Modalities Flashcards

Question

thermal US

Answer 1

produced by continuous sound energy of sufficient intensity range: 0.5-3w/cm2 (intensity will vary depending upon tissue type and pathology) ``` increased tissue temp increased pain threshold increased collagen tissue extensibility alteration of NCV increased enzymatic activity increased tissue perfusion ``` excessive high temps may produce a sudden, strong ache caused by overheating of periosteal tissue (periosteal pain)- reduce intensity or increase SA of tx

Answer 2

generated by very low intensity or pulsed (intermittent) sound energy related to duty cycle (20-50%) cavitation: alternating compression (condensation phase) and expansion (rarefaction phase) of small gas bubbles in tissue fluids caused by mechanical pressure waves

Answer 3

modulate pain increase CT extensibility reduce or eliminate soft tissue inflammation accelerate rate of tissue/wound healing reduce/eliminate soft tissue and joint restriction and muscle spasm

Answer 4

- impaired circulation - impaired cognition - impaired sensation - malignant tumors - over an area with thrombophlebitis - joint cement - directly over plastic components - over vital areas- brain, ear, eye, heart, cervical ganglia, carotid sinuses, reproductive organs, exposed or unprotected SC - over pacemakers - over abdomen, LB, uterus or pelvis during pregnancy - healing fracture Precautions: - over metal, - osteoporosis - plastic implants - primary repair of tendons, ligaments or scar tissue

Answer 5

introduces therapeutic substances into the body aided by US -substances seem to be absorbed more readily bc the membranes may be more permeable Hydrocortisone, dexamethasone, salicylates, lidocaine, or other ointments are massaged into the part followed by US transmission gel indications: - subacute and chronic MS conditions' local analgesic- lidocaine anti-inflammatory- dexamethasone, salicylates

Answer 6

distraction force applied to the spine to separate articular surfaces between vertebral bodies and elongate spinal structures may be sustained, intermittent, positional, gravity assisted, inversion, continuous or static

Answer 7

Joint distraction: - opening intervertebral foramen, relieves pressure on nerve root and decreases compressive forces on facets - Lumbar region: 50% of BW (initial 30-40lbs) - Cervical region: 7% of BW or ~20-30 lbs (initial 8-10lbs) Reduction of disc protrusion: - separation of vertebral bodies occurs at higher forces, causing a decrease in intradiscal pressure that creates a suction-like effect on the nucleus, drawing it back in centrally; the surrounding ligamentous structures are stretched taut, which also helps to push the disc centrally. - lumbar: 60-120lbs or up to 50% BW - cervical: 12-15lbs Soft tissue stretching - decreasing pressure on the fact joints, nerve roots, vertebral bodies and discs without achieving joint separation - Lumbar: 25% BW - Cervical: 12-15lbs Muscle relaxation: - both intermittent and static traction can decrease muscle tone - traction can interrupt the pain-muscle spasm cycle by stimulating mechanoreceptors through the motion caused by interrupted tractions and by inhibiting motor neuron firing with static tractions - same forces as stretching Joint mobilization: - at lower forces, intermittent traction stimulates mechanoreceptors to inhibit pain and decrease spasm - high force traction causes decreased pressure on the joint and stretches surrounding soft tissue - can't be isolated to particular segment

Answer 8

- acute strings, sprains, inflammation - spondylolisthesis - fractures - postop spinal surgery - spinal joint instability/hypermobility - SC compression - HTN - increased peripheralization of pain - numbness/tingling - decreased myotomal strength - decreased reflex Precautions: - clastrophobia - hiatal hernia - vascular compromise - pregnancy - impaired cognition - condition that compromises structure of the spine (osteoporosis, tumor, infection, RA)

Answer 9

0-5 deg flexion to increase intervertebral space at C1-4 maintained at 20-30 deg flexion for C5-7 maintained at 0 deg for disc dysfunction acute phase: - disc protrusion, soft tissue stretch, muscle spasm : 10-15 lbs or 7-10% BW - joint distraction: 20-30 lbs disc protrusions: static traction recommended - symptoms are aggravated by motion

Answer 10

split table supine 90/90 for spinal stenosis prone for disc herniation tx force: - acute: 30-40lbs - disc protrusion, spasm; elongation of soft tissues: 25% of BW - joint distraction: 50 lbs or 50% of BW

