Chapter 15 - Using Therapeutic Modalities Flashcards
1
Q
electromagnetic energy
A
electrical stimulation, shortwave & microwave diathermy, ultraviolet therapy, laser therapy
2
Q
electromagnetic energy travels
A
without a medium
3,000,000 m’s in a vacuum
in a straight line
3
Q
conduction
A
heat is transferred from a warmer object to a cooler one
4
Q
skin temperature influenced by
A
type of heat or cold medium
conductivity of tissue
quantity of blood flow in the area
speed at which heat is being dissipated
5
Q
high temperature limit
A
116.6 degrees farenheit
at 113 degress - should not go longer than 30 min
6
Q
types of modalities using conduction
A
MHP, paraffin, electric heating pads, ice/cold packs
7
Q
Convection
A
transference of heat through the movement of fluids or gases
ex. whirlpool bath
8
Q
radiation
A
heat energy is transferred from one object through space to another object
9
Q
types of radiation modalities
A
shortwave/microwave diathermy, infrared heating, ultraviolet therapy
10
Q
Conversion
A
generation of heat from another energy form such as sound, electricity, and chemical agents
11
Q
types of conversion modalities
A
ultrasound, diathermy, liniments/balms
12
Q
ultrasound
A
mechanical energy into heat energy at tissue interfaces
inaudible, acoustic vibrations of high frequency that may produce thermal or non-thermal physiological effects
13
Q
diathermy
A
heat produced by applying electrical current of specific wavelengths to skin
14
Q
liniments/balms
A
create heating sensation through counterirritation of sensory nerve endings
15
Q
Extent of tissue cooling
A
depends on type of cold medium, length of exposure, and conductivity of tissue
16
Q
38.8 degrees farenheit
A
muscle temperatures can be reduced as deep as 4 cm
17
Q
which tissue are good conductors
A
muscle is good, fat is poor conductor
18
Q
vasoconstriction occurs when
A
cold for 15-30 min at 50 degrees
19
Q
hunting response
A
slight increase in temperature during cooling (not vasodilation)
20
Q
physiological effects of cold
A
increased blood viscosity, decrease in release of chemical mediators, decreased capillary permeability
decreased secondary hypoxic death
decreased muscle spasm
21
Q
frostbite occurs at what temp
A
26.6-24.8 degrees farenheit
22
Q
raynaud’s phenomenon
A
cold exposure causes vasospasm of digital arteries lasting for 2 minutes to hours
23
Q
possible contraindications of cold
A
hypersensitivity
cold allergies
over superficial nerves
uncovered, open wounds
circulatory insufficiency
already decreased sensation
24
Q
ice massage
A
32 degrees
10-15 cm area, 5-10 min
25
cold/ice water immersion
50-60 degrees
10-15 min
26
ice bag
34-36 degrees
wet ice packs are best
15-20 min
27
vapocoolant sprays
fluori-methane
| reduce spasm, increase ROM, treat trigger points
28
Cryokinetics
cryotherapy and exercise
ice until dumb (12-20 min)
exercise 3-5 min
ice until numb 3-5 min
repeat 3-5x
29
effective tissue temperature for thermotherapy
100-113 degrees farenheit
or
40-45 degrees celcius
30
thermotherapy effects
```
increased extensibility
increased viscosity
decreased joint stiffness
reduced pain
reduced muscle spasm
increased nerve conduction velocity
reduce inflammation, edema, exudate
increased blood flow, venous return, and lympathic drainage
assist inflammation
```
31
superficial heat
infrared modality
indirectly heats deeper tissues by circulation and conduction
moist heat is greater than dry heat
32
contra-indications of heat
acute inflammation, impaired circulation, poor thermal regulation, anesthetic areas, infections, malignancy, neoplasm, low back/abdomen during pregnancy
33
moist heat packs
160-170 degrees
silicate gel in cotton pad
6 layers of toweling
break pain-spasm cycle (sedative)
34
whirlpool baths
100-110 degrees
| convection and conduction
35
paraffin
126-130 degrees
glove methond: 6-12 dips, paraffin cools in between, wrap in plastic bag, rest for 30 min
immersion: submerge for 20-30 min,
36
contrast bath
100-110; 50-60 degrees farenheit
3:1 or 4:1 warm:cold for 19-20 minutes
37
attenuation
sound scatters and is absorbed as it penetrates tissue - energy transferred is decreased
38
1 MHz or 3 MHz
one/three million cycles per second
absorption increases with increase in frequency
39
US equipment
high-freq generator provides current through a co-axial cable to a transducer inside the applicator US head
(crystal - barium titanate, zirconate titanate)
2-3 mm thick and 1-3 cm diameter
40
Reverse piezoelectric effect
alternating current passing through crystal causes expansion contraction of crystal (produces acoustic energy)
41
1.0/3.0 MHz - frequency absorption
1. 0: 3-5 cm
| 3. 0: 1-2 cm
