Therapeutic Modalities Final

Cryotherapy Contraindications

- Medical conditions in which vasoconstriction will aggravate the symptoms - Impaired circulation - Peripheral vascular diseases - Hypersensitivity to cold - Impaired sensations - Open wounds - Skin conditions (e.g., psoriasis) - Infections - Cold urticaria - Cryoglobulinemia - Raynaud's disease - Hypertension - Ischemic tissue - Ischemic disease

Cold Packs: Contraindications

- Peripheral neuropathy - Raynaud's phenomenon

Cold Packs Indications

-acute injury or inflammation -acute or chronic pain -prevention of swelling -decrease muscle spasm -neuralgia -CNS spasticity -Bursitis

The duty cycle that is historically recommended for strengthening when using NMES is: 1:5 1:4 1:1 1:7

1:5

Superficial thermal agents penetrate heat to a depth of: 1.5cm-2.5cm 1cm-2cm 2cm-3cm 5mm-1cm

1cm-2cm

Conventional TENS uses a frequency of ____________ pps with a pulse width of ___________ microseconds. 1-5; 20-100 7-10; 40-100 50-200; 20-100 70-100; 40-80

50-200; 20-100

To prevent burns, at least _____ layers of towels should be placed between the skin and the hot pack. 2 4 6 8

6

Superficial thermal agents heat to a mild or vigorous temperature. A mild dose is one that heats to ____degrees, and a vigorous dose heats to _____degrees. <107 degrees, >120 degrees <104 degrees, 104-113 degrees <98.6 degrees, 99-104 degrees 100-105 degrees, >111 degrees

<104 degrees, 104-113 degrees

Convection

A transfer of heat through movement of heated particles transfer of heat by convection is more efficient because the medium is continuously moving and coming into contact with the area being treated Modalities: fluidotherapy and whirlpool baths

When using TENS to decrease pain using the gate controlled theory, _________________ fibers are activated. nocicepter small-diameter A-beta unmyelenated

A-beta

Which of the following best describes conduction? The absorption of energy with a subsequent change from a liquid to a gas. The therapeutic application of any modality which results in an increased skin and superficial subcutaneous tissue temperature. An energy exchange between two materials transferring heat from the patient's extremity to the cooling agent. The conveyance of heat by the movement of heated particles.

An energy exchange between two materials transferring heat from the patient's extremity to the cooling agent.

Which of the following is NOT considered to be a contraindication for applying a superficial heating agent? Bleeding tendencies Acute edema Advanced cardiac disease Chronic inflammation

Chronic inflammation

The remodeling phase of wound healing is characterized by: Pseudomonas Vasoconstriction & Vasodilation Collagen Formation Wound Contraction

Collagen Formation

Patient with neurogenic pain report symptoms of: Pain from tissue damage with a sudden onset. Decreased movement, parasthesias and sensory changes. Pain with palpation Inconsistent pain with anxiety and depression.

Decreased movement, parasthesias and sensory changes.

Therapeutically, superficial colling of tissue produces all but which ONE of the following? Analgesia Decreased edema Lowered metabolic activity Decreased viscosity

Decreased viscosity

Which of the following best describes how ultrasound works? Movement of the sound-head on the skin/tissue causes heating from friction Deformation of the crystal causes oscillations or pressure waves into adjacent tissue Electrical current applied to the sound head causes it to warm and transfer heat through conduction Voltage polarization causes the crystal to heat up

Deformation of the crystal causes oscillations or pressure waves into adjacent tissue

What is the "hunting response"? The red area of the skin located near the application site of cold. Vasoconstriction followed immediately by vasodilation. Delayed vasodilation followed by vasoconstriction lasting up to 30 minutes. The effect of cold on the muscle spindle.

Delayed vasodilation followed by vasoconstriction lasting up to 30 minutes.

