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OCTH 742 exam 2
| Question | Answer |
|---|---|
| procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance | physical agent modalities |
| use various forms of energy and force to modulate pain, modifiy tissue healing, increase tissues extensibility, modify skin and scar tissue, decrease edema/inflammation | physical agent modalities |
| systematic application of various forms of energy or force to effect therapeutic change in the physiology of tissues | therapeutic modalities |
| absence or limitation of body function and structures may impact engagement in daily occupations | body functions |
| categories: thermal agents, electromagnetic agents, electric agents, mechanical modalities | physical agent modalities |
| most freuqent ailment for which individuals seek medical attention | pain |
| type of pain: sharp, stabbing, constant; localized; inflammation; warning of potential injury, tissue damage, or that something is wrong; lasts seconds to days | acute pain |
| type of pain: associated with psychological components, recurs at intervals or persists beyond stage of healing, may occur with inflammation, dull, aching, variable, long duration | chronic pain |
| type of pain: perceived to be in areas other than where nocioceptors (pain receptors) were stimulated | referred pain |
| small, localized area of hypersensitivity; tight band of skeletal muscle or muscle fascia; caused by acute overload, overwork, fatigue, or direct trauma to a muscle; clinically located through palpation or patient id | trigger point |
| source of pain: caused by involvement of neural tissues; presents as limitations in movements, pain, paresthesia, or sensory changes; results in mechanical and physiological changes in body | neurogenic |
| source of pain: accompanied by inflammation secondary to release of chemical mediators; local dysfunction caused by mechanical damage; presents as throbbing, aching, response to hot/sharp sensation | peripheral nocioceptive |
| source of pain: illness or injury in PNS or CNS; presents as burning or electric shock-like sensations | neuropathic |
| located in dorsal horn of spinal cord, modulated by transmission cells (T-cells) | pain center |
| free peripheral nerve endings located in almost all tissues that id potential or actual tissue damage; give rise to C-fibers and A-delta fibers - detect mechanical, thermal, or noxious stimuli, excitatory input | nocioceptors |
| type of fiber associated with pain: move quickly; cold, pressure, and acute pain signals; sharp, stabbing, or pricking pain; large, myelinated; onset at initial stimulus; well located; fast withdrawal reflex - lasts for a short period of time | A - delta fibers |
| type of fiber associated with pain: move slowly; small, unmyelinated; onset after initial stimulus; emotionally difficult to tolerate after a period of time; dull, poorly localized pain - slow, dull, throbbing, aching, constant pain | C - fibers |
| type of fiber associated with pain: housed in substantia gelatinosa of spinal cord; inhibitory input; large diameter, fast conducting, highly myelinated, sensory nerve fibers | A - beta fibers |
| pain theory: severity of pain is determined by balance of excitatory and inhibitory inputs to T-cells of spinal cord; increased A-beta activity "closes the gate" to C-fibers and A-delta fibers | Gate Control Theory |
| pain theory: pain-mediated chemicals produced by body are natural opiates and pain suppressors; released in response to painful stimuli, binding to respective chemoreceptors; TENS can reduce intensity | Opioid Mediated (Endorphin) Theory |
| use of pain theory: acute pain, applied at site of pain, effects last during treatment and very shortly after, pleasant sensation | Gate Control Theory |
| use of pain theory: chronic pain, applied at and around site of pain, effects last beyond treatment, often unpleasant sensation | Opioid Mediated (Endorphin) Theory |
| application of either heat or cold that results in a biophysical change in tissue temp; facilitates healing process and decreases symptomology; always used as an adjunctive addition to therapy and never used singularly without occ. performance context | thermotherapy |
| transfer of heat from 1 object to another | conduction |
| transfer of heat between a surface and a moving medium | convection |
| transfer of heat through radiant energy | radiation |
| type of thermotherapy: used to treat tissues 1-2 cm deep; tissue temp must be elevated and sustained between 104 and 113 degrees F; physiological response depends on intensity of heat, modality used, time of exposure, and surface area treated | superficial thermal modalities |
