Prac Exam Revision Flashcards
(56 cards)
1
Q
What are the therapeutic effects of a cold icepack or contrast bath?
A
- reduce pain
- reduce swelling
- increase muscle tone (short application)
- reduce muscle tone (sustained application)
- and inflammation
- reduce inflammation
- decrease secondary tissue damage
2
Q
What are the physiological responses of cold icepacks and contrast baths?
A
- reduced cellular activity
- encourage vasoconstriction to slow the inflammatory process and reduce oedema
- increased interstitial fluid viscosity
- promote haemostasis during acute/ bleeding phase
- encourage clotting - up to 24-72 hours depending on severity
- decreased metabolism
- pain relief via: counter irritation (endorphin release) and reduced transmission from a delta and c fibres
3
Q
What is the safety test required for an ice pack or cold contrast bath?
A
ice reaction test
4
Q
What are some precautions to using a cold icepack or contrast bath?
A
- unable to communicate
- relevant to sensory loss
- reduced peripheral vascular supply
- cold sensitivity (e.g. Raynaud’s, cryoglobinemia, cold urticaria)
- high blood pressure (can increase systolic and diastolic because of vasoconstriction)
- relevant psychological issues
5
Q
What are some contra-indications to using a cold ice pack?
A
- circulatory insufficiency
- risk of exacerbating existing conditions
6
Q
What are some risks to using a cold ice pack or contrast bath?
A
- adverse reaction to ice - local weal - systemic reaction
- ice burn
- superficial nerve damage (as early as 20-30 minutes)
- Hunting’s reaction
7
Q
What are the dosage parameters of using a cold icepack?
A
10-20 minutes depending on the depth of the structure tested
8
Q
How do you record cold superficial thermal modalities?
A
(type of) cold to… (area and side)
duration (minutes)
S tick tick W tick tick
// reassessment of S/E and O/E
name / signature / designation / date
9
Q
What are some therapeutic effects of using superficial heat?
A
- reduced pain
- reduced swelling
- reduce muscle spasm (sustained application)
- increase joint mobility
- promote healing
10
Q
What the methods of superficial heat appliation?
A
hot pack, contrast baths and wax
11
Q
What are the physiological responses of using superficial heat?
A
- promotes vasodilation / blood flow
- increases metabolism
- maximises appropriate inflammatory cascade
- promote laying down of new collagen and new circulation (macrophages release chemical mediators to encourage fibroblast and endothelial cells)
- increase elasticity of connective tissue
12
Q
What is the safety test required for superficial heat?
A
thermal sensitivity (hot/cold)
13
Q
What are some precautions to using superficial heat?
A
- unable to communicate
- relevant sensory loss
- relevant psychological issues
14
Q
What are some contraindications to using superficial heat?
A
- circulatory insufficiency
- risk of dissemination
- risk of exacerbating existing conditions
- eyes or testes
- areas of recent bleeding
- skin conditions
- infected tissue / open areas
15
Q
What are the risks of using superficial heat?
A
thermal burns and skin irritation
16
Q
What are the dosage parameters for superficial heat?
A
20 minutes
17
Q
How to record that you have used superficial heat?
A
(type of) heat to… (area and side)
duration (minutes)
S tick tick W tick tick
// reassessment of S/E and O/E
name/ signature/ designation/ date
18
Q
What are the therapeutic effects of pulsed (non-thermal) ultrasound?
A
sound waves enter the tissues to help:
- reduce pain
- optimise inflammation
- enhance tissue repair / e.g. wound, cartilage, # healing
19
Q
What are some physiological responses to pulsed ultrasound?
A
- Cavitation
- Standing waves
- Acoustic streaming
- Micromassage
20
Q
How does non-thermal ultrasound cause the physiological response of cavitation?
A
- if stable, along with acoustic streaming - can increase cell membrane permeability and promote healing and accelerate resolution or inflammation = PRO-inflammatory not anti-inflam
- in proliferative stage stim fibroblasts, myofibroblasts and endothelial cells and collagen synthesis
21
Q
How does non-thermal ultrasound cause the physiological response of standing waves?
A
superimposed waves create peaks of high and low pressure - can cause blood statis and vessel damage - negative physiological effect
22
Q
How does non-thermal ultrasound cause the physiological response of acoustic streaming?
