1. What is the wavelength of UV light? What are its physiological effects?
2. What are indications for using UV light?
3. What are contraindications to using UV light?
4. What is the MED? What dosage of MED is usually given and what is the maximum?
5. How often can treatments be given?
Answers:
1. Wavelength is 2000-4000A. It is bactericidal on motile bacteria, provides increased vascularization of wound margins, produces hyperplasia and exfoliation, increased Vit D production, excites Ca metabolism, and results in tanning.
2. Indications include treatment of wounds, psoriasis, acne, and folliculitis.
3. Contraindications include pellagra, porphyria, sarcoidosis, acute psoriasis, lupus, eczema, herpes simplex, xeroderma pigmentosum. Use with precaution on fair skin, scars, atrophic skin, acute renal and hepatic failure, severe DM, hyperthyroidism, generalized dermatitis, advanced arteriosclerosis, active TB. Eyes should be protected with goggles.
4. MED is the Minimal Erythema Dosage, which is the minimal exposure time required to cause erythema on the volar surface of the forearm. It subsides in 24 hours. MED dosage is usually 1-2 MEDS and is kept to less than 5.
5. 2-3 times per week.
Thursday, June 5, 2008
Cold therapy
1. What causes the therapeutic effects of cold therapy?
2. What are indications and precautions for cold therapy?
3. How is cold transferred via conduction?
4. How is cold transferred via convection?
5. What are other techniques of cold transfer?
Answers:
1. Cold results in local vasoconstriction, local metabolism decrease, decreased inflammation, slowed NCV, decreased muscle spindle activity, decreased pain/muscle spasm, decreased spasticity, increased tissue viscosity, transient increase in BP, release of vasoactive agents (histamine).
2. Cold therapy is used for acute processes such as trauma (first 24-48hrs), arthritis, bursitis, acute and chronic pain, spasticity management, and treatment of minor burns. Precautions and contraindications include cold intolerance (Raynaud's), arterial insufficiency, impaired sensation, communication deficits, cardiac or respiratory involvement, cryotherapy induced nerve injury, cryopathies, open wounds after 48 hrs.
3. Methods of conduction include cold packs wrapped in moist towels and ice massage, which is use to cool small areas before deep massage.
4. Methods of convection include a cold bath, which is used for treatment of localized burns, and evaporation such as a vapo-coolant spray, used to treat myofascial pain or local anesthesia.
5. Other techniques of cooling include cryotherapy compression units, which uses sleeves with circulating cold water, used to treat acute msk injury.
2. What are indications and precautions for cold therapy?
3. How is cold transferred via conduction?
4. How is cold transferred via convection?
5. What are other techniques of cold transfer?
Answers:
1. Cold results in local vasoconstriction, local metabolism decrease, decreased inflammation, slowed NCV, decreased muscle spindle activity, decreased pain/muscle spasm, decreased spasticity, increased tissue viscosity, transient increase in BP, release of vasoactive agents (histamine).
2. Cold therapy is used for acute processes such as trauma (first 24-48hrs), arthritis, bursitis, acute and chronic pain, spasticity management, and treatment of minor burns. Precautions and contraindications include cold intolerance (Raynaud's), arterial insufficiency, impaired sensation, communication deficits, cardiac or respiratory involvement, cryotherapy induced nerve injury, cryopathies, open wounds after 48 hrs.
3. Methods of conduction include cold packs wrapped in moist towels and ice massage, which is use to cool small areas before deep massage.
4. Methods of convection include a cold bath, which is used for treatment of localized burns, and evaporation such as a vapo-coolant spray, used to treat myofascial pain or local anesthesia.
5. Other techniques of cooling include cryotherapy compression units, which uses sleeves with circulating cold water, used to treat acute msk injury.
Wednesday, June 4, 2008
Deep heat: shortwave and microwave diathermy
1. How does shortwave diathermy work? What is the most common frequency and to what depth is heating provided?
2. What is the difference between the induction and conduction method of shortwave diathermy? What are indications for each?
