Modalities

Front 1

Cryotherapy

Back 1

use surface of cryoagents to lower soft tissue temp

Front 2

Cryotherapy rationale

Back 2

treatment of acute/subacute soft tissue

Hemostatic and inflammatory phases of tissue repair

manage pain/spasticity due to effects on peripheral nerves

Front 3

Cryotherapy based on what?

Back 3

heat absorption

heat transfer: heat withdrawn from soft tissue

Front 4

subcutaneous fat effect on cryotherapy

Back 4

acts as barrier for heat transfer due to thermal conductivity

modify parameters for pt based on subcutaneous fat layer

Front 5

Therapeutic effects/indications of cryotherapy

Back 5

vasocontriction

decreased blood flow

decreased cell metabolism

decreased edema

decreased pain

decreased muscle spasticity

Front 6

Optimal therapeutic temp window for cryotherapy

Back 6

50-60 degrees

Front 7

Cryotherapy overall indications

Back 7

moderate - substantiated

Front 8

Cryotherapy TKA indications

Back 8

strong, conflicting

Front 9

Cryotherapy post op musculoskeletal conditions indications

Back 9

strong, substantiated

Front 10

cryotherapy ankle sprain indcations

Back 10

moderate, substantiated

Front 11

cryotherapy spasticity indications

Back 11

moderate, substantiated

Front 12

cryotherapy joint/tendon/muscle condition indications

Back 12

moderate, substantiated

Front 13

cryotherapy arthritic/rheumatoid condition indications

Back 13

moderate, substantiated

Front 14

Qualitative dosimetry for cryotherapy

Back 14

CBAN - cold, burning, achey, numbness

Front 15

quantitative dosimetry for cryotherapy

Back 15

Dose = Tag-Ts (45 F)

Front 16

what should be coupled with cryotherapy

Back 16

wet towels - protects from germs - but does not absorb cold

Front 17

screening tests to do before cryotherapy

Back 17

skin thermal discrimination test

cold urticaria

nail bed test

blood pressure - before and after

skin fold test

Front 18

contraindications for cryotherapy

Back 18

Big 5

cold induced urticaria

raynaud's disease

cryoglobulinemia

paroxysmal cold hemoglobinuria

wounds

PVD

Front 19

Thermotherapy

Back 19

application of heat over skin for heating soft tissues

Front 20

types of thermotherapy

Back 20

most heat packs

paraffin bath

fluidotherapy

Front 21

Thermotherapy rationale

Back 21

increase temp over large areas (MHP)

increase tissue temp over difficult to reach areas (paraffin)

Front 22

4 modes of heat transfer

Back 22

conduction

convection

conversion

radiation

Front 23

specific heat

Back 23

capacity of a substance to store heat

Front 24

thermal conductivity

Back 24

capacity of substance to conduct heat

Front 25

Optimal thermal window

Back 25

104-113 F

Front 26

Why is the optimal thermal window where it is

Back 26

below 104 - desired results not acheived

above 113 - too hot and cell death occurs

Front 27

Indications for thermotherapy

Back 27

RA/OA

Neck/back/shoulder pain

Front 28

overall evidence for thermotherapy indications

Back 28

moderate, substantiated

Front 29

Quantitative Dosimetry for thermotherapy

Back 29

Dose = Tag - Ts (44 F warmer than skin temp)

Front 30

Moist heat pack dosimetric factors

Back 30

- size of pack

- temp difference btwn agent/skin

- application duration

- coupling thickness

Front 31

skin sensory discrimination testing

Back 31

give to assess pt. ability to perceive thermal stimuli

warm and hot test tubes

Front 32

Contraindications for all physical agents

Back 32

Big 5

pregnancy

malignancy

impaired mentation

impaired sensation

electronic implants

Front 33

contraindications for thermotherapy

Back 33

Big 5

thrombophlebitic areas

hemorrhagic areas

acute/severly inflammed areas

Front 34

risks for thermotherapy

Back 34

over area of impaired circulation

cardiac insufficiency

wounds

superficial metal

systemic infectious disease

hand fine motor

Front 35

dosimetry for paraffin bath

Back 35

temp 113-122 F - because it has lower specific heat and lower conductivity

Front 36

Ultrasound foudation

Back 36

use of mechanical acoustic/sound energy to treat pathological soft tissues, dermal wounds, bones, or transfer of ion into tissues

Front 37

Ultrasound rationale

Back 37

mechanical energy transmitted to induce deep/localized thermal and mechanical effects in pathological soft tissues

