| a flow of charged particles that are either electrons or ions | electrical current |
| continuous one directional flow of charged particles. It is used for iontophoresis and for stimulating contractions in denervated muscle. Batteries produce current | Dc - direct current |
| continuous, two directional flow of charged particles and can be used for pain control (interferential and premodulated current) and for muscle contraction (russian prototcol). Current is what flows out of an electrical wall outlet. | Ac - alternating current |
| produced by the interference (crossing, if you will) of two medium frequency (1000 to 10,000 hz) ac's of different frequencies.
This type of current is considered to be more comfortable than other waveforms and can be used to stimulate a relatively large and deeper area depending on the placement of the electrodes. Used for pain control. | Interferential current |
| the difference between the carrier frequencies (5100hz minus 5000hz = 100 hz which is felt between the "x" arranged electrodes.) | "beat" frequency |
| alternating current with a medium frequency (1000 to 10,000 hz) in which the amplitude (intensity) is sequentially increased and decreased. Same waveform as interferential current but is easier to set up. It typically is not used to treat the larger and deeper areas more suitable for interferential. Single unit with two electrodes. | Pre-modulated current |
| The period when electrical current flows in one direction. Phase duration is measured in microseconds. | phase |
| The amount of time between pulses. | Interpulse interval |
| used to improve patient comfort when using estim to produce a muscle contraction. Allows patient to become accustomed to the stimulation | ramps |
| Electrical currents depolarize nerve membranes, thus producing action potentials in either sensory or motor nerves. | Stimulation of action potentials |
| -60 to -90 mv (inside of nerve cell more negatively charged) | Resting membrane potential |
| during depolarization (inside of cell is very positive). The nerve cannot be further excited no matter how strong the stimulus is. | Absolute refractory period |
| lower current amplitudes and shorter pulse durations (less than 80 microseconds) can depolarize sensory nerves and higher amplitudes with longer pulsed durations (150 to 350 microseconds) are needed to depolarize motor nerves. | Strength-duration curve |
| an action potential will occur with any stimulus above the threshold and no action potential will occur with a stimulus below threshold. Increasing the current amplitude or pulse duration beyond the threshold will not make the action potential larger or longer. | all or none response |
| where do action potentials travel faster? | in larger diameter myelinated axons than in small diameter or unmyelinated axons. |
| - do not respond to the same parameters used to elicit a muscle contraction in a muscle whose innervation is intact.
- contracts only when the electrical current directly causes the muscle cells to depolarize. This requires pulses of electricity lasting 10ms (microseconds) or longer and is delivered via a special unit designed for this purpose. | denervated muscles |
| what is used in iontophoresis to force drug chemicals across the skin? | Dc current |
| Contraindications for estim: | 1. Cardiac pacemaker or cardiac arrhthmias as the estim may interfere with the pacing of the heart.
2. Over the carotid sinus – anterior or lateral neck as this may cause a rapid drop in bp and cause a syncopal episode.
3. Venous or arterial thrombosis or thrombophlebitis – may increase circulation and risk of the thrombus becoming an embolus.
4. Pelvis, abdomen, trunk and low back area during pregnancy as estim impact on unborn child is not fully known |
| Precautions for estim: | 1. Cardiac disease
2. Impaired mentation or sensatio
3. Malignant tumors
4. Skin irritation or open wounds |
| Electrode placement: | • Should lie smooth against the skin without wrinkles or areas void of medium
• Not over bony prominences
• The closer electrodes are, the more superficial the current will travel and vice versa |
| What are the types of electrodes? | - disposable
- carbon impregnated silicone rubber
- conductive fabric |
| Which electrodes tend to be more comfortable but require a higher amplitude to deliver the same punch? | larger electrodes |
| used to produce a muscle contraction in innervated muscle tissue. | Nmes = neuromuscular electrical stimulation |
| Produce the strongest and quickest contractions but fatigue quickly and rapidly atrophy with disuse | Fast-twitch type ii muscle fibers |
| what contraction is smoother and more controlled? | voluntary contraction |
| What produces a more rapid and jerky contraction? | Estim |
| What are the two ways estim strengthens muscles? | - overload
- specificity |
| the greater the load placed on a muscle and the higher the force of contraction = more strength gained (applies to both natural and artificial contractions). | Overload principle |
| contractions specifically strengthen the muscle fibers that contract. Estim has more effect on the fast-twitch type ii fibers. | Specificity |
| How do you increase strength? | with higher force contractions |
| How do you increase endurance? | prolonged stimulation with lower force contractions should be used. |
| What are the Orthopedic conditions that estim is good for? | 1. Accelerate recovery following immobilization and rest
2. Strengthening post surgery
3. Retard atrophy and loss of strength during periods of immobilization |
| What neurological conditions are estim used for? | - Sci, stroke, etc as long as peripheral nerves are intact.
