BPA Final -__-

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0-5 degrees

Cervical traction parameters: How many degrees of cervical flexion with C1/2 distraction? a. 0-5 b. 10-15 c. 25-30 d. 10-20

10-20 degrees

Cervical traction parameters: How many degrees of cervical flexion with C3/4 distraction? a. 0-5 b. 10-15 c. 25-30 d. 10-20

25-30 degrees

Cervical traction parameters: How many degrees of cervical flexion with C5-C7 distraction? a. 0-5 b. 10-15 c. 25-30 d. 10-20

slightly aBducted avoid touching the base or walls of the unit

During the dipping "phase" using paraffin wax the patients fingers are slightly (flexed/aDducted/aBducted) and instructions are given to avoid _____________________.

the motor units are generated at random and there is no modification of firing frequency or intensity

During voluntary muscle contraction: -there is predictable order of motor unit recruitment from small to larger -firing frequency is altered to assist adjacent motor units with heavier loads and fatigue. How does electrically induced recruitment work?

movement of the solute (Na and Cl) in tissues after estim provides a means for movement of ions

Electroosmosis is best described as a. movement of the solute (Na and Cl) in tissues after estim provides a means for movement of ions b. estim creates a potential gradient that depolarizes targeted tissues c. estim initiates a motor response resulting in 100% vessel occlusion d. after estim, ions are able to penetrate tissues with greater ease

after estim, ions are able to penetrate tissues with greater ease

Electroporation is best described as a. movement of the solute (Na and Cl) in tissues after estim provides a means for movement of ions b. estim creates "dimples" in selected tissue, which eases ion access to binding sites c. estim initiates a motor response resulting in 100% vessel occlusion d. after estim, ions are able to penetrate tissues with greater ease

pulse duration

Peak amplitude

Peak-to-peak-amplitude

Inter-pulse interval

Intra-pulse interval

3 MHz 20% 0.2-0.8 w/cm2

A 20-year-old volleyball player is referred to your office with chief complaints of bilateral knee pain. The script states evaluate and treat with ultrasound to bilateral patellar tendons (superficial structure). Your examination does reveal the presence of bilateral reactive patellar tendinopathy (acute stage of condition) secondary to participation in a jumping clinic last week. No significant PMHx. Depth (MHz)? Pulse ratio (%)? Intensity (w/cm2)?

3 MHz 100%/continuous 0.8-1.5 w/cm2

A 45-year-old marathon runner presents to the clinic with chief complaints of lateral hip pain. Your examination reveals the presence of degenerative (chronic stage of condition) gluteal tendinopathy( superficial structure). The patient relates their pain started 3-months ago and you feel ultrasound would be an appropriate intervention to help with managing pain along the tendon. The patient's PMHx is significant for Cholecystectomy in 2001. Depth (MHz)? Pulse ratio (%)? Intensity (w/cm2)?

2 sine waves different

A beat waveform modulation occurs when ___ or more _____ (type) waves with _____ (same or different) frequencies interfere with each other.

analgesic tolerance

A decrease in analgesic effectiveness from repeated use of TENS

> 40Hz

A frequency greater than what (Hz) will induce muscular fatigue?

Cryotherapy Precautions HTN Cold hypersensitivity or aversion to cold Impaired circulation thermoregulatory disorders Over superficial nerves Open wounds Areas of poor sensation Individuals w/ poor cognition Very young/old

biofeedback to the biceps with low sensitivity biofeedback to the triceps with low sensitivity

A patient has sustained a CVA with R hemiparesis. She suffers from hypertonicity in the R biceps. You decided to use biofeedback to assist in decreasing tone. Which of the following would be appropriate? Select all that apply a. biofeedback to the biceps with low sensitivity b. biofeedback to the biceps with high sensitivity c. biofeedback to the triceps with low sensitivity d. biofeedback to the triceps with high sensitivity

3 MHz 50% 0.5-1.0 w/cm2

A patient presents to therapy with chief complaints of left-sided shoulder pain. Your examination reveals the pain to be driven from the proximal long head of the biceps tendon. The patient injured their tendon 5 days ago during a bowling match and you feel ultrasound would be an appropriate intervention to help with optimizing tissue healing. Depth (MHz)? Pulse ratio (%)? Intensity (w/cm2)?

a-delta

A-delta or c-fibers? Karen experienced a sharp and prickly pain in her neck after complaining to your manager.

c fibers

A-delta or c-fibers? Nemo has dull and achy wrist pain that lasts for more than 2 hours after exercise.

a-delta

A-delta or c-fibers? small myelinated fibers that respond to mechanical and thermal stimuli (short lasting)

c-fibers

A-delta or c-fibers? small unmyelinated fibers that respond to a broad range of stimuli

5 minutes

About how often should you check on a patient with a hot pack applied? a. 2 min b. 15 min c. 5 min d. 20 min

amplitude frequency

Accommodation and habituation occur in which parameter? (select all that apply) a: pulse current b: amplitude c: frequency d: intensity

reflected refracted absorbed

Acoustic waves can be: Select all that apply a. deflected b. absorbed c. refracted d. reflected

acute

Acute, chronic, referred pain? associated with measurable change

chronic

Acute, chronic, referred pain? associated with psychosocial issues

chronic

Acute, chronic, referred pain? associated with structural and functional changes in the CNS

acute

Acute, chronic, referred pain? biologically meaningful

referred

Acute, chronic, referred pain? central interpretation of afferent input

chronic

Acute, chronic, referred pain? central sensitization

referred

Acute, chronic, referred pain? convergence of various nociceptors on spinal nerve root

referred

Acute, chronic, referred pain? pain at site remote from source

chronic

Acute, chronic, referred pain? persists beyond normal tissue healing time

acute

Acute, chronic, referred pain? results from injury and/or disease, causing potential or real tissue damage

comfortable tingle

IFC intensity? a. comfy tingle b. uncomfy tingle c. strong contraction d. motor twitch

