PT 626 Clinical Agents Final Examination

True or False

Larger joints usually require more force to achieve the same traction as smaller joints.

True

True or False

Healthy tissue tends to respond to less traction pressure than pathological tissue.

True

What percentage of body weight is needed to distract joint facets of the lumbar spine?

50%

What percentage of body weight is needed to distract joint facets of the cervical spine?

> 7 %

What are the effects of spinal traction?

1. soft tissue stretching

2. muscle relaxation/decreased muscle tone

3. joint mobilization/distraction

4. decreased facet joint pressure

5. decreased pressure on nerve root

6. May reduct pain from joint injury/inflammation

What is the difference between intermittent and static muscle relaxation?

Intermittent: oscillating movements stimulate GTO to inhibit alpha motor neuron firing

Static: sustained stretch stimulates monosynaptic stretch reflex

True or False

The intermittent theory for stretching via traction is more effective than the static theory.

False; studies suggest there is no difference

What are the indications for traction?

1. disc bulge or herniation

2. nerve root impingement

3. joint hypo-mobility

4. subacute joint inflammation

5. paraspinal muscle spasm

What are contraindications for traction?

1. spinal cord compression

2. spinal surgery

3. spinal fracture

4. acute injury/inflammation (0-72 hrs)

5. joint hyper-mobilty

6. rheumatoid arthritis

7. Marfan syndrome

8. Downs syndrome

9. pregnancy and lactation

What is an additional contraindication for inversion traction?

uncontrolled hypertension (>140/90)

-check for increase of BP by 10 mmHg or HR by 10 bpm

What are precautions for traction?

1. tumor, osteoporosis, prolonged steroid use

2. skin susceptible to belt friction

3. annular displacement/tears

4. claustrophobia

5. inability to tolerate test position for 15-20 mins

6. disoriented patient

7. TMJ or dentures

What arteries are most likely to be compromised by cervical and lumbar traction?

cervical: vertebral artery

lumbar: femoral artery

What is the precaution concerning dentures with cervical traction?

keep dentures in for duration treatment

What are weight limitations for lumbar spine traction?

no more than 50% of patients total body weight

What are weight limitations for cervical spine traction?

no more than 50% of the patient's head or 30 lbs maximum

What are the starting weights for cervical traction and lumbar traction?

cervical: 8-10 lbs

lumbar: 30-45 lbs

What are the maximal weights for cervical traction and lumbar traction?

cervical: 30 lbs

lumbar: < 50% of patient's body weight

What is the treatment duration for traction?

5-10 mins at first

10-15 mins typically

30 minutes maxiumum

What is an element of documentation that only applies to intermittent traction?

hold (on) and relax (off) times

What are all the elements of documentation required for traction?

1. justification

2. type of traction

3. area of body

4. patient position

5. type of halter

6. level of force

7. on/of times

8. total treatment time

9. response to intervention

10. plan of care

What is the evidence for the use of traction for back and neck disorders?

moderate and substantiated for strength of evidence and therapeutic effectiveness

What are the 5 methods of energy transfer for heat and cold modalities?

1. conduction

2. convection

3. conversion

4. radiation

5. evaporation

Define conduction.

transfer of heat or cold through direct interaction

Define convection.

transfer of heat or cold through moving fluid particles

What is the disadvantage for the use of convection currents?

only practical for distal extremities

Define conversion.

changing of a non-thermal form of energy to either heat or cold

Define radiation.

conversion of electromagnetic waves to heat

Why are radiation modalities not usually used in the clinic?

most are available to the general population

Define evaporation.

release of energy through the conversion of liquid to a gas or vapor

What are the disadvantages of modalities that use evaporation?

1. negligible effects on deeper tissues

2. environmental concerns

What forms of cryotherapy use conduction?

1. ice packs

2. ice cups

3. gel/chemical packs

What are some physiological effects associated with cyrotherapy?

