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ortho 207-test 2

Mod, tissue healing, mfr

QuestionAnswer
what kind of electrode must you have to to stimulate a muscle or nerve? Must have a negative charge.
What electrode is positive "ART"-Anode, Red, +(positive)
What does Id rather join AAA than be hit by a CAB anode attracts acid(AAA) and cathode attracts base=redness,burns.
Alternative paramaters names: pulse duration pulse rate amplitude duration=width rate=frequency Hz amplitude=intensity-how high turns it up?
What are the paramaters for Sensory Nerves? pulse duration (width)-20-60 microsec pulse rate-80-120 pulse per sec Hertz amplitude-"TINGLING" sensory only constant or set- 30secs on :0 secs off location-on sore spot
What are the parameters for motor nerves? Pulse duration (width)- 200-400 micro sec pulse rate-35-50 pulse per sec (pps) smplitude- muscle contraction constant or set-depends on muscle re-education or muscle fatigue.
What has the lesser pulse rate? sensory or motor Motor has a lower frequency.
What is tetani constant contraction when stimulated not twitching.
what needs to do be documentated on soap notes for ultrasound therapy? frequency(MHz), intensity (w/cm2), duty cycle (p and %), and total duration of treatment.
Higher than normal intensities of U.S. retard bone growth, damage sp. cord tissue, destroy other human tissue.
Two fibers that compose the fascia 1.collagenous fibers-very tough w little elasticity 2. elastic fibers- very stretchable
what is fascia surrounds and permeates every other tissue and organ of the body including nerves, vessels, muscle and bone.
What would you tell your patient to do after treating them with MFR? Drink plenty of water to decrease the lactic acid build up.
what are the benefits of MFR? 1. reduce inflammation 2.reduce muscle and nerve pain 3. decrease fascial tension beneath scar tissue 4. relief of pain if US or stretching didn't help 5. soft tissue mobilization, loosening constricted conn tissue. freeing impinged structures of musc
is MFR suited for children yes, the gentle release is well suited
What technique is used when doing a MFR maintain sufficient pressure to hold the stretch at barrier and wait a min of 90 to 120 secs but usually longer-180?
What are two superficial releases and how do they differ from a deep release? The pect minor and psoas are two superficial releases. They differ by placing your fingers with in the belly of the muscle using extreme deep pressure.
What are some transverse plane MFR techniques/ Hands are placed on top and bottom-joints(we did knee in lab), thoracic inlet(by sternum), thoracic outlet(diaphragm-one we did in class) and pelvic floor.
Contraindications for e stim Not directly over cancer
Contraindications for ultra sound Absolutely contraindicated for cancer
Why is ultrasound contraindicated in cancer? Because of heat and blood flow to area is increased. Lymphatic has to filter more and possibly distibutes to body.
Hot pack is contraindicated for Cancer
Waveforms: if biphasic, symmetrical, balanced can use Either electrode to stimulate area ,this is most common
Waveforms: if assymetrical you need to knowwhich electrode is negative and that electrode Must be focused to stimulate a nerve and/or muscle
Waveform for AC More than 3 phase burst, off beat
Waveform pulsed 3 or less phased with a space off in between pulses
Which electrode is + ART meaning anode red positive
What is a reason that someone may be red under an electrode? If waveform is assymetrical or unbalanced
What waveform would be used for treatment of Bell's palsy? Monophasic red unbalanced
