exam 1

a rise of 1 degree celsius results in

increased metabolic rate

a rise in 2-3 degrees celsius results in

reduced muscle spasm and pain

increased blood flow

a rise in 4 degrees celsius of more results in

increased collagen extensibility

what should the hydrocollator be warmed to

160-165 degrees F

what should the paraffin bath be heated to

124-130 degrees F

what is the treatment time for thermotherapy

15-20 min

how many layers must be between a hot pack and the skin

6-8 layers

what puts someone at a higher risk for burns (superficial thermotherapy)

more subcutaneous fat

what frequency for US is used when the target tissue is 2-5cm beneath the skin

1 MHz

what frequency for US is used when the target tissue is 1-2cm beneath the skin

3/3.3 MHz

duty cycle

• the portion of time that the US is on during a single pulse period

• expressed as percentage or ratio → on time/(on time + off time)

list in order the sensations a patient will experience during NMES when the current strength increases from 0 and the pulse duration is set to 300 microseconds

• tingling

• visual muscle contraction

• sharp pain

what is the pulse duration required to produce a muscle contraction in denervated muscle

>10 milliseconds

what is the typical format for NMES

pulse duration:

frequency:

on/off time:

ramp time:

time:

pulse duration: 150-300 microseconds

frequency: 50 pulses per second

on/off time: 1:5 or less

ramp time: 1-2 seconds

time: strength training = 10-20 contractions; NMRE = no more than 20 min per session

what are the 4 cardinal signs of inflammation

• heat

• tenderness

• pain (TTP)

• redness

superficial thermotherapy examples

• hot pack

• paraffin bath

deep thermotherapy example

ultrasound

how long must the hot pack be submerged for to be useful

at least 30 min

what is the treatment time for thermotherapy

15-20 min

indications for superficial thermotherapy

• pain control

• increase ROM and decrease joint stiffness

• accelerate healing

when should you stop thermotherapy

if BP drops 15-20 mmHg

what is the conventional frequency for ultrasound

1-3 MHz

what is the conventional intensity for ultrasound

0.1-3 W/cm2

when do you use 1 MHz frequency

2-5 cm beneath the skin

when do you use 3 or 3.3 MHz frequency

within 1-2 cm of skin

BNR

beam nonuniformity ratio

what is the typical BNR for ultrasound

between 5:1 and 6:1

indications for ultrasound

• joint contracture and scar tissue

• subacute and chronic soft-tissue inflammation

what is the preferred area size to be treated by ultrasound

2-3X ERA

what is the frequency for NMES

50 pulses (PC) or bursts (russian current) per second

what is the number for pulse duration

300 microseconds

what pulse duration level is required to produce muscle contraction in denervated muscle

>10 pulses

what is NMES used for

• muscle contraction of innervated muscle

• edema control

how does electrical muscle contraction differ from physiological contractions

electrical

• recruit type iib fibers first

• more fatiguing

• increase current

physiological

• less fatiguing

• recruit type i fibers first (slow twitch)

• increase resistance

FES

functional electrical stimulation

what is FES used for

enhancing motor control

when muscles are weak, do we give longer or shorter off time for NMES

longer

placement of electrodes for NMES

• one pad must sit on motor point (middle of muscle belly)

• pad is aligned with muscle fibers

• pads are separated

indications of e stim

• muscle contraction: innervated and denervated muscles

• pain modulation

• edema control

• tissue healing

• iontophoresis

pulsed or continuous US can be used on

• Intact skin overlying metal implants 

• Head 

• Chest wall if ribcage intact 

• Persons w/ cardiac failure or hypertension

pulsed US can be used on

areas near/over chronic wounds

on:off time for strengthening NMES (innervated muscle)

1:5 then gradually decreased 1:4 and 1:3 etc

on:off time for muscle pump NMES (innervated muscle)

1:1

treatment time for muscle strengthening (innervated muscle)

10 to 20 contractions

treatment time for muscle reeducation (innervated muscle)

no more than 20 mins/session

how many dips should you perform for paraffin

8

what is the spatial average intensity for US if BNR is 5:1

< 1.6 W/cm²

what does NMES activate

type 2 fibers

continuous US

thermal

pulsed US

nonthermal

what do u use continuous US for

soft tissue shortening

what do u use pulsed US for

• delayed tissue healing

• prolonged inflammation

difference btw innervated and denervated e-stim/NMES

• innervated: NMES depolarizes motor nerve

• denervated: electricity directly depolarizes muscle cell membrane

effects of cryotherapy

• initial decrease in blood flow → vasodilation

• decreases nerve conduction velocity

• increases pain threshold

• alters muscle strength

• decreases muscle spasms

• decrease metabolic reactions

• decrease connective tissue extensibility

what is hunting response

cold-induced vasodilation

when do you use cryotherapy (4)

• acute inflammation

• edema control

• pain control

• modify muscle spams

5 stages of sensation for cryotherapy

• intense cold

• burning

• aching

• analgesia

• numbness

1° cooling

red, mild edema, inflamed

2° cooling

edema, blisters

3° cooling

frostbite → necrosis

4° cooling

severe frostbite →gangrene & neurological complications

ratio for cryotherapy

2:1 but 6:1 is preferred

how long do u apply cold pack for

• 15-20 mins

• use insulating layer (damp towel)

how long do u apply ice cup for

• 5-10 minutes

• used for ice massage

how long do u apply cryocompression for

20-30 mins

indications for cryotherapy

• control of acute inflammation

• edema control

• pain control

• modification of muscle spasms

what is muscle pump used for

• edema

• muscle spasms

indications of NMES

• muscle contraction: innervated muscle

• edema control