Physical Agents Exam 2

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Author:
KatyRichman
ID:
298217
Filename:
Physical Agents Exam 2
Updated:
2015-03-11 22:30:32
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Estim traction
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Description:
Tens, NMES, ionto, cerival & lumbar flexion
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  1. what is defined as a flow of charged particles?
    electrical current
  2. is an electrical current composed of electrons or ions?
    it can be either
  3. electrical current is measured in ________.
    amperes
  4. What are some of the reasons you would use estim?
    • muscle strength and re-education
    • pain control
    • facilitate healing
    • edema s/p surgery or injury
    • enhance transdermal drug delivery
  5. what are the different types of estim?
    • nmes
    • fes
    • russian
    • tens
    • ifc
    • hvpc
    • microcurrent
    • ionto
    • biofeedback
  6. T/F: electrical currents depolarize neuron membranes producing an action potential
    true
  7. basic unit of nerve communication is what?
    action potential
  8. when a nerve is at rest and the inside is more negatively charged compared to the outside, this is called?
    resting membrane potential
  9. what is the reversal of the resting potential where the inside becomes more positive compared to the outside?
    depolarization
  10. what is the absolute refracrtory period?
    when no additional action potentials can be generated
  11. according the the strenth duration curve short pulses and low current amplitudes can e used for what type of stimulation?
    sensory
  12. according the strength duration curve longer pulses and higher amplitudes can be used for what type of stimulation?
    motor
  13. what is it called when a nerve becomes less responsive to stimulus?
    accomidation
  14. does accomidation happen fast or slowly?
    slowly
  15. what is propogation?
    the movement of an action potential across an axon, also called conduction
  16. what is salutatory conduction?
    the fast conduction that occurs in myelinated nerves where they jump from node of ranvier to node of ranvier.
  17. do bi-phasic waveforms leave a charge in the tissue?
    no
  18. what is the negative electrode called?
    cathode
  19. what is the positive electrode called?
    anode
  20. do cathodes attract positive or negative ions?
    positive
  21. what is a continuous bi-directional flow of charged particle?
    alternating current
  22. what is AC used for?
    muscle retraining, spasticity, denervated muscles
  23. T/F: pulsed currents can be either monophasic or biphasic?
    true
  24. which type of pulsed current is used for tissue healing and acute edema?
    monophasic
  25. what is produced by interference of 2 medium frequency alternating biphasic waveforms?
    interferential current
  26. number of cycles or pulses per second is called?
    frequency
  27. what is phase duration?
    the duration of one phase of a pulse
  28. what is the time between pulses called?
    interpulse interval
  29. how long can one set of electrodes be used for if they are not single use?
    up to a month unless they are a wooly mammath then maybe sooner
  30. will estim have more of an effect on type 2 or type 1 fibers?
    type 2
  31. do peripheral nerves need to be intact when using NMES?
    yes
  32. what is the purpose for NMES?
    increase strength and improve motor control in pts. with CNS damage
  33. what is FES?
    when you use estim to produce muscle contraction while pt. is performing a functional activity
  34. NMES for strength; is it biphasic or monophasic waveform?
    biphasic
  35. NMES for strength; what is the pulse duration for small muscles?
    150-200 microseconds
  36. NMES for strength; what is the pulse duration for large muscles?
    200-350 microseconds
  37. NMES for strength; what is the pulse frequency?
    35-80pps
  38. NMES for strength; what is the on/off time?
    • 6-10 seconds on
    • 50-120-seconds off
  39. NMES for strength; what is the ramp up time?
    at least 2 seconds
  40. NMES for strength; what is the treatment time?
    10-20 minutes for 10-20 contractions ever 2-3 hours when awake
  41. NMES for neuro re-ed; is it biphasic or monophasic?
    biphasic
  42. NMES for neuro re-ed; what is the pulse duration for small muscles?
    150-200 microseconds
  43. NMES for neuro re-ed; waht is the pulse duration for larger muscles?
    200-350 microseconds
  44. NMES for neuro re-ed; what is the pulse frequency?
    35-50pps
  45. NMES for neuro re-ed; what is the on/off time?
    depends on the functional activity
  46. NMES for neuro re-ed; what is the ramp up time?
    at least 2 seconds
  47. NMES for neuro re-ed; what is the treatment time?
    depends on functional activity, no longer than 20 minutes
  48. NMES spasm; biphasi or monophasic?
    biphasic
  49. NMES spasm; what is the pulse duration for for small muscles?