1. decreased temperature

2. decreased vasodilation

3. increased blood viscosity

4. decreased histamine, prostaglandin release

5. reflex excitation of sympathetic adrenergic receptors

What is the "hunting response"?

reflex vasodilation in the presence of cold and tissue temp. < 10° C

Why does the skin become red with the application of cold?

increased oxyhemoglobin concentration of blood

What are the neuromuscular effects of cryotherapy?

1. decreased nerve conduction velocity

2. increased pain threshold

3. decreased spasticity

4. facilitated muscle contraction

5/ decreased muscle strength

How long should cold application be to decrease spasticity for 1-1.5 hrs?

30 mins

How does cryotherapy stimulate a muscle contraction?

facilitation of alpha motor neuron activity

How long does cryotherapy affect muscle strength?

decreased for 1 hr and gradually recovered in next 2 hrs

What are the 4 stages of sensation associated with cryotherapy?

1. cold (1-3 min)

2. burning (3-5 min)

3. aching (5-7 min)

4. numbness (7+ min)

When using cryotherapy for an acute injury, what are the associated effects?

1. reduced edema

2. lowered WBC

3. decreased analgesic intake

4. increased pain threshold

5. reduced muscle soreness and spasm

What are the PEACE and LOVE acronyms for injury management?

P: Protection

E: Elevation

A: Avoid anti-inflammatories

C: Compression

E: Education

L: Load

O: Optimism

V: Vascularisation

E: Exercise

How is vapocoolant spray used?

applied before stretching for patients with reduced ROM or muscle length

How is spasticity reduced with cryotherapy?

decrease in deep tendon reflex

What are the parameters for cryotherapy for reduction of pain?

applied for 10-15 mins for reduction of pain for 1-2 hrs

What are the contraindications for cryotherapy?

1. cold hypersensitivity

2. cold intolerance

3. cryobulinemia

4. paroxysmal cold cyroglobinuria

5. Raynaud's Disease

6. over regenerating peripheral nerve

7. over area of peripheral vascular disease

What are precautions for cryotherapy?

1. open wound

2. over superficial nerve

3. hypertension

4. patients with poor sensation/mentation

5. very young or old patients

What are adverse effects of cryotherapy?

1. tissue death

2. frostbite

3. nerve damage

4. unwanted vasodilation

Which conditions have fewer than 5 moderate and substantiated studies supporting the use of cryotherapy?

1. neck and low back pain

2. multiple sclerosis

3. post-carpal tunnel release

Which condition has a conflicting benefit for the use of cryotherapy?

postoperative knee arthroplasty

What is the depth of penetration and duration for superficial heat?

1 cm w/ dissipation immediately after removal

What is the temperature range that target tissues should be heated to with the use of thermotherapies?

104-113° F

What occurs beyond 113° F with thermotherapy?

denaturation of proteins and tissue buring

What is the best modality for increasing general tissue temperature and blood flow?

active exercise

What are the physiological effects of thermotherapy?

1. increased body temp., HR and RR

2. decreased BP (vasodilation)

3. increased perspiration over area

4. increased capillary pressure and cell permeability

5. increased release of O2 from hemoglobin

What are the neuromuscular effects of thermotherapy?

1. muscle relaxation via muscle spindles and GTOs

2. pain relief via gate control theory

3. increased nerve conduction velocity

What are the musculoskeletal effects of thermotherapy?

1. increased tissue extensibility

2. increased stretch retention

3. reduced tear risk

True or False

Heat increases the metabolic rate of tissues.

True

What are the indications for thermotherapy?

1. pain relief

2. increase range of motion

3. decrease joint stiffness

4. accelerate healing

True or False

Thermotherapy is recommended for conditions with acute inflammation.

False

How is healing accelerated with the application of thermotherapy?

1. increased circulation and release of O2

2. increased delivery of O2 and nutrients to the tissues

3. histamine reaction

What are adverse effects of thermotherapy?

1. burns

2. fainting

3. bleeding

4. skin and eye damage

What are contraindications for thermotherapy?

