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Skills3 PAMs Shirish

Skills 3 PAMs SRM

What are the 3 classifications of PAMs Superficial Thermal Agents, Deep Thermal Agents, Electrotherapeutic Agents
Why do we use PAMs As adjunct treatment preparatory to intervention to enhance occupation and performance (TO GET PAID)
Name situations/reasons or conditions in which you would use Ultrasound (US) wound healing & pain management: painful muscle spasms, soft tissue contractures, bursitis, tendinitis, scar tissue, calcific deposits, first 24-48 hours of edema, healing wounds.
What condition would need FES (Functional Elec Stim) or NMES (Neuromuscular Elec Stim) treatment Edema
What are examples of superficial thermal agents hot packs, whirlpools, ice packs, US less than 2.3cm
What are deep thermal agents? Ultrasound more than 1" (inch)
What is TENS (transcutaneous electrical nerve stimulation) FES, & NMES electrotherapeutic agents
What is TENS used for? Pain relief....numbs the NERVE
FES is used for? Electrodes to illicit contraction & produce movement (like handbike stims agonist/antagonist)
T/F: It's your first day on clinical rotations & the OT tells you to hurry up & go get ice packs for Mrs. Jones before she throws a fit because they are 20 minutes behind. This is ok for you to do. True. Hot/Cold packs are allowed at entry level under direct supervision.
What is referred pain? Unrelated pain that shows up in another body part.
Describe acute pain Less than 3 months
Describe chronic pain over 6 months
What is sub acute 3-6 month range
What are thermal modalities any modality applied to the skin that can increase or decrease skin and superficial subcutaneous tissue temperature (warm or cold)
What are the objectives of superficial thermal agents decrease pain & stiffness (ex-post traumatic joint from fx)improve range of motion & tendon excursion, improve viscosity of synovia (increase lubrication in joint), promote healing & relaxation (inhibitory/Roods)
WE WANT HOT PACKS...WHEN DO WE WANT THEM...NOW>>>NOW>>>NOW! WHO'S GONNA GET THEM..YOU ARE... (Just a little chant I am hearing in my head after today...welcome to I get to warm my hands up in them?
Name conditions that would benefit from superficial thermal agents:(MSS.CNS TWC) Muscle spasm, Subcutaneous adhesion/scars, Sympathetic nervous syst disord, Contractures, Neuromas, Subacute & chronic inflammation, Trauma, Wounds-nonopen, Chronic Arthritis
What type of US do you use on wounds? Low temperature, low frequency, low threshold ultrasound (3 MHz)
What do you need in the PAM dosage guidelines? parameters: temperature, time, frequency(US), or current (stim)
What do you need in the PAM treatment plan? dosage guidelines/parameters, primary effects, modality selection
What is fluidotherapy warm convection device that circulates heated dry corn husk particles and air. The bombardment by the particles stimulates circulation & sensation.
What conditions are deep thermal agents used to treat? wounds, tendonitis, low threshold spasms/spasticity; medication distribution (phonophoresis) plantar fasciitis (low-level laser)
Electrotherapy agents and their uses: NMES (nerves), TENS (nerves), ESTR--tissue repair (wounds), FES (muscles), EMS (muscles), Iontophoresis (stim patches), sEMG (induce relaxation)
What conditions is sEMG used for? OCD, anxiety, depression---watch neuro waves on machine and try to change the motion
T/F: As a new graduate, you are eligible to treat patients with electrotherapy? NO!! Get outta town! Go back to school & get that (R) behind your name! You need the principles of electricity (chemistry, physics, biology) rise/decay times, frequency, and more :)
What is a hand bike called? Ergometer or Restorator
What MUST you document for PAMs? What PAM & ALL Parameters, site/where applied, duration, physiological responses elicited from tx, subjective responses from pat such as tolerance reaction and clinical effectiveness (KNOW THIS SLIDE) remember...give a handout to get paid!!
Where do you never put PAMs (beside the obvious places)? NO belly for cramps or head for headaches
HOT Pack Precautions (be very careful!): Edema--weigh benefits vs. possible effect of increased swelling:elevate extremity if possible!
HOT Pack ContraIndications (when don't you use them) abnormal or poor sensation, vascular disease (DVTs), bleeding/open areas/new scars, infection, cancer, acute trauma
What do you call the machine that warms the hot packs? & what temperature is normal? Hydrocirculator /150°F
When do you NOT use Cryotherapy? PVD or any circulatory compromised area, Raynaud's, R/A, SLE (scleroderma), Lupus, FMS, cold Urticaria, cryoglobinemia, paroxysmal cold hemoglobinurias, HPB, psych reactions to cold,
Why DO you use Cryotherapy? reduces pain, decreases metabolism, edema, & plasticity (regeneration), facilitates muscle contraction (quickly/"quick icing")(musculoskeletal & joint pain, muscle guarding, spasticity, acute inflammation, edema, post surgical swell, myofacial trigger pts
T/F: You can use hot packs on subacute inflammation? True--Just not acute!