What does frequency of ultrasound describe? Depth of penetration Acoustic Impedance level Amount of heat of the sound head Strength or intensity of the sound

Depth of penetration

Which one of the following best explains a benefit of non-thermal ultrasound? Facilitation of wound healing Decreased angiogenesis Decreased phagocytosis Decreased metabolic rate

Facilitation of wound healing

Which ultrasound parameter is more prone to unstable cavitation? Frequency using 3MHz Intensity's using low frequencies High SPA Frequency's using 1 MHz Low BNR

Frequency's using 1 MHz

Which form of electrical stimulation is used to facilitate wound healing and uses an interrupted monophasic wave? Iontophoresis High voltage galvanic stimulation Functional electrical stimulation Neuromuscular electrical stimulation

High voltage galvanic stimulation

What is the difference between electrically stimulated movement versus volitional movement? There is greater pain sensation due to the superficial stimulation There is no qualitative difference Larger motor units are recruited first Smaller motor units are recruited first

Larger motor units are recruited first

Ultrasound energy is propagated through what form of sound wave? Periosteal Shear Systemic Longitudinal

Longitudinal

Ohm's Law

Ohm's law refers to the relationship between the electrical current, voltage, and resistance. An increase in voltage causes an increase in current, and a decrease in voltage results in a decrease in current. Ohm's law is significant because the amount of current that passes through the biological tissues determines the physiological effects and changes that occur. I = V/R I= electrical current V=Voltage R= Resistance

Which one of the following would be a contraindication for ultrasound use? Application over hardware Open lesions or wounds While using corticosteriods Over plastic, prosthetic joints

Over plastic, prosthetic joints

Patients with nociceptive pain report symptoms of: Inconsistent pain with anxiety and depression Decreased movement, parasthesias, and sensory changes. Pain with palpation Pain with a sudden onset from tissue damage.

Pain with a sudden onset from tissue damage.

Patients with trigger points report symptoms of: Decreased movement, parasthesias and sensory changes. Pain with palpation Inconsistent pain with anxiety and depression. Pain with sudden onset from tissue damage.

Pain with palpation

Thermal modalities that involve convection includes all but which of the following: Fluidotherapy Contrasts baths Paraffin bath Whirlpool

Paraffin bath

Ice Massage Contraindications

Peripheral vascular disease, Reynaud's, multiple myeloma, leukemia, lupus, open wounds, cognitive impairments, deep vein thrombosis

When using TENS to decrease pain using the endorphin theory, TENS stimulates the production of beta-endorphins which are produced by the: Thyroid gland Thalamus Cerebrospinal fluid Pituitary gland

Pituitary gland

Which of the following is a contraindication for the use of cryotherapy? Spasticity Acute muscle spasm Raynaud's disease Arthritis

Raynaud's disease

_____________________type of TENS produces cuteneous paresthesia or tingling sensation without a muscle contraction. Motor Level Subsensory Level Sensory Level Noxious Level

Sensory Level

Biofeedback contraindications

Skin conditions · Pace maker

Which of the following medications is used in iontophoresis for its sclerolytic properties? Sodium salicilate Lidocaine Dexamethasone Sodium chloride

Sodium chloride

Ultrasound is based on what principle? Sound waves Scribonius work Submarine locating techniques Piezoelectric effect

Sound waves

What structure acts as a barrier to water and other ionic substances when using iontophoresis as an intervention? Fascia Stratum corneum Muscle Epidermis

Stratum corneum

Ice Massage Indications

Subacute injury or inflammation Reduce muscle spasms Prior to ROM exercises Trigger point therapy Muscle strains Contusions Acute or chronic pain Rapid cooling of the skin overuse injuries acute injuries sprains

Ultrasound works by

The basis for current ultrasound equipment was derived from the Curies' work on crystal oscillation and voltage polarization. The standard ultrasound unit consists of a power supply, oscillator circuit, transformer, coaxial cable transducer, and ultrasound applicator. Therapeutic ultrasound units usually have a generator that uses alternating current as a power source, converting this electrical energy into ultrasonic energy. With therapeutic ultrasound machines, the crystal is located inside the applicator, which is called a transducer. The crystal consists of natural quartz or a synthetic material that vibrates by contracting and expanding in response to alternating current. Each crystal has a unique, naturally occurring vibration frequency to which the electronics of the ultrasound unit are matched. Because of this, ultrasound transducers are not interchangeable between units. However, some of the current manufacturers have solved this problem and are producing interchangeable sound heads. The vibration of the crystal generates pressure waves that affect the tissue. The crystal deforms in response to the changes in the direction of the flow of the current and is proportional to the amount of voltage applied to the crystal. In therapeutic ultrasound, these pressure waves are transmitted to a small volume of tissue, which causes the molecules to vibrate. Ultrasound travels poorly through air, so a lubricant is used that allows the energy to be dispersed into the underlying tissue. The nonthermal aspects of ultrasound are primarily due to acoustic streaming, microstreaming, and cavitation, which alter the permeability of the cell membrane. Higher doses of thermal ultrasound that increase tissue temperature by 4 °C are needed to increase collagen tissue extensibility and to facilitate ROM and movement through increased flexibility of the tissue, while requiring less force to stretch the targeted tissue Physical Agent Modalities (p. 204). SLACK Incorporated. Kindle Edition.

