Lecture 21: Non-Systems: Modalities

Physiological effects of general heat application: increased

- CO

- Vasodilation

- HR

- Respiratory rate

- Metabolic rate

Physiological effects of general heat application: decreased

- Muscle activity (sedentary effect)

- BP

- Blood to internal organs

- Blood flow to resting muscle

- Stroke volume

Temperature settings: hot pack

- 165-170 °F Rx temp

- 6-8 layers of toweling

- Hot pack peaks heat in first 5 minutes during this time patient is at greatest risk of burns, treatment time: 20-30 minutes

Temperature settings: paraffin bath

- Rx temp: 125-127 °F

- Rx time: 15-20 minutes

- Used on wrist and hands or feet which are irregular distal areas

Temperature settings: contrast bath

- Immerse involved limb in 100-111°F water for 4 minutes

- Then immerse involved limb in 55-65°F water for 1 minute

A PT student suffered low back pain due to excessive studying during NPTE week and is using hot packs in the PT clinic. When using hot packs, which of the following scenarios is MOST likely to result in burns?

A. Using 6 layers of toweling between the hot pack and the patient

B. A treatment time of 30 minutes

C. A hot pack heated by immersion in water heated to 205 degrees Fahrenheit

D. The patient's skin having too many hair

C. A hot pack heated by immersion in water heated to 205 degrees Fahrenheit

Max risk for burns occurs in the first 5 minutes.

Superficial thermotherapy contraindications

- Acute MSK trauma

- Arterial disease

- Bleeding or hemorrhage

- Over an area of compromised circulation

- Over an area of malignancy

- PVD

- Thrombophlebitis

Indications for iontophoresis

- Hyperhidrosis

- Analgesic

- Calcium deposits

- MSK inflammation

- Sclerotic scars

- Dermal ulcers

- Analgesic

- Fungal infections

- Edema reduction

- Muscle spasm

Iontophoresis: water

- Use: hyperhidrosis

- Polarity: +/-

- Source: tap water

Iontophoresis: salicylate

- Use: analgesic

- Polarity: -

- Source: sodium salicylate

Iontophoresis: acetate

- Use: calcium deposits

- Polarity: -

- Source: acetic acid

Iontophoresis: dexamethasone

- Use: MSK inflammation

- Polarity: -

- Source: dexamethasone phosphate

Iontophoresis: iodine

- Use: sclerotic scars

- Polarity: -

- Source: iodine

Iontophoresis: zinc

- Use: dermal ulcers

- Polarity: +

- Source: zinc oxide

Iontophoresis: lidocaine xylocaine

- Use: analgesic

- Polarity: +

- Source: lidocaine xylocaine

Iontophoresis: copper

- Use: fungal infections

- Polarity: +

- Source: copper sulfate

Iontophoresis: hyaluronidase

- Use: edema reduction

- Polarity: +

- Source: wydase

Iontophoresis: calcium & magnesium

- Use: muscle spasm

- Polarity: +/+

- Source: calcium chloride and magnesium sulfate

A physical therapist is administering iontophoresis for the management of a sclerotic scar in a patient with adhesive capsulitis. To administer this treatment, which ion and polarity should be used?

A. Zinc, negative pole.

B. Acetate, positive pole.

C. Copper, positive pole.

D. Iodine, negative pole.

D. Iodine, negative pole.

Put medicine on a pole with the same polarity because "same repels," so the pole will repel the medicine, which makes the medicine go straight into the skin.

Intensity

- Amount of current delivered per unit area

- "How much"

Frequency

How many times per time

Pulse duration

Amount of time the current is delivered

Duty cycle

On time/ (on + off time)

MVIC

Maximum voluntary isometric contraction

Electrical stimulation parameters for muscle contractions: pulse frequency

35-80 pps

Electrical stimulation parameters for muscle contractions: pulse duration

- 150-220 for small muscles

- 200-350 for large muscles

Electrical stimulation parameters for muscle contractions: amplitude

- >10% of MVIC in injured

- >50% MVIC in uninjured

Electrical stimulation parameters for muscle contractions: on:off ratio

- 6-10 seconds on

- 50-120 seconds off

- Ratio of 1:5

- May reduce off time with repeated treatments

Electrical stimulation parameters for muscle contractions: ramp time

2 seconds

Electrical stimulation parameters for muscle contractions: treatment time

10-20 minutes

Electrical stimulation parameters for muscle contractions: times per day

Every 2-3 hours when awake

A PT is developing a treatment plan for a 32-year-old male patient 4 weeks post arthroscopic debridement of the L knee joint. The PT decides to use FES to improve the strength of the quadriceps. Which of the following parameters is the MOST APPROPRIATE?

A. Pulse duration- 250-300 microsec; 10 seconds on, 50 seconds off

B. Pulse duration- 150-170 microsec; 10 seconds on, 20 seconds off

C. Pulse duration- 250-300 microsec; 10 seconds on, 20 seconds off

D. Pulse duration- 150-170 microsec; 10 seconds on, 50 seconds off

A. Pulse duration- 250-300 microsec; 10 seconds on, 50 seconds off

High voltage pulsed galvanic current: negative electrode use

Used to promote healing of the inflamed or infected wounds

High voltage pulsed galvanic current: positive electrode use

Used to promote healing of the wounds without inflammation

High voltage pulsed galvanic current: electrode placement

Placed in or around the wound area

High voltage pulsed galvanic current: treatment time

- 5 days/week

- 45-60 minutes

Electrical stimulation for inflammatory phase: polarity

Negative

Remember, infection is a NEGATIVE thing, so negative electrode.