Answer 11

usd to decrease or prevent formation of edema machine serially compresses a sleeve placed over the part to be treated part is elevated and patient's BP determines setting of device -shouldn't exceed DBP ? at least 2 hours/day Indications: - chronic edema - lymphedema - stasis ulcer - traumatic edema - venous insufficiency - amputation Contraindications: - acute inflammation or infection in area - acute DVT or PE - arterial insufficiency - cancer - diminished skin sensation - kidney or cardiac insufficiency - HTN - cognitive dysfunction - obstructed lymph channels - very young and old frail patients

Answer 12

device that provides mechanical passive motion to a joint size of the motion arc, position of the arc, and rate of motion is controlled CPM inhibits adhesion formation, improves cartilage nutrition via better fluid mechanics and may stimulate the production of chondrocytes Indications: - post-immobilization fracture - tendon or ligament repair - TKR - THR Contraindications: - thrombophlebitis or DVT - CPM should be discontinued if increases pain, edema, or inflammation

Answer 13

mechanical/electrical table designed to elevate patient from horizontal to vertical Physiological effects: - stimulate postural reflexes to counteract orthostatic hypotension - facilitate postural drainage - gradual loading of 1 or both LE - begin active head/trunk control - provide positioning for stretch of hip flexors, knee flexors and ankle PFs Indications: - prolonged bed rest - immobilization - SCI - TBI - orthostatic hypotension - spasticity Procedure: - secure to table - table raised gradually in 15 deg increments - monitor VS: cyanotic lips or fingers may indicate compromised circulation - time: based on pt. tolerance, shouldn't exceed 45 min 1-2 x/day return to supine with a drop in BP, diaphoresis, and agitation contraindications: - unstable fractures - confused or anxious patient

Answer 14

manipulation of soft tissues by hands used to increase BF, stretch or loosen scar tissue, reduce edema and pain, relax muscles indications: - subacute and chronic MS conditions - muscle spasm - superficial scar formation - edema - postural drainage Contraindications: - acute inflammation or febrile condition - severe atherosclerosis or varicose veins - phlebitis and thrombophlebitis - areas of recent surgery - cardiac arrhythmia or heart failure - malignancy - hypersensitivity - severe RA - hemorrhage in area - edema secondary to kidney dysfunction - venous insufficiency

Answer 15

stroking - beginning and end - superficial strokes kneading -milking effect; aids in loosening adhesions and increasing venous return friction: - stretch scars and loosen adhesions - small circular or stroking manner tapotement: - stimulation cupping: - chest to mobilize secretions vibration: - loosen secretions

Answer 16

- pain modulation - muscle spasm - impaired ROM - muscle re-ed - disuse atrophy (muscle weakness) - soft tissue repair (wound healing) - edema reduction - spasticity (reduce hypertonicity) - denervated muscle

Answer 17

- healing fractures - areas of active bleeding - malignancies or phlebitis in tx area - superficial metal implants - pharyngeal or laryngeal muscles - demand type pacemaker - myocardial disease Precautions: - areas of impaired sensation - severe edema

Answer 18

chemical ions are driven through the skin by continuous direct current for a therapeutic result therapeutic ion must be placed under an electric of similar charge to "push" the chemical past the skin (transdermal) into the deeper soft tissue -like charges repel cathode (negative pole) is used for: - salicylate -pain relief - acetate - calcium deposits - dexamethasone -anti inflammatory - iodine - softens scars anode (positive pole) is used for: - hydrocortisone - antiinflammation - lidocaine -pain relief - magnesium or calcium - muscle spasm - lithium - gout - zinc - dermal ulcers - copper- fungal infections Contraindications: - impaired skin sensation - allergy or sensitivity to therapeutic agent or direct current - recent scars, cuts, bruises or broken skin - metal in or near area

Answer 19

provides afferent stimulation for pain management by affecting the peripheral and central NS impulses stimulating the large A fiber afferents, can act to block the pain impulses (gate control theory) stimulation may also cause release of the body's own endorphins/enkephalins, which inhibit pain or pain transmission current may be symmetrical or asymmetrical biphasic (AC) waveform or a monophonic (DC) waveform electrodes may be placed at the point of the pain, at dermatomes of nerve roots, over trigger points, proximal or distal to pain site and at segmental related myotomes contraindications: - demand type pacemakers - over chest area of patients with cardiac dysfunction - over eyes, laryngeal or pharyngeal muscles, head and neck of patient with CVA or epilepsy - application to mucosal membranes

