Term
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Definition
| The treatment of disease by physical and mechanical means (as massage, regulated exercise, water, light, heat, and electricity). |
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Term
| Tissues Affected by Physiotherapy Applications (9) |
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Definition
| Skin, blood vessels, CT, lymphatics, muscle, glands, nerve, organ systems, bone. |
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Term
| Pathologies affected by physiotherapy applications (9) |
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Definition
Tissue destruction
Ischemia
Inflammation
Fibrosis
Infection
Decreased CT plasticity
Toxicity
Decreased membrane permeability
Congestion |
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Term
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Definition
Waves at frequencies < 20 Hz are termed infrasound (“Chi” machines)
Waves >18,000 Hz are termed ultrasound |
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Term
| Frequency range used for therapeutic ultrasound, phonophoresis/sonophoresis, and diagnostic imaging |
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Definition
85 KHz - 3 MHz
4-16 Mhz phonophoresis/sonophoresis
16+ Mhz used for diagnostic imaging |
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Term
| Phonophoresis (sonophoresis) |
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Definition
| Use of ultrasound energy to enhance delivery of topically applied drugs. (enhancing skin permeability) |
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Term
| What is the intensity range for ultrasound for producing mechanical energy? |
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Definition
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Term
| Cavitation vs Transient Cavitation |
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Definition
Cavitation - The formation, in fluids or solids, of empty spaces or cavities resulting from the formation of microbubbles.
vs
Transient Cavitation - Violent collapse or implosion of microbubbles, which triggers very high temperature and pressure changes within the vicinity of the bubbles in the fluid. Only occurs with low frequency and higher intensity than is being dealt with in class.
Transient Cavitation is bad for people mmkay? |
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Term
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Definition
| The minute flow of fluid in the vicinity of the pulsating bubbles. |
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Term
| Which frequencies have better tissue penetration, low or high? |
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Definition
Low has better tissue penetration -- think about it -- it's the bass that travels!
As general rule, 3 MHz can penetrate soft tissues up to approx. 2 cm, whereas another beam emitted at 1 MHz can penetrate soft tissues up to approximately 5 cm. |
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Term
| Effective radiating area (ERA) |
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Definition
| Corresponds to size of transducer head (usually 1, 5, or 10 cm2). |
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Term
DUTY CYCLE (2 options)
&
Typical Treatment Time for Ultrasound |
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Definition
Continuous
or
Pulsed
Treatment time is 3-10 minutes, most commonly 5. |
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Term
| 3 treatment sizes associated with the 3 ERAs |
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Definition
| Grapefruit when using a 10 cm2 soundhead, tennis ball with 5 cm2 soundhead, & golf ball with 1 cm2 soundhead. |
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Term
| What needs to happen with the intensity when using ultrasound underwater for a finger for example? |
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Definition
| The intensity should be increased by .5 w/cm2 |
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Term
| 3 methods of ultrasound application |
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Definition
Direct contact
Water immersion
Cushion contact |
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Term
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Definition
Pacemakers
Over malignant tumors
Pregnancy (esp. over pelvis/uterus)
Over acute/subacute injuries (inflammatory conditions)
Over ischemic areas (poor circ. May lead to an inadequate thermoregulatory response)
Over metal implants
Over the ocular region
Over the testicles
Over areas of thrombophlebitis
Avoid using over pelvic region during menstruation or other areas during active bleeding/trauma
Caution in patients with impaired sensory response
Caution over bone epiphysial region in growing children
and most importantly
NEVER USE SIMULTANEOUSLY WHILE A DIATHERMY UNIT IS IN OPERATION!! |
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Term
| Charting Requirements (8) for US |
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Definition
Brand/model # of unit being used
Transducer ERA (1, 5, or 10 cm2)
Frequency (crystal—1.0, 3.0, 3.2, 3.3 MHz)
Intensity (W/cm2—typically between 0.5 and 2.0)
Duty cycle (continuous vs. pulsed--% of duty cycle if known)
Time (typically 3-10 minutes/site)
Coupling medium used (gel, water, phonophoresis agent if used)
