Modalities Lecture

Cyrotherapy physiological effects increased

joint stiffness

pain threshold

muscle activation

cryotherapy physiological effects decreased

collagen extensibility

blood flow

capillary permeability

spasticity

nerve conduction velocity

a clinician is treating a patient with knee osteoarthritis and utilizes a hot pack to decrease pain and stiffness. Which of the following is MOST LIKELY associated with a risk for burns?

a. using 6 layers of towels between hot pack and patient

b. treatment time of 20 min

c. hot pack immersed in water heated at 165

d. non blanching redness at 5 minutes

d. non blanching redness at 5 minutes

Hot Pack Temperature Settings

158-167

20-30 min treatment

6-8 layers of towel

peak temp in first 5 min

cold pack temperature settings

stored at 25

10-20 min treatment

can be applied every 1-2 hours

superficial thermotherapy contraindications

over malignancy

over compromised circulation

thrombophlebitis

impaired sensation or mentation

bleeding or hemorrhage

infrared irridation of eyes

arterial disease

superficial thermotherapy contraindications mnemonic

MC Tibia is Hot

superficial crytherapy contraindications

cold intolerance (hypersensitivtiy, cryoglobulinemia, paroxysmal cold hemoglobinuria, raynaud’s)

over regenerating peripheral nerves

circulatory compromise

E-Stim Parameters Muscle Strengthening

Frequency: 35-80 pps

Duration: 125-200 (small muscle), 200-350 (large muscle)

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

On:Off time: 6-10 sec on, 50-120 sec off, reduce with repeated treatment

Ramp Time: at least 2 seconds

Treatment Time: 10-20 min

Times per day: every 2-3 hours

MVIC

max voluntary muscle contraction

E Stim Muscle Strengthening Example

Russian

E Stim Muscle Reeducation

functional electrical stimulation (FES)

E Stim Muscle Reeducation Parameters

Frequency: 35-50

Duration: 125-200 (small), 200-350 (large)

Amplitude: sufficient for functional activity

On:Off Time: depends on functional activity

Ramp Time: at least 2 sec

Treatment Time; depends on functional activity

Times Per Day: NA

Muscle Spasm Reduction

Frequency: 35-50 pps

Duration: 125-200 (small) 200-350 (large)

Amplitude: visible contraction

On:Off Time: 2-5 sec on, 2-5 sec off

Ramp Time: at least 1 sec

Treatment Time: 10-30 minutes

Times Per Day: every 2-3 hours until spasm relieved

edema reduction using muscle pump parameters

Frequency: 35-50 pps

Duration: 125-200 (small), 200-350 (large)

Amplitude: to visible contraction

On:Off Time: 2-5 sec on: 2-5 sec off

Ramp Time: at least 1 sec

Treatment Time: 30 min

Times Per Day: twice a day

How to Increase patient comfort E stim

increase ramp time

pulse duration decrease

larger electrode size

increase pulse frequency

longer off than on period

electrical current contraindications

pacemaker

unstable arrhythmias

carotid sinus

thrombosis or thrombophlebitis

near pregnant uterus

electrical current contraindications mnemonic

please understand currents threaten pregnancy

a clinican is treating a patient with a radial nerve injury and drop wrist deformity. Which of the following NMES parameters is the most appropriate?

a. pulse duration 250-300, 10 on:50 off

b. pulse duration 150-170, 10 on: 20 off

c. pulse duration 250-300, 10 on: 20 off

d. pulse duration 125-200, 10 on: 50 off

d. pulse duration 125-200, 10 on: 50 off

high voltage pulsed galvanic curent (HVPC)

used for wound care

HVPC negative electrode

promote healing of inflamed or infected wounds

HVPC positive electrode

used to promote healing of the wounds without inflammation

HVPC treatment time

at least 3-7 days/week with treatment sessions lasting 45-60 minutes

HVPC tissue healing parameters inflammatory phase

infected

Polarity: negative

pulse freqeuncy: 100-105

pulse duration: ~100

amplitude: produce comfortable tingling

treatment time: 45-60 min

HVPC parameters proliferation phase

clean

Polarity: positive

pulse freqeuncy: 100-105

pulse duration: ~100

amplitude: produce comfortable tingling

treatment time: 45-60 min

a patient is being seen in PT for treatment of a wound that demonstrates yellowish brown drainage, and erythema in the periwound area. the clinician is implement estim to promote healing of wound. which is MOST effect for patient?