| effects: increases - local cell metabolism, elasticity, oxygen and nutrients, local temp., formation of edema, subjective comfort; decreases - pain through decreasing inflammation, muscle spasms; dilates blood vessels which causes capillaries to open | superficial thermal modalities |
| MAVE: metabolic, analgesic, vascular, extensibility | superficial thermal modalities |
| extensibility effect: raising tissue temp. between 104-113 degrees F for approximately 10-20 minutes facilitates soft tissue extensibility when combined with stretch; scar tissue, superficial joint capsules, tendons | heat |
| possible indications: stiff joints/contractures - goal is to improve ROM; pain/muscle spasms; chronic/subacute inflammation; wounds; chronic osteoarthritis; use when you want to decrease pain, increase ROM, and increase muscle relaxation | superficial thermal modalities |
| contraindications: acute edema/inflammation, absent/no sensation, poor thermal reg., tumors/cancer, DVT, pregnancy, semi-comatose/impaired mental status, infection, rheumatoid arthritis, open wounds/skin conditions | superficial thermal modalities |
| precautions: potential for burns, decreased/below normal sensation, compromised circulation, confusion or inability to articulate pain/discomfort, careful observation of older adults or pregnant women | superficial thermal modalities |
| heat agent: medium/tools - silica gel medium covered by canvas pouch, hydrocollator set between 165-175 degrees F, requires a coupling medium (2 covers or 6-8 towels); heat transfer method - conduction | hot packs |
| heat agent: benefits - increased circulation, increased tissue extensibility, improved ROM, decreased muscle spasticity and pain | hot packs |
| heat agent: application - position client for comfort and explain what to expect, wrap in towels or covers, position prepared hot pack and adjust towels as needed, general application time - 15 to 20 minutes (check after 5 minutes) | hot packs |
| heat agent: advantages - pleasant for client, can be preparatory, can be used with sustained stretch; disadvantages - 30 minutes to reheat, potential for burns and weight intolerance, uneven heat distribution, passive treatment | hot packs |
| heat agent: medium/tool - bath, wax and mineral oil, temp is between 118 and 135 degrees F; heat transfer method - conduction; benefits - decreases stiffness/increases ROM, effective for those with arthritis, decreases pain | paraffin |
| heat agent: application - explain and instruct; have patient wash area; wrap-dip and remove for 6 to 10 reps, 5 seconds between dips, wrap in plastic bag, elevate hand; treatment is 15-20 minutes | paraffin |
| heat agent: client should start with finger tips to sense temp., should not touch sides or bottom, 1st dip is deepest to decrease burn risk, maintain hand position and do not crack | paraffin |
| heat agent: advantages - even distribution of heat, inexpensive, client can do at home, passive stretch can be accomplished, not heavy; disadvantages - care of wax, no open wounds, distal joints/extremities only | paraffin |
| heat agent: method/tools - unit; heat transfer method - convection; benefits - desensitization, reduction in pain, increased ROM, decreased edema | fluidotherapy |
| heat agent: application - preheat unit, client instruction, remove jewelry, wash/dry tx. area, cover wounds, position client for comfort, secure sleeves, adjust temp and air flow; treatment time - 20 minutes | fluidotherapy |
| heat agent: advantages - patient comfort, desensitization, patient can do exercises during tx.; disadvantages - expensive, poor with open wounds, dusty, only applicable to distal extremity, extremity is in a dependent position | fluidotherapy |
| heat agent: medium/tools - tub filled with warm or cool water, can adjust agitation/movement of water; heat transfer method - convection | whirlpool therapy |
| heat agent: benefits - mechanical effects-wound care or debridement, improves circulation and tissue extensibility, facilitates healing process, sedation and analgesia, decreased gravity environment, can be used for exercise | whirlpool therapy |
| heat agent: application - ~15 to 20 minutes, uses antimicrobial agent when treating wounds, must be thoroughly cleaned after each use | whirlpool therapy |
| heat agent: advantages - can observe tx. area, temp and agitation of water controlled, AROM possible, agitation good for massaging soft tissue; disadvantages - set-up and cleaning is time consuming, sanitation can be an issue, extremity in dep. position | whirlpool therapy |
| transfer of heat through change of liquid to gas | evaporation |