(phonophoresis?) If drug used PLEASE NOTE type and quantity of medication
Treatment area (size & location) |
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Term
| Action potential propagation can be prevented in nerve fibers if (3) |
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Definition
Fiber is exposed to local pressure or anoxia
Na+ permeability is effected/blocked (e.g. Novocaine)
There is extreme cooling of nerve fiber |
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Term
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Definition
| Membranes with larger capacitance (e.g. denervated skeletal muscle) take longer vs. smaller capacitance membranes (nerve fiber) |
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Term
| Absolute refractory period vs Relative refractory period |
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Definition
A membrane requires ~0.5 millisecond to recover from an action potential in order to perform another one
This recovery time is called the Absolute Refractory Period
A membrane may require a higher amplitude stimuli to perform another action potential from 0.5 to 1 millisecond after an action potential
This is known as the Relative Refractory Period |
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Term
| Temporal summation for tetani |
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Definition
Postural muscles = tetanic contraction at ~20 pps (pulse per second)
Movement muscles = ~40 pps |
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Term
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Definition
Monopolar (active and dispersive pads) - Pads are different sizes
Bipolar - Pads are same size
Quadripolar (mostly IF therapy) - Pads are same size (requires modulation for IF therapy)
Others (as in IF therapy) - 6 pads & ? (others) |
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Term
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Definition
| AC is the default, DC is what would be used if a charge concentration was desired (to affect local pH). |
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Term
Interphase Interval
vs
Interpulse Interval |
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Definition
Interphase Interval is the period of NO electrical activity between two successive phases of a pulse
Interpulse Interval is the period of NO electrical activity between two successive pulses |
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Term
| Repetition Frequency for AC vs DC |
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Definition
Measured in pulses per second (pps) for PULSED current
Measured in cycles per second (Hz) for ALTERNATING current |
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Term
| 2 means by which tens works to reduce pain |
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Definition
Gate theory - Presumed to activate inhibitory interneurons located in the substantia gelatinosa of the dorsal horn of spinal cord
Endogenous Opioids |
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Term
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Definition
TENS is when analgesia is the goal
NMES is when neuromuscular stimulation is used |
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Term
NMES
Low strength & duration
vs
High strength & duration |
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Definition
Low strength with low duration leads to stimulation of sensory nerve fibers (S fibers)
Higher strength with longer pulse duration leads to stimulation of sensory-motor (S-M fibers) and then sensory-motor-nociceptive (S-M-N fibers) nerve fibers (C fibers belong to the N fibers) |
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Term
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Definition
Practitioners can determine via skin-muscle palpation technique which group of nerve fibers have been preferentially depolarized.
S fibers simulated if NO muscle contraction is apparent and the patient perceives the electrically evoke sensation as comfortable.
S-M fibers stimulated if evoked muscle contraction is apparent either visually or by palpation and the level of sensation still perceived as comfortable.
S-M-N fibers stimulated if muscle contraction is clearly apparent and the patient describes the sensation as tolerable, just below the threshold of being intolerable, or too painful. |
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Term
|
Definition
1. Conventional TENS
2. Strong Low-Rate
AKA “acupuncture-like” TENS
3. Brief-Intense TENS
4. Pulse-Burst TENS (AKA “burst” or “pulse train” TENS)
5. Modulation TENS
6. Hyperstimulation
AKA “noninvasive electroacupuncture” |
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Term
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Definition
Generally characterized by high frequency and low amplitude
Frequency range typically 10-100 pps (~60 pps has been demonstrated to be optimal for producing pain relief in this mode)
Amplitude (low to mid-range) results in comfortable cutaneous stimulation without muscle contraction (sensation of paresthesia is desired) minimum of 24 mA for optimal relief. |
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Term
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Definition
Characterized by low frequency and high amplitude (duh)
Frequency is <10 pps (most commonly in 1-4 pps range)
Pulse duration typically in range of 100-300 µsec