A-beta fibers

IFC targeted fibers a. a-alpha b. a-beta c. a-delta d. c fibers

Gate control theory

IFC theory a. central inhibition b. relativity c. gate control d. big bang

>30 minutes limited treatment effects

IFC treatment time

Amplitude-modulated alternating current, continuous

IFC waveform? a. biphasic alternating b. amplitude-modulated alternating c. biphasic pulsatile d. direct

Burst tens

Identify

Conventional tens

Identify

acupuncture-like tens

Identify

alternating

Identify

asymmetrical biphasic

Identify

balanced biphasic

Identify

brief intense tens

Identify

direct

Identify

monophasic pulsed

Identify

Dose II

Identify Diathermy dose level by its response mild heat sensation a. I b. II c. III d. IV

Dose III

Identify Diathermy dose level by its response moderate heat sensation a. I b. II c. III d. IV

Dose I

Identify Diathermy dose level by its response nonthermal a. I b. II c. III d. IV

Dose IV

Identify Diathermy dose level by its response vigorous heating a. I b. II c. III d. IV

gate control theory

Identify TENS theory activation of a-beta afferent to induce inhibitory circuits in dorsal horn to block a-delta and c-fiber input (brain can only interpret pain OR input stimulus)

central inhibition

Identify TENS theory activation of descending inhibitory pathways projecting to spinal cord

acupuncture

Identify correct TENS mode Low frequency/high intensity Activation of a-beta afferents and a-alpha a. acupuncture b. burst train c. conventional d. brief intense

burst train

Identify correct TENS mode combo of conventional and acupuncture a. acupuncture b. burst train c. conventional d. brief intense

brief intense

Identify correct TENS mode high frequency, duration, and intensity a. acupuncture b. burst train c. conventional d. brief intense

conventional

Identify correct TENS mode high frequency/ low intensity Most commonly used mode of TENS Preferential activation of A-beta afferents a. acupuncture b. burst train c. conventional d. brief intense

alternating

Identify correct current: Therapeutic forms of this current include Burst-modulated and amplitude-modulated a. Monophasic b. balanced biphasic c. asymmetrical biphasic d. monophasic pulsed e. alternating

alternating

Identify correct current: uninterrupted bidirectional flow of ions that must change direction at least 1 time/second a. Monophasic b. balanced biphasic c. asymmetrical biphasic d. monophasic pulsed e. alternating

asymmetrical biphasic

Identify correct current: Net charge= +3 select all that apply a. Monophasic b. balanced biphasic c. asymmetrical biphasic d. monophasic pulsed e. alternating

direct monophasic pulsed

Identify correct current: Net charge= +5 select all that apply a. Monophasic b. balanced biphasic c. asymmetrical biphasic d. monophasic pulsed e. direct

alternating balanced biphasic

Identify correct current: Net charge= 0 select all that apply a. Monophasic b. balanced biphasic c. asymmetrical biphasic d. monophasic pulsed e. alternating

amp/int

Identify correct e-stim parameter The amount of stimulus applied a. frequency b. waveform c. pulse duration d. electrode size and placement e. amplitude/intensity

waveform

Identify correct e-stim parameter The flow of positive and/or negative particles a. frequency b. waveform c. pulse duration d. electrode size and placement e. amplitude/intensity

amplitude/intensity

Identify correct e-stim parameter The most important factor in maximizing outcomes of e-stim a. frequency b. waveform c. pulse duration d. electrode size and placement e. amplitude/intensity

frequency

Identify correct e-stim parameter The number of pulses per second a. frequency b. waveform c. pulse duration d. electrode size and placement e. amplitude/intensity

frequency

Identify correct e-stim parameter minimal impact in pain modulation a. frequency b. waveform c. pulse duration d. electrode size and placement e. amplitude/intensity

frequency

Identify correct e-stim parameter typically described in Hz or pps a. frequency b. waveform c. pulse duration d. electrode size and placement e. amplitude/intensity

direct

Identify correct waveform by its Therapeutic form Iontophoresis a. pulsed b. direct c. alternating

pulsed

Identify correct waveform by its Therapeutic form NMES a. pulsed b. direct c. alternating

alternating

Identify correct waveform by its Therapeutic form TENS a. pulsed b. direct c. alternating

acute injuries, edema reduction, cell repair

Identify diathermy clinical use by its dose level Dose I a. pain, muscle spasm, chronic inflammation b. increase blood flow, heating of collagen tissues for stretching of soft tissues c. acute injuries, edema reduction, cell repair d. subacute injuries and inflammation

subacute injuries and inflammation

Identify diathermy clinical use by its dose level Dose II (12W) a. pain, muscle spasm, chronic inflammation b. increase blood flow, heating of collagen tissues for stretching of soft tissues c. acute injuries, edema reduction, cell repair d. subacute injuries and inflammation

