NPTE Modalities

What are the major physiological effects of heat?

↑ Cardiac output, ↑ vasodilation, ↑ HR, ↑ RR, ↑ metabolic rate; ↓ BP, ↓ muscle activity, ↓ blood flow to internal organs, ↓ blood flow to resting muscle, ↓ stroke volume.

What does cold increase vs. decrease?

↑ joint stiffness, pain threshold, muscle activation. ↓ collagen extensibility, blood flow, capillary permeability, local metabolism,

spasticity, nerve conduction velocity (time) so prolonged ice for 15-20 min

Hot pack temperature and treatment time?

158-167°F, 20-30 min, with 6-8 layers of toweling.

what about all terry cloth how many layers?

4-6 layers

When does a hot pack peak in heat?

During the first 5 minutes.

Cold pack temperature and treatment time?

Stored at 25°F, applied for 10-20 min; can be reapplied every 1-2 hours.

What are the stages of cold application? mnemonic (CBAAN)

CBAAN: Cold → Burning → Aching → Analgesic → Numb.

Major contraindications to superficial heat?

Malignancy, compromised circulation, thrombophlebitis

impaired sensation/mentation, bleeding/hemorrhage

infrared over the eyes.

arterial disease

MC TIBIA is hot

Major contraindications to cryotherapy?

Cold intolerance/hypersensitivity, cryoglobulinemia, paroxysmal cold hemoglobinuria, Raynaud's, over-regenerating peripheral nerves, and circulatory compromise.

NMES strengthening frequency?

35-80 pps.

NMES strengthening pulse, reeducation, muscle spasm reduction, edema reduction using muscle pump durations?

Small muscle: 125-200 μs

Large muscle: 200-350 μs.

NMES strengthening ON:OFF ratio initially?

1:5 — approximately 6-10 sec ON / 50-120 sec OFF.

What contraction intensity is desired for NMES strengthening?

>10% MVIC in injured muscle and >50% MVIC in uninjured muscle.

NMES muscle re-education frequency?

35-50 pps.

NMES for muscle spasm reduction: key parameters?

35-50 pps, visible contraction, 2-5 sec ON / 2-5 sec OFF, equal ON:OFF, 10-30 min.

NMES for edema reduction using the muscle pump?

35-50 pps, visible contraction, 2-5 sec ON / 2-5 sec OFF, 30 min, twice/day.

How can you increase patient comfort with electrical stimulation?

Increase ramp time, adjust (dec for comfort) pulse duration, use appropriate electrode size/quality (big and sticky), inc pulse frequency, and inc OFF time.

Major contraindications to electrical stimulation?

Mnemonic: Please Understand Currents Threaten Pregnancy

Pacemaker, unstable arrhythmias, carotid sinus, thrombosis/thrombophlebitis, near pregnant uterus.

Mnemonic: Please Understand Currents Threaten Pregnancy

HVPC for an inflamed/infected wound: which polarity?

Negative electrode (Negative = Nasty wound).

HVPC for a clean/proliferative wound?

Positive electrode (Positive = Progressing/clean wound).

HVPC frequency and treatment time?

100-105 pps and 45-60 min.

what is the goal for using iontophoresis treatment

transdermal medication delivery

What are the major negative ions used in iontophoresis?

ISAD: Iodine, Salicylate, Acetate, Dexamethasone.

What ion is used for calcium deposits?

Acetate (−).

What ion is used for fungal infections?

Copper (+).

What ion is used for edema reduction?

Hyaluronidase (+).

High-rate TENS is primarily used for what?

Acute pain — sensory stimulation.

100 pps, 50-100 μs, comfortable tingling, 20-30 min or during activity.

high rate acute pain TENS parameters

sensory stimulation, mono or biphasic waveform 100 pps pulse duration 50-100 duration 20-30 min

Low-rate/acupuncture-like TENS parameters?

can be used if patient is accommodated to high rate.

Brief-intense TENS parameters?

100 pps, >150 μs, strong muscle twitch,

Noxious hyperstimulation TENS parameters?

100 pps or 1-5 pps, >250 μs up to 1 sec, highest tolerable/painful stimulus, 30-60 sec per area.

DC or monophasic waveform

USED FOR TRIGGER PTS- myofascial pain syndrome

1. 50 pps, 150 us, on:off ratio 1:5

2. 100 pps, 100 us, comfortable tingling sensation

3. 100 pps, 300 us, highest tolerance, 30-60 seconds over a trigger point

4. 35 pps, 300 us, muscle contracts, equal on/off

5. 35 pps, 300 us, muscle contracts, on/off depends on task 6. 10 pps, 200 usec, visible twitch

A. Muscle Re Ed/FES

B. Low Rate TENS

C. High Rate TENS

D. Strengthening

E. Noxious TENS

F. Edema or Spasm reduction

A-5

C-2

B-6

D-1

E-3

F-4

What does ultrasound intensity measure?

Amount of energy delivered per unit area, measured in W/cm².

What are the two ultrasound frequencies?

1 MHz and 3 MHz.

Which ultrasound frequency is used for shallow vs. deep tissue?

3 MHz = shallow

1 MHz = deep

duty cycle for ultrasound

on time 5 sec

off 5 sec

5/10= 50% pulsed

continuous will be 100%

Acute ultrasound parameters?

Chronic ultrasound parameters?

>3 weeks → continuous → >1 W/cm² (Chronic = Continuous & High).

Major contraindications to ultrasound?

Malignancy, pacemaker, eyes, reproductive organs/pregnancy, joint cement/plastic, CNS tissue, and thrombophlebitis.

What should you do if a patient reports deep heat/burning during ultrasound?

Recognize this as a hot spot and stop/adjust the treatment rather than continuing over the area. KEEP MOVING THE HEAD AND ADD MORE GEL, REDUCE INTENSITY

CHANGE FROM 1 TO 3 HZ

What lumbar traction position is generally used for intervertebral/facet joints and muscle elongation?

Supine with pillow under knees.

What position is used for a posterior disc herniation?

Prone.

Hip flexion angle to increase L5-S1 intervertebral space?

45-60° hip flexion.

Hip flexion angle to increase L3-L4 intervertebral space?

75-90° hip flexion.

cervical and lumbar traction parameters

Joint Distraction

20-29 lbs. (max)

7% body weight

50 lbs. 50% body weight

Disc protrusion Muscle Spasms Elongation 11-15 lbs.

25% body weight

What is a contraindication to mechanical traction?

Joint hypermobility/instability, immobilization, peripheralization of symptoms, acute injury/inflammation, or uncontrolled hypertension.

A patient experiences increased radiating leg pain during traction. What should you think?

Peripheralization = contraindication. Stop traction rather than continuing to increase the force.

What is used for hyperhidrosis?

Water (+/−)

What is used for scars?

Iodine (−)

What is used for analgesia (pain relief)?

Salicylate (−)

What is used for calcium deposits?

Acetate (−)

What is used for musculoskeletal inflammation?

Dexamethasone (−)

What is used for dermal ulcers?

Zinc (+)

What is another ion used for analgesia?

Lidocaine/Xylocaine (+)

What is used for fungal infections?

Copper (+)

What is used for edema reduction?

Hyaluronidase (+)

What is used for muscle spasm?

Calcium or Magnesium (+)

What sensitivity is used for muscle relaxation?

Low sensitivity

What sensitivity is used for muscle re-education?

High sensitivity

How should electrodes be placed for muscle relaxation?

Closely placed

How should electrodes be placed for muscle re-education?

Far apart