If a waveform is more poitive than negative meaning you are building more charge under both electrodes The waveform is assymetrical unbalanced,red, unequal area
Which wave form would be equal in area Biphasic balanced symmetrical not red
PH of skin is about 5
In the event of a burn under an electrode, the electrode that draws the Base causes skin irritation
AAA+ electrode Anode attracts acid
CAB - electrode Cathode attracts base
I'd rather joinAAA than Be hit by a CAB
Contraindications to electrical stimulation: 1. Over damaged skin. 2.Over skin with decreased sensation3. Transcervical, transthoracic ,because of carotid sinus and heart4. Active seizure disorder5. Cardiac pacemaker beczuse could cause electrical interruption6. Cardiac arrhythmias
Contraindications to electrical stimulation continued: 7. Intercostal muscles 8. Pregnancy 9. Not directly over tumor
Parameter for sensory nerves for the reduction of pain Pulse duration 20 to 60 microseconds,Pulse rate 80 to 120 pps,Amplitude sensory only,Constant or 30:0 on:off,Location sore spot such as tingle
Parameters for motor nerves for muscle contraction Pulse duration 200 to 400 microseconds (200 optimal,Pulse rate 35 to 50 pps,Amplitude mm contraction (tetani),For muscle reeducation: 4:12 for endurance,10:50 for mm reducation(difficult for clinic use due to time off is extensive)
What is tetani? Constant contraction when stimulated, not twitching
E stim mm rededucation that is more pheasible in clinic 5:5 which equates to about 10-15 reps each set and takes about 2 minutes
Estim muscle fatigue parameters are used for: To decrease overuse of certain mm prior to retraining or to decrease spasticity of a muscle before training its antagonist
For 3 days post botox injection on spastic mucle what parameter should you use Muscle reeducation to antago
To decrease chronic edema, which parameters would you use with estim? For chronic- to decrease edema use biphasic symmetrical, pulsed 200-300 microseconds, 5-15 pps, amplitude start sensory get mm twitch then contraction, not painful. Constant or 30:0. Location-2mm distal and 2mm proximal to edema area Time: 30-60 minutes
To decrease Acute edema with estim: Monophasic (cathode black on edema site),Pulse rate 100pps,Amplitude-as tolerated, Constant or set 30:0,Location on edema site (anode red dispersive),*best if completed with in 1 hour of injury causing edema) Can use glove or sock electrode for hand/foot
Acu-mode tens Endorphin production Only for specific patients Goal is to induce pain to get endorphin production pulse duration: 200-400 microseconds pulse rate: 1-10 pps electrode location-acupoints time: 30-60 minutes
Acu-mode tens ST3 border of 5 MC @ transverse crease placed Bilaterally for Low Back Strain
Acu-mode tens GB 34 anterior/inferior to head of fibula for knee and ankle pain placed bilaterally
it is better to have buffered electrode than to have buffered medication in iontophoresis
without a buffer in iontophoresis it decreases penetration of medication and increases redness beneath the - cathode
charge of dexamethasone negative (black, cathode, negative)
charge of lidocane positive (red, anode, positive)
charge of ketoprofen negative (black, cathode, negative)
place medication in the electrode of the same charge
treatment in iontophoresis the first 2-3 minutes for electroporation then tx is pushing meds, after tx check under patch for skin, iritation, if ok, leave patch on 2-3 hrs to allow cont pasv diff of meds,do not heat, ice, or exercise up to 6 hrs to prevt vasodilation.
