Modalities – Indications, Contraindications, Precautions, and Parameters – Flashcards
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Indications for Cryotherapy
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Inflammation, Edema, Pain, Spasticity
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Contraindications for Cryotherapy
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Cold hypersensitivity/intolerance, cryoglobulinemia, Raynaud's Disease, paroxymal cold HgB
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Precautions for Cryotherapy
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Over superficial nerve, over wound, HTN, Poor sensation/mentation
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Ice massage Parameters
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5-10 minutes (IBAAN)
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Cold pack parameters
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10-20 minutes (Pain, inflammation, edema) 30 min (spacticity)
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Vapocoolant spray
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2-5 swipes, 4 inch/sec, along muscle fibers and trigger point.
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Indications for Thermotherapy
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Pain, Loss of ROM
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Contraindications for Thermotherapy
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Heat intolerance, malignancy
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Precautions for Thermotherapy
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Pregnancy, DVTs/clots, Open wounds
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Moist hot pack parameters
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20 min, 6-8 layers
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Paraffin parameters
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Dip 6-10 times, elevate hand, 10-15 mins
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Traction Indications
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Disc bulge/herniation, nerve root impingement, joint hypomobility, subacute inflammation, paraspinal muscle spasm
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Traction Contraindications
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Acute injury, joint hypermobility, peripherilization of symptoms (upon traction), uncontrolled HTN
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Traction Precautions
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Structural disease of spine, severe pain fully resolves, claustrophobia, medial disc protrusion
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Cervical Traction Parameters
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Initial: 7-9 lbs, static, 5-10 Joint distraction (facet pain): 20-29 lbs, 15 on/15 seconds off for 20-30 minutes Decrease muscle spasm: 11-15 lbs, 5/5, 20-30 minutes Disc Problem/Tissue stretch: 11-15 lbs, 60/20, 20-30 minutes
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Lumbar Traction Parameters
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Initial: 29-44 lbs, static, 5-10 minutes Joint Distraction: 55 lbs, 15 seconds on/ 15 off, 20-30 minutes Decrease muscle spasm: 25% BW, 5/5, 20-30 minutes Disc problem/Tissue stretch: 25% BW, 60/20, 20-30 minutes
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Compression Indications
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Edema, prevent DVT, Venous stasis ulcers, residual limb shaping, control hypertrophic scarring
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Compression Contraindications
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Heart failure, acute DVT, severe PAD, acute trauma, obstructed venous return
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Compression Precautions
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Impaired sensation/mentation, uncontrolled HTN, cancer, stroke, superficial peripheral nerves
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Compression for Edema/DVT/VSU parameters
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3:1, 30-60 mmHg (UE), 40-80 mmHg (LE), 2-3 hours, 1-2 times per day
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Compression for Residual Limb Shaping
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4:1, 30-60 mmHg (UE), 40-80 mmHg (LE), 2-3 hours, 1-2 times per day
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Compression for Lymphedema
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4:1, 40 mmHg 1-2 hours, once per day
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Indications for Ultrasound
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Soft tissue contractures (C), pain (C), dermal ulcers (P), incisions (P), tendon/ligament injuries (C-chronic, P-acute), Absorb Ca++ deposits (P), Bone fx (P), Carpal tunnel (P)
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Contraindications for Ultrasound
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Malignancy, pregnancy, CNS tissue, joint cement, clot, pacemaker
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Precautions for Ultrasound
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Acute inflammation, epiphyseal plates, fxs, breast implants
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Parameters for Ultrasound
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Duty cycle: continuous (thermal) vs. pulsed (non-thermal Frequency: 1 HMz (deep) vs. 3 MHz (superficial) Intensity: 1.5-2.0 W/cm2 (thermal) vs. 0.5-1.0 W/cm2 (non-thermal) Time: 8-10 minutes
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Indications for Laser
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Tissue healing (soft/bone), arthritis, lymphedema, carpal tunnel, diabetic neuropathy (anodyne), pain
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Contraindications for Laser
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Eyes, malignancy, within 4-6 months of Chemo, hemorrhages, over endocrine glands
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Precautions for Laser
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Pregnancy, epiphyseal plates, impaired sensation/mentation, meds that increase photosensitivity
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Parameters for Laser
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Use guidlines provided to determine intensity and time Don't move laser Repeat dose to areas 1 inch apart
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Parameters for Anodyne
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Intensity: 6-8 bars 30-35 minutes (diabetic neuropathy)
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Indications for Infrared
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Pain, Increase ROM, Decrease joint stiffness, Increase healing, Psoriasis
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Contraindications for Infrared
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Recent hemorrhage, clot, impaired sensation/mentation, malignancy, eyes
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Precautions for Infrared
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Acute Inflammation, pregnancy, impaired circulation, edema, open wounds
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Parameters for Infrared
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Allow lamp to warm up 5-10 minutes Lamp perpendicular and 45-60 cm away from treatment area 15-30 minutes
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Indications for Thermal Diathermy
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Pain, Joint Control
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Indications for Non-thermal Diathermy
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Pain, edema, soft tissue healing, treat symptoms of OA
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Contraindications for Thermal Diathermy
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Pacemaker, pregnancy, metal, malignancy, eyes, reproductive organs, epiphyseal plates
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Contraindications for Non-Thermal Diathermy
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Pacemaker, pregnancy, internal organs
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Precautions for Thermal Diathermy
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Near electronics/magnets, obesity, intrauterine conraceptives
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Precautions for Non-Thermal Diathermy
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Near electronics/magnets, obesity, intrauterine conraceptives, Epiphyseal plates, pregnancy
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Parameters for SWD (Thermal) Diathermy
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Frequency: 27.12 MHz Applicator: Inductive coil/capacitative plate Intensity: mild warmth Time: 20 minutes
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Indications for UV
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Psoriasis, wound healing (UVC), Vitamin D deficiency
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Contraindications for UV
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Eyes, Skin cancer, systemic conditions (TB, SLE, etc.)
