Hand Therapy Modalities – Flashcards
Unlock all answers in this set
Unlock answersquestion
Conduction
answer
an exchange of heat when two surfaces come in contact with one another. Heat is transferred from object to cooler one; hot/cold packs, paraffin
question
convection
answer
and exchange of theramal energy between an object and the fluid moving past it, more rapid exchange than conduction; fluido therapy
question
conversion
answer
energy is converted into heat, able to penetrate deeper tissue; ultrasound
question
physiological effects of heat
answer
Anagesic, connective tissue effects, Metabolic and vascular effects
question
analgesic effects of heat
answer
alters nerve conduction decreases protective posturing, muscle guarding heat as counter irritant (gate control theory)
question
Connective tissue effects of heat
answer
increases tissue extensibility and decreases joint stiffness therapeutic temperature ( 41 to 45 celsius, 104- 113 F)
question
metabolic and vascular effects of heat
answer
vasodilatation occurs with superficial heating indirectly affects sympathetic response via spinal cord reflex, cutaneous thermoreceptors carry histamine which produces vasodilation, heat with elevation aids veneous return
question
effectiveness of heat dependent upon
answer
duration of heat application, depth of heat penetration, degree of heat achieved, degree of stretch applied post heat
question
indications for heat modalities
answer
decrease pain/muscle spasm and to relax patient, precondtion tissue- increase soft tissue flexibility, increase blood flow and metabolism
question
contraindications of using heat
answer
diminished senstion,very young or elderly, nerve injured, insensate hand, impaired circulation, diabetic, vascular instability ( skin graft or replant)
question
hot packs
answer
conduction water temperature ranges (61-79.4 c or 165 f) never apply hot packs directly to skin ( use 8-10 towel layers to portect skin) destruction occurs at 50 c temperatures at a depth of 1 cm remain elevated approx 45-60 minutes before associated increased blood flow casues increased temperature advantages: inexpensive, easy, can apply passive stretch disadvantage; therapist can not observe body part, hand is static
question
paraffin
answer
conduction often gives greater temperature rise secondary to circumferential coating of wax
question
melting point of paraffin
answer
is 54.5 c which is above tissue deconstruction, mineral oil is added to paraffin drops changing melting points to 47.8 c (126 f)
question
precautions of paraffin
answer
do not apply to open wounds, burned tissue, insensate arease, recently healed wounds, increased sympathetic response, use caution with nail hooks
question
advantages of paraffin
answer
soothing, cost effective, good for home use
question
disadvantages of paraffin
answer
body part is static
question
fluidotherapy
answer
dry convection, cornhusk particles used similarly to whirlpool, heated by air, temperatures of 43-48 c (110-118 F) can be tolerated due to circulation of particles and less thermal conductance than water
question
duration of fluido
answer
20-30 minutes
question
added benefit of fluidotherapy
answer
assist with decreasing hypersensitivity
question
fluidotherapy advantages
answer
body part is moving, adjustable temperatures, particle stimulation
question
disadvantages of fluidotherapy
answer
semi-dependent position
question
physiological effects of cold
answer
pain reduction (slows sensory nerve conduction) affects firing of muscle spindle and slows nerve conduction velocity vasoconstriction decreases vessel diameter as well as increases resistance of flow of cooled blood due to increased viscosity decreased metabolic rate decreases metabolic rate decreases histamine response resulting in diminished inflammatory response edema reduction with compression decreases extensibility of collagen through decreased plastic deformation and increased viscosity
question
indications for use of cold
answer
pain control ( generally not tolerated as well as heat) inflammatory conditions ( tendititis, post operative edema with compression, post-exercise inflammation)
question
contraindications of use of cold
answer
diminished sensation ( very old, young, nerve injured) vascular compromised ( replant, new graft/flap, diabetics)
question
Cold packs
answer
conduction silica gel sotred at 05 c towel layer moistened with lukewarm water applied over skin provides maximum effect 15-20 minutes
question
advantages of cold packs
answer
easy to apply cost effective
question
disadvantages of cold packs
answer
can not observe skin
question
Homemade cold pack
answer
ziploc with 1:3 ratio isopropyl alcohol and water
question
ice massage
answer
effective for small areas such as small muscle bellies, lateral epicodyle small paper cup filled with water and frozen, peel rim so that ice is exposed ice is rubbed slowly in circles approx 3-10 minutes, response is burning, aching and eventually numbness/analgesia
question
vapocoolant spray advantages
answer
very comfortable with stretch of muscle/tendon, easy to apply
question
Vapocoolant spray disadvantages
answer
environmentally out of favor, expensive
question
ice massage advantages
answer
easy to apply, can monitor skin changes
question
ice massage disadvantages
answer
discomfort during initial course of application
question
vapocoolant sprays
answer
reduce temperature by evaporation, nontoxic-nonflammable, spray at 30 degree angle, 2 feet from skin, 6 sweeps parallel to muscle fiber, 10 cm per sec.
