PTA 200
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| 🇬🇧 | 🇬🇧 |
| A flow of charged particles that are either electrons or ions | Electrical current |
| Continuous one directional flow of charged particles. It is used for iontophoresis and for stimulating contractions in denervated muscle. Batteries produce current | Dc - direct current |
| The difference between the carrier frequencies (5100hz minus 5000hz = 100 hz which is felt between the "x" arranged electrodes.) | "beat" frequency |
| The amount of time between pulses. | Interpulse interval |
| Electrical currents depolarize nerve membranes, thus producing action potentials in either sensory or motor nerves. | Stimulation of action potentials |
| -60 to -90 mv (inside of nerve cell more negatively charged) | Resting membrane potential |
| During depolarization (inside of cell is very positive). The nerve cannot be further excited no matter how strong the stimulus is. | Absolute refractory period |
| Where do action potentials travel faster? | In larger diameter myelinated axons than in small diameter or unmyelinated axons. |
| Contraindications for estim: | 1. Cardiac pacemaker or cardiac arrhthmias as the estim may interfere with the pacing of the heart. 2. Over the carotid sinus – anterior or lateral neck as this may cause a rapid drop in bp and cause a syncopal episode. 3. Venous or arterial thrombosis or thrombophlebitis – may increase circulation and risk of the thrombus becoming an embolus. 4. Pelvis, abdomen, trunk and low back area during pregnancy as estim impact on unborn child is not fully known |
| Precautions for estim: | 1. Cardiac disease 2. Impaired mentation or sensatio 3. Malignant tumors 4. Skin irritation or open wounds |
| Electrode placement: | • Should lie smooth against the skin without wrinkles or areas void of medium • Not over bony prominences • The closer electrodes are, the more superficial the current will travel and vice versa |
| What are the types of electrodes? | - disposable - carbon impregnated silicone rubber - conductive fabric |
| Which electrodes tend to be more comfortable but require a higher amplitude to deliver the same punch? | Larger electrodes |
| Used to produce a muscle contraction in innervated muscle tissue. | Nmes = neuromuscular electrical stimulation |
| Produce the strongest and quickest contractions but fatigue quickly and rapidly atrophy with disuse | Fast-twitch type ii muscle fibers |
| What contraction is smoother and more controlled? | Voluntary contraction |
| What are the two ways estim strengthens muscles? | - overload - specificity |
| The greater the load placed on a muscle and the higher the force of contraction = more strength gained (applies to both natural and artificial contractions). | Overload principle |
| How do you increase strength? | With higher force contractions |
| How do you increase endurance? | Prolonged stimulation with lower force contractions should be used. |
| What are the Orthopedic conditions that estim is good for? | 1. Accelerate recovery following immobilization and rest 2. Strengthening post surgery 3. Retard atrophy and loss of strength during periods of immobilization |
| What neurological conditions are estim used for? | - Sci, stroke, etc as long as peripheral nerves are intact. - Improve strength, bone strength, decrease spasticity |
| What other conditions are estim used for? | 1. Preventing muscle atrophy 2. Improve swallowing 3. Treatment of urinary incontinence associated with pelvic floor dysfunction. 4. Promote blood flow in those with poor circulation. |
| What are the waveform used for innervated muscles? | Pulsed biphasic waveform or russian protocol |
| Where should the electrode be placed for innervated muscle contraction? | If contraction desired: one electrode should be placed over the motor point for the muscle (usually the middle of the muscle) and the other should be placed on the muscle being stimulated so that the electrodes are aligned parallel to the muscle fibers being stimulated. Electrodes should be at least 2 inches apart. |
| What pulse duration should be used for innervated muscle contraction? | Between 150 and 350 microseconds. Remember that as the pulse duration is shortened, amplitude will need to increase to produce the same result. |
| What frequency should be used for innervated muscle contraction? | • 35 to 50 pps for a smooth, tetanic contraction. This may be increased to a maximum of 80 pps. • 20-30 pps for smaller muscles such as those on the face. |
| What is the on/off time for innervated muscle contraction? | • On = 6-10 seconds • Off = 50-120 seconds • Or a ratio of 1:5 initially and then progressing to 1:4 or 1:3 for muscle contractions |
| What is the ramp time for innervated muscle contraction? | Comfort. If on time is 6-10 seconds, ramp up time should be 1-4 seconds |
| What is the current amplitude for an innervated muscle contraction? | Amp used that will produce just the desired result |
| What is the current amplitude for an innervated muscle for edema or to decrease spasticity? | Amp only needs to produce a visible muscle contraction |
| What is the treatment time for innervated muscle strengthening? | 10-20 contractions (this will usually take about 10 minutes) and repeated several times daily |