A
fluid movement in the ultrasonic beam - may beneficially alter cell function / permeability
23
Q
How does non-thermal ultrasound cause the physiological response of micromassage?
A
from mechanical effect of the sound pressure
24
Q
What is the safety test required for non-thermal ultrasound?
A
thermal sensitivity (hot/cold) and sharp/ blunt discrimination (pin prick)
25
What are the precautions to non-thermal ultrasound?
- vascular problems - circulatory insufficiency, DVT
- risk of dissemination
- risk of exacerbating existing conditions
- unable to communicate
- relevant sensory loss
- metal implants
26
What are the contraindications to non-thermal ultrasound?
- pregnancy (over area)
- over pacemakers/ inbuilt stimulators
- eyes or testes
- rapidly dividing tissues (e.g. tumour, pregnant uterus, epiphyseal plates)
- plastic or cement implants
- over acute infection
- radiotherapy
27
What are the risks to non-thermal ultrasound?
- thermal burns
- periosteal burns
- standing waves
- cavitation
28
What are the dosage parameters for non-thermal ultrasound?
Frequency
- 1MHz for deep
- 3 MHz for superficial
Pulsed Ratio (consider SATA vs SATP units):
1:9 very acute
1:4 acute
1:1 sub acute
Intensity at lesion W/cm2:
0.3 acute
0.3-0.5 subacute
0.3-1.0 chronic
Time
size per area of applicator head x2 minutes (x ratio SATP machine)
29
How to record non-thermal ultrasound?
(type of) U/S to... (area and side)
Frequency (MHz)
Pulsed (incl ratio) or continuous
Intensity (W/cm2)
Duration (minutes)
S tick tick W tick tick
// reassessment of S/E and O/E
name / signature / designation / date
30
What are the therapeutic effects of continuous or (deep thermal) ultrasound?
sound waves enter tissues to
- speed up healing
- reduce pain
- reduce stiffness
31
What are the physiological responses of continuous ultrasound?
All of the non-thermal effects, PLUS:
- in remodelling stage facilitates collagen fibre orientation to remodel scar tissue
- cavitation more likely when continuous = negative physiological effect from very high doses
PLUS - all thermal effects from superficial heat
32
What is the safety test required for continuous ultrasound?
Thermal sensitivity (hot/cold) and sharp/ blunt discrimination (pinprick)
33
What are some precautions to continuous ultrasound?
- metal implants
- circulatory insufficiency where heat is a contraindication
34
What are the contraindications to using continuous ultrasound?
- pregnancy (over area)
- over pacemakers / inbuilt stimulators
- circulatory insufficiency
- risk of dissemination and rapidly dividing tissues (e.g. tumour, pregnant uterus, epiphyseal plates)
- plastic or cement implants
- over active infection
- radiotherapy
- risk of exacerbating existing conditions
- unable to communicate
- eyes or testes
- relevant to sensory loss
35
What are the risks of using continuous ultrasound?
- thermal burns
- periosteal burns
- standing waves
- cavitation
36
What are the dosage parameters for continuous ultrasound?
Frequency
- 1MHz for deep
- 3MHz for superficial
Continuous
Intensity at lesion W/cm2
- 0.3 acute
-0.3-0.5 subacute
-0.3-1.0 chronic
Time
- size per applicator head x2 minutes
37
How would you record the use of continuous ultrasound?
(type of) U/S to... (area and side)
Frequency (MHz)
Pulsed (incl ratio) or continuous
Intensity (W/cm2)
Duration (minutes)
S tick tick W tick tick
// reassessment of S/E and O/E
name / signature / designation / date
38
What are the therapeutic effects of using TENs?
- reduce pain
- promote healing - improved blood flow, reduce oedema, improve tissue healing
- stimulate muscle (strengthen, re-educate)
39
What are the physiological responses of conventional TENs?
- 'gate' in the dorsal horn of the spinal cord controls transmission of nociceptive signals to the brain from A-delta and c fibres. But a-beta fibres (receptors for non-painful stimuli) also go through the same gate and travel faster because they are larger fibres , inhibiting the transmission of signals from so effectively 'close the gate' to the a delta and c fibres, preventing the nociceptive signals, reducing the perception of pain
- this is why it is important that conventional TENs electrodes need to be placed in the same spinal segment for effect
40
What are the physiological responses of intense TENs?