- Improve strength, bone strength, decrease spasticity |
| What other conditions are estim used for? | 1. Preventing muscle atrophy
2. Improve swallowing
3. Treatment of urinary incontinence associated with pelvic floor dysfunction.
4. Promote blood flow in those with poor circulation. |
| What are the waveform used for innervated muscles? | Pulsed biphasic waveform or russian protocol |
| Where should the electrode be placed for innervated muscle contraction? | If contraction desired: one electrode should be placed over the motor point for the muscle (usually the middle of the muscle) and the other should be placed on the muscle being stimulated so that the electrodes are aligned parallel to the muscle fibers being stimulated. Electrodes should be at least 2 inches apart. |
| What pulse duration should be used for innervated muscle contraction? | Between 150 and 350 microseconds. Remember that as the pulse duration is shortened, amplitude will need to increase to produce the same result. |
| What frequency should be used for innervated muscle contraction? | • 35 to 50 pps for a smooth, tetanic contraction. This may be increased to a maximum of 80 pps.
• 20-30 pps for smaller muscles such as those on the face. |
| What is the on/off time for innervated muscle contraction? | • On = 6-10 seconds
• Off = 50-120 seconds
• Or a ratio of 1:5 initially and then progressing to 1:4 or 1:3 for muscle contractions |
| What is the ramp time for innervated muscle contraction? | Comfort. If on time is 6-10 seconds, ramp up time should be 1-4 seconds |
| What is the current amplitude for an innervated muscle contraction? | amp used that will produce just the desired result |
| What is the current amplitude for an innervated muscle for edema or to decrease spasticity? | amp only needs to produce a visible muscle contraction |
| What is the treatment time for innervated muscle strengthening? | 10-20 contractions (this will usually take about 10 minutes) and repeated several times daily |
| What is the treatment time for innervated muscle reeducation? | no more than 20 minutes per treatment session |
| what estim is used for pain control? | Tens = transcutaneous electrical nerve stimulation |
| Short duration higher frequency pulses at an amplitude producing a comfortable sensation but no muscle contraction to modulate pain. | Conventional tens |
| How does conventional tens modulate pain? | Works via melzack and wall's gate control of theory of pain. |
| Causes the release of endogenous opiates (endorphins and enkephalins) that act similarly to morphine to modulate the perception of pain. | Low rate/acupuncture-like tens |
| What types of waveforms are used for tens? | • Pulsed biphasic waveform or interferential current
• Pulsed monophasic form (premodulated) |
| Where should the electrode placement be for tens? | • Placed around the painful area
• Placed over trigger points areas or over acupuncture points
• At the point of intersecting electrodes when four electrodes are used |
| What is the pulse duration for tens? | • Between 50 and 80 microseconds if conventional tens
• Acupuncture tens = between 200 and 300 microseconds
• If interferential = 200 to 400 microseconds that will be predetermined and dependent upon the fixed carrier frequency. |
| What is the frequency for conventional tens? | between 100 and 150 pps (high rate, short pulse duration or width) |
| What is the frequency for low rate or acupuncture tens? | below 10 pps |
| What is the frequency of burst tens? | usually preset at 100 to 150 pps |
| What is the current amplitude for conventional tens? | Tingling sensation that is comfortable but does not produce a muscle contraction |
| How is estim used for wound management? | 1. Attracts the right players to the area (those that assist in the healing process)
2. Alters cell membrane function
3. Reduces edema
4. Enhances antimicrobial activity
5. Promotes circulation (enhances oxygen and other chemicals/cells moving into the area) |
| What are the special considerations when using estim for wound management? | - Patients having a pressure ulcer many times also have diminished sensation in the immediate area so care must be taken wrt intensity
- If electrodes are placed in the wound, a new electrode should be used each time (with both self-adhesive electrodes placed around a wound or an electrode fashioned from solution soaked gauze that is placed directly in the wound)
- Protective covers for lead wires and estim devices are available to decrease the spread of infection and these items should become dedicated to that patient and remain in the patient’s room. |
| What waveform is used for estim for wound management? | Monophasic waveform (the electrodes remain opposite in polarity) such as high volt or hvpc (high volt pulsed current) |
