Modalities

Created by

Prabh

Cards (45)

Types of electrical stimulation
TENS - transcutaneous electrical nerve stimulation
NMES - neuromuscular electrical stimulation
FES - functional electrical stimulation
IFC - Inferential current
HVPC- high voltage pulsed current
Types of Thermal Modalities  
Short Wave Therapy
Heat Therapy - heat packs, wax bath, contrast bath, whirlpool
Cyrotherapy - ice packs, ice massage
Continous ultrasound
Types of non-thermal modalities
pulsed ultrasound
low level laser therapy
ultraviolet light
Skin Testing 
Electrical Stimulation: sharp/dull
Thermal: hot/cold
Non-thermal: none
Contraindications to Electrical Stimulation
Active deep vein thrombosis or thrombophlebitis
Haemorrhagic conditions
Local malignancy
Local infection
Locally recently radiated tissue
Abdomen or low back during pregnancy (NMES is CI anywhere on the body)
Tuberculosis locally
Anterior neck or carotid sinus
Head
To areas where it could cause malfunction of electronic devices, including cardiac pacemakers
To the low back or abdomen of pregnant women
To acupuncture points of pregnant women
To regions of known or suspected malignancy
To persons with active deep vein thrombosis or thrombophlebitis
To actively bleeding tissue or to persons with untreated hemorrhagic disorders
To infected tissues, tuberculosis, or wounds with underlying osteomyelitis
To recently radiated tissues
To the chest in persons with cardiac disease, arrhythmias, or heart failure
To the neck or head region of persons known to have seizures
Transcranially without specialized training
To areas near reproductive organs or genitalia without specialized training
To areas near or over eyes
To anterior neck or carotid sinus
To damaged or at-risk skin areas that would result in uneven conduction of current (excluding open wounds where the specific intent is to use electrical stimulation for tissue healing)
Persons with cognition or communication impairments sufficient to prevent them from giving accurate and timely feedback
Areas that have impaired sensory awareness
Contraindications specific to NMES
Pregnant women (anywhere)
Areas with impaired circulation
Any area unstable due to recent surgery, bone fracture, or osteoporosis
The chest or the intercostal muscles the lower abdomen
Contraindications Specific to Continuous and Pulsed Ultrasound
To the low back or abdomen of pregnant women
To regions of known or suspected malignancy
Near or over electronic devices
To actively bleeding tissue or persons with untreated haemorrhagic disorders
To regions with active deep vein thrombosis or thrombophlebitis
Over recently radiated tissues
To areas with myositis ossificans
To eyes
To anterior neck or carotid sinus
To reproductive organs (testes) over tissues infected with tuberculosis
Over spinal cord after laminectomy
Additional contraindications for continuous ultrasound that produces tissue heating
To persons with cognition or communication impairments sufficient to prevent them from giving accurate and timely feedback
To infected tissues that are under tension (abscess)
To tissues inflamed as result of recent injury or exacerbation of chronic inflammatory condition
To areas with impaired circulation
To areas of impaired sensation that prevent persons from giving accurate and timely feedback
Over areas affected by heat-sensitive skin diseases (e.g., eczema)
Overlying implants containing cement or plastic components
Contraindications specific to LLLT
Tissues infected with tuberculosis or other forms of virulent bacteria
The low back or abdomen of pregnant women
Regions of known or suspected malignancy
Actively bleeding tissue or persons with untreated haemorrhagic disorders
Regions with active deep vein thrombosis or thrombophlebitis
Eyes
Reproductive organs (testes)
Over thyroid gland
In patients with epilepsy
Contraindications specific to superficial heat
Large areas, or at sufficient intensity to raise core temperature, in pregnant women
Regions of known or suspected malignancy
Infected tissues or persons with tuberculosis
Persons with active deep vein thrombosis or thrombophlebitis
Areas of impaired sensation that prevent the patient from giving accurate and timely feedback
Actively bleeding tissue or persons with untreated haemorrhagic disorders
Recently radiated tissues
Large areas, or at sufficient intensity to raise core temperature, in persons with severe cardiac disease or in cardiac failure
Persons with cognition or communication impairments sufficient to prevent them from giving accurate and timely feedback
Areas with impaired circulation
Tissues inflamed as result of recent injury or exacerbation of chronicinflammatory condition
Areas affected by heat-sensitive skin diseases (e .g ., eczema)
Areas of skin breakdown or damage producing uneven heat conduction across the skin
Areas of severe edema
Reproductive organs (testes)
contraindications specific to paraffin wax
Open wound
Skin infection
Defective skin sensation
Ischemic conditions
Skin allergy to wax
Contraindications to cryotherapy 
Persons with cold urticaria (also called cold allergy or cold hypersensitivity)
Persons with Raynaud's disease
Persons with cryoglobulinemia
Persons with hemoglobinemia
Areas of impaired circulation
Areas near open or chronic wounds
Over regenerating nerves
Over peripheral vascular disease areas
Patients who are confused or unreliable
Tissues affected by tuberculosis
Haemorrhaging tissue or in persons with untreated haemorrhagic disorders
Persons with active deep vein thrombosis or thrombophlebitis
Anterior neck and carotid sinus
Home cold-therapy programs should NOT be prescribed for: Persons with cognition or communication problems that interfere with their ability to follow directions
Contraindications specific to short-wave therapy
Persons with known or suspected malignancy
Pregnant women (anywhere)
Persons with electronic implants
