MODALITY LVDC

INDICATIONS Denervated M. Iontophoresis Electrodiagnostic testing

PARAMETERS Monophasic Galvanic

CONTRAINDICATIONS Cardiac Pacemakers Significant cardiac pathology Phlebothrombosis Thrombophlebitis abnormal skin Anesthetic area Open wounds Extreme edema Over heart/ Pacemaker Over Carotid Sinus Over Pregnant Uterus

BENEFITS Painful

HVDC Pain

Monophasic Double Spikes 70-120pps/ 30m/ C 2-10pps/ 1-10m/ C 2-3pps/ 30m/ C 70-120pps/ 30m/ C 70-120pps/20-30m/C 70-120pps/ 30m/ C 70-120pps/ 30m/ C 30-50pps/ 10-20m/ S Biphasic Bipolar Monopolar Placement Frequency: 1-50 Hz/pps PR: 200-300 On/Off Ratio (adjustable)

Painful, but< LVDC

Edema

M. Spasm Tissue Healing Antibacterial M. Reeducation LVAC (FES) Exercising partially/ fully innervated M Pain reduction Spasticity reduction in UMN lesions M. Spasm reduced by M. fatigue Edema absorption

Cardiac Pacemakers Significant cardiac pathology Phlebothrombosis Thrombophlebitis Abnormal Skin Open wounds Extreme edema

Goals: Motor control Functional activities Gait

MODALITY

INDICATIONS

PARAMETERS

CONTRAINDICATIONS

BENEFITS

Iontophoresis TrP's Acute/Subacute inflammation Peripheral circ. deficit Post traumatic edema Acute RA Decubitus ulcers Plantar warts Rhinitis Gout

Pos/neg charged med. LVDC Ripple free current Size differential between pos/neg (lg) electrodes 40mA minutes 2-3x's/wk up to 6x's Depth=1.7cm

Cardiac pacemakers Anesthetic Skin in tx site Allergic reactions to meds Acute injury w/ bleeding Metal in skin Recent scars

No pain No tissue damage No chance of infection Most of med stays @ tx site Won't upset stomach

Medium Frequency (Russian)

Muscle Strength

PW: 200ms PR: 50-70pps 12-15m PW: 50-175ms PR: 50-70pps 20-30m PW: 175-250ms PR: 1-10pps 20-30m (m pump)

Muscle Spasm

Reduce Edema

Malignant areas Over pacemaker Over PG uterus Over lg wounds Very old/ young Pts Dermatological cond. Purulent areas Over uterus/low back during menstruation

Time Modulated (50% duty cycle) d electrical frequency d resistance Less discomfort

MODALITY Interferential (IFC)

INDICATIONS Acute Pain

PARAMETERS Rate: 80-150 Hz Mode: Continuous 20-30m (Sensory) Rate: 0.5-15 Hz Mode: Continuous 20-40m (Motor) Rate: 40-80 Hz Mode: Continuous Variable (Strong Motor) Rate: 100-150 Hz Mode: Surged 20-30m (Motor) Rate: 80-150 Hz Mode: Continuous 20-30m (Sensory) Rate: 40-80 Hz Mode: Surged up to 20m (Motor)

CONTRAINDICATIONS Over pacemaker Over PG uterus Over uterus/low back during menstruation Over lg wounds Very old/ young Pts Dermatological cond. Purulent areas Malignant areas

BENEFITS 4 Electrodes= greater area of stim USED ON BIG AREAS

Chronic Pain

M Reeducation/ Strengthening

Muscle Spasm

Acute Edema

Chronic Edema

MODALITY TENS

INDICATIONS Acute Pain Chronic Pain Circulatory Facilitation Angina Pectoris Headaches Conventional Mode (C) Acute/Chronic Pain Temporary Relief

