U/S,TENS,NMES, Iontopherisis Flashcards
U/S: Hi may name is ….This high frequency sound wave delivers sound into tissue which increases the temperature of tissue and helps with cell permeation and healing.
Rule out Precautions:Metal or plastic implants,unhealed fracture sites, acute inflammation or edema.
Check Skin, screen sensations
Describe procedure to pt.
Purpose:for use of soft tissue healing and pain.
advantages- significant tissue healing, very localized, short application
disadvantages- pt. feels little sensation, pressure of sound head not always tolerated, large areas are difficult to treat.
Procedure: time 5-12 minutes, count how many sound heads it takes to cover the area you treat and that determines amount of time one min per head.12 to 14 max total tx.
application- position body part in a position of relaxation, apply medium, set parameters. Spread medium evenly over area testing tolerance for sound head pressure if needed. While moving sound head turn on, move constantly in over lapping pattern. Assure sound head is in full contact with skin entire by rotating around body part to assure full contact.
settings- 1.2 heat continuous ( 100%), ( intensity button hit last!). Then 3.3MHZ 1-2cm deep ( less deep than 1 MHZ Nancy never uses this!) . If decide to use non thermal( 20% duty cycle) hit pulse between 0.6 -0.9.
Neuromuscular Electrical stimulation ( NMES): Hi my name is…im your Ot student today and I am providing an active assistive exercise with this machine that produces a contraction to the muscle that helps with AROM , strength and muscle re-education.
Precautions: In order to make sure this treatment is right for you I need to ask you some questions:
Polio, peripheral vascular disease, seizure, decrease sensation, over bony area, over excess adipose tissue/ obesity, over superficial metal implants, skin irritation or wound, use of machinery or sleep while unit on, around microwave or cell phone use, cognitive, esp when planning home use. Anytime active exercise is contraindicated, NMES is contraindicated.Check Skin, screen sensations
Purpose: To strengthen or prevent disuse atrophy, beneficial if need to isolate muscle. Helps with muscle reeducation giving sensory feedback helping motor learning, increases AROM.Could be orthotic substition for subluxation in SH., Edema control.
Procedure: Pt. and Ot must be relaxed! isometric 6 second hold to strengthen: 10 rep 1-3 sets, best to use active motion with NMES.
1.choose custom
2. Duty cycle on/off cycle: off is twice as long as ON.
3.put lead on lft insert always if using one lead.
4.RATE: 25 STIMULATION, 35 Contarction used for small muscle. 50 contraction for large muscle
Time: ON time 10 sec, OFF time 20 sec, ramp time 2 sec.
5.wave form: symmetrical which is more comfortable this is used for most people and in beginning of TX. Asymmetrical: less comfortable but used for deeper muscles or deinnervated muscles or if you do not get a contraction from symmetrical.
6. Cycling: Alternating if use one channel ( always pick this says nancy!) Synchronous if using 2 channels.
Notes: for stronger contraction pads further apart
Transcutaneous Electrical nerve stimulation:hi my name is…I am your OT student TENS is a stimulation ran by a 9volt battery which helps to manage pain.
Precautions: polio, MS, peripheral vascular disease! seizure! decrease sensation! over excess adipose tissue or obesity! over superficial metal implants! skin irritation or wound!use of machinery or sleep while unit on, around microwave or cell phone use! cognitive! ESP when planning home use.
contraindications for electromodalities: demand pacemaker, over carotid artery or anterior neck triangle, trans cerebral electrode placement- seizure, undiagnosed pain or unknown etiology, over
pregnant uterus,infection ( except when use for wound healing), cancer.
Purpose: helps to manage pain control but does not cure pain. used as an alternative therapy to medication. Stimulates sensory receptors. client can use at home and perform activities of daily life who live with chronic pain.gate theory feel it and not pain. Common uses: acute chronic pain, phantom limb pain, post operative pain, obstetric pain, neurological pain shingles, potential painful treatments.
Low frequency TENS: motor or technique: good for diffuse, throbbing, burning pain. Pulse frequency 1-4 pps, pulse duration: 150- 200 micro seconds, treatment time 30 - 45 minutes, pulse amplitude place electrode over motor point, turn up until get muscle twitch.
Noxious TENS: Rarely used, very low pulse frequency and duration. Very aggressive, high skill level.
Modulation concept: Patients will accommodate over time if left on continuous setting. Once TENS set up need to choose an alternate setting either modulation or burst. This will deliver the stimulation in a random fashion to reduce accommodation.
Electrodes: look to chose correct size to achieve specificity of muscle and enough penetration. Placements identify worst area of pain and place one electrode her and the other proximal, determine sensory dermatome pathway and place electrodes within the dermatome, at least one proximal.one pad apart on muscular part.
Proximal: between pain and brain
Parallel:on either side of an incision site or scar
Crossed method: use of 4 electrodes on 4. Corners with worst pain in center
UnilaterL : linear and overlapping with distal point
Contra-laterally: Trait opposite side: used to treat phantom pain or RSD patients who can’t tolerate. Too close: get higher current density at surface. If you spread apart you get deeper penetration.
Procedure: conventional TENS is a sensory technique which is good for patients with sharp well defined pain. Pulse frequency 50 -100 pps start here. Pulse duration is 50- 100 micro-seconds ( usely preset to this). Treatment time is 15-30 minutes, all day or when having pain prn. Pulse amplitude:(dial) turn until feels tingling, tapping or pins and needles ( without muscle twitch).
Application: position in a place of relaxation, ask questions, inspect skin, remove creams, lotions that limit penetration. Assess pain level before tx.
Explain procedure, describe sensation, potential benefits
Place electrodes, set to continuous, select parameters: pulse frequency and pulse duration, turn machine on slowly increasing amplitude until patient reports sensory response, adjust to one of other settings, burst, modulated etc..prevent accommodation. Train patient to turn amplitude up or down for comfort and accommodation. Evaluate effectiveness with pain scale or ability to complete functional task.
Iontophoresis
precautions: polio, MS,Peripheral Vascular Disease, seizure, Decrease sensation, over bony area, over excess adipose tissue/obesity, over superficial metal implants, skin irritation or wound, use of machinery or sleep while unit on, around microwave or cell phone use, cognitive, esp when planning home use.
contraindications: allergy to medication, allergy to sulfites, allergies to shellfish, diabetes alters sugar levels when using cortiocosteroids, precaution consider effect of heat on dispersal of medication
purpose: A therapeutic delivery of medication through a non invasive method of topical delivery of a prescribed medication( ionized drugs) into a localized area of tissue by using the force of direct electrical current to create a therapeutic effect.use DC current( small battery charged unit), to move medication across epidermis into subcutaneous tissue.
procedure: Ion penetration is 1mm below skin.
treatments 3 times a week for 5-9 sessions. techniques include: iontophoresor generally takes 10-20 min dependent on dosage rate. Hybresis: an accelerated method of medication delivery that generally take 3 min although sensation during delivery may be more intense.After tx with machine PT. goes home with medication patch for 2 hours as it enters slow then removes. localizes right to spot that needs it.
Effects are to reduce inflammation of soft tissue, reduce calcium deposits, reduce scar adhesions( dupytrens release). The medication is 2% NACL ( -charge)
Application: be familialr with in notes!
