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85 Cards in this Set
- Front
- Back
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1st law of Thermodynamics |
Energy transfers form but is not lost or gained in a closed system |
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2nd law of Thermodynamics |
Energy is transferred from hot to cold |
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Conduction |
Energy transferred through direct conduct |
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Evaporation |
Cooling through evaporation of liquid from a surface |
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Convection |
Energy transfer through the flow of air or water
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Radiation |
Energy transfer without touching -Electromagnetic currents |
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Conductivity |
How well a material transfers heat
High water content (Muscle) transfers well Adipose Insulates |
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Specific Heat Capacity (c) |
Amount of calories needed to increase the temperature of 1 gram of substance by 1°C
Adipose has a higher capacitance than muscle Increased energy storage |
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What aspects of treatment affect thermal transfer? |
-Conductivity of tissue -Length of exposure time -Body Volume exposed to heating agent -Temperature of heating agent |
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Hydroculator Temperature |
70-77°C
Heating storage for hot packs |
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Therapeutic temperature for heating tissue |
41-45°C Above 45° may burn |
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Superficial Heating Modalities |
-Hot Pack -Paraffin Wax Bath -Fluidotherapy |
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Deep Heating Modalities |
-Ultrasound -Shortwave Diathermy |
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Paraffin Bath Temperature |
52-53°C |
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Human Core Temperature Skin Temperature |
Core: 37°C Skin: Low 30's |
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Hot Pack Parameters |
Moist Conductive Heat Use 6-8 layers of towel (Covers count for 4-6 layers) Covers larger area 15-20 minutes 70-75°C Avoid laying on heat pack |
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Paraffin Bath Parameters |
52-53°C Dip Immersion Immersion Dip and rap (Dip 6-8 times) Common for hands and feet Skin must be dry, intact, and no jewelry 10-20 minutes |
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Fluidotherapy Parameters |
Dry heat through Forced Convection 41-52°C 20-30 minutes Can do ROM during treatment |
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Hunting Response |
Alternating vasoconstriction and vasodilation in extremities in response to exposure to cold temperatures < 10°C |
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Raynauds Syndrome |
Excessively reduced blood flow to extremities in response to cold Hypersensitivity |
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Contraindications for Cryotherapy |
Do not put over regenerating Nerves Open wounds Cardiac Dysfunction Arterial Insufficiency Raynaud's Hypersensitivity |
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Ice Pack Parameters |
Conduction -21 to -12°C Pillowcase for hygiene and condensation 10-30 minutes Can use over larger area |
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Ice Massage |
Conduction Use over smaller area Tear off strips of cup as ice starts to melt |
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Vapo-Coolant Parameters |
Evaporative cooling Ethyl Chloride sprayed on skin Prescription needed Used in conjunction with stretching program |
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Cold Compression Garments |
Used after surgery most often - Cryo Cuff Water is pumped into compression sleeve Temperature is 7-13°C |
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PRICE Acronym |
P - Prevention R - Rest I - Ice C - Compression E - Elevation |
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Gate Theory of Pain |
Pain and Touch are carried along the same Afferent nerve fibers so Touch blocks Pain signals Stimulating mechanoreceptors releases GABA inhibiting pain transmission at the dorsal horn of the spinal cord |
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Sequence of Cold Sensation |
Cold Stinging Burning Aching Numbness |
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Massage - Stroking |
Unidirectional and continuous motion Superficial and relaxing for the start or end of massage Causes vasodilation and increase in circulation and lymphatic flow |
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Effleurage |
Developed to mobilize fluid in the direction of venous and lymphatic flow Firm Palmer pressure and pause between strokes Used in edema treatment |
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Petrissage |
Mobilization of deep tissues
Used with edema, contractures, and scar tissue |
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Kneading |