Electrical stimulation for inflammatory phase: pulse frequency

60-125

Electrical stimulation for inflammatory phase: pulse duration

Usually press for HVPC at 40-100 microseconds

Electrical stimulation for inflammatory phase: amplitude

To produce comfortable tingling

Electrical stimulation for inflammatory phase: treatment time

45-60 minutes

Electrical stimulation for proliferative phase: polarity

Positive

Electrical stimulation for proliferative phase: pulse frequency

60-125

Electrical stimulation for proliferative phase: pulse duration

Usually press for HVPC at 40-100 microseconds

Electrical stimulation for proliferative phase: amplitude

To produce comfortable tingling

Electrical stimulation for proliferative phase: treatment time

45-60 minutes

A PT is considering implementing electrical stimulation in the patient's plan of care to promote healing duringproliferative phase of a non infected wound. Which of the following will be MOST effective for this patient?

A. High voltage pulsed waveform on positive electrode in wound, 110 PPS.

B. High voltage pulsed waveform on negative electrode in wound, 10 PPS.

C. High voltage pulsed waveform on positive electrode in wound, 10 PPS.

D. High voltage pulsed waveform on negative electrode in wound, 110 PPS.

A. High voltage pulsed waveform on positive electrode in wound, 110 PPS.

A patient presents with partial- and full-thickness burns on the chest regions. The PT decides to apply TENS before debridement to modulate pain. Which TENS mode should provide the BEST relief?

A. Acupuncture-like (low-rate) TENS.

B. Brief intense TENS.

C. Noxious TENS.

D. Conventional (high-rate) TENS.

B. Brief intense TENS.

Brief intense TENS is used to provide rapid-onset, short term relief during painful procedures. The pulse rate and pulse duration are similar to conventional TENS; however the current intensity is increased to patient tolerance.

Phonophoresis use

- Used for transdermal delivery of medication

- Anti-inflammatory

- Analgesic

- Duty cycle = pulsed

- Treatment time = 5-10 minutes

A PT is performing phonophoresis at 0.8 W/cm2, 1.0 MHz and 20% duty cycle on the distal hamstrings. During treatment, the patient reports feeling pain over distal hamstrings. The PT's FIRST appropriate course of action is to:

A. Decrease the intensity to 0.5 W/cm2 and continue moving the head at same speed

B. Keep the same intensity at 0.8 W/cm2and change the setting to 50% duty cycle

C. Increase the intensity to 2.0 W/cm2 and add more coupling medium

D. Turn off the ultrasound and immediately call the physician

A. Decrease the intensity to 0.5 W/cm2 and continue moving the head at same speed

Contraindications for ultrasound

- Acute and post-acute conditions

- Areas of active bleeding

- Area of reduced temperature sensation

- Area of reduced circulation

- DVT

- Infection

- Malignancy

- Over breast implants

- Over carotid sinus or cervical ganglia

- Over epiphyseal areas in children

- Over eyes/heart/genitalia

- Over methyl methacrylate cement or plastic

- Over a pelvic, lumbar, or abdominal areas in pregnant women

- Thrombophlebitis

- Vascular insufficiency

A physical therapist is considering the use of ultrasound to accelerate the tissue healing process of a dermal ulcer. Which of the following parameters is the MOST appropriate to achieve this goal using the non-thermal effects of the US?

A. 0% duty cycle

B. 20% duty cycle

C. 60% duty cycle

D. 100% duty cycle

B. 20% duty cycle

20% is for non-thermal

60% is for thermal

Traction: supine positioning

- Pillow under knee

- For intervertebral joints, facet joints, muscle elongation

Traction: prone positioning

For posterior disc herniation

Hip flexion + traction creates an increase in intervertebral space. To create more space at L5-S1, you need ___ to ___ deg hip flexion

45-60 deg

Hip flexion + traction creates an increase in intervertebral space. To create more space at L3-4, you need ___ to ___ deg hip flexion

75-90 deg

% body weight for disc protrusion, spasm, elongation

25%

% body weight for joint distraction

50 pounds or 50% of body weight

A patient presents to clinic with a posterior herniated nucleus pulposus at L2-3. During the traction treatment in supine, the patient reports increased localized back pain. Which of the following actions is MOST appropriate for the PT to take?

A. Change the position of the patient to side lying

B. Refer the patient back to the physician

C. Change the position of the patient to prone

D. Reduce the traction force to 15% of body weight

C. Change the position of the patient to prone

% body weight for cervical traction

7-10%

% body weight for lumbar traction

- 25-50%

- Do not go over 50

A 57-year-old male patient is having difficulty with walking. The PT documents the knee extension strength to be 2-/5 and incorporates EMG biofeedback to help increase motor recruitment. Which of the following protocol is the MOST appropriate to increase motor recruitment for the knee extensors?

A. Begin with electrodes close together and biofeedback sensitivity is low

B. Begin with electrodes widely spaced and biofeedback sensitivity is low

C. Begin with electrodes widely spaced and biofeedback sensitivity is high

D. Begin with electrodes close together and biofeedback sensitivity is high

C. Begin with electrodes widely spaced and biofeedback sensitivity is high

Weak muscles = high sensitivity = wide placement of pads. This increases motor recruitment. Using opposite of this (strong/tight muscle) = low sensitivity with close placement