Pain, mms spams, chronic inflammation

Identify diathermy clinical use by its dose level Dose III (24W) a. pain, muscle spasm, chronic inflammation b. increase blood flow, heating of collagen tissues for stretching of soft tissues c. acute injuries, edema reduction, cell repair d. subacute injuries and inflammation

increase blood flow, heating of collagen tissues for stretching of soft tissues

Identify diathermy clinical use by its dose level Dose IV (48W) a. pain, muscle spasm, chronic inflammation b. increase blood flow, heating of collagen tissues for stretching of soft tissues c. acute injuries, edema reduction, cell repair d. subacute injuries and inflammation

proliferation

Identify healing phase using its goal of therapeutic modality enhance blood flow and cellular activity

maturation

Identify healing phase using its goal of therapeutic modality facilitate collagen maturation and organization

inflammatory phase

Identify healing phase using its goal of therapeutic modality reduce blood flow and decrease cellular metabolism

medical

Identify medical vs therapeutic lasers concentrated light

therapeutic

Identify medical vs therapeutic lasers density is spread out over a large area

conduction

Identify the mechanism of heat transfer direct contact with the source a. radiation b. conduction c. convection

radiation

Identify the mechanism of heat transfer energy transfer through electromagnetic waves a. radiation b. conduction c. convection

convection

Identify the mechanism of heat transfer movement of a substance around the source a. radiation b. conduction c. convection

rarefactions

Identify ultrasound element Areas of decreased density a. rarefactions b. effective radiating area c. beam nonuniformity ratio d. compressions

compressions

Identify ultrasound element Areas of increased density a. rarefactions b. effective radiating area c. beam nonuniformity ratio d. compressions

effective radiating area

Identify ultrasound element The area of the crystal that moves a. rarefactions b. effective radiating area c. beam nonuniformity ratio d. compressions

beam nonuniformity ratio

Identify ultrasound element the balance between the spatial peak intensity measured anywhere within the ERA and the spatial average intensity a. rarefaction b. effective radiating area c. beam nonuniformity ratio d. compression

8-10 layers

If a patient is lying supine on a hot pack, how man layers of toweling are needed? a. 4-6 b. 6-8 c. 8-10 d. 10-12

6-8 layers

If a patient is prone or sitting and a hot pack is applied to the cervical area how man layers of toweling are needed? a. 4-6 b. 6-8 c. 8-10 d. 10-12

Lumbar traction set up: 1. Position the traction table at the appropriate height. 2. Assist the patient onto the table aligning the PSISs immediately below the separation. 3. Position the lumbar harness utilizing bony landmarks for appropriate pull. 4. Position the trunk harness utilizing bony landmarks for appropriate pull 5. Position the lower extremities in neutral alignment on pillows or a bolster and hook the harness to the traction machine removing the slack in the cable. 6. Place support, if needed, under the pts arms and pillow for head. 7. Explain the use of the " stop treatment" and "call button" should the pt experience pain or discomfort. 8. Emphasize that the patient should feel no pain when using the device. 9. After treatment, allow slack in the cable and unhook the traction from the harness 10. Lock the table in place and request that the patient lie flat for 4-‐5 minutes. 11. Inquire if the patient has any dizziness. If so, the patient should lie and rest for a longer period of time.

bone

Most body tissues behave as liquids of varying densities. What tissue does not?

1 MHz 3 or 3.3 MHz

Most ultrasound units have dual frequency applicators designed to deliver frequencies of ______MHz and ____ or _____ MHz.

-Subacute: comfortable motor twitch -Chronic: submax contraction

NMES edema intensity Subacute? chronic?

-Subacute: continuous -Chronic: 1:1 to 1:3

NMES edema on/off subacute? chronic?

Subacute: >200 μsec Chronic: 250-400 μsec

NMES edema pulse duration subacute? chronic?

Subacute: 1-10 pps Chronic: 30-50 pps

NMES edema pulse frequency subacute? chronic?

-Subacute: none -Chronic: 1-2 seconds

NMES edema ramp subacute? chronic?

submax contraction to tolerance

NMES spasticity intensity

-twitch = NONE -tetany = 1:1 or 1:3

NMES spasticity on/off for twitch? tetany?

200-400 μsec

NMES spasticity pulse duration a. 200-400 micro sec b. 100-600 micro sec c. 100-400 micro sec d. > 30 min

-twitch (reactive) <10 pps -tetany (maximizes fatigue) 30-50 pps

NMES spasticity pulse frequency for twitch? tetanty?

1-2 seconds (tetany only)

NMES spasticity ramp

15-60 minutes as tolerated

NMES spasticity treatment time a. up to 4 hours b. >30 min c. 15-60 min d. 15-20 min

Submax contraction (50% for disuse, 70% MVC for strengthening)

NMES strengthening intensity

1:3-1:5 with on time up to 10 seconds

NMES strengthening on/off a. 1:1-1:3 b. 1:3-1:5 c. 1:1-1:2 d. continuous

>250 μsec

NMES strengthening pulse duration a. 30-50 pps b. <10 pps c. >200 micro sec d. >250 micro sec

30-50 pps

NMES strengthening pulse frequency a. 30-50 pps b. <10 pps c. 250 micro sec d. 80-110 pps

8-10 contractions

NMES strengthening treatment time a. >30min b. 8-10 contractions c. 4 hours d. 15-20 min

Biphasic pulsatile currents (symmetrical or asymmetrical) -For disuse atrophy

NMES strengthening waveform a. biphasic alternating b. amplitude-modulated alternating c. biphasic pulsatile d. direct

direct alternating pulsed

Name the 3 main current types?

