Stanbridge - T4 - Modalities - W4 - Compression, CPM, & Diathermy

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary mechanism by which diathermy generates heat in tissues?

Infrared radiation absorption in muscle

Direct electrical stimulation of nerve endings

Eddy currents oscillating the ions (correct)

Resistance heating in adipose tissue

Which type of tissues are primarily targeted by diathermy for heating due to their properties?

Superficial skin and hair follicles

Adipose tissues and bone

High-water content tissues such as muscle and synovial fluid (correct)

Fatty tissues and skeletal muscle

In which of the following conditions is diathermy most effectively applied?

Vascular tissues with edema or effusion (correct)

Tissues with low water content

Areas with significant adipose tissue accumulation

Non-vascular needs, such as maintaining joint stability

What role does the electromagnetic field play in the induction method of diathermy?

It places the patient within a magnetic field creating heat through resistive heating Signup and view all the answers

Which statement best describes the use of diathermy in treating soft tissue injuries with hematomas?

Diathermy heats low impedance areas to improve blood flow and recovery Signup and view all the answers

What is the primary purpose of applying compression to the body?

To apply external mechanical pressure for therapeutic benefits Signup and view all the answers

What is the effect of compression on the cross-sectional area of veins?

Narrows the area, increasing blood flow speed Signup and view all the answers

Which of the following is a physiological effect of compression?

Stimulates capillaries to absorb interstitial fluid Signup and view all the answers

What does a higher Ankle-Brachial Index (ABI) of > 1.30 indicate?

Non-compressible rigid arteries Signup and view all the answers

Which statement accurately describes the role of compression on capillaries?

It alters pressure to decrease edema formation Signup and view all the answers

Compression impacts oxygen delivery in the body. Which of the following best describes its effect?

Increases oxygen delivery and CO2 uptake Signup and view all the answers

What is a common purpose of taking girth measurements before applying compression?

To assess the effectiveness of compression Signup and view all the answers

What is the primary mechanism by which heat is generated in diathermy using the condenser/capacitive method?

Oscillation of ions in the tissue Signup and view all the answers

What type of fields does the condenser/capacitive method of diathermy utilize?

Strong electrical and weak magnetic fields Signup and view all the answers

In the context of diathermy, where is heat typically generated most intensely?

Where the density of the electrical field is greatest Signup and view all the answers

Which statement accurately describes the patient’s role in the condenser/capacitive method of diathermy?

The patient aids in completing the circuit. Signup and view all the answers

What is a characteristic outcome of using the condenser/capacitive diathermy technique?

Superficial heating Signup and view all the answers

What is the primary physiological benefit of using Continuous Passive Motion (CPM)?

Decreases post operative pain Signup and view all the answers

Which statement describes the contraindications of Continuous Passive Motion?

May cause increased pain after use Signup and view all the answers

What is primarily generated due to the oscillation of ions in tissue during diathermy?

Heat Signup and view all the answers

Which factor is essential for the proper prescription of Continuous Passive Motion?

Initial arc for motion Signup and view all the answers

Which of the following is not typically associated with the condenser/capacitive diathermy method?

Mechanisms of conduction Signup and view all the answers

What does the density of the field in diathermy directly affect?

Level of ion oscillation Signup and view all the answers

What is a typical frequency for Continuous Passive Motion for optimal compliance?

4-8 hours a day Signup and view all the answers

Which of the following is NOT a benefit of Continuous Passive Motion?

Improves overall strength in muscles Signup and view all the answers

In diathermy treatments, what is the role of the strong electrical field?

To create oscillation of ions within the tissue Signup and view all the answers

What is the primary benefit of the condenser/capacitive diathermy method compared to other heating methods?

Targeted superficial heating Signup and view all the answers

What should be documented following the use of compression bandaging?

Type of compression used Signup and view all the answers

What characteristic distinguishes short stretch bandages from long stretch bandages?

They produce high pressure for working limbs. Signup and view all the answers

What describes the pressure gradient in lymphedema bandaging?

Distal pressure greater than proximal pressure Signup and view all the answers

Which type of compression is specifically mentioned for treating venous stasis ulcers?

Multi-layered bandages Signup and view all the answers

How often should disposable OTC devices be replaced?

Every 6 months Signup and view all the answers

Which of the following indicates an appropriate use of Continuous Passive Motion?

Limited range of motion after surgery Signup and view all the answers

What is the lifespan of compression garments indicated in the content?

6 months Signup and view all the answers

What documentation should be included regarding the patient's response to treatment with compression?

Patient's response to treatment Signup and view all the answers

What are the two primary types of pressure produced by long stretch ACE wraps?

High pressure at work, low pressure at rest Signup and view all the answers

What is a contraindication for using compression therapy?

