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Therapeutic Modalities

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chandlerrice's version from 2016-12-27 17:57

Thermal Modalities Indications

Question Answer
Joint StiffnessIndications
Musculoskeletal PainIndications
Muscle SpasmsIndications
Preparation for electrical stimulation and massageIndications
Preparation for passive and active exercisesIndications
Subacute and Chronic traumatic and inflammatory conditionsIndications
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Thermal Modalities Contraindications

Question Answer
Decreased CirculationContraindications
Decreased SensationContraindications
DVTContraindications
Impaired Cognitive FunctionContraindications
Malignant TumorsContraindications
History of Hemorrhaging or EdemaContraindications
Very young or Very oldContraindications
Acute or Subacute InflammationContraindications
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Therapeutic Modalities Hot Packs

Question Answer
Water Temperature165-170 Degrees
When to check patients skinBefore, during, and after (reaches peak heat in 5 minutes)
How many layers of towels?6-8 layers
Treatment time20-30 minutes
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Therapeutic Modalities Paraffin

Question Answer
Paraffin Temperature118-130 Degrees
Used forChronic conditions such as arthritis or other inflammatory conditions in the subacute or chronic phases
Other Contraindicationsallergic rash, open wounds, recent scars or sutures and skin infections
ProcedureRemove jewelry, wash part/check skin, dip part 6-12 times, once solid wrap part with plastic wrap and cover with several layers of towel, let sit for 15-20 minutes
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Therapeutic Modalities Hydrotherapy

Question Answer
WhirlpoolPartial or total immersion into a bath in which water is agitated and mixed with air to be directed against or around the affected area of the body
Uses of WhirlpoolTherapeutic benefits of heat and cold as well as debridement and loosening of dressings
Full body immersionWater temp should not rise above 100 degrees
Contrast BathsUses alternating hot and cold immersion to help decrease pain, increase circulation and decrease swelling. Water temp should be kept around hot 104F (40C) and cold 59F (15C). In subacute start with 10min hot and 1min cold then 4min hot. tx time is 20-30 minutes ending in hot immersion
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Therapeutic Modalities Aquatic Therapy

Question Answer
BuoyancyUpward force of the water on an immersed or partially immersed body or body part, which is equal to the weight of the water that is displaced. This creates an apparent decrease in the weight of an immersed body part, allowing easier movement in the water.
CohesionThe tendency of water molecules to adhere to each other. The resistance encountered while moving through water is due to cohesion.
Hydrostatic PressureCircumferential water pressure exerted on an immersed body part. A pressure gradient is established between the surface water and the deeper water due to the increase in water density at deeper levels
TurbulenceMovement of a body part through the water creates a circular motion of the water near the surface of the part, producing a frictional drag. Greater resistance is encountered when moving through turbulent water
Movement Upward or HorizontalEasier due to buoyancy of water. Weak patients may need assistance of flotation devices
Movement DownwardHarder because of the buoyancy of the water. A floating object or a paddle will increase resistance
IndicationsPoor standing balance, partial weight bearing ambulation, aerobic exercises, Active assist or resistive exercises, patients ability and patients ability with sore stiff joints
ContraindicationsBowel or bladder incontinence, urinary infections, severe epilepsy, unprotected open wounds, unstable blood pressure and severe cardiac or respiratory dysfunction
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Therapeutic Modalities Diathermy

Question Answer
ContraindicationsCardiac pacemakers, low back area during menstruation, metal implants, or pregnancy
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Therapeutic Modalities Ultrasound

Question Answer
Acute conditions or thin tissueUse lower intensity
Chronic conditions or thick tissueUse higher intensity
Treatment intensity0.3-1.5 w/cm^2
Depth of Penetration3-5cm
3 MHzGreater heat production in superficial layers occurs
1 MHzGreater heat production in deep layers occurs
IndicationsOpen wounds, neurons, periarticular contains
ContraindicationsAcute inflammation, healing fractures, Thrombophlebitis. Should not be applied over vital organs
PrecautionsMetal implants, osteoporosis, plastic implants,
Continuous USApplied for thermal effects
Pulsed USApplied for non thermal effects
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Therapeutic Modalities Cryotherapy