Front 38

where is ultrasound most effective

Back 38

tissues rich in protein - tendons/ligaments

minimal effect on overlying skin

Front 39

Biophysical characteristics of ultrasound

Back 39

- electric current passes over crystal

- crystal expands and compresses

- produces mechanical pressure waves

- waves travel through medium (gel) to biological tissues

Front 40

effective radiating area of ultrasound

Back 40

area of transducer where US energy radiates

because crystal does not vibrate uniformly, ERA smaller than area of treatment head

Front 41

spatial peak intensity

Back 41

peak intensity of US output over area of transducer. usually greatest in the center of beam, lowest at edge

Front 42

spatial average intensity

Back 42

average intensity of US output over area of transducer

Front 43

beam nonuniformity ration - BNR

Back 43

ratio of spatial peak intensity to spatial avg intensity

- usually between 5:1 and 6:1

Front 44

Thermal effects/indications of ultrasound

Back 44

acoustic energy absorbed

microvibration at high frequency

microfriction

increase kinetic energy

heat

Front 45

mechanical effects/indications of ultrasound

Back 45

stable cavitation

microstraming

Front 46

Attenuation coefficient

Back 46

ability of tissue to absorb US energy

Front 47

order of tissue absorption of US energy

Back 47

Bone > cartilage > tendon > skin > muscle

Front 48

indications of ultrasound

Back 48

Moderate, conflicting

Front 49

what is US used on?

Back 49

myofascial pain

heating of tendon pathologies

adhesive capsulitis

Front 50

Dosimetry of US

Back 50

frequency - based on depth of tissue

1-3.3 MHz

1 MHz deeper penetration - due to longer wavelength

Front 51

What is delivery mode of US based on?

Back 51

amount of thermal effect you are trying to achieve

- continuous

- pulsed

Front 52

Coupling mediums of US

Back 52

Gel

Water

Medium pressure

Front 53

Application techniques of US

Back 53

Dynamic

Hot spots

Front 54

Heating speed of tissues w/ US

Back 54

Superficial tissue heat quick than deep tissue

Front 55

How long do deep tissues require to heat?

Back 55

10 minutes

Front 56

Intensities for heating deep tissue, US

Back 56

>1.0

Front 57

Intensities for heating superficial tissue, US

Back 57

<1.0

Front 58

Indication for Non-thermal dose of US

Back 58

Acute injury- don't want to heat swelling

Front 59

Indication for mild thermal (1 C increase) dose of US

Back 59

Subacute injury

Front 60

Indication for moderate thermal (2-3 C increase) dose of US

Back 60

chronic inflammation, pain, trigger points

Front 61

Indication for vigorous thermal (4 C increase) does of US

Back 61

Stretch Collagen

Front 62

Frequency for .5 intensity

Back 62

1MHz - .04 C/ min

3 MHz - .3 C/min

Front 63

frequency for 1.0 intensity

Back 63

1 MHz - .2C

3 MHz - .6 C

Front 64

frequency for 1.5 intensity

Back 64

1 MHz - .3 C/min

3 MHz - .9 C/ming

Front 65

frequency for 2.0 intensity

Back 65

1 MHz - .4 C/min

3 MHz - .1.4 C/min

Front 66

application intensity to heat deep muscle using US

Back 66

freq - 1 MHz

100% duty cycle

1.5 W/Cm2

13 minutes for vigorous heating

Front 67

heating a tendon with US

Back 67

can heat less due to higher protein levels/vascularity

Front 68

Application intensity to heat superficial muscle with US

Back 68

freq - 3 MHz

100% duty cycle

.5-1.0 W/cm2

7-13 minutes

Front 69

Clinical window for muscle after US heating

Back 69

3.3 minute window

Front 70

Clinical window for tendon/ligament after US heating

Back 70

5 minute window

Front 71

Contraindications for US

Back 71

Hemorrhagic area

ischemic area

thrombosis

infected lesion

GONADS

EYES

PELVIS OF MENSTRUATING WOMEN

SPINAL CORD AFTER LAMINECTOMY

PLASTIC/CEMENT IMPLANTS

Front 72

US risks

Back 72

Epiphyseal growth plates

<6 months post radiotherapy

Front 73

HVPC foundation

Back 73

Use electrical current to aid in soft tissue repair/healing

Front 74

HVPC Rationale

Back 74

treatment of slow to heal chronic wounds in aging population. HVPC can mimic body's bioelectric system and accelerate wound healing process

Front 75

HVPC Waveform

Back 75

twin peak monophasic pulse

Front 76

HVPC voltage

Back 76

150-500 V

Front 77

HVPC pulse duration

Back 77

short 100-200 microseconds, fixed by manufacturer

Front 78

HVPC pulse frequency

Back 78

1-200 pps

Front 79

Why does HVPC have an effect on wounds?

