Modalities, IER NPTE, Physical therapy
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| Hot Packs | -heated by water 165-170 degrees
-6-8 layers of towels between hotpack and skin
-20-30min
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| 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
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| 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
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| 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)
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| What are some types of cryotherapy | -cold packs
-ice packs
-ice massage
-vapocoolant spray
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| 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
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| 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
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| Mechanical spinal traction | -cervical-20-30 pounds to cause distraction of vertebral bodies
-lumbar-25-65 pounds to effect change at the spinal segments
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| Neck positions for cervical traction | -C1-C4: 0-5 degrees of flexion
-C5-C7: 20-30 degrees of flexion
-disc dysfunction: 0 degrees
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| 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
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| Intermittent compression | -settings are determined by blood pressure
-must be worn for at least 2 hours per day
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| 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
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| 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
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| 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
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| 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)
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| 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)
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| 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
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| 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
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| 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
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| 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
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| 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
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| Modulation Mode TENS | -frequencies, intensities, or pulse widths can be altered by 10 or more % 1-2 times per second
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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