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68 Cards in this Set
- Front
- Back
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TENS is primarily used for what?
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Pain
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NMES is primarily used for what?
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When you need a muscle contraction: Decreased strength or poor voluntary control
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What are the two types of NMES currents?
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Russian and symmetrical Biphasic
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What is another name for the Russian current?
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Medium Frequency Burst A/C
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What is another name for the Interferential current?
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Medium frequency beat A/C
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High Volt Pulse Current is primarily used for what?
And Why? |
Acute edema and Wound healing
Because it delivers a charge, kills bacteria, and stimulates cell growth |
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Iontophoresis is primarily used for what?
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Superficial inflammatory conditions
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D/C currents are used primarily for what?
And Why? |
denervated muscles
It takes a lot more stimulation and phase charge to activate muscle. D/C current has an unlimited phase duration. |
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Phase charge is the sum of what?
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phase duration (time) multiplied by amplitude
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Interferential current is primarily used for what?
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Pain control
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What is intereferential current NOT good for?
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Motor
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What can NMES be used for?
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Increase Strength
Decrease spasticity Improved voluntary control Edema muscle pump Endurance Increased Mobility |
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What is the order of tissue excitability on the strength duration curve?
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A beta, A alpha, A gamma, C, and Muscle tissue
The further to right you go, the higher the capacitance of the fiber, i.e. it can store more energy |
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Define capacitance.
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Ability to store electrical charge
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How do we define low frequency, medium frequency and high frequency (in pps or Hz)
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Low < 1000 pps or Hz
Medium 1,000 - 10,000 pps or Hz High > 10,000 pps or Hz |
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What is the purpose of modulations?
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To prevent the patient from habituating to the stimulus - good for pain patients.
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When is continuous e-stim used vs. ratio on/off time?
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Continuous: Pain
on/off: strengthening |
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Which type of nerve is stimulated first? Sensory, pain, or motor?
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Sensory
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Describe what a cathode is.
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"active" electrode, depolarizes cell membrane
- charge and attracts + ions Greater concentration of electrons |
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Describe what an anode is.
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"Indifferent" electrode - hyperpolarizes
+ charge and attracts - ions and free electrons Fewer electrons |
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What are the contraindications for estim?
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Pacemaker
Over carotid sinuses Thrombosis or thrombophlebitis Indwelling electrical stimulators (bladder, phrenic nerve) Near an operating diathermy device While operating hazardous equipment |
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What are the indications for TENS?
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Pain (chronic or acute)
Wound healing Labor and delivery |
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What things can limit muscle contraction?
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Joint effusion
Pain Contractures |
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What are the physiological effects of NMES?
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- Increase strength of muscle weakened by disuse atrophy
- Facilitates improved motor recruitment during function - Increase endurance - Decreases spasticity - Increases ROM - Promotes peripheral circulation |
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What are the indications for NMES?
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- Impaired motor control due to joint pain/effusion
- Decreased strength - Edema (sub-acute or chronic and combine with heat) - Decreased ROM - Neurological injury |
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What were the study findings on using estim after a tka?
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Increased intensity results in increased motor unit recruitment and force generation.
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What are the contraindications for NMES?
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Pregnancy
Malignancy Metal implant Active motion contraindicated (unstable fracture or recent tendon repair) Thoracic region Pacemaker Implanted stimulators Impaired cognition Are of active bleeding |
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What are the physiological effects of High Volt Pulse Current?
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Stimulates large afferent neurons selectively (optimal for pain control)
Muscle contraction - Prevent atrophy - Reeducate - Reduced edema - Reduce spasm Prevents acute edema Increases rate of tissue healing in chronic non-healing wounds |
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When using High Volt Pulse Current for wound care, what is the MAJOR condition that is a contraindication for use?
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Osteomyolitis
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What are the physiological effects of the interferential current?
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Stimulation of afferent neurons to decrease pain
Pulsating contractions of innervated muscle at low frequency (0-10 pps) Tetanic contraction of muscle (30-50 bps) |
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What are the indications for Interferential current?
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Decrease pain
Increased blood flow-edema reduction Relaxation of muscle spasm |
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How far does Iontophoresis penetrate?
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8-10 mm
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What are the common medications used with iontophoresis?
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Dexamethasone
Acetate Lidocaine |
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What are the indications for iontophoresis?
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Local, superficial inflammatory conditions
Calcification Analgesia Plantar warts Fungal infections Edema |
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What are the contraindications for iontophoresis?
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Allergies to medications
Sensitivity to direct current Acute injury with bleeding Altered skin integrity Metal implants, staples, wires in immediate vicinity Where estim is generally contraindicated |
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What is the highest acceptable BNR for ultrasound?
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6:1
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When do you use continuous ultrasound?
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For thermal treatments
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When do you use pulsed ultrasound?
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When you do not want thermal effects.
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How far is a 3 MHz field penetrating in the body?
