Student Study Guide - Modalities PDF

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STUDENT STUDY GUIDE: THERAPEUTIC MODALITIES ULTRASOUND GUIDELINES Effects of Temperature increases in Tissue Temperature increase 1.8˚F (1˚C); mild heat 3.6-5.4˚F (2-3˚C): moderate heat 7.2˚F (4˚C); vigorous heat

Effect Increases metabolism, reduces mild inflammation Reduce pain and muscle spasm, increases blood flow Increases ROM and tissue extensibility

Continuous Ultrasound Temperature Changes (per minute) Intensity (W/CM2) Frequency 1MHZ (6cm deep) 0.5 0.07˚F (0.004˚C) 1.0 0.36˚F (0.2˚C) 1.5 0.54˚F (0.3˚C) 2.0 0.72˚F (0.4˚C)

Frequency 3 MHZ (2-3 cm deep) 0.54˚F (0.3˚C) 1.08˚F (0.6˚C) 1.62˚F (0.9˚C) 2.52˚F (1.4˚C)

*These treatments are only valid if using a treatment area no greater than twice the size of the ultrasound head ad moving it no faster than 4cm/sec. The Effects of Thermal and Non-Thermal Ultrasound Thermal Effects Increased extensibility of collagen fibers in tendons and joint capsules Reduced viscosity of fluid elements in the tissues Decreased joint stiffness Reduced muscle spasm Diminished pain perception Increased metabolism Increased blood flow

Non-Thermal Effects Increased histamine release Calcium ion influx Increased phagocytic activity of macrophages Increased protein synthesis Increased capillary density of ischemic tissue Tissue regeneration Wound healing Cell membrane alteration Attraction of immune cells to the injured area Increased fibroblasts Vascular regeneration

*You will always get the non-thermal effects whether using thermal or non-thermal. ELECTROTHERAPY GUIDELINES

Transcutaneous Electrical Nerve Stimulation (TENS) Current type: AC Wave form: Biphasic Effects: Pain relief; afferent nerve stimulation; motor stimulations (at higher amplitudes) Indications: acute pain; chronic pain Contraindications: Do not use on a patient who has a pacemaker or Hx of heart disease; do not treat transthoracic area; discontinue use if a skin irritation develops Parameters/conditions

Pulse rate

Electrode placement

Output intensity

Acute Pain (sensory TENS) Chronic Pain (Motor TENS)

80-200 pps

Directly on the painful area; proximal-distal to pain Motor points, trigger points; proximal-distal to pain

Pleasant tingling w/out contraction To tolerance; needling sensation w/light muscle twitch

1-5 pps

Treatment sequence 15-30 min; 12xs daily 15-30 min; 12xs daily

Onset of relief < 10 min 20-40 min

Duration of relief 30 min – 2 hrs 6-7 hrs

Interferential Current (IFC) Current type: Two ACs crisscross, forming one interference current Wave form: Sine Effects: pain relief; motor stimulations (at higher amplitudes); muscle spasm reduction Indications: Acute pain; chronic pain; pain covering a large area; muscle spasm Contraindications: Do not use on a patient who has a pacemaker or hx of heart disease; do not treat transthoracic area; discontinue use if a skin irritation develops Parameters conditions Acute pain

Carrier Frequency 4,000 – 5,000 Hz

Pulse Rate

Electrode placement Crisscross painful area

Output intensity

Vector

Pleasant tingling w/out contraction

1-10 pps

Crisscross painful area

Pleasant tingling w/out mild twitch contraction

4 pps

Crisscross local trigger points

Moderate visible muscle contraction

Target (specific pain) or sweep to increase treatment area Target (specific pain) or sweep to increase treatment area Target (specific pain) or sweep to increase treatment area

Chronic pain

2,500 Hz

Muscle Spasm

2,500 Hz

80 – 150 pps

Treatment sequence 10-30 min; 34xs daily

Onset of relief Immediatel y

Duration of relief 10 min – 1 hr

10-30 min; 12xs daily

30 min

6-7 hrs

10-30 min; 12xs daily

30 min

6-7 hrs

Neuromuscular Electrical Stimulation (NMES) Current type: AC Wave form: Russian or biphasic Effects: Muscle contraction to increase blood flow; retard atrophy development; decrease or retard neuromuscular inhibitions; increase muscle relaxation, decrease muscle spasm; pain relief Indications: Disuse atrophy; muscle reeducation; muscle spasm; post-acute edema Contraindications: Do not use on a person with a pacemaker; over the heart or brain; over recent or nonunion fx; over potential malignancies Parameters conditions Post- acute edema

