EXAM 1 Flashcards
(205 cards)
1
Q
acute phase lasts
A
0-4 days
2
Q
fibroblastic repair phase lasts
A
2 days - 6 weeks
3
Q
maturation remodeling phase lasts
A
3 weeks - 2 years
4
Q
sx of fibroblastic repair phase
A
not really red anymore, but tender and the scar formation is starting
5
Q
what is Wolf’s law
A
px dictates progress
tissue responds to the demands being placed upon it
6
Q
chronic is considered
A
more than 6 months
7
Q
what are the light touch mechanoreceptors
A
meisners
8
Q
what are the deep touch mechanoreceptors
A
pacinian
9
Q
what order neurons do modalities act on
A
1st
10
Q
1st order neurons run from
A
body to SC
11
Q
the 1st order neurons send sensations to the
A
dorsal horn
12
Q
proprioceptive fibers
A
Aa
13
Q
touch/vibration fibers
A
Abeta
14
Q
Aa and Abeta are
A
large and fast fibers
15
Q
what 3 chemicals are released in any cell damage
A
substance P
prostaglandins
leukotrines
16
Q
the 3 chemicals released in any cell damage do what
A
make nocioceptors sensitive and decrease depolarization threshold = increases pain and sensitivity
17
Q
of the 4 main fiber types, which are the smallest/slowest
A
A delta (delta is bigger than C so it may also be considered large) C
18
Q
most 2nd order neurons end in the (specific location)
A
thalamus (they run from SC to brain)
19
Q
explain gate control theory
A
ascending Abeta fibers bloc impulses at the spinal cord of Adelta and C fibers (essentially, large fibers bloc the small ones)
20
Q
examples of modalities that are gate control
A
TENS, massage
21
Q
explain the decending px control theory
A
low freq (motor level) current causes intense stimulation of small diameter fibers. This releases enkephalins which supressess substance P and blocks px at the spinal level.
22
Q
ex of descending px control theory
A
motor level TENS
23
Q
explain endogenous opiod theory
A
stimulation of smaller fibers release opiods resulting in prolonged analgesia
24
Q
ex of endogenous opiod
A
noxious level TENS
25
what is different about endogenous opiod theory
you have to leave this type of modality on longer bc it takes longer to kick in
26
what pps would you set for acute level for TENS
80-150
27
what pps would you set for sub acute level TENS
you want a motor response so 20-70pps (this stimulates smaller fibers)
28
what pps would you set for noxious level TENS
1-10 pps
29
which of the fibers require the least amt of electrical current in order to have an effect
Abeta (stimulating these - like the tingling with high pps TENS) occurs quickly. To reach A delta or C, it requires more current or duration
30
what does rheobase mean
the intensity of a current that is required to cause an observable response
31
what does chronoxie mean
the duration required for a current twice the intensity of rheobase to cause excitation
32
what modalities stimulate large fibers
high pps TENS, massage, balms
33
types of ESTIM currents
monophasic - direct current (only on 1 side of line)
biphasic -AC - above and below line
pulsed current - there is a break btwn
34
diathermy and lasers are ex of
Electromagnetic energies
35
what is the type of energy that has the longest wavelength and penetrates the deepest
radiation
36
explain the relationship btwn wavelength and freq
there is an inverse relationship btwn WL and freq
| the higher the freq the shorter the WL
37
energy itself is directly proportional to
freq
| so the higher the freq, the higher the energy
38
freq is what
number of waves per sec
39
if the amt of energy is insufficient, no change occurs (essentially, not using enough energy does nothing) is what law
arndt shultz principle
40
there is an inverse relationship between the energy absorbed and the penetration into the layers of tissue is what law (ex: with US, shorter freq with longer WL goes deep, but longer freq with shorter WL goes superficial)
Law of Grotthus draper
41
radient engergy is better absorbed if the source is at a right angle is what law
cosine
42
cosine law is indicative of
diathermy
43
intensity of radiation at a surface is inversley related to the square of DISTANCE from the source of the energy
inverse square law (essentially, we place modalities close to the body)
44
net movement of electrons is referred to as
electrical current
45
Rate of electron (electrical current) flow (mA or μΑ) (measure of intensity)
ampere
46
- Cycles per second (HZ or pps) (wavelengths per sec) (pps –pulses per sec)
freq
47
Opposition to electron flow (ohm)
resistance
48
Voltage/Resistance
Current is directly proportional to voltage & inversely proportional to resistance (higher voltage higher current) (higher current lower resistance)