Compressing and releasing muscle tissue
Slow circular motion Strong pressure to mobilize deep tissue |
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Wringing |
Lift tissue up and compress it between hands Slow and rhythmic motion Intends to increase ROM |
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Massage - Picking Up |
Grasp muscle and pull it away from underlying fascia and bone Circular motion along long axis of muscle Intent to increase ROM |
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Percussive / Tapotment |
Striking tissue at a rapid rate Not relaxing Over chest to loosen mucus and clear airways Can be used to elicit contraction |
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Deep Friction Massage |
Target connective tissues Scar tissue and adhesion mobilization Applied perpendicular to long axis of tissues Applied in one direction with structures fully stretched |
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Trigger Point |
1 specific band of local muscle contraction May cause sharp pain, muscle weakness, spasm, and referred pain Treat with direct sustained pressure to facilitate release |
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Properties of Hydrotherapy |
Temperature Buoyancy Pressure Drag Viscosity Cohesion |
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Whirlpool parameters |
Mechanical Debridement for wound care 36 to 41°C 20-30 minutes |
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Contrast Bath Parameters |
38-43°C for warm bath, 3-6 minutes 10-18°C for cold bath, 1 minute Continue with 3:1 or 4:1 hot to cold ratio Intend to create pumping effect |
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Benefits of Aquatic Exercise |
Analgesic effect from heated water Low Impact Buoyancy to aid ROM, strength, and gait Pressure to increase venous return Resistance training moving against drag |
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Pulsed Shortwave Diathermy (PSWT) |
Heating through radiation Electromagnetic energy from radio frequency 27.12 MHz Higher water content absorb more because of low impedance Patient must remain still 15-30 minute |
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Non-Thermal effects of Pulsed Shortwave Diathermy |
Used for acute injuries <5 watts, 65-80 micro seconds, 100-200 pps Reduce inflammation, Increase Collagen production, increase WBC, and Faster absorption of hematoma and edema |
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Thermal effects of Pulsed Shortwave Diathermy |
Used for Chronic injuries >5 watts, 300-400 micro seconds, >300 pps Vasodilation, increased metabolism, muscle relaxation, heat to 3 cm deep, increase extensibility |
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Low Level Laser Therapy |
Non-thermal modality to increase healing Increase cellular metabolism, scar reuction Coherence: same wavelength Monochromatic: Same color Collimated beam: concentrated together Shorter wavelength = superficial |
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Piezoelectric Effect and Reverse Piezoelectric Effect |
Piezoelectric Effect: Mechanical compression causes voltage output Reverse Piezoelectric Effect: Apply voltage to crystal which causes it to expand and contract |
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Ultrasound |
Sound Waves used to heat deep tissues (5 cm) 5-10 minutes to heat to 45°C Need medium/gel and must keep head moving Measured in watts/cm2 0.25-2 W/cm2 1 MHz is deeper 3 MHz is more superficial "Hot spots" absorbed more by Collagen tissue |
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Beam Non-Uniformity Ratio (BNR) |
Ratio to describe maximum intensity vs. Average intensity in the Ultrasound beam 2:1 to 6:1 are best (Higher than 6:1 means less uniform) |
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Effective Radiating Area (ERA) |
Ratio of crystal size to transducer head size Treatment area can be 2-3x ERA |
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Duty Cycle |
Ratio of time on to time off Most common in Ultrasound is 20% |
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Ultrasound Cavitation |
Expansion of gas bubbles in tissue Do not do ultrasound over eyes or laminectomy site for this reason |
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Acoustic Streaming |
Using ultrasound to move fluid along cell membranes |
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Phonophoresis |
Using ultrasound to transmit medication through the skin Lidocaine, Dexamethasone, and Hydrocortisone Need a prescription Alternative to injection |
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Ohm's Law |
Voltage = Current magnitude x resistance |
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Anions |
Negatively charged Electrons Repelled by the Cathode (-) Attracted to the Anode (+) |
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Cations |
Positively charged Protons Repelled by the Anode (+) Attracted to the Cathode (-) |
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Order of Electrical Stimulation |
Sensory → Motor → Noxious |
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Components of describing a Waveform |