A-beta< motor<A-delta, C

Name the order of fibers elicited by a stimulus at a given threshold? A-beta A delta C Motor

nerves: -70mv muscles: -90mv

Nerves get excitable at what mv? Muscles?

acousting streaming cavitation

Nonthermal effects of ultrasound are attributed by 2 processes. What are they? a. acousting streaming b. cavitation c. cell degranulation d. microshearing

paraffin wax

Of the following, which would be a more appropriate heating modality for patients with frail skin? a. hot pack b. paraffin wax c. fluidotherapy d. fire

none of the above the above modalities are not appropriate for deep structures as they only have a minimal change in blood flow and temperature

Of the heating modalities covered in unit 3 (moist hot pack, paraffin wax, fluidotherapy, warm whirlpool), which if any, can target muscle belly or deep joint capsules? a. MHP b. paraffin wax c. fluidoherapy d. warm whirlpool e. all of the above f. none of the above

3 MHz 1: 1-2 33%, 50% 0.5-2.0

Pete is in the sub-acute phase of healing following a supraspinatus strain while surfing. What are the ultrasound parameters for this patient? Depth (MHz)? Pulse ratio? Duty Cycle (%)? Intensity?

watts

Power of ultrasonic energy is measure in? a. Hz b. cm c. sec d. watts

Precautions for iontophoresis Sensation deficits cognitive deficits cancer

Proposed benefits of laser acute and chronic pain acceleration of inflammatory process increase microcirculation central and peripheral nervous system disease and injury wound healing-tissue repair reduce pain and inflammation

10 μsec

Russian burst duration a. 2-100 micro sec b. 10 micro sec c. 20-80pps d. 10 contractions

50 bursts/sec

Russian burst frequency a. <10 pps b. 250 micro sec c. 50 bursts/sec d. 80-110 pps

as high as needed for contraction (should be uncomfortable & intense) - >70% for strengthening

Russian burst intensity

1:5

Russian on/off a. continuous b. 1:2 c. 1:1-1:3 d: 1:5

10 contractions

Russian treatment time a. 2-100 micro sec b. 10 contractions c. >30 mins d. 4 hours

Biphasic pulsatile currents *only for higher-level pts

Russian waveform a. biphasic alternating b. amplitude-modulated alternating c. biphasic pulsatile d. direct

NMES: Freq- 40 pps, pulse duration- 350 microsec, on/off- 1:3

Select the appropriate e-stim modality and parameters for strengthening Andre is a 70-year-old patient s/p R TKA 3 days ago. He has a big head and has been accused of mouth breathing under his mask. He has moderate edema that is mild to moderately warm. -Quadriceps strength: 2+/5 -Pt Goal: increase strength of quadriceps NMES: Freq- 40 pps, pulse duration- 350 microsec, on/off- 1:3 Russian: Freq- 50bps, burst duration- 10 microsec, on/off- 1:5, treatment time- 10 contractions NMES: Freq- 8 pps, pulse duration- 200 microsec, on/off- continuous, treatment duration- 20 minutes HVPC: Freq- 100 pps, pulse duration- 50 microsec, treatment duration- 25 minutes

nociceptors

Sensory neurons that respond to chemical, mechanical, or thermal stimuli

biofeedback

Skeletal muscle assessment or monitoring that is used to affect future activation. a. iontophoresis b. biofeedback c. sensitivity d. centralization

35-50 Hz

Smooth muscle tetany = frequency of a: 35-50 Hz b: 50-75 Hz c: 25-50 Hz d: 25-75Hz

albumin

The most abundant plasma protein with the greatest influence on osmotic pressure gradient, is negatively charged and, affected by HVPC? a. globulin b. albumin c. fibrinogen d. whey isolate

pulsed

The most used current that can be monophasic or biphasic

reverse piezoelectric effect

The piezoelectric crystal is compressed and expanded by sending alternating electrical current through it, this is referred to as a. nonthermal effect b. rarefaction c. alternating acoustic effect d. reverse piezoelectric effect e. cause and effect

wave phase duration and wave amplitude or intensity

The power of ultrasonic energy is the product of _______ and _______ or intensity?

acoustic wave

The result of alternating compression and expansion a. thermal energy b. vibration c. mechanical wave d. acoustic wave

The treatment area for ultrasound should only be 2-4x the effective radiating area.

The treatment area for ultrasound should only be ___-___ times the effective radiating area. a. 1-3 b. 2-4 c. 3-5 d. 4-6

paraffin wax

This modality is typically used for distal extremities (hands or feet) with diagnoses ranging from osteo/rheumatoid arthritis, to administer over healed scar sites in order to increase ROM, and pliability of skin. a. hot pack b. paraffin wax c. fluidotherapy d. lava

113 degrees F

Tissue temperature above ____ degrees may cause tissue damage? a. 113 b. 100 c. 125 d. 99

1 hour

To avoid and minimize skin irritation using estim, treatment time should not exceed a. 1 hour b. 30 minutes c. 45 minutes d. 20 minutes

10 percent

To delay the occurrence of analgesic tolerance, the intensity of TENS should be increased _____% per day. a. 5 b. 10 c. 15 d. 20

convection conduction radiation

What are the 3 mechanisms of heat transfer? a. convection b. evaporation c. conduction d. radiation e. perspiration

acute chronic referred

What are the 3 types of pain? (according to unit 1 slides)

stage of healing

What is patient positioning based on? a. stage of healing b. height of table c. age of patient d. modality

medical: concentrated light therapeutic: density is spread out over a large area

What is the difference between medical and therapeutic lasers?