PARAMETERS Frequency= Rate Duration= Width Intensity= Amplitude Modulation Pulse or Burst PR: 40-100 Hz PW: <200_s Amp: 10-30mA Sensory/ no m contraction Lasts: 20m-4h PR: 1-4 Hz PW: 200-400_s Amp: 30-80mA Strong m. contractions Lasts: 2-6h PR: 100-150 Hz PW: 200-500_s Amp: 30-80mA Tetany Lasts: Immediate-15m PR: 70-100 Hz (M@1-4Hz) PW: 100-200_s Amp: 30-60mA Strong, rhythmic m. contractions Lasts: 30m-6h "Subliminal" 1mA total current

CONTRAINDICATIONS Potential interference w/ implantable device Allergic/ Skin irritation (<2%)

BENEFITS Analgesia Cont. Mental Activity No Fluctuating Pain Client Paticipation Extemely safe Non-Addictive Non-Invasive d mobility d post-op complications d drug intake AP: Post-op, orthopedic, gynecologic (labor, C-sec) orofascial CP: LBP, arthritis, osteogenesis, neurologic (phantom pains)

Low Rate Acupuncture (LRAT) Acute/Chronic Pain Circ. Facilitation Longer duration

Brief, Intense (BI) Uncomfortable proceedures Brief, profound analgesia

Modulation Mode (M)

MES

Wound Healing

Same as TENS

Restores biological balance to facilitate tissue healing & pain control

MODALITY NMES

INDICATIONS Prevent disuse atrophy Promote m reeducation Maintain/ joint mobility local bl circ Relax m spasm Prevent DVT after surgery

PARAMETERS Biphasic Pulsatile Symmetrical= lg m Asymmetrical= sm m Electrode Size Big= comfort, lg m Sm= sm m Placement Neg over MP distance= depth Duty Cycle On/ Off Ratio (adjustable) Monopolar placement Fequency: 1-50 Hz/pps PW: 200-300

CONTRAINDICATIONS Demand type pacemaker/ defibrillator Stim over carotid sinus Transcerebral/ Transthoracic e-stim Over malignant tumors 1st trimester of pregnacy Where motion is not indicated

BENEFITS Can be linked w/ exercise to facilitate m contraction & reeducation; AAROM, & AROM Goals: Motor control Strength spasm edema

MODALITY SWD (deep heat)

PARAMETERS Chronic: 20-30 m Acute: 10-15m

THERAPEUTIC EFFECTS Collagen extensibility Local blood flow Joint stiffness Pain Muscle spasm Inflammation

CONTRAINDICATIONS Metal objects (internal/external) Anesthetic area Obtunded Client Vascular supply Hemmorage Malignancy Developing fetus Gonads Eyes Growth zones in children Precaution: Acute RA

INDICATIONS Large, flat areas

UV

Find MED Suberythemal 1st degree 2nd degree 3rd degree

Formation of Vit. D Resistance to infection Skin condition Blood supply to skin Destruction of bacteria Stimulation of growth of epidermis Desquamation Counter-irritant

Acute skin conditions Sulpha preparations Acute diabetes Lupus erythematosis Active pulmonary tuberculosis

Vit D deficiency Dermatological Conditions Psoriasis Fungus infection Pressure sores/ Open lesions Acne Non-pulmonary TB Some upper respiratory manifestations Osteomyelitis

IF

24-36" from tx site 10-30m

Temperature rise Circulation Vasodilation Mild analgesia Phagocytosis

Fever Anesthetic area Severe circulatory disorders Hemorrhage Light sensitivities Menstruation Acute inflammation Certain dermatological conditions

No pressure over tx area Can observe tx site easily Intensity of heat easy to control When mild/ superficial heat needed Subacute/ Chronic inflammation Collagen contractures

MODALITY US

PARAMETERS 0.5-3 W/cm2 1 or 3 MHz (1=deep+heat) (3=superficial) 5-10m Continuous= Heat+Sound Pulsed= Less heat

THERAPEUTIC EFFECTS Thermal: Tissue temp Blood flow Collagen extensibility Pain threshold Tissue membrane permeability Enzymatic activity Selective heating Non-Thermal: Acoustical streaming ( membrane permeability) Cavitation Protein synthesis Calcium reabsorbtion

