Equipment, Devices and Technologies; Therapeutic Modalities Flashcards
(227 cards)
1
Q
A dependent patient must be ___ when changing positions in order to avoid shearing of skin across the bed.
A
lifted
2
Q
Practice moving ____ from one side of the bed to the other.
A
segmentally
3
Q
Min A is ___%.
Mod A is ___%.
Max A is ___%.
A
25%
50%
75%
4
Q
Dependent transfer of three person carry/lift.
Used to carry someone from stretcher to…
One therapist holds ____ , the second supports___, and the third supports ____.
Therapist at the ____initiates commands.
A
bed or plinth
head and upper trunk
trunk
LE
head
5
Q
Dependent transfer of two person lift.
Used to transfer patient between….
One therapist holds…..
Other therapists holds….
A
two surfaces of different heights or when transferring a patient to the floor.
underneath axilla; grab L forearm in R hand and R forearm in L hand.
mid to distal thighs and LE
6
Q
Stand pivot transfer requirements…
Lead with ….
Can also be used therapeutically for someone with CVA leading with….
A
unilateral WB restrictions or hemiplegia
uninvolved
involved
7
Q
Measuring seat height in w/c
A
measured from heel to popliteal fold and add 2 inches
8
Q
Measuring seat depth in w/c
A
posterior buttock to popliteal fold and subtract 2 inches
9
Q
Measuring seat width in w/c
A
measure widest aspect of buttocks, hips or thighs and add 2 inches
10
Q
Measuring back height in w/c
A
measure seat of chair to floor of axilla with users shoulder flexed to 90 degrees and subtract 4 inches
11
Q
Final back height of w/c should be below the ____of the scapulae
A
inferior angles
12
Q
Back height is affected by
A
cushion
13
Q
Measuring armrest height in w/c
A
seat of chair to olecranon process with users elbow flexed to 90 degrees and add one inch
14
Q
Hemi frame w/c is used for those who
A
self propel using LE
15
Q
One-hand drive frame w/c is used for those who
A
self propel using one UE
16
Q
Amputee frame w/c is used for those who
A
self propel but center of gravity is shifted posteriorly due to amputation
17
Q
Geri chair w/c is used for those who
A
are not able to self propel or safely operate a power mobility device
18
Q
Reclining chair w/c is used for those who are
A
unable to perform weight shifting or unable to sit upright for extended periods.
moderate to severe trunk involvement
19
Q
Backward tilt-in-space frame w/c is used for those who
A
are unable to sit upright or perform weight shifts but also has issues sliding or has extensor tone
20
Q
Sling back in w/c is for those who
A
require no postural support and has no neuromuscular deficits.
usually not for long term
21
Q
Planar back in w/c is for those who
A
require mild to moderate trunk support due to tone
22
Q
Curved back in w/c is for those who
A
require moderate trunk support
23
Q
Custom molded insert in w/c is for those who
A
require significant trunk support
24
Q
If the back height is below inferior angle of scapula the pt is able to
A
self propel and has good trunk control
25
If the back height is above inferior angle of scapula the pt is
able to self propel but requires additional spinal support
26
Planar seat in w/c is for those who
have no seated deformity
27
Curved seat in w/c is for those who
require mild to aggressive supportive curvature to provide increased contact between lower body and seat
28
Custom molded seat in w/c is for those who
require customized seat support to correct pelvic obliquity or a fixed asymmetrical deformity
29
Bevel (undercut) front edge of seat in w/c is for those
who self-propel using LE
30
Planar lateral supported for trunk in w/c is for those who
require mild to moderate lateral support duet o listing or scoliosis
31
Contoured or curved lateral supports for trunk in w/c is for those who
require total contact lateral support for significant lateral listing or scoliosis
32
Chest strap in w/c is for those who
require trunk support to correct for anterior listing
33
Chest harness in w/c is for those who
require both trunk and shoulder support to correct for anterior listing
34
Full length arm rests in w/c are for those
who perform STS
require additional postural support
pt utilizing lap board
35
Tubular or single posted arms in w/c are for those who
require minimal support for UE and easy access to wheels for propulsion and easily removal of arms
36
Fixed or non-removable armrests in w/c are for those who
require durable UE support
37
Covered rim wheel in w/c are for those that
require assistance for adequate grasp or friction when hands are in contact with wheel rims
38
Proportional control of power w/c
modulate speed
39
Non-proportional control of power w/c
pre-set speed
40
Bariatric w/c has weight limit of
300-1,000 lbs
41
Proper fit positioning of crutches
6 inches in front
2 inches lateral
crutch height should be no greater than 3 finger widths from the axilla
42
Lofstrand crutches can be used with all levels of ....