3. What are indications and contraindications for shortwave diathermy?
4. What is microwave diathermy?
5. What are indications and contraindications for microwave diathermy?
Answers:
1. SWD produces deep heating through conversion of electromagnetic energy to thermal energy. The most common frequency is 27.12 MHz and it heats to a deapth of 4-5cm.
2. Induction method produces high temperatures in water-rich tissues via a coiled magnetic field and is indicated when heat to more superficial muscles or joints is desired. Conduction method produces high temperatures in water-poor tissues with low conductiveity via rapid oscillation in an electric field, and is more effective for deeper joints. Precise dosing is difficult and is monitored via patient's pain perception.
3. Indications for SWD include chronic prostatitis, refractory PID, myalgia, back spasms. Contraindications include general heat precautions, metal, contact lenses, gravid or menstruating uterus, or skeletal immaturity.
4. Microwave disthermy is conversion of microwaves to thermal energy. It does not penetrate as deeply as US or SWD and is better for muscle heating.
5. Indications include heating superficial muscles and joints, to speed hematoma resolution, and for local hyperthermia in cancer patients. Contraindications include general heat precautions, skeletal immaturity. It should be avoided in edematous tissue, moist skin, eyes, blisters, and fluid-filled cavities due to selective heating of fluid-filled cavities. Eye protection should be worn due to cataract risk.
2. What is the difference between the induction and conduction method of shortwave diathermy? What are indications for each?
3. What are indications and contraindications for shortwave diathermy?
4. What is microwave diathermy?
5. What are indications and contraindications for microwave diathermy?
Answers:
1. SWD produces deep heating through conversion of electromagnetic energy to thermal energy. The most common frequency is 27.12 MHz and it heats to a deapth of 4-5cm.
2. Induction method produces high temperatures in water-rich tissues via a coiled magnetic field and is indicated when heat to more superficial muscles or joints is desired. Conduction method produces high temperatures in water-poor tissues with low conductiveity via rapid oscillation in an electric field, and is more effective for deeper joints. Precise dosing is difficult and is monitored via patient's pain perception.
3. Indications for SWD include chronic prostatitis, refractory PID, myalgia, back spasms. Contraindications include general heat precautions, metal, contact lenses, gravid or menstruating uterus, or skeletal immaturity.
4. Microwave disthermy is conversion of microwaves to thermal energy. It does not penetrate as deeply as US or SWD and is better for muscle heating.
5. Indications include heating superficial muscles and joints, to speed hematoma resolution, and for local hyperthermia in cancer patients. Contraindications include general heat precautions, skeletal immaturity. It should be avoided in edematous tissue, moist skin, eyes, blisters, and fluid-filled cavities due to selective heating of fluid-filled cavities. Eye protection should be worn due to cataract risk.
Deep heat: Ultrasound
1. What is ultrasound?
2. What are the thermal and nonthermal effects of ultrasound?
3. What are the indications for ultrasound?
4. What are contraindications and precautions to using ultrasound?
5. How is ultrasound usually administered? What are the direct and indirect techniques?
6. What is phonophoresis?
Answers:
1. Ultrasound is acoustic vibrations with frequencies above the audible range, which can produce thermal and nonthermal effects.
2. Thermal effects include heating of skin, fat, and muscle, increased distensibility of collagen fibers, and absorption by bone and tendon. The highest temperture is produce in cancellous bone and absorption is greatest at the bone-muscle soft tissue interface. Nonthermal effects include cavitation (gas bubbles in a sound field) and acoustic streaming, both of which are associated with wound contraction and protein synthesis.
3. Indications include bursitis, tendinitis, msk pain, degenerative arthritis and contracture (helps to maintain stretch and increases ROM), and subacute trauma. There is less evidence to show efficacy in scar tissue, postherpetic neuralgia pain, and plantar warts.
4. Contraindications include general heat contraindications, near brain, cervical ganglia, spine, and laminectomy sites, near heart or reproductive organs, near pacemakers, near tumors, gravid or menstruating uterus, infection site, skeletal immaturity, THA with methylmethacrylate or high density polyethylene. Precautions include avoiding intensities over 3W/cm2, use stroking technique, use multiple ports over large joints, and only use over water if water is degassed (allowed to sit overnight).