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Precautions for UV
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Photosensitizing meds, photosensitivity, recent x-ray therapy, do not repeat the dose
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Parameter for UV
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Determine MED (Time period) Time: 5o% MED --> 250% MED MED will increase 10-50% each time
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Indications for Whirlpool
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Cold: Inflammation Tepid: medium for exercise Warm: wounds, cardiac/circulatory tissues, sensory tissue Hot: Pain, increase ROM
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Contraindicatons for Whirlpool
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Maceration, bleeding, MS, DVT, Cancer
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Precautions for Whirlpool
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Impaired sensation/mentation, confusion
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Parameters for Whirlpool
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Get water to desired temperature, place agitator in desired position Time: 10-30 minutes
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Indications for TENS
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Pain (chronic), muscle inflammation, arthritis, cervical myofascial pain, CRPS, neuropathic pain, fibromyalgia
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Contraindications for TENS
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Pacemaker, arrhythmia, carotid sinus, clots, pregnancy
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Precautions for TENS
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Cardiac disease, impaired sensation/mentation, malignancy, open wounds, skin irritation
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Parameters for Conventional TENS
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Frequency: 100-150 pps Duration 50-80 us Amplitude: To tingling Time: 24 hours Theory: Gate theory
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Parameters for Acupuncture TENS
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Frequency: 2-10 pps Duration: 50-80 us Amplitude: to visible contraction Time: 20-30 minutes Theory: Opiate Theory
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Parameters for Burst TENS
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Frequency: Preset 10 bursts Duration: 100-150 us Amplitude: to visible contraction Time: 20-30 minutes Theory: Opiate receptor
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Indications for IFC
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Pain (acute), LBP, OA, Post-op knee, Urinary incontinence, TP
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Contraindications for IFC
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Pacemakers, bleeding, pregnancy, carotid sinus, clots
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Precautions for IFC
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Cardiac disease, impaired sensation/mentation, malignancy, open wounds, skin irritation, chronic corticosteroids, keep distance between electrodes
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Parameters for IFC
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20-220 Hz: Pain Relief 10-20 Hz: increase blood flow and skin temp 30-50 Hz: Tetanic contraction of muscle
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Indications for NMES
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ACL Repair, Weakness (joint pain, effusion), OA/RA, TKA, peripheral n. injury, Bell's injury, CVA, SCI, COPD, incontinence
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Contraindications for NMES
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Where motion is contraindicated, pacemaker, implanted stimulators, directly over metal implants, bleeding, malignancy, disorientation, pregnancy, carotid sinus
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Precautions for NMES
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Open wounds, extreme edema, heavy scarring, chronic corticosteroids
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Parameters for NMES
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Frequency: small msucle (20-35 pps); large muscle (35-50 pps) Duration: small muscle (150-200 us); large muscle (200-300 us) Amplitude: at least 10% of MVIC (50% to build strength) On/Off: Increase strength (5:1); decrease muscle spasm/edema (1:1) Ramp time: Gait (none), exercises (1-4 sec), CVA (4-8 sec)
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Indications for Russian
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Post-knee ligament surgery, post-arthroscopic surgery, ACL repair
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Contraindications for Russian
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Carotid sinus, transthoracic, transcranial, pregnancy, pacemaker, severely impaired sensation
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Precautions for Russian
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Areas of skin damage, impaired cognition, near functioning diathermy
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Parameters for Russian
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Frequency: 50 burst per second On/Off: 10/50 to strengthen 10 contractions for 10 sec with 50 sec rest time
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Indications for Microcurrents
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Wound healing
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Contraindications for Microcurrents
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Pacemaker, neoplastic region, osteomyelitis
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Precautions for Microcurrents
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Anterior cervical, hemorrhagic region, follow infection control practice
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Parameters for Microcurrents
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Amplitude: 1-1000 uA (patient response) 20-120 minutes 1-4 times per day
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Indications for Biofeedback
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Re-establish motor loops, sensory retraining, muscle relaxation
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Contraindication for Biofeeback
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If contraction would exacerbate condition, if pt can't move joint or contract
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Parameters for Muscle Re-ed
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Adjust unit to lowest thershold (uV), have pt contract and readjust threshold
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Parameters for Muscle relaxation
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Adjust unit to a threshold that picks up activity
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Indications for US/E-stim
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Painful muscle spasm, TP
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Contraindications for US/E-stim
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Tumor, pregnancy, CNS tissue, joint cement, pacemaker, clots
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Precautions for US/E-stim
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Acute inflammation, epiphyseal plates, fractures, breast implants, impaired sensation/mentation, open wounds
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Parameters for US/E-stim
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Adjust setting until they feel tolerable electrical stimulation, turn ultrasound on and begin (light will turn on), use same US/E-stim parameters for each