Back 79

injured tissues leak ions out of their cells, causing wound area to be positively charged relatively

Front 80

Galvanotaxis

Back 80

process of specific cells (neutrophils, macrophages, lymphocytes, and fibroblasts) being attracted to injured healing area by electrical charge

Front 81

Cells attracted to wound in inflammatory phase and charge

Back 81

macrophages

neutrophils

(negative charge)

Front 82

HVPC which electrode would be placed near wound in inflammatory phase?

Back 82

anode (+)

Front 83

cells attracted to wound in proliferative phase and charge?

Back 83

fibroblasts

(positive charge)

Front 84

which electrode should be placed near wound in proliferative phase?

Back 84

cathode (-)

Front 85

types of cell attracted to wound in remodeling/maturation phase and charge?

Back 85

keratinocytes

epidermal

(positive charge)

Front 86

which electrode should be placed near wound in remodeling/maturation phase?

Back 86

Cathode (-)

Front 87

Germicidal evidence of HVPC

Back 87

- limited, but stated that passing electric current will induce germicidal effect

- inhibits growth of microorganisms

Front 88

length of HVPC stimulation

Back 88

30 minutes to 2 hours

Front 89

Therapeutic effects of HVPC on edema

Back 89

conflicting

Front 90

therapeutic effects of HVPC on decreasing Pelvic Floor Muscle spasm

Back 90

supported - not specific to HVPC

Front 91

Therapeutic effects not supported for HVPC

Back 91

DOMS

Increased muscle strength/blood flow

Front 92

Evidence for HVPC in decrease pain

Back 92

supported due to gate theory

NOT RECOMMENDED DUE TO CHARGE BUILDUP

Front 93

Indications of HVPC on dermal wounds

Back 93

moderate, substantiate

Front 94

HVPC frequency

Back 94

1-200 Hz

Front 95

HVPC amplitude

Back 95

150-500 V (Comfortable level)

Front 96

HVPC polarity

Back 96

anodal for inflammatory

cathodal for everything else

Front 97

HVPC treatment duration

Back 97

30-90 mins. 1-3x per day

Front 98

HVPC contraindications

Back 98

Osteomyelitis

CA

electronic/metallic implants

anterior cervical

thoracic area

cranial area

ab/pelvis/lumbar of pregnant pt.

Hemorrhages

Front 99

HVPC risks

Back 99

Cross contamination

Universal precautions

Front 100

HVPC application of electrode in or around wound

Back 100

treatment electrode, saline soaked gauze directly in wound covered with foil or single pt. use attached to wire with clip

Front 101

HVPC application of electrode away from wound

Back 101

dispersive electrode placed close to wound site to ensure current delivery through wound

Front 102

interferential foundation

Back 102

low-frequency, amplitude modulated ES current from interference caused by crossing 2 or more medium frequency AC w/ different freq.

PRODUCES BEAT EFFECT

Front 103

interferential used as whaT?

Back 103

electroanalgesic (gate theory)

Front 104

interferential goal

Back 104

deeper penetration - more comfortable

Front 105

interferential used for whaT?

Back 105

pain control primarily

muscle re-education of pelvic floor

Front 106

interferential waveform

Back 106

superimposition of 2 sinusoidal AC of med. freq.

Front 107

how is beat created in interferential?

Back 107

medium frequencies cross and created low-frequency current - waves negate each other as they cross

beat frequency is the difference between the 2 carrier frequencies

Front 108

Quadrapolar technique interferential?

Back 108

4 electrodes - 2 crossing currents

creates 4 leaf clover shaped field

Front 109

Quadrapolar technique Vector scan in interferential ?

Back 109

more dynamic effect

creates more of a circular shaped field to enlarge treatment area

Front 110

interferential stereodynamic technique?

Back 110

6 electrodes make 3 crossing currents

3D field

Not commonly seen clinically

Front 111

interferential bipolar technique (Premodulated)?

Back 111

2 electrodes - 2 crossing currents

currents cross inside device - not tissues

modulated current delivered through one channel

Front 112

what is interferential bipolar technique used to treat?

