exam 2

no response to PC or AC but a response to DC

full reaction of degeneration

no response to PC, AC, or DC

absolute reaction of degeneration

iontophoresis

continuous, direct electrical current to deliver therapeutically charged ions through the skin into the systemic circulation

what current is used for iontophoresis

DC

what is the polarity match

positive charged ions = anode

negative charged ions = cathode

dexamethasone

• negative charge

• reduces tissue inflammation

lidocaine

• positive charge

• decreases local pain

what do we generally use for iontrophoresis

DC with a peak current amplitude of up to 4 mA

what do electrochemical burns result from

the alkaline reaction under cathode

how does the cathode form burns

formation of strong sodium hydroxide base that softens the skin and exposes to irritation and burns

where do you place the active electrode for iontophoresis

immediately over the treatment area

where do you place the dispersive electrode in iontophoresis

at least 3” away from active electrode

how many ionized medication per electrode (iontophoresis)

1

what is the typical iontophoresis dosage

40mA/min

most iontophoresis devices allow for…

0-4 mA

what should the current density on the active electrode

0.5

how to calculate maximum safe current amplitude

divide electrode’s conductive surface area in half

what is the limit on frequency of iontophoresis

no more frequently than every 2 days

TENS

transcutaneous electrical nerve stimulation

how does TENS work

by selectively depolarizing peripheral sensory, motor, and nociceptive nerve fibers for pain modulation

most TENS long term users select parameters based on

comfort

what are the 3 TENS modes

• conventional = no muscle contraction

• acupuncture-like = visible muscle contraction

• brief intense = strong muscle contraction and highest tolerable current amplitude

biofeedback

provide moment to moment info about biological function

goal of biofeedback

trains pt to perceive changes without the use of a measuring instrument

electromyographic biofeedback

• measure, process, and feedback electrical activity of muscle contraction using auditory or visual signals

• **does not directly measure muscle contraction

clinical applications of electromyographic biofeedback (4)

• muscle re-ed

• relaxation of muscle guarding

• pain re-ed

• treating neurological and other conditions

what is special about biofeeedback?

no contraindications!

mechanical traction

mecahnical force on the body to separate joint surfaces and elongate surrounding tissue

LASER

light amplification of stimulated emissions of radiation

LLLT

• low level laser therapy

• 3B

monochromaticity

single specific wavelength and frequency

coherence

temporal and spatial

collimation

• does not diverge (a parallel beam)

• propagate over distance

what is the primary hazard when using laser

• irradiation of the eyes

• can cause retinal damage

what is important about the application of laser

patient should not feel anything!

a strong response to PC or AC

there is no reaction of degeneration

a weak response to PC or AD

partial reaction of degeneration

how to apply electrodes for BIOFEEDBACK

• near the muscle being monitored

• parallel to direction of muscle fibers

IPC additional contraindications (7)

• heart failure/pulmonary edema

• CHF

• DVT

• obstructed lymphatic or venous return

• severe arterial insufficiency or peripheral artery disease

• acute fx or trauma

• infection @ site

IPC additional precautions (6)

• impaired sensation

• impaired cognition

• uncontrolled hypertension

• cancer

• stroke/cerebral vascular insufficiency

• superficial peripheral nerves

additional contraindications for iontophoresis (2)

• damaged skin/open skin

• allergies to therapeutic ions

additional precautions for iontophoresis (6)

• skin irritation and burn

• skin areas showing impaired sensation to heat and pain

• near flammable sprays

• minimize risk of electrochemical burn

• poor contact with electrodes

• no weight applied to electrodes

additional contraindications for mechanical traction (11)

• acute injury

• acute inflammation

• hypermobility

• any conditions where movement worsens it

• peripheralization of symptoms with traction: pain/numbness travels away from spine into arm/leg/etc

• structural diseases in spine (tumor, RA, OA, infection)

• severe disc herniation with displaced disc fragment

• abdominal/hiatal hernia

• vertebral artery occulsion

• spinal cord compression

• aortic aneurysm

additional precautions for mechanical traction (10)

• claustrophobia

• pts unable to tolerate supine or prone

• disorientation

• acute neck or back pain

• hx of surgery to spine

• conditions where pressure of belts may be hazardous (pregnancy/vascular compromise)

• respiratory impairments (lumbar traction)