    150-200 microseconds
  50. NMES spasm; what is the pulse duration for larger muscles?
    200-350 microseconds
  51. NMES spasm; what is the pulse frequency?
    35-50pps
  52. NMES spasm; what is the on/off time?
    • 2-5 on
    • 2-5 off
  53. NMES spasm; what is the ramp up time?
    at least 1 second
  54. NMES spasm; what is the treatment time?
    10-30 minutes ever 2-3 hours until spasm relieved
  55. NMES edema; biphasic or monophasic?
    biphasic or russian
  56. NMES edema; what is the pulse duration for small muscles?
    150-200 microseconds
  57. NMES edema; what is the pulse duration for larger muscles?
    200-350 microseconds
  58. NMES edema; what is the pulse frequency?
    35-50pps
  59. NMES edema; what is the on/off time?
    • 2-5 on
    • 2-5 off
  60. NMES edema; what is the ramp up time?
    at least 1 second
  61. NMES edema; what is the treatment time?
    30 minutes 2X/day
  62. What is tens used for?
    modulate pain
  63. what are the pain fibers?
    • A-delta
    • C fibers
  64. why do we want to activate a-beta fibers?
    because they decrease pain perception
  65. what are the three types of tens?
    • conventional¬†
    • acupuncture
    • burst mode
  66. conventional tens; what type of impulses does it have?
    short duration low amp
  67. conventional tens; pulse frequency
    100-150pps
  68. conventional tens; pulse duration
    50-80microseconds
  69. conventional tens; amp to produce tingling
    10-30 mA
  70. conventinal tens; Treatment time
    can be worn up to 24 hrs at a time
  71. Acu. tens; what type of impulses does it have
    long duration high amp
  72. acu. tens; what never fiber does it stimulate?
    a-delta
  73. acu. tens; pulse frequency
    2-10 pps
  74. acu. tens; pulse duration
    200-300 microseconds
  75. acu. tens; treatment time
    20-45 minutes every 4 hours
  76. burst tens; what type of current does it use?
    burst mode
  77. burst tens; what is the pulse freq. preset at?
    10 bursts
  78. burst tens; pulse duration?
    100-300 microseconds
  79. burst tens; what is the amplitude needed to produce visible contraction?
    30-60mA
  80. burst tens; what is treatment time?
    20-45 minutes every 4 hours
  81. What two types of tens produces endorphin release?
    burst mode and acupuncture
  82. how far away must the tens electrodes be placed?
    1 inch
  83. must tens electrodes intersect like IFC?
    no, but can be parallel or intersect
  84. what estim is used for wound healing
    hvpc
  85. waht are some benefits of HVPC?
    • increased protein syntheisis
    • increased cell migration
    • antibacterial effects
    • increased blood flow
    • improved tissue oxygenation
  86. what is an attraction of cells to an electrical charge?
    galvanotaxis
  87. what are some of the cells that are attracted during galvanotaxis?
    macrophages, lymphocytes, fibroblasts and neutrophils
  88. if you are using HVPC on a wound that has necrotic tissue, would you use a negative or positive charge?
    positive
  89. if you are using HVPC on a wound that has active neutrophils?
    negative
  90. mechanical force applied to the body that separates the jt. surface and elongates the soft tissue?
    traction
  91. the separation of 2 articular surfaces perpendicular to the plane of articulation for the widening of the jt. space?
    jt. distraction
  92. What are the 5 ways traction can affect the spine?
    • jt. distraction
    • reduction of disc protrusion
    • muscle relaxation
    • jt. mobilization
    • soft tissue stretching
  93. what is the max of body weight that you want to use when applying distraction to the lumbar spine?
    50%
  94. what is the max of body weight that you want to use when applying traction to the cervical spine?
    7%
  95. T/F: for soft tissue stretching, traction increases the length of soft tissues for muscles, tendons, ligaments, and discs
    true
  96. what type of load and  force should you use for traction?
    moderate load prolonged force
  97. what involves oscillatory movements that stimulate mechanoreceptos and relaxation of GTO's to inhibit alpha motor neuron firing, and pain-spasm pain cycle?
    intermittent traction
  98. what is static traction?
    when you stretch the muscles for several seconds or longer
  99. in chronic or subacute what type of traction would you most likely use?
    intermittent traction
  100. in the first 1-2 weeks of acute injury/inflammation what type of traction would you apply to the patient?
    static traction
  101. T/F: jt. mobilization is used to increase jt. mobility or to decrease jt. related pain?
    true
  102. intermittent traction is used for what?
    to stimulate mechanoreceptors
  103. what is a higher force traction to stretch soft tissue?
    static traction
  104. disc bulge or herniation
    nerve root impingement
    jt. hypermobility
    subacute jt. inflammation
    paraspinal muscle spasm