ohms law
49
what tissues are good conductors of ESTIM
fluid (water)
| bone, tendon, fat, muscle not so good
50
iontophoresis is ___phasic
mono (DC) - ionto is the only DC
51
TENS is ____phasic
bi (AC)
52
IFC and Russian are ___phasic
pulsed
53
parameters we set in ESTIM
Frequency (Hz or PPS)
Intensity (usually pt tolerance)
Duration
54
when we change intensity on a machine (to pt tolerance) we are changing
amplitude
55
durations on estim
```
Motor = 300-600 microseconds
Sensory = 75-150 microseconds
Noxious = 100-1000 microseconds
```
56
3 components of current density
electrode size
electrode spacing
electrode placement
57
explain electrode spacing
closer together = superficial current density, further apart = deeper current density)
58
explain electrode size
larger electrodes spread out current, decreasing density, smaller electrodes concentrate the current so smaller electrodes have higher current density
59
what is resting membrane potential
electrochemical gradient a cell maintains during the normal homeostatic environment
60
contraindications for estim
active CA, pregnancy, pace maker
61
when would tetany be a good option to use
foot drop - to achieve dorsiflexion
62
if your goal is muscle re-education you should always use ___ and___
estim and exercise
63
how to effectively use ex with estim for muscle re education
```
Type of electrical stimulation? Noxious TENS (high volt machine)
Electrode placement? Trigger points
Frequency (pps)? 1-10
Pulse duration? 100-1000 microseconds
Intensity? To tolerance (noxious)
Treatment duration? 15-60 min
```
64
which is typically more comfortable, mono or biphasic
biphasic
65
which is more comfortable bigger or smaller pads
bigger- more dispersment
66
diff btwn bipolar and quadrapolar with IFC
bi - 2 electrodes
| quad - 4 electrodes
67
explain monopolar TENS
electrodes use one or more small active electrodes over a treatment area and a large dispersive electrode placed somewhere else on the body (big pad little pad)
68
explain bipolar TENS
2 same size pads
69
amplitude is in
mA
70
parameterss for motor, mm re-ed
35-55pps, on:offrange from 1:1 to 1:4, 10-15min
71
Muscles respond with individual twitch contractions to pulse rates of less than ___pps
50
72
at ___pps tetany will occur
50
73
motor response, you would not use what type of current
DC
74
type of modulation when AC or PC current flows for a short duration and then is off for a short time in a repetitive cycle.
burst
75
When 2 interfering biphasic waveforms with differing frequencies are delivered to 2 separate pairs of electrodes through separate channels within the same unit.
beat
76
Surging modulation. Amplitude increases gradually to some present maximum and may also decrease in intensity.
ramping
77
____determines whether sensory or motor nerve will be stimulated,
amplitude
78
typical parameters for muscle strengthening motor NMES
70-85pps (tetany),
on:off 1:5 or more (5-10 sec on, 50-120 sec off),
3 sets of 10 contractions is common
79
typical parameters for muscle pumping for NMES
35-55pps,on:off 1:1 (5-10 sec on, 5-10 sec off) 20-30 min
80
electrons have a ___ charge
neg
81
movement of electrons is
current
82
rate of electrons (intensity) is measured in
amperes
83
the amps we usually achieve are btwn
2-15 (before 2 they don't feel, after 2 is pain)
84
electrochemical gradient a cell maintains during the normal homeostatic environment is
resting membrane potential
85
impulse reaches its effector organ (either another nerve cell or muscle), the impulse is trasnferred between the two at a motor endplate or synapse, a neurotransmitter substance is released
depolarization effect
86
Introduction of ions into the body tissues through direct electrical current (no alternating, the electrons move one direction continuously)
iontophoresis
87
movement of ions in a solution
electrophoresis
88
negative electrode, electrode with greatest concentration of electrons
cathode
89
positive electrode, electrode with lower concentrations of electrons
anode
90
why do you need to know pos/neg with ionto
neg charged ions are replled from a neg electrode
pos charged will be repelled from a pos electrode
pos ion meds, apply to pos electrodes
Neg ion meds apply to neg electrode
91
with ionto, which pad gets the meds
In iontophoresis, the "active" electrode is defined as the one used to carry the ion into the tissue (med on this one)
92
factors to consider when doing ionto
The force that moves ions through the tissues is determined by strength of the electrical field and electrical impedance of tissues.