| What pulse duration is used for estim for wound management? | 40-100 microseconds |
| What frequency is used for estim for wound management? | 60-125 pps |
| What is the on/off time for estim for wound mangement? | continuous (no off time) |
| What amplitude is used for estim for wound management? | high enough to produce a comfortable sensation without a motor response (no muscle contraction) |
| What is the treatment time for estim for wound management? | 5 times a week at least for 45-60 minutes each time. |
| What is the depth of penetration dependent on the drug used for iontophoresis? | 3-20 mm |
| What is the amplitude for iontophoresis? | patient comfort but not above 4 milliamps. |
| What is the treatment time for iontophoresis? | adjusted according to amplitude to achieve 40-80 ma-min. |
| what is compression used for? | 1. Improve fluid balance and circulation (decrease peripheral edema caused by vascular or lymphatic dysfunction) or
2. To modify (decrease) scar formation |
| What is the goal of compression therapy? | to increase the pressure outside the vessels in tissue creating a reversal or at least a decrease in fluid leaving the vessels (both blood and lymphatic) and collecting in the interstitial space. |
| What are the effects of external compression? | • Effects will vary depending upon the compression device used and the amount of pressure applied
• Intermittent may improve circulation more so than static pressure because it produces a "milking" of the fluids from distal to proximal. When venous and lymphatic vessels are compressed, the fluids within these vessels is forced proximally. When the compression is reduced, fluid again fills the spaces outside the vessels. Sequential intermittent compression is believed to be more effective than non sequential because of the "wave" like formation.
• This improved circulation benefits patients with edema, helps prevent the formation of dvt's and may facilitate the healing of wound ulcers cause by venous disease.
• Compression can help shape a limb or residual limb (post amputation or extensive scarring, for example)
• Increases skin temperature |
| what is the most common cause of venous insufficiency? | phlebitis or inflammation of the veins. |
| adverse consequences of edema: | • Decreased rom
• Pain
• Impaired function
• Disfigurement and altered appearance
• Increased risk of infection
• Itching and browning of the skin
• Ulcerations |
| How compression reduces edema: | Increases extravascular pressure |
| What are the risks for deep vein thrombosis? | - older age,
- inactivity,
- surgery,
- trauma,
- hospital or nursing home confinement,
- cancer,
- central vein catheterization,
- transvenous pacemaker,
- varicose veins,
- paralysis,
- use of oral contraceptives,
- pregnancy
- hormone therapy. |
| what are the characteristics of dvt? | • Pain
• Swelling
• Skin changes in the area |
| How do you prevent a dvt? | - compression stockings,
- intermittent pneumatic compression,
- calf muscle electrical stimulation,
- anticoagulant meds. |
| areas of tissue breakdown and necrosis occuring as a result of impaired venous circulation. | Venous stasis ulcers |
| What is the standard treatment for compression of venous stasis ulcers? | - treatment includes bandaging to promote ulcer healing and compression stockings to prevent recurrence.
- Elevation of the involved extremities aids in healing. |
| When is compression initiated for controlling hypertrophic scarring? | once healing has occurred and may continue for as long as 8-12 months. |
| Contraindications for external compression – (mechanical) | • Heart failure or pulmonary edema
• Recent or acute dvt, thrombophlebitis, pulmonary embolism
• Obstructed lymphatic or venous return
• Severe arterial insufficiency
• Skin infection
• Hyponatremia with protein levels below 2 gm/dl
• Acute trauma or fracture
• Arterial revascularization |
| Precautions for external compression – (mechanical) | • Impaired sensation or mentation
• Uncontrolled hypertensio
• Cancer
• Stroke or significant cerebrovascular insufficiency |
| Adverse effects of external compression: | • Aggravation of condition being treated with the compression
• Impairing circulation if too much pressure is used |
| What is the inflation time for intermittent pneumatic compression pumping? | 80-100 seconds |
| What is the deflation time for intermittent pneumatic compression pumping? | 25-35 seconds (generally a 3:1 ratio) |
| What is the inflation pressure for intermittent pneumatic compression pumping? | 30-60 mm hg for ue and 40-80 for le. Just below patient's diastolic blood pressure |
| What are the compression bandage parameters? | - figure eight moving distal to proximal.
