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Dependent Transfers
- Three Person carry lift
- two person lift
- dependent squat pivot (can't stand independently but can bear some weight)
- hyraulic lift
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Assisted Transfers
- Sliding Board Transfer
- Stand Pivot Transfer
- Stand Step Transfer
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Wheelchair Measurments
- Seat depth: posterior buttock to popliteal fold then -2 (avg. 16)
- seat width: widest aspect of butt of hips +2 (avg. 18)
- back height: seat of chair to floor of axilla with shoulder flexed to 90' then -4 (avg. 16-16.5)
- armrest height: seat of chair to olecranon process with arms flexed to 90' +1 (avg. 9" above chair)
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Different Assistive Devices
- HAVE ELBOW FLEXION BE TO 20-25'
- parrallel bars: max stability and security for pt
- walker: three point gait pattern, all levels of weight bearing
- axillary crutches, crutch height 3 finger widths from axilla, 2 point, 3 point, 4 point, swing to and swing through gait
- loftstrand crutches: highest level of coordination, all levels of weight bearing, all gait patterns
- cane: provides minimal stability, opposite side of involved extremity
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weight bearing status
- non-weight bearing: unable to place any weight through involved extremity
- toe touch weight bearing: place toes on the ground to assist with balance
- partial weight bearing: amount of weight bearing expressed as pounds or percent
- weight bearing as tolerated: proper amount of weight based on comfort (minimal to full)
- full weight bearing: can put full weight through extremity
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Feeding Devices
- NG Tube: through nostril into stomach, for short term feeding
- G tube: inserted through small incision in the abdomen into the stomach, long term feeding
- J tube: tube inserted through endoscopy into the jejunum via abdominal wall, long term feeding
- IV: sterile fluid source, a pump, a clamp, catheter into vein
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Monitoring Devices
- Arterial line: measure blood pressure and obtain blood samples
- central venous pressure catheter: measures pressure in R atrium or superior vena cava by indwelling venous catheter a pressure manometer, evaluates R ventricular function, R atrial filling, & circulating blood volume
- Hickman (indwelling R atrial catheter): inserted through cephalic or internal jugular vein and threaded into superior vena cava & R atrium, long term administration of substances into venous system (chemo)
- Intracranial pressure: measures the pressure exerted against the skull using pressure sensing devices placed inside the skull
- Oximeter: determines O2 sats of blood in finger or ear
- Pulmonary artery catheter (swan ganz): soft, flexible catherter that is inserted through vein into pulmonary artery, provides continuous measures of pulm. artery pressure... avoid excessive movement of head, neck and extremities if have this
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Oxygen Therapy
- nasal cannula: into nostrils, capable of delivering up to 6 L of O2 per minute
- oronasal mask: facepiece designed to cover the nose & mouth, can deliver medications, mucolytic detergents of humidity
- tent: canopy placed over the head and shoulders
- tracheostomy mask: placed over a stoma & tracheostomy for giving supplemental oxygen
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Catheters
- External catheter: applied over shaft of penis
- foley catheter: indwelling urinary catheter
- suprapubic catheter: indwelling urinary catheter that has to be surgically inserted
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Diagnostic Tests
- Arteriography: visualizes radioopaque dye in artery, sees arteriosclerosis, tumors, or blockages
- arthrography: invasive test w/ contrast medium to joint structures through raiograph, identifiies leakage of joints from hip, knee, ankle,elbow, and wrist
- bone scan: invasive test to see stress fractures, infections, and tumors, can identify 4-7% bone loss
- computed tomography: cross-sectional images with X-ray, for spinal lesions and diagnostics in brain
- doppler ultrasound: non-invasive, looks at blood flow in veins & arteries
- electrocardiography: electrical activity of heart, identifies conduction abnormalities, cardiac arrythmia, and MIs
- electrocephalography: recording of electrical activity of brain, looks at seizures, metabolic disorders, and cerebellar lesions
- electromyography: electrical activity of selected muscle or muscle group
- MRI: non-invasive looking at bone and soft tissue, looks at muscle, menisci, ligaments, tumors, internal organs
- myelography: invasive test using fluroscopy and radiography to look at subarachnoid space
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Principles of heat Transfer
- conduction: heat/cold transfer from direct contact (hot pack, cryo cuff, paraffin, ice massage)
- convection: air or water moving in constant motion over body (fluidotherapy, whirlpool)