Where does the heat come from in continuous (100 %) duty ultrasound? The transducer The kinetic energy from sound waves traveling through the tissue The sound head The electrical current

The kinetic energy from sound waves traveling through the tissue

What does the Beam Non-uniformity ratio describe? The area of the emitting surface The relationship between the spatial peak intensity (SPI) and the spatial average intensity (SAI) The intensity of the sound wave The maximum intensity of the sound wave

The relationship between the spatial peak intensity (SPI) and the spatial average intensity (SAI)

tissue absorption rates with ultrasound

Tissue Type Impedance (kg/m@sec x 106) Fat 1.38 Water 1.5 Blood 1.61 Muscle 1.7 Bone 7.8 •Absorption rates: •Blood 3% •Fat 13% •Muscle 24% •Blood vessel 32% •Skin 39% •Tendon/ligament 59% •Cartilage 68% •Bone 96%

As long as a scar exhibits a rosier appearance than normal, remodeling is underway. True False

True

Fluidotherapy indications

Used to treat distal extremities in effort to decrease pain, increase ROM and decrease swelling and spasm · Desensitization · Reduction in pain · ROM · Amputation · CRPS · Nerve lacerations · myofascial trigger points, decreasing pain through the physiological response affecting blood flow, decreasing pressure pain threshold, and suprathermal thresholds

The inflammatory phase of healing is characterized by: Wound Contraction Collagen Formation Vasoconstriction & Vasodilation Pseudomonas

Vasoconstriction & Vasodilation

What causes electric current to flow? When an external force is applied at a cellular level When there is an imbalance in electrons in two distinct locations When there is equilibrium between negative and positive ions When there is sufficient ambient pressure to equalize current

When there is an imbalance in electrons in two distinct locations

The proliferative phase of wound healing is characterized by: Vasoconstriction & Vasodilation Collagen Formation Wound Contraction Pseudomonas

Wound Contraction

When using NMES, the intensity should be slowly increased after approximately 5 minutes of use because of: impedance fatigue accommodation hydration of the skin

accommodation

Cryotherapy Indications

acute or chronic pain, myofascial pain syndrome, muscle spasm, bursitis, acute or subacute inflammation, musculoskeletal trauma, reduction of spasticity, tendonitis

The duty cycle refers to the: frequency or intensity of the stimulation amount of time between the stimulation period an the rest period degree/amount of resistance of the tissue amount of electrical current which is applied to the tissue

amount of time between the stimulation period an the rest period

The basic properties of the electrical current flow are the __________ and the ___________ of the current. amplitude; duration waveform; conductance conductance; resistance amplitude; resistance

amplitude; duration

Which of the following tissue has the greatest impedance value and acoustic absorption coefficient? Blood Tendon Skin Bone Fat

bone

It important that medications used for iontophoresis are manufactured to US Parmacopeia standards because they ____________________. specify polarity are less costly contain proper stabilizers and preservatives are considered generic equivalents

contain proper stabilizers and preservatives

Which factor impacts the dosage of the medication given during treatment? current amplitude and duration of flow amount of medication added to patch size of the patch used in treatment medication used

current amplitude and duration of flow

Epithelialization and wound contraction are synonymous terms. True False

false

Some clinicians report that interferential current is a better option when treating pain as the current is more superficial then TENS. True False

false

Using the Gate Control theory to mediate pain, the small C fibers close the gabe and the large A fibers open the gate. True False

false

When using cryotherapy as an intervention for 10 minutes, you should wait 15 minutes prior to assessing sensation. True False

false

conduction

involves the heat transfer where there is an exchange of thermal energy between two materials in physical contact. An exchange of energy between two materials that have two different temperatures an area with higher temperature comes into contact with an are with lower temperature, energy is transferred the temperature rises until both areas are equally heated. Modalities: hot packs, paraffin baths, and contrast baths.

