263 Edm: General Modalities

Front 1

indications for superficial thermotherapy:

Back 1

1. pain
2. joint stiffness
3. muscle spasm
4. Preparation for electrical stimulation (ES); massage; passive and active exercise

Front 2

General contraindications for superficial thermotherapy are:

Back 2

1. Acute and subacute traumatic and inflammatory conditions
2. Decreased circulation and/or sensation
3. Deep vein thrombophlebitis
4. Impaired cognitive function
5. Malignant tumors
6. Tendency toward hemorrhage or edema
7. Very young and very old patients

Front 3

Hot packs are heated at what temperature?

Back 3

165°F-170°F

Front 4

Treatment time for hot packs:

Back 4

20-30 minutes
If heat is transferred too quickly, mottling (red and white areas) occurs and permanent burn damage may result

Front 5

Paraffin bath is what?

Back 5

paraffin bath contains a paraffin wax and mineral oil mixture in a 6:1 or 7:1 ratio

Front 6

Treatment temperature for Paraffin bath:

Back 6

125°F-127°F

Front 7

Treatment time for Paraffin bath:

Back 7

15-20 minutes

Front 8

Indications for Paraffin bath:

Back 8

1. Painful joints due to arthritis
2. Other inflammatory conditions in the subacute or chronic phase
3. Joint stiffness of the hands and wrists

Front 9

Contraindications for Paraffin bath:

Back 9

1. Allergic rash
2. Open wounds
3. Recent scars and sutures
4. Skin infections

Front 10

Contrast baths are what?

Back 10

Use alternating hot and cold immerse to help decrease pain, increase circulation, and decrease swelling

Front 11

indications for contrast bath?

Back 11

1. Any condition requiring stimulation of peripheral circulation in limbs
2. Peripheral vascular disease
3. Sprains, strains and trauma (after acute condition abates)

Front 12

Water temperatures for contrast baths are around:

Back 12

40°C (104°F) for the hot immersion
15°C (59°F) for the cold

Front 13

In the subacute stage begin contrast baths with what?

Back 13

Hot immersion for 3-4 minutes and then in the cold for 1 minute
Alternate hot/cold for 20-30 minutes, ending in hot immersion

Front 14

Hydrotherapy (whirlpool, Hubbard tank) is what?

Back 14

1. Partial/total immersion baths in which the water is agitated and mixed with air to be directed against or around the affected part
2. Patients can move the extremities easily due to the buoyancy of the water
3. Can be used for debridement & loosening of dressings
4. Cleaning & disinfection are important considerations if open wounds are immersed

Front 15

If full body immersion (Hubbard tank) takes place, water temperature should not exceed what?

Back 15

38°C (100°F)

Front 16

Chronic conditions for Hydrotherapy do best between what?

Back 16

37.2°C and 40°C (99°F-104°f)

Front 17

If the patient has peripheral vascular disease, cardiac problems, or open wounds, temperature for Hydrotherapy should be at:

Back 17

Body temperature or below (not to exceed 38°C/100°F)

Front 18

Indications for Hydrotherapy

Back 18

1. Decubitus ulcers
2. Open burns and wounds
3. Post-surgical conditions or fractures of the hip
4. Subacute and chronic musculoskeletal conditions of the neck, shoulders, and back
5. Rheumatoid arthritis

Front 19

Physiological effects of cryotherapy:

Back 19

1. Decreases tissue metabolism and enzyme activity
2. Decreases nerve conduction velocity and synaptic transmission
3. Acts as a counterirritant to reduce pain
4. Vasoconstriction of the blood vessels resulting in blanching of the skin.

5. cold for greater than 20 minutes, reflex vailation will occur with reddening of skin

Front 20

General indications for cryotherapy:

Back 20

1. pain
2. acute and chronic traumatic and inflammatory conditions
3. muscle spasm

4. edema

5. thermal burns

Front 21

Contraindications to use of cryotherapy:

Back 21

1. impaired circulation

2. impaired sensation
3. Peripheral vascular disease

4. prolonged application over superficial nerves could result in neuropraxia

5. Raynaud's phenomena

6. cold sensitivity

7. allergic reaction to cold

Front 22

Treatment temperature and time for cold packs?

Back 22

0°F-10°F

10-20 minutes

Front 23

Sensation with ice massage happens in following stages:

Back 23

Cold, burning, aching

Front 24

Treatment time for ice massage

Back 24

5-10 minutes

Front 25

Vapocoolant spray is used for what?

