Traction, Heat, Cold... Flashcards
(146 cards)
1
Q
Define physical agent?
A
Consist of energy and materials applied to patients to assist in rehab (heat, cold, US…)
2
Q
What is the difference between Thermal, Mechanical, and Electromagnetic agents?
A
Thermal- transfer energy to increase or decrease tissue temperature, Mechanical- apply force to increase/decrease pressure in the body, Electromagnetic- apply energy in the form of electromagnetic radiation or electrical current
3
Q
Physiological effects with cryotherapy?
A
Decreased circulation, metabolic rate, tissue extensibility and pain
4
Q
Physiological effects with thermotherapy?
A
Increase in circulation, metabolic rate, and tissue extensibility. Decrease in pain.
5
Q
CI of traction?
A
Movement is contraindicated, acute injury, hypertension, peripheralization of symptoms, and joint instability
6
Q
Precautions of traction?
A
Spinal structural disease, severe pain resolved, Disorientation, Displaced annular fragment, Medial disc protrusion, Pregnancy (belt is hazardous), Pt cant tolerate position, and claustraphobia
7
Q
Define joint distraction
A
separation of two articular surfaces perpendicular to the plane of articulation–> reducing compression and widens the vertebral foramen
8
Q
Increased tension of what ligament will reduce disc protrusion, by pushing posteriorly displacing the disc anteriorly?
A
Posterior Longitudinal Ligament (PLL)
9
Q
Indications for Spinal traction
A
- Disc bulge/ Herniation 2. Impingement 3. Joint HYPOmobility 4. Subacute joint inflammation 5. Paraspinal muscle spasm
10
Q
How will the patient be positioned during traction for a disc bulge/herniation? Impingement?
A
Bulge- prone
Impingement- supine
11
Q
During traction, is a patient is in increased flexion what part of the spine is being treated?
A
Upper lumbar, Lower cervical
12
Q
During traction, is a patient is in increased extension/ neutral what part of the spine is being treated?
A
Lower lumbar, Upper Cervical
13
Q
Traction for paraspinal muscle spasm, what type of traction should be used to interrupt the pain spasm pain cycle –> inhibiting the alpha motor neuron firing (decreasing pain)
A
Static or Low-load intermittent traction
14
Q
Traction for paraspinal muscle spasm, what type of traction should be used to reduce protective paraspinal muscles?
A
High load traction
15
Q
What are the cervical traction clinical prediction rules?
A
- Peripheralization w/ C4-C7 mobility test
- (+) should abduction test
- > 54 years old
- (+) ULTTA
- (+) Neck distraction test
16
Q
What are the lumbar traction prediction rules?
A
- (+) crossed SLR
- Peripheralization w/ extension
- Age 18-60 w/ pain radiating below buttocks in last 24 hours
- ODI> 19%
- Signs of nerve root compression
17
Q
What are adverse effects of traction?
A
Excessive force can increase the pt’s symptoms, with cervical traction pt can experience lumbar pain or radiculopathy
18
Q
How do you document traction?
A
- Type of traction 5. Type of halter
- Patient position 6. Treatment duration
- Maximum force 7. Parameters
- Area treated 8. Patient response
19
Q
Define specific heat
A
the amount of energy required to raise the temperature (higher the specific heat= more energy to heat up)
20
Q
Define conduction and give an example
A
an energy exchange by direct collision between the molecules of 2 materials at a different temperature
Ex: hot pack, paraffin, cold pack, ice)
21
Q
Define convection and give an example
A
heat transferred by direct contact between a circulating medium with another material of a different temperature
Ex: whirlpool or blood circulating
22
Q
Which transfers more heat convection or conduction?
A
Convection
23
Q
Define conversion and provide an example
A
converts a nonthermal form of energy into heat (mechanical, electrical, or chemical)
Ex: Ultrasound
24
Q
Conversions heat transfer is dependent upon? Does it require direct contact?
