Non-Systems- Equipment and Modalities

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BPT
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190314
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Non-Systems- Equipment and Modalities
Updated:
2012-12-28 11:52:45
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Boards Review
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Non-Systems- Equipment and Modalities
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  1. Dependent Transfers
    • Three Person carry lift
    • two person lift
    • dependent squat pivot (can't stand independently but can bear some weight)
    • hyraulic lift
  2. Assisted Transfers
    • Sliding Board Transfer
    • Stand Pivot Transfer
    • Stand Step Transfer
  3. 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)
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. Catheters
    • External catheter: applied over shaft of penis
    • foley catheter: indwelling urinary catheter
    • suprapubic catheter: indwelling urinary catheter that has to be surgically inserted
  10. 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
  11. 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)
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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)
  24. 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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