They require the ___ level of coordination.
Arm cuff should be positioned ....
Platform attachment can be utilized.
WB
highest
one an one half inches below olecranon process so it doesnt interfere with elbow flexion
43
Quad canes can better assist with limited ___ on an involved LE.
WB
44
Canes can be used in what types of gait patterns?
2 point
4 point
modified 2 and 4 point
45
When guarding during ambulation what side do you stand on as the therapist?
to the affected side
46
2 point gait
two crutches or canes
opposite crutch and LE move forward together.
Each step is one point and a complete cycle is two points.
47
3 point gait
walker or crutches
involves one injured LE that may have decreases WB
AD is advanced, then the injured LE, then the uninjured LE.
AD and each LE is a separate point.
48
4 point gait
similar to 2 point gait but doesnt move extremities simultaneously with device.
This is for those with impaired coordination, balance or significant strength deficits.
Each advancement of LE and crutch is a point.
49
Guarding during ascending stairs using handrail
stand opposite side and behind
50
Guarding during ascending stairs not using handrail
stand behind patient slightly toward affected side
51
Ascending stairs with crutches/cane
turn crutch sideways and hold HR and crutch in same hand
52
Those with a femoral line, hip flexion WOM should be limited to
not >80 degrees
53
CVP catheter is aka
and what does it do?
central line
measures pressures in RA or superior vena cava by means of indwelling venous catheter and pressure manometer.
Used to evaluate R ventricular function, R atrial venous pressure and circulating blood volume.
54
With a CVP catheter, avoid ....
For internal jugular insertion limit....
For subclavian insertion limit.....
If this is dislodged it is a...
excessive movement and physical activity
limit head and neck movement
limit ipsilateral shoulder ROM to 90 degrees
life-threatening emergency
55
Indwelling R atrial catheter is aka
and is used for ....
Limit what kind of movements with this one?
Avoid what else?
Hickman
long-term use of substances in to venous system
limited repeated ipsilateral shoulder movements
limit aquatic therapy
avoid soft tissue mobilization and manual techniques over access point
56
Pulmonary artery catheter is aka
and is used for..
Limit....
For internal jugular insertion limit....
For subclavian insertion limit....
For femoral insertion limit....
Dislodging this is a...
Swan-Ganz
continuous monitoring of pulmonary artery pressure
excessive movement and physical activity
head and neck movement
ipsilateral shoulder ROM to 90 degrees
ipsilateral hip flexion to 70
life threatening
57
Intracranial pressure monitor:
Must notify... before starting physical activity.
Changing bed height might....
Maintain head and neck....
What position of bed, neck and hip increase ICP?
nursing
alter transducer reading
neutral
Trendelenburg
neck flexion
excessive hip flexion
58
NG tubes need to be stopped with patient in what position?
upright or semi-Fowler's position for at least 30 min prior to supine activities
59
Those with G tube or PEG tube should not
lie flat during feeding
60
PEJ (jejunostomy tube) is used for
long-term feeding
also should not lie flat
61
PICC line is used for ....
precautions for this
long-term administration of medications
ROM exercise of involved extremities allowed
Use of axillary crutches is often contraindicated due to risk of occluding blood flow or causing thrombus
62
Avoid excessive ___and ___ movements but functional mobility can still be performed with ....and tracheostomy tube.
head and neck movements
endotracheal tube (intubated)
63
Displacement of ET tube is a ...
