Quiz
Modalities
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Questions in this quiz (39)
1To reach hyperemia (a desired increase in [blank_start]blood flow[blank_end] to tissues), and be therapeutically beneficial, tissues must be heated to [blank_start]40[blank_end]-[blank_start]45[blank_end] degrees C (104-113 F). Below [blank_start]40[blank_end] degrees is not warm enough to reach hyperemia, and above [blank_start]45[blank_end] there is risk of tissue damage.
- Ablood flow
- B40
- C45
- D40
- E45
2Heat and strengthening:
[blank_start]Isometric[blank_end] strengthening is [blank_start]improved[blank_end] for the first 30 minutes post heat treatment
Other muscle strength and endurance is [blank_start]decreased[blank_end] for the first 30 mins post heat treatment- AIsometric
- Bimproved
- Cdecreased
3Ultrasound benefits
1) Promote [blank_start]healing[blank_end] of soft tissue (i.e. the [blank_start]fibroplasia[blank_end] phase of wound healing)
2) Release [blank_start]growth factors[blank_end] from macrophages
3) Facilitate [blank_start]collagen[blank_end] production- Ahealing
- Bfibroplasia
- Cgrowth factors
- Dcollagen
4Neuro Muscular Electrical Stim (NMES)
- [blank_start]electrodes[blank_end] on or near motor point of desired muscle
- should be therapist assisted
- Goal: [blank_start]10[blank_end] good quality contrctions
- Frequency: will need to achieve tetany of at least [blank_start]35[blank_end] pps, and on average will range from [blank_start]30[blank_end]-[blank_start]80[blank_end] pps (pulse per second)
- The crucial feature of any given set of parameters (frequency, voltage, intensity) is its ability to generate an a[blank_start]ction[blank_end] p[blank_start]otential[blank_end] in a motor nerve resulting in tetanic contraction
- This is characterised by strength-duration curves - S-D curves illustrate the minimal combinations of parameters required to generate a[blank_start]ction[blank_end] p[blank_start]otentials[blank_end]- Aelectrodes
- B10
- C35
- D30
- E80
- Fction
- Gotential
- Hction
- Iotentials
5Intermittent compression pumps
Should not be used with patients who have [blank_start]arterial[blank_end] insufficiency, infections, thromboses, cardiac dysfunction, pulmonary oedema, renal insufficiency, kidney dysfunction, obstructed lymphatic channels, and cancer.- Aarterial
6Cold intolerance
Normal response to cold = [blank_start]red[blank_end] tissues, due to h[blank_start]yperemia[blank_end] or v[blank_start]asodilation[blank_end].
Cold intolerance = severe [blank_start]pain[blank_end], n[blank_start]umbness[blank_end], [blank_start]colour[blank_end] changes, or w[blank_start]heals[blank_end] or h[blank_start]ives[blank_end].
Cold intolerance can occur in patients with rheumatic disease, post trauma, or post surgery. Cold hypersensitivity / allergy (cold-induced urticaria) = marked by w[blank_start]heals[blank_end] or h[blank_start]ives[blank_end] (smooth, slightly elevated patches, which are redder or may be more pale than the surrounding skin), may have severe itching.
If cold intolerance is noted, cold modality should be ceased and findings documented.- Ared
- Byperemia
- Casodilation
- Dpain
- Eumbness
- Fcolour
- Gheals
- Hives
- Iheals
- Jives
7Fluidotherapy
Dry heating agent, transfers heat by c[blank_start]onvection[blank_end], uses particles of cellulose ([blank_start]corn[blank_end]) that are suspended in air and moved like liquid.
Specific heat of this combination is very low, ie the amount of heat energy it contains at any given temperature is much less than that of water, and it can therefore be much hotter.
