Benefits of heat ? (5)
- pain relief
- reduces muscle spasm and joint stiffness
- promotes relaxation
- increases blood flow
- facilitates fine movement and increases ROM and exercise tolerance in some patients
Generally elevate tissues to __ - __ degree for therapeutic effect
40-45
Benefits of cold?
- decreases swelling after injury / surgery chronic edema and joint effusions
- decreases muscle spasm / spasticity
- mild cooling enhances muscular isometric contracture and endurance
- decrease pain
Infra-red heats via _____ heat transfer
radiation
Whirlpool heats via _____ heat transfer
convection
Parafinn wax heats via _____ heat transfer
conduction
US / diathermy heats via ______ heat transfer
conversion
Greatest effect of heat / cold in tissues is at __- __ mm, after that only about a 1 degree change
1-2
What MUST you test prior to Rx w/ heat / ice?
sensation! (hot / cold)
Paraffin wax usually kept b/w __ - __ degrees Celsius
42-52
Hot pack: use __ - __ cm or __ - __ towels between skin and hot pack
1-2;4-6
Hot packs: skin takes ~ __ minutes to reach max test, do an objective and subjective test at __ minutes, leave heat on for 15-20 minutes
8; 10
Constrast baths: increases blood flow to skin and provides considerable sensory stim, tubs at __ - __ degrees and __ - __ degrees , repeat 3-4x, __ - __ mins total
38-44; 10-18; 20-30
Whirlpool = mechanical stimulation + thermoreceptors, can help with wound ______
debridement
CI’s to use of thermal agents (heat)? (8)
- acute inflammation
- skin conditions
- altered thermal sensation
- hemorrhagic disease
- malignancies
- gonads
- open wounds
- unreliable pt
Check for allergic reactions to cold after __ minute and again after __ minutes
1;5
CI’s / dangers to the use of cold?
- ice burn
- peripheral nerve damage
- frostbite
- reduced peripheral blood supply
- cold sensitivity (Reynaud’s, cold urticaria)
EMG feedback = use for ___ _____ testing; estimated velocity of depolarization along ____ ____ neuron
nerve conduction; alpha motor
Normal skeletal mm EMG feedback = usually ____ at rest
silent
EMG feedback: reduced insertional activity seen in ____ or severely _____ muscles when needle is inserted
fibrotic; atrophied
Abnormal EMG activity at rest suggests _____ or _____
neuropathy; myopathy
Neuropathy of myopathy EMG recordings will be indicated by what 3 things?
- fibrillation potentials
- positive sharp waves
- fasciculation potentials
______ EMG provides info about mm activity in order to up train or down train avidity
surface
Surface EMG is used as a tool, not a treatment (T/F)
TRUE
Use _____ for acute and chronic pain, muscle twitch, muscle strengthening and spasticity management
TENS
TENS ______ setting = segmental mechanism gaiting at SC
conventional
TENS _______ mechanism = release of opiod and serotonin receptors
1extra-segmental
Parameters for conventional TENS?
- 80-150 Hz
- 60 microseconds
- intensity to comofortable tingle
- electrodes over site of pain / bracketing
- 30 mins, immediate pain management
Parameters for AL TENS?
- 10 Hz
- 200 microseconds
- intensity to muscle twitch
- electrodes on motor point
- duration 40-60 mins
- prolonged pain management
CI’s to TENS? (8)
- electronic devices
- low back or abdomen of pregnant women
- malignancy
- DVT or thromboembolism
- infected tissues
- impaired sensory awareness
- cognitive or communication impairments
- cardiac disease or arrhythmias
Use _____ for pain, produce muscle twitch, increasing muscle strength and spasticity management
NMES
Parameters for pain for NMES?
same as TENS
Parameters for edema management NMES?
- over extra-articular edema
- 5-10 Hz
- 200 microseconds
- motor intensity to twitch
Parameters for muscle strengthening NMES?
- > 35 < 65 Hz
- intensity to tetany
- rise and fall (2 s ramp up, 1 sec off, 6 s contraction = 9s in total)
- on/ off depending on strength of muscle
- 12 - 15 contractions
On/off periods for NMES based on muscle grades?
- Gr I = 1:5
- Gr III = 1:3
- Gr IV = 1:1
CI’s to NMES?
