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Modalities Flashcards

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0
Q

Whirlpool

A

Turbine: Motor, provides agitation and aeration, adjustable direction of flow
Duration: 10-30 Minutes
Extremity Tank: Distal extremity (10-45 gallons)
Lowboy Tank: Larger part of extremity - long sitting, midthoracic (90-105 gallons)
Highboy Tank: Larger part of extremity and trunk - sitting, chest height (60-105 gallons)
Hubbard Tank: Full-body immersion (425 gallons)

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1
Q

Contrast Bath

A

Alternating vasodilation and vasoconstriction - decrease edema, pain, increase flexibility
104-106 Degrees 3-4 minutes
50-60 Degrees 1 minute
Repeat 25-30 minutes total

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2
Q

32 - 79 Degrees F

A

Acute inflammation of distal extremities

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3
Q

79 - 92 Degrees F

A

Exercise

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4
Q

92 - 96 Degrees F

A

Wound care

Spasticity

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5
Q

96 - 98 Degrees F

A

Cardiopulmonary compromise
Burns
PVD 95-100

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6
Q

99 - 104 Degrees F

A

Pain management

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7
Q

104 - 110 Degrees F

A

Chronic RA or OA

Increased ROM

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8
Q

Shortwave Diathermy

A

Converts electromagnetic energy into heat - molecular vibration in tissue increases heat
Indication: Increase temp at greater tissue depth, target area will not tolerate direct contact, tissue cooling significantly slower
Frequency: 27.12 MHz
Pulsed: Nonthermal, 30-60 min
Continuous: Thermal, sweating, 20 min
Capacitive Plate Applicator: High frequency current alternates between plates, person part of circuit, ion oscillation heats
Place two plates over both sides of tx area 2-10 cm from skin
Inductive Coil Applicator: Coil generates electrical energy, perpendicular magnetic field, eddy currents in tissue heat
Wrap: Wrap with towel then coils

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9
Q

Phonophoresis

A

US delivery of medication

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10
Q

US Indications

A 
Acute and post-acute (nonthermal)
Calcium deposits
Chronic inflammation
Delayed soft tissue healing
Dermal ulcers
Joint contracture
Muscle spasm
Trigger points
Pain
Plantar warts
Scar tissue
Tissue regeneration
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11
Q

US Contraindications

A 
Acute and post-acute (thermal)
Bleeding
Decreased temp sensation
Decreased circulation
DVT
Infection
Malignancy
Breast implants
Carotid sinus, cervical ganglia
Epiphysis in children
Eyes, heart, genitalia
Methylmethacrylate cement or plastic
Pelvic/lumbar/abdominal in pregnancy
Pacemaker
Thrombophlebitis
Vascular insufficiency
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12
Q

US

A

Frequency above 20,000 Hz, therapeutic = 0.75 - 3.0
Transducer size: 5-10cm2
Water immersion: Rubber or plastic basin, 0.5 - 3.0 cm distance from skin, increase intensity up to 50% more
Effective Radiating Area (ERA): Area that transmits energy, smaller than transducer
Frequency: 1MHz = deep (3-5cm), 3MHz = superficial (1-2cm)
Depth of penetration, higher is absorbed faster, high water = low absorption, high protein/density = high absorption
Movement rate: Move US transducer 4 cm per second
Continuous: Thermal effects at higher intensities,
Pulsed: Primarily for nonthermal, 20% or less

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13
Q

US Duration

A 
Area 2-3x transducer size = 5min
Longer:
  Lower intensity
  Lower frequency
  Objective = higher tissue temperature
Do not treat area > 4x ERA
Thermal = Late healing, 2-3x/week
Nonthermal = Early healing, 1x/day
Positive response after 3 txs
>14 Txs = decreased RBCs, WBCs
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14
Q

Beam Nonuniformity Ration (BNR)

A

Spatial-peak intensity : Spatial-averaged intensity
Spatial-peak intensity = Intensity of US beam at its highest point
Spatial-averaged intensity = Intensity of US beam averaged over transducer area
From 2:1 to 8:1
Most 5:1 to 6:1
Higher quality crystal = Lower BNR = Less heat/discomfort
Higher = Move US more rapidly

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15
Q

Infrared

A

Majority of radiation absorbed first few mm, dries skin more than other heating agents
Increased temp = increased radiation penetration
Darker skin = greater absorption of radiation
Wavelength: 780 - 1500 nm
Maximum penetration: 1200 nm
Distance: 20 in from light
Duration: 15 - 30 min