It is not more or less safe than another modality, but can just be hotter because of its low specific heat capability.- Aonvection
- Bcorn
8A [blank_start]3MHz[blank_end] U/S frequency = depth of penetration of up to 2cm (i.e. hand and wrist)
A [blank_start]1MHz[blank_end] U/S frequency = used for deeper tissue, up to 5cm in depth ie back and lower extremities.- A3MHz
- B1MHz
9Gate Control pain theory
The "gate" opens to stimuli that approach the CNS with high [blank_start]speed[blank_end]
Therefore, sensations that travel along large-diameter nerve A-fibres (non-n[blank_start]ociceptive[blank_end]) inhibit pain or tend to "close the gate" to pain (especially throbbing, dull, pain)
Small diameter (n[blank_start]ociceptive[blank_end]) C-fibres elicit pain or "open the gate".
Thermal sensations and sensation of electrical stim are carried by [blank_start]large[blank_end] diameter fibres, so can be used to "close the gate" in practice- Aspeed
- Bociceptive
- Cociceptive
- Dlarge
10Continuous Passive Motion
Indicated for fractures that are stable post [blank_start]ORIF[blank_end], surgical release of j[blank_start]oints[blank_end], c[blank_start]apsules[blank_end], t[blank_start]endons[blank_end], and extra-articular scar adhesions. Can be used for tendon or ligament repairs. Can be used for overcoming joint s[blank_start]tiffness[blank_end], inflammatory conditions, pain, burns and total joint replacements.
Not indicated for u[blank_start]nstable[blank_end] fractures.
CPM has been shown to inhibit oedema formation, increase healing, and improve orientation of collagen fibres.- AORIF
- Boints
- Capsules
- Dendons
- Etiffness
- Fnstable
11NMES
Amplitude = i[blank_start]ntensity[blank_end]
Pulse duration = W[blank_start]idth[blank_end]
Frequency = rate, p[blank_start]ps[blank_end]
Rise time = r[blank_start]amp[blank_end] / surge
On time / off time = d[blank_start]uty[blank_end] c[blank_start]ycle[blank_end]
Post tendon repair, NMES can be used at [blank_start]6[blank_end] weeks post repair to elicit a strong muscle contraction.
It may be used with extreme caution as early as 7 - 10 days if discussed with surgeon first.- Antensity
- Bidth
- Cps
- Damp
- Euty
- Fycle
- G6
12Dexamethasone is an [blank_start]anti[blank_end] - [blank_start]inflammatory[blank_end] drug that is effective for treating arthritis, bursitis, and tendonitis via [blank_start]iontophoresis[blank_end]
- Aanti
- Binflammatory
- Ciontophoresis
13Post applying cold therapy, the skin may appear red as the body attempts to restore blood flow to the area, this is called [blank_start]hyperemia[blank_end].
The normal sequence of patient response to cold therapy is sensation of cold, [blank_start]burning[blank_end], pain and discomfort, [blank_start]tingling[blank_end] and numbness.- Ahyperemia
- Bburning
- Ctingling
14Hypergranulating tissue
Needs silver nitrate or [blank_start]corticosteroid[blank_end] cream.
Can use a [blank_start]semipermeable[blank_end] dressing (e.g. [blank_start]tegaderm[blank_end]) and decrease the frequency of the dressing changes.- Acorticosteroid
- Bsemipermeable
- Ctegaderm
15U/S Duty cycle refers to the amount of time the US energy is on over a one pulse period.
A 20% pulsed wave duty cycle interrupts the wave form. Therefore the pulse would only be [blank_start]2[blank_end] seconds of a 10 second pulse.
The heat will therefore not build up and inflame tissues. Conversely, heat will build with a constant 100% duty cycle as the pulse is on for the entire 10 sec.
For acute tendon inflammation, a [blank_start]pulsed[blank_end] cycle is more appropriate.
For chronic tendon inflammation, [blank_start]continuous[blank_end] cycle is effective, and can be combined with [blank_start]stretching[blank_end].- A2
- Bpulsed
- Ccontinuous
- Dstretching
16E-Stim parameters
- With all other factors held equal, increasing the [blank_start]intensity[blank_end] of the current results in stronger contraction
- Increasing the pulse rate to above [blank_start]20[blank_end] pps will result in smoother contraction (not stronger)
- Increasing the pulse rate from 20pps to [blank_start]80[blank_end] pps results in a slight increase in strength but also increases rapid fatigue
- Pulse rate over [blank_start]80[blank_end] pps has no benefits
- The rise time, or [blank_start]surge[blank_end] time, is the length of time from onset of the current until its highest intensity.
