Modalities Midterm Study Guide

what is radiation

Exchange of energy directly without an intervening medium

treatments that are radiation

IR lamp and short wave diathermy

what is conduction

transfer of heat through direct contract

treatments that are conduction

cold/hot pack

what is convection

heat transfer by circulation of a medium of a different temp

treatments that are convection

fluidotherapy, hydrotherapy

what is conversion

conversion of one type of energy to another

treatment that is conversion

ultrasound

what is evaporation

Absorption of energy as the result of material from one liquid to a vapor state

treatment that is evaporation

vapocoolant sprays

what is heat abstraction

All cooling occurs via heat leaving one material and going to another

Cold is never added to something to reduce its temperature

example of heat abstraction

ice pack applied to leg, and heat leaves the leg

what are the contraindications for cryotherapy

Cold hypersensitivity

Cold intolerance

Cryoglobulinemia

Paroxysmal cold hemoglobinuria

Reynaud's disease

over a regenerating nerve circulatory compromise

what is cold hypersensitivity

cold urticaria

vascular skin reaction

wheals with erythematous, raised borders, and blanched centers

who might have cold intolerance

people with rheumatological diseases

CRPS/RSD

what is cryoglobulinemia

abn blood protein that forms a gel when exposed to low temperatures

what is paroxysmal cold hemoglobinuria

release of hemoglobin into urine from lysed RBC in response to local or general cold exposure

what is raynaud's disease

digital cyanosis

what condition is associated with regenerating nerve circulatory compromise

PVD

normal sensation with cold

intense cold

burning

aching

analgesia/numbness

what type of injuries is the PEACE & LOVE framework good for

minor soft tissue

what is peace & love

PEACE (Immediate care: days 1-3 of inflammatory phase)

P: Protection

-Avoid activities and movements that increase pain during the first few days after injury

E: Elevation

-Elevate the injured limb higher than the heart as often as possible

A: Avoid anti-inflammatories

-Avoid taking medications as they reduce tissue healing

-Avoid icing

C: Compression

-Use elastic bandage or taping to reduce swelling

E: Education

-Your body knows best

-Avoid unnecessary passive treatments and medical investigations and let nature play its role

LOVE (After 3 days)

L: Load

-Let pain guide your gradual return to normal activities

-Your body will tell you when it is safe to increase load

O: Optimism

-Condition your brain for optimal recovery by being confident and positive

V: Vascularization

-Choose pain-free cardiovascular activities to increase blood flow to repairing tissues

E: Exercise

-Restore mobility, strength, and proprioception by adopting an active approach to recovery

JOSPT CPG bottom line for US and phonophoresis

should not be used as a stand-alone treatment, low evidence for therapeutic effects

How to use US/phonophresis (if decide to use)

combine with other forms of intervention to see best results

plantar fascia pain and US evidence level and application

A level evidence

-Clinicians should not use ultrasound to enhance the benefits of stretching treatment in those with plantar fasciitis

plantar fascia pain and phonophoresis evidence level and clinical application

C level

-may use phonophoresis with ketoprofen gel to reduce in individuals with heel pain/plantar fascitis

lateral elbow pain and US evidence level and clinical application

D level

rec cannot be made for use of US as a stand-alone treatment

lateral elbow pain phonophoresis evidence level and clinical application

C level

should not use phonophoresis with 10% hydrocortisone gel, topical prednisolone (2mg/d) or 1% diclofenac sodium gel for treatment of LET

ankle sprain ultrasound evidence level and clinical application

A level

should not use US for management of acute ankle sprains

if US is used on acute ankle sprain, what setting?