Skin & fat are poor conductors and offer greater resistance to current flow. Sweat glands decrease impedance. (so if patient sweats, resistance decreases which increases intensity)
93
how deep does ionto go
Ionotophoresis is superficial (penetrating no more than 1.5 cm over a 12-24 hour period and only 1-3 mm during treatment)
94
recommended amps for ionso
3-5 mA
95
check skin every___ with ionto
3-5 min
96
typical duration of ionto
10-20 min
97
how to determine exact dose of ionto
min x mA = specific dose
98
dexa is what polarity
neg
99
dexa does what to BS
increases it
100
russian is primarily used for
strenthening
101
a delta fibers transmit
fast pain (acute) local
102
c fibers transmit
chronic px
103
the 2 NMES
HV
| russian
104
electromotive force applied to produce a flow of electrons (current)
volt
105
which has higher density or concentration of current, large or small pads
small
106
the 1-10 pps (noxious) is for what purpose
chronic px
107
how many mA is sensation (before px)
2-15 (after 15 its pxful)
108
how many mA is cardiac arrest
100
109
for muscle re-ed. put pts limb in a ___position
isometric (ex for quads extend the leg to see if contracture occurs)
110
time frame for muscle re -ed e stim
15 min
111
for muscle pumping, electrodes are placed
proximal to the joint
112
With US, is 1 MHz freq deeper or 3MHz
1 goes deeper (grothes draper law)
113
US travels as a ___wave
longitudinal
114
with US, velocity depends on what
the tissue density
| denser= higher velocity
115
sound waves travel through ____ but is absorbed in_____
sound travels through water but doesn't absorb there, absorbs in muslce
116
penetration and absorption of US are ____ related
inversely
117
with US, absorption increases if ___ increases
freq
118
3 tissue types that absorb US best
nerve is highest, then muscle, then fat
119
what is piezoelectric effect
transducer of an US wand Contains a crystal (quartz or synthetic) that converts electrical energy to acoustic energy through mechanical deformation of the crystal. The crystal will expand and contract (piezoelectric effect), vibrating at a specific frequency & producing a sound wave
120
What is ERA
in US, it is the effective radiating area (transducer head)
121
how to determine US wand size
the tx area should only be 2-3 times larger than the head
122
depth of penetration of US at 1MHz
2-5 cm
123
depth of penetration of US at 3 MHz
1-2
124
pulsed US is good to use when you want a ___effect
non thermal
125
with US, pulse is same thing as
duty cycle (usually 20-50%)
126
Formation of gas-filled bubbles that expand and compress, inducing pressure changes in tissue fluids.
cavitation (happens with US)
127
what is stable vs non stable cavitation
stable -regular, repeated pressure changes over many cycles
non stable - large violent bubbles over a few cycles
128
therapeutic US only occurs with ___ cavitation
stable
129
Unidirectional movement of fluids along the boundaries of cell membranes resulting from mechanical pressure wave in an ultrasonic field. Produces high-viscous stresses which can alter cell membrane structure & function.
acoustic microstreaming (occurs with US)
130
non thermal US is usually done at what duty cycle
20%
131
what is coupling
tranducer head of US should be parallel to skin and a gel should be used
132
US duration
5-10 min
133
degrees of temp increase with US
```
1, 2, 4
mild, mod, vig
mild-subacute
mod-chronic
vig-scars
```
134
intensity of US is in
W/cm2 (done by pt tolerance)
135
how might you deal with boney areas for US
submersion or a bladder
136
phonophoresis is typically done with
pulsed
137
contraindications for US
```
pregnancy
pacemaker
malignancy
epiphyseal areas in young children
total joint replacements
infection
```
138
temp transfer (cryo and thermo) happens via
conduction
139
US and diathermy are done via
conversion
140
conductive modalities only go how deep
1cm (thermal)
141
how does thermal modalities offer px control
Analgesia through hyperstimulation of large sensory fibers by heating or cooling inhibits pain fibers (gate control theory)
142
what to do if you suspect your pt has frostbite after cryo
water submerge 100degrees and call dr
143
what does EMG stand for
electromyography (needle)
144
what does NCS stand for
nerve conduction study (electrodes)
145
EMG and NCS evaluate the ___NS
Periph.
