Modalities test 1

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lrfrank
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203888
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Modalities test 1
Updated:
2013-02-27 17:36:20
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modalities
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ch 1-7
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  1. forms of energy
    • electromagnetic
    • acoustic
    • thermal
    • mechanical
  2. relationship between wavelength and frequency
    inverse or reciprocal
  3. Energy of a photon is ____ to its frequency
    • directly proportional
    • higher frequency=higher energy
  4. Spectrum of visible light
    • (infrared)
    • Red
    • Orange
    • Yellow
    • Green
    • Blue
    • Violet
    • (ultraviolet)
  5. Electromagnetic spectrum (longest wavelength--> shortest)
    • Electrical stimulating currents
    • commercial radio and TV
    • shortwave diathermy
    • microwave diathermy
    • Infrared
    • visible light
    • ultraviolet
    • ionizing radiation
  6. what electromagnetic current has the greatest depth of penetration
    shortwave diathermy
  7. relationship between wavelength and penetration
    longer wavelength=greater penetration
  8. Arndt-shultz principle
    no changes or reactions can occur in the tissues unless the amount of energy absorbed is sufficient to stimulate the absorbing tissues
  9. Law of Grotthus-Draper
    if the energy is not absorbed it must be transmitted to the deeper tissues
  10. Cosine law
    the smaller the angle between the propagating radiation and the right angle, the less radiation reflected and the greater absoption
  11. Inverse square law
    the intensity of the radiation striking a surface varies inversely with the square of the distance from the source
  12. Diathermy
    • can be shortwave or microwave
    • high frequency electromagnetic energy
    • used primarily to generate heat in tissue (continuous)
    • can also produce non-thermal effects (pulse)
  13. Low-power LASER
    • Light Amplification by Stimulated Emission of Radiation
    • produces no thermal effects
    • promotes fracture healing
    • effective for pain management
  14. Ultraviolet therapy
    • physiologic effects that are chemical in nature
    • effects occur entirely in cutaneous layers of skin (very supeficial)
    • maximum depth of penetration=1mm
  15. Electrical stimulating currents
    • modulate pain
    • produce muscle contraction and relaxation
    • facilitate soft-tissue and bone healing
    • produce net ion movement
  16. Acoustic energy
    • pressure waves due to mechanical vibrations of particles at cellular level
    • Cannot travel through space
  17. Ultrasound
    • "deep heating" modality
    • mechanical vibration
    • depth of penetration is much greater than with electromagnetic radiations
    • also produce non-thermal effects capable of enhancing healing at the cellular level
  18. Extracorpoal Shock Wave Therapy
    • Treats soft-tissue and bone injuries
    • Pulsed high-pressure short duration sound waves
    • treats: plantar fasciitis, epicondylitis, non-union fractures
    • Expensive and is often inaccessible for clinicians
  19. Potential Energy
    stored by an object and has the potential to be created when that object is stretched, bent or squeezed
  20. Kinetic Energy
    Energy of motion
  21. Primary injury
    occur from trauma or overuse
  22. Macrotraumatic Injuries
    • Result of trauma, produce immediate pain and disability
    • Ex: fractures, dislocations, subluxations, sprains, strains and contusions
  23. Microtraumatic Injuries
    • Often called overuse injuries- result of repetitive loading or incorrect mechanics
    • Ex: tendinitis, tenosynovitis, bursitis
  24. Secondary injury
    Inflammatory or hypoxia resulting from primary injury
  25. Phases of the healing process
    • Inflammatory-Response Phase
    • Fibroblastic-Repair Phase
    • Maturation-Remodeling Phase
  26. Signs of inflammation
    • redness
    • swelling
    • tenderness to touch
    • increased temperature
    • loss of function
  27. Inflammatory-Response phase
    • Sx: swelling, pain, warmth, and creptius
    • Injury is walled-off
    • Sets stage for fibroblastic-repair phase
    • Lasts 2-4 days after initial injury
  28. Chemical mediators released during inflammatory response phase
    • Histamine: vasodilation & increased cell permeability
    • Leucotaxin: margination (leukocytes line cell wall) and increased cell permeability-> forming exudate
    • Necrosin: turns on phagocytes
  29. Vascular reaction during inflammatory-response phase
    • initially- vasoconstrict
    • then vasodilate
  30. Chronic inflammation
    • occurs when acute response does not eliminate injuring agent
    • Damage occurs to connective tissue resulting in necrosis and fibrosis --> prolongs healing process
    • No specific time frame for transition of acute to chronic inflammation
  31. Fibroblastic-Repair phase
    Proliferative, regenerative activity leading to a period of scar formation (fibroplasia) and repair of injured tissue
  32. Fibroplasia
    • Begins within the first few hours following injury
    • Signs of inflammation subside
    • Pain with movement that stresses injured area
    • May last 4-6 weeks