nonthermal, pulsed US

patellofemoral pain biophysical agents evidence level and clinical application

B

should not use biophysical agents for treatment of patients with PFP

carpal tunnel US evidence level and clinical application

C

should not use thermal US in treatment of patients with mild to mod CTS

pulsed ultrasound proposed non-thermal effects

1. Microstreaming and cavitation: diffusional changes across cell membrane, alter cellular activity/function

2. Edema resolution

3. Tissue regeneration

4. Fracture healing

5. Increased cell permeability

6. Increased macrophage response

7. Increased mast cell degranulation

8. Increased protein synthesis by fibroblasts

9. Increased intracellular calcium

10. Increased chemotactic factor

pulsed ultrasound is supposed to have ____-_____ effects to create a ____ ____ _____ for an ____ injury

non-thermal effects

good healing environment

acute injury

Deep US Frequency

1 MHz

Superficial US Frequency

3 MHz

as frequency increases, ____ tissues absorb more acoustic energy

superficial

-rate of superficial heating increases (3 MHz heats faster than 1 MHz)

what are some structures that you would use 3 MHz to target

patellar tendon

MCL

brachialis

what are some structures that you would use 1 MHz to target

rotator cuff

vastus intermedius

gastrocnemius

temp increase to achieve collagen changes

greater than or equal to 4 degrees C

high vs low frequency penetration

high frequency has shorter penetration

low frequency has deeper penetration

duty cycle calculation

on time/ (on time + off time) x 100%

what is duty cycle in continuous mode

100%

pulse 1:1 duty cycle

50%

pulse 1:2 duty cycle

33%

pulse 1:3 duty cycle

25%

pulse 1:4 duty cycle

20%

ohm's law

I=V/R

what are some common causes of resistance with e-stim

skin and hair

how to decrease resistance before application of electrodes (e-stim)

prep area by using alcohol wipe

what is TENS used for

pain management

what nerves can TENS activate

sensory and motor

what is NMES for

muscle re-ed

MVIC needed for NMES

50%

current types for NMES

pulsed biphasic and russian

use of IFC

deeper pain relief

what is IFC

2 AC that cross each other

what are the two ways that the current can be set for IFC

sweep: current moves around

target: current at center point between electrodes

use of premod

local pain relief

# of channels with premod

1

what makes premod unique

premodulates electrical signal

use of HVPC

wound healing and edema control

use of iontophoresis

med delivery

direct current

alternating current

is a direct or alternating current safer

alternating

-less likely to get burned

pulsed current

pulsed current

interferential current

interferential current

premodulated current

russian current

russian protocol

medium frequency AC with a carrier frequency of 2500 Hz

-10 ms bursts with 50 bursts/sec with a 10 ms interburst interval

what 3 things does a longer phase duration do

• increase depth of penetration

• recruit more motor units

• elicit stronger muscle contractions

explain image for sensory level

treat pain select 200 usec or less

explain image for motor levels

treating muscle weakness greater than 200 usec

allows for stronger contraction with less amplitude

explain this image

Points A and B represent two combinations of stimulus amplitude and duration capable of eliciting a motor response

Point C is incapable of eliciting a motor response because the pulse duration is too short despite the greater intensity

ramp up/down time

________ ramp up time to avoid shock and make pt more comfortable

Increase

frequency units

pps or Hz

frequency for pain (gate theory)

80-150 pps

what nerves are activated with pain (gate theory) frequency

sensory

frequency for pain (endogenous opioids)

1-10 pps

what type of nerves are activated with pain (endogenous opioids) frequency

motor

-rhythmic contraction

motor strengthening frequency

35-50 to gain tetanus of muscle

muscle spasm frequency

sensory response or muscle pump

100 pps

increase circulation frequency

100 pps

decrease edema: ion movement- current type and frequency

DC

100 pps

decrease edema: muscle pump- current type and frequency

biphasic AC

5 pps

electrical muscle recruitment order (and explain)

reverse recruitment order

1. Larger motor units (fast twitch, Type II) are recruited first because they have lower resistance to electrical current due to their larger axonal diameter

2. Smaller motor units (slow twitch, Type I) are recruited later because e-stim bypasses the CNS and directly depolarizes the motor neurons, favoring those with larger axons

what is iontophoresis

modality that uses electrical currents to deleiver meds transdermally

anode charge

positive

cathode charge

negative

what charge of ions do you want to put under anode

positive

what charge of ions do you want to put under cathode

negative

dexamethasone sodium phosphate charge and what it's used for

negative

anti inflammatory

lidocaine charge and what used for

positive

pain relief

acetic acid charge and what used for

negative

calcium deposits or myositis ossificans

iodine charge and what used for

negative

scar tissue management

DC dosage for iontophoresis

40-80 mA-min