Amplitude sufficient to produce visibly strong and rhythmic muscle contractions
Is generally “uncomfortable”, but tolerable to patient
Is believed to be more resistant to perceptual accommodation |
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Term
| Charting Requirements for TENS (8) |
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Definition
Make and model of TENS unit (the following parameters will potentially differ from unit to unit)
TENS mode desired (conventional, modulated, burst, etc)
Waveform setting (N, M, B, etc)
Pulse width setting
Frequency setting
Treatment location (electrode type, size, and placement)
Treatment time/duration, frequency
Intensity setting (often to patient tolerance, but may be sub-motor in case of conventional TENS mode use) |
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Term
| TENS Contraindications (6) |
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Definition
Patients suffering from mental confusion
Patients with high caffeine intake (>~3 cups/day, =~200mg/day) (caffeine has ability to decrease the ability of TENS to modulate pain)
Lack of adequate skin sensation over treated area
Keep home TENS therapy units away from children
When driving or operating potentially hazardous machinery (may effect motor skills)
Monitor all medication |
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Term
|
Definition
RA
OA
Dysmenorrheal
Labor and post labor pains
Post-abdominal surgery
Post-thoracic surgery
LBP
Chronic pain syndromes
Detrusor muscle overactivity
Myofascial pain
Postherpetic neuralgia
Peripheral neuropathies
Trigeminal neuralgia
Migraine/headache
Post-orthopedic surgery (shoulder, hip, knee, joint)
Post-urological surgery
Post-cholecystectomy
Post-hemorrhoidectomy
Neck pain
Facial pain
Ankylosing spondylitis
Neuropathic pain
Idiopathic detrusor instability
TMJ pain
Post-dental preparations
Acute posttraumatic pain |
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Term
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Definition
Typically denoting stimulation with high frequency and high amplitude
Typical frequency is 60 - >150 pps (produces significant muscle fatigue with continuous stimulation)
Amplitude set to produce muscle contraction
Patient sensation is paresthesia |
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Term
| Pulse-Burst TENS (AKA “burst” or “pulse train” TENS) (2) |
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Definition
Characterized by low frequency bursts (pulses) of high frequency (carrier frequency) at high amplitude
Attempt at improved patient acceptance of high-amplitude stimulation |
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Term
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Definition
Random electronic modulation of pulse duration, pulse frequency, and current amplitude
Often advocated by manufactures to “prevent accommodation” (not well studied in literature) |
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Term
| Hyperstimulation AKA “noninvasive electroacupuncture” (8) |
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Definition
Limited, but promising assessment
Most noxious form of TENS
High current density
Small electrodes/probes (usually ~1-3 mm diameter), thus may use currents as small as 50 µA
Very long pulse durations (eg, 500 msec)
Pulse frequency typically in 1-4 pps range (can go to 100 pps)
“sharp or burning” stimuli sensation
Only mode to use direct or monophasic pulsed currents |
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Term
|
Definition
CSWD (Continuous Short Wave Diathermy)
First type developed—delivers a continuous electromagnetic radiation to cause deep heating in tissues
PSWD (Pulsed Short Wave Diathermy)
Developed later than CSWD
Delivers a periodically interrupted (pulsed) electromagnetic radiation
First brands were called Diapulse (pulsed diathermy)
Produced an athermal vs. thermal effect |
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Term
| Capacitive Method of Diathermy |
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Definition
| Surrounding tissue with 2 electrodes |
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Term
| Inductive Method of Diathermy |
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Definition
Use of a single inductive-type electrode either wrapped around or positioned immediately over the treated body segment. IE
Flexible, long cable
Drums (coiled wire housed in casing)
Mostly absorbed by tissues with high water content (muscles and joint synovial fluid) |
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Term
| Diathermy Contraindications (8) |
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Definition
FIRST AND FOREMOST, NO PACEMAKERS!!!! PEOPLE CAN DIE!!!
At BCNH please ensure adjoining rooms do not have a patient who has a pacemaker or electronic implant
Caution/avoid with the presence of cardiac insufficiencies
Ensure personal belongings that can be harmed by diathermy are removed from room or as far from unit as possible (credit cards, electronic devices such as watches, etc.)
Do not perform of metal treatment tables
Do not perform over metal implants
In Pregnancy or pelvic region during menstruation
Do not perform or acute/subacute injuries (inflammatory conditions)
Do not perform over ischemic areas (poor circ. may lead to an inadequate thermoregulatory response) or the ocular region (too much fluid!)