Question Answer
Physiological effects of general colddecreased metabolic rate, decreased pulse rate, decreased respiratory rate and decreased venous blood pressure
Physiological effects of local coldSubcutaneous temperature falls less rapidly. Muscle and joints show the least temperature change, requiring longer exposure to cold. Vasoconstriction of capillaries results in blanching of skin.
IndicationsAcute and chronic traumatic and inflammatory conditions, edema, muscle spasms, musculoskeletal pain, and thermal burns
ContraindicationsImpaired circulation, impaired sensation and peripheral vascular disease.
Cold PacksTemperature: 0-10F Place a towel over the ice pack and apply to area for 10-20min
Ice MassageApplied to skin in slow overlapping strokes. Patient will experience cold, burning, aching, and numbness. DO NOT massage over bony area or superficial nerves
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Therapeutic Modalities Traction

Question Answer
IndicationsDecrease joint stiffness, decrease muscle spasm, degenerative disc, disc protrusion, joint disease, modulate discogenic pain, modulate subacute or chronic joint pain, reduce nerve root impingement
ContraindicationsAcute strains, sprains, and inflammation; spondylolisthesis fractures, post-op spinal surgery, spinal joint instability or hypermobility and spinal cord compression; hypertension; increased peripheralization of pain, numbness or tingling, decreased myotomal strength and decreased reflex response
Cervical TractionSeated (neck placed in 20-30 degrees flexion, you can very the degrees 0-5 to target specific areas C1-C5 and 25-30degrees for C5-C7. Neutral spine is 20degrees) Supine (head placed in 20-30degrees flexion. Acute phase Tx for disc protrusion, elongation of tissue and muscle spasm is 10-15lbs or 7-10% of body weight. Joint distraction is 20-30lbs. Tx time is 5-10min for acute conditions and disc protrusions. Other conditions is 15-30 minutes.
Lumbar TractionSupine position, pillow under knee to open up intervertebral foramen, separate facet joints, or elongate the muscle. Prone position is preferable for posterior herniated lumbar disc. Pelvic harness goes at the top edge above the iliac crest. Attach thoracic harness so that the inferior margin is slightly below the lower ribs. In the Acute phase 30-40lbs. Disc protrusion, spasm; elongation of soft tissues 25% of body weight. Joint distraction, 50lbs or 50% of body weight. Tx time; 5-10min for herniated disc, 10-30min for other conditions
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Therapeutic Modalities Electrotherapy

Question Answer
IndicationsPain modulation, decrease muscle spasms, increasing or maintaining joint mobility, decrease pain and edema, muscle re-education, wound healing, improving circulation, reduce spasticity
ContraindicationsHealing fractures, active bleeding, malignancies or phlebitis in tx area, superficial metal implants, demand-type pacemakers
TENS (Transcutaneous electrical stimulation)Used to manage acute and chronic pain.
NMES (Neuromuscular electrical stimulation)Uses an electrical current to cause a single muscle or group of muscles to contract. Also promotes blood flow to the area, decrease muscle spasms.
RussianA form of electrical stimulation that accomplishes a similar task as NMES, but uses different wave forms that are stronger.
IFC (Interferential Current)Often used to decrease pain, decrease muscle spasm, or improve blood flow. Often used to decrease low back pain and muscle spasm. 4 electrodes in a crisscross pattern
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Therapeutic Modalities Manual

Question Answer
Stroking (Effleurage)Gliding movements of hands over surface of skin
Kneading (Petrissage)Grasping and lifting of tissues, similar to kneading bread
FrictionCompression of tissue using small circular or long stroking movements with palmar surface of hands
Tapping (Tapotement)Rapid striking with palmar surface of hand, cupped hand (clapping or percussion), or ulnar edge of hands
VibrationShaking of tissue using short rapid quivering motion
ContraindicationsAcute inflammation, acute febrile condition, severe atherosclerosis, severe varicose veins, phlebitis, recent surgery, thrombophlebitis, cardiac arrhythmia, malignancy, hypersensitivity, severe rheumatoid arthritis, hemorrhage in area
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Section 20