Acute DVT Signup and view all the answers

Which range of mmHg is indicated for the lower extremities when using intermittent compression pumps?

40-80 mmHg Signup and view all the answers

What method is essential when applying ACE wraps?

50% stretch with 50% overlap Signup and view all the answers

What condition can compression therapy effectively help manage, according to the evidence provided?

Lymphedema Signup and view all the answers

Which of the following is NOT a precaution for compression therapy?

Venous ulcers Signup and view all the answers

Study Notes

Modalities (PTA 1009)

Compression, CPM, and Diathermy are discussed in this presentation.
Compression is the application of external mechanical pressure to the body for therapeutic purposes.

Objectives

The student should be able to describe the following:
- Anatomy of fluid movement
- Types of compression
- Signs of inflammation
- Types of edema
- Indications, contraindications, and precautions for compression
- Dosage and frequency of compression

Anatomy- Fluid Movement

Fluid travels through three main pathways in the body:
- Circulatory system
- Lymphatic system
- Interstitial space
90% of fluid absorbed on the arterial side of capillary bed is absorbed from the venous side.
10% of fluid, protein and debris are removed by the lymphatic system.
Fluids are held within interstitial space by a gel matrix.
Gel matrix functions as:
- Spacer between cells
- Prevents excessive fluid movement into the lower body
- Prevents rapid spread of bacteria throughout tissues
Lymphatic system Functions as:
- Regulates fluid balance (only mechanism for protein removal)
- Works with the immune system to defend against cancer/infection
- Transports digested fat from the gut
- Can transport up to 10 times the normal volume but not for long time
A review of the Cardiac and Pulmonary Systems and the Lymphatic System is also included. Demonstrates the relationship between circulatory and lymphatic systems in fluid movement.

Anatomy Review: 3 Systems

Blood flow in veins is dependent on:
- Skeletal muscle contraction
- One-way valves
- Respiratory movements

Edema

Edema occurs if things at the capillary level aren't working properly.
Arteriole end-exit of O2, water, and nutrients
Venous end-entrance of CO2, water, and wastes
Filtration and Absorption influenced by pressure gradients and concentrations. (Capillary level)
Types of Edema:
- Acute
  - Local: due to tissue injury (mechanical, infectious, toxic)
  - Widespread: metabolic disease (i.e., congestive heart failure, malnutrition)
- Chronic or Progressive= Lymphedema
  - Result of venous and/or lymphatic obstruction
  - Often painless and mildly warming, General Symptoms - Heaviness - Warmth - Aching - Stiffness - Shiny/tight skin - Loss of skin folds
Stages of Lymphedema

Early vs. Chronic Edema

Early edema is characterized by pitting.
Chronic edema is characterized by non-pitting, trophic skin changes (rough, leathery), and excessive protein deposits (fibrosis).

Edema Classification

Edema is classified as follows:
- Acute (1-14 days)
- Subacute/Post-acute (14 days - 3 months)
- Chronic (3+ months)

Examination of Edema

Examination should include:
- Timing of edema symptoms
- Medical/surgical history
- Pain assessment
- Self-treatment
- Medications
- Functional limitations

Edema Causes and Treatment

Edema can cause:
- Increased risk of infection
- Decreased blood flow and nutrient supply to tissues
- Decreased mobility, strength, and function
- Increased pain from mechanical pressure on nerve endings.
Treatment: RICE (Rest, Ice, Compression, Elevation)

Compression

Definition: Application of external mechanical pressure to the body for therapeutic purposes.
Physiological effects:
- Supports skin, allowing for more effective fluid pumping by muscles
- Stimulates capillaries (lymphatic and circulatory) to absorb interstitial fluid
- Altered pressure around capillaries decreases edema formation
- Narrows cross-sectional area of vein, increasing blood flow, and decreasing fluid leakage
- Makes valves more competent, increasing muscle pump activity
- Improves oxygen delivery and CO2 uptake
Take girth measurement and patient's ABI prior to wrapping
Types of Compression Bandages:
- Long stretch (ACE wraps - elastic)
- Short stretch (inelastic)
- Multi-layered bandages
- Semi-rigid bandages (e.g., Unna Boot)
Intermittent Compression Pumps
Compression Garments
- UE/LE/Trunk garments

Contraindications for Compression

Arterial insufficiency (ABI ≤ 0.5)
Arterial wounds
Untreated cardiac or pulmonary edema
Renal edema
Acute infections (e.g., cellulitis)
Acute DVT
Edema without diagnosis

Precautions for Compression

Mixed venous and arterial ulcers (ABI = 0.5–0.8)
Diabetes
Paralysis
Malignancy
Sensory deficits
Altered mental state
Sensitivity to compression
Inability to comply with home instruction
Genital lymphedema with compression for LE's

Red Flags for Systemic Edema (Organ)

