FF modalities (lecture 12)

what increases with thermal modalities

cardiac output, vasodilation, heart rate, respiratory rate, metabolic rate

what decreases with thermal modalities

muscle activity, blood pressure, blood to internal organs, blood flow to resting muscles, stroke volume

what increases with cryotherapy

joint stiffness, pain threshold, muscle activation

what decreases with cryotherapy

collagen extensibility, blood flow, capillary permeability, local metabolism, spasticity, nerve conduction velocity

how long must ice be applied to begin to affect spasticity

15-20 minutes or more

if someone has a recent injury with tender muscles, increased tone, and mild edema, would you use a hot or cold pack? how long?

cold pack, around 20 minutes

what temperature should hot packs be stored at

158-167 degrees F

what is treatment time for hot packs

20-30 minutes

how many layers of towels do you need for a hot pack? what about if it is good condition terry cloth?

6-8 for towels, 4-6 for good terry cloth

when do hot packs experience peak heat

in first 5 minutes

if you skin check at 5 min with a hot pack on, what might the skin look like

pink, blanching

what temperature should cold packs be stored at

25 deg F

what is treatment time for cold packs

10-20 minutes

how often can cold packs be applied

every 1-2 hours

how many layers do you need for a cold pack

single pillow case

what are the stages of cold

1. intense Cold

2. Burning

3. Aching

4. Analgesic

5. Numb

CBAAN

what are the contraindications for superficial thermotherapy

over an area of Malignancy

over an area of compromised Circulation

Thrombophlebitis

Impaired sensation or mentation

Bleeding or hemorrhage

Infrared irradiation of the eyes

Arterial disease

MC TIBIA

what are the contraindications for superficial cryotherapy

cold intolerance (cold hypersensitivity, cryoglobulinemia, paroxysmal cold hemoglobinuria, raynauds phenomenon)

over regenerating peripheral nerves

circulatory compromise

will BP increase or decrease with cryotherapy

increase

what is the pulse frequency for muscle strengthening e stim

35-80 pps

what is the pulse duration for muscle strengthening, muscle reeducation, muscle spasm reduction, and edema reduction with muscle pump e stim

125-200 microseconds for small muscles, 200-350 microseconds for large muscles

what is the amplitude for muscle strengthening e stim

> 10% MVIC if injured

> 50% MVIC if uninjured

what are the on/off times for muscle strengthening e stim

6-10 seconds on, 50-120 seconds off

1:5 ratio

can reduce off time with repeated treatments

what is ramp time for muscle strengthening e stim

at least 2 seconds

what is treatment time for muscle strengthening e stim

10-20 minutes to produce 10-20 repetitions

what is times per day for muscle strengthening e stim

every 2-3 hours when awake

what is pulse frequency for muscle reeducation (NMES), muscle spasm reduction, and edema reduction with muscle pump e stim

35-50 pps

what is amplitude for muscle reeducation e stim

sufficient for functional activity

what is on/off time for muscle reeducation e stim

depends on functional activity

what is ramp time for muscle reeducation e stim

at least 2 seconds

what is treatment time for muscle reeducation e stim

depends on functional activity

what is amplitude for muscle spasm reduction and edema reduction with muscle pump e stim

to visible contraction

what is on/off time for muscle spasm reduction and edema reduction with muscle pump e stim

2-5 seconds on, 2-5 seconds off

equal on/off times

what is ramp time for muscle spasm reduction and edema reduction with muscle pump e stim

at least 1 sec

what is treatment time for muscle spasm reduction e stim

10-30 min

what is times per day for muscle spasm reduction e stim

every 2-3 hours until spasm relieved

what is treatment time for edema reduction with muscle pump e stim

30 min

what is times per day for edema reduction with muscle pump e stim

twice a day

how can you adjust ramp time to increase patient comfort

increase

how can you adjust pulse duration to increase patient comfort

decrease duration

how can you adjust electrode size and quality to increase patient comfort

larger electrodes, sticky and fresh

how can you adjust pulse frequency to increase patient comfort

increase

how can you adjust on/off time to increase patient comfort

increase off time

what are contraindications for electrical currents

pacemaker, unstable arrhythmias, carotid sinus, thrombosis or thrombophlebitis, near pregnant uterus

"please understand currents threaten pregnancy"

if applying e stim to wrist extensors to improve reaching, what would pulse duration and on/off time be

pulse duration: 150 microseconds

on/off: coordinated to the activity

treatment goal is muscle reeducation

with high voltage pulsed galvanic current (HVPC), when would you use a negative electrode?

to promote healing of inflamed or infected wounds

with HVPC, when would you use a positive electrode?