A
The power of the energy source
NO direct contact is required
25
Define radiation and provide an example
A direct transfer of energy without the need for an intervening medium or contact
Ex: Infrared lamps
26
Define evaporation and provide an example
energy is absorbed to change a liquid into a gas or vapor (humidity impairs evaporation)
Ex: Vapocoolant or sweat
27
Cryotherapy nueromuscular effects
Decreased nerve conduction velocity, spasticity, and metabolic rate. INCREASED pain threshold. Facilitation of muscle contraction and altered muscle strength
28
Indications for Cryotherapy
Inflammation, Edema, Pain, spasticity, MS symptom management
29
CI for Cryotherapy
Cold intolerance and hypersensitivity, Cryoglobulinemia, Paroxysmal cold hemoglobinuria, Raynaud's, Regenerating peripheral nerves, and poor circulation
30
Precautions for Cryotherapy
Hypertension, impaired sensation and mentation, very young/old, superficial branch of a nerve, and open wound
31
Adverse reactions to cold
Tissue death/ damage (
32
Describe patient experience with cryotherapy
```
Intense cold
Burning
Aching
Analgesia- loss of pain
Numbness
```
33
How do you document for cryotherapy
1. Area treated
2. Type of cooling agent
3. Time
4. Patient position
5. Patient response
34
Indications for Thermotherapy
Pain, Decreased ROM/ Joint stiffness, healing, and Psoriasis
35
Adverse reactions to thermotherapy
Burns, fainting, bleeding, skin or eye damage from IR
36
Thermotherapy CI
Hemorrhage, Impaired sensation and mentation, thrombophlebitis, malignant tumor
37
Thermotherapy Precautions
Acute injury, cardiac insufficiency, Edema, Metal, open wound, over topical irritant, Demyelinated nerves, pregnancy, impaired circulation, and poor thermal regulation
38
How many layers are required for thermotherapy
6-8
39
What is paraffin heated too
126-134 degrees
40
Documentation for thermotherapy
1. Area treated
2. Type of heating agent
3. Patient position
4. Time
5. Patient response
41
How does diathermy differ from hot packs and ultrasound
Heats deeper and larger areas
42
What are the three types of diathermy?
Inductive coils- shortwave (20-30 mHz)
Capacitive plates- shortwave
Magnetron- microwave (2-300 Hz)
43
Describe inductive coils? What type of structures do they treat?
Heating produced by the creation of a magnetic field (wrapped around the extremity)
Used mainly for deep structures but superficial as well
44
Describe capacitive plates? What type of structures do they treat?
High frequency alternating electrical current flow from one plate to another
Used for Superficial tissue
45
Describe Magnetron? What type of structures do they treat?
used when only a small area of tissue is involved
| Used for superficial tissue
46
Benefits of using Diathermy?
Heat large areas and deep tissue at the same time
47
Diathermy CI
Metal, malignancy, Growing epiphysis, eyes, and testes
48
Diathermy Precautions
Obesity, copper IUD, and Magnetic components in area
49
What type of waves are used in US
Sound waves >20,000 Hz
50
Define intensity for US and the units
the power per unit area of the sound head, w/cm^2
51
Define frequency for US and the units
the number of compression cycles per unit of time (Hz), MHz
52
Define duty cycle for US and the units
The proportion of the total treatment time that the US is on, % or ratio
53
Define effective radiating area (ERA)
The area of the transducer from which the US energy radiates--> treatment area should be no bigger than 2x the head
54
Define Beam nonuniformity ratio (BNR)
The ratio of spatial peak intensity to the spatial average intensity (5:1 or 6:)
55
Describe parameters for thermal and nonthermal US
Thermal- continuous
| Non-thermal- pulse less than .5 (50%)
56
When you have a frequency of 1 or 3.3 MHz what intensity will be used? Which one is deep?