  33. Collagen Formation
    • occurs at day 6 or 7 of fibroblastic repair phase
    • Deposited randomly throughout the scar
    • Tensile strength increases proportionally to collagen synthesis
    • Mature scar is devoid of physiologic function
    • Less tensile strength and not well vascularized
  34. Maturation-Remodeling Phase
    • Realignment of collagen fibers along lines of tensile force
    • Ongoing breakdown/synthesis of collagen
    • May require several years to complete
  35. Factors that impede healing
    Extent of injury, Edema, Hemorrhage, Poor vascular supply, Separation of tissue, Muscle spasm, Atrophy, Corticosteroids, Keloids and hypertrophic scars, Infection, Humidity/climate, Age/health
  36. Minimize the early effects of excessive inflammation  by:
    • Controlling edema
    • Modulating pain
    • Facilitating healing
  37. Cryotherapy
    • Decreases metabolism to control secondary hypoxic injury
    • Analgesia (numb/pain reducer)
    • Possibly cause vasoconstriction
    • Avoid cold bath and gravity dependent position during initial healing
  38. What can be used to modulate pain
    • Cold
    • Electrical stimulating currents (avoid generating muscle contractions- may increase clotting time)
  39. What can be used to facilitate healing
    • Low power LASER
    • Low intensity ultrasound (non-thermal)
  40. What to use during Inflammatory-response phase
    • Intermittent compression
    • Incorporate active and passive ROM exercise
  41. What to use during fibroblastic-repair phase
    • When swelling ceases, can go from cold-> heat
    • Intermittent compression
    • Electrical stimulating currents
    • ROM and strengthening exercises
  42. What to do during maturation-remodeling phase
    • Heating modalities are beneficial
    • Deep-heating modalities (ultrasound, shortwave and microwave diathermy used to increase circulation to deeper tissues)
    • Superficial heating modalities are less effective
  43. Wolff's Law
    Bone and soft tissue will respond to the physical demands placed on them causing them to remodel along lines of tensile force
  44. 6 types of pain
    • Acute
    • Chronic
    • Persistent
    • Referred
    • Radiating
    • Sclerotomic (pain associated with a segment of bone innervated by a spinal segment that is a deep somatic pain)
  45. Visual analogue scales
    Line 10 cm long, put line where pain is
  46. Pain Charts
    used to establish spatial properties of pain
  47. McGill Pain Questionnaire
    78 words that describe pain are grouped into 20 sets and divided into 4 categories
  48. Activity Pain Indicators Profile
    64 question, self-report tool used to assess functional impairment associated with pain
  49. Numeric Pain scale
    Rate pain 1-10
  50. Goal in managing pain
    "to control acute pain and protect patient from further injury while encouraging progressive exercise in a supervised environment"
  51. Accommodation
    Decline in generator potential and reduction of frequency that occurs with prolonged or repetitive stimulus
  52. Afferent
    nerve fibers transmit impulses from the sensory receptors toward the brain
  53. Efferent
    such as motor neurons transmit impulses from the brain toward the periphery
  54. First order neurons
    (primary afferents) transmit impulses from the sensory receptor to the dorsal horn of the spinal cord
  55. Types of first order neurons
    • Aα - large diameter afferent
    • Aβ - large diameter afferent
    • Aδ - small, slower (acute pain)
    • C - small, slower (chronic pain)
  56. Second order neurons
    • carry sensory messages up the spinal cord to the brain
    • categorized as wide dynamic rang or nociceptive specific
  57. Nociception steps
    • Substance P (prostaglandin) leukotrines released following injury
    • Sensitizes nociceptors by lowering depolarization threshold
    • Referred to as primary hyperalgesia= enhances pain response
    • Secondary hyperalgesia occurs as chemicals spread, increasing size of painful area
  58. Third order neurons
    project to sensory cortex or other centers in CNS
  59. 3 mechanisms of pain control
    • Gate control theory
    • Descending mechanism (central biasing)
    • Release of endrogenous opoids (β- endorphin)
  60. Gate control theory
    • use of non-nociceptive stimulus to inhibit pain
    • Information from ascending Aβ afferents blocks transmission of pain messages carried along Aδ and C afferent fibers from entering dorsal horn
  61. Descending pain control
    • Theorized that pervious experiences, emotions, sensory perception could influence transmission and perception of pain
    • Pain reduction pathway involves dorsal lateral projection from cells in PAG
  62. β-Endorphin and Dynorphin
    • stimulation of Aδ and C afferents can stimulate release of endogenous opoid
    • β-endorphin released into blood from anterior pituitary gland
    • Dynorphin released from periaqueductal grey
  63. Pain management: therapeutic modalities can be used  to:
    • Stimulate large-diameter afferent fibers
    • Decrease pain fiber transmission velocity
    • Stimulate small-diameter afferent fibers and descending pain control mechanisms
    • Stimulate release of endogenous opioids through prolonged small diameter fiber stimulation with TENS

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