- electrical devices / implant
- pregnancy ANYWHERE
- active DV T of thromboembolism
- infected tissue
- chest w/ cardiac disease / arrhythmias / heart failure
- neck or over eyes
- impaired circulation
- unstable (recent Sx, OP, #_
- intercostal mms or lower abdomen
_____ used for pain management via gaiting and/or endogenous opiate release, edema management via muscle twitch, increasing local blood flow, muscle stimulation for strengthening of pelvic floor
IFC
IFC = ___ voltage, ____ intensity, 2 _____ waves at alternating current of 4000 Hz
low; medium; sinusoidal
IFC: each wave = slightly different ______ and interfere with one another in tissues creating new wave that varies in shapes frequency and amplitude; what is this interference called?
frequencies; linear super-position
Series of wave packets in IFC called ?
beats !
Is IFC balanced or unbalanced ?
BALANCED!
IFC = symmetrical or unsymmetrical? biphasic or triphasic?
symmetrical biphasic !
IFC = amplitude ______ , pulse duration of ____ microseconds, phase duration of ___ microseconds
modulated; 250; 125
Motor parameters for IFC?
- 1-10 Hx w/ strong but comfortable twitch
- 40 - 60 minutes
Sensory parameters for IFC?
- 80 - 150 Hz w/ strong but comfortable sensation
- 20-40 mins
Motor and sensory parameters for IFC?
- 1-150 Hz for both (less effective for motor though!)
Add _____ to IFC to avoid accommodation
sweep
IFC can treat large, deep areas (T/F)
TRUE
IFC caution: can output __ - __ mA - NO THORACIC APPLICATION over __ mA
50-90
Why do you not put IFC over thorax over 50mA?
Bc it might cause ventricular fibrillation!
IFC: ____ electrodes increase current density and risk of burns
smaller
IFC: ______ current flow and increased risk of _____ if electrodes placed too close together
superficial; burns
CI’s to IFC?
- to chest / thorax
- electronic devices
- regions of known or suspected malignancy
- low back or abdomen of pregnant women
- active DVT or thrombophlebitis
- actively bleeding tissues or untreated hemorrhagic disorders
- infected tissues, TB or wounds w/ underlying osteomyelitis
- recently radiated tissue
- impaired sensory awareness
- to the neck or head
- to areas near reproductive organs or genitalia
- to areas near or over eyes
- damaged or at risk skin areas that would result in uneven conduction of current
- cognition of communication impairments
Precautions to using IFC?
- active epiphysis in children
- skin disease
- impaired circulation
- metal implants
- fragile skin
_____ = used for decreased pain, decreased edema, increased wound healing, mm stim
HVPC
HVPC = ___ peak intensity (current), ____ average intensity
high; low
HVPC = __phasic
mono
Monophasic waves can build up a ______ net charge
bigger
HVPC frequency = __-___ Hz, pulse width sized at _- -__ microseconds
1-200; 5-65
HVPC: peak current is high (=higher risk of burning) but there is a long _____ _____ so charge has a chance to dissipate, allowing safer application
interpulse interval
HVPC: parameters for pain management?
same parameters as TENS
HVPC: parameters for wound healing?
- 50 - 100 Hz (submoto!)
- 30-60 minutes
- 3-7 days a weak
HVPC for wound healing: polarity is based on ___ of ____
stage of healing
HVPC: macrophages / epidermal cells / epithelial cells are all _____, fibroblasts are ______
negative; positive
HVPC : one electrode in _____, one __ - __ cm away
wound; 10-20
HVPC: parameters for subacute edema reduction?
- 5-20 Hz
HVPC edema reduction: want muscle twitch, usually start w/ _____ polarity
negative
HVPC edema reduction: 2 possible electrode placements?
- active red on edema (if set as negative, will push away positive portions)
- muscle twitch on motor point and nerve trunk for CHRONIC
HVPC parameters for muscle stim?
- 35-65 Hz
______ = can repel molecules or attract desired cells based on polarity
Galvanotaxis
CI’s to HVPC? (4)
- seizure / epilepsy
- electronic implant
- neck area
- inflammation (don’t want to add energy to injury)
?
