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87 Cards in this Set
- Front
- Back
Name 6 assessments of coordination/dexterity
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1. Perdue pegboard
2. Minnesota manual dexterity test 3.O'connor tweezer test 4. crawford small parts dexterity test 5. nine hole peg test 6. Jebson hand function test |
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Why is perdue pegboard preferred over nine-hole peg test?
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perdue peg board can be both unilateral and bilateral
it is more reliable |
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What UE assessment tool includes 7 subtests in various areas of occupation
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Jebsen hand Function Test
Includes writing, page turning, picking up common objects, feeding, stacking, picking up large light objects, picking up large heavy objects |
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what 2 UE assessment tools look at finger dexterity
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purdue pegboard
nine hole peg test |
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what assessment tool looks at eye hand coordination in the context of fine motor?
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o'connor tweezer test
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what UE assessment tool looks at gross hand and arm movements?
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Minnesota Manual Dexterity Test
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what are the 2 components of the perdue peg board?
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manual dexterity (30 sec)
assembly job simulation (1 min) |
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What are the 2 components of the Minnesota Manual dexterity test?
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placing test (1 hand)
turning test (2 hands) |
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How do you increase ROM?
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1. PROM and passive stretch
used when there is contracture, or PROM = AROM 2. AROM use when PROM is greater than AROM 3. cannot increase ROM if there is arthrodesis, ankylosis, long-standing contracture, or joint destruction Incorporate into occupation |
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How do you know what type of passive exercise is appropriate?
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Review MD orders
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How do passive stretch and PROM differ?
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passive stretch includes over-pressure
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how do you apply passive stretch
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manual stretch within person's tolerance
-hold for 15-30 seconds -pain should go away immediately when pressure released (otherwise too much pressure) -adding weight increases stretch. Be careful what objects you are using when doing this in the context of occupation |
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What exercises are often prescribes s/p shoulder surgery
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codman's exercises (a type of
PROM) |
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What are some additional methods of PROM
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dynamic and serial splinting
equipment such as continuous passive movement and pulleys |
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When is it appropriate to use AROM to improve range of motion?
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when PROM > AROM
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what are some methods to improve ROM via AROM?
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differential tendon glides (increase tendon excursion in case of adhesions)
blocking exercises (isolate joint motion) encourage functional use/occ based activities preparatory interventions: wall walking, cane exercises, AROM |
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Precautions when increasing ROM
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overstretch can create myositis ossificans
(a type of heterotopic ossification) |
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How do you increase ROM?
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1. PROM and passive stretch
used when there is contracture, or PROM = AROM 2. AROM use when PROM is greater than AROM 3. cannot increase ROM if there is arthrodesis, ankylosis, long-standing contracture, or joint destruction Incorporate into occupation |
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How do you know what type of passive exercise is appropriate?
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Review MD orders
|
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How do passive stretch and PROM differ?
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passive stretch includes over-pressure
|
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how do you apply passive stretch
|
manual stretch within person's tolerance
-hold for 15-30 seconds -pain should go away immediately when pressure released (otherwise too much pressure) -adding weight increases stretch. Be careful what objects you are using when doing this in the context of occupation |
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What exercises are often prescribes s/p shoulder surgery
|
codman's exercises (a type of
PROM) |
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What are some additional methods of PROM
|
dynamic and serial splinting
equipment such as continuous passive movement and pulleys |
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When is it appropriate to use AROM to improve range of motion?
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when PROM > AROM
|
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what are some methods to improve ROM via AROM?
|
differential tendon glides (increase tendon excursion in case of adhesions)
blocking exercises (isolate joint motion) encourage functional use/occ based activities preparatory interventions: wall walking, cane exercises, AROM |
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Precautions when increasing ROM
|
overstretch can create myositis ossificans
(a type of heterotopic ossification) |
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How do you increase strength? what type of contraction is most efficient?