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1-2.5 cm
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How far is a 1 MHz field penetrating in the body?
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2.5-5 cm
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What is the RATE of energy transfer dependent upon?
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Intensity
Size of area treated Size of applicator Efficiency of transmission Type of tissue |
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What are the physiological effects of thermal ultrasound?
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Increase in tissue temperature
Increased blood flow Increased NCV Increased extensibility Increased metabolism |
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What are the physiological effects of non-thermal ultrasound?
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Overall acceleration of healing via:
Skin and cell membrane permeability Intracellular Ca++ Mast cell degranulation Chemical release Macrophage responsiveness Rate of protein synthesis by fibroblasts Cavitation Acoustic streaming Microstreaming |
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What are the indications for ultrasound?
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Soft tissue shortening (Capsule, tendons, ligaments)
Resorption of calcium deposits Pain Wound healing (pressure ulcers) Tendon injuries |
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What conditions has ultrasound been shown beneficial for?
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Osteoarthritis
Fibromyalgia Calcific tendonitis Lumbar stenosis Carpal tunnel syndrome |
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What conditions has ultrasound NOT been shown beneficial for?
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Ankle sprains
Spasticity Soft tissue "shoulder pathology" |
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What are the contraindications for ultrasound?
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Malignancy
Pregnancy CNS tissue Pacemaker Acute infection Hemorrhage Thrombophlebitis Eyes Reproductive organs Diminished circulation |
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What are the precautions for ultrasound?
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Acute inflammation (continous ultrasound)
Epiphyseal plates Fractures Breast implants Joint cement and plastic components (heat faster) |
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What is phonophoresis?
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Ultrasound facilitation of transdermal diffusion of medicinal molecules.
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What is the APTA's stance on Physical Agents?
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The use of physical agents alone is NOT considered PT.
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What does the RATE of transfer of ANY thermal modality depend on?
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1) temperature difference between the two surfaces
2) Thermal conductivity |
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What does the TOTAL of transfer of ANY thermal modality depend on?
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1) Temperature differential
2) Duration of contact/treatment 3) Size of contact area |
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What is convection?
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Transfer of heat through a circulating medium.
Heats up faster at same temp! |
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What is specific heat?
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Amount of energy per unit mas required to increase material by 1 degree Celsius.
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What is thermal conductivity?
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Rate at which a material transfers heat by conduction.
Skin has higher specific heat than fat or bone, water is higher than air. |
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What are the physiological effects of superficial heat?
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Increased local temp
Decreased pain Increased soft tissue extensibility Increased circulation Increased metabolism Muscle relaxation Increased cell permeability Accelerated healing |
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What are the hemodynamic effects of heat?
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Vasodilation
Increased capillary permeability Increased blood flow Increased lymphatic/venous drainage Increased formation of edema |
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What are the neuromuscluar effects of heat?
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Increased NCV (2 m/s for every 1 degree C increase)
Increased pain threshold/analgesia Decreased muscle tone Decreased muscle spasm |
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What are the metabolic effects of heat?
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Increases chemical rx rate
Increased oxygen tension Increased activity of collagenase Metabolic rate increased 13% for every 1 degree C |
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What are the indications for heat?
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Pain
Decreased joint ROM/joint stiffness - subacute edema removal - increased tissue extensibility - increased tolerance to stretch Proliferative/maturation phase of healing Muscle spasm and guarding |
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What are the contraindications for heat?
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Acute injury
Recent or potential hemorrhage Thrombophlebitis Impaired circulation - cannot dissipate heat Impaired sensation Impaired mentation Malignancy Post-radiation therapy |
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What are the precautions with heat?
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Elderly or young children
Abdomen or low back during pregnancy Cardiac insufficiency Existing edema if in dependent position With counterirritants Superficial metal |
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What are the physiological effects of cold?
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Decreased tissue temp
Decreased inflammation (decreased histamine release) Decreased pain Decreased blood flow Decreased swelling Decreased spasm Facilitated movement |
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What are the hemodynamic effects of cold?
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Decreased blood flow (first 15 min)
- vasoconstriction - increased viscosity Decreased histamine release Decreased lymphatic drainage Vasodilation after 15 min or <50 degrees ("hunting response") |
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What are the neuromuscular effects of cold?
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Decreased NCV
Increased pain threshold Alteration of muscle force production Altered neuromuscular control Decreased spasticity - decreased muscle spindle activity - decreased gamma motor neuron activity Facilitation of muscle contraction - Alpha motor neuron excitability |
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What ate the metabolic effects of cold?
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Decreased metabolic rate
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What are the indications for cold therapy?
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Acute inflammation
Acute edema (or prevention of after acute injury) Pain Spasticity Flaccidity |
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What are the contraindications for cold therapy?
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Cold hypersensitivity
Cold intolerance Complex regional pain syndrome Paroxysmal cold hemoglobinuria Cryoglobulinemia Reynaud's disease Regenerating peripheral nerve Vascular compromise |