20-80 mA/min (current amplitudes: 0.1-4mA)

What is the dosage of Iontophoresis? a. 20-35 burst/min b. 15 minutes c. 20-80 mA/min d. 20-80 pps

10-25 pounds

What is the general poundage applied for cervical traction? a. 1/2 the patients body weight b. 15-25 pounds c. 1/3 the patients body weight d. 10-25 pounds

1/2 pts body weight

What is the generally accepted force goal for lumbar traction? a. 1/2 the patients body weight b. 15-25 pounds c. 1/3 the patients body weight d. 10-25 pounds

104-113

What is the intended tissue temperature range for vigorous heating? (degrees F) a. 98-112 b. 100-115 c. 97-105 d. 104-113

1/3 pts body weight

What is the more appropriate poundage applied for lumbar traction? a. 1/2 the patients body weight b. 15-25 pounds c. 1/3 the patients body weight d. 10-25 pounds

pain heat cannot be dissipated adequately by the cooler blood from adjacent body regions

What is the problem with heating tissue rapidly? Select all that apply a. heat cannot be dissipated by cooler blood from adjacent regions b. heat will dissipate too quickly and render the modality useless c. pain d. deeper tissue cannot be reached

nociception

What is the process of encoding and processing noxious stimuli?

6 cm

What is the treatment depth of the 1 MHz ultrasound frequency? (cm) a. 2.5 b. 6 c. 4.5 d. 3

2.5 cm

What is the treatment depth of the 3 MHz ultrasound frequency? (cm) a. 2.5 b. 6 c. 4.5 d. 3

5-20 min (depending on amplitude range)

What is the treatment time for Iontophoresis? a. 5-20 min b. 15-20 min c. 10 contractions d. >30 min

10-20 min

What is the typical treatment time for cervical traction? (min) a. 5-20 b. 10-20 c. 15-30 d. 20-35

motor twitch

What should the patient expect with acupuncture-like for pain? a. comfy tingle b. uncomfy tingle c. submax contraction d. motor twitch

comfy tingle

What should the patient expect with e-stim for pain (conventional)? a. comfy tingle b. uncomfy tingle c. submax contraction d. motor twitch

mms contraction and pt will perform functional activity

What should the pt. expect with e-stim for shoulder subluxation?

alternating

What type of current expands and compresses the piezoelectric crystal, producing an acoustic wave? a. alternating b. biphasic pulsatile c. direct d. monophasic

convection

What type of heat transfer mechanism does fluidotherapy use? a. convection b. conduction c. radiation

proliferation

Yvonne fractured her pinky toe while hang-gliding 3 weeks ago and wants to know when she can go again. What phase of tissue healing is she most likely in?

high

(High/low) TENS frequency activates delta-opioid receptors

low

(High/low) TENS frequency activates micro-opioid receptors

phase duration

decreases tissue hydrostatic pressure (compression increases tissue hydro blah blah)

All are effects of compression EXCEPT? a. increases effects of cold application b. decreases tissue hydrostatic pressure c. reduces bleeding d. reduces edema

type of exposure (correct ans: Time of exposure)

All are influencing factors of cryotherapy EXCEPT a. temperature gradient b. type of exposure c. thermal conductivity d. type of cooling agent

increased afferent input due to slower nerve conduction velocity (we will see a decrease of afferent input)

All are results of cryotherapy EXCEPT a. reduced edema formation b. increased afferent input due to slower nerve conduction velocity c. stimulation of thermal receptors d. reduced tissue metabolism

decreases alpha motor neuron firing rate by decreasing gamma activity

Applying heat has been shown to decrease Type II afferent fibers and increase 1b fibers from the GTO. How does this effect alpha motor neurons? a. increases firing rate b. decreases firing rate

Contracts mms enough to fatigue them & decrease spasticity (overactivity)

How does e-stim exert its effects for spasticity?

FES: Freq- 45 pps, pulse duration- 300 microsec, treat duration- to fatigue, ramp 0-1 sec

As a result of studying for midterms, Sivan developed 2+/5 weakness of her R anterior tibialis and she now drags her toes while walking. What mode and parameters would you choose to address the impairment? a. FES: Freq-40 pps, pulse duration- 300 microsec, on/off- 1:3, treatment duration 15 minutes b. NMES: Freq- 30 pps, pulse duration- 250 microsec, on/off- 1:3, treatment duration- 10 contractions c. Russian: Freq- 50 burst/sec, duration- 10 microsec, on/off- 1:5, treat time- 10 contractions d. FES: Freq- 45 pps, pulse duration- 300 microsec, treat duration- to fatigue, ramp 0-1 sec

decreases

As contraction strength increases, biofeedback sensitivity.... a. increases b. decreases c. stays the same

IFC: changing amplitudes Russ/Auss: constant amplitudes

As far as current amplitudes, what is the difference between IFC and Russian or Aussie currents?

diathermy

Between diathermy and ultrasound, which is best at treating angular surfaces?

Cervical traction set up 1. Position the traction table at the appropriate height and/or the cervical traction unit to the appropriate amount of cervical flexion. 2. Assist the patient onto the table with their head fitting into the traction cradle. 3. tighten the traction cradle to fit snugly on the patients occiput 4. Position the lower extremities in neutral alignment on pillows or a bolster. 5. Place support, if needed, under pts arms 6. Explain the use of the "stop treatment" and "call button" should pt experience pain or discomfort. 7. Emphasize that the patient should feel no pain when using the device. 8. After treatment, allow slack in the cable and slowly release the traction cradle from pts occiput 9. Request that the patient lie flat for 4-‐5 minutes. 10. Inquire if the patient has any dizziness. If so, the patient should lie and rest for a longer period of time.