ultrasound basics continuous=on all time pulsed=on and off which dissipates heat duty cycle=time on/time on plus time off= percentage range=5-50%
ultrasound basics most common range=20% written p20 Intensity= watts per cm squared range for intensity usually .25-2.0 w/cm2 greater the intensity the greater the heat developed BNR-2:1 to 6:1 (calculated and reported by manufacturer)
temporal average intensity how much ultrasound is actually delivered
temporal average calculation (2.0 W/cm2 ) x 0.5 = 1.0W/cm2
documentation of US on SOAP note includes: frequency 3.0 mHz intensity 0.5 W/cm2 duty cycle p20% total duration 5 min ie. 3.0 mHz/0.5 W/cm2 / p20%/5 min
spatial average intensity= the W/cm2
transducer 2x sound head=max tx area for every 5 min exposure
Thermal beneficial effects of US increase collagen extensibility alterations in blood flow charge nerve conduction velocity increased increased pain threshold increase enzymatic activity (healing) change contractile activity of muscle
bad thermal affects of US (above 3.0 mHz) retard bone growth damage spinal cord tissue destroy other human tissue
increase content of collagen= increased effect from US
absorbs the most US bone and joint capsule
absorbs least US fat and skin
Frequency to use for structures 1-2 cm deep 3.0 mHz
frequency to use for structures deeper than 2 cm 1.0 mHz
non thermal effects of US cavitation acoustic streaming
vibrational effects or gas bubbles by the US beam cavitational
stable cavitation= diffusional change along cell membrane
unstable cavitat tissue destruction
movement of fluids along the boundries of cell membranes= mechanical pressure wave acoustical streaming
acoustical streaming causes changes in ions and cellular activity
beneficial non-thermal effects total of US increased cell membrane permeability increased vascular wall permeability increased fibroblastic activity (increased protein synthesis)
adverse effects of nonthermal effects of US in animal studies: blood flow stasis platelet aggregation (clotting) enothelial damage(lining inside vessel is damaged)
US parameters for Joint contracture or scar for deep structures: 1.0 mHz, 1-2 W/cm2 /CW /5-10 min Superfiscial structures: 3 mHz, 0.5W/cm2 / CW / 5-10 min
Things to consider when picking parameters for US Depth of tissue (tells you what mHz, watts per cm2 you need), Size of area treated (tells you length of tx and size of head of transducer), stage of injury(tells you thermal or pulsed), Flexibility required(tells you intensity)
phonophoreses used for lateral epicondylosis would typically require what parameters? use dexamethasone at 3 mHz / 1.0 W/cm2 / CW / 3 min
patient sensation during US/iontophoresis/phonophoresis some authors suggest increasing intensity til pt reports dull ache and then decrease by 10%, Some patients may report sensation of warmth then reduce
lower BNR which is more uniform US under transducer may result in the patient feeling less likely to report feeling warmth
If patient reports deep pain during US/iontophoresis/phonophoresis decrease intensity and cover larger area
Immersion technique US: Hold the transducer 0.5-3.0 cm from body surface
During immersion technique for US is using a metal container: the metal will reflect the soundwaves and increase treatment intensity
During immersion technique for US you should remove buddles on transducer quickly and use tap water
What is a patient reason that you would use US immersion? may use with hand/ankle or someone that hurts to be touched or has RSD (Reflex Sympathetic Dystrophy)
Parameters for Immersion US Example could be 1.5 W/cm2 / CW / 10 min at 1 mHz to ankle
ERA is Effective radiating area
ERA is set by ? and is what set by the manufacturer and is the ratio of acoustic power
Indications for Phonophoresis or immersion technique? contractures, scars, pain, mm spasm, tendinosis, wound healing
diebetic patients should avoid hot application to feet or legs and avoid full body heating such as body wraps due to decreased sensation and vascular flow problems
Who should avoid cold applications? dx of Raynauds
contraindication for Diabetic and multiple sclerosis, women who are pregnant or anyone with abnormally high BP for hydrotherapy? hot immersion baths and long hot saunas
Who should avoid cold foot baths those prone to bladder or rectal irritation, those with sciatica, pelvic inflammation or rhuematism in the toes or ankles should also avoid.
Massage is what? "systemic" manipulation of soft tissues of the body to enhance health and healing
When should massage not be used? Someone with DVT or cancer-
Doing massage has a Physcial effects of the integumentary (skin) system 1. stimulates sensory receptors in skin. 2. increase superficial circulation 3. remove dead skin 4. add moisture with oil or lotion. 5. increase sebaceous gland excretions.
How does massage affect the nervous system? 1.STIMULATE parasympathetic n.s.(relaxation). 2. reduce pain (gate theory) 3. increase body awareness
Overall massage could eventually lower what Blood pressure and heart rate with regular relaxation massage
Massage affects the body how? decreases chemical build up while increases sensory input making allowing awareness of body parts. it turns down muscle spindles and stimulates the golgi tendon whcih relaxes the muscle for stretching.
