physiotherapy: review for the final

here are some review questions and summaries for our physiotherapy final-- definitely some overlap with physio lab material.

LVAC, or low voltage alternating current is good for tissue healing, edema reduction, reduction of hypertonicity, among other things. it is purported to work by depolarization of peripheral sensory and motor nerve fibers, resulting in muscle contraction and pain relief. different frequency and intensity settings can be fine tuned to the specific application: for example, a sensory intensity level with a high frequency would be used for connective tissue repair with acute pain relief, whereas nociception level with low frequency would be used for pain reduction via the opiate method.

low lever laser therapy is a technique that makes use of the therapeutic effects of low power laser light. lasers are unique as a light source in that they are monochromatic, coherent, and collimated and by an essentially unknown mechanism they provide physiological benefit by way of tissue repair, pair reduction, and superficial wound healing.

TENS: transcutaneous electrical nerve stimulation. best for pain relief, although the research is spotty and inconclusive. there are several different modes that can be used which vary the frequency, pulse frequency, intensity, and use bursts of pulses as well. the conventional mode uses a high frequency, low intensity, and long pulse duration, whereas the low freq mode uses a low frequency, motor intensity, and short pulse duration. conventional is thought to manage pain via the opiate response whereas low frequency is thought to work through the gate control system.

UV lamps come in different varieties and have been used recently as an effective treatment for certain skin conditions such as psoriasis. the light is produced by electrical excitation of mercury vapor in a quartz tube and the resulting photon emission. as opposed to infrared, UV lamps do not give therapeutic heat but can stimulate chemical change in the tissues and can also have disinfectant effects. a "hot quartz" uses mostly UVA, also known as blacklight- which has the longest wavelength out of the different types of UV. it is used about 30 inches away and the dosage is determined by the sleeve test, which is used to calibrate for the minimal erythematous dose (a dose which causes erythema that starts in 6-8 hours and disappears in 24). in contrast, cold quartz is used 1 inch from the skin, and is used mainly in wound care and disinfecting.

russian current is a modality developed by Dr. Yakov Kots in 1977 which uses a biphasic, balanced, symmetrical sinewave of a medium frequency, divided into bursts of 50 bu/s. the claim is that the combination of the medium carrier frequency with the overlying burst frequency can reach the deep nerve fibers in muscles and is therefore an effective way for increasing muscle strength and endurance (although these claims have not been substantiated outside of russia).

diathermy is a deep heating modality, up to 5cm, that uses high frequency and low amplitude radio waves. it is purported to have physiological effects based on the principle of resonance, when the patients tissues oscillate at the same frequency as the diathermy wave. this can produce thermal effects as in increased circulation and metabolism, or athermal effects on a cellular level such as increased ion binding and ATP synthesis. to achieve athermal effects, "pulsed mode" is used with lower power settings and pulse frequency. two different methods of delivery are possible depending on electrode type: capacitive method uses a capacitor which produces a strong electric field, better for areas with low water content. inductive method uses a coil which produces a strong magnetic field, better for high water content areas.

IR light is another form of phototherapy that uses electromagnetic radiation with wavelengths in the IR range- approximately 1,500-5,600. they can be luminous, which uses near infrared wavelength and is best for the epidermis and dermal layers, or non-luminous which uses far infrared and is best for the stratum corneum. IR is applied about 20 inches away with no towelling and is generally good as a superficial heat source, used to heat peripheral vascular disease, inflammatory conditions, and can also help joint pain. it is not recommended in areas of malignancy, thrombus formation, or impaired sensation, and excess use might end up in mottled skin known as erythema ab igne.

IFC utilizes two separate medium frequency carrier waves which produce an interference pattern shaped like a cloverleaf which penetrates deep into tissues and depolarizes sensory and motor nerves. it uses two pairs of electrodes which create two overlapping currents of slightly different frequency, or one pair of electrode with a pre-modulated wave (still from two different carrier frequencies in the IFC machine). the "vector scan" can be used to increase treatment area in the quadripolar application by oscillating the current amplitude in one channel while keeping the other constant, and the frequency sweep can be used to subvert sensory nerve adaption. IFC is used for pain reduction, edema reduction, muscle contraction, and is contraindicated near diathermy.

ultrasound is a modality that makes use of the reverse piezoelectric effect- electrically exciting a piezoelectric material causes oscillations which then transmit pressure waves. ultrasound waves have a longitudinal and transverse component and penetrate relatively deeply within tissues. they are better transmitted through homogenous tissues (fat or high water content) and absorbed (and produce heat) in deeper, denser layers and bones. lower frequencies produce greater depth of penetration. it is best used for tissue healing, soft tissue shortening, increasing blood flow, and contraindicated in cancer, hemorrhage, pregnancy, among other things. the mechanism is thought to be both thermal and athermal- athermal effects are thought to be attributed to microcavitation, formation and movement of microscopic air pockets, and fluid shearing/movement near the bubbles.

questions
LVAC...
1. ∂escribe the general schematic for the sequence of physiological events stimulated by LVAC.
2. what are the physiological effects of LVAC?
3. what are the contraindications for LVAC?
4. what is the "reciprocal" mode of delivery for LVAC?
5. what intensity and frequency setting is best for connective tissue healing and acute pain relief?
6. what intensity and frequency is good for chronic edema reduction via muscle twitch?
7. what intensity and frequency is good for reducing muscle hypertonicity?
8. what intensity and frequency is good for pain relief using opiate vs. gate control method?