PTs should develop what kind of communication with those who are intubated?
Are out of bed activities allowed?
life-threatening
nonverbal
yes
64
With an oxygen tent, avoid ....
Electrical devices should.... be used inside.
opening more often than necessary
not
65
Those with woundvac if it is how full... it should be emptied before activity.
more than half full
66
Arteriography
catheter inserted into artery either through groin or arm to heart.
Used to identify arteriosclerosis, aneurysm, vascular malformations, tumors or blockages.
67
Arthrography
visualize joints
68
CT used to diagnose
spinal lesion
diagnostic studies of brain
69
EEG does what?
record electrical activity of the brain
epilepsy or narcolepsy
70
EMG doe what?
records electrical activity of selected muscle or group of muscles during voluntary contraction
71
Fluoroscopy can show motion
within joints or movement of dye within digestive tract
72
Myelography looks at
spinal cord
nerve roots
meninges
diagnoses:
bone displacement, spinal stenosis, disk herniation, spinal cord compression, infection/inflammation of meninges or tumors
73
PET looks for
tumors or other lesions
74
Venography diagnoses
DVT
tumors
valve dysfunction
75
Ice massage can be used as a stimulus to
facilitate a desired motor response in those with impaired motor control.
applied with direct pressure over muscle belly for 3-5 seconds or quickly stroked over targeted muscle belly to enhance contraction.
76
Ice massage area and time
10cm x 15 cm
5-10 minutes
77
Phases of cooling
intense cold
burning
aching
analgesia
78
Cold packs should be applied for how long?
Can be reapplied every...
If treatment goal is spasticity reduction, can extend treatment time to ...
20 min
1-2 hours
30 min
79
Vapocoolant spray is used for
trigger points
80
Standard size of hot pack is
12x12 inches
81
How many layers of towel need to be used with a hot pack ?
If commercial hot pack, how many layers of towels?
6-8
2-3
82
Pts cannot lie___ of hot back
on top of
83
Fluidotherapy used for
tissue healing, skin desensitization, edema management
84
Infrared lamp use for
soft tissue healing
85
Amount of infrared lamp tissue temperature increase is
directly proportional to amount of radiation that penetrates tissue
86
What should you do to protect outside target area tissue in infrared lamps?
protective toweling
87
How many times do you dip the hand in parrafin in a dip-wrap method?
6-10 times
88
What do you document when using modalities?
body part treated
modality used
treatment duration
parameters
response to treatment
outcome measure
89
Deep heating agents can heat to depths of
3-5 cm
90
Deep thermotherapy examples are
ultrasound and diathermy
91
Direct coupling agents in US are...
gel
lotion
92
Indirect coupling agents in US are...
employed when treatment area is excessively small, irregularly shaped or unable to tolerate pressure from transducer.
Water is an example.
93
Effective radiation area (ERA) is always smaller than
total size of transducer head
94
Spatial averaged intensity is calculated by...
power output in Watts/total effective radiating area of soundhead in cm2
95
Lower BNR is
preferred because pts are less likely to experience hot spots during treatment
96
Attentuation
decrease in energy intensity as US travels through tissues
97
Tissues high in water content: blood, plasma have a ___ rate of absorption while more dense tissues have...
low
high
98
US delivered at a higher frequency is absorbed more .... .than US delivered at a lower frequency.
rapidly
99
Superficial tissues frequency
3 MHz
100
Deep tissue frequency
1 MHz
101
Portion of treatment time US is generated during entire treatment is referred to as the
duty cycle
102
Duty cycle is calculated by
on time / on+off time x100
103
Continuous US is for
heat
104
Pulsed US is for
non thermal
105
Duty cycle for pulsed US
20% or lower
106
Duty cycle for continuous US
100%
107
An area two to three times the transducer typically requires a duration of
5 min
108
Longer duration of US may be necessary when
using lower intensities or lower frequencies
109
US should not be used for
areas 4x larger than ERA
110
US with thermal effects is used at what stage of healing
later stages
111
US is used how often
2-3 x per week
112
US with nonthermal effects can be used when
earlier in healing process
once a day
113
Most common frequency used for shortwave diathermy is
27.12 MHz
114
Dosing for diathermy:
Dose I
Dose II
Dose III
Dose IV
no sensation of heat
mild heating
moderate heating
vigorous heating
115
Diathermy treatment time with thermal effects?
