat inflammatory conditions – arthritis, myositis ossificans, plantar fasciitis Non-invasive and painless

Answer 65

Broad term for the application of light to provide therapeutic treatments for orthopedic injuries, skin conditions and psychological problems Light-emitting diodes (LED), superluminous diodes, fluorescent lamps, infrared lamps, UV lamps, diachronic lamps, very bright incandescent light bulds Laser – device that transforms electromagnetic energy of various frequencies in or near the range of visible light into an extremely intense, small and nearly nondivergent beam of monochromatic radiation with all its waves in place To produce laser radiation – energy source, mechanical structure, a lasing medium, gas/liquid/chemical/crystal or semiconductor Effect of a laser – determined by level of energy it emits Laser thought to – increase mast cell membrane, promote interleukin-6 formation, decrease dermal necrosis, increase collagen formation, degranulation, myofibroblast conversion

Answer 66

Manipulation of soft tissues to increase cutaneous circulation, cell metabolism, venous/lymphatic flow to assist removal of edema, stretch superficial scar tissue, alleviate soft-tissue adhesions, decrease neuromuscular excitability Result – relaxation, pain relief, edema reduction, increased ROM Reduce friction between patient’s skin and therapist’s hand - lubricant such as lotions, oils (lanolin base)

Answer 67

Effleurage – superficial, longitudinal stroke to relax the patient Use = relaxes patient, distributes any lubricant, increases surface circulation

Answer 68

Petrissage – pressing and rolling the muscles under fingers and hands Use = increases circulation, promotes venous/lymphatic return, breaks up adhesions in superficial connective tissue, increases elasticity of skin

Answer 69

Tapotement – sharp, alternating, brisk hand movements such as hacking, slapping, beating, cupping and clapping Use = increases circulation, stimulates subcutaneous structures

Answer 70

Vibration – finite, gentle and rhythmic movement of fingers to vibrate underlying tissues Use = relaxes/stimulates

Answer 71

Friction – deepest form of massage, deep, circular motions performed by thumb, knuckles Use = loosens fibrous scar tissue, aids in the absorption of edema, reduces inflammation, reduces muscular spasm

Answer 72

Increase local circulation Increase venous and lymphatic flow Reduce pain Reduce muscle spasm Stretch superficial scar tissue Improve systemic relaxation Chronic myositis, bursitis, tendinitis, tenosynovitis, fibrositis

Answer 73

Acute contusions, sprains and strains Over fracture sites Over open lesions or skin conditions Conditions such as acute phlebitis, thrombosis, severe varicose veins, cellulites, synovitis, arteriosclerosis and cancerous regions

Answer 74

Process of drawing or pulling tension on a body segment

Answer 75

Herniated disk protrusions Spinal nerve impingement Spinal nerve inflammation Joint hypomobility Narrowing of intervertebral foramen Degenerative joint disease Spondylolisthesis Muscle spasm and guarding Joint pain

Answer 76

Unstable vertebrae Acute lumbago Gross emphysema S4 nerve root signs Temporomandibular dysfunction Patient discomfort

Answer 77

Applies an external force to move the joint through a pre-set arc of motion Primarily used post-surgically at the knee, after knee manipulation or after stable fixation of intra-articular and extra-articular fractures of most joints such has hands/wrists/hip/shoulder/elbow/ankle Improve wound healing, accelerate clearance of hemarthrosis, prevent cartilage degeneration in septic arthritis Pain-free

Answer 78

Postoperative rehabilitation to – reduce pain, improve general circulation, enhance joint nutrition, prevent joint contractures, benefit collagen remodeling Following knee manipulation, joint debridement, meniscal or osteochondral repair, tendon lacerations

Answer 79

Noncompliant patient Disrupt surgical repair, fracture fixation Malfunction of device

Chapter 12 Therapeutic Modalities Flashcards

(106 cards)