42
effective radiating area
surface of transducer that produces sound energy
1MHz is more divergent than 3 MHz
43
transverse wave
displacement perpendicular to direction of propagation (solids)
44
longitudinal wave
displacement in direction of wave propagation (liquids and solids -soft tissue)
45
beam non-uniformity ratio
amount of variability
ideal 1:1
typically 6:1
46
US - intensity
w/cm^2
| power/ERA
47
types of US
continuous - intensity remains constant
pulsed - intensity periodically interrupted
ducty cyle - % of time that US is being generated
48
Biphasic Current
alternating current
-direction of current reveres itself once during each cycle
uses: pain modulation or muscle contraction
49
Monophasic Current
Direct current
flows only from positive to negative pole
pain modulation, muscle contraction, produce ion movement
most commonly used in AT settings
50
Pulsatile Current
3+ pulses grouped together
interrupted and repeat at regular intervals
used in interferential pre-modulated and Russian currents
51
type of current parameters
```
waveform
modulation
intensity
duration
frequency
polarity
electrode setup
```
52
waveform
graphic representation of the shape, direction, amplitude, and direction of a particular electrical currents (sine, square, triangular)
53
modulation
ability of the e-stim unit to change the magnitude or duration of a waveform
bursts, continuous, surging (biphasic), monophasic, or pulsatile
54
Intensity
voltage output of the e-stim unit.
low voltage - 150 V - monophonic
high voltage - 500 V - biphasic or monophasic
55
Duration
length of time that current is flowing
pulse or width duration
normally is preset
56
frequency
number of waveforms being emitted by the e-stim unit in 1 second
pules/sec (pps)
cycles per second (cps
Hertz (Hz)
57
polarity
direction of current flow
58
electrode set up
large pads - dispersive - away from tx area
| small pad - active - close as possible to tx area
59
e-stim parameters for gate control
intensity adjuted to create tingling
| no contraction - with pulse and freq high as possible
60
e-stim parameters for descending pathway control
very high intensity, almost painful, 10 microseconds for pulse duration; freq at 80 pps
61
opiate pain control e-stim parameters
intensity - as high as can be tolerated
pulse duration - max
freq - 1-5 pps
62
muscle pumping e-stim parameters
freq - 20-40 pps
surged mode at 5 seconds each for on/off modes
injured part elevated
active contraction encouraged
63
muscle strengthening e-stim parameters
```
high-freq bi-phasic current
50-60 pps
surging curent at 15 sec on, 50 sec off
10 reps, 3x a week
combined with titanic muscle contraction with maximal active contraction against resistance
```
64
retardation of atrophy e-stim parameters
high-freq bi-phasic
30-60 pps to elicit a tetanic contraction
voluntary isometric contraction
65
muscle re-education
intensity increased to comfortable contraction
30-50 pos using interrupted or surged current
15-20 min, several times per day
66
iontophoresis
drives ions into the body via electrical current
67
interferential indications
pain control, joint pain w/ swelling, neuritis, retarded callus formation following fx, restricted mobility
20-25 pps for muscle contraction and 50-120 pps for pain management
68
shortwave diathermy
emits electromagnetic energy that is capable of producing temperature increases in the deeper tissues
69
Laser
light amplification by stimulated emission of radiation
| Helium-NEon) or (Gallium-Arsenide
70
physiological effects of thermal US
increased blood flow, metabolism, enzymatic activity, collagen extensibility,
decreased viscosity, pain, chronic inflammation, muscle spasm, joint stifffness
71
mild heating US
1 degrees celcius - accelerates metabolic rate
72
Moderate heating US
2-3 degrees celcius - reduces muscle spasm, pain, chronic inflammation, increase blood flow
73
vigorous heating 3-4 degrees celcius
decreases viscoelastic properties of collagen
74
physiologic effects of non-thermal US
microstreaming
cavitation
separation of collagen fibers
increased extensibility
increased fibroblastic activity
mechanical break-up of metabolites and waste products
reduction of edema and pain
75
microstreaming
flow of fluid/tissue components causes mechanical pressure waves - alters cell membrane permeability to Na+ and Ca2+ ions
76
Cavitation
formation of gas-filled bubbles that expand and compress due to pressure changes in fluid
stable: - increased fluid flow around bubbles
unstable: can cause damage
77
monopolar electrode
small (active) and large (dispersive) pad
78
bipolar elctrode
2 equally sized pads
79
bifurcate electrode