Back 25

To reduce muscle spasm by desensitizing trigger points

Indications for vapocoolant spray:
Myofascial referred pain
Trigger points

Front 26

Treatment time for vapocoolant spray:

Back 26

10-15 minutes

Front 27

General indications for deep thermotherapy:

Back 27

1.Joint contractures
2. Musculoskeletal pain
3. Muscle spasm
4. Subacute and chronic traumatic and inflammatory conditions

Front 28

General contraindications for deep thermotherapy

Back 28

1. Acute infections
2. Impaired circulation,

3. Impaired cognitive function

4. impaired sensation
5. Malignancy
6. Thoracic area containing pacemaker
7. Very young or old patients

Front 29

With US for superficial conditions what frequency is used?

Back 29

3 MHz

Front 30

With US for deeper conditions what frequency is used?

Back 30

1 MHz

Front 31

Treatment intensity for US:

Back 31

0.3-1.5 w/cm2 depending on the treatment goal

Front 32

what intensities are used for acute conditions or thin tissue?

Back 32

Lower intensities
Pulsed US

Front 33

What intensities may be used for chronic conditions or thick tissue?

Back 33

Higher intensities
Continuous US

Front 34

what determines US absorption?

Back 34

1. tissue high in fat or water content = US penetration more deeply with less attentuation

2. if there is more protein (collagen) content, US absorption increases and penetration dec

3. absorption from high to low:

1. bone

2. cartilage

3. tendon

4. skin

5. muscle

6. nerve

7. fat

8. blood

Front 35

what determines US duration?

Back 35

non-thermal = 2 x transducer head per 5-10 minutes

thermal: depends on treatment goal; intensity and frequency used to determine duration required for desired effects.

Front 36

Physiological effects of US:

Back 36

1. Increased tissue temperature
2. Pain threshold
3. Collagen tissue extensibility
4. increased Nerve conduction velocity
5. Tissue temperatures at tissue interfaces (e.g.,bone to muscle)
Deep, aching pain is due to overheating periosteal tissue-reduce intensity immediately

Front 37

Indications for US:

Back 37

1.Joint contractures
2. Musculoskeletal pain
3. Muscle spasm
4. Subacute and chronic traumatic and inflammatory conditions

5. Open wounds
6. Neuromas
7. Periarticular conditions

Front 38

Contraindications for US:

Back 38

1. Acute inflammatory joint pathologies
2. Healing fracture
3. Thrombophlebitis (swelling of a vein from a blood clot)
4. Use of radium or radioactive isotopes
Treatment over

5.brain

6. ear

7. epiphysis of growing bone,

8. eye,

9. heart,

10. cervical ganglia or carotid sinuses,

11. reproductive organs,

12. spinal cord,

13. directly over pacemakers

14. pregnant uterus

Front 39

Precautions for US:

Back 39

1. Metal implants
2. Osteoporosis
3. Plastic implants
4. Primary repair of tendons or ligaments or scar tissue

Front 40

What is Phonophoresis?

Back 40

-Use of US to drive medications through the skin into the deeper tissues
-Local analgesics (lido­caine) and anti-inflammatory drugs (dexamethasone, salicylates) are often used
-Method of application is similar to direct contact technique, except that a medicinal agent is used as part of coupling medium

Front 41

what are the parameters for phonophoresis?

Back 41

mode: Pulsed 20%

Intensity: 1-3 w/cm2

Duration: 5-10 minutes

use gel or transdermal patch

-avoid pastes and creams

Front 42

what force is required for traction in lumbar and cervical regions?

Back 42

1. For the lumbar region, a force of 50% of the patient's body weight is required to cause separation (25-65 lbs)
2. In the cervical region, 7% of the patient's body weight or about 20-30 lbs results in separation
3. In both instances, lower traction forces (lumbar: 30-40 lbs; cervical: 8-10 lbs) are recommended for initial treatment

Front 43

Indications for spinal traction:

Back 43

1. DDD
2. Discogenic pain
3. Herniated nucleus pulposus (disc protrusion)
4. Joint disease or stiffness
5. Meniscoid blocking muscle spasm
6. Nerve root impingement
7. Subacute or chronic joint pain

Front 44

Contraindications for spinal traction:

