modalities

after ________ cryotherapy decreases spasticity (otherwise promotes joint stiffness for short periods of time)

15-20 min

hot pack temp

158-167

hot pack layers

towels: 6-8
special terry cloth: 4-6

total treatment time for heat

20-30 min

when is the most important time to check heat as it peaks at this time?

first 5 min

cold pack temp

25

cold pack treatment time

10-20 min

stages of cold

C-cold

B- burning

A- aching

A- analgesic

N- numbness

cold packs can be applied every ________ hours

1-2 hours

thermotherapy contraindications

M-over an area of malignancy

C-over an area of compromised circulation

T- thrombophlebitis

I- impaired sensation or cognition

B- bledding or hemorrhage

I- infrared irradiation of eyes

A- arterial disease

cryotherapy contraindications

• cold intolerance

  • cold hypersensitivity

  • cryoglobulinema

  • paroxysmal cold hemoglobinuria

  • raynaud’s phenomenon

• circulation issues

• over/on regenerating peripheral nerve

pulse frequency is

amount of “pokes” per second (pps)

the ________ the pulse frequency, the more ________

the higher the pulse frequency, the more comfortable it is

(low pps = discomfort)

pulse duration/width is

how long the pulse lasts

the ______ the pulse duration/width, the more _______ it is

the longer the pulse duration, the more uncomfortable it is

muscle strengthening estim pulse frequency

35-80pps

general estim pulse width/duration

smaller muscles

• 125-200 us

larger muscles

• 200-350 us

muscle strengthening estim amplitude (intensity)

for injuries

• >10% of MVIC

for uninjured

• >50% of MVIC

muscle strengthening estim on:off times

initially 1:5 ratio

• ex. 10 seconds on, 50 sec off

  • can decrease off time with repetition

muscle strengthening ramp time

at least 2 seconds

muscle strengthening treatment time

10-20 min for 10-20 reps

muscle strengthening estim times per day

every 2-3 hrs when awake

NMES or FES pulse frequency

35-50 pps

NMES or FES amplitude/intensity

sufficient for functional activity

NMES or FES ramp time

at least 2 seconds

NMES or FES on:off time

dependent on activity

muscle spasm estim pulse frequency

35-50 pps

muscle spasm estim amplitude/intensity

visible contraction

muscle spasm estim on:off times

equal on:off

• ex. 2-5 seconds ON, 2-5 seconds OFF

muscle spasm estim ramp time

at least 1 second

muscle spasm estim treatment time

10-30 min

muscle spasm estim times per day

every 2-3 hours until spasm is relieved

edema reduction using muscle pump estim pulse frequency

35-50 pps

edema reduction using muscle pump estim amplitude/intensity

visible contraction

edema reduction using muscle pump estim ramp time

at least 1 second

edema reduction using muscle pump estim on:off times

equal on:off

• ex. 2-5 secs ON, 2-5 secs OFF

edema reduction using muscle pump estim treatment time

30 minutes

edema reduction using muscle pump estim times per day

twice

estim contraindications

(Please Understand Currents Threaten Pregnancy)

P—pacemaker

U— unstable arrythmias

C— carotid sinus

T— thrombosis

P—near pregnant uterus

high voltage pulsed galvanic current parameters for pulse frequency

100-105 pps

high voltage pulsed galvanic current parameters for pulse duration/width

100

high voltage pulsed galvanic current parameters for amplitude

to produce comfortable tingling

high voltage pulsed galvanic current (HVGC) parameters for treatment time

45-60 min

high voltage pulsed galvanic current (HVPGC) treatment frequnecy

3-7 days/week

(45-60 min sessions)

when to use negative electrode for high-voltage pulsed galvanic current (HVPC)

when wound is “BAD”

• signs of infection, inflammation, etc

when to use positive electrode for high-voltage pulsed galvanic current (HVPC)

when wound is healing

• no inflammation

• visible granular tissue

if you want to use HVPC in the wound, what else must you use with the electrodes?

saline soaked gauze as a barrier

what are the negative polarity of medial ions used during iontophoresis

(ISAD)

I— iodine

S— salicylate

A— acetate

D— dexamethasone

iontophoresis medication: iodine

• tx of scars

• (-)

iontophoresis: water

• tx of hyperhidrosis

• + or -

iontophoresis medication: salicylate

• analgesic tx

• (-)

• source: sodium salicylate

iontophoresis medication: acetate

• tx of calcium deposits

• (-)

• source: acetic acid

iontophoresis medication: dexamethasone

• tx of musculoskeletal inflammation

• (-)