Compression Contraindications acute pulmonary edema CHF recent or acute DVT acute fracture uncontrolled HTN

Compression Precautions recent skin graft acute local dermatological infections impaired sensation or mentation controlled HTN

Contraindications for TENS -Over pregnant uterus -electrical implants -carotid sinus -over damaged skin -thrombosis -thrombophlebitis -hemorrhage -over malignant tumors -patients with impaired sensation or cognitive ability

Contraindications for TENS -Over pregnant uterus -over electrical implants -over carotid sinus -over damaged skin -thrombosis -thrombophlebitis -hemorrhage -over malignant tumors -patients with impaired sensation or cognitive ability

Contraindications for iontophoresis Trunk/heart with demand-type pacemakers Pelvis, abdominal, lumbar, hips of pregnant females carotid bodies neurostimulators PVD DVT Active osteomyelitis hemorrhage

Contraindications for iontophoresis Trunk/heart with demand-type pacemakers Pelvis, abdominal, lumbar, hips of pregnant females carotid bodies neurostimulators PVD DVT Active osteomyelitis hemorrhage Trunk/heart with demand-type pacemakers Pelvis, abdominal, lumbar, hips of pregnant females carotid bodies neurostimulators PVD DVT Active osteomyelitis hemorrhage

Contraindications for superficial heat therapy: decreased sensation to hot/cold burns infections/open wounds cancer decreased cognition acute injury/inflammation HTN >160/90 long-term steroid therapy ( tends to thin the skin)

Contraindications of ultrasound Pregnancy (over low back or abdomen) Over known or suspected area of malignancy Over active epiphyseal bone growth Tuberculosis infection Hemorrhagic conditions Impaired circulation

Cryotherapy Contraindications Cold sensitivity: -Cold uticaria -cryoglobulinemia -Raynaud's -paroxysmal cold hemoglobinuria Compromised circulation Peripheral vascular disease Over areas of nerve regeneration

Cryotherapy Contraindications Cold sensitivity: -Cold urticaria -cryoglobulinemia -Raynaud's -paroxysmal cold hemoglobinuria Compromised circulation Peripheral vascular disease Over areas of nerve regeneration

-Artificially contracts muscles -Increased strength similarly to using them voluntarily

How does e-stim exert its effects for strengthening?

10-15 mintues

How long do temperature changes from diathermy last? (min) a. 5-10 b. 10-15 c. 15-20 d. 20-25

a heat modality applied to a different portion of the body, or within a nerve distribution, can have effects at a site not directly heated by the modality.

Explain the consensual heating effect

submax contraction to about 3-/5 MMT grade

FES gait intensity

timed with device (set off time to zero when finding appropriate intensity to trigger good contraction)

FES gait on/off

100-400 μsec (250-400 most common)

FES gait pulse duration a. 80-110 pps b. 100-400 micro sec c. 30-50 pps d. 200-400 micro sec

30-50 pps (>40 can lead to fatigue)

FES gait pulse frequency a. 80-110 pps b. 10 micro sec c. 30-50 pps d. 200-400 micro sec

0-1 seconds

FES gait ramp

to fatigue

FES gait treatment time a. 15 min b. to fatigue c. 10 contractions d. up to 6 hours

reduction of subluxation w/o any abhorrent motion (like abd)

FES shoulder subluxation intensity

1:3 to 1:7

FES shoulder subluxation on/off a. continuous b. 1:3-1:7 c. 1:1-1:5 d. 1:3-1:5

100-400 μsec

FES shoulder subluxation pulse duration a. 2-100 micro sec b. 100-400 micro sec c. 200-400 micro sec d. 50-100 micro sec

30-50 pps (>40 can lead to fatigue)

FES shoulder subluxation pulse frequency a. 100-125 pps b. 20-80 pps c. 80-110 pps d. 30-50 pps

1-2 seconds

FES shoulder subluxation ramp

15 minutes for first time, can increase up to 6 hours

FES shoulder subluxation treatment time (first time) a. 15 min b. >30 min c. 15-60 min d. 60-90 min

Propagation of ultrasound waves Production of compressions and rarefactions Effects of ultrasound on various tissue densities

Fill in the Principles of Acoustic Energy: ______ of ultrasound waves Production of _____ and rarefactions Effects of ultrasound on various tissue ______

superficial tissues increase extensibility reflex heating reaction

The main reason for therapeutic heat is to heat _____ tissues of the skin in order to (increase/decrease) extensibility. This may in turn create a ____ heating reaction that allows the deeper structures to be heated as well.

sensory level (10% below motor twitch)

HVPC intensity

continous

HVPC on/off a. 1:1 b. 1:1-1:3 c. 1:5 d. continuous

2-100 μsec

HVPC pulse duration a. >200 micro sec b. 10 micro sec c. 2-100 micro sec d. 200-400 micro sec

100-125 pps

HVPC pulse frequency a. 100-125 pps b. <10pps c. 20-80 pps d. 2-100 pps

none

HVPC ramp

10-30 minutes as tolerated (up to 3-4 hours)

HVPC treatment time a. 10-30 min b. 15-20 min c. > 30 min d. 15-60 min

high threshold

High threshold or wide-dynamic range neurons? (central pain pathway) nociceptive-specific receiving input from peripheral nociceptors only

wide-dynamic range

High threshold or wide-dynamic range neurons? (central pain pathway) receive input from nociceptive and non-nociceptive primary afferent fibers

15-30 min

Hot pack treatment time? (min) a. 5-20 b. 10-25 c. 15-30 d. 20-35

-estim triggers muscle contraction that help squeeze blood through veins & away from swollen area (SUBACUTE/CHRONIC) -OR uses (-)charged current to repel (-)charged albumin in blood (ACUTE)

How does e-stim exert its effects for edema?

helps mms activation of anterior tibialis

How does e-stim exert its effects for gait?

