Test 2 Flashcards
(96 cards)
1
Q
Starting with cryotherapy
A
N
2
Q
Conduction
A
Direct contact
3
Q
Examples of conduction
A
Ice massage
Cold pack
Ice bath
Cold water
4
Q
Convection
A
Air or water particles move across the body part causing cooling
5
Q
Example of convection
A
Cold whirlpool
6
Q
Evaporation example
A
Vapocoolant spray
7
Q
Cryotherapy
A
Application of cold for therapeutic purposes
8
Q
Cryokinetics
A
Combination of cold and exercise
9
Q
CIVD-cold induced vasodilation aka?
A
Hunting response (hunting-Lewis response)
Cold induced vasodilation
Increased tissue temperature during cold therapy approx. 15 minutes into treatment then alternates. But never above baseline
10
Q
Goals of cryotherapy
A
- relieve of decrease pain
- decrease blood flow and metabolism
- protect injured tissue
- decrease muscle spasm
11
Q
Contraindications to cryotherapy
A
- impaired cold sensation
- cold-induced urticaria (allergy)
- Raynaud’s disease
- cryoglobulinemia
- paroxysmal cold hemoglobinuria
- open wounds
- peripheral vascular disease
- confused/unreliable patients
12
Q
Cryoglobinemia
A
- abnormal clumping of plasma proteins stimulated by cold application
- leads to skin discoloration and dyspnea
- associated with multiple myeloma
13
Q
What is cryoglobinemia associated with
A
Multiple myeloma Walden storm macroglobulinemia Chronic liver disease Infections Coexistence connective-tissue diseases like SLE, Sjogren syndrome
14
Q
Aka for cold induced hemoglobinuria and info
A
Paroxysmal cold hemoglobinuria
- cold activates antibody to to RBCs causing lysis and excess hemoglobin is excreted in the urine
- dark urine and back pain
Acute disease MC in young child ex: URI
Chronic disease MC in elderly ex: neoplastic or infectious
15
Q
Risks of cryotherapy
A
Impaired circulation Thoracic area in patients with CAD HTN patients Cardio disorders (take BP before, after, during) Superficial peripheral nerves Hemiplegic Very young/old Obesity( increased risk of frostbite)
16
Q
How does ultrasound work (type of waves)
A
Uses sound waves at high frequencies to heat muscles, tendons, ligaments etc.
17
Q
What is the Mc deep heating modality
A
Ultrasound
18
Q
How does ultrasound work
A
Electrical current passed through a crystal causing it to vibrate. Vibration generates sound waves
19
Q
What type/thickness of crystal used in ultrasound
A
Quartz, lead etc. very thin. 2-3mm
20
Q
Frequency of ultrasound
A
~1 million HZ (1MHz-3.3Mhz)
21
Q
What is duty cycle
A
Time sound is delivered by divided by total treatment time
100% continuous
50%/20% are Mc pulsed duty cycles
22
Q
When it continuous ultrasound used
A
Tissue healing
23
Q
When is pulsed ultrasound used
A
Mechanical/non-thermal effects
24
Q
Piezoelectric effect
A
Mechanical deformation of a crystal causes and electrical current to form
25
Reverse piezoelectric effect (indirect)
Alternating current is passed through a crystal resulting in fast contraction and expansion of the crystal
—> produces high frequency sound waves
*requires high voltages
26
Near field aka and distance
5cm into tissues
Treatment area
Fresnel zone
27
Far field and aka for ultrasound
Fraunhofer zone
2ndary Tex affect
Deeper than 5cm/tissue
28
Spatial peak intensity
Peak intensity of max intensity
| Watts/cm2
29
Spatial average intensity
Average intensity
Isp x duty cycle
30
ERA (effective radiating area)
Area of the sound head that produces sound energy (smaller than ultrasound head)
*ideally only a bit smaller
31
Beam nonuniformity ratio (BNR)
Amount of variability of the beam
Ratio between the peak intensity of the ultrasound mean divided by the average intensity sound beam
Used to compare quality between machines
32
What is ideal BNR (beam nonuniformity ratio)
1:1 within the range of 2:1-8:1 acceptable