- A gradual or long rise time yields a gradual increase in muscle [blank_start]strength[blank_end]
- The duty cycle (or on/off time) has a big effect on [blank_start]fatigue[blank_end]. Duty cycles of 10 sec on, 10 sec off (1:1) tends to fatigue muscles within several minutes, in contrast, 1:5 (15 sec on, 75 sec off) ratio allows muscles to be active for 30 mins or longer- Aintensity
- B20
- C80
- D80
- Esurge
- Fstrength
- Gfatigue
17CPM
Most effective in [blank_start]early[blank_end] stages of wound healing and scar formation
Not proven once [blank_start]contracture[blank_end] has occurred
CPM enhances healing and regeneration of musculoskeletal tissues including: articular [blank_start]cartilage[blank_end], [blank_start]synovial[blank_end] membranes, [blank_start]joint[blank_end] capsules, ligaments and tendons.
CPM can also be used to overcome joint stiffness and pain- Aearly
- Bcontracture
- Ccartilage
- Dsynovial
- Ejoint
18Intermittent Pneumatic Compression (IPC)
- Used for [blank_start]oedema[blank_end] reduction
- Consists of pump, hoses, and a sleeve with 1 or more chambers that are sequentially [blank_start]compressed[blank_end] in a distal to proximal fashion
- never set pressure greater than [blank_start]10[blank_end] mmHg below client's diastolic blood pressure.
- Pressure is generally [blank_start]30[blank_end]-[blank_start]50[blank_end] mmHg for upper extremity depending on diagnosis and goals.
- Volumetric, circumferential or girth ([blank_start]figure-8[blank_end]) measures can be used to track oedema- Aoedema
- Bcompressed
- C10
- D30
- E50
- Ffigure-8
19NMES for AROM:
- NMES stimulates an [blank_start]intact[blank_end] peripheral nerve to achieve muscle [blank_start]contraction[blank_end]
- Use with disuse atrophy, to facilitate muscle relearning after joint has been immobilised
- NMES does not replace volitional motion and exercise, but will boost [blank_start]motor[blank_end] recruitment and enhance exercise
- Once a patient can achieve an F+ (Fair +) - that is, the ability to contract against gravity, with minimal resistance), other forms of volitional exercise including strengthening are most appropriate- Aintact
- Bcontraction
- Cmotor
20U/S
The overall movement of fluid and gas bubbles within cells in response to vibration is called [blank_start]acoustical[blank_end] streaming. Medications placed on the skin are pushed deeper into structures via this process.
The formation of gas bubbles within the cells in response to the vibration in the target tissue is called C[blank_start]avitation[blank_end]- Aacoustical
- Bavitation
21Electromyographic (EMG) Biofeedback
- adjunct to other treatment
- Use of electrodes to pick up neural signals from active skeletal muscles and display feedback to patient
- Primary use is to teach control of [blank_start]neural[blank_end] activation of skeletal muscle, which can help to decrease muscle spasm, increase muscle [blank_start]contractions[blank_end] in weak areas and quiet antagonistic or antagonist muscles- Aneural
- Bcontractions
22Spray and stretch technique with vapocoolant spray.
