Modalities

What systemic & physiologic increases with thermotherapy?

Cardiac output

Vasodilation

Heart rate

Respiratory rate

Metabolic rate

What systemic & physiologic decreases with thermotherapy?

Muscle activity

Blood pressure

Blood to internal organs

Blood flow to resting muscle

Stroke volume

What systemic & physiologic changes increases with cryotherapy?

Joint stiffness

Pain threshold (reduce pain)

Muscle activation

What systemic & physiologic changes decreases with cryotherapy?

Collagen extensibility

Blood flow

Capillary permeability

Local metabolism

Spasticity (prolong ice time 10-15 mins)

Nerve conduction velocity

What temperature should hot packs be stored at?

158-167 degrees Fahrenheit

What is the appropriate treatment time for hot packs?

20-30 minutes

How many layers of toweling when applying a hot pack?

6-8 layers

When does the hot pack reach peak heat?

first 5 minutes

What temperature should cold packs be stored at?

25 degrees Fahrenheit

What is the appropriate treatment time for cold packs?

10-20 minutes

how often can cold packs be applied?

every 1-2 hours

What are the stages of cold?

“CBAAN”

• Intense Cold

• B: Burning

• A: Aching

• A: Analgesic

• N: Numb

What are contraindications of Thermotherapy? (MC Tibia Is Hot”

• Malignancy

• compromised circulation

• thrombophlebitis

• impaired sensation or mentation

• bleeding or hemorrhage

• infrared irradiation of the eyes

• arterial disease

What are contraindications of Cryotherapy?

• Cold intolerance

  • cold hypersensitivity

  • cryoglobulinemia

  • paroxysmal cold hemoglobinuria

  • Raynaud’s phenomenon

• over regenerating peripheral nerves

• circulatory compromise

What are ESTIM Parameters for muscle strengthening?

• Pulse frequency: 35-85pps

• Pulse duration: 125-200 microsec for small muscles, 200-350 microsec for large

• Amplitude: > 10% MVIC in injured, >50% MVIC in uninjured

• On:Off Time & Ratio:

  • 1:5 ratio

  • 6-10s on, 50-120s off

• Ramp time: atleast 2s

• Treatment time: 10-20 min to produce 10-20 repetitions

• Times per day: every 2-3 hours

What are ESTIM Parameters for muscle reeducation? (FES/NMES)

• Pulse frequency: 35-50pps

• Pulse duration: 125-200 microsec for small muscles, 200-350microsec for large muscles

• Amplitude: sufficient for functional activity

• On:Off Time & Ratio: depends on functional activity

• Ramp time: atleast 2s

• Treatment time: depends on functional activity

• Times per day: During functional tasks

What are ESTIM Parameters for muscle spasms reduction?

• Pulse frequency:

  • 35-50pps

• Pulse duration:

  • 125-200 microsec for small muscles, 200-350microsec for large muscles

• Amplitude:

  • to visible contraction

• On:Off Time & Ratio:

  • 2-5s on , 2-5s off

• Ramp time:

  • atleast 1s

• Treatment time:

  • 10-30min

• Times per day:

  • every 2-3 hours until spasm relieved

What are ESTIM Parameters for edema reduction using muscle pump?

• Pulse frequency:

  • 35-50pps

• Pulse duration:

  • 125-200 microsec for small muscles, 200-350microsec for large muscles

• Amplitude:

  • to visible contraction

• On:Off Time & Ratio:

  • 2-5s on , 2-5s off; equal on:off time

• Ramp time:

  • atleast 1s

• Treatment time:

  • 10-30min

• Times per day:

  • 2x/day

How do you increase patient comfort in regards to ramp time?

Increase

How do you increase patient comfort in regards to pulse duration?

decrease

How do you increase patient comfort in regards to electrode size & quality?

increase size

How do you increase patient comfort in regards to pulse frequency?

increase

How do you increase patient comfort in regards to On:Off Time?

increase off time

What are contraindications to ESTIM?

• Pacemaker

• Unstable arrythmias

• Carotid sinus

• Thrombosis or thrombophlebitis

• Near pregnant uterus

A clinician is treating a patient following a quad tendon tear and quad atrophy. Which of the following neuromuscular electrical stimulation parameters is the MOST appropriate?

• Pulse duration: 250-300 microsec; 10s on, 50s off

What are High-Voltage Pulsed Galvanic Current (HVPC) used for?

Wound healing

What are Negative electrode in HVPC used for?

promote healing of inflamed or infected wounds

What are positive electrode in HVPC used for?

promote healing of wounds that aren’t inflamed

What is the appropriate treatment frequency & time for HVPC?

At least 3-7 days/week treatment sessions, lasting 45-60 mins

What are HVPC treatment parameters tissue healing of an infected/inflamed wound?

• Polarity: Negative

• Pulse frequency: 100-105 pps

• Pulse duration: Preset at 100 microsec

• Amplitude: produce comfortable tingling

• Treatment time: 45-60

What are HVPC treatment parameters tissue healing of an non-infected/non-inflamed wound?

• Polarity: Positive

• Pulse frequency: 100-105 pps

• Pulse duration: Preset at 100 microsec

• Amplitude: produce comfortable tingling

• Treatment time: 45-60

Patient is being seen in PT for treatment of a wound that demonstrates red granulation tissue in the wound bed. The clinician is implementing ESTIM to promote healing of the wound. Which of the following will be MOST EFFECTIVE for this patient?

HVPC on positive electrode in wound, 100 pps

What is the most appropriate ion and polarity to treat scars with iontophoresis?

iodine, negative polarity

What is the most appropriate ion and polarity for analgesic effects with iontophoresis?

Salicylate, negative polarity

What is the most appropriate ion and polarity to treat calcium deposits with iontophoresis?

Acetate, negative polarity

What is the most appropriate ion and polarity to treat MSK inflammation with iontophoresis?

Dexmethasone, negative polarity

PT decides to use iontophoresis to treat an acute lateral ankle sprain. Which of the following is most appropriate ion and polarity to use in this case?

Dexamethasone, negative polarity

What are TENS treatment parameters for acute pain (high rate)?

• Type: Sensory stimulation

• Waveform: Mono or biphasic pulsed

• Pulse freq: 100 pps

• Pulse duration: 50-100 microsec

• Amplitude: comfortable tingling

• Tx duration: 20-30 min or during activities

What are TENS treatment parameters for acupuncture like mode (low rate)?

• Type: Motor stimulation

• Waveform: Mono or biphasic pulsed

• Pulse freq: < 10 pps

• Pulse duration: > 150 microsec

• Amplitude: visible twitch

• Tx duration: 20-45 min

What are TENS treatment parameters for brief intense mode (wound debridement)?

• Type: Motor stimulation

• Waveform: Mono or biphasic pulsed

• Pulse freq: 100 pps

• Pulse duration: > 150 microsec

• Amplitude: strong muscle twitch

• Tx duration: < 15 min

What are TENS treatment parameters for noxious (Myofascial pain syndrome/ trigger points)?

• Type: Hyperstimulation

• Waveform: DC or monophasic

• Pulse freq: High: 100 pps, Low: 1-5 pps

• Pulse duration: > 250 microsec to 1 sec

• Amplitude: Highest tolerance / painful stimulus

• Tx duration: 30-60s per area