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Exam 1 Flashcards

1
Q

Tissue temp. rise of Thermotherapy

A

1: Increases metabolic rate
2-3: Reduces muscle spasm and pain, increases blood flow
4 or more: Increases the collagen extensibility

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2
Q

Hot Pock - Superficial Thermotherapy

A
  • Hydrocollator: 160 to 165 degrees F
  • immersed for at least 30 minutes before usage
  • Recommended treatment duration: 20 minutes
  • Never applied directly over skin
  • 6 to 8 layers of toweling between the pack and skin
  • check on the patient every 5 minutes
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3
Q

Paraffin Bath - Superficial Thermotherapy

A
  • Paraffin bath: 124 - 130 degrees F
  • Check the temperature of the bath first
  • use the wax as an exercise tool immediately post tx
  • wrap for 15 to 20 minutes
  • Immersed hand should not touch the sides and the bottom of the paraffin bath
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4
Q

General Indications for Superficial Thermotherapy

A
  • Pain control
  • Increase ROM and decrease joint stiffness
  • Accelerate healing
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5
Q

Contraindications for Superficial Thermotherapy

A
  • Large Areas in pregnant women
  • suspected malignancy
  • tuberculosis
  • active DVT or thrombophlebitis
  • impaired sensation
  • bleeding tissue with untreated hemorrhagic
  • recently radiated tissues
  • large areas in people with cardiac disease
  • cognition or communication impairments
  • impaired circulation
    location of eczema
  • edema
  • reproductive organs
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6
Q

Precautions for Superficial Thermotherapy

A
  • Areas near or over eyes
  • anterior neck and carotid sinus
  • pregnant women
  • people with cardiac failures
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7
Q

Safe for superficial Thermotherapy

A
  • intact skin with metal, plastic, or cement implants
  • areas over electronic devices
  • areas near chronic wounds
  • superficial or regenerating nerves
  • head, chest, or heart
  • areas over active epiphysis
  • persons with hypertension
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8
Q

Safe practice for superficial thermotherapy

A
  • risk of burn increases with the amount of subcutaneous fat
  • should not lie on top of hot packs, can compromise the vasodilatation response
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9
Q

Clinical Signs of Tissue Temperature Rise

A
  • Erythema (reddness)
  • Blisters, mottling
  • Pupil dilation
  • Decrease in BP
  • Increase in HR

*STOP thermotherapy if BP drops 15-20 mmHG

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10
Q

Treatment parameters of Thermotherapy

A
  • Intensity
  • Duration
  • Coupling medium

*change in skin appearance

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11
Q

Conventional US in PT

A
  • Frequency: 1-3 MHz
  • Intensity: 0.1 - 3 W/cm2
  • Usage: soft tissue pathology

*1 MHz: 2-5 cm beneath the skin
* 3 or 3.3 MHz: within 1-2 cm of skin

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12
Q

Duty Cycle for Pulse US

A
  • Proportion of time that US is on during a single pulse period, in a percentage or a ratio
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13
Q

ERA

A
  • Effective radiating area, area of the crystal
  • Always smaller than the sound head surface
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14
Q

Strength & Intensity of US wave

A
  • Strength: Acoustic power produced by the crystal (W)
  • Intensity: Power per unit area of the crystal (W/cm2)
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15
Q

Spatial peak Intensity vs. Spatial Average Intensity

A
  • Spatial Peak Intensity: Peak Intensity of the US output over the ERA
  • Spatial Average Intensity: average intensity of the US output across the ERA
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16
Q

Beam Nonuniformity Ratio (BNR)

A
  • ratio of spatial peak intensity to spatial average intensity
  • 5:1 and 6:1 usually
  • the lower the ratio, the more uniform the output
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17
Q

Spatial Peak Intensities of () have been shown the damage tissue

A

8 W/cm2

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18
Q

How to minimize the potential of creating standing waves?

A
  • continue to move the head
  • hold the soundhead perpendicular
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19
Q

General Indications for Conventional US - Thermal

A
  • Deeping Heating modality
  • Joint contracture and scar tissue
  • Subacute and chronic soft-tissue inflammation
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20
Q

General Indications for Conventional US- Nonthermal

A
  • To facilitate healing
  • Acute injury or inflammation of soft tissue
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21
Q

General Guidelines for Applying US

A
  • warmth within 2-3 minutes
  • preferably 2-3 X ERA
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22
Q

Number and Frequency of US treatments

A
  • depend on goals of treatment and patient’s response
  • Treatment effect usually deetectable with 1 or 3 treatments
23
Q

