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What are the 2 primary modalities that are considered deep heating agents?
- microwave
- shortwave diathermy - ultrasound
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What is the temp range for cryotherapy?
32-65 degrees F
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What is the difference b/t hot and cold therapy in terms of depth of penetration?
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Are cold or hot modalities more penetrating and have longer lasting effects?
cold
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Why is patient education important with the home use of thermal agents?
- thermal agents can cause frostbite or burns depending on the modality used
- CBAN explained
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Why would certain thermal agents be considered contradindicated with a patient who has Raynaud's Phenomenon?
certain thermal agents can't be used for RP b/c cold modalities will send the fingers into a spasm from hyperactivity to the old
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What will be the first affected if cold modalities are used with a patient suffering from Raynaud's Phenomenon?
fingers and toes
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What method of cryotherapy delivers the fastest temperature change?
ice pack with no insulator
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What form of cryotherapy could quickly lead to tissue damage and why?
resuable ice pack b/c they can get below freezing
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When using cold immersion interventions, what special considerations should the PTA consider?
this is the most uncomfortable and the PTA should avoid having the patient continually immerse and withdraw the body part b/c this causes more pain
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How might a PTA reduce the risk of any tissue damage when using cold immersion interventions?
- avoid gravity dependent positions b/c this increases the risk for swelling
- avoid subcutaneous nerves
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What is the appropriate temp range for a paraffin bath for a lower extremity?
113 to 121 degrees
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What is the appropriate temp range for a paraffin bath for a lower extremity?
118 to 126 degrees
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Why would you never want to run the whirlpool turbines when there isn't water in the tank?
it will burn up the electric motor
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Which thermal method will increase skin temperature the greatest?
moist heat packs
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What clinical signs indicate that a heat therapy is in excess?
mottling, ghost white areas, and beet red splotches mark the patient's skin
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When placing a swollen foot/ankle in a whirlpool, what may the patient be instructed to do to eliminate the negative effects of dependent position?
ankle pumps
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What are universal contraindications for any heat therapy?
- acute injuries
- neurovascular deficits
- thrombophlebitis which could cause the clot to break free tumors which may cause it to spread
- impaired circulation
- advanced arthritis
- poor thermal regulation
- anesthetic areas
- neoplasms
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What are indications for heat therapy?
- decrease pain
- decrease muscle spasm
- increase ROM
- sub-acute or chronic inflammatory conditions or pain
- sub-acute or chronic pain or muscle spasms
- decreased ROM
- hematoma resolutions
- joint contractures
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What is the thermal treatment of choice for most acute musculoskeletal injuries?
ice bags
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How many pounds of pressure occluded lymphatic vessels with compression therapy?
30-40 mm Hg
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When treating an edematous extremity, once a compression treatment is completed, what must the PTA remember to help maintain the reduction in edema?
to elevate the extremity
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What does CBAN stand for?
cold, burning, achy, numb
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Why is it important for the patient to understand CBAN?
so the patient understands the physiological effects that are feeling are normal so treatment may be more tolerable
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What must the PTA remember when working with patients who have worked thru CBAN?
repeated exposures can decrease the sensory and effective response to cold applications
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What does RICE stand for?
rest, ice, compression, elevation
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What one major positive effect may both heat and cold therapies produce?
reduce pain perception by increasing the pt's pain threshold
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When using a whirlpool, what different conditions are treated with what temp ranges?
- (1) wound cleansing - 96 to 98 degrees F
- (2) decreased ROM - 90 to 102 degrees F
- (3) burns - 90 to 94 degrees F
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What are the optimum pt positions based on the location of any cervical herniated disk?
seated and supine are the most common pt positions
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Why is supine more optimum than seated lbased on the location of any cervical herniated disk?
- b/c seated requires first overcoming force of gravity before therapeutic forces are placed on the cervical region
- supine positioning allows cervical musculature to relax, therefore requiring a lower amount of tension to obtain therapeutic effects
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What is the line of pull for tractions based when dealing with any cervical herniated disk?
- pain relief obtained (extension, neutral, or flexion)
- whether it was an anterior or posterior herniation
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If you are treating an anterior herniation what form of traction would you avoid?
flexion
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If you are treating a posterior herniation what form of traction would you avoid?
extended position
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What does the cervical spine flexed at approximately 20-30 degrees do?
straightens the normal lordosis
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What does the cervical spine extended do?
creates more lordosis
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What is the opitimum position for lumbar traction?
- derived by trial and error
- depends on pt pathology
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What does an anterior line of pull do in lumbar traction?
increases lumbar lordosis
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What does a posterior line of pull do in lumbar traction?
increases lumbar kyphosis
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What are pelvis traction contraindications?
- actue injury
- unstable spinal segments
- cancer
- meningitis or other disease affecting the spinal cord or vertebra
- extruded disc fragmentation
- advanced disc degeneration or advanced herniation
- spinal cord compression
- rheumatoid arthritis
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What are cervical traction contraindications?