Non-thermal?
20 min
30-60 min
116
When to use diathermy?
when increase in temp is required at tissue depths greater than those achieved with superficial heating agents and when target area will not tolerate direct contact with thermal agent.
117
Diathermy can heat surfaces ____x the typical US transducer.
25
118
Water temps for acute inflammation of distal extremities?
32-70 degrees
119
Water temps for exercise?
79-92 degrees
120
Water temps for wound care?
92-96 degrees
121
Water temps for cardiopulm compromise or treatment of burns?
96-98 degrees
122
Water temps for pain management?
99-104 degrees
123
Water temps for RA or OA and increased ROM?
104-110 degrees
124
Flexion position for lumbar traction is in what position and results in greater separation of
supine
posterior structure: facet joints, intervertebral foramen
125
Extended position for lumbar traction is in what position and results in greater separation of
prone
anterior structure like disks
126
Static traction is for
symptoms that are slightly exaggerated by movement
127
Intermittent traction is for
joint mobes
or those who cannot tolearate static
128
Force during relax period of intermittent traction is usuallly
50% of force during hold
129
Coefficient of friction is
0.5
130
How many pounds should be used for initial traction session?
Force of __% of body weight used for stretching soft tissue, muscle spasm, disk protrusion.
Force of ___% used for
30
25%
50%
131
Disk related symptoms treatment time for traction
other spinal conditions?
10 min
30 min
132
Flexion traction for cervical spine:
Upper is how many degrees?
Mid?
Lower?
0-5
10-20
25-35
133
Intermittent cervical traction
reducing pain and increasing ROM
134
Force for cervical traction initially
Percentage of body weight for soft tissue, muscle spasm or disk.
Percentage of body weight for joint distraction
Force should not exceed how many pounds?
10 lbs
7-10%
13-20%
30
135
Compression works to keep
venous and lymphatic flow from pooling in venous system and interstitial space
136
Therapeutic effects of compression
control peripheral edema
management of scar formation
preventing DVT
promote lymphatic and venous return
shaping of residual limb
137
When to use compression?
edema
hypertrophic scarring
lymphedema
new residual limb
DVT risk
stasis ulcers
138
Working pressure in compression bandages
pressure is only exerted when patient is active
139
Compression bandages offer greater pressure in which direction
distally than proximally
applied with figure 8
140
Long-stretch bandages provide greatest ____ pressure applying ___-____mmHg of pressure. Very little working pressure. Long-stretch are used in those who are...
resting
60-70
immobile
141
Short-stretch bandages produce low pressure at ___ and high ____pressure. Moderately effective while patient is active or at rest. Most often used during.....
Pts must have functional...
rest
working
exercise
functional calf muscle and functional gait pattern.
142
Multi-layered bandages produce ___-___ resting pressure through the use of several bandages containing elastic and inelastic layers.
These are most commonly used to treat....
moderate to high
venous stasis ulcers
143
Semirigid bandages most often consist of ...
These treat.... and example?
treated gauze applied to distal extremity
venous stasis ulcers
Unna boot
144
Off the shelf compression garments provide force of ___-___mmhg and used to prevent .... on bed rest.
Stocking are to be worn at all times unless bathing.
Garments used for scar tissue control ___-____mmHg.
Garments used for edema control ____-____mmHg.
16-18
DVT
20-30
30-40
145
Compression garments last how long?
6 months
146
Intermittent compression is most often delivered using
intermittent pneumatic compression pump
147
Intermittent pneumatic compression pump is used to reduce
chronic and/or post-traumatic edema
148
Before using intermittent pneumatic compression pump what should be taken?