Bilateral edema of extremities
Sudden onset without traumatic event
Progressive edema
Edema involving the face/arm with discoloration of the chest/arm/face loss of carotid pulses, dysphagia, etc.
Total body, total quadrant edema
Edema that occurs simultaneously with fever, sweats, and chills
Inflammatory changes (e.g., red streaks)
Calf pain and edema after trauma
Edema warm/hot to palpation
Arterial vascular changes (paleness, cool skin temperature, tight/shiny skin)

Methodology for Compression

Compression garments
Classes of compression (Preventative, I-IV)
Custom vs. OTC compression
Replacements every 6 months
Dosages
Pneumatic Compression Pumps
Diastolic pressure maximum mmHg for venous ulcers
Dosages
Lymphedema bandaging:
Short stretch requires special training
Gradient: distal > proximal
Includes
- Massage
- exercise
Replace every 6 months

Documentation for Compression

Type of compression used
Vital signs (if necessary)
Volumetric/circumferential measurements (before and after tx)
Region of body treated
Dosage (time, max mm Hg, position, extremity)
Number and size of bandages used
Patient response to treatment
Patient education
Document compression, capillary refill, sensory check, and extremity mobility

Continuous Passive Motion (CPM)

Passive motion by a mechanical device
Benefits: Decreased adhesions, improved ROM gains, improved synovial fluid, decreasing post-operative pain, reducing edema, and stimulating tissue healing.
Indications: Pain, limited ROM, edema, susceptibility to contractures/adhesions, muscle/joint stiffness.
Contraindications: Increased pain after use, use with anticoagulants that put the patient at risk for intra-compartment hematoma, unwanted translation of opposing bones (fracture, arthrodesis).
Prescription:
- Initial arc: 20°-30°
- Progress: 10°-15° / day as tolerated
- Rate of motion: 1 cycle/45 sec - 2 min
- Frequency: 4-8 hrs/ day for best compliance
- Duration: < 1 week

Diathermy (SWD and PSWT)

Types of Diathermy
Physical principles of Diathermy
Physiological Responses
Indications, contraindications, and precautions
Advantages/Disadvantages of Diathermy
Dosage and frequency
Deep Heat (Tissue penetration 3-5 cm)
Can treat up to 25x the size of an US transducer head (large area)
Heat transfer via: Conversion
Continuous or Pulsed Mode
Non-Thermal effects
Thermal effects

Indications for Diathermy

Pain (e.g., sub-acute and chronic low back pain, trigger point pain, osteoarthritis, muscle strain, bursitis)
Limited ROM (soft tissue tightness, DJD, joint stiffness)
Inflammation (including chronic inflammation)
Reflex heating
Pelvic Inflammatory Disease
Herpes Zoster
Peripheral nerve regeneration
Increased metabolism of cells

Contraindications for Diathermy

Infections
- Recent x-ray therapy
Existing fever
Cardiac insufficiency
Older adults/children under 4
Patients who are generally debilitated
Over epiphysis of growing bones
Ischemic tissue
Hemophilia
Patients, staff, or visitors wearing pacemakers
Implanted systems or leads (neurostimulators)
Pregnancy (therapist or patient)
Internal/external metal objects that cannot be removed
Active bleeding (including menses or acute trauma)
Malignancies
Pain and sensory deficits

Diathermy Dosage

Common Doses (Low to High):
- Dose I – No sensation of heat (Acute)
- Dose II – Mild heating sensation (Subacute)
- Dose III – Moderate heating sensation (Resolving inflammatory process)
- Dose IV – Vigorous heating that is tolerable below threshold (Chronic).
Dose is based on:
- Patient response during treatment (heat, no heat felt)
- Intended goal (thermal/non-thermal affects)
- Phase of healing (acute, subacute, vs. chronic)

Diathermy (SWT and PSWT): Non-Thermal Dosage

Intensity ≤ 5 W – used for acute conditions
Narrow pulse durations (65-80 µs)
Medium pulse rates (100–200 pps)
Duration up to 30-60 minutes
Treatment frequency
- Acute: 2-3x daily
- Sub-Acute: 2-3x/wk
- Chronic: 1x/wk

Diathermy (SWT and PSWT): Thermal Dosage

Intensity > 5 W – considered thermal and is reserved for sub-acute/chronic conditions
21 W is the average dose for thermal effects
Longer pulse durations (300-400 μs)
- Higher frequencies introduce (>300 pps)
Duration – 20 minutes
Heating of tissues lasts longer than with ultrasound, giving the therapist additional time for therapeutic interventions.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore the principles and applications of diathermy in therapeutic settings. This quiz covers the mechanisms of heat generation, targeted tissues, effective conditions for use, and the role of electromagnetic fields in diathermy's induction method. Test your understanding of diathermy in treating soft tissue injuries and hematomas.