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91 Cards in this Set
- Front
- Back
applied by placing the patient in a device that requires a head-down position, and uses the weight of the patient's upper body to apply traction to the lumbar spine. Adverse effects in patients with hypertension because of increases in systolic and diastolic blood pressure. This type is no longer recommended.
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Inversion Traction
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self traction that requires the use of a purpose built table with sections that can be moved apart by the patient during treatment. It allows the therapist to passively position the patient in a position that is most comfortable and utilizes the principles of positional traction and gravity assisted traction.
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Auto-Traction
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Prolonged placement of the patient in a position that places tension on one side of the lumbar spine only. Gently stretches the lumbar spine by applying a prolonged low load longitudinal force to one side of the spine. It is unlikely to cause joint distraction but may be effective in decreasing spasm, stretching soft tissue, and inserting a force on the disc by spinal elongation. Could be used as a part of a patients home program
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Positional Traction
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requires a patient to be suspended vertically in the water with a floating ring around the chest. Weights may be attached to the ankles if additional weight is desired. The duration of treatment is between 5 and 30 mins, depending upon the tolerance of the patient.
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Traction in Water
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uses gravity and the weight of the patient's body or force exerted by the patient , to exert a force on the spine. It can be used for the lumbar but not for the cervical spine. The amount and duration of the force is limited by the strength of the patient's upper body and the weight of the lower body. Can be performed in sitting, between corner counters, or with the use of an overhead bar
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Self Traction
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Used for static cervical traction only. Inexpensive, easy to set up, and compact. The patient must be educated on the position, the application, the amount of wt to use and the duration of the treatment. The duration may range from 5 minutes in an acute patient to 30 minutes.
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Over the door Cervical Traction
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Can be applied to the cervical or lumbar spine. A variety of belts and halters and a number of different positions can be used to affect different segments or structures. Electrical units can apply static or intermittent traction of varying force. With static traction, the same amount of force is applied throughout the treatment session. With intermittent traction, the traction force alternates between two set points every few seconds throughout the treatment session.
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Mechanical Traction
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application of the force by the therapist in the direction of distracting joints. Can be used for the cervical and lumbar spine. can also be applied to peripheral joints, but this is usually called _______ therapy.
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Manual Therapy
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application of a mechanical force to the body in a way that separates or attempts to separate the joint surfaces and elongate the surrounding tissues.
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Traction
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Effects of Spinal Traction
(5) |
1. can distract joint surfaces
2. Reduce protrusions of nuclear discal material 3. Stretch soft tissue 4. Relax muscles 5. Mobilize joints |
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the separation of two articular surfaces perpendicular to the plane of the articulation. Reduces the compression of joint surfaces, widens intervertebral foramina which potentially decreases pressure on articular surfaces, intraarticular surfaces of the spinal nerve roots
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joint distraction
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Distraction of the Lumbar Vertebrae is achieved with a force equal to
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50% of the total body weight
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Distraction of the cervical vertebrae is acheived with a force equal to
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7% of the total body weight.
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receptors that receive mechanical stimuli such as pressure from sound or touch.
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Mechanoreceptors
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Clinical Indications for the use of Spinal Traction (5)
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1. back or neck pain, with or without radiating symptoms when caused by a disc bulge or herniation
2. Nerve root impingement 3. Joint hypomobility 4. Subacute joint inflammation 5. Paraspinal muscle spasm |
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Positioning the patient in more flexion localizes the force to the:
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upper lumbar and lower thoracic spine areas.
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Positioning the lumbar spine in more neutral or extended positions will localize the forces to the:
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lower lumbar area
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Positioning the cervical spine in a more flexed position localizes the forces to the:
Neutral or slightly extended position will localize forces to the: |
1. lower cervical area and upper thoracic area
2. upper cervical area |
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Positions for cervical traction
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0-5 degrees flexion= C1-C2
10-20= C2-C5 25-30= C5-C7 |
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Contraindications for the use of traction (5)
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1. Where motion is contraindicated (unstable fracture, cord compression, shortly after surgery)
2. Acute injury or inflammation (acute inflammation after surgery or trauma or as the result of an inflammatory disease such as rheumatoid arthritis or osteoarthritis) 3. Joint hypermobility or instability (particulary in the C1-C2 articulations common in patients with RA, down syndrome, marfan syndrome due to ligament degeneration. NO TRACTION to these patients 4. Peripheralization of symptoms with traction (progression of spinal symptoms from a central area to a more peripheral area/arms or legs. This could cause worsening of nerve function and increase compression of the nerve) 5. Uncontrolled hypertension (for inversion traction) |
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Precautions for the use of traction (10)
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1. structural diseases or conditions affecting the spine (tumor, infection, rheumatoid arthritis, osteoporosis, or prolonged systemic steroid use)
2. When pressure of the belts may be hazardous (pregnancy, hiatal hernia, vascular compromise, osteoporosis) 3. Displace anular fragment 4. Medial disc protrusion 5. When severe pain fully resolves with traction (nerve block) 6. Claustrophobia or other psychological aversion to traction 7. Inability to tolerate the prone or supine position 8. Disorientation 9. TMJ Problems 10. Dentures |
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theory of pain, developed by Melzack and Wall that suggests pain can be blocked at various gate locations in the spinal cord
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Pain Gate Theory
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Hemodynamic Effects of Cold (2)
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a. Initial decrease in blood flow (immeadiate constriction of cutaneous vessels, lasts as long as duration of cold, limited to less than 15-20 minutes)
b. Later increase in blood flow |
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Neuromuscular Effects of Cold (5)
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a. Decreased nerve conduction
b. Increased pain threshold c. Altered muscle strength d. Decreased spasticity e. Facilitation of muscle contraction |
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Metabolic Effects of Cold (1)
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a. Decreased metabolic rate
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When cold is applied for a longer period of time or when the tissue temperature reaches less than 50 degrees F, vasodialation occurs. Most likely occurs in distal extremities, such as the fingers and toes.