Back 112

smaller areas

Front 113

Indications for inferential therapy

Back 113

Moderate, substantiated

Pain - Gate theory

Pelvic floor strengthening

bowel dysfunction

Front 114

Inferential pain frequency

Back 114

frequency in BPS

pre-set for 80-150 bps

similar to tens

Front 115

inferential frequency rationale

Back 115

High rate/frequency

Preferentially stim sensory fibers (large A-beta)

Close dorsal horn gate

Front 116

Inferential pain duration

Back 116

15-30 minutes

Front 117

Inferential dosimetry for muscle strengthening and spasm reduction

Back 117

1-10 bps for edema management

10-100 bps for muscle rehabilitation

Front 118

Contraindications of Inferential

Back 118

Big 5

transcervical/thoracic

hemorrhagic area

ARTERIAL/VENOUS THROMBUS

CONTRAINDICATED ACTIVE MOTION - MOTOR

same as TENS

Front 119

Iontophoresis foundation

Back 119

use of electrical current to transfer ionized medication/substances through skin to target tissue

Front 120

Iontophoresis Rationale

Back 120

use DC to deliver ionized substances to skin

Front 121

Why would Iontophoresis be used?

Back 121

pt unable to tolerate oral medications

pt do not want needle injection

Front 122

Electromigration

Back 122

movement of ions across the skin

Front 123

Polarity of electrode for iontophoresis

Back 123

same charge as the druge in its ionic form - like charges repel

Front 124

Electrode labeling of iontophoresis

Back 124

Active, treatment - therapeutic ions are placed

Dispersive, Non-treatment - return electrode, mandatory, closes electrical circuit

Front 125

Drug substance penetration depth iontophoresis

Back 125

Reservoir of medication of epidermis

Passive diffusion to dermis

Localized blood flow

Front 126

Phoretic effects of ionto

Back 126

transfer of ions through stratum corneum

Front 127

electrolytic effects of ionto

Back 127

electrolysis at electrode sites

Front 128

pharmocologic effects of ionto

Back 128

relates directly to the specific pharmaceutical content of ionic drug used

Front 129

what are physiological events under anode in ionto

Back 129

Cl- ions attracted to positive anode

reaction of Cl- ions w/ water leads to weak hydrochloric acid

reaction is sclerotic, can harden skin

Front 130

what are physiological event under cathode in ionto

Back 130

Na+ attracted to negative cathode

reaction of sodium w/ water leads to stronger sodium hydroxide base

stronger alkaline reaction is scleryotic, softens skin, which can raise burn potential

Front 131

Traditional delivery of ionto

Back 131

constant current type electrical device creating continuous monophasic current waveform (DC) w/ peak amp. of 5 mA

Front 132

Monophasic waveform negative reactions

Back 132

unwanted electochemical reaction

pH instability

Front 133

Buffering caused by ionto

Back 133

electrolysis-induced pH changes at skin/electrode interface: impregnation of buffering agent into pad covering drug resevoir

Control current density

Front 134

Indications for ionto

Back 134

Moderate and substantiated

Hyperhidrosis

Rheumatoid d/o

Epicondylitis

Peyronie's disease

TMJ

Calcifying tendinitis

Front 135

4 factors for ionto dosimetry

Back 135

drug ions

polarity

concentration/volume of ionic solution

dose used

Front 136

Dose equation for ionto

Back 136

dose = mA x min

Front 137

current density

Back 137

amount of current amplitude applied against the electrode conductive surface area

Front 138

current density equation

Back 138

CD = A (mA) / S (cm2)

Front 139

max current density under cathode (ionto)

Back 139

.5 mA/cm2

Front 140

max current density under anode (ionto)

Back 140

1.0 mA/cm2

Front 141

ionto contraindications

Back 141

open skin

temporal/orbicular areas

sensitivity/allergy to drug ions

electronic implants

Front 142

ionto risks

Back 142

skin irritation/burns

presence of flammable sprays/solution

over skin w/ impaired sensation

recently shaved skin

Front 143

ionto steps of application

Back 143

ID target tissue

ID active electrode

saturate active electrode with medication

place on target tissue

select appropriate CD

slowly increase amplitude

Front 144

Neuromuscular electrical stimulation (NMES) foundation

Back 144

use pulsed electrical currents applied to skeletal muscle to elecit a motor response to preserve/restore muscle function

Front 145

Types of currents used in NMES

Back 145

Biphasic, pulsed

Russian

Interferential

Front 146

NMES rationale

Back 146

provide practitioners alternate muscle strengthening method that mimics voluntary training methods for those unable to perform contraction

