Modalities Cheat Sheet

Paraffin Bath Contraindications

- Open wounds - Skin infections - Sensory loss - Peripheral vascular disease

Ice Packs (Bags)

- Used for minimizing swelling and providing analgesia following injury - Ice may be flaked or crushed and will be encapsulated in wet towel or plastic bag - Both are easily moldable to body - Elastic wrap generally utilized to secure pack in place for 20 minutes - Compression and elevation are also used in conjunction with ice

NMES indications

- peripheral nerve injuries - tendon transplants - UMN lesions to reduce spasticity and facilitate active contraction (stroke, SCI, TBI) - decrease atrophy - shoulder subluxations - improved bladder control - improve sensation i.e. stroke - visual prostheses (blindness) - auditory prostheses (deafness) muscle reeducation delay atrophy edema reduction muscle strengthening

Ultrasound Contraindications

-Application over cardiac pacemaker, eyes, genitalia, joint replacements. -Pregnancy -Cancer -Infection -Minimize exposure over open epiphyses and spinal cord.

Ultrasound Indications

-Heat protein-rich, deeper tissues -Increase blood flow in deep tissues -May speed repair in slow-to-heal wounds, including nonunion fractures and tendinopathy

Ultrasound Indications

-acute and post-acute conditions (nonthermal effects) -calcium deposits -chronic inflammation -delayed soft tissue healing -dermal ulcers -joint contracture -muscle spasm -myofascial trigger points -pain -plantar warts -scar tissue -tissue regeneration -Heat protein-rich, deeper tissues -Increase blood flow in deep tissues -May speed repair in slow-to-heal wounds, including nonunion fractures and tendinopathy

Fluidotherapy advantages

1. Pt can exercise during intervention 2. Good for distal extremities and joint contours 3. Increased mechanical stimulation 4. Has good temperature control 5.More Active 6.Comfortable

Paraffin bath temp

126 F

ultrasound therapy

A deep heating modality using high-energy sound waves that is most effective for heating tissues or deep joints and is performed by a physical therapist. The application of sound waves to a body area to increase circulation and flexibility as well as to decrease pain and muscle spasms in that area.

Fluidotherapy

A dry heating agent that transfers heat by convection. It consists of a cabinet containing finely ground particles of cellulose through which heated air is circulated. Self-contained unit filled with sawdust-type particles heated to the desired temperature and circulated by air pressure around the involved body part. Container that circulates warm air and small cellulose particles. extremity is placed into container and dry heat is generated thru energy transferred by forced convection. promotes tissue healing and prevention of edema. body part should be placed into unit prior to turning machine on.

Functional Electrical Stimulation (FES)

Application of low-level, computer- controlled electric current to the muscles, including paralyzed muscles, to enhance or produce function

Heat Contraindications

Areas of active bleeding Acute injuries/ localized inflammation problems Areas of loss/decreased sensation Scars Skin infections Open wounds can't report heat Skin or lymphatic cancer excess HTN (160/90) Hemophilia Steroid Therapy (long term) Cardio Vascular or Resp. Problems -areas with sensory deficits -areas with circulatory deficits -tumors

NMES parameters

Bipolar electrode placement over muscle. interrupted current is used with a range of 20-40 pulses per second an on time of 6-10 secs followed by off time of approx 50-60 secs. 15-20 mins for several times a day

Continuous Passive Motion (CPM)

Exercises that are performed by motorized exercise machinery that keeps a joint in constant slow motion. A therapy that prevents stiffness and improves circulation by delivering a form of passive range-of-motion exercise so that the joint is moved without the patient's muscles being used. -Continuously flexes and extends the knee to prevent scar tissue from forming and increasing gradually

NMES

Neuromuscular electrical stimulation: used to facilitate skeletal muscle activity. Stimulation of an innervated muscle occurs when an electrical stimulus of appropriate intensity and duration is administered to the corresponding peripheral nerve. commonly used to facilitate return of controlled functional muscular activity or to maintain postural alignment until recovery occurs.

Vasopneumatic Compression Device

Pneumatic device consisting of a bi-layered sleeve to provide compression

Heat therapy Indications

Promotes vasodilation, decreases blood viscosity, increases metabolism of tissues, increases capillary permeability - should not be applied for longer than 20-30 minutes, or reflex vasoconstriction and tissue congestion can occur

Cryotherapy Indications

Reduce pain Reduce swelling Reduces secondary tissue injury More cells are able to survive due to the low metabolic activity and decreased need for oxygen Help break the pain-spasm cycle Managing persistent pain problems Acute conditions

Paraffin Bath Protocol

Remove jewlery, wash hands, dip up to 15 times, place plastic bag over hand, place towel/oven mitt over plastic bag. Leave on for 15 minutes

Ultrasound

Sound waves with frequencies above the normal human range of hearing

Paraffin Bath Indications

Subacute and chronic inflammatory conditions. Limitation of motion after immobilization - stimulates circulation

Hydroculator (Hot pack machine)

Temperature 160-166

Fluidotherapy Temperature

Temperature set between 111-125

Deep thermal agents

Therapeutic ultrasound Phonophoresis Short-wave diathermy

Fluidotherapy treatment time

Treatment time 15-20 minutes

Electrotherapeutic agents

Use electricity and the electromagnetic spectrum to facilitate tissue healing, improve muscle strength and endurance, decrease edema, modulate pain, decrease the inflammatory process, and modify the healing process.

mechanical devices

Vasopneumatic devices and CPM machines

transcutaneous electrical nerve stimulation (TENS)

a battery-powered device delivers stimulation to nerves to relieve acute and chronic pain. electrical stimulation of nerves for relief of pain. uses a device that delivers electrical impulses through the skin, which cause changes in muscles

Cryotherapy

cold therapy

Cryotherapy Contraindications

compromised circulation, peripheral vascular disease, ischemic tissue, cold hypersensitivity, raynaud's phenomenon, cold urticaria, hypertension, infection, cryoglobinemia

CPM

continuous passive motion

Infrared

electromagnetic radiation with wavelengths longer than visible light but shorter than radio waves

Electrotherapeutic agents

neuromuscular electrical stimulation (NMES) functional electrical stimulation (FES transcutaneous electrical nerve stimulation (TENS) high-voltage galvanic stimulation for tissue and wound repair (ESTR) high-voltage pulsed current (HVPC) direct current (DC) iontophoresis

Paraffin bath

the immersion of a body part in melted paraffin to increase circulation and flexibility as well as to decrease pain and muscle spasms. The use of hot wax and mineral oil to reduce pain and stiffness in patients with arthritis

superficial thermal agents

therapeutic application of any modality that raises the temperature of skin and superficial subcutaneous tissue to a depth of 1 cm. Include but are not limited to hydrotherapy/whirlpool, cryotherapy (cold packs, ice), Fluidotherapy, hot packs, paraffin, water, infrared, and other commercially available superficial heating and cooling technologies.

Cold therapy

therapy using ice or cold application to reduce or prevent swelling by decreasing circulatory flow to the injured body part Promotes vasoconstriction, increases blood viscosity, decreases metabolism of tissues, has local anesthetic effect - Decreases muscle tension - should not be applied for longer than 20 minutes or reflex vasodilation can occur

Fluidotherapy Contraindications

• Open wounds • Metal plates and/or pinning present in hand or distal arm. • Current fractures; newly healed fractures that may not be stable. • RA • Recent Burns • Current Infections • Poor circulatory response and/or poor sensation