Passive Care exam 1 outline

Passive care

Doctor applies treatment and patient passively receives therapy

Active care

Patient performs activity/exercise for therapeutic effect

Examples of electrophysical agents

Electrical stimulation, heat, cold, mechanical energy, light

Purpose of electrophysical agents

Treatment/prevention of impairments, activity limitations, participation restrictions

First stage of healing

Hemostasis

Hemostasis timing

Seconds to minutes

Purpose of hemostasis

Blood clotting to stop bleeding

Second stage of healing

Inflammatory (acute)

Inflammatory phase timing

Hours to days to weeks

Signs of inflammation

Heat, redness, swelling, pain, loss of function

Purpose of inflammation

Defend, remove debris, immobilize area

Inflammatory characteristics

Vasodilation, increased permeability, phagocytosis

Chemicals causing pain

Bradykinin, prostaglandins, serotonin

Secondary injury types

Enzymatic and hypoxic

Secondary enzymatic injury

Lysosomes damage healthy tissue

Secondary hypoxic injury

Decreased oxygen/nutrition damages tissue

Goal of acute phase

Limit inflammation and preserve ROM

Ice use

Only first 24–48 hours in acute phase

Third stage of healing

Proliferation (repair)

Proliferation timing

Weeks to months

Cells involved in proliferative phase

Fibroblasts, chondroblasts, osteoblasts

Collagen type in proliferative phase

Type III (weak, disorganized)

Goals of proliferation

Decrease pain/swelling, increase ROM, promote healing

DO NOT do in proliferation

Ice

Fourth stage of healing

Remodeling (maturation)

Remodeling timing

Months to years

Collagen change in remodeling phase

Type III → Type I

Goals of remodeling

Restore strength, ROM, biomechanics

Effect of stress on tissue

Increases collagen strength and alignment

Electricity

Flow of electrons

Requirements for electricity

Source, driving force, conductor

Capacitance

Ability to store charge

Monophasic current

One direction, DC, net charge

Biphasic current

Alternating current, changes polarity

Symmetrical waveform

Same shape both phases

Asymmetrical waveform

Different shapes

Balanced waveform

Equal charge, no polarity effect

Unbalanced waveform

Unequal charge

Phase duration

Time from baseline to peak and back

Amplitude

Intensity of current

Average current

Current over time (most important biologically)

Strength-duration curve

Relationship between amplitude and phase duration

Rheobase

Minimum amplitude to depolarize nerve

Chronaxie

Time to depolarize at 2x rheobase

Frequency

Pulses per second (Hz)

Absolute refractory period

Limits nerve firing rate

Tetany

Fused contraction at 35–50 Hz

Wedenski inhibition

1000 Hz prevents contraction

Dispersal electrode

Large electrode spreads current

Electrode spacing

~2 inches apart

IFC frequency

3000–5000 Hz

IFC setup

2 channels, 4 electrodes, crisscross pattern

Constructive interference

Waves add together

Destructive interference

Waves cancel out

Heterodyne

Combination creating beat frequency

IFC for acute pain

80–150 Hz

IFC for chronic pain

1–15 Hz

Treatment time IFC

15–20 minutes

Premodulated current

Interference occurs in machine

Vector scan

Rotates treatment area

Stereodynamic

3D interference pattern

IFC contraindications

Anterior neck, chest, head, pacemaker, pregnancy, cancer, etc.

Russian current purpose

Muscle strengthening, re-education

Carrier frequency

2500 Hz

Burst frequency

50 Hz

Duty cycle strength

10:50

Duty cycle fatigue

10:10

Motor points

Most excitable muscle point

Electrode placement

Parallel to muscle fibers

NMES goal

Stimulate alpha motor neurons

Physiological recruitment

Slow twitch first

Electrical recruitment

Fast twitch first

Electrical contraction

Synchronous, more fatigue

TENS purpose

Pain modulation

Sensory TENS

Acute pain, A-beta fibers, no contraction

Sensory TENS frequency

80–150 Hz

Motor TENS

Chronic pain, causes contraction

Motor TENS frequency

1–15 Hz

Noxious TENS

Stimulates C fibers, very high intensity

TENS treatment time

20–30 minutes

High volt stimulation

150V monophasic current

Benefits

Deep penetration, low average current

Primary use

Healing and edema reduction

Microcurrent

Subsensory, no depolarization

Skin battery

Natural electrical gradient in skin

Galvanotaxis

Cell movement via electrical polarity

Polarity inflammatory phase

Positive

Polarity proliferation phase

Negative

Polarity remodeling phase

Negative

HiVolt for edema

Negative polarity

HiVolt placement

Active over area, dispersal proximal

Low volt current

DC current

Electromigration

Movement of ions via current

Iontophoresis

Drug delivery through skin

Iontophoresis rule

Same charge repels (like repels like)

Dosage formula

mA × minutes

Max amplitude

4 mA (except hyperhidrosis)

Current density limits

0.5 mA/cm² cathode, 1.0 mA/cm² anode

Iontophoresis contraindications

Broken skin, allergies, near eyes

Risks

Skin irritation, burns