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high resistance, low reps increases strength
isometrics can produce more powerful contractions |
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When strengthening, what type of contraction may be contraindicated? With what populations?
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Isometrics are contraindicated with cardiovascular conditions and HTN because they increase HR & BP
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What are the 3 types of muscle contractions
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-isometrics = contract without movement
2 types of isotonics: -eccentric = muscle lengthens -concentric = muscle shortens |
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How do you increase endurance?
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Work at 50% of max resistance or less
-increase reps and duration, but not resistance -use energy cons methods |
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What do you increase in order to improve endurance
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increase number of reps, and duration of activity
do not increase resistance |
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What are 5 methods of reducing edema?
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1. Elevate above heart
2.Retrograde massage 3. compression garments 4. cold packs 5. contrast bath |
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You patient has poor circulation and an edematous UE. What should you NOT do?
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you should not use elevation to reduce edema if a patient has poor circulation
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principles of retrograde massage
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stroke distal to proximal
stroke in centripetal direction perform with extremity elevated |
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when is it appropriate to use a compression garment?
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to prevent re-accumulation of edema following retrograde massage
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Examples of compression garments
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isotoner glove for hand
tubigrip for UE (elastic stockinet) ace wraps coban wrap (for digits) (can exercise and use hand for ADL while wearing coban) |
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What should be done when a cold pack is applied to manage edema?
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cold packs are most effective with elevation
monitor vascular status (vasoconstriction) |
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What is a contrast bath?
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method of reducing edema
there is conflicting evidence regarding effectiveness for hand edema emerse hand in warm water then cold water |
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What are the contraindications for managing edema?
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-avoid heat
do not use edema management techniques if: infections, grafts, wounds, vascular damage, unstable fractures, CHF |
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When is it appropriate to use heat if there is edema
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may be used in cases of mild edema when application of heat is necessary, but must be closely monitored
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6 principles of scar management
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1. ROM - early mobilization is most effective
2. massage (circular and friction) 3. compression garments (coban, isotoner glove, tubigrip) 4. Scar pads with compression 5. splinting to prevent contractures 6. edema control (particularly in acute phase) |
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What are 3 interventions for sensory training
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1. desensitization for hypersensitivity
2. sensory re-education 3. compensation |
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Types of desensitization interventions
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-if s/p surgery, begin in periphery of scar and work over as tolerated
1. massage 2. textures 3. vibration 4. 3 phase desensitization kit 5. fluidotherapy |
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Types of sensory re-education interventions
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1. massage
2. textures 3. vibration 4. 3-phase desensitization kit |
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compensatory strategies for sensory re-training
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avoid using hands with vision occluded
observe safety precautions |
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principles of improving coordination
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1. begin with slow gross movements, gradually progress to fast percise movements
2. focus on accuracy and speed |
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what are the 2 main types of splints?
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static (immobilizes)
dynamic (increases PROM or augments AROM) |
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5 purposes of splinting
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1. rest
2. prevent deformities/contractures 3. increase joint ROM 4. protect bone, joint, and soft tissue 5. increase functional use |
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2 main principles of designing splints
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maintain arches of the hand
(proximal and distal transverse arches, longitudinal arches) Don't impinge on creases (distal and proximal palmar creases, distal and proximal wrist creases, thenar crease) |
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4 Mechanical principles of splinting
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1. decrease pressure with a long wide base and round edges
2. slings should be positioned at 90* angle of pull 3. use low load to increase duration 4. maintain 3 points of pressure v. circumference |
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What is the position of deformity?
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avoid in splinting
wrist flexion MCP hyperextension IPs flexed thumbs adducted |
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what is the safe splinting position?
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wrist = 20-30* extension
MCP = 50-70* flexion IP extension thumb abducted and extended |
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Resting splinting position
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wrist = 10-20* extension
MCP = 30-45* flexion IP = 0-20* flexion thumbs abducted |
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What is an important precaution for splinting
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check skin before and after wear
educate patient to check skin |
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what patient education should be completed for splinting?