- variation of cryotherapy
- needs specific technique
- transfers heat from the patient using [blank_start]evaporation[blank_end] (thus spray changes from a liquid form to a gas or vapour)
- beneficial because it provides rapid, brief [blank_start]cooling[blank_end] of skin over a muscle which reduces muscle tone
- helps to facilitate muscle relaxation in spasm due to trauma
- proper technique: spray parallel to muscle fibres, proximal to distal, at a speed of about 10cm per second.- Aevaporation
- Bcooling
23Contrast bathing
- vasodilation ([blank_start]hot[blank_end] water) and vasoconstriction ([blank_start]cold[blank_end] water)
- Stimulates local [blank_start]circulation[blank_end]
- Can be used for arthritis, joint sprains, muscle strains, plus to toughen amputation stumps (desensitise)
- Efficacy is not well researched
- Temp should be between 38-44 deg celsius (104-112 F) in one bath and 10-18 deg C (50-64 F) in the other
- Place hand in warm basin for [blank_start]3[blank_end]-[blank_start]4[blank_end] minutes, then immerse in the cold bath for 1 minute, then return to warm for [blank_start]4[blank_end] mins. This cycle should be continued for [blank_start]30[blank_end] mins with the last immersion being in the warm bath. (or if severe oedema, end in the cold bath for 1 minute)
If using for desensitisation: start with mild temp differences and gradually increase difference as sensitivity decreases- Ahot
- Bcold
- Ccirculation
- D3
- E4
- F4
- G30
24Anode = [blank_start]positive[blank_end] pole
Cathode = [blank_start]negative[blank_end] pole
Most commercially available stimulators are biphasic or alternating current stimulators, meaning each electrodes alternates between positive and negative polarity throughout the treatment.- Apositive
- Bnegative
25Aching during U/S are caused by overheating the periosteum.
This can be reduced by:
- [blank_start]increasing[blank_end] the frequency - which decreases the depth of penetration
- [blank_start]decreasing[blank_end] intensity - decreases amount of heat generated
- [blank_start]increasing[blank_end] size of treatment area - lowers the spatial averaged intensity
Also important to keep the sound head [blank_start]moving[blank_end] to prevent hot spots forming.- Aincreasing
- Bdecreasing
- Cincreasing
- Dmoving
26TENS
TENS can be used for painful procedures such as debridement for analgesic purposes using a b[blank_start]rief[blank_end] and i[blank_start]ntense[blank_end] high-rate (above 100 pps) and high width (above 200 microseconds) current at intensity to a visible contraction or as high as the patient can tolerate
- brief TENS produces a tetanic contraction and results in surface analgesia for 20-30 mins.
- this is a noxious stimulus and the mechanism of action is a release of e[blank_start]ndorphins[blank_end] - so it can be used with and before painful procedures- Arief
- Bntense
- Cndorphins
27Cold therapy should not proceed longer than 20 mins, particularly around superficial peripheral nerves (ie around medial epicondyle).
Over 20 mins can lead to a nerve conduction block (a[blank_start]xonotmesis[blank_end] or n[blank_start]eurapraxia[blank_end]) and could result in tissue [blank_start]death[blank_end]
When applying heat over a main branch of a nerve, watch for signs of nerve conduction changes such as distal numbness or tingling. If these occur remove cryotherapy application.- Axonotmesis
- Beurapraxia
- Cdeath
28Iontophoresis drugs
Acetic Acid: used to treat calcific t[blank_start]endonitis[blank_end]
Iodine: anti-sclerotic agent, good for use with heavy [blank_start]scar[blank_end] tissue
Dexamethasone: [blank_start]anti[blank_end]-[blank_start]inflammatory[blank_end]
Saline: another option to reduce [blank_start]scar[blank_end] adhesion- Aendonitis
- Bscar
- Cinflammatory
- Danti
- Escar
29U/S for supraspinatus tendon
Supraspinatus tendon can be located when the arm is [blank_start]abducted[blank_end] and [blank_start]internally[blank_end] rotated (hand behind back), this makes the tendon pop out from under the [blank_start]acromion[blank_end] process- Aabducted
- Binternally
- Cacromion
30FES aim = achieve high levels of muscle [blank_start]contraction[blank_end] force for improved motor control or strength gains, goal is to initiate a contraction that can achieve a [blank_start]task[blank_end].
- Acontraction
- Btask
31Strength-duration tests
- help determine the e[blank_start]xcitability[blank_end] of nerve and muscle tissues
- Tests are plotted on log paper
- Y axis = stimulus i[blank_start]ntensity[blank_end]
- X axis = d[blank_start]uration[blank_end]
- Rheobase = the minimum i[blank_start]ntensit[blank_end]y required to elicit a minimally visible contraction when the duration is infinite
- Chronaxie = duration required for a stimulus with t[blank_start]wice[blank_end] the rheobase intensity to elicit a visible contraction
- sensory tissue responds more quickly than m[blank_start]otor[blank_end] tissue and requires a lower intensity and shorter duration.