-Sends electrical current through skin -triggers nerves -these nerves override the pain signals preventing the signal from reaching the brain

How does e-stim exert its effects for pain modulation?

-Strengthening mms that help approximate humerus into glenoid

How does e-stim exert its effects for shoulder subluxation?

the weight of the ice pack/bag on injured tissue that is having a motor response could result in overloading of the injured tissue

If tolerable, it is appropriate to add elevation and cryotherapy to our e-stim treatment of acute edema however cryotherapy is not an appropriate addition when treating subacute and chronic edema. Why? a. evidence shows little effect of cryotherapy at this stage of healing b. the injured tissue can become overloaded by the weight of the ice pack c. there are more effective modalities available at this stage of healing d. the patient will refuse

low frequency

In terms of depth, to reach deep structures using ultrasound the operator will choose a (low/high) frequency?

dense tissues

In the body, ultrasonic energy is more rapidly converted from acoustic energy to thermal energy in _____ tissues, such as ligaments, tendons etc

increase motor units recruited

Increased pulse duration = depth____ (increase or decrease) and increase in ___ (type of functional unit) recruited.

Indication for cryotherapy Acute injury or surgery Pain management Muscle spasms Myofascial pain syndrome DOMS

Indications for Iontophoresis inflammatory disorders pain neuralgia edema scar tissue acne

1 MHz 1:1 /Continuous 50%, 100% 0.8-2.0

Keegan has capsular tightness of his right knee following cast immobilization from an injury 8 weeks ago. What are the ultrasound parameters for this patient? Depth (MHz)? Pulse ratio? Duty cycle (%)? Intensity?

20 sec on/ 20 sec off

Stenosis/DDD/facet joint hypomobility on/off time using intermittent cervical traction? (sec on/sec off) a. 10/10 b. 20/20 c. 15/15 d. 5/5

10-20 min

Stenosis/DDD/facet joint hypomobility treatment duration using intermittent cervical traction? (min) a. 15-20 b. 20-30 c. 12-15 d. 10-20

true

T or F Unlike paraffin wax, patients are able to move their hand in the fluidotherapy machine?

false static and intermittent traction have the same use and dosage

T or F unlike the cervical spine, intermittent traction is used for muscle spasms

F: > 1 sec alternating current =<1 sec

T/F direct currents= one direction for <1 second

F: Frequency has no effect on pain. Has effect on muscle contractions

T/F increased frequency= decreased pain sensation

T/F: closer electrode placement= more superficial sensation

>200 μsec

TENS acupuncture pulse duration a. 30-50 pps b. <10 pps c. >200 micro sec d. 80-110 pps

<10 pps

TENS acupuncture pulse frequency a. 30-50 pps b. <10 pps c. 250 micro sec d. 80-110 pps

A-alpha & A-beta fibers

TENS acupuncture targeted fibers? a. a-alpha b. a-beta c. a-delta d. c fibers

Central inhibition theory

TENS acupuncture theory a. central inhibition b. relativity c. gate control d. big bang

~15-20 minutes pain relief can last for hours

TENS acupuncture treatment time? a. >30 min b. 15-20 min c. 250 micro sec d. 10 contractions

50-100 μsec

TENS conventional pulse duration a. >250 micro sec b. <10 pps c. 50-100 micro sec d. 100-600 micro sec

80-110 pps

TENS conventional pulse frequency a. <10 pps b. 250 micro sec c. 50 bursts/sec d. 80-110 pps

A-Beta fibers

TENS conventional targeted fibers a. a-alpha b. a-beta c. a-delta d. c fibers

>30 minutes limited treatment effect

TENS conventional treatment duration a. >30 min b. 15-20 min c. 250 micro sec d. 10 contractions

TENS more superficial IFC deeper

TENS depth relative to IFC?

biphasic alternating

TENS waveform? a. biphasic alternating b. amplitude-modulated alternating c. biphasic pulsatile d. direct

158-167

Temperature range of a hydrocollator? (degrees F) a. 158-167 b. 160-170 c. 125-134 d. 143-157

The greater the volume of tissue, the greater the possibility

The (greater/lower) the volume of tissue, the (greater/lesser) the possibility of having temperature changes occur systemically.

piezoelectric crystal sound head

The 2 key elements of the ultrasound applicator are: Select all that apply a. piezoelectric crystal b. wand c. sound head d. wave pulse

isoelectric line

The baseline segment of waveforms that does not show charge a. interpulsed interval b. axis c. isoelectric line d. current base

greater the heating effect

The faster the tissue temperature is increased, the (lower/greater) the heating effect.

Traction Contraindications: Acute cervical spine trauma (ie whiplash) Connective tissue diseases resulting in tissue laxity Rheumatologic disorders (ie. RA) Joint hypermobility/instability Ankylosing spondylitis Osteoporosis/Osteopenia Hx of steroid use Post surgical stabilization procedures Post surgical decompression procedures Spine implants/prosthetic discs Spine discectomies Pregnancy (lumbar) Spinal malignancies Non-‐mechanical pain

Traction Precautions: Claustrophobia (depends on anxiety within the traction cradle) COPD (unable to lie supine) Pregnancy (cervical traction depending on relaxin levels)

5-8 min

Treatment duration of static cervical traction when treating HNP/hypertonicity? (min) a. 4-7 b. 5-8 c. 6-9 d. 7-10

20-30 minutes

Treatment time for a commercial cold pack? (min) a. 20-30 b. 5-10 c. 10-20 d. 3-5

20-30 minutes

Treatment time for an ice bag? a. 20-30 b. 5-10 c. 10-20 d. 3-5

10-20 minutes

Treatment time for cold immersion bath/whirlpool? a. 20-30 b. 5-10 c. 10-20 d. 3-5

5-10 minutes

Treatment time for ice massage? a. 20-30 b. 5-10 c. 10-20 d. 3-5

15-30 min

Treatment time for paraffin wax? (min) a. 5-20 b. 10-25 c. 15-30 d. 20-35

3 MHz 1 : 3-4 20%, 25% 0.2-0.8

Tyler sustained a left hamstring strain yesterday while working on his golf swing. What are the ultrasound parameters for this patient? Depth (MHz)? Pulse ratio? Duty Cycle (%) Intensity?

