Chapter 15 - Using Therapeutic Modalities Flashcards Preview

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Flashcards in Chapter 15 - Using Therapeutic Modalities Deck (114):
1

electromagnetic energy

electrical stimulation, shortwave & microwave diathermy, ultraviolet therapy, laser therapy

2

electromagnetic energy travels

without a medium

3,000,000 m's in a vacuum

in a straight line

3

conduction

heat is transferred from a warmer object to a cooler one

4

skin temperature influenced by

type of heat or cold medium

conductivity of tissue

quantity of blood flow in the area

speed at which heat is being dissipated

5

high temperature limit

116.6 degrees farenheit

at 113 degress - should not go longer than 30 min

6

types of modalities using conduction

MHP, paraffin, electric heating pads, ice/cold packs

7

Convection

transference of heat through the movement of fluids or gases

ex. whirlpool bath

8

radiation

heat energy is transferred from one object through space to another object

9

types of radiation modalities

shortwave/microwave diathermy, infrared heating, ultraviolet therapy

10

Conversion

generation of heat from another energy form such as sound, electricity, and chemical agents

11

types of conversion modalities

ultrasound, diathermy, liniments/balms

12

ultrasound

mechanical energy into heat energy at tissue interfaces

inaudible, acoustic vibrations of high frequency that may produce thermal or non-thermal physiological effects

13

diathermy

heat produced by applying electrical current of specific wavelengths to skin

14

liniments/balms

create heating sensation through counterirritation of sensory nerve endings

15

Extent of tissue cooling

depends on type of cold medium, length of exposure, and conductivity of tissue

16

38.8 degrees farenheit

muscle temperatures can be reduced as deep as 4 cm

17

which tissue are good conductors

muscle is good, fat is poor conductor

18

vasoconstriction occurs when

cold for 15-30 min at 50 degrees

19

hunting response

slight increase in temperature during cooling (not vasodilation)

20

physiological effects of cold

increased blood viscosity, decrease in release of chemical mediators, decreased capillary permeability

decreased secondary hypoxic death

decreased muscle spasm

21

frostbite occurs at what temp

26.6-24.8 degrees farenheit

22

raynaud's phenomenon

cold exposure causes vasospasm of digital arteries lasting for 2 minutes to hours

23

possible contraindications of cold

hypersensitivity

cold allergies

over superficial nerves

uncovered, open wounds

circulatory insufficiency

already decreased sensation

24

ice massage

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

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