• cardiovascular problems

• tempromandibular joint problems

• children or elders

types of spinal traction

• lumbar

• cervical

types of traction units

• electrical unit

• weighted device

• pneumatic device

indications of spinal traction

• nerve root impingement

• disc herniation/bulge

• joint hypomobility

• paraspinal muscle spasm or guarding

• subacute joint inflammation

specific

• radiculopathy

• DJD of spine

how does biofeedback reduce pain

• relaxes muscles that are tense

• break pain guarding pain cycle

clinical indications for LASER

• tissue healing

• lymphedema

• neurological conditions

• pain management

what conditions is LASER used for pain management

• lateral epicondylitis

• chronic low back and neck pain

• trigger points

• delayed onset muscle soreness

what neurological conditions is LASER used for

• carpal tunnel

• diabetic peripheral neuropathy

how deep does infrared wavelength penetrate

30 to 40mm

how deep does red wavelength penetrate

5 to 10mm

what would u use lower doses for LASER

acute and superficial conditions

what would u use higher doses for LASER

chronic and deeper conditions

uses of IFC

• pain management

• urinary incontinence management

• muscle weakness management

how do the IFC currents work

• they interfered within IFC machine

• don’t crisscross electrode channels

physiological effect of IFC

depolarizes peripheral sensory and motor nerve fibers

beat frequency for IFC (muscle contraction)

50 bps

additional effects of IFC

• fainting, nausea

• using IFC with high current density may lead to skin and tissue burns

difference btw delivery methods for premodulated IFC and IFC

• premodulated IFC: 2 electrodes

• IFC: 4 electrodes

beat frequency for IFC (pain modulation)

1-200 bps

HVPC

• twin-peak, monophasic, pulsed current

• driven by high voltage (always > 150 V)

• pulse duration: 100-200 microseconds

max voltage for HVPC

500 V

uses for HVPC

tissue healing

how long is Rx for HVPC

60 minutes

what should you feel with HVPC

comfortable sensory level

application specifics to HVPC

• stop topical wound care products composed of hypertonic salt solutions or metal ions for several days

• use aseptic technique (gloves, antibacterial wash, etc)

what should i follow for IFC pain modulation

TENS

what should i follow for IFC muscle contraction

NMES

what modality should u feel mild tingling

iontophoresis

what is IPC

application of intermittent external compressive forces that pump air into custom made inflatable garments to compress veins and arteries in UE and LE

uses of IPC

• reduce edema

• decrease pain (by edema and chemical mediators removals)

• increase ROM (by edema removal)

inflation/deflation ratio for IPC

3:1

becker theory

• endogenous current (current of injury) is present in tissue after trauma/diseases

• these currents may be important in soft-tissue repair

what happens when an endogenous system fails

exogenous electrical current is used → boosts weak endogenous healing system

inflation pressures for IPC

• UE: 30-60 mmHg

• LE: 40-80 mmHg

how long is Rx for IPC

• 2-3 hours for once/twice a day

• ppl can do this 3/4x a day

when do you see maximum edema reduction with IPC usage

3-4 weeks

what should you feel w/ IPC

pressure but NO pain, tingling, or numbness

important things to do while using IPC

• CHECK SKIN HOURLY!

• measure BP and girth

adverse effects of external compression

• impaired circulation

• impaired healing

• tissue death

which modality can also enhance the current of injury

HVPC

NCV values for sensory neuroms

• UE: ≥ 53 (median sensory)

• LE: ≥ 48 (sural sensory)

NCV values for motor neurons

• UE: ≥ 45 (median motor)

• LE: ≥ 41 (tibial motor)

what is motor NCV (MNCV)

• distance btw 2 stimulating cathode sites

• L2-L1

sensory NCV (SNCV)

cathode to active distance/latency

phases of EMG eval

• during needle insertion

• at rest

• min effort contraction

• max effort contraction

contraindictaions for HVPC

• fatties

• osteomyelitis area

how long is conventional TENS Rx

20-30 mins to 24 hrs

how long is acupuncture-like TENS Rx

20-30 mins

how long is brief intense TENS Rx

< 15 mins

uses of TENS

pain modulation

what theory is TENS based on

gate control

how is biofeedback used for relaxation

relax muscle guarding

muscle guarding

protective response in muscle that occurs due to pain or fear in movement

how is biofeedback used for muscle re-ed

• elicits muscle contraction

• more useful for pts who perform poorly on MMTs

conditions treated using biofeedback (6)

• hemiplegia after stroke

• SCI

• spasticity

• cerebral palsy

• facial paralysis

• UI and fecal incontinence

how does spinal traction affect the body

• joint distraction/spinal elongation

• soft tissue stretching

• reduction of disc protrusion

• muscle relaxation

• joint mob

what % of force is required to separate vertebral joints

50-60