- acute injury
- unstable spine
- diseases affecting the vertebrae or spinal cord
- vertebral factures
- extruded disc fragmentation
- spinal cord compression
- positive vertebral artery test
- condition in which vertebral flexion and/or extension is contraindicated
- osteoporosis
- rheumatoid arthritis
- conditions that worsen after traction treatments or motions
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What are the contraindications that are common to both cervical and pelvis traction?
- acute injury
- diseases affecting the vertebrae or spinal cord
- extruded disc fragmentation
- spinal cord compression
- rheumatoid arthritis
- conditions that worsen after treatments
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What is the vertebral artery test?
clinical test performed prior to cervical traction
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If your patient has a HNP or herniated disk, how long should the treatment session last?
- no longer than 8 minutes (LA)
- 8-10 min (book)
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What medical conditions make inversion traction dangerous for any patient?
- hypertension
- cardiovascular disorders
- glaucoma
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Why is the Saunder's cervical traction harness preferred to the mandible-occipital cervical harness?
place all the force on the skull's occipital bone and the cervical spine can be placed in various degrees of flexion, extension, or lateral bending
MOC harness places too much pressure on the TMJ and may cause discomfort
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What are the indications for traction?
- nerve root decrompression
- herniated or protruding intervertebral disc
- degenerative disc disesase
- muscle spasm
- osteoarthritis
- facet joint inflammation
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What are the precautions for traction?
- discontinue if symptoms increase
- only use continuous traction when motion is contraindicated
- low tension is used when hpermobility is present or if ligamentous damage is suspected
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When is the only time you should use continuous traction?
when motion is contraindicated
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When is low tension traction used?
- when hpermobility is present
- if ligamentous damage is suspected
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What are the contraindications for traction?
- acute injury
- unstable spine
- disease affecting the vertebrae or spinal cord
- extruded disc fragmentation
- spinal cord compression
- RA
- conditions that worsen after treatment
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What are the benefits of continous passive motion machines?
- stimulating tissue remodeling and regrowth of articular cartilage
- accelerating the healing of articular cartilage, tendons, and ligaments
- improves jt nutrition and metabolic activity of articular cartilage
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What are the 3 different types of CPMs?
- free linkage
- anatomic
- non-anatomic
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What are the indications for CPM?
- (1) surgical repair of stable intra-articular or extra-articular jt fx
- (2) jt surgery
- (3) jt arthoplasty
- (4) surgery or chronic pathology to the knee extensor mechanisms
- (5) meniscectomy
- (6) knee manipulations
- (7) jt debridement for arthrofibrosis
- (8) osteochondal repair
- (9) surgical correction of chondromalacia patelle
- (10) jt contractures
- (11) tendon lacerations
- (12) thrombophlebitis
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What are the contraindications for CPM?
- if device is causing an unwanted translation of opposing bones
- overstressing the healing tissue
- unstable fracture
- spastic paralyses
- uncontrolled infection
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What may using CPM with anticoagulation therapy produce?
intracompartmental hematoma or deep vein thrombosis
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Can CPM cause skin irritation from straps or carriage cover?
yes
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What post-op condition is CPM not indicated?
post ACL surgery
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When do the greatest positive tissue healing effects of CPM occur?
w/in the first 3 days of treatment
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When using CPM what must the joint axis align with?
hinges on the CPM cradle
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When using CPM you must adjust the foot plate so that the tibia is in what?
neutral
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When using CPM adjust the machine aligning with the thigh from what?
the ischial tuberosity to the knee and adjust distal portion accordingly
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When using CPM what must you confirm the pt is clear of?
contraindications
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What is the paramter of the CPM do the pt have control over?
paramter of control for the pt is stopping and starting the CPM with handheld control
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Why is a CPM effective in use with a hemiarthosis with pts with hemophilia?
enhances reabsorption of a hemarthrosis bringing the swelling down and disperses blood away from the knee
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When should you use lumbar or pelvic traction?
when there is a lower back prob such as HNP, nerve root compression, DJD, lumbar muscle spasm, osteoarthritis, or facet joint inflammation
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When applying plevic traction, why would you use a split table?
to eliminate friction and allow vertebral separation to occur at a lower applied force
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What are the names of the 3 Swedish massage techniques?
- effleurage
- petrissage
- tapotement
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Which of the 3 swedish massage techniques would be best for applying lotion or a medium?
effleurage
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What massage technique is used to stretch superficial tight muscles or tissue?
effleurage
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What are the contraindications for any massage or soft tissue work?
- acute sprains/strains
- active inflammation
- site of unhealed fx
- open wounds
- phlebitis or thrombophlebitis
- varicose veins
- asteriosclerosis
- cellulitis
- abscess or other forms of infection
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what are the 2 primary types of scoliosis?
functional and structural
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Which type of scolosis may be treated with traction?
functional
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When can traction not be used to treat functional scolosis?
when the vertebral segment is hypermobile such as with spondyloisthesis
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