Hot Pack Contraindications

loss of sensation or hypersensitivity, acute sprains and strains, acute circulatory disorders (hemorrhage), acute infection (might spread), skin rashes, open wounds, cancer (stages 2-3) rheumattoid arthritis

Peak amplitude refers to which concept? Ratio of on time to off time Length of time the current is being delivered to the tissue Level of skin impedance magnitude or intensity of the electrical current

magnitude or intensity of the electrical current

All but which of these have opiate-mediating pain effects? Beta-endorphins Enkephalins Oxytocin Dynorphins

oxytocin

Which electrical current is interrupted for short periods of time? Pulsed Monophasic Direct Alternating

pulsed

Which one of the following variables is uncontrollable when applying iontophoresis? Drug containment electrode Skin Medication used Power source

skin

Ultrasound tissue temperature.

the goal of thermal ultrasound is to increase soft tissue length A frequency of 3 MHz increased tissue temperature at a faster rate than a frequency of 1 MHz A frequency of 1 MHz will provide therapeutic effects to a depth of 5 cm, whereas a frequency of 3 MHz will penetrate to a depth of 1 to 2 cm. As the frequency increases (3 MHz), the energy is absorbed more rapidly by the underlying tissue, leading to a more superficial effect. Thermal ultrasound will increase soft tissue temperature as much as 0.2 °C when administered at 1 W/cm2 at 1 MHz, and by as much as 0.6 °C using a frequency of 3 MHz

Patients demonstrate greater improvements in strength with the use of NMES, than with exercise alone. True False

true

TENS (Transcutaneous electrical nerve stimulation) indications

· Acute pain · Chronic pain · Diabetic neuropathy

Iontophoresis contraindications

· Anesthetized skin in the area to be treated · Over the carotid sinus · Over implanted stimulators- phrenic nerve or bladder stimulators · Unintended medication contraindication · Venous or arterial thrombus or thrombophlebitis · Demand-inhibited pacemaker or unstable arrhythmias · Malignant tumors · Pelvis, abdomen, trunk, and low back during pregnancy · Eschar or scarring in the area of treatment

Contrast Baths Indications

· Complex regional pain syndrome, warm to touch, increase hair growth, sweating - excessive vasoconstriction · CRPS- blueish hue, skin is dry, cold- dilate them by adding heat · Decrease edema in an extremity · Improve peripheral flow,circulation · Control subacute or chronic inflammation as well as for some musculoskeletal conditions. · Decrease blood vessel spasm · Decrease stiffness · Decrease pain · Decrease swelling · Chronic inflammation

Paraffin bath indications

· Decrease joint stiffness · Decrease pain · improve ROM · arthritis

TENS (Transcutaneous electrical nerve stimulation) contraindications

· Demand-type pacemakers · Placement over carotid sinus · Pregnant patients during first trimester · Anterior neck area · Cardiac disease (stimulation across chest) · Epilepsy (avoid head and neck area) · Placement over the eyes · Muscosal surfaces · Patients with CNS disorders · Patients with cerebrovascular accidents · Patients who are confused or noncompliant · Children

Paraffin bath contraindications

· Diabetes · Skin rashes · neuropathy (poor sensation · peripheral vascular disease

Whirlpool contraindications

· Fever · Infection or open area (wound incision or scratch) · Heart problems · Cancer · Difficulty sensing heat and cold · Dizziness or motion sickness

superficial thermal agents contraindication

· Impaired sensation (superficial, skin graft, scar, or inability to determine temperature changes) · Poor thermal regulation · Tumors/cancer · Acute inflammation, including acute edema · Deep vein thrombophlebitis · Pregnancy- full immersion (the systemic effects of circulating blood on a fetus are unclear, superficial application over an extremity can be used) · Bleeding tendencies · Infection · Primary repair of tendon or ligament · Advanced cardiac disease · Semi-comatose or impaired mental status (or patients with speech and language difficulties, they may not be able to inform or understand the therapists directions) · Rheumatoid arthritis (vigorous dosages of heat may facilitate proteins that act as catalysts to increase enzyme activity, exacerbating joint inflammation) · Acute musculoskeletal conditions · Compromised circulation · Peripheral vascular disease · Skin anesthesia · Open wounds or skin conditions

Hot Pack Indications

· Increase tissue elasticity · Scar tissue · Neuropathy

Iontophoresis indications

· Inflammation · Inflammatory conditions · Point specific pain · Lateral epicondylitis · Infrapatellar tendonitis · Tendonitis at the shoulder · Plantar fascilitis · Achilles tendon pain · Capral tunnel syndrome · Epicondylitis · Ulnar nerve inflammation · Elbow strain/sprain · Radiohumeral bursitis · Triceps tendinitis · Gelnohumeral bursitis · Hand and wrist tendinitis/tenosynovitis · De quervain's disease · Carpal tunnel syndrome, epicondylitis, tendinopathy, plantar fasciitis, calcifying disorders, osteoarthritis in the knee, pain, TMJ disorders, adhesive capsulitis, and rheumatic disease