Thermal: 1 MHz- 1.5-2 w/cm^2
3 MHz- .5- 1 w/cm^2
Non-thermal: .5-1
1=deep, 3=superficial
57
What are some non-thermal effects with US?
Increase intracellular calcium and skin and cell membrane permeability. Promotes cell function
58
Adverse effects of US
Burns, blood cell statis, cross contamination/infection
59
Documentation for US
1. Area treated
2. Parameters
3. Patient Position
4. Time
5. Patient tolerance
6. If underwater
60
Define electromagnetic radiation (EMR)
equals electric and magnetic fields that vary over time and are orientated perpendicular to each other
61
Define Laser
a light amplification by stimulated emission radiation
62
Define Light emitting diode (LED)
is a semiconductor diode light source
63
Define Low-level laser therapy
equals application of laser light for therapeutic purposes (Cold laser, low-intensity, low power, or soft laser)
64
Define light
EMR in the visible range of the electromagnetic spectrum
65
What is the difference between polychromatic and monochromatic?
Poly- various wavelengths, broad area
| Mono- single wavelength, laser light
66
Why is light commonly used for inpatient PT, neuropathy, or pain in LE
Because the lasers stimulate nitric acid which causes vasodilation and provides a temporary relief.
67
How many nm is visible light?
400-650 nm
68
How many nm is infrared light?
650-1300 nm (2-4 cm deep)
69
A longer wavelength will penetrate _____ structures.
Deeper
70
What wavelength (nm) has the most therapeutic effect?
over 650 nm
71
Define power in lights and lasers
rate of energy flow
72
Effects of laser and light
Promote ATP production, Increase RNA production, collagen production, and vasodilation. Decrease bacteria growth. Modulates Inflammation
73
Indications for laser and light
Soft tissue/ bone healing, Arthritis, Pain, Lymphedema, and neurological conditions
74
Adverse reactions to laser and light therapy
Retinal damage, Rash, Burning sensation, Increased pain, tingling, erythema, and numbness
75
Documentation for Laser and Light therapy
1. Type of diode
2. wavelength (nm)
3. Power (mW/cm^2)
4. Area treated
5. Energy density (J/cm^2)
6. Patient response
76
How much energy density should be used for:
1. Soft tissue
2. Fractures
3. Arthritis
4. Lymphedema
5. Neuropathy
6. Inflammation-
1. Soft tissue- 5-16 J/cm^2
2. Fractures- 5-16
3. Arthritis- Acute: 2-4, Chronic: 4-8
4. Lymphedema: 1.5
5. Neuropathy: 10-12
6. Inflammation: Acute: 2-8, Chronic: 10-20
77
What are the differences between monophasic PC and Biphasic PC?
Mono- one direction, positive polarity, used to promote tissue healing and acute edema (HVPC)
Biphasic- current flows back and forth during pulse, used for muscle contraction
78
Anode attracts ____, and repels____ ions?
Negative, positive
79
Cathode attracts____ and repels ____ions?
Positive, Negative
80
Documentation for Estim?
1. Area treated
2. Patient position
3. Parameters
4. Electrode placement
5. Duration
6. Patient response
81
What does TENS stand for?
Transcutaneous Electrical Nerve Stimulation
82
What is the difference between Conventional (high) TENS and Low Tens?
High-: Acute, short duration with high freq. , NO muscle contraction , no long term effects (only while being stimulated)
Low: Chronic, Muscle contraction, repetitive stimulation of motor nerves, Long term effects, cannot be used over 45 min (DOS)
83
For demyelinated nerves use a _____ approach.
Direct (NMES)
84
ES for muscle contraction stimulates which muscle fibers FIRST?
Fast twitch- Type 2 fibers
85
A physiological muscle contraction stimulates which muscle fiber FIRST?
Slow twitch- Type 1 fibers
86
Characteristics of type 2 fibers
Fatigue quickly and atrophy quickly
87
Define the overload principle
Increased pulse duration, amplitude, electrode size, and external resistance will lead to a higher load with higher force contraction that has greater strengthening
88
When using Estim with stroke patients, antagonist contraction will _____agonist spasticity.