Persons with active deep vein thrombosis or thrombophlebitis
Persons with tuberculosis
Recently radiated tissues
Heart, anterior neck region, or carotid sinus
Actively bleeding tissue or persons with untreated hemorrhagic disorders
Over metallic objects externally worn by patient
Contraindications to thermal short wave therapy
Areas of impaired circulation
Areas of impaired sensation that prevent the patient from giving accurate and timely feedback
Areas with ceramic-, plastic-, or cement-containing implants
Persons with metal implants
Persons with heat-sensitive skin diseases (e.g., eczema)
Persons with a fever to areas of skin damage or severe edema
Infected tissues
Tissues inflamed as result of recent injury or exacerbation of chronic inflammatory condition
Areas of the body covered with a thick layer of adipose tissue (obesity)
Eyes
Persons with cognition or communication impairments sufficient to prevent them from giving accurate and timely feedback
Lung fields
Reproductive organs
Areas with regenerating nerves
Contraindications specific to UV light
Over the eye
Over a malignant skin lesion or if history of melanoma
To persons with lupus erythematosus
To persons with pulmonary tuberculosis
To persons with significant kidney, cardiac and liver diseases
To persons with hyperthyroidism, diabetes mellitus
black cathode 
negative charge (anion), placed on the mm belly of the mm wanting to be contracted in order the get a contraction. "active cathode"
red anode 
positive charge (cation), placed proximal or distal to the cathode on or near the mm that is being contracted.
motor point 
an area of great excitability of a mm to which a small amount of current is applied in order to contract the mm. usually located over the mm belly, black cathode is applied to this.
electrode size 
the amount of current that is dispersed under the electrode is relative to the size of the electrode
larger electrode size  
lower current density
less intense
advantage = more comfortable
disadvantage = stimulates undesired mm
smaller electrode size  
higher current density
disperses current over a smaller areas
more intense
advantage: more focused tx
disadvantage: less comfortable
electrode distance 
do not overlap electrodes
the space between the cathode and the anode should be the same distance as the diameter of the cathode
what is affected by the distance between the electrodes?
current density: decreases with distance
depth of penetration
what are the effects of the electrodes being closer together?
smaller treatment area
current density between the electrodes is greater
depth penetration is less
what are the effects of the electrodes being further apart?
larger treatment area
decreased current density between the electrodes
depth penetration is greater
what are the three types of electrode set-ups?
monopolar
bipolar
quadripolar
monopolar electrode set-up  
electrodes are different sizes, there is a higher current density underneath the cathode
the cathode is placed over the motor point
the anode is placed proximal or distal to the the target mm
more commonly used when targeting smaller mm
bipolar set up  
electrodes are the same size
similar physiological effect underneath each electrode
both electrodes are placed over mm belly or at proximal/distal ends of the treatment area
more commonly used when treating larger mm
quadripolar set-up  
4 electrodes used
criss-cross pattern around the point that needs to be stimulated
area being treated is central to all electrodes
used for larger mm/treatment areas.
Transcutaneous Electrical Nerve Stimulation (TENS) 
use of electrical stimulators capable of delivering pulsed current to stimulate peripheral nerve depolarization via the skin
purpose: pain modulation
method: pulsed biphasic waveform
Conventional TENS  
acute
sensory
frequency: 80-150 Hz
pulse duration: ~60microsecs
time: ~20mins - 3 hours
intensity: strong but comfortable
electrode placement: site of pain or dermatomal
analgesic profile: rapid onset, rapid offset
main mechanism: segmental - pain gating
Acupuncture-like TENS 
chronic
motor
Frequency: 1-10 Hz
Pulse Duration ~200 microsec
Time: 30-60 mins - need at least 30 mins for opioid release for pain
Intensity: strong, comfortable twitch
Electrode placement: site of pain, motor point
Analgesic profile: onset ~ 30 min, offset ~4-6 hours
Main mechanism: segmental and extrasegmental (opioid release)
neuromuscular electrical stimulation (NMES) 
using electrical stimulation to generate an AP in a nerve to cause mm contraction
used for: mm strengthening and spasticity management, can also be used for pain modulation, and edema management
characteristics: pulse biphasic waveform
NMES Parameters
Parameters:Pain: same as TENS (acute: 80-150Hz for tingle; chronic: 1-10Hz for twitch)
Edema: 5-20Hz – intensity to muscle twitch
Frequency: 35-65 Hz §
Pulse duration: 300us Time:n/a
12-15contractions
Ratio- on:off time is based on muscle strength:
Grade5-do not need to use
Grade 4 - 1:2 (e.g. on for 1 second, off for 2)
Grade 3 - 1:3
Grade 2 - 1:4
Grade 1 - 1:5 (e.g. on for 1 second, off for 5)
Intensity: muscle tetany - strong but comfortable muscle contraction
Encourage patient to contract muscles during muscle stimulation
NMES Parameters for Spasticity
Spasticity:
Frequency: 35-100Hz
Pulse duration: 200-300usT
ime:20min
Ratio on:off=1:1
Intensity: muscle tetany - strong but comfortable muscle contraction
Functional electrical stimulation (FES) 
Use of NMES in a functional manner - functional application during muscle stimulation
FES Commonly used for
Treatment of disuse atrophy
Increasing ROM
Re-educating muscle activation
Managing spasticity
Gait orthoses
Improving motor recruitment
Increasing muscle endurance
Re-educating gait
Promote normal shoulder alignment in the hemiparetic patient
Improving subluxation of GH joint
FES: Assist a stroke patient with DF during gait activities
Drop-foot stimulation (reduce fall risk)