1. cardiac output
    norms at rest
    • SVxHR
    • men: 5.6 L/min
    • women: 4.9 L/min
  2. effect of heat on CO, SV, BP, HR, RR
    • CO: increase
    • SV: decrease
    • BP: decrease
    • HR: increase
    • RR: increase
  3. conduction vs convection vs radiation
    • conduction: heat transfer by direct contact (heat packs, paraffin)
    • convection: by air or fluid (whirlpool, hubbard, fluidotherapy)
    • radiation: by electromagnetic energy (infrared lamp)
  4. effects of cold on CO, SV, HR, RR
    • CO: increase
    • SV: increase
    • HR: decrease
    • RR: decrease

    (opposite of heat, except CO)

    BP: venous decreases, arterial increases
  5. urticaria
    • a rash of round, red welts on the skin
    • itch intensely,
    • sometimes with dangerous swelling,
    • caused by an allergic reaction, typically to specific foods.
  6. wheal
    an area of the skin that is temporarily raised, typically reddened, and usually accompanied by itching
  7. cold urticaria
    • hypersensitivity to cold resulting in:
    • erythema of skin w wheals
    • itches 2/2 histamine reaction
  8. signs of bad reaction to cold
    • cold urticaria
    • facial flush, puffy eyelids, resp problems, anaphylaxis w syncope 2/2 histamine reaction
  9. signs of anaphylaxis
    • decreased BP
    • increased HR
  10. cryoglobulinemia
    blood contains many cryogolublin proteins that solidify at temps below normal body temp, and dissolve when returned to normal temp
  11. normal sequence of sensations for cold therapy
    cold, burning, aching, numb
  12. muscle spasm response to hot and cold
    • decreased by both
    • cold also targets spasticity
  13. muscle strength in response to cold?
    increases bc of facilitation of alpha motor neuron (1-5 min)
  14. time ratio for contrast baths
    • 4:1 min hot:cold
    • 100-111 / 55-65 degrees
    • 20-30 min
    • useful for pain modulation, debatable for raising deep tissue temp via increased circ
  15. contraindications to contrast baths
    • advanced arteriosclerosis
    • arterial insufficiency
    • loss of sensation to heat or cold
  16. acoustic streaming in US
    • mvmnt of fluids along boundaries of cell membranes 2/2 mechanical pressure wave
    • --> increased cell wall permeability, increased intracelluar calcium, increased macrophage response, increased protein synthesis ... may accelerate tissue healing
  17. US intensity -- how to decide?
    it's 0.5-2.5 w/cm^2
    • lower for acute conditions and thin tissue (wrist skin)
    • higher for chronic conditions and thick tissue (low back)
  18. US settings for phonophoresis
    • pulsed mode, 20%
    • intensity 1-3 w/cm^2, or .5-.75 if using a med that's prepared in a medium that will allow transmission of the US (??)
    • 5-10 min (regular US is 3-10 min)

    for pain modulation and anti-inflam
  19. % of body wt used for cervical traction
    7% or 8-10 lbs
  20. traction - low vs high force
    • low: inhibit pain, decrease spasm
    • high: decrease pressure on joints, stretch surrounding tissues
  21. HTN and mechanical spinal traction?
    it's a contraindication
  22. lumbar traction timing
    • 5-10 min for herniated disc
    • 10-30 min for other conditions
  23. cervical traction timing
    • 5-10 min for acute
    • 15-30 for chronic
  24. settings for intermittent mechanical compression
    • elevate 45 and abduct 20-70 limb
    • stockinet over extremity
    • inflation/deflation ~ 3/1, 45-90 sec on, 15-30 sec off
    • use 1-3 hours, for some concerns do multiple times a day
  25. pressure in intermittent mechanical compression
    some say stay below diastolic, some say you can go above bc it's on for only a short time
  26. benefits of continuous passive motion machines
    • accelerate rate of interarticular cartilage regeneration, tendon healing, ligament healing
    • decreased edema
    • decrease joint effusion
    • decrease post-op pain
    • increase synovial lubrication of the joint
    • improve ciruclation
    • improve nutrition to articular cartilange and periarticuar tissues

    and of course, increase ROM, reduce contractures and adhesions
  27. timing for tilt table
    up to 45 min, 1-2x/day
  28. effleurage
    • stroking massage
    • usually starts and ends treatment
  29. petrissage
    kneading massage - grasping and lifting the tissues
  30. tapotement
    tapping w palm, fingers, cupped hand, ulnar boarder (hacking)
  31. cupping massage technique
    • tapotement w  cupped hands
    • for mobilizing bronchial secretions
  32. surprising skills of e-stim
    • bactericidal (disrupts DNA, RNA synth, and cell transport of microoranisms)
    • increases ATP concentration, and protein and DNA synth
    • galvanotaxic (attracts helpful cells to speed tissue repair)
  33. cells you want around during inflam stage
    • macrophages (+) (these are WBCs)
    • mast cells (-) (WBCs rich in heparin and histamine)
    • neutrophils (-/+)
  34. cells you want around during proliferation stage
    fibroblasts (+)
  35. intensity and timing of iotophoresis
    • intensity: anode - 1 mA/cm^2, cathode - 0.5, up to max of 4-5 mA
    • 10-40 min, check every 3-5 min
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