| application of any substance to body resulting in a withdrawal or abstraction of heat from body which lowers temp of tissue; used to cool tissues 1-2 cm in depth; frequently used to treat acute injuries or trauma, spasticity/spasms, edema | superficial cryotherapy |
| effects: decreases - blood flow, edema/inflammation, sensory nerve conduction (pain relief), spasticity, tissue/collagen extensibility, metabolism | superficial cryotherapy |
| 4 stages of sensation that occurs with cooling: 1. initial feeling of COLD on skin, 2. BURNING sensation, 3. ACHING sensation, 4. NUMBNESS and pain relief (CBAN) | superficial cryotherapy |
| indications: acute/subacute inflammation/edema/swelling, acute or chronic pain due to m. spasm, myofascial trigger points, post-exercise pain and edema, acute m. or ligament strain, arthritic exacerbations or flare-up, spasticity | superficial cryotherapy |
| contraindications: conditions in which vasoconstriction will aggravate symptom; absent/no sensation; open wounds/skin conditions; infections; hypersensitivity to cold; HTN | superficial cryotherapy |
| precautions: pregnancy, decreased/below normal sensation, avoid placement over superficial nerves and directly on skin, be aware of bony prominences, always monitor skin closely to watch for adverse reactions and side effects | superficial cryotherapy |
| common agents: ice massage/direct icing, ice/cold packs, vasocoolant sprays, cool whirlpools, contrast bath/cool water immersion, controlled cold compression units | superficial cryotherapy |
| cold agent: media/tools - pillowcase, towel, or paper towel, pack; heat transfer method - conduction; benefits - decreases blood flow/circulation, edema, spasticity, extensibility metabolism, pain relief for more generalized area; tx. time - 10-20 mins | cold packs |
| cold agent: application - remove jewelry; wrap pack; ask client how they are feeling before, after 2 minutes, and after 5 minutes; visually check skin; insulate over bony prominence | cold packs |
| cold agent: advantages - commonly used and convenient, conforms to extremity; disadvantages - may require bandage wrap or elastic wrap to maintain position, amount of adipose affects level and rate of tissue change | cold packs |
| cold agent: medium/tools - cup with ice, towel; heat transfer method - conduction; benefits - decreases blood flow/circulation, edema, spasticity, tissue extensibility, metabolism, pain relief for generalized area; tx. time - 3-10 mins | ice massage |
| cold agent: application - position client and provide towels, rub ice in small rhythmic circles, inform client of 4 stages and ask them to state when they feel each, may continue for 1 minute past numbness | ice massage |
| cold agent: advantages - effective for superficial, localized, and small areas, can anesthetize a small area; disadvantage - ineffective for larger areas | ice massage |
| cold agent: media/tools - 2 buckets or sinks of water, warm water=100-104 F, cold water=50-59 F; heat transfer method - conduction | contrast baths |
| cold agent: hypothesis of benefits - alternating vasodilation and vasoconstriction will decrease edema, increase blood flow, improve peripheral blood flow, decrease pain and joint stiffness | contrast baths |
| cold agent: application - 10 min warm -> 1 min cold -> 4 min warm -> 1 min cold -> 4 min warm -> 1 min cold -> 4 min warm -> 1 min cold | contrast baths |
| cold agent: advantages - tx. can be modified to meet condition/goals, tx. can be active with exercises or strengthening, can be done at home; disadvantages - limited EBP, time consuming, potentially passive | contrast baths |
| cold agent: media/tools - can of spray; heat transfer method - evaporation; benefits - sensory tool for pain management, reduces resistance to stretch and decreases muscle spasm | vapocoolant spray |
| cold agent: application - bottle 4-5 cm from skin at 30 degree angle, 2-5 parallel sweeps at 10 cm/sec, "spray and stretch" | vapocoolant spray |
| heat transfer of ultrasound, sound waves are converted to mechanical energy (heat) | conversion |
| how it works: alternating current is impressed on crystal, vibration of crystal produces mechanical waves, sound waves cause molecules in tissue to vibrate, vibration in tissues causes a metabolic response | ultrasound |
| biophysical principle: heat is produced within tissues as molecule vibration increases due to absorption of energy | ultrasound |
| amount of resistance it encounters as it passes through a tissue; travels best through liquid, travels less through solids | impedence |