5. Ultrasound is given at a frequency of 0.8-1.1 MHz with intensity of 0.5-2 W/cm2 for 5-10 mins per site, delivered either continuous (greater thermal effects) or pulsed. The direct technique is most common, in which the applicator is moved slowly over an area of 4 sq in in a circular pattern with gel. The indirect technique is for uneven surfaces and involves immersing applicator and body part in degassed water.
6. Phonophoresis is a technique that utilizes US to drive medications through the skin, but increasing cell permeability.
2. What are the thermal and nonthermal effects of ultrasound?
3. What are the indications for ultrasound?
4. What are contraindications and precautions to using ultrasound?
5. How is ultrasound usually administered? What are the direct and indirect techniques?
6. What is phonophoresis?
Answers:
1. Ultrasound is acoustic vibrations with frequencies above the audible range, which can produce thermal and nonthermal effects.
2. Thermal effects include heating of skin, fat, and muscle, increased distensibility of collagen fibers, and absorption by bone and tendon. The highest temperture is produce in cancellous bone and absorption is greatest at the bone-muscle soft tissue interface. Nonthermal effects include cavitation (gas bubbles in a sound field) and acoustic streaming, both of which are associated with wound contraction and protein synthesis.
3. Indications include bursitis, tendinitis, msk pain, degenerative arthritis and contracture (helps to maintain stretch and increases ROM), and subacute trauma. There is less evidence to show efficacy in scar tissue, postherpetic neuralgia pain, and plantar warts.
4. Contraindications include general heat contraindications, near brain, cervical ganglia, spine, and laminectomy sites, near heart or reproductive organs, near pacemakers, near tumors, gravid or menstruating uterus, infection site, skeletal immaturity, THA with methylmethacrylate or high density polyethylene. Precautions include avoiding intensities over 3W/cm2, use stroking technique, use multiple ports over large joints, and only use over water if water is degassed (allowed to sit overnight).
5. Ultrasound is given at a frequency of 0.8-1.1 MHz with intensity of 0.5-2 W/cm2 for 5-10 mins per site, delivered either continuous (greater thermal effects) or pulsed. The direct technique is most common, in which the applicator is moved slowly over an area of 4 sq in in a circular pattern with gel. The indirect technique is for uneven surfaces and involves immersing applicator and body part in degassed water.
6. Phonophoresis is a technique that utilizes US to drive medications through the skin, but increasing cell permeability.
Monday, June 2, 2008
Superficial heat: Conductive and Conversive agents
1. How do hot packs work? How long should they be applied for? What are the advantages and disadvantages?
2. What is a Kenny pack?
3. What is the peak temperature for a heating pad? What is the risk when used with moist towels?
4. What is a paraffin bath? What is it used for?
5. What are three methods for using paraffin baths?
6. What is radiant heat? Who is it most useful in? What are precautions to radiant heat?
Answers:
1. A hot pack such as a hydrocollator is a canvas bag filled with silicon dioxide immersed in tanks of heated water. It is a conductive agent. It is applied for 30 min, over several layers of insulated towels. Advantages are that it's low cost, requires minimal maintenance, and ease of use. Disadvantages include skin mottling with prolonged use (erythema abigne), characterized by reticular pigment and telangiectasia.
2. A Kenny pack is a wool cloth soaked in 60C water, then spun dried.
3. A heating pad is a conductive agent with circulating heated fluid such as water. Peak temperature is 52C. If used with most towels, there can be an electric shock.
4. A paraffin bath is a conductive agent, using paraffin wax and mineral oil in a 6-7:1 ratio. It is common used in irregular surfaces such as distal extremities and have been helpful with contractures, RA, and scleroderma.
5. Dipping is most common and involves placing body part in paraffin bath, then remove and allow wax to harden, then insulate wax for 20-30 mins. Immersion involves serial dips done to form a thin glove, followed by immersion in bath for 30 mins. Brushing involves using a brush to apply paraffin to larger body parts.