LLLT...
9. describe the nature of light created by lasers.
10. expand the acronym for lasers.
11. what are the notable differences between lasers and SLD's?
12. of the three properties of lasers in question 9, which is thought to provide most of the therapeutic effects?
13. what are the main therapeutic effects attributed to LLLT?

TENS...
14. describe the waveform used in TENS...
15. what is the "conventional" TENS mode characterized by?
16. what is the "low frequency" TENS mode characterized by?
17. what is the "brief intense" TENS mode characterized by?
18. what is the "burst" TENS mode characterized by?
19. what is the general protocol for the conventional TENS mode? which method of pain relief does this mode make use of?
20. what is the general protocol for the low frequency TENS mode? which method of pain relief does this mode make use of?
21. what are some indications for TENS?
22. what are some contraindications for TENS?

UV lamps...
23. what has been the primary therapeutic use of UV light recently?
24. what are the different types of UV light?
25. what are some notable general characteristics of UV light?
26. how is the UV light produced?
27. what are the hallmarks of the hot quartz UV lamp?
28. what are the hallmarks of the cold quartz UV lamp?
29. what are the hallmarks of the wood's lamp?
30. what are the major physiological effects of UV light?

more on UV...
31. what are some traditional indications for UV lamps?
32. what are the contraindications for UV lamps?
33. what are two laws that govern dosage of UV light?
34. what is the sleeve test?
35. how is the MED determined?
36. how are the dosages for cold quartz determined?
37. what are some precautions to follow for UV application?
38. what are some signs of a UV overdose?
39. what is the PUVA psoriasis treatment?
40. what is the goeckerman regimen for psoriasis?

russian current...
41. describe the waveform used in russian current.
42. what is the burst frequency?
43. physiological effect is dependent on what parameter?
44. what is unique about the medium frequency characteristics of russian current?
45. what were Dr. Kot's claims about Russian current?
46. what are the indications and contraindications for Russian?

diathermy...
47. describe the type of radiation used in diathermy.
48. how does the principle of resonance apply to diathermy?
49. when is pulsed SWD used?
50. what are the thermal effects of CSWD?
51. what are the athermal effects of PSWD?
52. what is the penetration depth of diathermy?
53. what are some effects on RBC's and WBC's?
54. what is the way to decrease thermal effects of diathermy?
55. what are some indications for diathermy?
56. what are some contraindications for diathermy?
57. what is the capacitive method of application? when is it best used?
58. what is the inductive method of application? when is it best used?
59. describe the 4 dosage levels of diathermy in terms of heat sensation.
60. how far away should the lamp be in the capacitive method?
61. how thick should the towel layer be in the inductive method?

infrared...
62. what is the wavelength range for infrared light?
63. what is the depth of penetration for infrared?
64. what are the characteristics of the luminous infrared lamps? which layer does it heat most effectively?
65. what are the characteristics of the non-luminous infrared lamps? which layer does it heat most effectively?
66. how far away should IR lamps be?
67. what are the advantages to IR lamps?
68. what are some traditional indications for IR therapy?
69. what are some contraindications for IR therapy?
70. what is a local sign of IR excess?

interferential...
71. describe the waveform used in interferential.
72. describe the penetration depth of interferential current.
73. what is IFC's effect on nerve depolarization?
74. what is the parameter that is most relevant for muscle contraction?
75. when is frequency sweep used?
76. ∂escribe the quadripolar method of electrode placement.
77. what is the "vector scan"? why is it used?
78. what are the main therapeutic uses for IFC?
79. what is a condition that IFC can treat effectively?
80. what is a contraindication for IFC?

ultrasound...
81. what is the principle by which the ultrasound head produces soundwaves?
82. which is the only tissue that conducts transverse US waves?
83. what is the relationship between frequency and beam divergence?
84. what is the BNR? what is a recommended value?
85. absorption of the US beam is proportional to...
86. what is the relationship between tissue homogeneity and US absorption?
87. what are the different outcomes of a US wave within the tissue?
88. what is the relationship between frequency and depth of penetration?
89. what are the physiological effects of US?
90. what are some indications for US?
91. what are some contraindications for US?

answers
1. biphasic pulsed or continuous current causes peripheral nerve depolarization which causes pain reduction by gate closing method and muscle contraction which leads to edema and spasm reduction.
2. tissue healing
edema reduction
hypertonicity reduction
pain relief
3. general contraindications for electrotherapy: pregnancy, malignancy, pacemaker, etc.
4. two pairs of electrodes, and current switched from one pair to the other in a periodic fashion.
5. sensory intensity level, 80-150pps.
6. motor intensity, 1-10pps.
7. motor intensity, 80-150pps.
8. opiate method: nociception intensity, 1-15pps.
gate control method: nociception intensity, 80-150pps.