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Cold Induced Vasodalation
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which are generally small-diameter, mylineated pain transmitting fibers, demonstrate the greastest decrease in conduction in velocity, or post injury edema.
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A-delta fibers
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Gate Control Theory of Pain
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a theory of pain control and modulation that states pain is modulated at the spinal cord level by inhibitory effects of nonoxious afferent input
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Diagnoses involving upper motor neuron dysfunctions (5)
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Spinal cord injuries, multiple sclerosis, Parkinson's disease, cerebral vascular accident, head injuries.
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acute onset of neurological dysfunction due to an abnormality in cerebral circulation with signs and symptoms that correspond to involvement of focal areas of the brain
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CVA (stroke)
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Uses of Cryotherapy (7)
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1. Inflammation Control
2. Edema Control 3. Modification of Spasticity 4. Symptom management in Multiple sclerosis 5. Facilltation 6. Cryokinetics 7. Cryostretch |
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Acute Inflammation Resolution time
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48 to 72 hours
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Cryotherapy treatment time
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15 minutes
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Edema control for Cryotherapy
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the combined treatment of rest, ice, compression, and elevation is used.
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technique that combines the use of cold and exercise in the treatment of pathology of disease.
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Cryokinetics
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application of a cooling agent before stretching. The purpose of this sequence of treatments is to reduce muscle spasm and thus allow greater ROM with stretching.
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Cryostretch
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Contraindications for the use of Cryotherapy (7)
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1. Cold hypersensitivity (cold induced urticaria)
2. Cold intolerance 3. Cryoglobulinemia 4. Paroxysimal Cold Hemoglobinuria 5. Raynaud's disease/phenomenon 6. Over regnerating peripheral nerve 7. Over an area with circulatory problems |
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Precautions for the Application of Cryotherapy (5)
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1. Over a superficial main branch of a nerve (may cause nerve block)
2. Over an open wound 3. Hypertension 4. Poor sensation of poor mentation__ 5. Very young or old patients |
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Adverse effects of Cryotherapy (4)
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1. tissue death
2. Prolonged vasoconstriction 3. Ischemia 4. Thromboses in the smaller vessels |
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Sequence of Sensations in Response to Cryotherapy: (4)
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1. Cold
2. Burning 3. Aching 4. Numbness |
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Ice packs provide:
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More aggressive cooling than cold packs because the ice has a higher specific heat than most gels and because ice absorbs a large amount of energy when it melts and changes from a solid to a liquid
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Ice Pack Treatment time for control of pain, inflammation, or edema
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10-15 mins
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Ice Pack Treatment time for spasticity
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30 minutes
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Plastic Bags filled with a 4:1 ratio mixture of water and rubbing alcohol cooled in a home freezer
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Homemade Cold Pack
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Ice Pack vs. Cold Pack (3)
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1. Ice pack provides more intenses cooling
2. Ice pack is less expensive 3. Cold pack is quicker to apply |
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When Frostbite occurs
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when skin temperature drops to between 39 and 14 degrees F or lower
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Advantages of Ice Massage (5)
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1. tx are can be observed during application
2. can be used for small and irregualr areas___ 3. short duration of tx 4. inexpensive 5. can be applied to elevated limb |
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used to achieve brief and rapid cutanueous cooling. Cools by evaporation. Not used anymore
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Ethyl Chloride
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charactherized by diffuse pain, swelling, and limitation of movement that follows an injury such as a fracture in an arm or leg. Contrast bath may be used for this
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Reflex Sympathetic Dystrophy
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Contrast Bath Procedure
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1st Container: 100-111 degrees for 3-4 mins
2nd container: 50-64 degrees F for 1 minute Repeat 5-6 times for a total of 25-30 minutes |
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CIVD
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Cold induced vasodialation
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NCV
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nerve conduction velocity
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CVA
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cerbovascular accident
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DJD
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degenerative joint disease
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OA
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osteoarthritis
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Effects of Heat (4)
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1. Hemodynamic Effects
2. Neuromuscular Effects 3. Metabolic Effects 4. Altered tissue extensibilty |
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Heat Hemodynamic Effects(1)
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vasodilation and increased blood flow- NOT viscosity of blood
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Heat Neuromusclar Effects (4)
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(1) increases nerve conduction