- denervated muscle requires a stimulus of higher a[blank_start]mplitude[blank_end] and longer d[blank_start]uration[blank_end] than a normal muscle- Axcitability
- Bntensity
- Curation
- Dntensit
- Ewice
- Fotor
- Gmplitude
- Huration
32Methods of heat transfer examples
Whirlpool/fluidotherapy - [blank_start]Convection[blank_end]
Infrared lamps- [blank_start]radiation[blank_end]
Hot packs/paraffin - [blank_start]Conduction[blank_end]
Ultrasound- [blank_start]conversion[blank_end]
Vapocoolant spray- [blank_start]evaporation[blank_end]- AConvection
- Bradiation
- CConduction
- Dconversion
- Eevaporation
33E-stim for pain relief options
1) continuous voltage at 50-120 Hz for [blank_start]10[blank_end] - [blank_start]30[blank_end] minutes. Continuous is most effective because the patient can comfortably tolerate an ongoing, unmodified series of pulses. This helps muscle relaxation and pain reduction
2) TENS
- Interferential current (IFC)- A10
- B30
34With U/S, what parameter determines the depth of penetration?
[blank_start]Frequency[blank_end] (1 vs 3 MHz)
The amount of energy absorbed in the target tissue is the...
[blank_start]Intensity[blank_end]
The fraction of the time the ultrasound energy is on over one pulse period (on : off time) is...
[blank_start]Duty[blank_end] cycle
The area on the sound head that actually emits waves is... (Acronym)
[blank_start]ERA[blank_end]- AFrequency
- BIntensity
- CDuty
- DERA
35E-Stim electrode placement
- In theory, an increase in the distance between electrodes would increase depth of [blank_start]penetration[blank_end], although this sometimes doesn't relate in practice
- Electrodes should be placed [blank_start]2[blank_end] inches a part
- For a deeper penetration, place one electrode over a [blank_start]superficial[blank_end] aspect of the motor nerve, and the other electrode over the muscle [blank_start]belly[blank_end].- Apenetration
- B2
- Csuperficial
- Dbelly
36Iontophoresis set up
- active electrode should be the same [blank_start]polarity[blank_end] as the medication ion
- to reduce the risk of burns, the cathode ([blank_start]negative[blank_end]) electrode should be twice the size of the anode ([blank_start]positive[blank_end]) electrode, regardless of which is the active electrode.
Electrodes should be placed at least the size of the a[blank_start]node[blank_end] away from each other- Apolarity
- Bnegative
- Cpositive
- Dnode
37Low level laster therapy (LLLT)
- "[blank_start]cold[blank_end]" laser therapy
- reduces inflammation, stimulate [blank_start]nerve[blank_end] function, develops collagen and muscle tissue, helps generate new and healthy cells and tissues, increases [blank_start]blood[blank_end] supply, reduces acute and chronic pain
- LLLT is painless, sterile, noninvasive, drug-free treatment
- Used for a variety of pain syndromes including [blank_start]carpal tunnel[blank_end] syndrome- Acold
- Bnerve
- Cblood
- Dcarpal tunnel
38Cold therapy:
- to remember order of physiological effects during cryotherapy remember CBAN: c[blank_start]old[blank_end], b[blank_start]urning[blank_end], a[blank_start]ching[blank_end], n[blank_start]umbness[blank_end].
Grip strength should be measured prior to cold therapy as it will temporarily increase post (skewed measurement)- Aold
- Burning
- Cching
- Dumbness
39Laser cluster probe
- individual d[blank_start]iodes[blank_end] in one laser/probe.
The amount of power per individual diode (eg 200 mW) does not increase the power from the cluster, it simply allows a larger area to be treated simultaneously.- Aiodes
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- CHT hand therapy (Modalities) Quiz on Modalities, created by Rosie C on 11/10/2018.
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- Rosie C
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