NMES ( Neuromuscular electrical stimulation) indications

· Muscle re-education · Muscle Pump · Decrease Scar Tissue · Neuromuscular facilitation · Decrease muscle spasm · Stimulate denervated muscle · Stimulation of skeletal muscle · Facilitate neuromuscular reeducation · Relax muscle spasm

NMES ( Neuromuscular electrical stimulation) Contraindications

· Over the thoracic region as it may interfere with heart activity · Patients with demand-type pacemakers, defibrillator or deep brain stimulator, or implanted electrical device · Do not place over phrenic nerve or bladder stimulators · Do not place over the anterior neck or carotid sinus as this may cause cardiac arrhythmias; where placement of electrodes could adversely affect a reflex center (e.g., the heart, parasympathetic nerves, ganglion, laryngeal muscles) · Transcerebral or individuals with epilepsy · Peripheral vascular disease, venous thrombosis, or thrombophlebitis · Over the eyes or reproductive organs · Over or near superficial metal pins, plates, or hardware · Active cancer, malignancy, infection, tuberculosis, or active hemorrhage · Pregnant people, over a pregnant uterus during the first trimester · Over areas with pathology within the muscle (i.e., Duchenne's muscular dystrophy) · Over areas where movement is contraindicated or to be avoided Near diathermy devices

Contrast bath contraindications

· Poor peripheral circulation · Fever · Open wound or sore · Difficulty sensing heat or cold; impaired sensation · Acute injury of less than 73 hours or active swelling · Peripheral vascular disease · Active swelling · Acute injury of less than 72 hours

Whirlpool indications

· Reducing edema · Reducing pain · Reducing inflammation · Open or chronic wounds · Status post fracture (where stiffness and excessive skin dryness is present) · Inflammatory conditions (with tepid water) · Peripheral vascular disease · Peripheral nerve injuries · Wound care/debridement · Improve circulation · Reduce swelling · Relax muscles · Prepare the tissue for stretching · Reduces or eliminates gravity

biofeedback indications

· Stroke · Fibromyalgia · Chronic pain (low back, pelvic, and other pain syndromes)

superficial thermal agents indications

· Subacute and chronic inflammation · Subacute or chronic pain · Subacute edema removal · Decreased ROM · Resolution of swelling · Myofascial trigger points · Muscle guarding · Muscle spasm · Subacute muscle strain · Subacute ligament sprain · Subacute contusion decrease pain and stiffness, improve ROM and flexibility, increase tendon excursion, improve synovial viscosity, and promote healing and relaxation

ultrasound indications

· decrease pain, including shoulder pain, plantar fasciitis, bursitis, ankle sprains, reflex sympathetic dystrophy, lateral epicondylitis, myofascial trigger points, pelvic pain, and other soft tissue injuries · increase tissue extensibility · Biological Changes o Increase metabolic rate o Increase blood flow o Increase extensibility of collagen o Decrease sensitivity of neural elements o Elevate pain threshold o Increased cell diffusion and membrane permeability o Increase calcium ion transport o Facilitates inflammatory process o Increase protein and collagen synthesis o Changes in electrical activity of excitable cells · Increase soft tissue length · facilitate tissue regeneration and repair · increase protein synthesis · improve blood flow · decrease muscle tone, · activate the calcium cycle, · stimulate nerve fibers and peripheral nerves, · increase ROM and tissue extensibility in collagen-rich tissues, decrease muscle spasm and pain, · and decrease chronic inflammation · osteoarthritis

Ultrasound contraindications

· patients with vascular disease, deep vein thrombosis, emboli, atherosclerosis · patients with hemophilia not covered by factor replacement · over the eye, sex organ, over the uterus during pregnancy · over stellate ganglions · over the spinal cord following laminectomy · directly over external metal implants · over pacemakers, the heart, or implanted electronic devices · cancer, areas of malignancy · carotid sinus · over anesthetic areas · over areas that have been irradicated

tissue temperature changes in ultrasound

• Increase Metabolic Rate - Increase temp 1C • Decrease Pain - Increase temp 2-3C • Increase Collagen Tissue Extensibility - Increase temp 4C

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 arterial, lymphatic, and venous disorders