CONTRAINDICATIONS Malignant tumors Circulatory disorders PG uterus Acute inflammation After/ during radiation tx Open wounds Epiphyses of growing bones Anesthetized areas Pacemakers Possible healing fx May promote destruction of articular cartilage

INDICATIONS High= Connective tissue shortening Mod= Painful conditions Low= Superficial/ Acute conditions Strong= Thicker tissue/ Chronic Joint contractures Arthritic conditions Traumatic soft tissue injuries Bursitis Myositis Adhesive capsulitis Scar tissue softening Nerve root irritation Warts & neuromas Muscle spasm/ Pain/ TrP's Subacute inflammatory conditions Calcium deposit Wound healing

MODALITY Hot Pack

PARAMETERS Hydrocollator: 165-170 6-8 Layers 20m Pack on client, not client on pack

THERAPEUTIC EFFECTS Extensibility of collagen Local blood flow Joint stiffnes Pain Muscle spasm Assists in resolution of inflamm Cancer therapy

CONTRAINDICATIONS Impaired sensation Impaired circulation Dermatological conditions Open wounds Acute inflammation Malignancies Active bleeding Already existing fever Cardiac insufficiency Extremely old/ young pt

INDICATIONS Painful MS disorders Subacute/ Chronic inflamm. cond. (bursitis, tendonitis, arthritis) Joint pain Preheat to e-stim

PHYSIOLOGICAL EFFECTS Plasticity of collagen Elasticity of capsule & synovium; viscocity of synovial fluid, ( friction) Capillary permeability GTO discharge 2 Muscle spindle discharge Vasodilation Endorphine release Counterirritant

Paraffin

5:1 Paraffin: Mineral oil 125-130 Dip 10-12 times. Wrap 1st in plastic, then in towl. Up to 20m

Anesthetized areas Open wounds Infections/ Contagious disease Recent, thin scars Acute inflammation Peripheral nerve/ vascular disease May promote destruction of articular cartilage

Joint stiffness OA or RA Old scar tissue limiting ROM Subacute/ Chronic inflamm or traumatic conditions

MODALITY

PARAMETERS

THERAPEUTIC EFFECTS Promotes relaxation Blood flow Pain

CONTRAINDICATIONS Fever Anesthetic area Hemorrhage Severe circulatory disorders Heat sensitive pt.

INDICATIONS Inflammation (RA & OA) Post-Op rehab Subacute/ Chronic conditions

Fluidotherapy 20m w/ AROM

MODALITY Cryotherapy Ice Bag Gel Pack Ice H2O immersion Cold Whirlpool Ice Massage Compressure Ice Towel Contrast bath

PARAMETERS

THERAPEUTIC EFFECTS Muscle tone spasm/ spaticity in UMN lesions Pain nerve conduction velocity threshold of pain receptors Bleeding & edema Inflammation Tissue metabolism PHYSIOLOGICAL EFFECTS: Local tissue temp Capillary permeability Bl flow 2 to arterial & capillary vasoconstriction Edema formation Muscle spindle firing Vasoconstriction (post. hypothal.) Vasodilation after 20m (Huntingtons response)

CONTRAINDICATIONS RA Raynaud's phenomenon Hypersensitivity Sensory impairment Circulatory impairment

INDICATIONS Sprains, strains, contusions To muscle spasms Prior to stretching Prior to ROM exercises

15-20m 15-20m 65 15-20m 65/ 15m 5-10m (until numb) (Cold, Pain, Numb) 10-20m 5-10m

MODALITY CPM

PARAMETERS 8-24h/ day 0-3wk __ flex/ __ ext Speed PRECAUTIONS: Proper positioning Claustrophobia External fixation devices

THERAPEUTIC EFFECTS Pain Edema Motion Enhance & facilitate connective tissue strength, size, & shape Evacuate joint hemarthrosis Improve joint nutrition Inhibit adhesions Initiate normal arthrokinematics Reduce articular surface changes effects of immobilization

CONTRAINDICATIONS Unstable fractures Active infections Fused joints Hemophilia/ bl thinning meds Renal failure