Front 147

effects of NMES

Back 147

improve motor unit recruitment

induce muscle hypertrophy

Front 148

how does NMES strengthen muscles

Back 148

depolarizes motor nerve

rapid repolarization

refractory period

Front 149

difference between motor recruitment in NMES and physiologic

Back 149

NMES recruits largest fibers that innervate larger, fast twitch muscle fibers and recruit small, slow twitch fibers nest

Physiological contractions recruit slow twitch fibers first

Front 150

what is caused by the difference in motor recruitment btwn NMES and physiologic contraction

Back 150

quicker fatigue, more recovery time btwn contractions

NMES contractions rapid and jerky, while physiologic contractions are smooth

Front 151

NMES indications

Back 151

Moderate, substantiated

for quad weakness

IFC pelvic floor weakness, bowel dysfunction, pain

Front 152

NMES dosimetry pulse frequency

Back 152

30-60 pps (mean of 50)

Front 153

NMES dosimetry for pulse duration

Back 153

150-350 microseconds

Front 154

NMES dosimetry for amplitude

Back 154

strong, but tolerable - higher amplitude means more motor units contracted

Front 155

On:off ratio for NMES

Back 155

1:5 to 1:3, 1:1

Front 156

Ramp up for NMES pulse

Back 156

.5-2 seconds

Front 157

NMES duty cycle

Back 157

10 secs on, 50 secs off

Front 158

Electrode placement in NMES

Back 158

over motor point and peripheral nerve

Front 159

Overload principle of NMES

Back 159

muscle must be overloaded to hypertrophy. strength only improves with overloading.

Front 160

Specificity theory of NMES

Back 160

E-stim causes larger, fast twitch muscles to contract before smaller fibers, which produces more force. Therefore, e-stim should be able to produce greater strength gains than exercise alone with same force contractions (Russian protocol)

Front 161

contraindications of NMES

Back 161

ant cervical

thoracic/cranial area

rate resp. pacemakers

1st trimester preg woman (ab, pelvis, lumbar)

over metal implants

epilepsy

hemorrhagic areas

CA

damaged skin

Front 162

NMES risks

Back 162

contact dermatitis

SWD

fainting, nausea, skin rashes, swelling, pain

muscle damage

Front 163

recommended pulse freq. for NMES Russian

Back 163

2500 Hz continuous sine wave, burst modulated for 10 ms w/ 50 pulses per second

Front 164

recommended pulse duration for NMES Russian

Back 164

400 microsecs - each sine wave cycle equaling 200 microsecs per phase

Front 165

Recommended amplitude and on/off time for NMES Russian

Back 165

Amplitude: to tolerance

On/off: 10:50

Front 166

Recommended Ramp/treatment time and times/day to do NMES Russian

Back 166

Ramp: not disclosed

Treatment time: 10-20 mins to produce 10-20 contractions

times/day: once

Front 167

Recommended parameter settings for NMES muscle strengthening

-Pulse freq/duration

-amp

-on/off time

-ratio

- ramp/treatment time

- times/day

Back 167

frequency - 35-80pps

duration - 150-200 microsecs (small m) 200-350 microsecs (large m)

Amp - >10% of MVIC injured, >50% in uninjured

On/Off - 6-10 secs : 50-120 secs

Ratio - 1:5 initially, may reduce over time

Ramp time: 2 secs

treatment time: 10-20 mins for 10-20 reps

Times/day: every 2-3 hours

Front 168

NMES Muscle re-ed. (FES) pulse freq/duration, amplitude

Back 168

freq: 35-50 pps

duration: 150-200 small muscles, 200-350 large muscles

amplitude: sufficient for functional activity

Front 169

NMES muscle re-ed on/off times, ration, ramp time

Back 169

on/off - depends on functional activity

ratio - depends on functional activity

ramp time - at least 2 secs

Front 170

NMES muscle re-ed treatment time, times/day

Back 170

treatment time - depends on functional activity

times/day - N/A

Front 171

NMES Muscle spasm redux pulse freq/duration, amplitude

Back 171

freq - 35-50 pps

duration - 150-200 microsecs (small muscles), 200-350 (large muscles)

amplitude - to visible contraction

Front 172

NMES muscle spasm redux on/off times, ratio, ramp time

Back 172

on/off times - 2-5 sec off

ratio - equal on/off times

ramp time - at least 1 sec

Front 173

NMES muscle spasm treatment time, times/day

Back 173

treatment time - 10-30 min

times/day - every 2-3 hours until spasm relieved

Front 174

NMES edema redux pulse freq/duration, amplitude

Back 174

freq - 30-60 pps

duration - 100-200 microsecs (small m), 200-600 microsecs (large m)

amplitude - to visible contraction

Front 175

NMES edema redux on/off times, ratio, ramp time

Back 175

on/off time - 2-5 sec off

ratio - equal on/off time

ramp time - at least 1 sec

Front 176

NMES edema redux treatment time, times/day

Back 176

treatment time - 30 mins

times/day - twice per day

Front 177

Foundation of TENS therapy

Back 177

use of electrical current (pulsed, biphasic) to stim peripheral nerves to produce ELECTROANALGESIA