Ultrasound precautions Areas of infection Acute injury Impaired sensation, cognition, or communication Impaired circulation Over plastic or cemented implants Over spinal cord of regenerating nerves

dip and wrap dip and reimmerse

What are the 2 ideal applications of paraffin wax? a. dip and flip b. dip and wrap c. dip and reimmerse d. dip I dip you dip e. dip and dip

Gate control theory central inhibition

What are the 2 main theories supporting TENS?

a-delta c fibers

What are the 2 nociceptor fibers types of the peripheral pain pathway? a. a-alpha b. a-beta c. a-delta d. c fibers

static and intermittent

What are the 2 settings available for cervical traction? a. static b. dynamic c. constant d. intermittent

high threshold wide-dynamic range

What are the 2 types of second order neurons of the central pain pathways?

fluidotherapy

Which heat modality has the greater tissue temperature increase? a. warm whirlpool b. paraffin wax c. MHP d. fluidotherapy

intermittent

Which of the 2 cervical traction types have a longer treatment time?

conduction and convection

Which of the 3 heat transfer mechanisms are readily seen in the clinic? a. radiation b. conduction c. convection d. a & b e. b & c f. a & c

diathermy

Which of the following delivers electromagnetic waves to the body? a. ultrasound b. e-stim c. diathermy d. cryotherapy

anterior glide

Which of the following is NOT a Therapeutic Modality? a. compression b. anterior glide c. diathermy d. cold pack

IFC

Which of the following is an example of beat waveform modulation? a. NMES b. HVPC c. FES d. IFC

decreased responsiveness to non-noxious stimuli

Which of the following is false? Central sensitization results in: a. decreased responsiveness to non-noxious stimuli b. increased responsiveness to noxious stimuli c. increased receptive fields d. decreased activation thresholds

static

Which traction type is preferred for a patient with a muscle spasm or herniated nucleus pulposus? a. static b. dynamic c. constant d. intermittent

pulsatile

Which type of current is the safest? a: direct b: monophasic c: pulsatile d: alternating

FES: Freq-40 pps, pulse duration- 300 microsec, on/off- 1:3, treatment duration 15 minutes

While performing bed mobility with a patient with hemiparesis, you forget to protract the scapula, and your patient's shoulder subluxes. What mode and parameters do you need to fix your mistake before you get sued? a. FES: Freq-40 pps, pulse duration- 300 microsec, on/off- 1:3, treatment duration 15 minutes b. NMES: Freq- 30 pps, pulse duration- 250 microsec, on/off- 1:3, treatment duration- 10 contractions c. Russian: Freq- 50 burst/sec, duration- 10 microsec, on/off- 1:5, treat time- 10 contractions d. FES: Freq- 45 pps, pulse duration- 300 microsec, treat duration- to fatigue, ramp 0-1 sec

she is imposing a large volume of tissue to a heating medium which can contribute to changes in BP, HR, and RR (the greater the tissue volume, the greater the temp change)

With the effect of a heating medium on tissue volume in mind, explain why pregnant women should limit their time in warm water.

10-15 minutes

You are applying a hot pack to a patient for the first time. When is it appropriate to remove. (min) a. 5-10 b. 10-15 c. 15-20 d. 3-10

5 minutes

You are planning to stretch your patient following ultrasound. How long do you have before the tissue cools? (min) a. 5 b. 10 c. 20 d. 15

inflammatory response

You are seeing Larz, who twisted his ankle at a silent yoga retreat last weekend. What phase of tissue healing is he most likely in?

NMES: Freq- 10pps, pulse duration- 300 microsec, on/off- 1:2, Ramp- 1-2 sec

You are treating Bohdi s/p R ACL reconstruction 3 months ago. He continues to have moderate edema and 3/10 pain with walking. Select the appropriate mode and parameters to address the edema. a. NMES: Freq- 10pps, pulse duration- 300 microsec, on/off- 1:2, Ramp- 1-2 sec b. Acupuncture-like: Freq- <10pps, duration- 230 microsec, treat time- 18 min c. IFC: Freq-80-110 pps, pulse duration- 50-100 microsec, treat time- 35 min d. HVPC: Freq- 100-125 pps, duration-60 microsec, on/off- continuous, treat time 25 min

Russian: 50 burst/sec, pulse duration- 10 microsec, on/off- 1:5, treat time- 10 contractions

You are treating a division 1 college football player looking to increase the strength of his triceps. What is the best mode and parameters for this patient? a. TENS: Freq- 80-110pps, duration 50-100 micro sec, treat time- >30min b. Russian: 100-125pps, pulse duration- 10 microsec, on/off- continuous, treat time- 10 contractions c. NMES: Freq-40 pps, pulse duration- 300 microsec, on/off- 1:3, treatment duration 15 minutes d. Russian: 50 burst/sec, pulse duration- 10 microsec, on/off- 1:5, treat time- 10 contractions

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