1. acute injury or inflammation

2. recent or potential bleeding

3. thrombophlebitis or PVD

4. post-denervation or surgical repair

5. impaired sensation and mentation

6. malignancy

7. existing fever

8. tissues devitalized by radiation therapy

What are the precautions for thermotherapy?

1. cardiac insufficiency

2. metal

3. areas with topical counterirritants

Which conditions have fewer than 5 moderate and substantiated studies supporting the use of thermotherapy?

1. hand scleroderma

2. trigger point pain

3. burn contracture

4. podiatric conditions

What conditions have moderate and substantiated studies supporting the use of thermotherapy?

1. rheumatoid/osteoarthritic conditions

2. neck, back and shoulder pain

What are the disadvantages of using a cold pack?

1. may lead to cold burns

2. gel packs may cause frostbite sooner or chemical burns if broken

What is the normal treatment duration for a cold pack?

5-15 mins

What is treatment duration for decreasing spasticity with an ice pack?

20-45 mins

When should cryotherapy cease for an acute injury?

after the initial 2-3 days

How high should the Cryo-Cuff be raised during treatment?

maximum of 15"

When is ice massage more appropriate than other cold modalities?

for small areas of pain and acute injury

What is the treatment duration for an ice massage?

5-10 mins

What are the temperature ranges for contrast therapy?

Cold: 50-60° F

Hot: 100-110° F

What is the most common ratio for hot and cold in contrast therapy?

Hot: 3 mins

Cold: 1 min

4-5 cycles

Why would you end a treatment with cold immersion during contrast therapy?

increase circulation or decrease swelling

Why would you end a treatment with hot immersion during contrast therapy?

pain relief (for chronic conditions)

What is the ratio of paraffin wax to mineral oil used in a paraffin bath?

7:1

What is the temperature of a paraffin bath?

52-53° C or 125-127° F

What are the methods of application of paraffin?

1. immersion bath

2. dip wrap

3. painted on

What are the results of the use of paraffin bath for patients with hand osteoarthritis?

short-term decrease in pain and improvement in hand mobility

What is the temperature for most hydrocollators?

170° F

How many towel layers are used for heat packs?

6-8 towel layers

What is the treatment time for hot packs?

15-20 minutes

10-15 minutes prior to e-stim

What is the normal skin response to hot packs?

pink skin and perspiration

What is the frequency of therapeutic ultrasound?

1 MHz - 3 MHz

What is the frequency of diagnostic ultrasound?

1 MHz - 10 MHz

What are the materials used for the reverse piezoelectric effect?

barium or lead zirconate titanate

Where are the ultrasound waves produced?

generator

Where is the crystal housed in the ultrasound unit?

transducer

-converts electrical energy

What is the difference between continuous and pulsed ultrasound?

thermal effects vs mechanical effects

How is the thermal effect produced with ultrasound?

vibration of molecules absorbing ultrasound

What are the thermal effects of ultrasound?

1. increased extensibility of collagen fibers

2. decreased fluid viscosity

3. increased local blood flow

4. increased metabolism at site

5. pain decreased, healing enhanced

True or False

Molecular vibration occurs with pulsed ultrasound.

False

What are the mechanical effects of pulsed ultrasound?

acoustic streaming and cavitation

What is the process of acoustic streaming?

bubble formation changing cell membrane permeability --> ionic exchange increased at the cell site --> facilitates diffusion of metabolites and promoting protein/collagen synthesis --> facilitates tissue healing

What is the process of cavitation?

bubbles form dissolved gas --> bubbles expand and contract --> action stress cell boundaries/cell walls

What is stable cavitation?

bubbles contract and cause micro-streaming

What is unstable cavitation?

bubbles expand too large and implode causing damage

What causes unstable cavitation?

not moving ultrasound head during treatment

What happens as a result of implosion in unstable cavitation?

free radicals, OH-, H+, increased temperature and increased pressure