BP and girth measurements
149
Inflation of intermittent pneumatic compression pump should not exceed...
Arterial capillary pressure is approximately ___mmHg and inflation below this point will not typically have.....
Inflation pressure greater than SBP may...
diastolic BP
30
therapeutic value
restrict arterial blood flow and create a medical emergency
150
Treatment of UE with intermittent pneumatic compression pump should be ____-____mmHg.
LE ____-____mmHg.
Treatment time?
Times per week?
30-60
40-80
30 min to 4 hours
3x/week
up to 4x/day
151
Rate of CPM
two cycles per minute
152
Direct current of is used with
iontophoresis
153
When direct current or a monophasic pulsed waveform is used, ___ electrode remains the cathode and the other the anode.
In alternating the cathode and anode are ....
one
changing
154
Unequal size electrodes are used, the current will be more concentrated in..
smaller electrode
155
If electrodes are in close proximity, current is more dense in
superficial tissues
156
If electrodes are further apart, current is more dense in
deeper tissues
157
Monopolar technique
stimulating or active electrode is over target area.
second dispersive electrode is placed at another site away from target area.
active is smaller than dispersive
used with wounds, iontophoresis, and edema
158
Bipolar technique
two active electrodes placed over target area
equal in size
for muscle weakness, neuromuscular facilitation, spasms and ROM
159
Amplitude
magnitude of current
160
Average amplitude
average amount of current supplied over a period of time
161
Peak amplitude
maximum positive or negative point from zero where the pulse is maintained.
162
Higher the amplitude, greater the
peak amplitude
163
Rise time is the time it takes for
current to move from zero to the peak intensity within each phase
164
Fast rise times are necessary with ____ capacitance tissues, such as large motor nerves.
Rise times are typically...
low
very short
165
Decay time
time it takes for current to move from peak intensity to zero
166
Phase begins when current departs from
zero line and ends as the current returns to zero line.
167
Pulse duration
amount of time it takes for two phases of a pulse with biphasic current
168
In monophasic current, the phase duration and pulse duration are...
the same
169
Frequency is labeled as...
expressed as..
rate
pulses per second or hertz
170
Common categories of modulation include
bursts, interrupted pulses and ramps
171
Bursts
occur when ceases flow but only for a little bit of time without true interruption of muscle contraction
172
Interrupted pulses
stop muscle contraction
173
Functional electrical stimulation example
anterior tib for DF in walking
174
In FES, electrodes should be separated by
minimum of 2 inches
175
Pulse duration in NMES
shorter pulse durations are more comfy with small muscles
longer pulse duration are more comfy with large muscles
176
When pulse duration is shortened, a greater...
current amplitude will be required to produce the same strength contraction
177
Frequency in NMES
smooth tetanic contraction usually produced at a frequency of 35-50 pps
178
Higher frequencies in NMES will not produce a stronger contraction but will....
promote more rapid fatigue.
179
On/off time for NMES
on time=6-10 seconds
off time= 5x longer
180
Ramp times for NMES if on time is 6-10 seconds
1-4 seconds
181
Treatment time and contractions for NMES
10 contractions with max of 20 contractions
182
Conventional TENS duration and frequency with amplitude?
short duration
high frequency
low current amplitude
183
Acupuncture-like TENS is for
frequency, duration, amplitude
muscle twitching for longer lasting relief
low frequency
long duration
high amplitude
184
Brief intense TENS frequency, duration and amplitude
high frequency
long duration
high amplitude for a motor response
185
Noxious TENS frequency, duration and amplitude
high or low frequency
long duration
highest tolerated amplitude
186
Interferential current is used for
pain relief
increased circulation
muscle stimulation
187
Iontophoresis
like charges repel
so positive solution will repel from a positive electrode
188
Safety concerns with electricity
always turn intensity dial to zero before unplugging
keep equipment 3-5 meters from each other
189
Indications for Iontophoresis
pain
calcium deposits
fungal infection
hyperhidrosis
inflammation
ischemia
keloids
muscle spasm
myositis ossificans
plantar warts
wounds
scar tissue
190
Dosage in ionto
40-80 mA
191
40 mA-min can be delivered in___ min with a current amplitude of ___mA.