9. coherent, monochromatic, collimated.
10. light amplication by stimulated emission of radiation.
11. SLD's: lower power density, not coherent, collimated.
12. monochromaticity.
13. superficial wound healing, pain reduction, tissue repair.

14. biphasic, balanced, asymmetrical or symmetrical.
15. high frequency, sensory intensity, short pulse duration.
16. low frequency, motor intensity, long pulse duration.
17. high frequency, long pulse duration, motor intensity. short duration of application.
18. bursts of 5-10 pulses, low frequency, motor intensity.
19. sensory intensity level, >85pps, 75usec pulse. uses the gate control system.
20. motor intensity, <10pps,>

organ systems III: visual system part 2b

this lecture covered a few last concepts about the iris, the lens, and the sympathetic / parasympathetic innervation of the muscles that mediate the aperture of the pupil. the iris is the colored part of the eye, the specific color of which results from the particular distribution of melanin pigments scattered throughout the iris-- if the melanin is deep in the iris, this results in a blue color, and a more general distribution results in a brown or green color.

the iris can be dilated or constricted, allowing varying levels of light into the pupil, depending on the contraction of the dilator pupillae vs. the sphincter pupillae. the more the pupil is constricted by the sphincter pupillae, the less light is let into the eyeball, and the greater the "range of focus" is. this constriction is mediated by a parasympathetic pathway. it can be initiated by light hitting melanopsin ganglion cells in the back of the eye, which innervate the pretectal nuclei, which innervates the edinger westfall nuclei of both eyes, which projects to the ciliary ganglion behind the eyeball, which then projects post ganglionics to the dilator pupillae, constricting the pupil. it also projects to the ciliary muscles, increasing the convexity of the lens as well.

the dilation of the pupil is mediated by a sympathetic pathway which can be initiated by local reflexes or descending influences from the limbic system or hypothalamus. the sympathetic preganglionics originate from the T1-T2 level and synapse at the superior cervical ganglion, which then project post ganglionics via the arterial system to the dilator pupillae, as well as to the tarsal muscle- which connects to the tarsal plate and raises the eyelid when constricted.

questions
1. the iris contains...
2. where does eye color come from?
3. where is the melanin mainly distributed in blue eyes?
4. where is the melanin mainly distributed in brown or green eyes?
5. what does the iris control?
6. what is the relationship between pupil aperture size and the range of focus?
7. describe the action and innervation of the sphincter pupillae.
8. describe the action and innervation of the dilator pupillae.

9. describe the parasympathetic pathway of autonomic innervation of the lens muscles.
10. describe the sympathetic pathway of autonomic innervation of the lens muscles.
11. what is the edinger-westfall nucleus?
12. describe the net effect of parasympathetic innervation on the eye muscles.
13. describe the pathway by which incoming light can cause an autonomic constriction of the pupil.
14. sympathetic innervation of the iris and upper eyelid muscles is initated by...
15. describe the pathway by which sympathetics can cause dilation of the pupil.
16. what is the tarsal muscle? what does it do? where does it insert?
17. what is "ptosis"? what syndrome is this phenomenon seen in?

answers
1. pigmented striations of connective tissue, blood vessels, smooth muscle.
2. the refraction of light from the different distributions of melanin pigment in the iris.
3. on the deep surface of the iris.
4. evenly distributed throughout the iris.
5. the aperture of the pupil.
6. smaller aperture increases range of focus.
7. constricts the pupil aperture, increasing focal length. innervated by parasympathetics.
8. opens the pupil aperture, decreases focal length. innervated by sympathetics.

9. follows the oculomotor nerve CN (III) and synapses at the ciliary ganglion which is posterior to the eyeball.
10. originates from the thoracic spine, synapses on the superior cervical ganglion, and follows the arterial system to the eye.
11. the nucleus of the oculomotor nerve from which the lens muscle preganglionics originate.
12. the sphincter pupillae contracts and the ciliary bodies contract lens.
13. incoming light into at least one eye hits the melanopsin ganglion cells, which innervate the pretectal nuclei, which innervates the EW nuclei of both eyes, which projects to the ciliary ganglion, which projects to the eye muscles and contracts the sphincter pupillae and ciliary bodies.
14. local reflexes, descending influences from limbic system and hypothalamus during emotional state.
15. sympathetic influences described in question 14 can cause the innervation of preganglionics from the T1-T2 level which synapse on the superior cervical ganglion, which then sends axons out to the dilator pupillae (but not the ciliary muscle) and the tarsal muscle, causing dilation of the pupil and lifting of the eyelid.
16. the muscle that lies deep to the levator palpabrae and attaches to the tarsal plate.
17. a drooping eyelid caused by damage to the sympathetic pathway which innervates the tarsal muscle.