    these are clinical indicators for what?
    traction
  105. What is the main issue with a disc bulge or herniation?
    it takes up space that doesnt need to be taken up.
  106. when is traction the most effective when dealing with a disc bulge or herniation?
    soon after the discal injury
  107. knowing what triggers it
    correct posture and body mechanics
    lumbar stabilization
    know how to manage their pain
    gradual return to prior activities

    what are these?
    patient education on how to reduce stress on the spine after traction to decrease the chance or recurrent symptoms.
  108. what can happen if greater effects are applied after an onset of symptoms during traction?
    nerve root impingement
  109. disc bulge or herniation
    ligament encroachment
    narrowing of intervertebral foramen
    osteophytes
    spinal nerve root swelling
    spondylolisthesis

    these are all causes of what?
    nerve root impingement
  110. T/F: patients with deceased pain with spinal unloading may be a good candidate for traction?
    True
  111. is traction effective if an individuals segment is hypermobile?
    no
  112. neutral or increased extension in lumber equals what during traction?
    more localized to lower lumbar area
  113. increased flexion in the lumbar spine during flexion equals what during traction?
    more localized to upper lumbar and lower thoracic spine.
  114. what are some ways that intermittent traction can help with suactue joint inflammation?
    • reduced pressure on enflamed surfaces
    • control pain by gate theory
    • maintain normal fluid exchange to relieve edema
  115. what effect can traction have on the paraspinal muscles if pain is reduced?
    reduce spasms
  116. What are the C's for traction?

    JAW-UP
    • J- joint hypermobility/instability
    • A- acute injury/inflammation
    • W- where motion is contraindicated
    • U- uncontrolled HTN
    • P- peripherilization of symptoms with traction
  117. What are the P's for traction?

    McDD SPITS
    • M-medial disc protrusion
    • c-claustrophobia or psychological aversion
    • D-disorientation
    • D-displaced annular fragment
    • S-structural diseases affecting the spine
    • P-pressure of belts
    • I-inability to tolerate supine or prone
    • T-TMJ or dentures (cervical)
    • S-severe pain fully resolves with traction
  118. T/F: you should keep the force low initially and gradually to increase during traction?
    true
  119. for lumbar positioning, the pt. has a facet jt. problem. what position would you put the pt. in for traction?
    supine with hips flexed
  120. for lumbar position, the patient has discal problem. what position would you put them in for traction?
    prone
  121. for cervical positioning increased flexion equals what during traction?
    increased separation of the posterior structures and force directed to lower facet jt.s and intervertebral foramina.
  122. maximum posterior elongation for the vervical spine is what?
    25-35* flexion
  123. what position should you place the pt. in for cervical traction?
    supine or seated and choose appropriate halter
  124. what are some ways you could do self traction?
    • sitting
    • between corner counters
    • overhead bar
  125. how could you do positional traction?
    by placing tension on one side of lumbar spine
  126. type of traction
    area of body where traction is applied
    pts position
    type of halter if one is used
    max force/min force
    hold/relax time
    total Tx time

    What do all of these things have in common
    everything you document in the objective portion of the SOAP note about the traction intervention of the session.

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