146
only ___ tests CNS and PNS
SEP
| somatosensory envoked potential
147
for emg the room temp should be
25 c 77 f
148
why do you have to check the skin with ionto every 3-5 min
Check the skin every 3-5 minutes; skin impedance decreases during treatment and intensity may need to be decreased to avoid burning
149
Intense stimulation of Adelta and C fibers transmits pain to midbrain, pons, and medulla. This causes release of enkephalins through descending neurons, which suppresses the release of neurotransmitter substance P and blocks pain impulse at the spinal level.
descending px control theory
150
examples of descending px control theory
low freq tens
151
noxious tens and HV are what theory
end opiod
152
what fibers get stimulated with the end opiod theory
Ad and C (which causes release of opiods)
153
formula for ionto
min x mA = dose
154
formula for US
degrees you want to achieve/degrees in box = time
155
diathermy is ___freq (high or low)
high
156
can't have any what around diathermy
metals
157
which diathermy can be cont or Pulsed
shortwave
158
does diathermy create AP or depolarization
no (WL too short)
159
PSWD
pulsed short wave diathermy (can help with ion imbalance)
160
watts of diathremy
80-120
161
type of diathermy that pt is in the circuit
capacitance
162
explain resistance in capacitance
fatty areas are resistors in capacitance- they gather heat
163
inductors, pts are not part of the
circuit
164
low sub q tissue is best for ___ diathermy
capacitance (shortwave)
165
which type of diathermy uses a coil and has eddy currents
inductor
166
diathermy is best for what scenario
deep heat large area
167
advantages of diathermy
heat lasts long and get a bigger area
168
lazers are mono ___
chromic
169
high power lazers are used for
cutting (surgery) or coagulation
170
low power lazers are used for
wounds collagen or px
171
weird side effect of lazer
syncope
172
which of the electrophysiological type of studies applies stimulus
NCS
173
EMG is what
no stimulus, just needle watching activity
174
what (in an emg) might be the earliest indicator of a prob
latency
175
ncv FOR UE and LE snap
General NCV = at least 50 m/s for for UE and at least 40 m/s for LE (tables available
176
latency for motor nerves take longer for 3 reasons
1) the AP has to cross the NM junction,
(2) the AP has to spread across the muscle fiber,
(3) larger motor axons conduct more slowly than the largest sensory fibers.
177
there is snap for sensory and ___ for motor
Compound motor unit action potential (cmap)
178
cmap velocities
UE amplitudes are typically 5 mV or greater, LE CMAPS are typically 2 mV or greater
179
sx that warrent emg study
sensory changes, weakness, atrophy, reflex changes, easy fatigue-ability.
180
dennervated muscle looks ___phasic on emg
poly (should be bi)
181
spontaneous contraction of a single muscle fiber (can only be seen via EMG
fibrilation
182
pulsed diathermy effects
Mechanism for non-thermal effects may be repolarization of damaged cells or by creating a negatively charged cellular environment which reactivates the sodium pump and allows the cell to regain ionic balance
183
short or micro diathermy goes deeper
micro
184
microwave has strong___ and weak___
strong electric weak magnetic
185
which reverses polarity, mono or biphasic
biphasic (mono phasic goes towards pos always)
186
reading waves, if there is a space btwn that is
pulsed
187
IFC and Russian are ___ waves
pulsed
188
speed is ___ x ____
WL x Freq
189
pulsed has to have ___ in a row
3
190
all of the ------ines are the ____ in the inflammatory process
histamine, leukotriene, cytokines
| are chemical mediators
191
• Injured structures should be subjected to controlled mobilization and progressively increasing loads, particularly during the ____ phase
remodeling
192
movement of ions
current
193
pps for muscle re-ed AND pumping
35-55
194
pps for muscle strengthening
70-85
195
pulse duration is in
microseconds
| 100 or 300 (300 for motor)
196
ions are ___ or ___ charged
neg or pos
197
issues with ionto (contraindications)
* Sensitivity to aspirin (salicylates)
* Gastritis/stomach ulcer (hydrocortisone)
* Asthma (mecholyl)
* Sensitivity to metals (zinc, copper, magnesium)
* Sensitivity to seafood (iodine)
198
contraindications cryotherapy
* Impaired circulation
* Peripheral vascular disease
* Hypersensitivity to cold
* Skin anesthesia
* Open wounds or skin conditions
* Infection
199
2 main reasons for thermotherapy
• Subacute & chronic inflammatory conditions*
200
impaired circ is contra for
both thermo and cryo
201
2 reasons for US
stimulate soft tissue repair and relieve px
202
pulsed US is mainly for
soft tissue healing-modulate membrane permeability, alter cellular proliferation, and increase production in proteins associated with inflammation & injury repair.
203
cavitation and acoustic microstreaming are ___ effects of US
nonthermal
204
contraindications US
* Acute or postacute conditions (thermal)
* Decreased temperature sensation
* Decreased circulation
* Vascular insufficiency
* Thrombophlebitis
* Eyes
* Reproductive organs
* Pelvis immediately following menses
* Pregnancy
* Pacemaker
* Malignancy
* Epiphyseal areas in young children
* Total joint replacements
* Infection
205
laser stands for
• Light amplification of stimulated emissions of radiation (LASER)