question
electrical modalities physiological effects
answer
electrical excitability (transmission of electrical signals along afferent pathways) efferent response ( dependent on type of waveform used to stimulate tissue) facilitates muscles contraction through nerve or muscle stimulation stimulation of sensory nerves for pain reduction creates an electrical field in biological tissue to stimulate or alter healing response creates an electrical field on the skin surface to drive ions beneficial to healing process into or through the skin
question
3 major types of currents used in therapeutic stimulators
answer
Direct current "true galvanic current" alternating current pulsatile "pulsed" current
question
Direct current
answer
steady applied voltage resulting in a steady constant current unidirectional with ion flow one direction low voltage galvanic current is used for iontophoresis stimulation fo denervated muscle ( pulse duration > 10 msec to facilitate denervated muscle
question
alternating current
answer
continuouse bi-directional flow of charges particles
question
pulsatile current
answer
noncontinuous flow of direct or alternating current
question
wave form shape of alternating or pulsed current
answer
sine rectangular triangular
question
common configuarations of pulsatile current
answer
monophasic pulsatile current (unidirectional) paired spikes ( type of monophasic) asymmetrical biphasic symmetrical biphasic
question
monophasic pulsatile current
answer
ion flow in one direction, sometimes referred to as pulsed galvanic, generally not used for NMES secondary to skin irritation at level of intensity required to facilitate contraction. used for edema reduction/wound healing at low amplitudes (micro amp). Need additional clinical research
question
paired spikes (type monophasic)
answer
waveform most used in high voltage stimulatiors for wound healing/edema reduction and pain reduction. Incorrectly referred to as pulsed galvanic stimlation (HVPGS). Unidirectional current literature supports use for wound healing/edema reduction; generally not used for muscle facilitation
question
asummetrical Biphasic
answer
bi-directional current allows for ion flow in two directions. Less skin irritation at higher itentsities. Common waveform used in NMES and TENS.
question
symmetrical Biphasic
answer
BI-directional current allows for ion flow in two directions. current flows in one direction and the reverses as mirror image. Common waveform used in NMES.
question
Iontophoresis
answer
induction of topically applied ions into the tissue by application of a low-voltage direct glavanic current. Positive ions placed under positive electrodes, negative ions under negative electrodes, electrically charged electrode will repel a similarly charged ion Two electrodes (+) and (-) no specific distance optimal clean skin to decreased impedance, remove excessive hair (scissors not razor)
question
common ions used in iontophoresis
answer
dexamethasone (-) polarity, inflammatory conditions saline (-) polarity, adhesions, scar formation salicylate ( sodium salicylate) (-) polarity, pain relief lidocaine (xylocaine) (+) polarity, pain relief selection of ion and proper transfer is based on knowledge of effective ions and their polarity
question
dosage of iontophoresis
answer
inflammatory conditions; desired goal 4.0 MA/10 minutes treatment time may vary depending on patient tolerance (common 2.0 mA/20 mins) scar formation: intensity 4.0mA/ 20 mins number of treatment sessions dependent on tissue response; generally 6 treatment some degree of skin reaction is expected ( localized redness, erthema) due to DC current
question
timing of iontophoresis
answer
do not use US or heat modality following iontophoresis, increased blood flow dissipates medication from target tissue
question
precautions of iontophoresis
answer
consider skin sensitivity, integrity allergy to drug administered no clinical studies on use over tendon repairs and effectiveness on tensile strength
question
advantages of iontophoresis
answer
better tolerated than injection, no bolus of fluid as with injection
question
disadvantages of iontophoresis
answer
requires repeat treatments, expensive, skin sensitivity need additional clinical studies comparing iontophoresis to injection and other forms of treatment
question
1. "Gate Theory of Pain"-Melzack and Wall (1965)
answer
Theory that pain impulses can be altered or modified presynaptically. The pain signal is carried via small diameter, slow conducting (peripheral nerve fibers). Larger A-fibers (light pressure, proprioception) haveI th_e__abi1ity to "close.the_gate" on theI When both types of sensory stimuli reach the spinal cord, one of them dominates (A-ñbers) effectively closing the gate on the smaller pain fibers (C-fibers). This gate control system is thought to be in a segment of the spinal cord called the Subsantia Gelatinosa, in specialized cells T-cells.
