VCU DPT - Agents (Jeopardy)

name 5 physiological effects of heat

vasodilation

decrease muscle spasm

- relaxes GTO, decreases alpha motor neuron

increase nerve conduction velocity

decreased pain

- nociocepters go to sleep

increase tissue extensibility

decrease muscle strength and perforamnce

increased metabolic rate

increased oxygen uptake in tissue

increased pain threshold

discuss contraindications unique to traction

claustrophobia

pregnancy

ankylosing spondyltisi

hyper mobility

TMJ tensh

whiplash injury

- acute cervical injury

periph of sx with traction

hardware in area

steroids/osteopenia

physical properties of water, and how exercise can be made more challenging

turbulance

- move around them to be harder

hydrostatic pressure

- go deeper to be harder

viscosity

- velocity dependent, the more resist the faster you go

surface tension

- move through surface for more resistance

drag forces

- the more surface area, more drag

- velocity dependent

buoyancy

- can assist or resist; foam

discuss what structures ultrasound is best for heating

small areas

tendon/ligament

bone (periosteal heating)

muscle

superficial stuff

DOUBLE JEOPARDY

optimal technique for foam rolling

move distal to proximal attachment

1-6 seconds per stroke

total time more than 120 seconds

pain should either be at the pain threshold, or 6/10

how do we do ischemic compression

apply compression up to pain threshold

hold up to 3 minutes, and then they say no more pain

then you push harder, and hold at pain threshold

then you do it one more time

continue massage in area, stretch afterwards

4 types of heat transfer

convection

radiation

evaporation

conduction

describe sets, reps, rest time, total time for BFR training

4 sets

30 X 15 X 15 X 15

rest 30-60 seconds

max total time 20 minutes

3-4 exercises

discuss 3 advantages of pulsed lavage over whirlpool

less infection

portable, at bed side

dont have to clean it

location specific, can get selective/small area

shorter time

list 4 primary ways ultrasound energy is attentuated

refraction

reflection

scattering

absorption

- majority

where do harnesses/straps go for lumbar trction

lowest part of ribs

right over ASIS

tissue temperature needs to be raised to WHAT for heating

104-113 deg F

5-10 min

list 3 massage storkes under petrisssage

kneading

skin roll

picking up

wringing

it is your first treatment for 150 lb patient with lumbar issue. you do traction, what paramters do you use

start 30-45lbs

60 sec on, 20 sec off

- intermittent traction

two critical considerations with water immersion ultrasound vs non

do not contact with water

(1-3 cm away)

longer duration needed

- rate goes at 1/2

list 2 physiologic effects of aquatic exercise on cardiovasc exercise

increased work of breathing

increases cardiac output, SV

maximum oxygen uptake decreeses

what temp should the hydroculator bebefore use

158-167

think: 5, 6, 7, 8 are all in it but the 6 and 7 need to be together

what is best evidence for ultrasounds

chronic wounds is the best and tissue extensibility, knee OA

max % body weight of force for L and C

C: 10%

- never exceed 30 pounds regardless

L: 50%

when using BFR training, what is standard limb occlusion pressure used

UE: 50%

LE: 80%

what level does the body need to be immersed for 50% weight bearing reduction

what about 90% reduction

what about 67% reduction

ASIS

C7

xiphoid process

how many layers is needed for heat

how many layers doe shot pack cover count as

6-8

2-3

what % of 1RM is used for BFR

20-40%

how many layers do you need for ice, less than 30 deg

1 layer

most common indication is used for traction

radic/impingement

what is optimal temp for theraputic pool

90-94 deg F

how deep for ultrasound does:

1 MHz go

3 MHz go

1: 2 inches

3: 1 inches

all parameters for contrast bath

cold temp: 50-64

cold time: 1-2 min

warm temp: 100-111

warm time: 3-4 min

end on heat unless edema

total duration: 5-6 repeats, for 20-30 min

3 physiological effects of cupping

tension under cup, compression on edge of cup

increased blow flow

decrease inflammation

increased lymphatic flow

increases pain threshold

relaxaton

discuss phases of lymphedema

0: no visible edema, can see it on BIA

- latency phase

1: reversible with elevation, visible here

- patient complains of heaviness

2: irreversible with elevation, often found with circumferential measurements

- mod edema, greater than 2 cm difference

3: permanent skin changes

- severe edema

discuss theory of pulsed ultrasound

fluid movement

acoustic streaming

changes cell membrane permeability

contraindications to diathermy

metal

pacemakers

implants

cement or hardware

malignancy in the area

pregnancy in the area

obesity can be, esp in thermal

DVT

describe mechanism of action for dry needle

endogenous opiods

microtrauma is created to cause an inflammatory response to help the collagen

list components of treatment for lymphedema

complete decongestive therapy components:

skin therapy

gold pressure: compression garments

manual lymphatic drainage

what type of compression wrap is most effective for immobile patients with lymphedema

high stretch wraps

what type of compression wrap is most effective for mobile patients with lymphedema

low stretch wraps

reaction to cryotherapy in order

intense cold

burning

aching

numbness/anesthesia

range of healthy tissues temperature to be in

59-113 deg F

strategies for increasing patient comfort in ultrasound

decrease intensity

decrease BNR

keep moving

patient positioning

name common causes for lymphedema

trauma

cancer treatment & radiation

obesity

filiaris disease (not in US)

congential

adv of diathermy vs ultrasound

can heat larger area

does not heat bone, reflection

extensibility lasts longer

does not reflect off tissues

when would you choose ultrasound over diathermy

ultrasound superficial tendon/ligament

how long does lymphedema take to heal

never heals!

why does it take longer for cold area to remain cold longer than hot area remains hot

vasoconstriction so blood stays there, vs the other blood moves

side effects of dry needling

bruising

DOMS

fatigue

after few min, patient does not feel heat from thermal ultrasound

name some adjustments

the head is not perpendicular

area is too large of area

- this is the most common area

increase intensity

change from 1 MHz to 3 MHz

check for 100% duty cycle

in cupping, what to do if want to stress deeper tissues

use a bigger cup size

with infrared energy (monochromatic) energy, what is the gas used

what is reaction

nitric oxide

causes vasodilation

list contraindications to intermittent pneumatic devices

DVTs

congestive heart failure

- other systemic disease

arterial insufficeiny

ABI less than 0.06

pulmonary edema

cold pack reduce temp of skin up to ____ cms

superficial heat goes ____ cm

2

3

what type of short wave diathermy more effectively heats muscle and deep tissue

skin?

inductive

capacitive

temp increase needed to get tissue elongation

7 deg F

name some terms to describe laser wavelengths

monochromatic (Single)

directional (parallel)

coherent

at what rate should ultrasound transducer be moved

4 cm/sec