Front 178

Purpose of TENS therapy

Back 178

pain management

Front 179

TENS Rationale

Back 179

option for management of pain other than med or surgery

Non-invasive, no side effects, less expensive

Front 180

TENS Waveform

Back 180

biphasic, pulsed current

Modulated, pulse/burst

Front 181

A-beta fibers

Back 181

mechanosensistive

Front 182

A-delta fibers

Back 182

nociceptive

Front 183

C-fibers

Back 183

Nociceptive

Front 184

Gate system

Back 184

Gate to brain may be open or closed in spinal cord, one sensory impulse at a time

Front 185

Opiate system

Back 185

human body pain modulation system

Front 186

level which opiate system operates

Back 186

supraspinal

Front 187

what is involved in opiate system

Back 187

neuroendocrine activity from subcortical areas (periaqueductal gray matter/nucleus raphe magnus)

Front 188

How do we open gate in TENS?

Back 188

preferential depolarization of A-delta & C-fibers

negative fdbk loop, T-cell inhibition

Front 189

TENS strong, substantiated indications

Back 189

Postop ab pain

Labor/post labor pain

postop thoracic pain

OA pain

Dysmennorrheal pain

post op ortho pain

Front 190

TENS moderate, substantiated indications

Back 190

LBP

neurogenic pain

chronic pain syndroms

stump/phantom pain

RA pain

orofascial pain

Front 191

Types of TENS dosimetry

Back 191

convential (high rate)

acupuncture (low rate)

brief intense

burst

modulation

Front 192

Convential TENS dosimetry

Back 192

sensory level

- short duration, high freq

- comfortable pins and needles

preferential depolarization of large diameter A-beta fibers

Close gate

Rapid Analgesi

Front 193

Acupuncture like TENS therapy dosimetry

Back 193

Motor stim

- preferential depol of A-beta fibers AND motor fibers

- tingling and motor contraction to stim DEOS

- Onset of analgesia is slow, but sustained for long period

Front 194

Brief Intense TENS therapy dosimetry

Back 194

High amp capable of noxious stim

- brief due to duration of application being brief

- somewhat painful

- tingling, motor contraction, strong motor contraction, max tolerable pain

- onset of analgesia rapid, sustained for long period

Front 195

what is brief intense TENS dosimetry painful

Back 195

preferential depolarization of A-beta, motor fibers A-delta AND c-delta

Front 196

TENS burst mode dosimetry

Back 196

delivery of bursts of pulses instead of single pulse

(otherwise same as acupuncture- like)

Front 197

Modulation mode TENS dosimety

Back 197

Random modulation of pulse duration, freq, and amp

difficult to state exact mechanism for pain modulation

Front 198

TENS Duration of application

Back 198

30 mins - 3 hours

Front 199

How do you choose mode for TENS therapy?

Back 199

change based on effectiveness on analgesia

Front 200

Contraindications for TENS Therapy

Back 200

pacemaker (especially new ones)

defibrillators

contact dermatitis

ant. cervical

thoracic/cranial

ab/lumbar/pelvic area of pregnant woman

epilepsy

hemorrhagic area

CA

damaged skin

impaired mentation

Front 201

where are electrodes placed in TENS therapy

Back 201

Over pain

surround pain

over trigger point

over acupuncture point

2 or 4 electrodes

Front 202

Conventional TENS Pulse freq/duration/amplitude

Back 202

Freq - 100-150 pps

Duration - 50-100 microsecs

Amp - to produce tingling

Front 203

Conventional TENS modulation, treatment time

Back 203

Modulation - use if possible

Treatment time - 3 hours, multiple time over day, remove unit for skin checks once every 8 hrs.

Front 204

When does conventional TENS control pain?

Back 204

only during stimulation

Front 205

What is likely the mechanism of action of Conventional tens?

