Modalities basics..

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