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16
Q

Paraffin

A

Low melting point, low specific heat (more tolerable)
Wash body part first, no application to wounds/infections
Can heat to 212 to kill bacteria in paraffin, contents changed every 6 months
Temperature: 113 - 122 degrees F
Dip-wrap: Re-dip 6-10 times, bag, towel, 10 - 15 min
Dip-reimmursion: 6-10 Dips, remain in bath with unit off and at lower temp range up to 20 min
Paint application: Paint 6-10 layers, plastic, towel, 20 min

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17
Q

Hot Pack

A 
Check skin after 5 min, 6-8 layers
Temperature: 158 - 167 degrees F
Max surface temperature: Reached in 6-8 min, check skin frequently first 10 min
Duration: 15-20 min
2 hrs to heat, 30 min to reheat
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18
Q

Fluidotherapy

A

Convection: Warm air circulated, cellulose particles become suspended, move rapidly as if a liquid
Indication: Heal, desensitize, reduce edema
Temperature: 100 - 118 Degrees F, max temp rise in 15 min
Duration: 15-20 min
Agitation: Air speed, may be controlled for comfort/desinsitization (can preheat, pulse mode)

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19
Q

Vapocoolant Spray

A

Mechanism: Counter-irritant stimulus to cutaneous thermal afferents, reduces motor activity, decreasing resistance to stretch
Application: 30 Degree angle, one direction only (increase ROM with no trigger points = proximal to distal)
Distance: 12-18 in
Stretch begins during and continues after

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20
Q

Cold Bath

A

Gravity-dependent position
Temperature: 55-64 Degrees F
Duration: 15-20 min

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21
Q

Controlled Cold Compression Unit

A

50-77 Degrees F

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22
Q

Cold Pack

A

Temperature: 25 Degrees F
Preparation: Initial cool 2 hrs, recool 30 min
Duration: 20 min reduces skin temp to 2 cm
Tx 30 min for spasticity but may need to replace at 20 min
Apply every 1-2 hrs to reduce inflammation/pain

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23
Q

Ice Massage

A

Cools tissue more rapidly than other cryotherapy
Duration: Until analgesia (5-10 min)
10-15 cm = 5-10 min
Sensation: Intense cold, burning, aching, and analgesia
Response: Red or dark pink, abnormal - wheals/rash
Mechanism: Increased stimulation of thermal and pain receptors, blocking sensory nerve conduction
Maintain skin temp > 59F to avoid tissue damage

