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97 Cards in this Set
- Front
- Back
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Exchange of heat when when two surfaces come in contact with each other
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Conduction (hot/cold packs,paraffin)
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Exchange of thermal engery between an object and the fluid moving past it
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Convection (fluidotherapy)
Faster than conduction |
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energy is convered into heat, able to penetrate deeper tissue
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Conversion (US)
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List in order from coldest to hottest:
Paraffin Hot pack in hydrocollator Fluidotherapy Whirlpool |
Whirlpool 96*-104*
Fluidotherapy 102*-118* Paraffin 113*-129* Hot pack 158*-167* |
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US has been shown to ?
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Accelerate healing of soft tissue
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The intensity of US affects what?
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The depth of penetration
1MHZ= up to 5cm depth 3MHZ= up to 2 cm depth |
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Whats the benefit of applying US while hand immersed in water?
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Prevent damage to soundhead
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US is a what type of heat energy?
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Conversion
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Continuous verses Pulsed
Thermal or Non thermal? |
Continuous is thermal
Pulsed non thermal |
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Clinical reason to use pulsed US
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Decrease inflammation
Increase fibroblastic activity and wound healing Decrease acute tendonitis |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Precautions with US
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Silicone implants
Healing Fractures 3MHZ heats faster than 1MHZ, need to lower intensity |
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Tissues high in ___ tend to be better absorbed and faster absorbed by US
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Protein (collagen, bone/cartilage/tendon/scar tissue/skin/muscle
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Continuous verses Pulsed
Thermal or Non thermal? |
Continuous is thermal
Pulsed non thermal |
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Continuous verses Pulsed
Thermal or Non thermal? |
Continuous is thermal
Pulsed non thermal |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Clinical reason to use pulsed US
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Decrease inflammation
Increase fibroblastic activity and wound healing Decrease acute tendonitis |
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Clinical reason to use pulsed US
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Decrease inflammation
Increase fibroblastic activity and wound healing Decrease acute tendonitis |
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Clinical reason to use pulsed US
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Decrease inflammation
Increase fibroblastic activity and wound healing Decrease acute tendonitis |
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Precautions with US
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Silicone implants
Healing Fractures 3MHZ heats faster than 1MHZ, need to lower intensity |
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Clinical reason to use pulsed US
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Decrease inflammation
Increase fibroblastic activity and wound healing Decrease acute tendonitis |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Precautions with US
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Silicone implants
Healing Fractures 3MHZ heats faster than 1MHZ, need to lower intensity |
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Clincial reason to use Continuous US
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Increase circulation (heat)
Increase tissue elasticity Assist with scar remodeling (heat) |
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Tissues high in ___ tend to be better absorbed and faster absorbed by US
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Protein (collagen, bone/cartilage/tendon/scar tissue/skin/muscle
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Precautions with US
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Silicone implants
Healing Fractures 3MHZ heats faster than 1MHZ, need to lower intensity |
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Physiological effect of heat
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Analgesic
Increases tissue extensibility and stiffness at 41-45C Vasodilation Indirectluy affect sympathetic response Aids in venuous return |
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Contraindications for Heat
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Diminsheed sensation
Very young or elderly Nerve injured, insensate hand Impaired circulation, diabetic Vascular instability (replant, skin graft) |
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Physiological effect of Cold
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Pain reduction
Slows nerve conduction velocity Vasoconstriction Decreases metabolic rate Diminished inflammatory response Edema reduction decreases extensibility of collagen |
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Indications and Contraindications to use cold
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Indications: Pain control, Inflammatory conditions
Contraindications: Diminshed sensation, Vascular compromised |
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Physiological effects of Electrical Modalities
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Electrical excitability
Effernt response Facilitates muscles contraction Stimulation of sensory nerves for pain reduction To drive ions into or through the skin for healing |
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"True Galvanic Current"
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Direct Current
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Describe Direct Current
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Steady, "constant" current
UNIdirectional with ion flow in one direction Stimulates denervatede muscle (pulse > 10msec to facilate) |
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Describe Alternation Current
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Continues BI-directional flow
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Describe Pulsatile "Pulsed" current
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Non-Continuous flow or Direct OR Alternating current
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Diffent waveform shapes of AC or Pulsed current
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Sine
Rectangular Triangular |
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Monophasic Pulsatile Current
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-UNI-directional
sometimes referred to as "pulsed galvanic" -Used for edema reduction/wound healing as low amp |
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Explain Paired Spikes
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-Used for wound healing/edema reductions and Pain reduction
-Incorrectly referred to as "pulsed galvanic stim" -Unidirectional current supports use for wound healing/edema reductions, generally not used for muscle facilitation -Pulsatile current |
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Asymmetrical Biphasic
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-Bi-directional
-less skin irritation at higher intensities -Commen for NMES and TENS pulsatile current |
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Symmetrical Biphasic
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-Bi-directional
-Common for NMES -Pulsatile currnent |
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What is Iontophoresis?