- tolerable (umcomfortable) sensation stimulates the c fibres which causes release of endorphins, by activating opioid receptors in the nervous system, from the pituitary gland to systemically reduce the perception of pain
- a delta fibre stimulation from non-comfortable sensation also inhibits nociceptor neurons - descending inhibition of pain
- because of the systemic effect, the electrodes do not need to be placed segmentally to have effect
41
What is the safety test required for TENs?
sharp/ blunt discrimination (pinprick)
42
What are the precautions of TENs?
- circulatory insufficiency
- risk of dissemination
- risk of exacerbating conditions
- unable to communicate
- relevant sensory changes (loss or hyperalgesia/ allodynia)
- broken skin
- operating hazardous equipment
43
What are the contraindications to using TENs?
- pregnancy (over area)
- over pacemakers / inbuilt stimulators
- if muscle contraction is contraindicated
- transthoracic application
- epilepsy
- non-adherent patients
- skin conditions
- eyes or testes
44
What are the risks of using a TENs machine?
- skin irritation
- electrical burns
- pain
45
What are the dosage parameter for conventional TENs?
targets large diameter A-beta fibres, segmental
- Freq: 100-200 Hz (high)
- Pulse Duration: short (document number from the machine)
- Intensity: (comfortable - record number)
- Duration: 30 minutes +
46
What are the dosage parameters of Intense TENs?
targets a delta and c fibres
- freq: 200 Hz
- pulse duration: long (document number from machine)
- intensity: (tolerable - record number)
- duration: 15 minutes max
47
What are the dosage parameters of acupuncture TENs?
Freq: <10Hz (low)
pulse duration: long (document number from machine)
Intensity: (tolerable- record number)
Duration: 30 minutes max
48
How would you record the use of a TENs machine?
(type of) TENs to... (area and side)
Where electrodes were placed (icl. single or dual channel)
Intensity (comfortable or tolerable)
Pulse Frequency (Hz)
Pulse Duration
Frequency (conventional, modulated, burst)
Duration (minutes)
S tick tick W tick tick
// reassessment of S/E and O/E
name/ signature / designation / date
49
What are the therapeutic effects of MMF/ IFT?
MMF/IFT: a low energy modality that can help target deep into the tissues to:
- reduce pain
- promote healing
50
What are the physiological responses of MMF/IFT?
pain gate theory is mainly used:
- 'gate' in the dorsal horn of the spinal cord controls transmission of nociceptive signals to the brain from A-delta and c fibres. but A-beta (receptors for non-painful stimuli) also go through the same gate and travel faster because they are larger fibres, inhibiting the transmission of signals from, so effectively 'close the gate' to the a delta and c fibres, preventing the nociceptive signals, reducing the perception of pain.
- this is why it's important that electrodes need to be placed in the same spinal segment for effect
- (can target endorphin release if use tolerable intensities but consider negative effects of such high intensities)
- increased healing due to increase in cell permeability
51
What is the safety test required for MMF/IFT?
sharp/ blunt discrimination (pinprick)
52
What are the precautions for using MMF and IFT?
- circulatory insufficiency
- risk of dissemination
- risk of exacerbating existing conditions
- unable to communicate
- relevant to sensory less
- broken skin
53
What are the contraindications of using MMF and IFT?
- pregnancy (over area)
- over pacemakers / inbuilt stimulators
- when muscle contraction is a contraindication
- transthoracic application
- epilepsy
- skin conditions
- cranium, anterior neck or testes
54
What are the risks of using MMF and IFT?
- skin irritation
- electrical burns
- pain
55
What are the dosage parameters for MMF/ IFT?
- comfortable intensity for pain gate theory - (may accommodate so need to check for a continued comfortable sensation throughout to ensure continue to stimulate the A-beta fibres)
- as the circuits are set to medium frequencies that are either modulated with the machine (MMF) or are set to be slightly different so will interfere to create the desired effect at depth (IFT), only the modality, pad placement and comfortable intensity need to be selected
- consider sweep to reduce effect of accommodation
- consider vector scan if sensation outside the electrodes
56
How would you record the use of MMF and IFT?
Modality (MMF or IFT) to... (area and side)
where the electrodes were placed
frequency (Hz)
Duration
Intensity (read from the machine)
S tick tick W tick tick
// reassessment of S/E and O/E
name / signature / designation / date