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24
Cryo Cuff
Container elevated 15-18 in above sleeve | Hours of mild cooling far less intense than on cryotherapy
25
Heat Therapeutic Effects
``` Decrease muscle spam Decrease tone Increase blood flow Increase capillary permeability Increase collagen extensibility Increase temperature Increase metabolic rate Increase muscle elasticity Increase NCV Increase pain threshold ```
26
Heat Indications
``` Abnormal tone Decreased ROM Muscle guarding Muscle spasm Trigger points Subacute or chronic pain Subacute or chronic inflammation ```
27
Heat Contraindications
``` Acute trauma Arterial disease Bleeding or hemorrhage Compromised circulation Malignancy PVD Thrombophlebitis ```
28
Cold Therapeutic Effects
``` Decrease blood flow Decrease edema Decrease temperature Decrease metabolic rate Decrease NCV Decrease tone Increase pain threshold ```
29
Cold Indications
``` Abnormal tone Acute or chronic pain Acute or subacute inflammation Bursitis Muscle spasm Trauma Trigger points Tendonitis Tenosynovitis ```
30
Cold Contraindications
``` Cold intolerance Cold urticaria (hives) Cryoglobulinemia (abnormal proteins in blood) Infection Compromised circulation Regenerating peripheral nerves Paroxysmal cold hemoglobinuria PVD Raynaud's phenomenon Skin anesthesia ```
31
UV Light Therapeutic Effects
``` Bacteriocidal Exfoliation Healing Increase pigmentation Thicken epidermis Vit D production ```
32
UV Light Indications
``` Acne Chronic ulcer/wound Osteomalacia Psoriasis Sinusitis Vit D deficiency ```
33
UV Light Contraindications
``` Area receiving radiation DM Herpes simplex Pellagra Photosensitive meds Skin CA Lupus TB ```
34
UV Light
Absorbed 1-2 mm into skin, used to tx skin disorders Use polarized goggles Determine Minimal Erythemal Dose (MED) first, reassess with use of different lamp 24-40 in, Paper on anterior forearm with 5 separate 1in cuts sequentially exposed 15sec intervals (15, 30, 45, 60, 75) Visual inspection after 8hrs, oral psolaren or bathe in psolaren first if using such meds Increase intensity each session by increasing time or decreasing distance (half distance = 4x intensity)
35
Hydrotherapy Therapeutic Effects
``` Decrease abnormal tone Increase blood flow Increase core temp Pain relief Relaxation Vasodilation Wound debridement ```
36
Hydrotherapy Indications
``` Arthritis Burns Edema Decreased ROM Desensitization Joint stiffness Muscle spasm/spasticity Muscle strain Pain Sprain Wound care ```
37
Hydrotherapy Contraindications
``` Advanced CV or pulmonary disease Bleeding Decreased sensation Gangrene Impaired circulation Incontinence Mace ration PVD Renal infection Severe infection Severe mental disorders ```
38
Lumbar Traction
Supine = Posterior separation, stenosis Prone = Anterior separation, disk protrusion Non-slip belt directly on skin Intermittent: Relax force = 50% hold force Relax period relatively short but comfortable Coefficient of Friction: 0.5 on mattress x 50% body weight below L3 = 25% Force: 30lbs = Initially, 25% = Stretch, 50% = Separation Duration: 5-30 Minutes, Disk = 10 min or less, Other = up to 30 min
39
Cervical Traction
Supine = Control flex, SB, rot; Sitting = control flex/ext Position toward traction force for increased flexion Upper: 0-5 Degrees Mid: 10-20 Degrees Lower: 25-35 Degrees Intermittent: Pain and ROM Force: Initial = Up to 10lbs, Stretch = 11-15lbs (7-10%), Separate = 20-30lbs (13-20%) Duration: 5-30min, Disk = 10 or less
40
Compression
Resting Pressure: When elastic band placed on stretch - patient active or at rest Working Pressure: When active muscle contracts against inelastic bandage - patient active Long-Stretch Bandages: Greatest resting pressure, 60-70mmHg, little working pressure, with immobile Short-Stretch Bandages: Low resting, high working, moderate at both, with exercise Multi-Layered Bandages: Mod-high resting, several bandages with elastic and inelastic layers, with venous stasis ulcers Semirigid Bandages: Treated gauze, wet-dry, Unna boot, sustained compression 35-40mmHg, with venous stasis ulcers Compression Garments: Change every 6 months 16-18mmHg - Prevent DVT 20-30mmHg - Scar tissue control 30-40mmHg - Edema control
41
Intermittent Compression
Stockinette, compression sleeve Inflation Pressure: 30-80mmHg Do not exceed diastolic Do not exceed systolic - restrict arterial blood flow - med emergency No less than arterial capillary pressure (30mmHg) - ineffective UE = 30-60mmHg LE = 40-80mmHg Duration: 30min - 4hrs, 3x/week - 4x/day, extended times for primary lymphedema Combined: May couple with cold and estim Adjust current intensity after sleeve is fully inflated
42
Excitation
Resting Potential: potential difference in concentration and permeability of Na and K ions Action Potential: Change in electrical potential between inside and outside of nerve cell Creating Impulse: Resting potential reduced below threshold, changes permeability Creates AP causing depolarization Estim: Amplitude and phase duration must overcome threshold
43
Electricity Principles
Current Amperes Ampere: 6.25x10^8 electrons per second (mA = 1,000th an A) Voltage Volts Amount of difference between (+ and -) poles Resistance Ohms Ability of material to oppose flow of ions 1V to drive 1A current thru 1O resistance
44
Direct Current
Constant flow anode (+) to cathode (-) > 1 second uninterrupted Modulation: Interrupt current p 1sec, reverse polarity, or gradually change amplitude Inotophoresis
45
Alternating Current
``` Polarity constantly changes (+ to -) with change in direction of current flow Biphasic Symmetrical or asymmetrical Sinusoidal Frequency: Hz or cycles per second Burst or time-modulated estim ```