- conversion: nonthermal energy absorbed into tissue and transformed into heat (diathermy & ultrasound)
- evaporation: absorbs energy and changes form into vapor (vapocoolant spray)
- radiation: direct transfer of heat from radiation energy source of higher temp to one of cooler (infrared lamp, laser, UV light)
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Cryotherapy
- therapeutic effects: decreased blood flow, decreaesed edema, decreased metabolic rate, decreased nerve conduction velocity, decreased tone, increased pain threshold
- indications: abnormal tone, acute/chronic pain, acute/subactue inflammation, bursitis, spasm, tendonitis, trigger points, tendonitis
- contraindications: cold intolerance, infection, comprimised circulation, regenerating peripheral nerves, peripheral vascular disease, raynauds, skin anesthesia
- sensations of cold: cold, burning, aching, analgesia
- ice massage: 5-10 minutes
- cold pack: 20 minutes, cools up to 2 cm in depth, can use every 2 hours
- cold bath: 55-64', 15-20 inutes, circumferential cooling
- cryo cuff: combines cold with compression
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Superficial Thermotherapy
- therapeutic effects: dcreased spasm, decreased tone, decreased blood flow, increased capillary permeability, increased collagen extensibility, increased local temp, increased metabolic rate, increased muscle eleasticity, increased nerve conduction velocity, increased pain threshold
- indications: abnormal tone, muscle guarding, spasm, decreased ROM, trigger point, subacute/chronic pain, subacute/chronic inflammation
- contraindications: acute trauma, arterial disease, bleeding, compromised circulation, malignancy, PVD, thrombophlebitis
- heats up to 2 cm in depth
- hot pack: 158-167', 6-8 towel layers, don't lie ON hot pack, check skin in 10 minutes can leave on for 15-20 min.
- fluidotherapy: 100-118', 15-20 minutes, promotes tissue healing, desensitization, edema management
- infrared lamp: enhances soft tissue healing, positioned 20" from source, 15-30 minutes
- paraffin: evenly distributes heat, 113-122', low specific heat
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Deep Thermotherapy
- indications: acute/post-acute conditions, calcium deposits, chronic inflammation, delayed soft tissue healing, dermal ulcers, joint contracture, muscle spasm, trigger points, pain, plantar warts, scar tissue, tissue regeneration
- contraindications: active bleeding, decreased temp sensation, decreased circulation, DVT, infection, malignancy, breast implants, carotid sinus or cervical ganglia, epiphyseal plates in kids, eyes/hearts/genitelia, pregnant women, pacemaker, thrombophlebitis, vascular insufficiency
- Ultrasound: has thermal (100% duty cycle) and non-thermal effects (results occur from cavitation), US has piezoelectric crystal, needs a coupling agent, in water keep .5-3 cm away and wipe away air bubbles, intensity in W/cm2, frequency is in 1 MHz (up to 5 cm) or 3 MHz (1-2 cm), duration usually about 5 minutes
- phonophoresis: uses US to deliver medication
- diathermy: deep heating agent converting high frequency electromagnetic energy into therapeutic heat
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UV light
- therapeutic effects: bacteriocidal effects, exfoliation, facilitate healing, increased pigmentation, epidermis thickening, vitamin D production
- indications: acne, chronic ulcer, osteomalacia, psoriasis, sinusitis, vitamin D production
- contraindications: areas receiving radiation, DM, herpes, pellagra, skin cancer, systemic lupus, TB
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Hydrotherapy
- buoyancy: upward force on the body when immersed in water
- resistance: resistance to movement of the body in water
- specific gravity: specific gravity of water is 1, so a person will usually float if submerged in water
- specific heat: measure of ability of a fluid to store heat
- total drag force: hydromechanic force that normally opposes the direction of the bodys motion
- viscosity: megnitude of cohesive forces between molecules specific to the fluid
- advantages: decreased weight bearing, enhanced control over resistance, diminished risk of falling
- patient type: arthritis, musculoskeletal injuries, neuro defects, SCI, CVA, MS, cardiopulm
- 79-92' typically temp of pool for exercises, 92-96' for wond care or spasticity
- increased risk of fainting in water due to hypotension, especially if on beta blockers
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Contrast bath
- 104-106' degrees for 3-4 minutes
- 50-60' for 1 minutes
- 25-30 minutes total
- alternating vasodialation/constriction allows the benefits of heat without the risk of increased edema
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Traction
- therapeutic effects: decreased disk protrusion, decreased pain, decreased joint mobility, increased muscle relaxation, increased soft tissue elasticity, arterial/venous/lymph flow
- indications: disk herniation, jt hypomobility, muscle guarding/spasm, narrowing of intervertebral foramen, nerve root impingement, osteophyte formation, spinal ligament and connective tissue contracture, subacute jt inflammation, subacute pain