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-Induction of topically applied ions into tissue by application of a low voltage direct galvanic current
-Place (+) over (+) ions and vice vers, like charges repel -no specific distance optimal |
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Common solutions used for iontophoresis
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Dexamethasone (-) polarity, used for inflammation
Saline (-), adhesions, scar formation Salicylate (sodim salicylate) (-), Pain relief Lidocaine (cylocaine) (+), pain relief |
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Recommended dosage for ionto
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Inflammatory conditions: desired 4.0mA/ten min
-Treatment time varies on pt tolerance -Generally 6 treatments -DO not use US or heat following ionto, increased blood flow dissipates medication |
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Precautions of ionto
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Consider skin sensitivity
Allergy to drug No clinical studies on use over tendon repairs |
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Two common theories of Pain control with Electrical Stimulation
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-"Gate Theory of Pain"-(melzack and wall (1965)
-"Endorphin Theory" -Eriksson, sjolund, And Nielzen (1979) |
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Explain Gate Theory of Pain
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A fibers: Large, fast, light pressure/prioprioception
C fibers: Small, slow, PAIN Electrical stimulation travels along the A fibers and beats the C fiber (pain) at the spinal cord and closing the gate on the C fibers (pain). Gate control system is thought to be in a segment of the sponal cord called the Susantia Gelationosa |
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explain how the Endorphin Thoery
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Electrical stimulations facilitates the production of endogenous opiates, blocking the perception of pain
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Placement of electodes for deeper and superfical penetration
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Superfical: closer together
Deeper: further apart |
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Precautions of electrical stimulation
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-Areas of decreased sensation
-Unhealed incisions -Erythemia -Bony prominence -Pain/burning sensation -Obese patients -Over growth plates -Skin irritations to electricityor gels |
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Contraindications of electrical Stimulation
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Demand cardiac pacemakers
Heart disease Carotid sinus/artery Eyes Unstable fractures Indewelling stimulators Hx of seizures Pregnancy Peripheral nerve disease rapid fatgiue syndromes INfections |
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Sensory Level Stimulations "conventional TENS" High Rate
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Stimulation at or above sensory threshold and below motor
Freq: 50-150 pps Pulse duration: 40-100 usec Intensity: 20-30 mA Duration: 20-30 min Comfortable, tried first for pain relief |
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Motor Level Stimulation "high Intensity/Acupuncture-Like TENS" Low rate
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Produces visible muscle contraction
Freq: 1-10 pps Pulse Duration: 150-400 usec Intensity: visible contraction 30-40 mA Durations: 30-60 mins Electrode place: antomically linked to pain site |
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Noxious Levle stimulation "brief Intense"
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Painful stimulus is produced
Freq: 100-150 pps Pulse duration: 150-400 usec Inetnsity: to max tolerance Duration: 1-15 mins Pain releif equal to tx time, short carryover |
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High Voltage Galvanic Stimulation (HVGS)
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Used for pain, edema, wounds
Interrupted monophasic waveform Voltage > 100 volts Pulse duration: 2-50 per pulse Freq: varied Intensity noxious, bleow motor thrshold, 2000-2500 mA Polarity variable controlled by therapist |
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Contraindication and indications for HVGS
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Contraindications: heart dysrhythmas
Indications: Edema Pain: chronic and acute, Wound healing: (-) if microorganism are present Higher freq: 15-120 for acute pain Low freq: 5-15 for chronic pain (-) vasocinstriction (+) vasodilation |
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IFC
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Interferential current
Used for pain control Intersection of 2 sine wave of different frequencies |
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Indications for NMES
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facilitate AROM, tendon excursion
Re-education, "backdown program" Reduction of localize edema Relaxation of muscle spasm: high freq Pain relief Increased blood circulation Reduction of jt contracture Temp inhibitation of spasticity Strengthening to prevent atrophy Used as orthotic device (FES) |
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NMES characteristics
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-Stimulates large diameter muscles or fast twitch fibers FIRST
-Active exercise recruits smaller slow twitch fibers - Fast twitch fibers atrophy first; therefore, NMES is used to increase active exercise and reverse atrophy -Rapid fatigue is an issue w/ NMES -Freq: 10-60 pps Pulse duration: 300 usec Ratio: general 1:3 or 1:5 ratio |
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Asymmetrical biphasic NMES
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Good for isolated recruitment of small muscles
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Symmetrical biphasic NMES
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Good for large muscle recruitment or facilitation of two muscles at one time without having to use 2 channels
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Rec treatment size with US
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2x size of sound head
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1MHZ vs 3MHZ
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1MHZ: up to 5 cm, heats us 3x faster and intensity should be lower
3MHZ: up to 2cm |
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Indications for Pulsed US
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Decrease inflammation
Increase fibroblastic activity and wound healing Decrease acute tendonitis |
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Indications for Continuous US
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Increased ciruclation (thermal effect)
Increase tissue elasticity Scar remodeling |
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Precautions for US
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Silcone implants
Healing fractures 3Mhz heats faster than 1mhz, lower intensity |
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Whirlpool is a form of ____?