| What is the treatment time for innervated muscle reeducation? | No more than 20 minutes per treatment session |
| What estim is used for pain control? | Tens = transcutaneous electrical nerve stimulation |
| Short duration higher frequency pulses at an amplitude producing a comfortable sensation but no muscle contraction to modulate pain. | Conventional tens |
| How does conventional tens modulate pain? | Works via melzack and wall's gate control of theory of pain. |
| Causes the release of endogenous opiates (endorphins and enkephalins) that act similarly to morphine to modulate the perception of pain. | Low rate/acupuncture-like tens |
| What types of waveforms are used for tens? | • Pulsed biphasic waveform or interferential current • Pulsed monophasic form (premodulated) |
| Where should the electrode placement be for tens? | • Placed around the painful area • Placed over trigger points areas or over acupuncture points • At the point of intersecting electrodes when four electrodes are used |
| What is the pulse duration for tens? | • Between 50 and 80 microseconds if conventional tens • Acupuncture tens = between 200 and 300 microseconds • If interferential = 200 to 400 microseconds that will be predetermined and dependent upon the fixed carrier frequency. |
| What is the frequency for conventional tens? | Between 100 and 150 pps (high rate, short pulse duration or width) |
| What is the frequency of burst tens? | Usually preset at 100 to 150 pps |
| What is the current amplitude for conventional tens? | Tingling sensation that is comfortable but does not produce a muscle contraction |
| How is estim used for wound management? | 1. Attracts the right players to the area (those that assist in the healing process) 2. Alters cell membrane function 3. Reduces edema 4. Enhances antimicrobial activity 5. Promotes circulation (enhances oxygen and other chemicals/cells moving into the area) |
| What are the special considerations when using estim for wound management? | - Patients having a pressure ulcer many times also have diminished sensation in the immediate area so care must be taken wrt intensity - If electrodes are placed in the wound, a new electrode should be used each time (with both self-adhesive electrodes placed around a wound or an electrode fashioned from solution soaked gauze that is placed directly in the wound) - Protective covers for lead wires and estim devices are available to decrease the spread of infection and these items should become dedicated to that patient and remain in the patient’s room. |
| What waveform is used for estim for wound management? | Monophasic waveform (the electrodes remain opposite in polarity) such as high volt or hvpc (high volt pulsed current) |
| What pulse duration is used for estim for wound management? | 40-100 microseconds |
| What is the on/off time for estim for wound mangement? | Continuous (no off time) |
| What amplitude is used for estim for wound management? | High enough to produce a comfortable sensation without a motor response (no muscle contraction) |
| What is the treatment time for estim for wound management? | 5 times a week at least for 45-60 minutes each time. |
| What is the amplitude for iontophoresis? | Patient comfort but not above 4 milliamps. |
| What is the treatment time for iontophoresis? | Adjusted according to amplitude to achieve 40-80 ma-min. |
| What is compression used for? | 1. Improve fluid balance and circulation (decrease peripheral edema caused by vascular or lymphatic dysfunction) or 2. To modify (decrease) scar formation |
| What is the goal of compression therapy? | To increase the pressure outside the vessels in tissue creating a reversal or at least a decrease in fluid leaving the vessels (both blood and lymphatic) and collecting in the interstitial space. |
| What are the effects of external compression? | • Effects will vary depending upon the compression device used and the amount of pressure applied • Intermittent may improve circulation more so than static pressure because it produces a "milking" of the fluids from distal to proximal. When venous and lymphatic vessels are compressed, the fluids within these vessels is forced proximally. When the compression is reduced, fluid again fills the spaces outside the vessels. Sequential intermittent compression is believed to be more effective than non sequential because of the "wave" like formation. • This improved circulation benefits patients with edema, helps prevent the formation of dvt's and may facilitate the healing of wound ulcers cause by venous disease. • Compression can help shape a limb or residual limb (post amputation or extensive scarring, for example) • Increases skin temperature |
| What is the most common cause of venous insufficiency? | Phlebitis or inflammation of the veins. |
| Adverse consequences of edema: | • Decreased rom • Pain • Impaired function • Disfigurement and altered appearance • Increased risk of infection • Itching and browning of the skin • Ulcerations |
| How compression reduces edema: | Increases extravascular pressure |
| What are the risks for deep vein thrombosis? | - older age, - inactivity, - surgery, - trauma, - hospital or nursing home confinement, - cancer, - central vein catheterization, - transvenous pacemaker, - varicose veins, - paralysis, - use of oral contraceptives, - pregnancy - hormone therapy. |