- contraindications: acute inflammation, aortic aneurysm, bone disease, dislocation, fracture, hiatal hernia, meningitis, osteoporosis, peripheralization of symptoms, + alar ligament or vertebral artery test, pregnancy, advanced RA, vascular conditions, tumors
- patient position for lumbar: extended (prone) gives greater seperation of anterior structures like disk space, flexed position (supine) gives greater seperation to posterior structures like facet joints and intervetebral foramen
- apply harness directly to skin
- static vs/ intermittent: static if movement increases pain
- lumbar force: 25% for soft tissue stretch, or 50% body weight for actual seperation, 5-30 minutes
- cervical force: 7-10% (11-15 lbs) for stretch, 13-20% (20-30lbs)for distraction
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Compression
- THerapeutic effects: control of peripheral edema, manage scar formation, prevent DVT, promote lympatic/venous return, shaping of residual limb
- indications: edema, hypertrophic scarring, lymphedema, new residual limb, risk for DVT, stasis ulcer
- contraindications: circulatory obstruction, DVT, heart failure, infection of treated area, malignancy of treated area, unstable or acute fracture, pulmonary edema
- compression bandages: greater pressure distally than proximal, figure eight pattern
- compression garments: control edema, limit scar formation, improve venous return, 20-30 mmHg for scar formation, 30-40 mmHg for edema
- intermittent compression: ranges from 30-80 mmHg, DO NOT exceed pt's diastolic BP, 30 -60 minutes
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Electrotherapy principles
- therapeutic effects: decreased edema and pain, eliminate disuse atrophy, facilitate bone repair & wound healing, improve ROM, increase local circulation, muscle re-ed, muscle strengthening, relax muscles
- indications: bells palsy, decreased ROM, facial neuropathy, fracture, joint effusion, labor and delivery, muscle atrophy/spasm/weakness, open wound/ulcer, pain, stress incontinence, shoulder sublux
- contraindications: cardiac arrythmia, pacemaker, malignancy, osteomyelitis, pregnant uterus, over carotid sinus, seizure disorder
- current: direct (often used with ionto) or indirect, milliamps
- amplitude: magnitude of current, volts or microvolts
- rise time: time to go from zero to peak intensity, nano or milli seconds
- phase duration: amount of time for one phase or a pulse
- electrode placment: monopolar (stimulating electrode over target area and other is away from site), bipolar (two electrodes placed over active area
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Different times of E-Stim
- NMES: used to facilitate skeletal muscle activity, usually want about 20 contractions
- conventional TENS: short duration (50-100 usec), high frequency (30-150 pps), low amplitude, most often for pain relief
- acupuncture like TENS: long duration (100-300 usec), low frequency (2-4 pps), moderate current amp, most often for longer lasting pain relieve
- Brief intense TENS: long duration (150-500usec), high frequency (60-200 pps), moderate amplitude, minimized pain during therapeutic activities
- Noxious TENS: administered with a probe and generally uncomfortable of painful
- interferential: bipolar (2 electrodes) or quadripolar (4 electrodes
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Iontophoresis
- ions introduced into body through skin by continous direct current E-steim
- like charges repel
- positive pole (anode)
- negative pole (cathode)
- measured in milliamp minutes, dosage ranges from 40-80 mAmin
- 40 mA min could be delieved in 10 min if current amplitude is 4 mA
- electrode containing the ion soluation is the active electrode and should be put over specific spot
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EMG reading
- evaluates motor units (anterior horn cell, neuromuscular junctions, and muscle fibers innervated by unit)
- abnormal potentials include: fibrillations (indicate LMN), positive sharp wave (denervated muscle disorders at rest), fasiculations (degeneration of anterior horn, nerve root compression), repetitive discharges (myopathies), volunatary polyphasic potentials (myopathies)
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Massage
- Therapeutic effects: decreased anxiety/tension, altered pain transmission, decreased muscle spasm/atrophy, improved circulation, facilitate healing, increased lymph circulation, loosen adhesions, reduce edema, relax, remove metabolic waste
- indications: adhesion, busitis, decreased ROM, edema, intermittent claud, migraine, muscle spasm/cramping, pain, raynauds, scar tissue, trigger point, tendonitis
- contraindications: acute injury, arteriosclerosis, cancer, cellulits, embolus, infection, thrombus
- effleurage: produces reflexive response, beginning and end of massage, strokes directed toward heart
- friction: small cicular motions over trigger point or spasm
- petrissage: kneading to improve lymph return and facilitate removal of metabolic waste, perform distal to proximal
- tapotement: rapid alternating movements, tapping, cupping, or slapping
- vibration: rapid, shaking motion
- back takes 15 minutes, smaller area 8-10 minutes
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