Carrier Frequency 5000 Hz

Pulse Rate

Electrode placement

30-50 pps

Bipolar on muscle group proximal to edema

Muscle spasm

5000 Hz

50-70 pps

Muscle reeducation

2,500 – 5,000 Hz

50-70 pps

Bipolar on motor points and muscle spasm Bipolar on motor points and on muscle belly for best contraction

Output intensity Visible muscle contraction

Duty cycle

Ramp

Patient duty

5-10 sec on; 510 sec off

Elevate part

Visible muscle contraction

10 sec on; 10 sec off

Minimum (0.5 sec on; 0.5 sec off) to none 1-2 sec on; 1-2 sec off

Visible muscle contraction

10 sec on; 50 sec off (later in rehab: 10 sec on; 30 sec off)

2-3 sec on; 2-3 sec off

Treatment sequence 10-20 min; 2x daily

Try to relax

10-20 min; daily

Contract on cycle

20 min; daily

High Volt Pulsed Current (HVPC) Current type: AC (monophasic) Wave form: Twin pulse Effects: Wound healing; pain relief (sensory or motor level); muscle contraction for: disuse atrophy; spasm reduction; edema reduction. Indications: Acute or chronic edema; wound healing Contraindications: Do not use on a person with a pacemaker; over the heart or brain; over the lumbar and abdominal area of pregnant women; over potential malignancies; over anterior cervical area. Parameters/conditions Edema control

Polarity Negative

Pulse setting 120 pps

Wound management

Negative to attract fibroblasts; positive to attract macrophages

100 pps

Electrode placement Negative over edema; positive proximal to injury Active electrode in wound or adjacent to wound edges

Output 90% of visible motor threshold Pins and needles; tingle

Iontophoresis Current type: DC Wave form: Rectangular Effects: (depending on drug ion delivered): pain relief; anesthesia; decrease inflammation, decrease the size of calcium deposits Indications: acute and chronic pain; inflammation Contraindications: Do not use with a person who has a pacemaker; damaged or denuded skin on the treatment area; drug allergies to medicine being delivered; recent laceration over treatment area; over the transcranial area; over the orbital region Common Drug Ions Used in Orthopedic Medicine Drug Dexamethasone

Polarity Negative ion

Acetate

Negative ion

Hydrocortisone

Positive ion

Lidocaine

Positive ion

Effect Inhibits the biosynthesis of prostaglandins and various other inflammatory substances thus reducing inflammation Dissolves calcium deposits and scar tissue in soft tissues such as muscles and tendons Inhibits the biosynthesis of prostaglandins and various other inflammatory substances thus reducing inflammation Decrease local pain by blocking nerve impulse transmission

Sample Dose Delivery for Iontophoresis Total Charge 40 mA/min 40 mA/min 40 mA/min

Current (total 1-5 mA) 2 mA 3 mA 4 mA

Time 20 min 13.5 min 10 min

Frequency Every other day; up to 3 weeks Every other day; up to 3 weeks Every other day; up to 3 weeks

*Important notes:  Keep electrodes at least six inches (15 cm) apart from each other  Many electrodes have a maximum delivery dose of 80 mA/min with a negative polarity, max dose of 40 mA/min with a positive polarity  The drug is injected onto the active electrode pad and placed over the target site; saline solution is injected onto dispersive pad and preferably placed over a muscle belly  Lead clips are placed onto like polarities as drug ion charge  Dexamethasone and lidocaine may be used in same treatment with dexamethasone as the active pad and lidocaine as the dispersive pad  If there is no automatic ramp, maximize the patient’s comfort CRYOTHERAPY Effects: reduced tissue temperature, blood flow, cellular metabolism and nerve conduction velocity Application type Ice bag

Ice massage Vapo-coolant spray Cryokinetics

Cryotherapy w/intermittent compression

Parameters 20-30 min on/1-2 hrs off 1 hr off is fine if patient is active in between applications 10-15 min (or until numb) Spray and stretch technique 10-20 min ice immersion 2-3 exercise 3-5 min of re-cooling Repeat* 20 min application Performed 2-3x per day

Indications Acute orthopedic or soft tissue injury

Contraindications Will cause frostbite if applied directly for 1 hr Any patient with Raynaud’s disease, cold hypersensitivity, cardiac disorder, compromised local circulations

Soft tissue injury Myofascial trigger points Ankle, finger, shoulder, and other joint sprains

Anyone that is hypersensitive to cold Anyone that is hypersensitive to cold Any exercise that causes pain, use of ice on a person who is hypersensitive to cold

Posttraumatic and postoperative edema, chronic edema, venous stasis ulcers, persistent swelling caused by venous insufficiency

Compartment syndrome, peripheral; vascular disease, arteriosclerosis, DVT, local superficial injection, edema 2nd to congestive heart failure, ischemic vascular disease, gangrene, dermatitis, acute pulmonary edema, displaced fractures

*Things to remember: ...