US parameters

A
  • Frequency
  • Mode
  • Intensity
  • Treatment Time
24
Q

Types of Electrical Currents

A
  • Direct Current (DC): Current moves in one direction, continuously, at one polarity
  • Alternating Current (AC): Polarity of current switches back and forth sinusoidally
  • Pulse Current (PC): Can be monophasic/biphasic (number of polarity), symmetric/asymmetric (waveform), balanced/unbalanced (net charge)
25
Time-Dependent parameters for PC
- frequency: pulses per second - pulse duration: pulse width - on: off time - Ramp up/ ramp down time - Amplitude: Current intensity - Modulation: changing machine parameters to create different patterns - Burst Mode / Time modulated - Russian current: one burst = one pulse
26
Electrode arrangement
- when the electrodes are closer together, they do not travel as deep - if they are farther apart, they travel deeper into the tissue - can be arranged in Monopolar, Bipolar, and Quadripolar
27
Electrical Currents
- Nerve depolarization: short pulses of electricity (NMES) - Muscle Depolarization: pulses longer than 10 sec (EMS)
28
Adverse Effects
- Burns (most common with AC/DC current) - Skin reactions (irritation/inflammation from electrodes): a different type of electrode should be tried - Pain (ramp up slowly for a longer period of time for better patient tolerance)
29
NMES
- Time Modulated / Burst AC/ Russian Current: bursts per second - Pulsed current: pulses per second
30
Clinical use of NMES
- muscle contraction (Innervated muscle) - Edema control
31
Muscle Contraction - Electrical
- Activates fast twitch muscle fibers first - Type IIb, Type IIa, Type I - More fatiguing (fast twitch muscle fibers fatigue quicker) - Longer rest times are needed
32
Muscle Contraction - Physiological
- Activates slow-twitch muscle fibers 1st - Less Fatigue, slow-twitch more fatigue resistant
33
Muscle contraction; overload
- physiological: increase the weight - electrical: increase the total amount of current *limited by patient tolerance and fatigue
34
Outcomes of NMES
- increase strength and motor control after CNS injury - Can use functional electric stim (FES): using NMES in a more functional manner - Increase MSK strength - Increase motor control - increase sensory awareness - effectiveness supported by several large RCTs
35
NMES electrode placement
- Motor point: usually over the middle of muscle belly - parallel to the direction of muscle fibers - keep electrodes separated
36
Pulse duration for NMES application
150 to 350 microseconds
37
Frequency for NMES application
- 50 pps (pulsed current) - 50 bps (bursts per second for Russian current)
38
On: Off Time
- Strengthening: 1:5 (10 sec on & 50 sec off) to 1:4 to 1:3 - Muscle pump: 1:1 (5 sec on & 5 sec off)
39
Ramp up time for NMES
- usually 1 to 2 seconds - ramp time for gait should be 0 second
40
Treatment time for NMES
- for muscle strengthening: recommended 10 to 20 contractions - for muscle reeducation: no more than 20 minutes/session
41
Waveform for NMES
- pulse biphasic - Russian current ( Time-modulated / Burst AC)
42
Tissue Temperatures for Cryotherapy
- 73: Peripheral nerve activity decreases - 32 to 68: will perceive pain but tissue not frozen - 48: nerve conduction ceases - 28: skin freezes
43
Effects of Cryotherapy - Hemodynamic
- Initial decrease in blood flow: helps to decrease edema - Later, cold-induced vasodilation: hunting response
44
Effects of Cryotherapy - Neuromuscular
- Decreases nerve conduction velocity - Increases pain threshold - Alters muscle strength - Decreases muscle spasm - Decreases muscle spasticity
45
Effects of Cryotherapy - Metabolic
- Decreases rate of all metabolic reactions - Controls acute inflammation - Decreases activity of cartilage-degrading enzymes
46
Effects of Cryotherapy - Soft Tissue
- Decreases connective tissue extensibility
47
General Indications for Cryotherapy
- Control of acute inflammation - Edema control - Pain control - Modification of muscle spasm or spasticity
48
Cryotherapy - 5 stages of sensation
1. Intense cold 2. Burning 3. Aching 4. Analgesia 5. Numbness
49
Tissue damage if too cold
- 1 degree: red, mild edema - 2 degrees: edema, blisters - 3 degrees: Frostbite = necrosis of tissue - 4 degrees: Severe frostbite = gangrene & neurological complications
50
Safe practice for Cryotherapy (ratio)
- ratio between rewarming period and treatment time: at least 2:1 * but 6:1 is preferred
51
Cold Pack
- should not put it directly on the skin - Application duration: 20 minutes or until the area is numb
52
Application duration for Ice Cup
5-10 minutes
53
Effects of Cryotherapy
- Pain: Decrease - Muscle Spasm: Decrease - Blood Flow: Decrease - Edema Formation: Decrease - Nerve conduction velocity: Decrease - Metabolic Rate: Decrease - Collagen extensibility: Decrease - Joint stiffness: Increase
54
Effects of Thermotherapy
- Pain: Decrease - Muscle Spasm: Decrease - Blood Flow: Increase - Edema formation: Increase - Nerve conduction velocity: Increase - Metabolic rate: Increase - Collagen extensibility: Increase - Joint stiffness: Decrease

Physical Modality (8 decks)

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