Number of Phases Symmetry Balance Shape (Sine, Rectangle, Triangle, Spike) |
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Higher Frequency = __________ Impedance |
Less Impedance |
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Can a waveform be Balanced and Asymmetrical? |
True |
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What Characteristics can be Ramped Up/Down in Electrical Stimulation? |
Amplitude, Duration, and Frequency |
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Electrical Bursts |
Finite series of pulses at a set frequency for a set time interval |
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Electrical Trains |
Continuous repetitive fixed frequency electrical stimulation
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CNS recruits the _____ neurons first Electrical Stimulation recruits ______ first |
CNS recruits the smaller alpha motor neurons first then moves to largest E-Stim recruits the largest first then the smallest **Greater Fatigue Action Potential travels in both directions along nerve during E-stim |
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Smaller diameter nerve fibers have ____ resistance and _____ propagation |
Higher resistance and slower propagation |
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Describe an action potential |
There is a rapid change in ion permeability Na+ enters the cell and it is depolarized Na+ influx stops when the membrane potential is +35 mV Repolarization as K+ leaves the cell |
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Rheobase |
Measure of membrane excitability Minimal current amplitude of infinite duration that results in a deploarization |
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Chronaxie |
Minimum time required for an electric current double the strength of the rheobase to stimulate a neuron dependent on the density of sodium channels Fast twitch = lower chronaxie than slow twitch |
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Why should you have a patient contract during strengthening with electrical stimulation? |
CNS recruits smaller fibers to larger but e-stim is reversed Using a voluntary contraction will help recruit those smaller muscles and make the strength more functional |
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Hyperalgesia |
Increase pain response to noxious stimuli (pin prick) Primary = at the site of injury Secondary = outside of the site of injury |
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Allodynia |
Painful response to innocuous stimuli (light touch) |
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Conventional TENS Parameters |
High frequency 50-110 pps 50-125 microsecond duration Amplitude below motor threshold Intent to Gate Pain Can be worn all day but patient may build up a tolerance in 4 days (modulation can delay to 9 days) "Buzzing" feeling |
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Acupuncture like TENS Parameters |
Low frequency 1-5 pps 200-500 microseconds Amplitude above motor threshold "Twitching" Intent to release endogenous opioids which will last 4-6 hours after treatment 60 minute limit |
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Spinothalamic Tract |
Transmits nociceptive signals to thalamus, ventroposterior lateral nucleus, onto somatosensory cortex |
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Postsynaptic Dorsal Column |
Transmits noxious and innocuous stimuli to brainstem (medulla) |
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Spinoreticular Tract |
Involved in autonomic pain response and endogenous analgesia Transmit signals to brainstem |
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Current Density |
Concentration of current under electrodes Higher and more uncomfortable under smaller electrodes Same current in a smaller area = Higher |
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Describe the Waveform |
Continuous Train Symmetrical Rectangular Balanced Biphasic |
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Describe the Waveform |
Asymmetrical Unbalanced Biphasic Rectangular and spike |
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Describe the Waveform |
Asymmetrical Biphasic Unbalanced Sinusoidal |
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Describe the Waveform |
High Voltage Pulsed Current Twin Spike Monophasic (asymmetrical and unbalanced) |
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What Waveform Characteristic does this portray? |
Number of phases Monophasic, Biphasic Monophasic can be positive or negative but only one direction, builds up charge |
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What Waveform Characteristic does this portray? |
Symmetry of phases Symmetrical, Asymmetrical A waveform can be asymmetrical but balanced because the area under the curve can be equal |
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What Waveform Characteristic does this portray? |
Balance of the Phases Balanced, Unbalanced |
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What Waveform Characteristic does this portray? |
Shape of Phase Sinusoidal, rectangular, triangular, spike |
