Passive Care

Sound energy from an US machine is produced by

Indirect (reverse) piezoelectric effect

US waves are ____ to the human ear

inaudible

What BNR is acceptable

5:1

What will cause a greater depth of penetration

decreased frequency

What is an acceptable US coupling medium

water in a plastic bucket

What is responsible for the non-thermal effect of US

acoustical streaming

What is the term for using US to drive drugs or compounds across the pt’s skin and surrounding tissues

Sonophoresis/Phonophoresis

What is the best protocol for a pt with chronic lumbar muscle spasm using US

Continuous US, 1 MHz, 8 min

What is the best protocol for a pt with 6wks of epicondylitis pain

Combo = pre-med, 0-15Hz + US continuous, 3.3MHz

What is the MC type of diathermy generator

short wave

What are the two types of electrodes used in short wave diathermy

inductance (magnetic field)

capacitance (electrical field)

Which law states that intensity diminished w/distance

inverse square law

When an excited electron gives up energy it moves to a lower orbit, this is called

spontaneous emission

What is the term for the structure light energy in cells

chromophore

What is the exact structure in human tissue that can absorb light photons to trigger biochemical reactions

cytochromes

What is the most appropriate safety protocol for laser therapy

pt and therapist should wear safety glasses

What is a contraindicated area for laser therapy

thyroid gland

Which type of UV light may have an antimicrobial effect

UVC

How is UV dose determined

Fitzpatrick’s skin phototype or Minimum skin erythema dose

What method of heat transfer is used is paraffin

conduction

What is an example of heat transfer by convection

whirlpool

How many layers of towels are btw a hydrocollator pack and the pt

6-8

What is the appropriate temp for a paraffin bath

124-133 deg F

Regarding whirlpools, what is the correct relationship

the GREATER the surface area, the LOWER the water temperature (colder)

What pt is safe to treat with ice packs

neck of pt with diabetes

What is the correct treatment time for an ice massage

5 minutes

What is the desired physiological effect of cryotherapy

vasoconstriction

What modalities could be used for acute pain

IF (true, premod) = 80-150

Sensory TENS = 80-150

Low level Laser = high dose to inhibit

Cryotherapy = ice pack, whirlpool, etc.

What modalities could be used for chronic pain

IF (true, premod) = 1-15

Motor TENS = 1-15

Low level Laser = high dose to inhibit

Cryotherapy = ice pack, whirlpool, etc.

Thermotherapy = US, diathermy, paraffin

What modalities could be used for muscle spasm

NMES (russian, biphasic) = 10:10

Thermotherapy = US, diathermy, paraffin

Cryotherapy = ice pack, whirlpool, etc.

What modalities could be used for edema

Cryotherapy = ice pack, whirlpool, etc.

Hi-volt = negative polarity

Cold laser = high dose to inhibit

What modalities could be used for acute healing

Cold laser = low dose to stimulate

Hi-volt or microcurrent = positive polarity

Ultrasound = pulsed (50%)

What modalities could be used for chronic healing

Cold laser = low dose to stimulate

Hi-volt or microcurrent = negative polarity

Thermotherapy = US, diathermy, paraffin

4 stages of healing

hemostasis (sec/min)

inflammatory/acute (hr/days/wks)

proliferation/repair (wks/mo)

remodeling/maturation (mo/yrs)

Hemostasis

initial blood clotting to stop bleeding

Purpose of Inflammatory/acute phase

defend against foreign intruders (infection)

removing damaged tissue and debris

immobilize area

Inflammatory/acute phase is characterized by

vasodilation

increased capillary permeability

phagocytosis by neutrophils and macrophages

Inflammatory chemicals that cause pain

bradykinin

prostaglandins

serotonin (pain-spasm cycle)

What is the goal of the inflammtory/acute phase

limit extent of inflammation and preserve ROM via active care

**non-damaged tissue needs protection + PRICE

Proliferation/repair phase is characterized as

angiogenesis (new capillaries)

fibroblasts, chondroblasts, osteoblasts

In the Proliferation/repair phase, the extracellular matrix contains

type III collagen (weak, disorganized, begin cross-linking)

proteoglycans

What is the goal of the proliferation/repair phase

encourage and increase proliferation

decrease pain and swelling

increase pain-free ROM

begin non-weight bearing proprioceptive training

Remodeling/maturation phase is characterized by

scar contraction (can lead to joint adhesion and loss of motion)

decrease blood vessels

Type III collagen gets replaced by _____ during the remodeling/maturation phase

type I

What is the goal of the remodeling/maturation phase

increase pain-free ROM

progress proprioceptive training

regain full strength + normal biomechanics

protect + strengthen residual joint stability

Secondary enzymatic injury

lysosomal enzymes released

not specific

damage to surrounding uninjured tissue

Secondary hypoxic injury (hemorrhage/clotting/edema/spasm/hematoma)

lead to decreased O2 and nutrition

damage to surrounding uninjured tissue

Physiologic effects of electrical stimulation

decrease pain and muscle spasm

reduce edema

stimulate exercise by muscle contraction

stimulate healing

Monophasic/Galvanic/Direct Current (DC)

current flow in one direction

net charge = positive and negative electrode

charge builds in tissue

Biphasic/Alternating Current (AC)

flow of electrons changes direction regularly (changes polarity)

net charge = balance or unbalanced

wave form = symmetrical or asymmetrical

shape = sinusoidal, square, rectangular, triangular

A-beta is close to ____ and has a ____ threshold and therefore is stimulated first

skin; lower

Patient reports tingling but no muscle twitch, which fibers are stimulated

A-beta fibers ( no A-alpha motor neurons)