| amount being absorbed dependent on tissue density - if molecules are widely dispersed there is low absorption, if molecules are not widely dispersed there is higher absorption | ultrasound |
| bubble formation in blood or tissue fluids caused by ultrasound | cavitation |
| type of cavitation: expansion and contraction of gas bubbles in cavities without growing to critical size, somewhat normal | stable cavitation |
| type of cavitation: expansion of gas bubbles in blood which collapse and cause increased heat and possible damage to surrounding tissues, can be avoided by continually moving transducer around | unstable cavitation |
| thermal effects - raises temp of structures like tendons, ligaments, and joint capsules, continuous, heating; non-thermal effects - facilitates tissue healing, pulsed, healing | ultrasound |
| type of US: physiological changes - increased metabolic rate, blood flow and permeability, tissue extensibility, viscoelasticity of connective tissue; decreased pain perception by elevating pain threshold; stimulation of immune system | thermal ultrasound |
| type of US: goals - increase ROM, increase blood flow, decrease joint stiffness, decrease muscle spasm, decrease pain, decrease chronic inflammation, facilitate function | thermal ultrasound |
| type of US: indications - soft tissue tightness/contracture, joint contractures, scar tissue, chronic conditions (exception is chronic inflammatory conditions like carpal tunnel and ephicondylitis) | thermal ultrasound |
| type of US: pulsed, non continuous; does not cause heating of tissue; healing; physiological changes - mechanical/cellular changes, facilitation of tissue repair, micro-massage | non - thermal ultrasound |
| type of US: goals - facilitate tissue healing and repair, decrease pain, decrease acute inflammation, facilitate function | non - thermal ultrasound |
| type of US: indications - acute injury/inflammation, exacerbation of inflammatory conditions, tendinopathies/tendon injuries, wound healing, fracture/bone healing, near bony prominences, plantar warts, myofascial trigger point release | non - thermal ultrasound |
| area of transducer that produces sound waves, sound energy diverges through transducer | effective radiating area (ERA) |
| number of vibrations generated/second and is expressed as Hertz (Hz), 1 and 3 commonly used, higher=shorter wavelength=less penetration, lower=longer wavelength=deeper penetration; 3 MHz=1-2 cm; 1 MHz=3-5 cm | frequency |
| strength of acoustic energy at site of application; greater intensity=greater resulting increase in temp; 0.1-2.5 W/cm^2; can be high or low | intensity |
| intensity: acute - 0.1 to 0.4 W/cm^2, subacute - 0.5 to 1.0 W/cm^2, chronic - 1.1 to 2.0 W/cm^2 | ultrasound |
| fraction of time US energy is delivered during treatment; pulsed - 10%, 20%, or 50%, periodic interruption, reduced heating, non-thermal effect, HEAL; continuous - 100%, no interruption, heating, higher intensities, HEAT | duty cycle |
| tx. time - 5 to 8 minutes for 3 MHz or 8 to 10 minutes for 1 MHz; considerations - initial tx. is usually shorter than subsequent txs., smaller tx. area is shorter than larger areas, acute conditions tx. is shorter than chronic conditions | ultrasound |
| frequency - once/day or every other day, ongoing reassessment of client's condition and response, number of sessions varies, utilize as long as results are evident (up to 9-12 txs.) | ultrasound |
| contraindications: cancer or areas of malignancy; hemophilia; vascular disease or decreased circulation - DVT, emboli, atherosclerosis, thrombophlebitis | ultrasound |
| contraindications: never apply over heart, pregnant uterus, reproductive organs, eyes, pacemaker, external metal implants, rash, eczema, skin irritation | ultrasound |
| precautions: over metal implants, epiphyseal growth plates, plastic or cemented implants; areas of decreased/lost sensation, bony prominences, vicinity of pacemaker, impaired cognition or ability to communicate | ultrasound |
| media: must use a coupling medium to create bond between skin and transducer, reduce static, improve transmission; typically gel | ultrasound |
| advantages- able to target specific tx. sites, accomplishes multiple goals simultaneously, able to use in conjunction with stretch, comfy; disadvantages - unable to tx. large areas, risk of cavitation, can require multiple txs. | ultrasound |
| US with med. delivery; thermal and non-thermal; US increases permeability of stratum corneum which allows for enhanced absorption of topically-applied meds.; indications - inflammation, pain, injury, need prescription for use of med. | phonophoresis |
| contraindications/precautions: same as US plus precautions for chosen med.; application - before=heat and moisten skin and trim hair, during=same as US and use med. as medium, after=seal tx. area with plastic wrap | phonophoresis |