Patient has a fever |
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Term
| Diathermy Treatment Aspects (6) |
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Definition
Ensure the electrode cables are NOT CROSSED
Advise patient that if treatment area gets too warm/hot to alert clinician & be cautions where this sensation may be absent/lacking
Caution where thermoregulation may be impaired (children < 4 & older adults) & over epiphyseal plates in growing children
Remain with patient throughout treatment
Ensure resonance is achieved (most newer models do this internally/automatically)
Treatment time is ~20 min per site
Keep person in a comfortable position that they can KEEP STILL in to achieve/maintain resonance
Place single layer of absorbent material between electrode and skin (to absorb sweat) |
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Term
|
Definition
Make/model of diathermy*
Power/intensity setting
Pulsed (frequency) vs continuous
Time/treatment
Electrode arrangement
Treatment timing/frequency |
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Term
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Definition
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Term
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Definition
| “Beat” occurs when tow waves of different frequencies interfere with each other and summate (e.g. fixed frequency of 4000 Hz and modulated frequency of 4001 to 4050 results in beat frequency of 1 to 50 bps) |
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Term
| Ways to deliver interferential NMES |
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Definition
Bipolar - 2 pads that do a premodulated interferential
Quadripolar - 4 pads with 2 different channels crossed (requires amplitude modulation--causes frequency to go up and down (set 5-6 below tolerance))
6 pads |
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Term
|
Definition
Purpose is to provide a “three-dimensional” treatment in the tissue
Six pads place “around” area to be treated
Three channels/circuits intersect with each other
Is unmodulated (treatment area doesn't move) |
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Term
|
Definition
Pain management
Urinary incontinence (3D stimulation of deep pelvic floor muscles)
Blood flow/edema management |
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Term
| Active Pad vs Dispersive Pad Monopolar Arrange |
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Definition
Active Pad is small; placed over the motor end point of a muscle (usually the belly of the muscle)
Dispersive Pad is large (4x or so larger); |
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Term
| Iontophoresis (monopolar) treatment frequency for innervated vs denervated muscle |
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Definition
For innervated muscle ~ treat three times/week
For denervated muscles ~ treat three times/day to forestall atrophy |
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Term
|
Definition
Low Volt Less than 150 volts
High Volt More than 150 volts |
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Term
| Settings for Constitutional |
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Definition
| Low volt sine wave set to surge. |
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Term
| Current that flows unidirectionally (not AC) for less than 1 second (esp. a few milliseconds or less) is termed |
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Definition
| NOT termed DC; termed "pulsed current" |
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Term
| Main Indications for Iontophoresis (3) |
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Definition
| To date - Hyperhidrosis, Peyronie’s disease, and TMJ disorders (studied) |
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Term
| HVPC stands for & definition |
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Definition
High Volt Pulsed Current - Not Considered DC
Pulses are characteristically very short 100-200 microseconds
Pulse frequencies are typically 1-200 pulses per second
Pulse duration is usually set by manufacturer and not adjustable by practitioner |
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Term
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Definition
Dermal wound healing
Soft-tissue edema
Muscle spasms
Pain therapy
Muscle weakness |
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Term
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Definition
Continuous sine wave output of about 2500 to 5000 Hz (medium frequency)
Modulated to yield 50 bursts per second (bps) |
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Term
| Contraindications of NMES (10) |
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Definition
Pacemakers (all other electronic implants)
Over metal implants
Over and around malignancies
Over lower abdominal, lumbosacral, and pelvic area during pregnancy
Over anterior transcervical region
Over transthoracic & cranial areas
In patient suffering from mental confusion
With patients suffering from severe cardiopathies
Over a thrombus |
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Term
| Properties of Laser Light (4) |
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Definition
Monochromatic
At BCNH we use 830nm wavelength, which is not visible to human eye (infrared range)
Other wavelengths are available (can effect targeted tissues/depth of penetration), typically between 600-1000nm
Specific tissues can be effected by specific wavelengths of light |
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Term
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Definition
| Typically in the 0.3-19 Joules per cm2 |
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Term
|
Definition
| Pain/Inflammation & Healing |
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Term
| LLLT Contraindications (4) |
|
Definition
Caution over thyroid
Cancerous tumors
Pregnancy
Over hemorrhagic areas
And of course... of course, shine it in people's eyes, derp. |
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Term
|
Definition
Specific treatment location/sites
Dosage (in Joules)
Frequency and duration of treatment (how many days/week for how many weeks) |
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