- Greater tension distally than proximally. |
| What amount of pressure is used for edema control? | 30-40 mm hg |
| General considerations for massage: | • Inappropriate touching and unnecessary exposure of the body are to avoided at all times
• Therapist should be relaxed in his/her manner, clean of person, free of jewelry that could scratch a patient (patient may also need to remove jewelry that could potentially be problematic
• Therapist should provide a clear explanation of pending intervention and the need for exposure of a body part.
• Hands should be clean and well groomed but strong and flexible; nails should be cut short and rounded or filed.
• "hands should be well padded, warm, supple, and dry – they should express sensitivity and gentleness, but yet have firmness and strength.”
• Start in slow and start to grow – also don't just end abruptly. Once you have begun, always have at least one hand on the patient performing a massage technique.
• Make a smooth transition from one technique to the next |
| Draping and positioning for massage: | • Comfort is a critical factor – for both the patient and the therapist. Be cognizant of background noise, light, room temperature, music; choice, odors and overall privacy.
• Position will be dictated by various factors, especially the part of the body receiving the massage
• Drape and cover the part of the body not being treated at that particular moment and expose the body part being treated. |
| Basic patient positions for massage intervention: | 1. Supine
2. Prone
3. Long sittin
4. Seated with one arm supported
5. Seated with both arms and head supported
6. Seated in a forward leaning specialized massage chair |
| What does deep pressure produce during massage? | a stronger stimulation and may increase tension and pain |
| What does light pressure produce during massage? | a milder stimulation which induces relaxation and decreases pain |
| What effect does slower strokes have on massage? | tend to be more relaxing |
| What effect does rapid strokes have on massage? | tend to be more stimulating |
| What is important about rate and rhythm during massage? | Constant rhythm with continuity of contact with patient’s body is important |
| What is the duration of a massage? | 1. Dictated by the purpose of the massage and desired response
2. 10-15 minutes for a specific body region; 45-60 mintues for a total body massage |
| Purpose of stroking? | - used to begin and end a massage sequence.
- Allows the patient to become accustomed to the feel of the therapist’s hands and likewise for the therapist.
- Helps the patient relax and is a good transition stroke between two different strokes. |
| type of stroking that is slow, gentle but firm = relaxation? | superficial stroking |
| indications for a stroking massage: | relaxation, pain relief, decrease muscle spasm (slower); invigorating muscle stimulation (more rapid) and increase in blood flow |
| Contraindications for massage? | - large open wounds or burns,
- gross edema - there is danger of splitting the skin,
- cancer in the targeted area,
- marked varicosities in the area to be massaged,
- if area has been irradiated in the past 3-6 months,
- hyperesthesia (those who are very sensitive to touch or very ticklish),
- extremely hairy areas of the body.