dispersive pad, and 2 active pads
80
quadpolar electordes
2 sets of electrodes - IFC
81
biofeedback
electronic instruments to accurately measure, process, and feed back reinforcing info via auditory or visual signals
82
EMG biofeedback
measures electrical activity in muscle fibers - quality of contraction
83
Mechanical response to massage
encourage venous and lymphatic drainage
mildly stretch tissue
avoid stagnant edema
84
physiological responses to massage
increased: circulation, metabolism, removal of lactic acid
85
Effleurage
stroking
light - sedative
deep - compression of soft tissue
hand over hand or cross body methods
86
petrissage
kneading
loose and heavy tissues
wrings out muscle, loosens adhesions, squeeze out material in to circulation
87
friction
used around joint where tissue is thin or unyielding
circular movement
stretch underlying tissue, develop heat, increase circulation
88
Tapotement
percussion
| cuping, hacking, pincing
89
vibration
produces trebling effect
| relax and sooth
90
indications for traction
spinal nerve root
impingement
use to decrease muscle guarding
treat muscle strain
treat sprain of spinal ligaments
relax discomfort resulting form normal spinal compression
91
diathermy
emit electromagnetic energy capable of producing temperature increases in deeper tissues,
good for larger surface areas
92
shortwave diathermy
heats deeper tissue with high freq electrical current
- through a condenser (electrostatic field heating, patient is part of circuit)
- electromagnetic/induction field heating (heated by field, patient is not in circuit)
- pulsed diathermy - output of continuous shortwave diathermy is consistently interuppted
93
shortwave diathermy equipment
power amplifier (converts AC-DC)
Applicators: condenser - electrodes
or
inductive coil or drum
94
shortwave diathermy indications
bursitis, capsulitis, osteoarthritis, deep muscle spasm, strains
can reach temps of 107
95
Microwave Diathermy
lower freq cause less conversion of energy into subQ tissue
easily absorbed
96
microwave diathermy equipment
AC-->DC by magnetron oscillator
coaxial cable transports energy from magnetron oscillator to applicator head
97
indications for microwave diathermy
fibrositis, myositis, osteoarthritis, bursitis, calcific tendinitis, sprains, strains, post-traumatic joint stiffness,
can penetrate up to 5 cm
98
conductive thermal energy
thermotherapy, cryotherapy
99
electrical energy using modalities
E-stim currents, iontophoresis, biofeedback
100
sound energy using modalities
ultrasound, extracorporeal shockwave therapy
101
mechanical energy using modalities
traction, massage, intermittent compression
102
velocity=
wavelength x frequency
103
characteristics of electromagnetic radiation:
1. ) produced when sufficient electrical or chemical forces are applied to any material
2. ) travel readily through space at an equal velocity (300,000,000 meters/sec)
3. ) Direction of travel is always in a straight line
104
Electromagnetic radiation can be do what when contacting tissue?
reflection, transmitted, refracted, absorbed
105
Arndt-Schultz Principle
No changes or reactions can occur in the tissues unless the amount of energy absorbed is sufficient to stimulate the absorbing tissues
106
Law of Grotthus-Draper
if the energy is not absorbed utmost be transmitted to the deeper tissues
> absorption =
107
Cosine Law
the smaller the angle between the propagating radiation and the right angle, the less radiation reflected and the greater the absorption
108
inverse square law
the intensity of the radiation striking a surface varies inversely with the square of the distance from the source
"moving the object away from energy source = less absorption"
109
pulsed SWD can cause
depolarization in damaged cells correcting dysfunction
110
when should Diathermy be used?
if skin/tissue is tender and cannot handle pressure
if SubQ tissue is thick and deep heating is required
if 1 MHz US is contraindicated, Pulsed SWD will produce the same magnitude and depth of muscle heating
if the tx area is a large area
111
when should UV Therapy be used
cause chemical changes in skin, that have a bactericidal effect
effects are superficial in nature
treat skin lesions
topical agents are often better options
112
when should low level lasers be used
when you do not desire thermal effects
soft tissue and fracture healing
pain management
113
all electrical stimulating currents are classified as what?
Transcutaneous Electrical stimulating currents
114
Types of Transcutaneous electrical stimulating currents
EMS - Electrical muscle stimulators
TENS - Transcutaneous Electrical Nerve Stimulators
LIS/MENS - Low Intensity Stimulators