Basic rule of massage is TO DO NO HARM
What are the endangerment sites of massage? 1.anterior neck(carotid, jugular, bagus nerve, larynx,thyroid). 2. Axillary (brachial artery and plexus, axillary art n vein, and cephalic vein. 3.elbow-ulnar nerve(medial) 4.umbilicus 5. kidneys (12 thoracic-3rd lumbar)6. groin 7. popliteal fossa, 8 eyes
Do not do massage: 1. if person feels ill,severe pain, has a fever, serious injury recently. 2. if skin has a pathologic condition-rashes open wounds 3. speread thru the lymph or circulatory system-lymphangitis, malignant melanoma, swollen glands-over 6 months is cancer.
Continue of do no do massage; 4. bleeding 5. acute inflammation(inc bl. flow inc inflamm.) 6. circulatory system disorder- red swollen painful or hot. 7. abnormal sensation-diabetes, stroke, 8 monitor stages of healing. 9. edema-be aware of reason-ok for lymphedema massage(license)
Communication is vitally important during massage. Reasons why? Touching another person-explain exactly step by stpe what u r doing-ok?, gender, talking and feedback-comfortable? sensations?, confidentiality-privacy and dignity-draping.
What is an effleurage technique slide or glide over the skin with a smooth continuous motion. pressure light to moderate, deep w oil.
which type of muscle fibers are usually most abundant in the posture muscles? Type I ST
Which type of muscle fibers are usually found in muscles for mobility? Type II FT
Type of muscle fiber that is slower to contract? Type I ST
Type of fiber that is easily fatiguable? Type II FT
Type of muscle fiber that has more mitochondria? Type I ST
Type of muscle fiber that has less mitochondria? Type II FT
This muscle fiber type is for spped, strength and power: Type II FT
This type of muscle fiber is for endurance activities such as running a marathon: Type I ST
Which muscle fiber types are red oxidative? Type I ST
Which muscle fiber types are white glycolytic? Type II FT
There are no eccentric motions in what plane? transverse plane
Crossing the vertical plane is unique in that you start an action with concentric agonists and end with eccentric of antagonist once plane is crossed
SAID stands for Specific Adaptations to Imposed Demands
Parameters for strength training *frequency*Intensity*Duration*Resistance type* Muscle contraction type* number of reps*Number of sets*length of rest btwn sets*order of exercise*degree of effort
How many days per week does one have to do strengthening to maintain muscle strength? 3 days per week minimum
Why would a PTA not use MMT on a patient with tone? Because the tests are used to isolate specific muscles and if your patient has tone, you are not testing just one muscle
DOMS means Delayed onset muscle soreness
When would DOMS normally appear? 24-48 hrs post exercise
S/S of DOMS pain, swelling, tenderness, decreased ROM, stiffness
What is the clinical significance of seeing DOMS? it means your treatment was too agressive or intensity was too high. You overloaded the patient and should reduce the intensity.
DOMS would most likely be seen after what type of exercise/contraction? eccentric contractions because it has more strength but you are most likely to damage or injury with these types of contractions
PRE means progressive resistance exercise
DeLorme's PRE strategy 10 rep max (RM) increasing weight over time
Knight's PRE strategy 6 rep max (RM) setting next treatment by increasing weight each treatment
Oxford's PRE strategy 10 rep max (RM) reducing weight over time, significant because muscle fatiging over time
DeLorme's PRE increments 50%, 75%, 100% of 10 RM x 10
Knight's PRE increments 50%, 75%, 100% of 6 RM x 10
Oxford's PRE increments 100%, 75%, 50% of 10 RM X 10
what are plyometrics? intense, power generating exercise, like 1 RM, that is traditionally sports specific, seen near end of rehab furing minimal protective phase, works by using stretch reflex to increase mm contraction speed
When would plyometrics be used with a patient? during end of rehab, minimum protection phase
How do plyometrics work? it uses the stretch reflex to increase muscle contraction speed. By increasing load and speed then greater firing frequency of the muscle spindle makes stronger muscle contraction
what joint is moving in a closed chain knee flexion exercise? more than one joint must be moving with the distal point fixed to be a ckc. ankle, knee, hip are moving
Benefits of CKC more functional and loads joints while increasing kinesthesia increases neuromuscular coordination, increases cocontraction
when working on hypertrophy, what parameters would you generally use? low weight and high reps