46
Pulsatile Current
Non-continuous flow of direct or alternating current Pulse: Discrete electrical event separated from other pulses Monophasic: One phase or each pulse, (+ or -) polarity effect Biphasic: Two phases (one +, one -), symmetric or asymmetric, balanced or unbalanced
47
Electrodes
Direct/Monophasic = One cathode, one anode Alternating = Constantly changing Cleanse skin, hair option Reusable: Requires gel or coupling spray, securing Small = Small areas/muscles, low stimulation Current Density: Influenced by size and distance Smaller = Higher density Farther = Deeper tissues receive higher intensity
48
Electrode Placement
``` Monopolar: Stimulating/active electrode over target area Other electrode placed away from target area Active electrode = smaller Wounds, Iontophoresis, Edema Bipolar: Two active electrodes over target area Equal size Weakness, NMF, Spasms, ROM ```
49
Law Of Dubois Reymond
1. Intensity reach threshold (Amplitude) 2. Current reach accommodation (Rise Time) 3. Duration exceed capacitance (Phase Duration)
50
Amplitude
Referred to as Intensity or Voltage Average Amplitude: Average amount of current over time Peak Amplitude: Max (+ or -) point from zero Must exceed threshold Higher = Greater peak amplitude
51
Rise Time
Time current moves zero to peak intensity in each phase Nanoseconds to milliseconds Faster for lower capacitance tissues (large motor nerves) Decay Time: Time from peak intensity to zero
52
Phase Duration
``` Phase Duration: Time for one phase of a pulse (from zero line back to zero line) Pulse Duration: Biphasic - Time for two phases Monophasic - Same as phase duration Must exceed capacitance to cause AP Microseconds ```
53
Frequency
Pulses delivered through each channel per second Hz/Pulses per second Affects number or APs elicited Same number of fibers recruited, higher frequency = fire more rapidly
54
NMES
Electrode Placement: Parallel, separated a minimum of 2in Current Amplitude: Depends on desired contraction strength Pulse Duration: Overcome motor nerve low capacitance Shorter = more comfortable for smaller muscles Shorter = Greater current amplitude needed to yield same strength contraction Frequency: Smooth tetanic contraction - 35-50pps Higher = more fatigue, not more strength Duty Cycle: On Time = 6-10sec, Off Time = 5x longer and decrease with progress Ramp Time: 1-4sec if on time is 6-10sec Duration: 10-20min for 10-20 contractions, 3+days/week
55
Conventional TENS
Short duration, High frequency, Low amplitude [50-100usec, 30-150pps, sensory, activity duration] Amplitude: Sensory response only (mild tingling) Pain Relief: Brief, only when current is present Duration: During ADLs
56
Acupuncture-Like TENS
Long duration, Low frequency, Moderate amplitude [100-300usec, 2-4pps, twitching, 20-45min] Amplitude: Muscle twitching (uncomfortable or burning) Pain Relief: Several hours after Duration: 20-45min, not during ADLs (twitching)
57
Brief Intense TENS
Long duration, High frequency, Moderate amplitude [150-500usec, 60-200pps, strong paresthesia/motor, 15min] Amplitude: Higher, strong paresthesias or motor response Duration: 15min, during painful therapeutic activities
58
Noxious TENS
Duration, Frequency, Amplitude [250usec-1sec, High or low, highest tolerated, 30-60sec for each point] High density current uncomfortable or painful Small probe type applicator or electrode Duration: 30-60 sec intervals Waveforms: Mono- or biphasic pulsation current -> spike, square, rectangle, or sine Net polarity = 0 Unbalanced waveform = accumulation of charges, skin irritation
59
IFC
Combines 2 medium frequency alternating waveforms that are biphasic Current Intersection: Higher amplitude when in same phase, lower when in opposite phases This sequence creates beats (envelopes of pulses) Low amplitude in skin, high amplitude in deeper tissues = comfortable Indication: Pain relief, Increase circulation, Muscle stimulation Suction electrodes option Can combine with ice or heat
60
Bipolar IFC
2 Electrodes, 1 channel, 2 medium sinusoidal currents Interference: Creates amplitude modulated IFC with beat frequency Beat Frequency: Beats per second, net difference between 2 currents Can modulate prior to current reaching electrodes Oval shape
61
Quadripolar IFC
Currents intersect 90 degrees, max amplitude halfway between 2 current lines Four-leaf clover shape
62
Quadripolar IFC With Automatic Vector Scan
Increases size of field current One circuit allowed to vary amplitude Field pattern automatically rotates between 2 lines of current Circular shape
63
Iontophoresis
Continuous direct current, anode for positive ions, cathode for negative ions Rate of Ion Delivery: [Ion], Solution pH, Current density, Treatment duration Dosage: Amount of electricity, 40-80mA-min (amplitude x time) 40mA-min = 10min and 4.0mA Amplitude = 1.0-4.0mA Lower amplitude + Longer duration = decreased chance of skin irritation/burns Electrodes: Active and dispersive electrodes Spacing: Min = diameter of active electrode, Larger = decrease current superficial density, less skin risk Smaller: Higher current density and used to treat specific spot Duration: No more than every other day, should determine effectiveness within 3-5 sessions
64
Iontophoresis Adverse Reactions
Acidic Reaction: HCl acid forms under anode (+) Alkaline Reaction: NaOH forms under cathode (-) Decrease Chance of Burns: Decrease current density Increase cathode size Increase space between electrodes End of tx, slowly decrease intensity Active electrode sometimes left on 12-24hrs to diffuse ions further into skin

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