Back 205

closes gate at spinal cord level

Front 206

TENS acupuncture like Pulse freq, duration, amp

Back 206

Freq - 2-10 pps

duration - 100-300 micros

amp - to visible contraction

Front 207

TENS acupuncture like modulation, treatment time

Back 207

modulation - none

treatment time - 30 minutes

Front 208

Likely mechanism of action in TENS acupuncture like therapy

Back 208

opening gate, DEOS system, endorphins

Front 209

traction foundation

Back 209

to provide mechanical distraction to spinal structures, including joint surfaces

Front 210

traction rationale

Back 210

provide passive spinal elongation and increase intervertebral space

Front 211

what is traction used for

Back 211

decrease compression forces on disc/peripheral nerve tissues

Front 212

what is mechanical energy for in traction

Back 212

intension is separation of vertebrae

Front 213

what is the steps of tensile forces in traction

Back 213

take up slack

elongate soft tissues

cause joint separation

Front 214

how must tensile forces be applied in traction, why?

Back 214

slow, low level force, consistent. reflexic muscular contraction may happen if too sudden

Front 215

where is forces placed?

Back 215

first muscles, then ligaments, then capsule, then IV disc

Front 216

What is purpose of removing force from IV disc?

Back 216

if outer layer of disc is ruptured and nucleus pulposus is bulging, removing force will draw pulposus back in

Front 217

modes of traction

Back 217

static

intermittent

Front 218

Therapeutic effects/indications of traction

Back 218

reduce disc protrusion

stretch soft tissue structures

relax muscles

mobilize joints

relieve pain

centralize symptoms

prepare pt. for active therapy

Front 219

Moderate, substantiated indications for traction

Back 219

disc bulge

nerve root impingment

joint hypermobility

subacute joint inflammation

paraspinal muscle spasm

central/lateral stenosis

DJD

Front 220

Force dosimetry for traction

Back 220

large enough to overcome weight, friction, gravity acting on spinal segments

Front 221

Force needed for cervical traction

Back 221

10-30% body wt

Front 222

force needed for lumbar traction

Back 222

30-60% body weight

Front 223

traction angle dosimetry

Back 223

0-30 angle of pull

more facet joint separation in 0 degree pull

Front 224

traction duration dosimetry

Back 224

10-30 minutes

Front 225

contraindications of traction

Back 225

Big 5

CONTRAINDICATED MOTION

acute injury/inflammation

spinal cord compression

vertebral artery occlusion

peripheralization of symptoms with traction

uncontrolled hypertension

pregnancy/breastfeeding

Front 226

structural diseases affecting spine to contraindicate traction

Back 226

tumor

infection

RA

osteoporosis

prolonged steroid use

spinal cord stenosis

spondylo

Front 227

When is pressure of traction belt hazardous

Back 227

pregnancy

hiatal hernia

vascular compromise

osteoporosis

TMJ

Front 228

Yellow flags of traction

Back 228

Displacement of annular fragment

medial disc protrusion

severe pain fully relieved by traction

claustrophobia

pt who can tolerate prone/supine

disorientation

dentures

Front 229

what is Diathermy (SWD)

Back 229

electromagnetic agent carrying nrg to soft tissues - absorbed as heat

Front 230

SWD theoretical rationale

Back 230

use of electrotherapeutic agent capable of DEEP HEAT over LARGE SURFACE AREA of soft tissues, minimally heats superficial tissues

Front 231

what is required for movement of waves

Back 231

no medium - travel through vacuum of space @ speed of light

Front 232

how is SWD described

Back 232

wavelength (Peak to peak distance)

Frequency (cycles per sec)

Front 233

frequency characteristics of SWD

Back 233

radio frequency

non-ionizing radiant energy

MOST common (27.12 MHz)

Front 234

SWDD tuning

Back 234

happens when biological tissues oscilllate at same freq as device circuit

Front 235

Type of waves for SWD

Back 235

alternate from + to -

Front 236

Thermal effects of SWD

Back 236

heat increases kinetic NRG of tissues

Front 237

Athermal effects of SWD

Back 237

hypothetical - improves ATP production and growth factor

Front 238

Two modes of application for SWD

Back 238

pulsed

continuous

Front 239

Pulsed SWD

Back 239

on/off time

use when athermal effects desired

Front 240

continuous SWD

Back 240

use when thermal effects desired

Front 241

two methods of SWD

Back 241

capacitive

inductive

Front 242

capacitive SWD

Back 242

use of 2 capacitive metal electrode producing electrical field in patient

Front 243

when is capacitive SWD recommended

Back 243

treatment of superficial soft tissues

mostly absorbed by tissues with high electrical impedence (fat)