| What are the characteristics of dvt? | • Pain • Swelling • Skin changes in the area |
| How do you prevent a dvt? | - compression stockings, - intermittent pneumatic compression, - calf muscle electrical stimulation, - anticoagulant meds. |
| Areas of tissue breakdown and necrosis occuring as a result of impaired venous circulation. | Venous stasis ulcers |
| What is the standard treatment for compression of venous stasis ulcers? | - treatment includes bandaging to promote ulcer healing and compression stockings to prevent recurrence. - Elevation of the involved extremities aids in healing. |
| When is compression initiated for controlling hypertrophic scarring? | Once healing has occurred and may continue for as long as 8-12 months. |
| Contraindications for external compression – (mechanical) | • Heart failure or pulmonary edema • Recent or acute dvt, thrombophlebitis, pulmonary embolism • Obstructed lymphatic or venous return • Severe arterial insufficiency • Skin infection • Hyponatremia with protein levels below 2 gm/dl • Acute trauma or fracture • Arterial revascularization |
| Precautions for external compression – (mechanical) | • Impaired sensation or mentation • Uncontrolled hypertensio • Cancer • Stroke or significant cerebrovascular insufficiency |
| Adverse effects of external compression: | • Aggravation of condition being treated with the compression • Impairing circulation if too much pressure is used |
| What is the deflation time for intermittent pneumatic compression pumping? | 25-35 seconds (generally a 3:1 ratio) |
| What is the inflation pressure for intermittent pneumatic compression pumping? | 30-60 mm hg for ue and 40-80 for le. Just below patient's diastolic blood pressure |
| What are the compression bandage parameters? | - figure eight moving distal to proximal. - Greater tension distally than proximally. |
| General considerations for massage: | • Inappropriate touching and unnecessary exposure of the body are to avoided at all times • Therapist should be relaxed in his/her manner, clean of person, free of jewelry that could scratch a patient (patient may also need to remove jewelry that could potentially be problematic • Therapist should provide a clear explanation of pending intervention and the need for exposure of a body part. • Hands should be clean and well groomed but strong and flexible; nails should be cut short and rounded or filed. • "hands should be well padded, warm, supple, and dry – they should express sensitivity and gentleness, but yet have firmness and strength.” • Start in slow and start to grow – also don't just end abruptly. Once you have begun, always have at least one hand on the patient performing a massage technique. • Make a smooth transition from one technique to the next |
| Draping and positioning for massage: | • Comfort is a critical factor – for both the patient and the therapist. Be cognizant of background noise, light, room temperature, music; choice, odors and overall privacy. • Position will be dictated by various factors, especially the part of the body receiving the massage • Drape and cover the part of the body not being treated at that particular moment and expose the body part being treated. |
| Basic patient positions for massage intervention: | 1. Supine 2. Prone 3. Long sittin 4. Seated with one arm supported 5. Seated with both arms and head supported 6. Seated in a forward leaning specialized massage chair |
| What does deep pressure produce during massage? | A stronger stimulation and may increase tension and pain |
| What does light pressure produce during massage? | A milder stimulation which induces relaxation and decreases pain |
| What effect does slower strokes have on massage? | Tend to be more relaxing |
| What effect does rapid strokes have on massage? | Tend to be more stimulating |
| What is important about rate and rhythm during massage? | Constant rhythm with continuity of contact with patient’s body is important |
| What is the duration of a massage? | 1. Dictated by the purpose of the massage and desired response 2. 10-15 minutes for a specific body region; 45-60 mintues for a total body massage |
| Purpose of stroking? | - used to begin and end a massage sequence. - Allows the patient to become accustomed to the feel of the therapist’s hands and likewise for the therapist. - Helps the patient relax and is a good transition stroke between two different strokes. |
| Type of stroking that is slow, gentle but firm = relaxation? | Superficial stroking |
| Indications for a stroking massage: | Relaxation, pain relief, decrease muscle spasm (slower); invigorating muscle stimulation (more rapid) and increase in blood flow |
| Contraindications for massage? | - large open wounds or burns, - gross edema - there is danger of splitting the skin, - cancer in the targeted area, - marked varicosities in the area to be massaged, - if area has been irradiated in the past 3-6 months, - hyperesthesia (those who are very sensitive to touch or very ticklish), - extremely hairy areas of the body. - chronic edema in the lower extremities associated with congestive heart failure or other heart conditions. |
| What are the indications for effleurage? | - edema, - pain, - muscle spasm, - superficial scar tissue |