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Convection]
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Indications for whirlpool
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Open wounds, frailskin, infections
Cleansing effect Assits with dressing removal Assists with light wound debridement Temp: 91F (33-34C) |
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Intermittent Pneumatic Compression Pumps Paramters and precautions
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On/off 3:1 ratio
Pressure not to excedd 40-60 mmHG or disatolic pressure Precautions: acute fracture, CHF, DVT |
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US facilitate the mvt of medications by
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Acoustical streaming
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Max tx time for cold applicatons
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20 mins
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Should US be used on a pt under the age of 16?
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Should be avoided in those still growing, can disrupt epiphyeseal plates
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Should you heat US gel
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No, bc it decreases viscosity
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Best position to treat supraspinatus with US
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Arm IR, abducted to expose the supraspinatus tendon
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US intensity and frequency units
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Intensity w/cm2
Frequency MHZ |
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What are common cold sprays?
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Ethyl chloride: not recommended
Fluorimethane: safere but can freeze skin if on area for > 6 sec |
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Use of whirlpools has declined bc of:
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Advances in wound care
Danger of transmitting infection from pt to pt Efficacy of medications to enhance peripheral circulation |
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Does CPM enhance healing and regeneration of musculoskeletal tissues?
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Yes, and articulare cartilage, synovial membranes, jt capsules, ligaments, tendons, over jt stiffness
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LLPS
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Low load prolonged stretch, explained as "the fibroblasts of the fibrous connective tissue matrix apparently respond to physical forces by a homeostatic biofeedback loop to maintain the proper balance of tissue constituents"
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When is a CPM contraindicated?
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unstable fractures.
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Can a CPM provide LLPS?
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Yes
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Numonic to remember the order of physiological events during ice massage
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CBAN
Cold Burning Aching Numbness |
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Increasing intensity of ES results in
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increased strength of contraction
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Increasing pulse rate from 20-80 yields?
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A slight increase in strength but also induces more rapid onset of fatigue.
Increasing pulse rate above 20 pps results in a smoother contraction |
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What duty cyles of ES induces fatigue faster?
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1:1 ratio fatigues w/i several minutes
1:5 allow the muscles to be active for 30 mins longer |
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The rise time or ramp does what to muscle strength?
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It is the length of time form the onset of the current until its hightest intensity.
It yields a gradual increase in muscle strength |
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T/F: Rheobase is the minimum intensity required to elicit a minimally visible contraction when the duration is infinite
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TRUE
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T/F;Chronaxie is the duration required for a stimulus with twice the rehobase intensity to elicit a visible contraction
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TRUE
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T/F: The strength-duration curve of a denervated muscle requires a lower intensity for a given duration than does an innervated muscle
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FALSE
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T/F; Sensory nerve tissue has a higher threshold than muscle tissue
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FALSE
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Anode
Cathode Which is neg an positive? |
A+ (anode)
C- (cathode) |
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Which current is used with denervated muscle?
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Any current with a long-pulse duration (>1000 microseconds)
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Which TENS modes is appropriate when painful procedures are performend on a pt?
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Brief, Intense
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Ideal parameters for treating wounds with ES
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Direct currents of 75-100 volts
Pulse rate of approx 100 Positive electrode over the wound to stimulate epithelializaton Neg electrode over the wound to stimulate formation of granulation tissue |
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LLLT
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Low level laser therapy
reduces inflammation, stimulates nerve function, develops collagen and muscle tissue, generate new and healthy cells and tissues, increases blood supply, reduces acute and chronic pain. LLLT is painless, sterile, non invasive, drug free. |