when working on power, what parameters would you generally use? high weight and low reps
If your goal is for power of a muscle, how many reps, what load, and rest time paramaters would you use? 1-2 reps at 80-90% max weight and resting 2-3 minutes between sets
If your goal is for strength how many reps, what load, and rest time paramaters would you use? less than or equal to 6 reps, at 85% of 1 RM, and 2-3 minutes rest time between sets
If your goal is hypertrophy, how many reps, what load, and rest time paramaters would you use? 6-12 reps at 67% to 85% of 1 RM, and 2-3 minutes rest between sets
If your goal is endurance, how many reps, what load, and rest time paramaters would you use? 15+ reps at less than or equal to 67% 1 RM and 1-2 minutes rest between sets
Lymphatic helps the immune system by destroying pathogens and filtering waste
Lymphatic system works with the circulatory system to deliver nutrients, oxygen, and hormones from blood to the cells that make up the tissues of the body
Important protein molecules are created by cells in the tissue. Because these molecules are too large to enter the cappilaries of the circulatory system, these protein molecules must be transported by the lymph to the blood stream at the terminus
In lymphedema affected tisses, the lymph is unable to drain properly
If lymph cannot drain properly, protein-rich lymph becomes stagnant, making lymphedema tissues prone to infection
Intercellular fluid is found where between cells or outside cells
Intracellular fluid is inside the cell
What is delivered to cells by intercellular fluid nutrients, oxygen, and hormones
As fluid leaves a cell, what does it take with it cellular waste products and protein cells
90& of this tissue fluid flows into the venules intercellular/interstitial fluid
When interstitial fluid enters the venules, it enters venous circulation as plasma and continues to the circulatory system
10% of the fluid left is known as lymph
This system does not have a pump to aid in its flow and relies on muscle contraction lymphatic system
As fluid travels through the lymp systems, it passes through lymph nodes where it is filtered
70% of specialized lymphatic cappilaries are located near the skin
Deep lymphatic cappillaries surround most of the body's organs
blind-ended tubes that are only a single cell in thickness arranged in slightly overlapping pattern like shingles on a roof lymphatic capullaries
lymphatic cappilaries join together to form a mesh-like network of tubes that are located deeper in the body
have one-way valves to prevent backflow of fluid lymphangions
Because there are only about 600-700 lymph nodes present in the average human body, lymphedema mght occur if they are damaged or destroyed because they do not regenerate
Afferent carry lymph into the node
Efferent carry lymph out of the node
Damage to lymph vessels disturbs flow
When lymphatic tissues or lymph nodes have beed damaged, destroyed or removed, lymph cannot drain normally from the affected area. When this happens excess lymph accumulates and results in the swelling that is characteristic of lymphedema
treatment of lymphedema is based on the natural structures and flow of lumph. Affected drainage area determines pattern of manual lymph drainage or self massage
what does MLD (manual lymph drainage) do? stimulates flow from one area to another and encourages formation of new lymph drainage pathways
worn between treatments to help control swelling by providing pressure that is needed to encourage the flow of lymph into the capillaries compression garments, aids, and/or bandages
prescribed by the therapist, it is another way to encourage flow into cappilaries self-massage or simplified lymphatic drainage
an important treatment of lymphedema because the movements of the muscles stimulate the flow of lymph into the capillaries exercise
structurally, lymph vessels are very delicate, thus they are easily damaged
List benefits of aerobic exercise after the activity: increased mitochondira, increased myoglobin, increased mobilization of fats and carbs, hypertrophy of type I, decrease HR and submaximal HR, increase blood volume and increase hemoglobin, decrease systolic and diastolic BP, increase ability to extract O2
aerobic exercise should be what intensity and duration long duration low intensity
Age Adjusted Max Heart Rate 220-age= number then decide what percentage you should be exercising at.
Karvonen formula for HR max use max HR from MHR minus resting HR, then multiply by 50% for low end and 85% for high end
Created by: tspratley