Reduce
89
When using Estim with stroke patients, agonist contraction will _____agonist strength and control.
Increase
90
What is the required pulse duration for denervated muscle with Estim?
>10ms
91
Where should the electrodes be placed?
One over a motor point of the muscles and the other over stimulated muscle aligned parallel to the muscle fibers
**2 inches apart
92
Estim parameters for Pain:
High
Low
IFC
High- 100-150 pps, 50-80 ms, comfortable, modulation if available, time as needed
Low- 2-10 pps, 100-300ms, contraction, less than 45 min
IFC- 80-150 Hz, Time-15-30 min
93
Estim parameters for muscle contraction:
Muscle reeducation
Muscle Spasm
Muscle Edema
Reeducation: 35-50 pps, 150-350 ms, 10-50% contraction, 1:5 0r 1:3 on:off, 1-4 secs ramp, 10-20 min.
Spasm- 35-50 pps, 150-350 ms, contraction, 2-5 secs on/off, 1-4 secs ramp, 10-30 min
Edema- 35-50 pps, 150-350 ms, contraction, 2-5 secs on/off, 1-4 secs ramp, 20 min
94
Estim parameters for Healing:
Inflammatory phase
Proliferation phase
Inflamm.- HVPC, negative, 60-125 pps, 40-100 ms, comfortable, 45-60 min
Proliferation- HVPC, positive, 60-125 pps, 40-100 ms, comfortable, 45-60 min
95
Estim parameters for Edema:
Inflammation
Lack of contraction
Inflammation- HVPC, negative, 100-120 pps, 40-100 ms, comfortable, 20-30 min
Lack of Contraction- Biphasic, 35-50 pps, 150-350 ms, contraction, 20-30 min
96
What is the time limit for using Estim for muscle strengthening?
10-20 min
97
Define galvontaxis
attracting or repelling appropriate cell types
98
What is Iontophoresis?
Use of an electrical current to promote transdermal drug penetration
99
Where should electrodes be placed for wound healing?
In or around wound
| Polarity is determined by the electrode on or near the wound
100
Negative polarity is used for what stage of healing?
Acute inflammation- will repel negatively charged serum proteins, therefore blocks their movement out of the blood vessels which decreases inflammation
101
Positive polarity is used for what stage of healing?
Facilitate epithelization (chronic)
102
What types of Edema can we treat?
Edema due to inflammation
- area will be red and warm
Edema due to lack of motion or muscle contraction
- Area will be cold, pale, and swollen
NOT SYSTEMIC EDEMA
103
Parameters for Iontophoresis
Amount of electricity: 40-80 mA-min (will be on package)
Treatment time= Dose/ current amplitude
Amplitude: 1-4, 1 being the most comfortable but takes longer.
104
What medications are commonly used with Iontophoresis?
```
Acetic Acid (-): calcific deposits, myositis ossificans
Calcium Chloride (-): scar tissue, keloids, muscles spasms
Dexamethasone (-): Inflammation
Lidocaine (+): Analgesia, inflammation
```
105
Documentation for Iontophorisis
1. Area treated
2. Patient position
3. Parameters
4. Electrode placement
5. Treatment time
6. Patient/ wound response
7. Condition of skin
106
Define compression
a mechanical force that increases external pressure on the body or body part
107
How is fluid balance improved with compression?
By increasing the hydrostatic pressure in the interstitial space
108
Indications for edema control
DVT prevention, venous stasis ulcers, residual limb shaping post-amputation, and to control hypertrophic scarring
109
What causes edema?
```
Imbalance between hydrostatic and osmotic pressure
Venous or lymphatic obstruction
Increased capillary permeability
Immobility
Pregnancy
Systemic failure
```
110
How does compression reduce edema?