a. HVPC positive electrode in wound, 100 pps

b. HVPC on negative electrode in wound, 20 pps

c. HVPC on positive electrode in wound, 80 pps

d. HVPC on negative electrode in wound, 100 pps

d. HVPC on negative electrode in wound, 100 pps

Iontophoresis Negative Polarity Ions

iodine, salicylate, acetate, dexamethasone

Iontophoresis Negative Polarity Ions mnemonic

ISAD

a PT decides to use iontophoresis to treat an acute lateral ankle spain. which of the following is most appropriate ion and polarity to use?

a. dexamethasone, negative pole

b. acetate, negative pole

c. copper, positive pole

d. iodine, negative pole

a. dexamethasone, negative pole

TENS - acute pain

high rate

type: sensory stimulation

waveform: mono or biphasic pulsed

pulse frequency: 100 pps

pulse duration: 50-100

amplitude: comfortable tingling

Tx duration: 20-30 min or during activities

TENS - Accupuncture Like

low rate, chronic pain

type: motor stimulation

waveform: mono or biphasic pulsed

pulse frequency: <10 pps

pulse duration: >150

amplitude: visible twitch

Tx duration: 20-45 min

TENS - brief intense

use: child birth, wound debridement

type: motor stimulation

waveform: mono or biphasic pulsed

pulse frequency: 100

pulse duration: >150

amplitude: strong muscle twitch

Tx duration: <15 min

TENS - noxious

use: trigger point, myofasical pain syndrome

type: hyperstimulation

waveform: DC or monphasic

pulse frequency: high 100 pps, low: 1-5

pulse duration: >250 up to 1 sec

amplitude: highest tolerance/painful stimulus

Tx duration: 30-60 sec per area

a patient has been using a home TENS unit for several weeks and reports the effects on pain to be decreasing. In order to further benefit from pain relief which type of TENS can be recommended?

a. acupuncture like

b. brief intense

c. noxious

d. conventional

a. acupuncture like

Ultrasound contraindications mnemonic

my poor exhausted old joints can travel

Ultrasound contraindications

maligancy, pacemaker, eyes, organs of reproduction or pregnancy, joint cement or plastic, CNS tissue, thrombophlebitis

during exam, the PT performs a test by stabilizing the lower leg with one hand and pulling the heel forward with the other hand to assess ligament integrity. Which ligament is being tested with this procedure?

a. deltoid ligament

b. ATFL

c. posterior tibiotalar ligament

d. calcaneofibular ligament

b. ATFL

Which of the following parametes is the MOST appropriate for use of ultrasound at the lateral ankle?

a. 20% duty cycle, 3 MHz, 0.7

b. 50% duty cycle, 1 MHz, 1.2

c. 100% duty cycle, 1 MHz, 1.5

d. 100% duty cycle, 3 Mhz, 0.5

a. 20% duty cycle, 3 MHz, 0.7

the clinician notes that the patient has poor activation of the calf muscle while performing heel raises. Which of the following EMG biofeedback parametes is most appropriate for intial treatment?

a. low sensitivity, closely placed electrode

b. low sensitivity, widely placed electrode

c. high sensitivity, closely placed electrode

d. high sensitivity, widely placed electrode

d. high sensitivity, widely placed electrode

EMG biofeedback sensitivity and electrode placement: muscle relaxation

low

closely placed

EMG biofeedback sensitivity and electrode placement: muscle reeducation

high

far apart

Lumbar Traction

supine position with pillow under knee - intervertebral joints, facet, muscle elongation

prone: posterior disc herniation

lumbar traction supine: increase intervertebral space of L5-S1

45-60 degrees hip flexion

lumbar traction supine: increase intervertebral space of L3-4

75-90 degrees hip flexion

Cervical Traction joint distraction

20-29 lbs max, 7% BW

cervical traction: disc protrusion, muscle spasm, elongation

11-15 lbs

lumbar traction joint distraction

50 lbs

50% BW

lumbar traction: disc protrustion, muscle spasm, elongation

25% BW

a patient presents to clinic with posterior herniated nucleus pulposus at L2-3. during lumbar traction in supine, patient reports pain radiating into leg. Which of the following is most appropriate action to take?

a. change patient to sidelying

b. refer patient back to physician

c. change patient to prone

d. reduce traction force to 15% BW

c. change patient to prone

Mechanical Traction Contraindications

joint hypermobility or instability

immobilization

peripheralization of symptoms with traction

acute injury or inflammation

uncontrolled hypertension