Modalities Final Theory Exam Review

4 Reasons Electrical Currents is Used in Rehab

1. producing muscle contractions (strengthening, re-education)
2. prevents atrophy, DVT formation, pressure ulcers
3. controlling pain
4. promoting tissue healing, decreasing edema

What is Direct Current?

- continuous undirectional flow of charged particles

- Used for intophoresis

- stims contractions in denervated muscles

What is Alternating Current?

- continuous bidirectional flow of charged particles
- used for pain control and muscle contraction

Pulsed Current

- interrupted flow of charged particles
- used for pain control, tissue healing and muscle contraction

3 Time-dependent parameters

1. Pulse duration - 1 complete wave
2. phase duration - half of a pulse
3. interpulse duration - amt of time between pulses

What are the EC parameters

Amplitude - magnitude of current or voltage
Frequency - # of cycles/pulses/seconds (Hz or pps)
On-time - train of pulses
Off-time - tome between train of pulses
Ramp up - time it takes for current to reach max amp from 0
Ramp down - time it takes for current amp to decrease from 0

Effect of EC

Nerve Depolarization
- nerves polarized at rest
- + charge outside, - charge inside
- ions move (Na, K), electrical charge in and out of cell

Action Potential
- Current with enough amp and duration causes AP move along nerve
- AP moves in waves; nerve needs time to rest
- all or nothing effect

AP in Adjacent Areas
- Natural stim (1 direction)
- External stim (both directions; only effect natural direction)
- speed is determined by diameter (myelination)

Sensory and Motor nerves
- sensory nerves respond to shorter amp and pulse duration (80 microsec)
- motor nerves respond to longer amp and pulse (150-350 microsec)

Direct Muscle Depolarization
- electricity delivered directly to nm, not its nerve
- charge can repel drug molecules
- can help healing, reduce edema acut inflam

4 Contrindication of EC

1. cardiac pacemaker/ unstable arrhythmias
2. placement over carotid sinus
3. areas of venous/arterial thrombosis or thrombophlebitis
4. pregnancy

4 Precautions of EC

- cardiac disease
- impaired sensation and mentation
- malignant tumours
- open wounds

3 Adverse Effects of EC

1. burns
2. inflammation
3. pain

Documentation of EC

- area treated
- position of pt.
- stim para
- electro placement
- duration
- response to intervention

2 Pain Control Theories

1. gate control
2. endogenous Opiods

Conventional (high-rate) TENS

Setting:
short duration pulse
high frequency
low amplitude
Sensation:
Comfortable sensation w/o contraction
Pain Relief:
gait control theory
Treatment Length:
effective only while stim applied
continuous
Typical Conditions:
acute injury
repetitive strain

Acupuncture-like (low rate) TENS

Settings:
long duration pulse, low frequency, high amp
Sensation:
Twitching
Pain Relief:
Stims endogenous opioid prod and release
Treatment Length:
Effective for 4-5hrs after stims ends
no more than 45 mins/session
Typical Conditions
Chronic conditions

IFC (interferential Current)

- more comfortable stim bc of low amp currents
- more total current to stim larger area
- less burn risk

4 enhances for Tissue using Electrical stim

1. tissue healing
2. controls inflammation
3. decreases edema
4. Iontophoresis

EC for muscle contractions

Inntervated muscles = NMES (neuromusclar electrical stimulation)
Deneravated muscles = EMS (electrical muscle stimulation)

4 EMS benefits

1. strengthens muscles
2. improves muscle endurance
3. improves cardio health
4. decrease muscle atrophy

3 Signs of Muscle Fatigue

1. uncomfortable sensation
2. tremulousness
3. inability to complete ROM

Precautions of EC

- may cause DOMS (delayed onset muscle stimulation)

Contraindications of EC

delay or disrupt healing

How ES Strengthens Muscles

Overload Principle
increases pulse duration, amp, electrode, size, external resist
higher load => higher force => strengthening
Specificity
contractions strengthen fibres
more effect on type 2 fibres than type 1

Clinical Applications

Orthopedic
increases strength after surgery (ACL, TKA)
non-surgical management (OA, RA)
Neurological
stims intact peripheral nerves with CNS dmg
Spinal Cord Injury
improves circulation
contract muscles to assist locomotion, hand grasp
Stroke
improved gait
increase ankle DF torque
Reduce agonist-antagonist co-contraction

Contraction in Denervated Muscles using EMS

becomes denervated due to disease or nerve injury
requires pulse duration >10ms
improvements don't persist after stim is done

Muscle Motor points

- location on skin where e-stim more effectively caused contractions
- spots where nerves are more easy to stim
- most comfortable

4 Effects of Traction

1. jt distraction and mobilization
2. reduction of spinal disc protrusion
3. soft tissue stretching
4. muscle relaxation

What happens in Jt distraction?

