Modalities E-Stim and Cryo

Question 1

Muscle Re-Education

Answer 1

• Muscle inhibition after surgery
• Neuromuscular mechanism for contraction still intact
• CNS inhibition is the cause: Local swelling, Pain, atrophy
• Electrical impulses increase sensory input to muscle(pt feels sensation of contraction, pt voluntarily contracts)

Question 2

Evidence for NMES

Answer 2

• Can increase isokinetic strength = 65 degrees/sec

- Only use NMES when pt is struggling to contract on own (literature supports voluntary contraction is better)

Question 3

Muscle Re-Education Parameters (Russian)

Answer 3

Carrier Frequency: 2500-5000 Hz
Freq: 30-60 pps
Intensity: visible muscle contraction
Ramp: 1:5(20%) at first, then 1:3(30%) then 1:2(50%)
Time: 15-20 minutes
*10 seconds on 50 Seconds off

Question 4

E-Stim for Muscle Spasm

Answer 4

-Not a muscle cramp, but a low-grade contraction or tightness
-Goal: break the pain-spasm-pain cycle via involuntary tetanic contractions
- Increase local circulation
- Remove metabolic waste
- Mechanically stimulate muscle fibers
- Induce muscle fatigue
Contraindications = Acute injuries and local instability

Question 5

Muscle Spasm Parameters

Answer 5

Pulse rate: 50-60 pps
Intensity: visible contraction
Duty cyle: 10 sec on/10 sec off
Ramp: 1-2 sec on/1-2 sec off
Time: 10-20 minutes
No voluntary contractions necessary

Question 6

E-Stim for Edema Reduction

Answer 6

• Muscle contractions aide by manually forcing fluids from extremities to heart
• Primary way: Motor-Level Stim
• Use reciprocal contractions “milking” effect

Question 7

Motor-Level Edema Parameters

Answer 7

Gentle: 1-10 pps
No signs of pain: 30-50 pps
Intensity: Visible contraction
Agonist Contract: 5-10 sec
Antagonist Contract: 5-10 sec

Question 8

High Volt Pulsed Current (HVPC)

Answer 8

-Monophasic Neg charge
-Decrease capillary permeability(WBC’s)
Freq: 120 pps
Intensity: Sensory only, no contraction
Polarity: cathode (-) over injured tissue
-Dispersive(+) pad over another body part
Time: 4x30 mins with 60 min rest intervals

Question 9

Russian E-Stim

Answer 9

• 10/50/10: 10 sec on/50 sec off/ 10 minutes

- Preferential for type II muscle fiber recruitment

Question 10

Russian Parameters

Answer 10

Carrier Freq: 2500 Hz
Amp: muscle contract
Freq: 30-60 pps
Burst Duty cyle: 50%
On/off duty cyle: 1:5
time: 10 minutes

Question 11

Biphasic Parameters

Answer 11

Freq: 1-200 pps
Phase Duration: 20-300 Micro seconds
Intrapulse interval: 100 micro seconds
Intensity: contraction
Burst duty cycle: 40-50%
On/Off duty cycle: 1:5, 1:3
Ramp: 1-3 seconds
Note: Lower frequency = higher phase duration

Question 12

1. Conduction

Answer 12

=Heat loss or gain through DIRECT contact

• Temp change dependent on:
  1. Temp difference
  2. duration

Question 13

2. Convection

Answer 13

=Heat loss or gain through MVMT OF FLUID OR AIR between regions of unequal temp

• Temp change dependent on
  1. Temp difference
  2. Duration
  3. Size of tx area

Question 14

3. Radiation

Answer 14

=EMISSION of energy

-May be emitted from a source then absorbed by body

Question 15

4. Conversion

Answer 15

=CHANGING from one energy to another

-i.e. ultrasound- converts acoustic energy to thermal energy

Question 16

5. Evaporation

Answer 16

=Thermal energy must be removed to undergo a PHASE CHANGE from liquid to gas
-i.e. Vapo-Coolant sprays

Question 17

Cryotherapy

Answer 17

• Heat is REMOVED from body and absorbed by the cold modality
• Application of cold modalities that have a temp range btw 32-65 Degrees F

Question 18

Heat Transfer

Answer 18

• Cold modalities work by removing the heat in the tissue
• Hot to Cold always
• One object must have higher temp than other