**peak intensity: avg intensity
33
A lower BNR means what
more uniform the intensity of the sound wave
34
Benefits of lower BNR
Eliminate hot spot
Higher dosage without discomfort
Greatest comfort/safety
35
PAMBNR (peak area of the maximum beam nonuniformity ratio)
Area of sound head covered by peak intensity
Large: larger area of sound head; less uniform heating
Small: small area
36
Why is gel used in ultrasound
It prevents reflection of sound waves by air bc air is a poor conductor
37
More watts during ultrasound causes what
More heating NOT greater penetration
38
In ultrasound what does frequency affect
Depth
| Time required to cause increase in tissue temperature
39
High and low frequency for ultrasound effects and indications
High: 3.3MHz- absorbed more rapidly affects superficial tissues
Low: 1.1MHz-absorbed slower and affects deeper
40
Continuous US
More sound energy delivered and absorbed so treated tissue healing
41
Scattering affect with ultrasound
When US encounters a boundary between tissues energy scatters by reflection or refraction
42
Reflection
Reversal of direction of ultrasound wave at soft-tissue-bone interface and leads to increased heating
**tissues close to bone receive increased dose
43
Refraction
Change of ultrasound wave from a straight path when passing obliquely from one medium to another
Lead to concentrations of US at point of refraction ex: tendon joints bone
44
Effects of ultrasound
-tissue healing due to increase in metabolic activity and blood flow
45
Increase in 1, 2-3 and 4 C effects with ultrasound
1- increased metabolic activity
2-3: reduction of muscle spasm, increased blood flow, reduced chronic inflammation
4: alters viscoelastic properties of collagen
46
Relationship with ultrasound and treatment time and tissue healing
Longer time needed when lower intensity used
47
Therapeutic effect of ultrasound
- increase extensibility of collagen of tendons/j-capsule and synthesis
- increased blood flow
- increased cell metabolism
- decreased joint stiffness and muscle spasm
- enhanced tendon, lig, and muscle healing
48
Non thermal effects of ultrasound
Pulsed ultrasound
- stimulation of fibroblast activity
- increased blood flow
- increased proteins associated with injury repair
Through acoustical streaming and stable cavitation
49
Acoustical streaming
Movement of fluids along cell membranes due to mechanical pressure exerted by sound waves
Movement is in direction of sound waves
-increased cell membrane permeability
50
Cavitation
Formation of gas filled bubbles from pressure changes in tissue fluids
51
Stable vs. unstable cavitation
Stable: rhythmic expansion and contraction of bubbles during repeated pressure changes over many acoustic cycles
Unstable: collapse of gas bubbles that may cause tissue damage. Associated with low frequency, high intensity ultrasound (not therapeutic)
52
Contraindications of ultrasound
```
Malignancy
Hemorrhage
Ischemia
Thrombus
Infection
Gonads
Eye
Pelvic abd, lumbar/pregnant
Eye
Spinal cord after laminectomy
Plastic and cemented implants (metal ok)
Near/over electronic implant
Unknown etiology
```
53
Risks of ultrasound
```
Bony prominence (use indirect/smaller head)
Epiphyseal plate
```
54
What intensity not to exceed in ultrasound
8.0 W/cm2
55
Treatment area of ultrasound
2-3x of the size of ERA
56
Phonophoresis
Aka sonophoresis
Uses energy to drive medication into tissue
Medication doesn’t require charge
57
Ultrasound and E-stim (combo)
```
Useful potentially for:
Trigger point
Epicondylitis
Superficial pain areas
Decrease adhesions
```
Ultrasound head becomes the treated electrode when used with dispersal pad
**premod is used for pain relief in combo with mechanical pulsed/continuous US
58
Low intensity pulsed US use?