| flow of ions due to imbalance, follows path of least resistance, flows from cathode (negative) to anode (positive) | electric current |
| 3 primary forms: direct current, alternating current, pulsed current | electric current |
| how it works: when a stimulation is applied to a neuron, increases membrane permeability, sodium ions rush into cells, therefore activating an AP | electrotherapy |
| time necessary for membrane to return to resting state before another AP can be generated | absolute refractory period |
| type of movement: motor units fire asynchronously, smaller motor units recruited first, larger fibers are added as more strength is needed, smooth and controlled movements | normal movements |
| type of movement: larger motor units fire first synchronously, quickly fatigue, lack FM control | electronically - stimulated movement |
| type of current: "Galvanic current"; continuous, unidirectional electron flow; positive or negative; used to "push" med. through skin; may also be used to prevent muscle atrophy by stimulating denervated muscle; example=iontophoresis | direct current |
| type of current: continuous change in direction of electron flow; current is bidirectional=alternate between positive and negative; no true cathode or anode as electrical fields alternate; examples=Russian stim. and IFC | alternating current |
| type of current: currents where electron flow/current is periodically interrupted for brief periods of time, definitive segments of currents | pulsatile current |
| type of pulsatile current: 1 phase to a single pulse; unidirectional flow of electrons; less fatiguing than polyphasic; clinical uses - wound healing (HVPC), direct stimulation of denervated mm., delivery of meds transdermally (iontophoresis) | monophasic waveform |
| type of pulsatile current: 2 opposing electrical phases constructing a single pulse; pulse is bidirectional; symmetrical or asymmetrical; balanced or unbalanced; clinical uses - pain control (TENS) or eliciting m. contraction (iontophoresis) | biphasic waveform |
| type of pulsatile current: bursts of 3 or more electrical phases; clinical uses - IFC or Russian stim. | polyphasic waveform |
| series of pulses delivered as single charge, perceived as single pulse | burst |
| level or distance that impulse rises above or below baseline; measured in milliamps/microamps or volts; determines how many electrons are pushed by voltage; increased amplitude=deeper stim.; average tolerated is 35-80 mA | amplitude |
| maximum amount of current delivered during a single phase of a pulse, measures amount of current flow from 0 to point of maximum output | peak amplitude |
| how long 1 waveform lasts, effects strength of current | phase duration |
| how long 1 pulse lasts, "pulse width"; too long or too short may be uncomfy, inverse correlation between duration and comfort, ranges from 50-400, 300 most used | pulse duration |
| number of pulse cycles delivered to tissue, modify rate dependent on tx. goals, faster=greater pps, affects quality of muscle contraction and rate of fatigue, most preset parameters use 20-50 pps | rate / frequency |
| property of substances which opposes flow of current, measured in Ohms, greater impedance=lower rate of electrical flow | resistance |
| force that moves electrons from 1 point to another; high - usually 500 volts, low -1 to 100 volts | voltage |
| amount of time needed for amplitude to reach its peak in a single peak; directly related to ability of amplitude to excite nervous tissue; if too slow nerve membrane can accommodate to electrical stimulus and AP may not be reached | rise time |
| amount of time it takes for peak amplitude to return to 0 volts | decay time |
| change from 0 to peak intensity; can be abrupt or gradual; ranges from 1-8 seconds, but typically 2; if stimulation is too painful use a longer time, increased time is useful when treating spastic mm.; 2-5 seconds most common and most comfy | ramp time |
| amount of time between stimulation period and rest period; expressed as ratio; affects rate of m. fatigue; adequate recovery time assures quality of subsequent contractions; 1:3 or 4:12 common | duty cycle |
| interface between electric stimulator and skin; point where electron-ion conversion occurs; density of current is inversely related to electrode size, as electrode size decreases current density increases; should be placed longitudinally along m. | electrodes |
| electrode placement type: active and dispersive electrodes; active placed over target area, dispersive used to complete circuit; ex. used to stimulate trigger points or during wound healing | monopolar electrode placement |