Precaution to HVCP?
impaired cognition
______ = treatment method using current flow b/w two electrodes to push ions through the skin barrier
iontophoresis
Iontophoresis: current is _____
direct
Anode = ____ electrode
positive
Iontophoresis: possible ______ reaction under anode, = skin hardening over time (_____)
acidic ; sclerosis
Iontophoresis: possible _____ reaction under cathode, = softening and ____ of skin
alkaline; burning
Iontophoresis: keep the ____ larger ! Current ______ is therefore lower and skin is less likely to burn
cathode; density
Iontophoresis: current density is limited to __ mA/cm^2 under the anode and __ mA/cm^2 under the cathode
1; 0.5
______ is used for hyperhidrosis, MSK inflammatory disorders, plantar fasciitis, TMJ disorders, ischemic skin ulcer, fungal infections, bursitis and tendonitis
iontophoresis
CI’s to iontophoresis?
- over damaged skin or open lesions
- allergy to therapeutic ions
- impaired sensation
- over electric implants
3 features of laser?
- monochromaticity
- coherence
- collimation
_______ = all photons have a single wavelength
monochromaticity
_____ = all photons travel in same phase and direction
coherence
_____ = minimal divergence over distance
collimation
_____ = used to increase tissue healing, decrease pain, decrease inflammation (wound management)
laser
Laser head = based on ___ of lesion
depth
Red - near infrared laser = _- __ mm, near - mid infrared = __ - __mm
1-5;5-10
Dose of lase: acute __J/point, chronic __ J/point
2;4
Frequency of laser: acute = < ____ kHz, wavelenght of __ - ___ nm, chronic = > ____ kHz, wavelengths of _____ - _____ nm
1000; 600-1000; 1000; 1000-1350
Laser can be continuous or pulsed, and non-contact is preferred over contact (T/F)
FALSE - contact preferred over non-contact !
CI’s to laser? (8)
- over eyes (WEAR GOGGLES!)
- known or suspected malignancy
- low back or abdomen of pregnant women
- hemorrhage or severe vascular disease
- tissue infected by TB of virulent bacteria
- actively bleeding tissues o untreated hemorrhagic disorders
- active DVT of thrombophlebitis
- reproductive tissues
Precautions to laser?
- recently radiated tissues
- infected regions (compromised immune function)
- anterior neck
- photosensitive areas
- cognitive impairments
- epiphyseal plates in children
5 BCCDC LASER safety guidelines ?
- use in a controlled area
- laser eye protection is required ***
- only authorized personnel must occupy the area
- the area must have appropriate warning sign
- any windows, doorways openings etc must be either covered or restricted !
____ therapy = treat psoriasis, eczema, vitiligo, pruritus (secondary to liver / kidney disease), acne, photodermatoses, wound healing, atopic dermatitis
UV
UV dosage based on _____
MED
UV dosage: start at __% MED, then work up by __ -__ % as tolerated
70; 5-10
UV therapy = combo of both UVA and UVB (T/F)
TRUE
CI’s to UV therapy ?
- photosensitivity
- skin cancer
- CT disorder
- on eyes (wear protection!)
UV on eyes can cause _____ or ______ (inflammation of the cornea) - cataracts are cursed by chronic exposure to UV
conjuntivitis; photokeratitis
____ = accelerates inflammatory phase to make it as efficient as possible, alters membrane permeability and released wound healing factors
US
Thermal effects of ultrasound? (4)
- decreased pain
- decreased joint stiffness
- improved blood flow
- promote healing
Non thermal effects of ultrasound?
- wound healing
- inflammation and soft tissue healing
- altered scar tissue formation
- stimulation of collagen synthesis
- angiogenesis
- repair of articular cartilage
US parameters: frequency = __ Mz for deep, __ MHz for superficial
1; 3
US intensity: __ - __ W/cm^2 inflammatory phase; __ - __ W/cm^2 proliferation phase; up to __ W/cm^2 during remodelling phase
0.1-0.5; 0.5-0.8; 2.5
US: ___ for acute, ____ for chronic
pulsed; continuous
US: apply to area nor larger than __ - ___ x ERA
2-2.5
US ERA = areas producing __% or more of max power output
5
CI’s to US? (15)
- implantable devices
- abdomen and pelvis if pregnant
- malignancy
- bleeding disorder
- acute sepsis or infection
- TB of lungs or bone
- active DVT or thrombophlebitis
- myositis ossificans
- fracture
- impaired circulation or sensation
- pelvis and lumbar spine if menstruating
- radiotherapy
- gonads
- abscess
- areas of acute inflammation (if using continuous as it generates heat)
Precautions to US? (4)
- SC or superficial nerves
- regenerating nerves
- epiphyseal plate unfused
- implants (metal ok if used pulsed!)
Can leave tape on for __ - __ days, or take off if it increased pain, is red or itchy, etc
2-3