Stimulation of fracture healing
59
Noncontact low-frequency ultrasound (NCLFUS)
Would cleaning and debridement
| Propels sterile saline across wound and stimulates healing
60
What phase is targeted with 100%/continuous with heat for ultrasound
Repair phase
61
What phase is targeting with 50%-pulsed-no heat with ultrasound
Acute phase
62
What settings are used with repair phase with ultrasound
Continuous (100%) with heat
63
What settings are used for acute phase for ultrasound
Pulsed (50%) no heat
64
Chronic tendonopathies such as lat. epicondylitis and Achilles tendonosis are painful with ischemic and fibrotic changes of the tendon that may benefit from what treatment?
Thermotherapy with US in combination with premod
Decrease pain and increase circulation
65
When is indirect/underwater ultrasound used
When the head won’t contact the skin flat
66
What is pulsed, no heat used with ultrasound
Goal of increase healing in an acute patient
67
When is continuous with heat for ultrasound used?
Goal of decrease muscle spasm, chronic pain, and increase healing
68
When is combo US and premod IF used
Chronic tendonosis, trigger points or acute or chronic pain
69
Depth of 1MHz and 3.3 MHz
1: 2-5cm
| 3. 3: 1-2cm
70
Types of diathermy
Shortwave (MC) and microwave
71
What is diathermy
High frequency electromagnetic energy
72
Arndt-schultz law
Dose vs response
73
Grotthuss-Draper law
Absorption vs therapeutic effect
74
Inverse square law
Dose vs divergence
1/4 as much heat with 2x the perpendicular distance
75
Indications of short wave diathermy
```
Osteoarthritis
Neck/back pain
Ankle pain
Dermal wounds
Other musculoskeletal injuries/pain
```
76
Contraindications (11) of short wave diathermy
```
Loss of sensation
Electronic implants
Surgically implanted metal
Metal in contact with skin
Cancerous areas
Pregnant patients
Hemorrhagic areas
Ischemic areas
Testes
Eyes
Open growth plates
```
77
Precautions with short wave diathermy
```
Prenant operator shouldn’t be around daily and remain 3 feet away
Copper IUDs
Other patients keep 10 foot distance
Other EPA devices-10 feet
Mentally confused
```
78
Types of electrodes with diathermy
Capacitive or inductive
79
Capacitive electrode with diathermy
Targets what?
Use for who?
Produces electrical field
Targets low electrolyte/water content tissues such as adipose
Use on things patients are areas with low subQ fat like: knee, foot, hand, shoulder
80
What areas should you use capacitance technique of diathermy
Low subQ fat—knee, foot, hand, shoulder
81
Induction electrode with diathermy
Targets
Use on who
Produce a magnetic field
Greatest absorption in high electrolyte and high dipole tissue such as deep muscle, tendon, joint
Use on patients with more subQ fat/obese patients
82
When should you use inductive technique for diathermy
Obese patients
Targets muscle, tendons, joints
83
Clinical goals of diathermy
Decrease pain
Increase joint mobility
Increase would healing
84
Application of diathermy
Test warm/cold sensation first
Remove jewelry
2-3cm layer towel between electrode and skin
85
DIATHERMY LOOK UP
1. 4 LAWS
| 2. CONTINUOUS VS PULSED INDICATIONS
86
Light is transmitted as _____ and is packaged in “_____”
Waves
| Photons
87
Giving up energy is called?
Spontaneous emission
88
Adding energy to electrons causes them to do what? The atom is in an ________ state. An excited atom will then do what? If that ______ interacts with another _____ _____ it will do what?
Move to higher orbit
Excited state
Excited atom releases a photon
If photons interacts with another excited atom, it will release another photon
89
Population inversion
Number of excited atoms outweighs the number at ground state
90
Pumping
Application of external source of power that causes population inversion
91
Explain steps in production of laser
```
Pumping of active medium
Population inversion
Spontaneous emission
Stimulated emission
Amplification
```
92
Coherence in laser
Same wavelength and all in phase
Light emitted in an organized fashion
93
Monochromatic
Single color
AKA same wavelength
94
Collimation in cold laser
Photons move in parallel fashion, they don’t diverge
95
What wavelength gives deeper penetration
Longer—lower frequency gives deeper penetration
96
As concentration of melanin or hemoglobin increase the depth of penetration of laser of the light _____?
Decreases