| electrode placement type: equal stimulation to both electrodes, electrodes should be near equal in size, stimulates large muscles, 1 electrode over motor point and the other along the m. belly | bipolar electrode placement |
| electrode placement type: 2 channels and 2 sets of electrodes, increased current density at intersection, used for pain management or stimulation of antagonistic m. groups | quadripolar electrode placement |
| distance between electrodes influences depth and course of current; closer together=superficial, farther apart=deeper | electrodes |
| indications: increase ROM; inhibit hypertonicity, spasticity, or m. spasm; increase m. strength, prevent atrophy; improve endurance; m. re-edu. or neuromuscular facilitation; orthotic substitution; edema control; pain management | electrotherapy |
| contraindications: implanted electrical devices, epilepsy, pregnancy, peripheral vascular disease, venous thrombosis, thrombophlebitis, active cancer/malignancy, tuberculosis, active hemorrhage, near deep thermal modalities | electrotherapy |
| never use over ant. neck or carotid sinus, thoracic region, phrenic n./bladder stimulators, eyes, repro organs, infections, superficial metal hardware, skull, areas of m. pathology, areas where movement is contraindicated/to be avoided | electrotherapy |
| precautions: hyper/hypotension; obesity and/or excessive adipose tissue; inability to provide feedback regarding stim.; skin conditions-eczema, psoriasis, dermatitis; autonomic dysreflexia | electrotherapy |
| precautions: over areas with cell body pathology, myelin sheath pathology, pathology of m./n. synapse, absent or diminished sensation | electrotherapy |
| type of e-stim: pulsating current; used for m. re-ed. of innervated m., intact peripheral nn.; produces motor response causing mm. and extremities to move | neuromuscular electrical stimulation |
| type of e-stim: electrode placement - monopolar placement=active electrode is negative and goes over m. belly, bipolar placement=active and dispersive electrodes not in specific spots | neuromuscular electrical stimulation |
| type of e-stim: active form of NMES; stimulate a m. contraction during a functional movement/activity; substitute for an orthotic device to produce muscular contractions or movement | Functional Electrical Stimulation |
| type of e-stim: indications - slow or prevent disuse atrophy, maintain/increase ROM, facilitate vol. motor control, improve endurance, decrease edema, decrease spasticity, substitute for orthotic, increase tendon excursion, increase strength | NMES / FES |
| type of e-stim: benefits - client gets proprioceptive and visual feedback, motivates clients, motor and sensory response, flood CNS with sensory and kinesthetic info for anticipated motor response, can facilitate movement into function | NMES / FES |
| type of e-stim: symm. biphasic waveforms used for large mm. of UE, asymm. biphasic waveforms may be more effective for smaller mm. of UE, smaller electrodes, patient should attempt to contract mm. during | NMES / FES |
| type of e-stim: "Russian stim.", medium frequency, polyphasic alternating current waveform, max tolerable intensity; indications - disuse atrophy, spasm reduction, m. strengthening | Medium Frequency Alternating Current |
| generic term used to describe a class of electrotherapy that provides low-voltage electrical pulses to the nervous system using surface electrodes; therapeutic goal is sensory analgesia rather than a motor response | Transcutaneous Electrical Nerve Stimulation |
| type of e-stim: application for pain control - facilitating occ. performance, decreasing the amount of medication needed | Transcutaneous Electrical Nerve Stimulation |
| type of e-stim: use - wide variety of parameters, each client is unique, no right or wrong answers with use of this, requires a "trial and error" approach | Transcutaneous Electrical Nerve Stimulation |
| type of e-stim: TENS level - body accepts low levels of electricity more, this helps realign natural electrical current to facilitate tissue healing, 1,000 times less than conventional TENS; used to tx. pain, depression, anxiety | subsensory level |
| type of e-stim: TENS level - conventional, used for acute/chronic pain during occ. tasks and activities, below motor threshold, effects are short-term, client should be cautioned to not over-do it just because pain is controlled | sensory level |
| type of e-stim: TENS level - used for acute/chronic pain with longer lasting relief, high intensity, visible m. twitch or isometric contraction, slow onset of relief | motor level |