(2)decreases the conduction latency of both sensory and motor nerves. (3)Decrease in muscle spasm (4)increased pain threshold. |
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Metabolic Effects of Heat (1)
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Increases Metabolic Rate
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Heat Altered Tissue Extensibility (1)
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Increases tissue extensibilty
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Uses of superficial heat (4)
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1. pain control
2. increased ROM 3. accelerated healing 4. infrared radiation for psoraisis |
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Contraindications for Thermotherapy (6)
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1. Recent of potential hemmorage
2. Thrombophelbitis 3. Impaired Sensation 4. Impaired Mentation 5. Malignant Tumor 6. IR irradiation of the eyes |
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Precautions for Thermotherapy (10)
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1. Acute injury or inflammation
2. Pregnancy 3. Impaired Circulation 4. Poor thermal regulation 5. Edema 6. Cardiac insufficency 7. Metal in the area 8. over an open wound 9. over areas where topical counterirritants have been applied 10. demyelinated area |
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Adverse effects of thermotherapy (4)
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1. Burns
2. Fainting 3. Bleeding 4. Skin and eye damage |
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Patient may feel faint when getting up after thermotherapy due to:
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postural (orthostatic) hypotension
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Different Applications for Thermotherapy (6)
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1. Hot packs
2. Paraffin 3. Fluidotherapy____ 4. Infrared lamps 5. Whirlpool 6. Contrast Bath |
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Paraffin melting temperature
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129 degrees to ---113 to 122 degrees---
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Paraffin is usually best for heating
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distal extremities becasue is can maintain good contact with these irregularly contoured areas
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Paraffin is applied by:
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1. dip-wrap (glove best- mild heat___)
2. dip-immersion 3. Paint |
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dry heating agent that transfers heat by convection. It consists of a cabinet containing finely ground particles made from corn cobs. Temp: 100-118 degrees lasting 20 minutes
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Fluidotherapy
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Infrared Radiation 3 bands of wavelength
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1. IR-A
2. IR-B 3. IR-C |
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IR-A
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wavelengths of 770-1400nm
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IR-B
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wavelengths of 1400-3000nm
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IR-C
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wavelengths of 3000-10 to the 6th power nm
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intensity of the rays from a point source varies inversely with the square of th distance from the source. So if the distance from the source increases, the intensity of the rays decrease
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Inverse Square Law
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optimal absorption will occur when the rays strike perpendiculary to the source
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Cosine Law
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IR treatment times
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15 mins for subacute
chronic conditions: up to 30 minutes |
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the application of a mechanical force that increases external pressure on the body or a body part
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Compression
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Compression improves: (2)
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fluid balance and ciruculation
modify scar tissure formation |
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Primary clincial application of compression is for:
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control of peripheral edema due to vascular or lymphatic dysfunction
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Compression helps prevent: (2)
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1. DVT
2. facilitate the healing of venous ulcers |
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Effects of External Compression (3)
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1. increase circulation by increasing hydrostatic pressure in the intersitial space
2. improved venous return 3. Increases venous temperature |
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Clinical implications for the use of external compression (5)
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1. Edema (due to venous insufficency or lymphadema___)
2. Prevention of DVT 3. Venous stasis ulcers 4. Residual limb shaping 5. control of hypertrophic scarring |
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Carry deoxygenated blood from the periphery back to the heart
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Function of Peripheral Veins
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most common cause of VI
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Phlebitis
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Adverse consequences of edema (3)
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1. restricted ROM
2. Limitiation of function 3. Pain |
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Most common areas of hypertrophic scarring (3)
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sternum, upper back, shoulders
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Precautions for Intermittent Compression pumps (5)
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1. impaired sensation or mentation
2. uncontrolled hypertension 3. cancer 4. stroke or significatn Cerebrovascular insufficency 5. superfical peripheral nerves |
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semi-rigid formed of zinc oxide impregnanted gauze applied to the LE that is used to exert working pressure and to control edema
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Unna's boot
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LED
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light emitting diodes
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SLD
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supraluminous diodes
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