- chronic edema in the lower extremities associated with congestive heart failure or other heart conditions. |
| What are the indications for effleurage? | - edema,
- pain,
- muscle spasm,
- superficial scar tissue |
| 4 types of petrissage: | - kneading,
- picking up,
- wringing
- skin rolling. |
| Purpose of petrissage: | mobilize the skin, subcutaneous tissues and deeper muscles. This stroke increases circulation and the return of venous and lymphatic fluids back toward the heart, can decrease edema, more rapid elimination of waste products, mobilizes scar tissue, reduces muscle spasm and promotes relaxation. |
| Indications of petrissage: | - chronic edema,
- chronic pain,
- scar tissue,
- contractures |
| indications for tapotement: | - chronic chest conditions such as cystic fibrosis,
- to provide a good stimulating massage to the body,
- to relieve neuralgia post amputation,
- trauma or other pathological process |
| 4 types of tapotement: | - pounding
- beating
- hacking
- clapping |
| small accurately localized, deeply penetrating movements performed in a circular or transverse direction, usually performed by the finger tips or the thumb with the primary purpose of immobilizing soft tissues. | Deep friction massage |
| A mechanical force that increases external pressure on the body or body part. | Compression |
| what is compression used for? | 1. to improve fluid balance and circulation
2. to modify scar formation |
| What is the goal of compression? | To increase the pressure outside the vessels in tissue creating a reversal or at least a decrease in fluid leaving the vessels and collecting interstitial space. |
| Effects of external compression: | - Effects depend on compression device used and amount of pressure applied
- improves circulation; intermittent more than static, fluids within the vessels are forced proximally
- improved circulation benefits pts with edema, helps prevent formation of DVT’s and may facilitate the healing of wound ulcers
- can help shape a limb or residual limb
- increases skin temp |
| Clinical indications for external compression: | - Edema
- prevention of DVTs
- venous stasis ulcers
- residual limb shaping post amputation
- controlling hypertrophic scarring |
| Caused by an accumulation of fluid in interstitial spaces outside vessels and cells. Causes include venous or lymphatic insufficiency or obstruction, increased capillary permeability, and increased plasma volume due to sodium and water retention. Can also follow trauma and acute inflammation or be a result of inactivity or pregnancy. | Edema |
| Most common cause of venous insufficiency? | Phlebitis or inflammation of the veins. |
| Causes a thickening of the vessel walls and damage to the valves. Result is elevated fluid pressure in veins = edema | Phlebitis |
| Edema in the lymphatic system | Lymphedema |
| Adverse consequences of edema: | - Decreased ROM
- pain
- impaired function
- disfigurement and altered appearance
- increased risk of infection
- itching and browning of skin
- ulcerations |
| How does compression reduce edema? | Increases extravascular pressure |
| Blood clot in a vein. Increased with inactivity - less blood flowing through vein with increased tendency to coagulate and form a clot. | Deep Vein Thrombosis |
| Risks for DVT: | - older age
- inactivity
- surgery
- trauma
- hospital or nursing home confinement
- cancer
- central vein catheterization
- transvenous pacemaker
- varicose veins
- paralysis
- oral contraceptives
- pregnancy
- hormone therapy |
| Characteristics of DVT: | - pain
- swelling
- skin changes in area |
| Prevention for DVT: | - Compression stockings
- intermittent pneumatic compression
- calf muscle e-stim
- anticoagulant meds |
| Areas of tissue breakdown and necrosis occurring as a result of impaired venous circulation. Compression increases rate of healing and is identified as the most important intervention for healing. | Venous stasis ulcers |
| What is used for residual limb shrinking? | Ace bandaging or limb shrinkers |
| Results from burn injuries or extensive trauma and scarring used in conjunction with compression. | Hypertrophic scarring |
| How long is compression used for hypertrophic scarring? | 8-12 months, or 1-2 years |
| How often are compression garments supposed to be worn? | 23/24 hours of the day, removed for bathing |
| Contraindications for external compression (mechanical): | - Heart failure more pulmonary edema
- DVT, thrombophlebitis, or pulmonary embolism
- obstructed lymphatic or venous return
- hardening of the arteries
- skin infection
- Hyponatremia
- acute trauma or fracture
- arterial revascularization |
| Precautions for external compression (mechanical): | - Impaired sensation or mentation
- uncontrolled hypertension
- cancer
- stroke |
| Adverse effects of external compression: | - Aggravation of condition being treated with compression