| type of e-stim: TENS level - used for debridement, painful procedures, passive stretch, joint mobilization; causes endorphin release; quickly produces a surface analgesia and can be of short duration or extended periods lasting a few hours | noxious level |
| type of e-stim: considerations for parameter selection - if client is on pain meds=sensory protocol, can use this to ween from pain meds | Transcutaneous Electrical Nerve Stimulation |
| type of e-stim: pulsed current, biphasic waveform, active and dispersive electrode not as important because there are +/- coming through both | Transcutaneous Electrical Nerve Stimulation |
| contraindications: pacemakers, over carotid sinus, heart disease, epilepsy, pregnancy, anterior neck area, over eyes or mucosal surfaces, CNS disorders, CVAs or history of CVA, confused or noncompliant clients, children | Transcutaneous Electrical Nerve Stimulation |
| precautions: undiagnosed or acute pain, decreased or absent sensation, post-op, when clients may "over-do" it, keep out of reach of children | Transcutaneous Electrical Nerve Stimulation |
| type of e-stim: allows for a deeper penetration of tissue; 2 sets of electrodes which cross and intersect; can be used for sensory effects or amplitude; applications - pain relief, decreasing edema, increase blood flow, m. stim. | Interferential Current |
| type of e-stim: uses alternating, low-frequency current that has been modified and uses 2 medium frequency currents, 4 electrodes | Interferential Current |
| type of e-stim: parameters - beat high=highest number frequency increases to; beat low=lowest number frequency decreases to; carrier frequency=frequency of unmodulated medium frequency current; amplitude/intensity=slight tingling | Interferential Current |
| type of e-stim: treatment time - acute pain=8 to 12 minutes, chronic pain=15-20 minutes, never exceed 20 minutes | Interferential Current |
| type of e-stim: monophasic, twin-peaked, pulsed current or direct current; 100 to 150 volts since pulse duration at its peak is short | ESTR / HVPC |
| type of e-stim: electrical current occurs naturally in body but injury causes disruption; wound has a pos. electrical potential; edema has neg. electrical potential; electrical stim. has shown to affect process of healing | ESTR / HVPC |
| indications: chronic and acute edema, wound healing, increase blood flow, pain, muscle spasms, delay of muscle atrophy | ESTR / HVPC |
| type of e-stim: proliferative phase application - increases fibroblasts, increases epithelial cells, increases DNA, increases ATP, improves cell membrane permeability, improves collagen matrix organization, stimulates wound contraction | ESTR / HVPC |
| type of e-stim: remodeling phase application - stimulates epidermal cell repro which will produce smooth and thin scarring, wound must be kept moist with saline to maintain bioelectric charge, treat wounds with necrotic tissue | ESTR / HVPC |
| type of e-stim: application - if in inflammatory or proliferative phases - polarity=negative, frequency=30 pps, amplitude/intensity=moderate tingling but no motor response, 60 minutes, 5 to 7 x/week | High Voltage Pulsed Current |
| transcutaneous delivery of ions into the body, direct current, ionizes medication into tissue, utilized as alternative to oral or injected drug delivery; treat inflammatory conditions, decrease pain, modify and manage scar formation | Iontophoresis |
| how it works: delivery of topically applied medications with an ionic charge through the skin with the use of low-voltage direct current | Iontophoresis |
| uses "like charges" to push medication across the barrier, therapist must know the charge of the medication they are using so that they can appropriately connect lead wires | Iontophoresis |
| anode (+) produces an acidic reaction - hardens tissues, analgesic; cathode (-) produces an alkaline reaction - softening agent | Iontophoresis |
| physiological effect that a drug or medication will have on the body | pharmacodynamics |
| how medications are metabolized to provide a therapeutic effect; absorption, distribution, metabolism, excretion | pharmacokinetics |
| process of aging affects metabolism - decreased liver size, blood flow, and enzyme production | Iontophoresis |
| indications: treatment of inflammatory conditions; other diagnoses and interventions include local anesthesia, decreasing joint pain, modifying scar tissue, hyperhidrosis | Iontophoresis |
| advantages: localized treatment area, remains superficial in tissues, safe and effective medication delivery, essentially painless, nontraumatic, sterile, relatively noninvasive, cost effective | Iontophoresis |