• source: dexamethasone phosphate

iontophoresis medication: zinc

• tx for dermal ulcers

• (+)

• source: zinc oxide

iontophoresis medication: lidocaine or xylocaine

• analgesic

• (+)

• source: lidocaine or xylocaine

iontophoresis medication: copper

• tx of fungal infections

• (+)

• copper sulfate

iontophoresis medication: hylauronidase

• tx of edema reduction

• (+)

• wydase

iontophoresis medication: calcium or magnesium

• tx for muscle spasm

• (+)

• calcium chloride or magnesium sulfate

TENS: high rate/ acute pain parameters: type and waveform

waveform

• mono or biphasic

type

• sensory stimulation

TENS: high rate/ acute pain parameters: pulse frequency and duration

pulse frequency

• 100 pps

pulse duration

• 100 usec

TENS: high rate/ acute pain parameters: amplitude and tx time

amplitude

• comfortable tingling

tx duration

• 20-30 min or duration of activity

TENS: low rate/ acupuntuce-like parameters: type and waveform

waveform

• mono or biphasic

type

• motor stimulation

TENS: low rate/ acupuntuce-like parameters: pulse frequency and duration

pulse frequency

• <10 pps

pulse duration

• > 150 usec

TENS: low rate/ acupuntuce-like parameters: amplitude and tx duration

amplitude

• visible twitch

tx duration

• 20-45 min

TENS: brief intense parameters: type and waveform

type

• motor stimulation

waveform

• mono or biphasic

TENS: brief intense parameters: pulse frequency and duration

pulse frequency

• 100 pps

pulse duration

• >150 usec

TENS: brief intense parameters: amplitude and tx duration

amplitude

• strong muscle twitch

tx duration

• <15 min

TENS: noxious parameters: type and waveform

type

• hyperstimulation

waveform

• DC or mono

TENS: noxious parameters: pulse frequency and duration

pulse frequnecy

• high: 100 pps

• or

• low 1-5 pps

pulse duration

• >250 usec up to 1 sec

TENS: noxious parameters: amplitude and tx duration

amplitude

• highest tolerance/painful stimuli

tx duration

• 30 to 60 seconds per area

initial parameters for muscle relaxation for EMG biofeedback

• low sensitivity

• electrodes are CLOSE together

initial parameters for muscle re-education for EMG biofeedback

• high sensitivity

• electrodes placed FAR apart

what position for lumbar traction to treat disc herniation

prone (in extension)

supine position for lumbar traction treats/aims at

• intervertebral joints

• facet joints

• muscle elongation

to increase intervertebral space of L5-S1, we need _______ hip flexion during lumbar traction

45-60 degrees

to increase intervertebral space of L3-L4, we need _______ hip flexion during lumbar traction

75-90 degrees

joint distraction parameters for cervical traction

20-29 lbs (MAX) 25 lbs

or

7% body weight

joint distraction parameters for lumbar traction

50 lbs

or

50% of body weight

disc protrusion, muscle spasms, or elongation parameters for cervical traction

11-15 lbs

disc protrusion, muscle spasms, or elongation parameters for lumbar traction

25% body weight

mechanical traction contraindications

H—P—H

• joint hypermobility or instability

• Immobilization

• Peripheralization of symptoms with traction

• acute Injury or Inflammation

• uncontrolled Hypertension

with US, frequency of 3 MHz is used for

SHALLOW depths

1-2 cm

with US, frequency of 1 MHz is used for

DEEPER depths

up to 5 cm (if any deeper, the US cannot penetrate)

duty cycle in US is

on time / (on + off time)

• continous is 100%

• pulsed is anything below 100%

when to use NON-thermal (pulsed) US

for ACUTE (0-3 wks) injury

• delayed tissue healing

• prolonged inflammation

when to use THERMAL US

chronic conditions (> 3wks)

• soft tissue shortening

• pain

non-thermal US parameters: intensity

<1 W/cm2

thermal/chronic/continous US intensity parameters for shallow depth (3MHz)

.5 W/cm2

thermal/chronic/continous US intensity parameters for deep depth (1 MHz)

>1 W/cm2

duration of tx for US

5-10 min / 2 x ERA (size of the soundhead)

US contraindications

(My Poor Exhausted Old Joints Can’t Travel)

M— malignancy

P— pacemaker

E— eyes

O— organs of reproduction or pregnancy

J— joint cement or plastic (joint replacements)

C— central nervous system tissue

T— thrombophlebitis

what actions to take if US hot spot happens:

• increase sound head movement

• add more gel

• decrease sound head size

• increase treatment area size

• change to pulsed US

• change from 1MHz to 3MHz

• reduce intensity