to promote healing of wounds without inflammation

where is electrode placed in HVPC

in or around the wound area

if in, it is used with saline soaked gauze

what is treatment time for HVPC and how often

3-7 days/week with 45-60 minute sessions

what is pulse frequency for HVPC (positive and negative)

100-105 pps

what is pulse duration for HVPC (positive and negative)

100

what is amplitude for HVPC (positive and negative)

to produce comfortable tingling

what ion is indicated for hyperhidrosis, is it positive or negative? and what is the commonly used medicinal source?

water, +/-, tap water

what ion is indicated for scars, is it positive or negative? and what is the commonly used medicinal source?

iodine, -, iodine

what ion is indicated for analgesic, is it positive or negative? and what is the commonly used medicinal source?

salicylate, -, sodium salicylate

what ion is indicated for calcium deposits, is it positive or negative? and what is the commonly used medicinal source?

acetate, -, acetic acid

what ion is indicated for MSK inflammation, is it positive or negative? and what is the commonly used medicinal source?

dexamethasone, -, dexamethasone phosphate

what ion is indicated for dermal ulcers, is it positive or negative? and what is the commonly used medicinal source?

zinc, +, zinc oxide

what are other ions indicated for analgesic, are they positive or negative?

lidocaine and xylocaine, +

what ion is indicated for fungal infections, is it positive or negative? and what is the commonly used medicinal source?

copper, +, copper sulfate

what ion is indicated for edema reduction, is it positive or negative? and what is the commonly used medicinal source?

hyaluronidase, +, wydase

what ions are indicated for muscle spasm, are they positive or negative? and what is the commonly used medicinal source?

calcium and magnesium, +, calcium chloride and magnesium sulfate

what is the mnemonic for remembering which ions are negative

I SAD

iodine, salicylate, acetate, dexamethasone

what are the four kinds of transcutaneous electrical nerve stimulation (TENS)

acute pain (high rate), acupuncture like (low rate), brief intense, noxious

what type of TENS is acute pain (high rate)

sensory stimulation

what is waveform for acute pain (high rate), acupuncutre like (low rate), and brief intense TENS

mono or biphasic pulsed

what is pulse frequency for acute pain (high rate) TENS

100 pps

what is pulse duration for acute pain (high rate) TENS

50-100 usec

what is amplitude for acute pain (high rate) TENS

comfortable tingling

what is treatment duration for acute pain (high rate) TENS

20-30 min or during activities

what is the type of TENS for acupuncture like (low rate) and brief intense TENS

motor stimulation

what is pulse frequency for acupuncture like (low rate) TENS

< 10 pps

what is pulse duration for acupuncture like (low rate) TENS

> 150 usec

what is amplitude for acupuncture like (low rate) TENS

visible twitch

what is treatment duration for acupuncture like (low rate) TENS

20-45 min

what is pulse frequency for brief intense TENS

100 pps

what is pulse duration for brief intense TENS

> 150 usec

what is amplitude for brief intense TENS

strong muscle twitch

what is treatment duration for brief intense TENS

< 15 min

what is type of noxious TENS

hyperstimulation

what is waveform for noxious TENS

DC or monophasic

what is pulse frequency for noxious TENS

high: 100 pps

low: 1-5 pps

what is pulse duration for noxious TENS

> 250 usec up to 1 sec

what is amplitude for noxious TENS

highest tolerance/painful stimulus

what is treatment duration for noxious TENS

30-60 seconds per area

when would you use noxious TENS

trigger points

what kind of e stim has the parameters of 50 pps, 150 us, on/off of 1:5

strengthening

what kind of e stim has the parameters of 100 pps, 100 us, comfortable tingling sensation

high-rate TENS

what kind of e stim has the parameters of 100 pps, 300 us, higihest tolerance, 30-60 seconds over a trigger point

noxious TENS

what kind of e stim has the parameters of 35 pps, 300 us, muscle contractions, equal on/off

edema or spasm reduction

what kind of e stim has the parameters of 35 pps, 300 us, muscle contractions, on/off depends on task

muscle reeducation/FES

what kind of e stim has the parameters of 10 pps, 200 usec, visible twitch

low rate TENS

what kind of sensitivity is required for muscle relaxation with EMG biofeedback

low

what kind of sensitivity is required for muscle reeducation with EMG biofeedback

high

how should electrodes be placed for muscle relaxation with EMG biofeedback

closely placed

how should electrodes be placed for muscle reeducation with EMG feedback

far apart

if someone is having shoulder pain, what biofeedback parameters would you use

low sensitivity and closely placed electrodes

how would you position someone for lumbar traction if they have discomfort in intervertebral joints, facet joints, and for muscle elongation

supine with pillow under knees (relatively flexed)

how would you position someone for lumbar traction if they have posterior disc herniation

prone

if dealing with L5-S1 for lumbar traction, how much hip flexion should be present

45-60 deg