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-skin inspection
-splint care -provide wear and care form -teach to don/doff -make sure they understand purpose, functions, and limitations -teach use during role activities |
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What can a COTA do in terms of splinting?
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help determine splint type
experienced COTAs can make static splints and help with dynamic splints |
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what splint is used for brachial plexus injury?
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flail arm splint
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What splint is used for radial nerve palsy?
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dynamic wrist, finger, thumb extension splint
(lose extensors) |
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What splint is used for median nerve injury?
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opponens splint, c-bar or thumb post splint
(lose opposition) |
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What splint is used for ulnar nerve injury?
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dynamic or static MP flexion splint
(lose intrinsics-- lumbricals 4 & 5 and interossei) |
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what splint is used for combined median-ulnar nerve injury
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figure of 8 or dynamic MCP flexion splint
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when is a tenodesis splint used?
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C6-C7 SCI
(C6 has wrist extension and use of biceps C7 has wrist/finger extensors and use of triceps) C8 does not need this splint because they have wrist/finger flexors |
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what splint is used for carpal tunnel
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wrist splint in neutral
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what splint is used for cubital tunnel
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elbow splint in 30* flexion
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what splint is used for DeQuervains?
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forearm based thumb splint (includes wrist) with IP free
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What splint is used for skier's thumb?
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Ruptured ulnar collateral ligament
Hand based thumb splint (thumb spica) |
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What splint is used for CMC arthritis
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hand based thumb splint
(thumb spica) |
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What splint is used for ulnar drift?
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ulnar drift splint
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What splint is used for flexor tendon injury?
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dorsal block (protection) splint
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what splints are used for swan neck deformity?
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silver ring splint or buttonhole splint
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what splints are used for boutonniere deformity?
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silver ring splint or PIP extension splint
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what splints are used for arthritis?
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functional splint or safe splint depending on the stage
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what splint is used for flaccidity
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resting hand splint
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what splint is used for spasticity
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spasticity splint or cone splint
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What splints are used for muscle weakness?
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For ALS, SCI, Guillan Barre
-balanced forearm orthosis -deltoid sling -suspension sling |
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How are balanced forearm orthoses, deltoid slings, and suspension slings used?
What movement is needed? |
mount to wheelchair
need shoulder or trunk movement to use |
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splinting for hand burns
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wrist = 15-30* extension
MCP = 50-70* flexion IPs = full extension |
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When is it appropriate to use PAMs?
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PAMs can only be used if they precede, support, or enable engagement in occupation.
-a PREPARATORY method |
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What are 8 types of PAMs?
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1. paraffin baths
2. hot packs 3. cold packs 4. fluidotherapy 5. whirlpool 6. contrast baths 7.ultra sound 8. electrical stimulation units |
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what are 3 types of Estim?
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1. functional electrical stim (FES)
2. Neuromuscular electrical stim (NMES) 3. trancutaneous electrical nerve stimulator (TENS) |
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Benefits of superficial heat
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1. relieves pain
2. increases tissue extensibility (for increasing range of motion) 3. assists with wound healing |
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benefits of cryotherapy
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1. relieves pain
2. controls edema 3. decreases abnormal tone 4. facilitates muscle tone |
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benefits of whirlpool
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1. cleans and debrides an open infected wound
cannot be used as a heat modality--it is not hot enough |
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benefits of electrical stimulation
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1. relieves pain
2. decreases swelling 3. stimulates and strengthens muscles 4. stimulates denervated muscle |
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benefits of ultrasound
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1. relieves pain
2. decreases inflammation 3. increases tissue extensibility 4. decreases adhesions |
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benefits of contrast baths
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reduces edema
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6 general contraindications for PAMs
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1. cancer
2. pacemaker 3. pregnancy 4. cognitive impairment 5. sensory impairment 6. vascular impairment always consider age and diagnosis (ex. ultrasound cant be used over a growth plate) |