Front 244

Inductive SWD

Back 244

use of single inductive coil type electrode wrapped around a treated body segment

produces magnetic field in pt. perpendicular to coil

Front 245

when is inductive SWD used

Back 245

for treatment of deeper tissues - mostly absorbed by tissue with high water content

Front 246

SWD dosimetry

Back 246

qualitative (1-4 scale from pt)

quantitative (total EM NRG to tissues)

Front 247

SWD Duration

Back 247

15-20 minutes

Front 248

SWD indications

Back 248

moderate, substantiated for OA and ankle sprain

Front 249

SWD contraindicaitons

Back 249

big 5

metal, implanted electrical devices

pacemakers

eyes, testes

growing epiphyses of growing children

acute injury/inflammation

recent/potential hemorrhage

thrombophlebitis

Front 250

SWD precautionss

Back 250

follow instructions

other pts. must be at least 15 ft away

adequate toweling

Front 251

SWD screenings

Back 251

sensation

mentation

circulation

metal in/on pt.

skin sensory discriminatory test

Front 252

SWD adverse effects

Back 252

burns

fire

Front 253

SWD set up

Back 253

remove clothing from treatment area

remove metal

postition pt.

inquire pain level

Front 254

SWD pt should feel

Back 254

warming sensation

post - ask from subjective pain level

Front 255

SWD documentation

Back 255

mode/method

electrode placement

pre/post modality measures

qualitative scale

quantitative

pt. reaction

Front 256

low level last therapy (LLLT)

Back 256

use of monochromatic light therapy within visible or infared wavelengths of EMS, used to alter cell behavior w/out heating tissue

Front 257

fundamental biophysical properties of LLLT

Back 257

monochromatic (all photons must have same wavelength)

collimated (not divergent)

coherent (all waves move in phase w/ each other)

EMS Spectrum - 100 nm - 1 mm

Front 258

LLLT types

Back 258

gaseous HeNE

GaAs/GaAlAs semiconductor or diode lasers

Front 259

LLLT treatment needs

Back 259

active medium

resonance chamber

energy source

Front 260

HeNe Laser

Back 260

active medium is He & Ne mixture

resonance chamber - glass tube with mirrors on end

energy source - electric current

Front 261

Biophysical characteristics of LLLT

Back 261

resting/ground state

pumping and population inversion

spontaneous emission

stimulated emission

Front 262

how does a diode laser work

Back 262

electrons cross junction, photons released at specific wavelength

resonance chamber is gap in junction btwn semiconductor material

energy source - electrical current

Front 263

cellular effects of LLLT

Back 263

stim macrophages

increase ATP production

stimulate fibroblasts/increase collagen

altered nerve conduction

vasodilation

Front 264

clinical effects of LLLT

Back 264

wound/fracture healing

musculoskeletal disorders

pain management

*more research needed

Front 265

Laser penetration

Back 265

absorption

scatter/disperse/transmission through tissue

reflection/bounces off

Front 266

HeNe direct effect penetration

Back 266

first .5 cm of tissue

Front 267

GaAs/GaAlAs penetration

Back 267

direct effect: first 2-5 cm

indirect effect: 1-5 cm

Front 268

LLLT indications

Back 268

wound/ulcer management

pain management of local/systemic disorders

Front 269

LLLT contraindications

Back 269

over eye and neoplastic lesion

over ab of pregnant women

over hemorrhagic region/heart

over vagus n./sympathetic region of cardiac pt

over photosensitive skin and infected areas

over bone epiphyseal regions

Front 270

LLLT application

Back 270

with hand held or cluster probe

contact or no contact

manual gridding

manual or auto scanning

Front 271

LLLT dosimetry

Back 271

based on power, power density, NRG density

Front 272

LLLT mode

Back 272

pulsed or continuous

Front 273

LLLT superficial treatment

Back 273

HeNe Laser

Front 274

LLLT deep treatment

Back 274

semiconductor laser

Front 275

How large should the treatment area be for LLLT treatment

Back 275

handheld: <3 cm2

cluster probe: >3 cm2

Front 276

Documentation for LLLT

Back 276

type of laser

power output (mW)

probe/beam type and surface area

mode of delivery (cont. or pulsed)

Method

therapeutic dose/NRG density

total treatment surface area

total irradiation time

Front 277

methods of LLLT

Back 277

direct contact

non contact

gritting

manual scan

auto scan