T/F: We use diagnostic US in therapy? NO! That's what they use in radiology...we use therapeutic.
How is the easiest way to ruin the ultrasound machine? By turning to talk to Betty on the other side of the treatment room and losing contact with the skin while still sending power through the head.
3mhz US is used to treat what conditions MGE & LTE (medial "golfer's" epilcondylitis & Lateral "tennis")
What is a main difference between superficial 3Mhz & deep 1 MHz US? Superficial goes much faster and is absorbed quicker and is seen longitudinally
What is the depth range on deep US 2-5cm
What is intensity? The amount of sound we are producing expressed in W/cm² in US regulated by the WHO
What is non-thermal US? What is the avg. cycle? Pulse or deliver US only during a portion of the treatment. Usually 20 or 50% also called a duty cycle
Why do we choose non-thermal US? To speed up the inflammation or wound healing process.
What is the correct procedure to start US? Apply gel, start moving head, then turn up intensity, never more than 2x size of the head
What is important to know about TENS Must be applied along the pathway of the nerve
T/F: you should heat up the US gel for Mrs. Jones because she is always complaining about the cold and how bad she hurts NO! decreases the conductivity
what modality would you use to treat wrist extension IFC (Interfenential current): always place diagonally
T/F: Mrs. Jones is really complaining today about her pain. Let's give her a hot pack to warm up those arthritic bones and place some E-stim on her to help relax her muscles too so she will have more ROM for therapy this week. NO! Never give a pat more than one modality--it changes the feedback & you may damage Mrs. Jones with the second treatment. Make sure to talk to her during her PAM about what she has been doing in her HEP this week & go over a new handout so you get paid!
Why does TENS work? You cannot feel 2 things at once: the sensory fibers OVERRIDE the pain fibers
What do we use NMES for? making a muscle contract that cannot generate enough force on it's own to move thru ROM
T/F: Do Med's have polarities? YES! very important when using Iontophoresis (current has polarity as well!)
What are the 3 most common drugs used in OT with Iontophoresis (think A.I.D.) Acetic acid (breaks up calcifications), Iodine (scar tissue), Desamethosone (tendonitis inflammation)...all negative polarity
Contraindications for fluidotherapy & precautions NO open area/infections. Precautions: edema-exercise while in device; Labile BP, vertigo, & seizure disorders don't leave alone!
Precautions for Hydrotherapy Labile BP, vertigo, & seizures-don't leave alone (since when do you leave your patient alone???) Monitor sensory deficit, vascular conditions, & edema pat's for excessive heating; SANITIZE (& clean/fill) after EVERY pat!!!!!!!!!!!
Indications for paraffin wax bath arthritis, contractures, etc.
What should you tell Mrs. Jones about the paraffin bath? It's pre-mixed w/mineral oil, it's @ 120°F. Go thoroughly wash/dry her hands and remove any jewelry from the area to be dipped/brushed. Used to increase circulation, decrease joint stiffness & pain in distal extremities. test with meat thermometer!
Contraindications for paraffin spa? abnormal sensation, vascular disease, bleeding or open areas, infection, acute trauma, cancer, edema
What else should you know about the paraffin spa? It is billable!!! :)
How cold are cold packs? 22°F
What is the name of the thermos looking like cold water unit Controlled cold compression unit (uses ice/water/gravity up to 4 hours-recirculate after 1 hr unless has pump)
T/F: Modalities must be used by practitioners skilled in their use. The OTA should not employ any modality until service competency is established. True
Adjunctive modalities are used as a preliminary step toward purposeful activities to prepare pt. for occupational performance. Name some examples: Therapeutic exercise; Orthotics; Sensory stimulation; Physical agent modalities (PAMs)
Why is 3Mhz US used for superficial areas only penetrates up to 2.3cm; good for superficial tendons/tissues
What are 2 conditions of the elbow that 3mhz US: Medial Epicondylitis (MGE)--golfer's; Lateral Epicondylitis (LTE)--tennis
Which frequency goes faster 1 or 3Mhz? 3-superficial/fast (1 is long/deep)
What conditions benefit from superficial thermal agents Muscle spasms, subcutaneous adhesions, SNS disorders, contractures, neuromas, chronic arthritis, trauma, wounds, subacute/chronic inflammation (NOT acute!)
Created by: RadGirl13
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