10
4.0
192
Current amplitudes in ionto range from
1-4
193
Electrode containing ion solution is referred to as the ...
The second electrode is called the ___ electrode and is placed....
Recommended spacing is ...
As spacing increases the current density in superficial tissues.....
Smaller electrodes have ___ current density and used to treat specific lesion.
Larger electrodes are used when treatment area is ____.
Slowly increase intensity towards max of ___ mA.
Treatment should last ___-___min.
active
dispersive
away from active
equivalent to diameter of active electrode
decreases
higher
less well defined
4
10-20
194
Acidic reaction with ionto
from hydrochloric acid under positive
195
Alkaline reaction to ionto
from sodium hydroxide under negative
196
Can leave active electrode on skin for how long?
12-24 hours
197
Acetic acid what what polarity and used for what?
negative
calcific deposits
myositis ossificans
198
Dexamethasone has what polarity and is used for what?
negative
inflammation
199
Iodine has what polarity and is used for what?
negative
scars
adhesive capsulitis
200
Lidocaine has what polarity and is used for what?
positive
analgesia
inflammation
201
Magnesium sulfate has what polarity and is used for what?
positive
muscle spasms
ischemia
202
Salicylates has what polarity and is used for what ?
negative
muscle and joint pain
plantar warts
203
Zinc oxide has what polarity and is used for what?
positive
healing
dermal ulcers
wounds
204
With EMG, normal relaxed muscle should exhibit
electrical silence
205
With EMG, spontaneous potentials during rest means
nerve or muscle damage
206
Fibrillation potentials in EMG
LMN disease
207
Positive sharp wave in EMG
denervated muscle disorders at rest, primary muscle disease like muscular dystrophy
208
Fasciculations in EMG
irritation/degeneration of anterior horn cell, nerve root compression or muscle spasms
209
Repetitive discharges in EMG
myopathies, lesion of anterior horn cells and peripheral nerves
210
Voluntary polyphasic potentials in EMG
myopathies, muscle or peripheral nerve involvement
211
EMG sites:
C6-7
C7-8
C8-T1
L4-5
L5-S1
L5-S2
S1-2
triceps and flexor carpi radialis
extensor indicis proprius
abductor pollicis brevis
first dorsal interossei
tib anterior
fibularis longus
glute max and hamstrings
gastroc
212
Centrifugal direction in massage
Centripetal direction in massage
center of body out
moving from extremities toward center of body
213
Effleurage..
Stroke direction
Can also be applied as..
light stroke for reflexive response
towards heart
deep stroke for mechanical and reflexive response
214
Friction massage for
chronic inflammation
overuse injuries
215
Tapotement
rapid alternating movements: tapping, hacking, cupping, slapping
enhances stimulation to peripheral nerve endings
216
Vibration massage
initiates motion from forearm while maintaining contact. Primarily used for relaxation
217
Air temp during massage
72-75
218
Standard w/c seat specifications
18 in wide
16 in deep
20 in high
219
Walker, crutches, cane should allow flexion of elbows ___-___ degree.s
20-25
220
Superficial heating agents produce the larges temp elevation within ___ cm from skin surface.
0.5
221
Paraffin has a low
specific heat
222
Area of ___-___ times of size of US transducer typically requires duration of ....
2-3
5 minutes
223
Minimal erythemal dose refers to...
smallest does of UV light needed to produce an area of mild redness within 8 hours of UV exposure that disappears within 24 hours after exposure.
224
Static traction is more desirable for
acute symptoms
225
Pulsatile current is characterized by
non-continuous flow of direct or alternating current
226
Small electrodes exhibit increased current.....
increased ..... and decreased current...
density
impedance
flow
227
Likelihood of burn using ionto can be decreased by...
increasing size of cathode relative to anode
