NPTE Devices, equipment and modalities

Metatarsal Pad

What: Moves pressure from the met heads to the met shafts

Allows more push-off in weak or inflexible feet

Cushion Heel

What: cushions and absorbs forces at heel contact, used to relieve strain on plantar fascia

Rearfoot posting: Medial Wedge

Limits eversion of calcaneus and IR of tibia after heelstrike

-Reduces eversion during running

Rearfoot posting: Lateral Wedge

Limit excessive inversion and supination at heel strike

Forefoot posting: Medial Wedge

For forefoot varus

Forefoot posting: Lateral Wedge

For forefoot valgus

A forward axle makes a w/c ....

more tippy

-good for SCI

-bad for amputees bc less weight in from so more likely to tip over

A more posterior axle makes a w/c ....

less tippy and more stable

Ramps calculation for w/c

For ever 1 in of rise, the ramp is 12 in of run

Ramps should be less than <30 inches of raise

Minimum Door width for W/c

32 inches

Standard toilet height

17-20"

UCBL

semirigid plastic molded insert to correct for flexible pes planus

Pes Plantus

Flat foot

Pes Cavus

High arch

Pulsed Lavage

(PL)

-Non-selective debridement of wounds

What: used to remove loosely adhered necrotic tissue, slough , exudate and dirt

Contraindications:

-presence of granulating tissue UNLESS contaminated with bacteria or non-viable tissue present

-uncontrolled bleeding

-blood vessels in wound bed

Use

-Intensity: 4-8 psi (maybe as high as 15)

-Duration: 5-15 min once a day

Ultrasound

Duty Cycle: on and off time of US unit

-longer on = more sound waves into skin = more heat

-example: Duty cycle of 20% = on 20% of the time

-100% Duty Cycle = Continuous Thermal US (for bf, deform scars or heat contractile tissue

-50% duty cycle = pulse non-thermal US for healing and pain

-20% duty cycle = pulsed non-thermal US for fluid dynamics

Frequency: Determines the DEPTH of US

-1 MHz= deep heating 3-5 cm below skin (capsule, deep mm, arthritis)

-3 MHz= shallow heating 1-2 cm below (fingers and superficial tendons)

Therapeutic Intensity: strength or amplitude of US

- measured in w/cm2

-0.5-30 w/cm2

-0.5-1.25 w/cm2 for acute conditions require less intensity

-1.5-2.0+ w/cm2 for chronic conditions require more intensity

Other things about US

-indirect contact used with tub for irregular body parts

-Hot spots are peak intensity = need to move the head around more or reduce the duty cycle

-BNR: ration of spatial peak intensity to spatial average intensity, High BNR= risk of tissue damage; Ideally keep btwn 2:1 to 6:1 (closer to 10= damage)

-Do NOT use UR to reduce swelling, promote joint healing, or achieve LT pain relief for MSK conditions

Minimum hallway width for 1 w/c

36 inches

Minimum hallway width for 2 w/c

60 inches

Ramp slope (degree)

4.8 degrees

Minimum Ramp Width

3 ft or 36 inches

Maximum ramp length before landing

30 ft or 360 inches

Ramp landing/rest area dimensions

5ft x 5ft

FES or NMES

What: Muscle strengthening

Frequency: 35-80 PPS

Pulse Duration: 150-200 microseconds for small muscles and 200-300 for large muscles

On:Off = 1:5 ratio

Ramp time: 2 seconds

Tx: 10-20 reps

Acupuncture-Like TENS (low rate TENS)

What: noxious stimulation to get body to release endogenous opiates within body for LONGER lasting pain relief

Frequency: <10 PPS

Pulse Duration: >150 microseconds

Visible twitch

20-45 min

Intensity: High enough to evoke visible muscular contraction

Brief Intense TENS

What: used when pt undergoing painful procedure (wound care) to block pain from the procedure and get endogenous opiates through descending pain inhibition pathway

Frequency: 100 PPS

Pulse Duration: >150 microseconds

Intensity: Highest tolerable intensity of brief period of time (15 min or less)

Tx time: <15 min

Iontophoresis: I SAD

Mnemonic for cathode medications

I- Iodine: Sclerotic scars

S- Salicylate: Analgesic

A- Acetate: Calcium Deposits

D- Dexamethasone: MSK inflammation

Iontophoresis: Anode medications

All use + to be driven into body

Zinc: Dermal ulcers

Lidocaine or Xylocaine: analgesia

Copper: fungal infection

Hyalurondiase: edema reduction

Calcium or Magnesium: Muscle spasms

High Rate (conventional TENS)

What: Gate theory, temporary pain relief

Frequency: 100 PPS

Pulse Duration: 50-100 microseconds

Intensity: Comfortable tingle

Tx time: 20-30 min or during activities

Lumbar traction

Supine: pillow under knees for more flexion

-Used for tx of Intervertebral joints, facet joints and muscle elongation

-L5-S1= need 45-60 deg hip flexion

-L3-L4= need 75-90 deg hip flexion

-50% BW

Prone

-Tx for Posterior disc herniation

-25% BW

Dosage

-25% of Body weight for elongation, disc protrusion and spasm

-50% (or more than 50lbs) for joint distraction

EMG Biofeedback: Sensitivity and electrode placement

Low sensitivity for muscle relaxation and close together

(other terms may be used: inhibition, decrease tone/activity, downtrain)

High sensitivity for muscle re-education and far apart

(other terms may be used: facilitate, activation, recruitment, up train)

How to remember EMG Biofeedback:

Low and close to relax

Far and high to activate

Low and close: low sensitivity and close together

High and far: high sensitivity and far apart

Thermal US

-used for soft tissue shortening and pain

Dosage/Settings for shallow problems (1-2 cm)

-Duty cycle: 100%

-US Frequency: 3 Hz

-US intensity: 0.5 W/cm2

-5-10 min/2 x ERA

Dosage/Settings for deep problems (<5cm)

-Duty cycle: 100%

-US Frequency: 1 Hz

-US intensity: 1.5-2.0 W/cm2

-5-10 min/2 x ERA

Non-thermal US

-Pulsed US for prolonged tissue healing or prolonged inflammation

Dosage/Settings

-Duty Cycle: 20 or 50%

-US Frequency: 3 Hz for superficial and 1 Hz for deep

-US intensity: 0.5-1.0 W/cm2

-5-10 min/2 x ERA

How to remember US depth

1 turns into a D = deep tissue

3 kind of looks like an S = superficial