6. Radiant heat such as infrared lamps is a conversive agent in which energy is absorbed through the skin and converted to superficial heat. It is used in patients who can't tolerate heat packs. Precautions include general heat precautions, light sensitivity, skin drying, and photosensitive medications.
2. What is a Kenny pack?
3. What is the peak temperature for a heating pad? What is the risk when used with moist towels?
4. What is a paraffin bath? What is it used for?
5. What are three methods for using paraffin baths?
6. What is radiant heat? Who is it most useful in? What are precautions to radiant heat?
Answers:
1. A hot pack such as a hydrocollator is a canvas bag filled with silicon dioxide immersed in tanks of heated water. It is a conductive agent. It is applied for 30 min, over several layers of insulated towels. Advantages are that it's low cost, requires minimal maintenance, and ease of use. Disadvantages include skin mottling with prolonged use (erythema abigne), characterized by reticular pigment and telangiectasia.
2. A Kenny pack is a wool cloth soaked in 60C water, then spun dried.
3. A heating pad is a conductive agent with circulating heated fluid such as water. Peak temperature is 52C. If used with most towels, there can be an electric shock.
4. A paraffin bath is a conductive agent, using paraffin wax and mineral oil in a 6-7:1 ratio. It is common used in irregular surfaces such as distal extremities and have been helpful with contractures, RA, and scleroderma.
5. Dipping is most common and involves placing body part in paraffin bath, then remove and allow wax to harden, then insulate wax for 20-30 mins. Immersion involves serial dips done to form a thin glove, followed by immersion in bath for 30 mins. Brushing involves using a brush to apply paraffin to larger body parts.
6. Radiant heat such as infrared lamps is a conversive agent in which energy is absorbed through the skin and converted to superficial heat. It is used in patients who can't tolerate heat packs. Precautions include general heat precautions, light sensitivity, skin drying, and photosensitive medications.
Superficial heat:Convective Agents
1. How does fluidotherapy work? On what body parts is it most useful? When should it be avoided?
2. What is hydrotherapy? How long should it be given for?
3. What is the difference between a Whirlpool bath and a Hubbard tank?
4. What are contraindications to a Hubbard tank?
5. What is a contrast bath? What are its uses?
6. What are contraindications to a contrast bath?
Answers:
1. Fluidotherapy is a convective agent by which hot air is blown through a container holding fine cellulose particles, producing a warm air-fluid mixture with properties similar to a liquid. It works best on the hands and feet. It should be avoided in infected wounds. Burn precautions should be maintained.
2. Hydrotherapy involves external use of water to treat a physical condition, which produces convective heating and cooling, massage, and gentle debridement. Treatment should be given for approximately 10-20 minutes, depending on cardiopulmonary tolerance.
3. A whirlpool bath is used for partial body immersion. A Hubbard tank provides total body immersion. A lower temperature is used for a Hubbard tank (<39C) to avoid changing core temperature.
4. Incontinence, skin infections, unstable BP, uncontrolled epilepsy, acute febrile episodes, URI, tuberculosis, and multiple sclerosis. Caution should be taken in patients with VC < 1L.
5. A contrast bath involves distal limbs receiving alternating heat and cold in a whirlpool tank to produce reflex hyperemia. Alternate 1-4min cold soak with 4-6 min warm soaks. It is used for RA, reflex sympathetic dystrophy, to toughen residual limbs, muscular strains, and joint sprains.
6. Small vessel disease (diabetes), arteriosclerotic endarteritis, Burger's disease.
2. What is hydrotherapy? How long should it be given for?
3. What is the difference between a Whirlpool bath and a Hubbard tank?
4. What are contraindications to a Hubbard tank?
5. What is a contrast bath? What are its uses?
6. What are contraindications to a contrast bath?
Answers:
1. Fluidotherapy is a convective agent by which hot air is blown through a container holding fine cellulose particles, producing a warm air-fluid mixture with properties similar to a liquid. It works best on the hands and feet. It should be avoided in infected wounds. Burn precautions should be maintained.