INDICATIONS ORIF w/ fx fragments stable Postdiaphyseal & metaphyseal fx Capsulotomy & arthrolysis Arthroplasty Ligament reconstruction Synovectomy Arthrotomy Tendon reconstruction Burns Drainage of acute specific arthritis

Traction

Skin Skeletal Continuous Static Intermittent Mech. Manual Positional Autotraction Inversion (gravity) Cervical: 10-40 #'s (normal= 25 #) Lumbar: 1/3-1/2 body weight

Relieves pain by relieving spasm Positions fractures (prevents shearing, overcomes tone) ROM

Tumor/ infections Claustrophobia RA Osteoporosis, Osteomalacia Osteomyelitis Acute: sprains, strains, inflamm PRECAUTIONS: Chronic sprains, strains, inflamm Joint hypermobility Referred pain from vicera Nerve root inflammation PG (lumbar tx) Spondylothesis

Fractures Heriated Nucleus Pulposus (HNP) Nerve Root Compressions Dislocations Strains/ sprains Degenerative disc disease Joint dysfunction

MODALITY

PARAMETERS

THERAPEUTIC EFFECTS Distal to proximal movement of lymph from affected extremity

CONTRAINDICATIONS

INDICATIONS

Intermittent Cut and fit Compression stockinette Place in cuff UE=30-50mm/HG LE=30-60mm/HG 3:1 On:Off 45-60m

Unstable fractures Edematous limbs Internal bleeding or hemorrhage High blood pressure (not controlled) Unhealed skin grafts Loss of pain sensation

Massage

Effleurage Petrissage Friction Tapotement UE=10m ea LE=10m ea Chest=5m Back=10m Abdomen=5m

Assists venous flow Encourages lymphatic flow Loosens soft adhesions (scars) Warmth in area Pain Edema Promotes relaxation Improves condition of skin Circulation Nutrition to area Secretion/ excretion Absorbtion of blood/ lymph Exchange- circulation/ tissues

Acute systemic disease Communicable disease Acute inflammatory process Skin diseases Tubercular lesions Multiple abscesses Circulatory disorders During complete BR Tumors/ Malignancy Hemorrhaging Menstruation Bone conditions Neuritis/ Neuralgia (acute) Phlebitis/ existence of thrombus

Paralysis due to nerve involvement (Perpheral n. injuries, Bell's palsy) Healed/ Consolidated fractures Post trauma of joints & muscles (sprains/ strains) Healed skin grafts Adhesions & scar formations (burns, healed lesions/ incisions) Fibrositis Myositis/ Myalgia Arthritis Edematous conditions Tension

MODALITY Hydrotherapy Cold: Cool: Tepid: Warm: Hot: Very Hot: Whirlpool Extremity Lowboy Highboy Hubbard Tank

PARAMETERS

THERAPEUTIC EFFECTS ROM Strength (resistive exercises) Edema Muscle spasm (Acute=cold Subacute/ Chronic=warm) Relief of pain (cold) Promotes relaxation Sedate sensory nerves

CONTRAINDICATIONS Feverish client Client w/ recent skin graft Pt w/ edema (dependent position) Marked circulatory disturbance Infections that may spread Pt w/ cardiac instability, hypertension/ respiratory instability Malignancies Active bleeding that could be prolonged by heat ADVERSE REACTIONS: Skin pallor Shivering Dizziness Rapid, weak pulse Headache Edema, ROM Hyperventilation "Seasickness"

INDICATIONS Burns (w/o agitation) Open wounds (light/ mech agitation) Post-Op orthopedic conditions Medium for exercise

55-65 65-80 80-95 96-99 99-104 104-110

120L (30gal) 300L (79gal) 300L (79gal) 2000L (528gal) 20-30m (dependent on temp)

Contrast Tx

2 containers: 1=55-65 1=100-110 3m= Heat 1m= Cold 20-30m

ROM Local tissue metabolism Bl & lymph circulation Pain Edema

Acute injuries See contraindications for heat and cold applications

Subacute/ Chronic inflammation & injuries (sprains/strains) Injury prevention Accelerates tissue healing Poor/ suppressed immune function