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Modalities IER
Modalities, IER NPTE, Physical therapy
| Question | Answer |
|---|---|
| Hot Packs | -heated by water 165-170 degrees -6-8 layers of towels between hotpack and skin -20-30min |
| Paraffin bath | -wax melts b/w 118-130 F and is self sterilizing -treatment temp: 125-127 F -time: 15-20 min dip 6-8 times |
| Contrast bath | hot/cold immersion -temp: hot 40C (104F); cold 15C (59F) -subacute stage begin with HOT for 3-4 min then in cold 1 min -alternate hot/cold for 20-30 min ending in hot water |
| Hydrotherapy (whirlpool) | -can be used for debridement -full body-hubbard tank- water not to exceed 38C (100F) -chronic conditions 37.2-40C (99-104F) -if pt has PVD, cardiac problems or open wounds temp should be at body temp or below not to exceed 38C(100F) |
| What are some types of cryotherapy | -cold packs -ice packs -ice massage -vapocoolant spray |
| Ultrasound | -high frequency .8-3.0MHZ -3MHZ=superficial -1MHZ=deep -lower intensities and pulsed US are used for acute conditions or thin tissue -higher intensities and continuous US may be used for chronic conditions or thick tissue -if tissue is high in fat or |
| Phonophoresis | -introduces therapeutic substances into the body aided by US -hydrocortisone, dexamethasone, salicylates, lidocaine and others are massaged into the body part followed by US using transmission gel |
| Mechanical spinal traction | -cervical-20-30 pounds to cause distraction of vertebral bodies -lumbar-25-65 pounds to effect change at the spinal segments |
| Neck positions for cervical traction | -C1-C4: 0-5 degrees of flexion -C5-C7: 20-30 degrees of flexion -disc dysfunction: 0 degrees |
| Lumbar positions for lumbar traction | -spinal stenosis the hip and knee are placed in 90 degrees of flexion 90/90 -posterior herniated disc the prone position without a pillow is preferred postion -spondylolisthesis is contraindicated |
| Intermittent compression | -settings are determined by blood pressure -must be worn for at least 2 hours per day |
| Continuous Passive Motion (CPM) | -motion arc, position of arc and rate of motion can be controlled/changed -CPM should be discontinued if increases in pain, edema, or inflammation are noted |
| Tilt table | -used to deal with orthostatic hypotension as well as preventive measure for osteoprosis development by providing weight bearing for bedridden patients -A drop in BP, diaphoresis(excess sweating) and agitation are indications to return the pt to a more h |
| Iontophoresis | -chemical ions are driven through the skin by continuous direct current for a therapeutic result -therapeutic ion must be placed under an electrode of similar charge to "PUSH" the chemical past the skin into the deeper soft tissue |
| What is the cathode used for in iontophoresis | -cathode-negatice pole- is used for salicylate (pain relief), acetate (calcium deposits), dexamethasone (anti-inflammatory), and iodine (softens scars) |
| What is the anode used for in iontophoresis | -anode- positive pole- is used for hydrocortisone (anti-inflammation), Lidocaine (pain relief), magnesium or calcium (muscle spasm), lithium (gout), zinc (dermal ulcers), and copper (fungal infections) |
| Transcutaneous electrical nerve stimulation (TENS) | -impulses stimulating the large A-fiber afferents can act to block pain impulse (gate control theory) -current may be a symmetrical or asymmetrical biphasic (AC) waveform or a monophasic (DC) waveform |
| Conventional (high rate)TENS | -high frequency (75-120pps) -very short pulse width (50-100 microseconds) -low intensity -provides temporary relief of acute or chronic pain -onset of pain relief is relatively fast -treatment time 20-60 minutes |
| Acupuncture-like (strong,low rate)TENS | -low frequency (1-4 pps) -wide pulse width (150-300 microseconds) -higher intensities than conventional -chronic conditions with longer lasting pain relief -treatment time 30-40 minutes |
| Brief Intense TENS | -high pulse rate (150pps) -long pulse width (300 microseconds) -rapid onset, short term pain relief -pain relief for painful procedures such as wound debridement, deep friction massage or passive stretching -treatment time 15 minutes |
| Burst Mode TENS | -combines both high and low rate TENS -stimulation of endogenous opiates but the current is more tolerable to patient than low rate TENS -onset of analgesia is similar to low rate TENS -treatment time 20-30 minutes |
| Modulation Mode TENS | -frequencies, intensities, or pulse widths can be altered by 10 or more % 1-2 times per second |
| High Voltage Pulsed Monophasic Stimulation | -a form of pulsed DC using high voltage twin spikes with pulse widths in microseconds -useful with denervated muscles -not tolerated well by patients |
| Russian Current | -high frequency (2500HZ)- which is modulated to 70pps for comfort -used for strengthening of normal muscle by assisting with the muscle contraction during volitional activities such as isometric exercises and short arc joint movements |
| Interferential Current IFC | -characterized by the crossing of two sinusodial waves having similar amplitudes but different carrier frequencies -the waves interfere with one another to generate an amplitude modulated beat frequency -used for pain relief and muscle strengthening |
| Functional Electrical Stimulation (FES) | -can use alternating current (AC at 80-100HZ) to stimulate an innervated muscle for general stimulation or direct current that is interrupted with a long pulse width for a denervated muscle -also called neuromuscular electrical stimulation NMES |
| What is the duty cycle and atrophy ratios for FES/NMES | -the duty cycle is the current "ON" time versus "OFF" time -the ratio should increase as muscle atrophy or weakness increases to prevent over fatigue during treatment -minimal to no atrophy or weakness- 1:1 02 1:2 ratio -moderate atrophy- 1:3 or 1:4 r |
| When should you use FES/NMES | -disuse atrophy, impaired ROM, muscle spasm, muscle re-ed, spasticity -useful as an alternative or supplement to the use of orthotic devices |
| When should you adjust FES/NMES | -if the skin is sensitive or the patient senses burning -use larger electrodes -reduce intensity or increase pulse width AC is better tolerated than DC |
| Biofeedback EMG | -an electronic instrument that monitors the muscle activity of skeletal muscles and provides physiological information (feedback) to the patient -THIS IS NOT A FORM OF ELECTRICAL STIMULATION |
| Chronaximetry | -test of electrical excitability of peripheral nerves -normal value is <1 millisecond -the value for a denervated muscle is in the hundreds of milliseconds -it takes severed neuron about 7-14 days to degenerate-the test should be done after this -the |
| Nerve Conduction Velocity TEST | -determines the time it takes for a muscle to respond after the peripheral nerve has been stimulated -can be done over sensory nerves by determining the time it takes for a nerve to respond to a stimulus -upper extremity range from 45-70 meters/seconds |
Created by:
jen_p99
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