Increase extravascular hydrostatic pressure promotes circulation, and may move fluid proximally through vessels
111
Parameters for pneumatic compression pumps
Inflation: Deflation time- 3:1
Inflation pressure should be UNDER diastolic BP (30-60 mmHg for UE, and 40-8- mmHg for LE)
Time: 1-4 hours, 3x a week 4x a day
112
Compression documentation
1. Type of compression
2. Area treated
3. Patient position
4. Inflation:Deflation time
5. Compression pressure
6. Time
7. Patient response
113
Define UV
Is electromagnetic radiations with a frequency 7.5 x 1014 to >1015 Hz
Wavelength: 400 to
114
What are UVA nm
320-400 nm
115
What are UVB nm?
290-320 nm
116
What are UVC nm?
117
Lower wavelength will have ____ penetration
Deeper
118
Factors that effect UV intensity?
Angle ( needs to be 90 degrees), Distance, power of the lamp, and skin pigmentation
119
Effects of UV radiation?
Erythema production, tanning, epidermal hyperplasia (thickening of skin), Vitamin D synthesis, and bacteriocidal
120
What is the primary clinical use for UV radiation?
Psoriasis
121
Documentation for UV
1. Medication used (psoralen)
2. Area treated
3. Type of UV radiation
4. Lamp serial number
5. Distance of lamp
6. Time
7. Patient response
122
How is heat transferred?
Convection and conduction
123
Specific heat of water is ___ that of air.
4x
124
The Thermal conductivity of water is ___ that of air.
25x
125
Water holds ___ the energy of air.
4x
126
Water transfers heat ____ faster than air.
25x
127
What is buoyancy?
The upward thrust against gravity
128
Density of the human body is ___ than water.
Less
129
What is hydrostatic pressure?
The pressure exerted by a fluid on a body immersed in the fluid.
130
Physiological effects for hydrotherapy
Cleansing (wound care), musculoskeletal, cardiovascular (displaces venous blood proximally), respiratory, renal, and psychological
131
Benefits of warm water? Cold water?
Warm- relax muscles, decreases pain
| Cold- Decreased pain and inflammation
132
Cardiovascular effects of hydrotherapy?
```
Central blood volume increases by 60%
Cardiac Volume increases by 30%
Cardiac Output increases by 30%
Decreased HR response to exercise
Increases stroke volume
```
133
Respiratory effects of hydrotherapy?
Increased pressure in chest walls
Increased circulation in the chest cavity
Decreased humidity( good for asthmatic)
134
Renal effects of hydrotherapy?
```
Increased urine production
Increased renal blood flow
Increased central blood volume
Decreased ADH and Aldosterone
Increase in K and Na which results in a decrease in edema
```
135
Avoid ____ water with edema
Hot
136
Hydrotherapy ______ wound healing
accelerates
137
Whirpool temperature for inflammation
32-79 degrees Fahrenheit
138
Whirpool temperature for exercise
79-92 degrees Fahrenheit
139
Whirpool temperature for open wounds and control tone
92-96 degrees Fahrenheit
140
Whirpool temperature for Burns (chronic)
96-98 degrees Fahrenheit
141
Whirpool temperature for pain control & Increase soft tissue extensibility
99-110 degrees Fahrenheit
142
Documentation for hydrotherapy
1. Type of hydrotherapy
2. Patient position or activity
3. Water temp
4. Duration
5. Patient response
6. Fluid pressure and water additive (if used)
143
Estim CI
```
Pacemaker
Pregnancy
Arrhythmia
Clot
Carotid sinus
```
144
Estim Precautions
Cardiac disease
Impaired sensation/ mentation
Malignancy
Open wound
145
Compression CI
```
Heart failure
DVT
Obstructed lymphatic/ venous return
PAD
Infection
Hypoproteinemia
Acute trauma/ fracture
```
146
Compression precautions
```
Impaired sensation/mentation
Hypertension
Cancer
Stroke
Superficial peripheral nerves
```