Answer 20

Conventional (high rate) TENS: - uses high frequency (75-120pps), very short pulse width (50-100 microseconds) , and low intensity - provides temporary relief of acute or chronic pain - onset of pain relief is relatively fast - duration: 20-60 minutes Acupuncture like (strong, low rate) TENS - low frequency (1-4pps), wide pulse width (150-300 microseconds), higher intensities than conventional - used more with chronic conditions with longer lasting pain relief - duration: 30-40 min Brief intense TENS - high pulse rate (150pps), long pulse width (300 microseconds) - rapid onset short term pain relief - used to provide pain relief for painful procedures such as wound debridement, deep friction massage, passive stretching - duration: 15 min Burst mode TENS - combines characteristics of both high and low rate TENS - stimulation of endogenous opiates, but the current is more tolerable to patients than low rate TENS - onset of analgesia is similar to low rate TENS - duration: 20-30 min modulation mode TENS - a method of modulating the parameters of the the above TENS modes for the purpose of preventing neural or perceptual adaptation d/t constant e-stim - frequencies, intensities or pulse widths can be altered by >10%, 1-2 times/second

Answer 21

a form of pulsed direct current (DC) stimulation using high volt twin spikes with pulse widths in microseconds the chemical, polar, and thermal effects of DC are minimized becomes of the extremely short duration (pulse width) of the stimulus useful for denervated muscles not tolerated well indications: - muscle stimulation/re-ed - reduce pain from TENS like properties - reduce edema (increased turgor) - facilitate wound healing

Answer 22

uses high frequency (2500 Hz) current, which is modulated to 70 apps for comfort indications: -used for strengthening of normal muscle by assisting with the muscle contraction during volitional activities (isometrics and short arc joint movements)

Answer 23

characterized by crossing of 2 sinusoidal waves having similar amplitudes, but different carrier frequencies -the waves interfere with one another to generate an amplitude modulated beat frequency indications: - used for pain relief - muscle strengthening

Answer 24

can use alternating current (AC 80-100Hz) to stimulate an innervated muscle for general stimulation or DC that is interrupted with a long pulse width for a denervated muscle AKA neuromuscular estim (NMES) encompasses a wide range of stimulator units and techniques Indications: - disuse atrophy - impaired ROM - muscle spasm - muscle re-ed - spasticity mgmt useful as an alternative or supplement to the use of orthotics

Answer 25

larger electrodes, a reduced intensity or an increased pulse width may be indicated AC is better tolerated than DC although research indicates the estim of denervated muscles is not beneficial. use DC is preferred over AC

Answer 26

on:off min/no atrophy/weakness: 1:1 or 1:2 ratio mod atrophy: 1:3 or 1:4 ratio severe atrophy: 1:5 or 1:10 ratio

Answer 27

electronic instrument that monitors the muscle activity of selected muscles and provides physiological info (feedback) to the patient patient tries to manipulate or change the feedback and thus voluntarily controls muscle activity goals are either enhancement or reduction of the EMG activity relax training is combined with EMG biofeedback when trying to achieve progressive muscle relaxation not a form of e-stim

Answer 28

a test of electrical excitability of peripheral nerves rare chronaxie value is the minimal amount of time that the current must be on in order to produce a min muscle contraction -normal chronaxie value

Answer 29

clinical EMG consists of the recording of electrical potentials of muscles at rest, motor units should be electrically silent with max contraction, the result should be an interference pattern various abnormal patterns that indicate a specific problem -fibrillation potentials seen in denervation

Answer 30

a test that determines the time it takes for a muscle to respond after the peripheral nerve has been stimulate can be done over sensory nerves by determining the time it takes for a nerve to respond to a stimulus UE conduction times can range from 45-70 meters/second LE average is 50m/sec UE average is 60 m/sec NCV is slower in children 70 lower intramuscular temps slow NCV and higher temps increase NCV test useful in assessing peripheral nerve lesions and neuropathies (CTS)

Answer 31

a test of excitability in which the intensity required to produce a minimal muscle contraction is plotted against a set of measured durations. -rare graph results give an index of electrical excitability steep, continuous curves displaced to the R indicate denervation discontinuous curves indicate partial denervation