Muscle contraction - which fibers are stimulated

exceeded A-alpha motor neurons

Burning/needling sensation - which fibers are stimulated

exceeded A-delta fiber capacitance

Chronaxie

time/phase duration required to depolarize a nerve fiber when a peak current is 2x rheobase

What provides the greatest comfort for the patient

amplitude is 2x rheobase

phase duration is slightly greater than chronaxie

If electrodes are placed close together, the current is concentrated in

superficial tissues

If electrodes are farther apart the current has the potential to take a deeper path through the

nerve and blood vessels that have less resistance

Electricity doesn’t go through what substance well

air

Monopolar electrode configuration

two or more unequal electrodes (1 active, 1 dispersive)

used w/monophasic or biphasic

Reasons for monopolar electrode configuration placement

leads placed far away creates deeper penetration

greater comfort at dispersive pad

creates an electrical field w/specific polarity

Bipolar electrode configuration

2 equal sized electrodes

used w/monophasic or biphasic

**MC in TENS

Quadripolar electrode configuration

two separate medium frequency currents placed as cross currents

**MC in Interferential

True Interferential current (3000-5000Hz)

2 channels, 4 electrodes (quadripolar electrode placement)

most intense where currents cross

treatment frequency is based on type of pain

Pre-modulated (pain relief)

1 channel, 2 electrodes (bipolar electrode placement)

interference occurs in machine, not body

Vector scan (larger tx area)

2 channels, 4 electrodes (quadripolar electrode placement)

cloverleaf pattern rotates

Effects of IFC

pain reduction

muscle strengthening or re-education

Interferential Treatment (beat) frequency for pain

acute = 80-150

subacute = 1-150

chronic = 1-15

Interferential treatment time and amplitude for pain

15-20min

amplitude = pt comfort

Pre-mod treatment (beat) frequency and duty cycle for strength

40-60 Hz

10:50 w/ramp time

Pre-mod treatment amplitude

pt comfort

Indications of Russian current

muscle re-education + retard atrophy

muscle strengthening

decrease muscle spasm through fatigue

Carrier frequency, burst frequency, and pulse rate of Russian current

carrier = 2500 Hz

burst = 50 Hz

pulse rate = 50 Hz

The carrier frequency of Russian current results in

maximally summated muscle contraction

In order to cause tetanus muscle contractions, the pulse rate has to be at least

>35 Hz

**Notes: more doesn’t cause stronger cx it promotes fatigue

Russian Current amplitude

pt tolerance

Russian current duty cycle for muscle strengthening (retard atrophy/retrain muscle)

10:50 (16.7%)

10 contractions

Russian current duty cycle for muscle fatigue (spasms)

10:10 (50%)

Russian current ramp time

0.5-2 seconds

mimics voluntary contractions + eases pt into stimulation

What ramp time is the closest to actual physiological muscle contraction

0.5

Electrode placement always needs to be

parallel to muscle fibers

at motor points (btw belly and tendon/musculotendon junction)

Russian current electrode configurations

monopolar (2 unequal sized electrodes) - active electrode over target

bipolar (2 equal sized electrodes) - single muscle protocol

quadripolar (4 electrodes) - agonist/antagonists

TENS (transcutaneous electrical nerve stimulation)

stimulation of nerves through the skin for pain management

can be addicting to patients

MC waveform in TENS

biphasic, symmetrical, square/rectangle

Microcurrent (heals cutaneous wounds)

stimulus amplitude in microampeage (uA)

monophasic, continuous/pulsed current, w/polarity reversal

peak amplitude is below rheobase of A-beta afferent/sensory fibers

• subsensory/motor → don’t feel anything

High-voltage pulsed current (heals wounds, injuries, dec swelling)

>150 V

frequency units changes from 1-120 Hz

• acute (80-150), chronic (0-15), spasm relief (30-50)

twin peak monophasic/DC current

low average current

Benefits of high-volt

allows deeper penetration

twin peaks doesn’t allow small sensory fibers (a-delta + C) to be stimulated → MORE COMFORT

Phase duration in hiVolt cannot be adjusted by clinician b/c

could stimulate A-delta and C fibers causing PAIN

Edema reduction can only be achieved via

high volt

Edema reduction

negative polarity repels negatively charged proteins

monophasic electrode placement

• small electrode over swelling, large electrode proximal

Muscle spasm reduction - ______ is preferred over hivolt due to lack of polarity effect

russian

Pain reduction - ___ and ___ is preferred over hivolt due to lack of polarity effect

interferential and TENS

Negative polarity attracts what positive cells

fibroblasts, epidermal cells, keratinocytes

Positive polarity attracts what negative cells

neutrophils and macrophages

Inflammatory/acute phase of healing polarity

positive polarity attracts neutrophils and macrophages

Proliferation/repair phase of healing polarity

negative polarity attracts fibroblasts and promotes collagen formation

Remodeling/maturation phase of healing polarity

negative polarity attracts keratinocytes and epidermal cells

Indications of hivolt and microcurrent

stimulate healing (wound healing and germicidal effect)

Indications of hivolt ONLY

decrease edema and decrease spasm/guarding (pelvic floor)

Iontophoresis (low intensity direct current/galvanic stimulation)

true DC current

local transfer of ionized substances (drugs) across the skin via electrical potential (Coulomb’s law)

• through sweat glands and hair follicles

• reservoir in epidermis (passive diffusion to surrounding tissue)