- impairing circulation if too much pressure is used |
| Application techniques for compression: | - Compression bandaging
- compression garments
- intermittent pneumatic compression pump |
| Figure eight moving distal to proximal. Greater tension distally to proximally. | Compression bandaging |
| Can be purchased off the shelf or custom made. 20-30 mmhg pressure used for scar control and 30-40 mmhg used for edema control. | Compression garments |
| Hose pumps air intermittently into a closed chamber placed around a limb. | Intermittent pneumatic compression pump |
| What is the inflation time for compression pumping? | 80-100 seconds |
| Deflation time for compression pumping? | 25-35 seconds
3:1 ratio |
| Inflation pressure for compression pumping? | - 30-60 mmhg for upper extremities
- 40-80 mmhg for lower extremities
- below pts diastolic blood pressure |
| Treatment time for compression pumping? | 1-4 hours from several times a day to several days a week |
| Application technique for compression pumping: | 1. determine contraindications
2. remove jewelry and clothing
3. inspect skin, elevate extremity
4. assess pts BP
5. take and record circumferential measurements
6. place a stockinette over limb
7. apply pump sleeve
8. attach pump to sleeve
9. adjust parameters on unit
10. call bell
11. monitor pt during treatment, including BP
12. end of treatment - reassess skin, remeasure, apply compression garment or bandage
13. document |
| Advantages of compression pumping: | - Actively moves fluid and therefore may be more effective than static devices
- compression quantifiable
- can provide sequential compression
- required less finger and hand dexterity to apply than compression bandages and garments
- can be used to reverse and control edema
- use can be supervised in a pt shoes noncompliant with static compression |
| Disadvantages of compression pumping: | - Used only for limited times during the day and therefore not appropriate for modification of scar formation
- generally requires a static compression device to be used btw treatments
- expensive to purchase unit or to pay for regular treatments in clinic
- requires moderate comfort using machinery to apply
- requires electricity
- extremity can’t be used during treatment
- pt can’t move during treatment
- pumping motion of device may aggravate an acute condition |
| What are you looking for in an analysis of stance phase? | - Heel strike
- foot flat
- midstance
- heel off
- toe off |
| What are you looking for in analysis of swing phase? | - Acceleration
- midswing
- deceleration |
| Hip flexion ROM for normal gait? | 0-30 degrees |
| Hip extension ROM for normal gait? | 0-10 degrees |
| Knee flexion ROM for normal gait? | 0-60 degrees |
| Knee extension ROM for normal gait? | 0 degrees (full) |
| Ankle DF ROM for normal gait? | 0-10 degrees |
| Ankle PF ROM for normal gait? | 0-20 degrees |
| What is the peak activity of tibialis anterior during gait? | Just after heel strike |
| What is the peak activity for Gastroc-soleus during gait cycle? | During late stance phase |
| 3 types of electrical current waveforms: | - direct current (dc),
- alternating current (ac)
- pulsed current (pc). |
| an interrupted flow of charged particles where the current flows in a series of pulses separated by periods where no current flows. Used for pain control, tissue healing, and muscle contraction and is the waveform most commonly used for electrical stimulation (in the form of biphasic) | Pc - pulsed current |
| a waveform with specific parameters initially intended for quad strengthening. Used earlier to train russian olympic athletes. Medium frequency ac with a frequency of 2500 hz delivered in 10 ms long bursts. 50 bursts per second with a 10 ms interburst interval between bursts. Also known as medium frequency burst. Used for muscle reeducation and strengthening. | Russian protocol |
| two types of pulsed current: | - monophasic
- biphasic |
| • How long each pulse lasts, usually measured in microseconds.
• Shorter durations = used for pain control
• Longer pulse durations = needed to produce muscle contractions | pulse duration or pulse width |
| The number of cycles or pulses per second and is measured in hertz (hz) or pulses per second (pps). | Frequency or rate (used interchangeably) |
| The magnitude of the current or voltage = think of this as the intensity or strength of the current. | Amplitude |
| - current is flowing,
- produces a muscle contraction
- expressed as a ratio | on time |
| - no current is flowing,
- allows the muscle to relax and recover
- expressed as a ratio | off time |
| What is the ratio for on:off time? | 1:5 |
| - the amount of time it takes for the current amplitude to increase from zero to its maximum amplitude.
- usually included in the on time | ramp up |
| - the amount of time it takes for the current amplitude to decrease from its maximum amp down to zero.