Question 19

Factors Influencing Depth and Duration of Treatment

Answer 19

• Adipose tissue is the primary limiting factor affecting the depth of penetration
• Thinner pt = shorter tx time
• External insulator(towel) = longer tx time

Question 20

Primary Rationale Use of Cryotherapy

Answer 20

= To decrease the metabolic rate of tissue: Reduce demands for O2 in tissue and limits secondary hypoxic injury
-Max temp for reduction of cell metabolism = 50-59 degrees F

Question 21

Local Effects of Cold Modalities: Cellular Response

Answer 21

= Decrease cell metabolism leads to decrease need for O2

Question 22

Local Effects of Cold Modalities: Blood and Fluid dynamics

Answer 22

• Vasoconstriction
• Decrease blood flow to area
• Decrease hydrostatic pressure
• Decrease capillary permeability

Question 23

Local Effects of Cold Modalities: Nerve Conduction

Answer 23

• Decrease afferent nerve conduction

- Decrease threshold of afferent nerve endings

Question 24

Local Effects of Cold Modalities: Inflammation

Answer 24

• Decrease inflammation
• Decrease release of inflammatory mediators
• Decrease prostaglandin synthesis
• Decrease capillary permeability

Question 25

Local Effects of Cold Modalities: Muscle spasm

Answer 25

- Decrease sensitivity of muscle spindle | - Breaks pain-spasm-pain cycle

Question 26

Pain Control through Cold Therapy

Answer 26

- Stimulates large Abeta nerve fibers - Reduces nerve conduction velocity and amplitude - Reduces muscle spasm - Controls edema - Gate control theory

Question 27

Indications for Cryotherapy

Answer 27

- Acute injury or inflammation - Acute or chronic pain - Post-surgical pain - Cyrokinetics(ice + ROM) - Small, superficial burns - Acute or chronic muscle spasm - Neuralgia(nerve pain) - Spasticity secondary to CNS disorders

Question 28

Contraindications for Cryotherapy

Answer 28

- Cold allergy - Cardiac/Respiratory involvment - PVD/circulatroy insufficiency - Wounds - Anesthetic skin - lost sensation - Advanced diabetes - Raynaud's phenomenon: blood vessels spasm - Prolonged application on superficial nerves

Question 29

POLICE

Answer 29

- Protection - Optimal - Loading - Ice - Compression - Elevation

Question 30

Reusable Cold Packs

Answer 30

``` =Silica, water, and antifreeze Advantage: cost effective Disadvantages: risk of frostbite -Poor conformation to body -Doesn't undergo phase change ```

Question 31

Instant Cold Packs

Answer 31

=2 chemicals separated by barrier Advantages: portable, quick to use Disadvantages: one-time use, looses cooling quickly, chemicals are caustic to skin

Question 32

Cold Compression Therapy Units

Answer 32

-Combines static external compression with cold application -Less tissue cooling compared to ice pack -Keep tx area elevated -Provides 40mmHG circumferential compression Advantages: PRICE, reusable, Circumferential compression Disadvantages: initial investment, set-up/clean up, only for extremities

Question 33

Ice Massage

Answer 33

Advantages: convient self-tx, cost and time effective Disadvantages: only small areas, and no compression time: 5-10 minutes

Question 34

Col Whirlpool

Answer 34

= uses Convection for large areas Indications: Decreased ROM, subacute or chronic, peripheral vascular disease Contraindications: Acute conditions, postural support

Question 35

Whirlpool parts

Answer 35

Primary turbine regulates water and air: 1. Water turbulence valve 2. Water aeration valve 3. Aeration outlet 4. Water outlet 5. Water intake

Question 36

Cold Water Immersion

Answer 36

Temp: 40-50 degree F time: 10-15 mins use: extremities -have to move around so thermopane does not develop Indications: acute/ inflammation, chronic, post surgical Precautions: dependent position, nerve palsy, uncomfortable

Question 37

Cryostretch

Answer 37

= Vaso-Coolant spray: - Decreases skin temp and decreases pain - AT adds gentle passive stretch to relieve spasm - i.e. flouromethane spray - Gate control theory - reduces intensity and speed of pain Indications: Trigger point, muscle spasm, Decreased ROM, ACUTE pain Contraindications: allergic, post surgical, open wounds, face and eyes