Back 44

1. Impaired cognitive function
2. Spinal tumors and infections
3. Spondylolisthesis
4. Rheumatoid arthritis
5. Osteoporosis
6. Very young and very old patients
7. Vascular compromise (e.g.,vertebral artery syndrome)

Front 45

Precautions for spinal traction:

Back 45

1. Acute inflammation aggravated by traction
2. Acute strains and sprains
3. Claustrophobia
4. Hiatus hernia
5. Joint instability
6. Pregnancy
7. TMJ problems with use of halter. Remove dentures. consider using a mouth piece

Front 46

Neck positions for spinal traction should be maintained at:

Back 46

1. 0°-5° of flexion to increase intervertebral space at C1-C4
2. 20°-30° of flexion for C5-C7
3. 0° for disc dysfunction

Front 47

Lumbar spine positions for spinal traction:

Back 47

1. For spinal stenosis the hip and knee are placed in 90° of flexion (90/90 position)
2. For posterior herniated disc the prone position without a pillow is preferred position

Front 48

Treatment time for cervical and lumbar traction:

Back 48

5-10 minutes for acute conditions and disc protrusion, herniated disc
15-30 minutes for other conditions

Front 49

Intermittent compression is used to do what?

Back 49

Decrease or prevent the formation of edema

Front 50

What determines the setting of the Intermittent compression device?

Back 50

Patient's BP

-some manufacters recommend never exceed pt's DBP. others advise that can fall between diastolic and systolic

Front 51

Intermittent compression must be used at least how many hrs per day?

Back 51

2 hours per day (2 of every 24 hours)

Front 52

Indications for Intermittent compression:

Back 52

1. Chronic edema
2. Lymphedema (e.g., postmastectomy)
3. Stasis ulcer
4. Traumatic edema
5. Venous insufficiency
6. Amputation

Front 53

Contraindications for Intermittent compression:

Back 53

1. Acute inflammation or infection in treatment area
2. Acute deep venous thrombosis or pulmonary edema
3. Arterial insufficiency
4. Cancer
5. Diminished skin sensation
6. Kidney or cardiac insufficiency
7. Hypertension
8. Cognitive dysfunction
9. Obstructed lymph channels
10. Very young and frail elderly patients

Front 54

Continuous passive motion (CPM) is what?

and what can be changed regarding settings/

Back 54

provides mechanical passive motion

1. size of motion arc

2. position of arc

3. rate of motion

Front 55

CPM inhibits what?

Back 55

1. Adhesion formation
2. Improves cartilage nutrition via better fluid mechanics and

3. may stimulate the production of chondrocytes

Front 56

Indications for CPM:

Back 56

1. Post-immobilization fracture
2. Tendon or ligament repair
3. Total knee replacement
4. Total hip replacement

Front 57

Contraindications for CPM:

Back 57

Thrombophlebitis or deep venous thrombosis

Front 58

CPM should be discontinued when?

Back 58

Increases in pain, edema, or inflammation are noted

Front 59

Precautions for CPM:

Back 59

Intracompartmental hematoma from anticoagulant use

Front 60

For tilt table what are indications to return the patient to a more horizontal position?

Back 60

1. Drop in BP
2. Diaphoresis (excessive sweating)
3. Agitation

Front 61

Indications for tilt table:

Back 61

1. Prolonged bed rest
2. Immobilization
3. Spinal cord injury
4. Head injury

Front 62

Contraindications for tilt table:

Back 62

Unstable fractures
Confused or anxious patient

Front 63

what are measures that can be added to tilt table use to prevent venous pooling?

Back 63

elastic wrap and an abdominal binder

Front 64

what signs during tilt table use give indication of peripheral oxygenation?

Back 64

lip color

nail bed color

Front 65

Massage is used for what?

Back 65

1. Increase blood flow
2. Stretch or loosen scar tissue
3. Reduce edema and pain
4. Relax muscles

Front 66

Indications for massage:

Back 66

1. Subacute and chronic musculoskeletal conditions
2. Muscle spasm
3. Superficial scar formation
4. Edema
5. Postural drainage

Front 67

Contraindications for massage:

Back 67

1. Acute inflammation or febrile condition
2. Severe atherosclerosis or varicose veins
3. Phlebitis and thrombophlebitis
4. Areas of recent surgery
5. Cardiac arrhythmia or heart failure
6. Malignancy
7.Hypersensitivity
8. Severe rheumatoid arthritis
9. Hemorrhage in area
10. Edema secondary to kidney dysfunction
11. Venous insufficiency