question
endorphin theory -ericksson, sjolund, nielzen
answer
electrical stim facilitates the produ tion of endogenous opiates; these chemicals interact with receptors, blocking the perception of pain much as morphine does
question
common parameter selection of E stim
answer
current amplitude pulse duration frequency modulation ramps on and off times
question
electrode placement with Estim
answer
superficial musculature- electrodes closer together electordes no closer than 1/2 of the diameter of each or will not penetrate deep musculature- electrodes further apart polaritiy- important with DC current skin cleaner and hair clipped if necessary electrode attached firmly and evenly with coupling medium if needed size of electorde will change charge
question
precautions of E stim
answer
areas of decreased sensation unhealed incisions erythemia bony prominence pain burning sensation obese pt's over growth plates skin irritations to electricity or gels
question
general contrindications with Estim
answer
demand cardiac pacemakers heart disease carotid sinus/artery eyes unstable fractures indwelling stimulators hx of seizures pregnancy peripheral nerve disease rapid fatigue syndromes infections
question
TENs modes of stimulation
answer
sensory level stimulation motor level stim noxious level stim
question
Sensory level stim "conventional TENs" high rate
answer
stim at above sensory threshold and below motor threshold frequency 50-150 pps pulse duration 40-100 usec (microseconds) intensity 20-30 mA duration of treatment 20-30 mins, can be continued until pain relief quick onset of pain relief but short carryover electrode placement over site of pain trigger point comfortable generally tried first accommodation use various modulations to reduce accommodation
question
motor level stim "high intensity/acupuncture like TENs" low rate
answer
stim produces visible muscle contraction frequency 1-10 pps pulse duration 150-400 usec intensity visible contraction 30-40 mA duration of treatment 30-60 mins electrode placement remote but anatomically linked to pain site ( trigger point) slow onset of pain relief however improved carryover
question
noxious level stim "brief intense"
answer
painful stim is produced in or remote from pain site frequency 100-150 pps pulse duration 150-400 usec intensity to maximal tolerance duration of treatment 1-15 mintues pain relief equal to treatment time, short carryover
question
general precautions for use of electrical current
answer
do not cross axis of health or use with demand pacers use cautions with pts with sensory deficits don not use on pt's with undiagnosed pain or growths use caution when stimulating over metal/silicone implants safety of use during pregnancy not established
question
High voltage galvanic timulation (HVGS)
answer
used for pain control, edmea reduction and wound healing interrupted monophasic wave form voltage is greater than 100 volts pulse duration is 2-50 per pulse frequency varied by clinician intensity noxious, usually below motor threshold 2000-2500 mA polarity variables controlled by clinician contraindications patients with heart dysrhythmias
question
Indications for HVGS
answer
edema control, increases membrane permeability, aids lymphatic system, proteins are removed from interstitial space into lymphatic system, also increases blood flow Pain relief; used in chronic and acute pain wound healing; may have positive effect on wound healing in terms of decreased growth of microorganisms and increase epithelialization; (-) polarity if microorganisms are present
question
Parameters for HVGS
answer
higher frequency (50-120) for acute pain, low frequency (5-15) for chronic pain (-) vasoconstriction (+) vasodilation
question
interferential current
answer
used for pain control intersection of two AC sine wave of different frequencies stereo effect current flow both superficial and deep
question
NMES indications
answer
faciliation of AROM, tendon excurision re-education ( imbalance, tendon transfers) "backdown program" recuduations of localized edmea; decrease in edema secondary to rhythmic muscle contraction is well documented in literature relaxation of muscle spasm; high frequency > 80pps, low lon:off or continuous stim pain relief increase local blood circulation; muscle contraction to increase aterial blood lfow; increase circulation in cappillaries; well documented in literature reduction of joint contracture ( drop out casting) temporary inhibition of spasticity strengthening to prevent or retard disue atrophy used as orthotic device (FES)
question
Characteristics of NMES
answer
stimulate large diameter muscle fibers or fast twitch fibers first ( active exercise recruits smaller slow twitch fibers) (with immobilaitionat, fast twitch fibers atrophy first, therefore, NMES is adjunctive tool to increase active exercise and reverse atrophy) rapid fatigue is an issue with NMES
question
parameters of NMES
answer
frequency 10-60 pps pulse duration 300 usec on: off ratio 1:2 or 1:3 general orthopedic pt, 1:5 debiliated pt/neuro pt (at 30 pps, a 1:3 on/off artio is recommended) ( at 50-80 pps a 1:5 ratio is recommended) ramping time ( ramp up/ramp down) 2-4 sec 6-8 sec; with neuro pt intensity to tolerance20-40 mA, units generally produce intensities of 100 mA
question
Asymmetrical biphasicwaveforms of NMES
answer
equal sized electrodes (_) 60% (+) 40 % unequal red 50% larger than white (-) 80% (+) 20% good for isolated recruitment of small muscles (intrinsics)
question
Symmetrical biphasic of NMES
answer
equal sized electrodes (_) 50% (+)50% good for large muscle recruitment or for facilitation of two muscles at one time without having to use 2 channels (FPL and FPB)
question
electrode placement for NMES
answer
motor point placement (specific recruitment) superficial nerve (generalized)
question
NMES placement current density
answer
distance between electrodes close together+ superficial current flow for treatment of superficial muscular; far apart _ increase current density (dpeth) for treatment of deep musculture
question
electrode sizing NMES
answer
small electrode=increase current density larger electrode =superficial current density