- separation of 2 articular surfaces
- reduces jt compression and widen intervertebral foramines
- reduces pressure on articular surfaces, intraarticular structures, nerve roots

Reduction of Disc Protrusion

amt of separation of vertebrae
can be done with Pt's 25% of body
50% of body weight for lumber spine
7% of body weight for cervical spine
lumber = 60-120lbs
cervical = 15-30lbs

Clinical indication of traction

herniation
nerve root impingement
jt hypermobility
subacute jt inflammation

Contraindications of Traction

-acute injury or inflam
-jt hypermobility
-peripheralization of symptoms w/ traction
-uncontrolled hypertension

Precautions of traction

-medial disc protrusion
-displaced annular fragment
-severe pain
-inability to be supine or prone

Adverse Effects of traction

excessive force may increase symptoms
rebound increase pain
lumbar radicular discomfort

3 Types of traction Apparatus

1. Mechanical
- belts and halters
- positions
- devices
- traction table, over the door
2. Manual
- application by therapist
3. Self and positional
- body weight to exert force
- used for lumbar

Advantages of Traction

inexpensive
does not need full supervision
force and time readily controlled, graded and re-applicable

Disadvantages of Traction

- time-consuming setup
- lack of pt control

Effects of Compression

improves venous and lymphatic circulation
- increases external hydrostatic pressure
- intermittent compression may be better than static
limits shape and size of tissue
increases tissue temp

3 ways Compression reduces edema

1. increases extravascular hydrostatic pressure
2. promotes circulation
3. may move fluid proximally

compression v.s VSU (venous static ulcer)

- improves circulation
- improves healing rate of VSU
- multilayered compression is more effective

DVT prevention with compression

- increase compression = increase circulation = decrease DVT
- compression used w/ blood thinners to circulate blood

residual limb shaping

intermittent compression can reduce residual limb

precautions for COMPRESSION

impaired sensation and mentation
uncontrolled hypertension
cancer
stroke

contraindication of compression

heart failure/pulmonary edema
recent/acute DVT, thrombophlebitis
acute local skin infection

Indications of LASER

- Healing: soft tissue and bone
- Arthritis to manage pain and dysfunction
- Lyphedema
- Neurological Conditions- impacs nerve condiction, regeneration and function
- pain management

Contraindications of LASER

- Direct irradiation of the eyes
- malignancy
- Within 4-6 months after radiotherapy
- Over hemorrhaging area
- Over tyroid or other endocrine glands

Precautions for LASER

- low back or abdomen during pregnancy
- epiphyseal plates in children
-impaired sensation/ mentation
- photophobia (high sensitivity to light)
- Pretreatment with one or more photosensitizers

Safety for LASER

- Patient and clinican must wear safety goggles BEFORE it's turned on until after it's turned off
- The googles should be marked with the range of wavelength that they block
- Laser must not be able to affect others in the clinic

Compression Bandaging

- short stretch bandages- develops high working pressure (pressure during muscle contraction)
- long stretch bandages-develop high resting pressure (pressure at rest)

US is a modality from the ___ category?

Thermal and mechanical

Ice pack is the LEAST desirable Rx for:

Inflammation related to carpal tunnel

Indication for superficial heat therapy would be?

Chronic Inflammation

Contrast baths with large differences in water temp are better for:

Decreasing edema and increasing circulation

In which of the following cases is superficial thermotherapy LEAST appropriate?

Fall off ladder 12 ours ago- no fractures (this is an acute injury)

Which statement about how tissues are heated using US is true?

Heat accumulates in tissues by conversion of kinetic energy

Tissues with higher absorption coefficient?

bone cartilage tendon

Pulsed US- what statement is true?

Minimizes temperature increases

What should patients feel with US?

Mild, gentle warmth

Precautions for US

- Acute inflammation
- Wound healing
- Epiphyseal plates
- Fractures
- THR (non-cemented, metal)

Contraindications for US

- TKR plastic
- TKR cement & metal
- Tumor
- Thrombophlebitis

Thermal Agents

1. Deep heating agents- US
2. Superficial heating agents- Hot pack
3. Superficial cooling agents- Ice pack

Mechanical Agents

1. Traction- Mechanical
2. Compression- Stockings & Tensors
3. Water- Whirlpool baths (increase movement of molecules to promote healing)
4. Sound- US

Laws of Radiation

Reflection: some of the energy bounces off interface
Refraction: some of the energy changes direction as it passes through interface
Absorption: some of the energy is absorbed by the interface

Contraindications for CRYOTHERAPY

- cold hypersensitivity
- cold intolerance
- Cryoglobulinemia
- Raynaud's disease or phenomenon
- Over regenerating peripheral nerves
- over area with poor circulation

Precautions for CRYOTHERAPY

- Over a superifical main branch of a nerve
- over an open wound
- hypertension
- poor sensation or mentation
- very young or very old patients

Indications for Thermotherapy

- Inflammation
- muscle spasm
- swelling
- adhensions
- soft tissue stiffness

Contraindication for THERMOTHERAPY

- potential or recent hemorrhage
- impaired sensation/mentation
- malignant tumour
- Thrombophlebitis

precautions for THERMOTHERAPY

- Acute injury or inflammation
- pregnancy
- impaired circulation
- edema
- metal in area
- open an open wound
- demyelinated nerves

Cardinal Sign of Inflammation

- heat
- redness
- swelling
- pain
- loss of function

what is Microstreaming and Acoustic Streaming- US

Microsteaming- microscale eddying that occurs around the gas bubbles. vibrating bubbles make fluid around it move.
Acoustic Streaming- circular flow of cellular materials, moviing materials from one part of the US field to another.

Gate Control

- pain modulation at the spinal cord
- "close the gate" on the path of pain sensation, creating a bottle neck

Endogenous Opioids

- getting a "high" from natural chemicals in the body
- the body produces natural substances that help block the sensation of pain