- usually included in the off time. | ramp down |
| sodium channels open and sodium rushes into the cell and reverses the charge inside the cell to more positive. When the membrane potential reaches +30mv an impulse is propagated along the axon | depolarization |
| Potassium ions then rush into the cell, occurs back to -60 to -90mv. | repolarization |
| the process by which a nerve gradually becomes less response to stimulation. | Accommodation |
| what type of stim is used for innervated muscles? | nmes or neuromuscular electrical stimulation |
| What type of stim is used for denervated? | ems or electrical muscle stimulation |
| Adverse effects of electrical currents: | 1. Burns
2. Skin irritation
3. Painful or uncomfortable for some patients. |
| what type of electrode is most commonly used? | disposable and have a self-adhesive gel coating that serves as the conduction medium. |
| Which electrodes target smaller areas? | smaller electrodes |
| What should be documented for estim? | 1. Area of body treated
2. Patient position
3. Parameters
4. Electrode placement
5. Treatment duration
6. Patient's response |
| produce lower force contractions but have more endurance and fatigue slower than fast-twitch type ii muscle fibers; they are also atrophy resistant | Slow-twitch type i muscle fibers |
| used for denervated muscles. This usually involves dc applied for a number of seconds in order to produce a muscle contraction. It has been suggested that this stim can retard or reverse muscle atrophy. Used for a long time for bell's palsy. | Ems = electrical muscle stimulation |
| There are a number of pulses in each burst | Burst rate tens |
| What is the on/off time for tens? | Delivered continuously with no off time |
| How often is tens used? | Used whenever the patient is in pain |
| How is the electrode placed for estim for wound management? | place saline soaked gauze in wound and then place self-adhesive electrode or carbon electrode over that. |
| - Low intensity dc to deliver a drug across the skin.
- Based on the fact that like charges repel one another.
- Current essentially pushes a drug through the skin
- Studies suggest that this only occurs in the outermost layer of the skin
- Most commonly used drug in ionto: dexamethasone follwed by lidocaine | Iontophoresis |
| What is the treatment time and dosage used for 1 amplitude during iontophoresis? | Treatment time: 40 min
dosage: 40 ma-min |
| What is the treatment time and dosage used for 2 amplitude during iontophoresis? | Treatment time: 20 min
dosage: 40 ma-min |
| What is the treatment time and dosage used for 3 amplitude during iontophoresis? | Treatment time: 13.3 min
dosage: 40 ma-min |
| What is the treatment time and dosage used for 4 amplitude during iontophoresis? | Treatment time: 10 min
dosage: 40 ma-min |
| a mechanical force that increases external pressure on the body or body part. | compression |
| What two pressures are used during compression therapy? | - static
- intermittent |
| when is deep vein thrombosis increased? | with inactivity – less blood flowing through vein with increased tendency to coagulate and form a clot. |
| What amount of pressure is used for scar tissue control? | 20-30 mm hg |
| certain soft tissue manipulation techniques, most often performed with the hands, performed for a wide variety of purposes. | massage |
| Equipment needed for massage: | 1. Hands used by an intelligent mind
2. Treatment table that is adjustable in height
3. Pillows, prone pillow
4. Draping materials – sheets
5. Towels and lubricants |
| Different types of lubricant used for massage? | - powder
- creams or lotions
- oils
- soap and warm water |
| What type of powder is used for massage and what are the pros and cons? | - lightly or unscented baby power, for example.
- Pros = therapist hands don't get oily and slippery.
- Cons = messy, gets on everything, not good to breathe and slippery if it gets on the floor. |
| What type of creams or lotions are used for massage and what are the pros and cons? | - lanolin, vitamin e, moisturizing creams.
- Con = can absorb into therapist's skin and become sticky |
| What type of oils are used for massage and what are the pros and cons? | - baby oil, olive oil, almond, palm, avocado.
- Con = makes therapist's hands slippery; more difficult to remove |
| what is soap and warm water used for during massage? | To remove dead skin from an area that was casted |
| toward the heart which is the direction of venous and lymphatic flow | centripetal |
| away from the heart in the direction of arterial flow | centrifugal |
| What is the frequency of a massage intervention? | can be provided daily or several times a day as indicated |
| What should be documented after a massage? | Observe how the patient responded to intervention and record what you did |
| performed with the entire palmar surface of one or both hands or thumb pads or fingers moving in any direction on the surface of the body. | stroking |
| type of stroking that uses great pressure and usually slower; tends to stimulate circulation in deeper tissues and for this reason, is usually given in the direction of venous and lymphatic flow. | deep stroking |