| parameters: dosage-number of ions delivered, current amplitude-intensity and typically 0.5 to 4.0 mA based on tolerance, time-dependent on tolerance and dosage, pad size-increases treatment area | Iontophoresis |
| type of ionto: med delivered in clinic, therapist sets parameters; app. - prep skin, select patch, fill med, apply to tx. site, apply electrodes (dispersive 4 to 6 in. away), connect lead clips, begin tx. | Phoresor |
| type of ionto: patient will feel an irritating sensation during application but it should not feel like burning, be sure electrode maintains flat contact, patient should not move during application, check skin following tx. and note any red spots or bumps | Phoresor |
| type of ionto: patch with built-in battery that delivers medication over extended period of time, applied in clinic and stays on client, often utilized with clients who can't tolerate other types, orient +/- to sides of patch, saline on opp. side of med. | Iontopatch |
| type of ionto: application - clean skin, apply saline in indifferent/dispersive side and charged ion solution in tx. side, apply patch with medicated pad over area to be treated, instruct client on wear/removal time | Iontopatch |
| type of ionto: patch with self-contained battery, applied in clinic and charged for a short period of time, charger is take off and worn home, shorter wear time | I - Bresis |
| type of ionto: app.- clean skin, apply saline and ion to sides of patch, apply patch putting medicated side over tx. area, turn unit on, slide controller onto battery, start, then remove controller from battery, instruct client on wear/removal time | I - Bresis |
| considerations: most of solutions/medications used need a prescription from physician, most solutions are aqueous and are impregnated into electrode reservoir of active electrode using a syringe | Iontophoreis |
| medications: inflammation-dexamethasone, ketaprofen, naproxen sodium; pain-lidocaine; scar tissue and adhesions-sodium chloride, potassium iodide; soft tissue mineralization-acetic acid; wounds/infections-zinc; 2 can be used on same patch | Iontophoresis |
| contraindications: same as e-stim; known sensitivity or allergy to med. being used; over open or damaged skin; gastritis or active stomach ulcer; asthma; sensitivity to aspirin, metals, seafood; always ask about drug allergies and know drug interactions | Iontophoresis |
| precautions: pregnancy, diabetes who are insulin dep., food allergies or sensitivities to sulfites or shellfish, abnormal localized reaction/sensitivity to skin, drug sensitivities, other known allergies | Iontophoresis |
| side effects: skin irritation/burn - caused by build up of ions changing skin pH; minimize by using a buffered electrode and decreasing current density | Iontophoresis |
| treatment: usually every other day, should notice decreased pain/symptoms after 4 to 6 sessions, may continue another 9 to 12 sessions if patient continues to show improvements | Iontophoresis |
| mechanical device: used to decrease edema or lymphedema; provides external compression by pumping air into sleeves; variety of sizes and body parts; settings typically 30 to 40 mmHg range | vasopneumatic devices |
| contraindications: bone fractures, DVT, severe PVD, uncontrolled HTN, DHF and pulmonary edema; must be very careful not to overload heart when mobilizing edema | vasopneumatic devices |
| indications: therapeutic benefits-prevents joint stiffness and decreases edema; can be used for UE or LE; use following surgery or trauma to maintain joint motion; can be used to tx. edema in hemiparetic extremities or joint stiffness | continuous passive motion devices |
| parameters: physician/surgeon will likely set these, parameters are ROM and speed/rate of motion, joint angles can gradually increase | continuous passive motion devices |
| use: can be used in the hospital following surgery or at home; goal is to get client to 80% of max. joint motion without significant pain | continuous passive motion devices |
| procedure: educate caregiver on how to use, instruct what to do/what they will feel, set parameters, position client laying down with body parts in correct spots, start machine; client will use continuously when not engaged in functional activities | continuous passive motion devices |
| contraindications: infected or complicated wound/incision at affected joint, unstable bone fracture related to affected joint | continuous passive motion devices |
| precautions: decreased/impaired sensation, muscle spasm | continuous passive motion devices |
Created by:
emma.scarmon-coyotes
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