2. Hydrotherapy involves external use of water to treat a physical condition, which produces convective heating and cooling, massage, and gentle debridement. Treatment should be given for approximately 10-20 minutes, depending on cardiopulmonary tolerance.
3. A whirlpool bath is used for partial body immersion. A Hubbard tank provides total body immersion. A lower temperature is used for a Hubbard tank (<39C) to avoid changing core temperature.
4. Incontinence, skin infections, unstable BP, uncontrolled epilepsy, acute febrile episodes, URI, tuberculosis, and multiple sclerosis. Caution should be taken in patients with VC < 1L.
5. A contrast bath involves distal limbs receiving alternating heat and cold in a whirlpool tank to produce reflex hyperemia. Alternate 1-4min cold soak with 4-6 min warm soaks. It is used for RA, reflex sympathetic dystrophy, to toughen residual limbs, muscular strains, and joint sprains.
6. Small vessel disease (diabetes), arteriosclerotic endarteritis, Burger's disease.
Sunday, June 1, 2008
Thermotherapy
1. What are the maximum and minimum temperatures that can be used without injury to tissue?
2. What are applications for heat therapy?
3. What are contraindications to using heat therapy?
4. What is heat therapy contraindicated with scar tissue?
5. What is convection and what are some examples of heating by convection?
6. What is conduction and what are ways you can heat by conduction?
7. What is conversive heating and what are examples?
Answers:
1. T>45-50C or T<0C
2. Decrease muscle spasms, decrease pain, reduction in joint stiffness, decrease contractures, arthritis, collagen vascular diseases, chronic inflammation, superficial thrombophlebitis.
3. Ischemia (arterial insufficiency), bleeding disorders, hemorrhage (due to incr blood flow), impaired sensation (risk of burn), inability to communicate, malignancy, acute trauma or inflammation, scar tissue, edema (due to increased diffusion across membranes), atrophic skin, poor thermal regulation.
4. Scar tissue has inadequate vascular supply and heat increases its metabolic demand, this causing ischemic necrosis.
5. Convection is contact between two surfaces at different temperatures with flow of one liquid or gas past the other. The resulting flow causes transfer of heat energy. Examples include fluidotherapy, hydrotherapy (whirlpool), and contrast baths.
6. Conduction is the transfer of heat between two bodies at different temperatures without movement. Examples include hot water, paraffin, hot packs.
7. Conversive heating in when nonthermal energy converts to heat in tissues Examples include radiant heat (heat lamps), shortwave diathermy, ultrasound, and microwave.
2. What are applications for heat therapy?
3. What are contraindications to using heat therapy?
4. What is heat therapy contraindicated with scar tissue?
5. What is convection and what are some examples of heating by convection?
6. What is conduction and what are ways you can heat by conduction?
7. What is conversive heating and what are examples?
Answers:
1. T>45-50C or T<0C
2. Decrease muscle spasms, decrease pain, reduction in joint stiffness, decrease contractures, arthritis, collagen vascular diseases, chronic inflammation, superficial thrombophlebitis.
3. Ischemia (arterial insufficiency), bleeding disorders, hemorrhage (due to incr blood flow), impaired sensation (risk of burn), inability to communicate, malignancy, acute trauma or inflammation, scar tissue, edema (due to increased diffusion across membranes), atrophic skin, poor thermal regulation.
4. Scar tissue has inadequate vascular supply and heat increases its metabolic demand, this causing ischemic necrosis.
5. Convection is contact between two surfaces at different temperatures with flow of one liquid or gas past the other. The resulting flow causes transfer of heat energy. Examples include fluidotherapy, hydrotherapy (whirlpool), and contrast baths.
6. Conduction is the transfer of heat between two bodies at different temperatures without movement. Examples include hot water, paraffin, hot packs.
7. Conversive heating in when nonthermal energy converts to heat in tissues Examples include radiant heat (heat lamps), shortwave diathermy, ultrasound, and microwave.
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