HVPC
Wounds are charged when cells get damaged and leak out cells. HVPC uses this quality of cells to move them around based on charge.
What is galvanotaxis?
What are two ways (equipment) we can apply short wave diathermy?
BONUS 200pts: What is one thing you need to remember before using each type?
With inductive coils and capacitive plates
BONUS: For coils, you should place a dry towel between the skin and the coils. The coils should also be placed close to the skin. Capacitive plates should be situated equidistant from the skin with a slight air gap between the plates and the skin.
What is the frequency range for therapeutic ultrasound?
1-3 MHz
Which modality reaches deeper tissue levels, thermotherapy or cryotherapy?
Cryotherapy reaches 2cm deep, whereas thermotherapy only reaches 1cm.
What two classes of lasers are most often used in clinics? Which one requires goggles?
Class 3A and 3B are what you'd usually see in clinic. Class 3B can cause retinal damage, so you and your patient should both have protective goggles on.
HVPC can help speed up wound closure by doing this in fibroblasts, which aids in collagen formation.
What is, stimulate Ca2+ channels?
Why should there be a slight air gap between capacitive plates and the skin?
To allow for heat to dissipate.
After inspection, it is found that your clinic's ultrasound machine has a BNR of 3:1 what does this mean?
This means that the peak intensity can reach 3x the intensity you set the device to. For instance, if you set the device to 2 W/cm2, then the peak intensity the device can reach is 6 W/cm2
What are three ABnormal skin responses you want to avoid with thermotherapy?
Skin appears bright red, skin feels excessively warm, blisters
Explain to a patient how LLLT works.
Full points for any explanation that accurately captures the gist of LLLT while using patient friendly language.
Example: Lasers emit a low level light that stimulates the cells in your body. The light carries photon energy that the cells can convert into the energy they need to proceed with healing.
Your patient was hiking when a speeding mountain bike hit them. They fell on their knees, getting nasty cuts and a rash from poison oak :( Your plan of care includes HVPC, what charge should you use?
BONUS 100pts: What do you need if you’re going to place an electrode on the wound?
Use a negative charge, since this wound is infected and we need to attract neutrophils, mast cells, and lymphocytes to the area.
BONUS: Place the electrode on moist gauze to help conduct electricity.
You're walking past a patient room when you notice out the corner of your eye that capacitive plates have been set up to treat the patient's L knee. However, one plate is closer to the skin than the other by about an inch. Will the effects be closer towards plate 1 (closer to the skin) or plate 2 (farther from the skin)?
Effects will be uneven and biased towards the plate that is closer to the skin (plate 1).
Your direct access patient had a hamstring strain 3 weeks ago while running and has not had treatment since the onset of symptoms. You determine that ultrasound would be a good modality to use in their treatment. Which effect type would be the better choice for this patient?
Thermal effects would be a better choice given that this patient's issue is now 3 weeks old and becoming more of a chronic issue.
Your patient has limited knee extension during their gait cycle. You find their hamstring muscle length are shortened due to an old hamstring tear in the muscle bulk 1 year ago. You want to treat the muscle length impairment. Which modality would you use and why:
a - thermotherapy
b - cryotherapy
c - short wave diathermy
Correct answer: C
We want to increase the tissue extensibility of the hamstrings, so we need to use heat (not cold). Thermotherapy only reaches a depth of 1cm and is better for superficial use. Diathermy is the best choice for this patient.
This property of water aids in venous return during hydrotherapy.
What is hydrostatic pressure?
How does HVPC help with edema reduction?
BONUS 100pts: Should this be done on a patient diagnosed with CHF?
Usually a negative charge (which has greater effects for some unknown reason), pushes cells back into circulation. This increases oncotic pressure and will draw water back into circulation through osmosis.
BONUS: No, HVPC for edema reduction introduces more fluid volume into circulation and could end up overloading the affected heart.
Your patient is a collegiate athlete complaining of widespread pain over their right shoulder. You observe muscle tightness and stiffness. You decide to include short wave diathermy in their plan of care. Should you use inductive coils (in a drum) or capacitive plates? Why?
You should use inductive coils because they can reach deeper tissues like muscle. Capacitive plates have more superficial effects than inductive coils.
Your patient has pain deep in their lower back on the left side, as well as in their R knee at the insertion point of the IT band (reported as "close to the surface" by the patient). They have been having those pains for about 12 days and you don't observe any inflammation. What are the most appropriate ultrasound parameters to use and what is your total treatment time?
This seems to be more chronic of an issue, so the most appropriate parameters to use are those for thermal effects (continuous cycle). One area is deep and the other is superficial, so the frequencies will differ along with the intensities. For the back: 1 MHz; 1.5-2.5 W/cm2. For the knee: 3 MHz; 0.5-1.0 W/cm2. Since we have two areas that are 2x the ERA, our total treatment time will be 10-20 min.
You're seeing a patient who has complaints of anterior knee pain, at the patellar tendon. During the session, you find they have tight quadriceps. You want to treat the muscle length impairment, would using hot packs be acceptable for this patient? Why or why not.
Based on the patient's presentation, we want to increase the tissue extensibility of the patellar tendon, which is also the sight of pain. Given the area, hot packs should be able to reach deep enough to heat the tendon. Therefore they are acceptable for use with this patient.
Your next patient has complaints of B knee pain. Looking at their chart you see that they are 12 y/o (growing age), pre-diabetic, and taking vitamin supplements. Which part of this patient profile would lead to think LLLT is contraindicated?
The patient's age.
LLLT over bone growth plates is contraindicated and since this patient's main complaint is B knee pain, there is a risk of applying the laser over the growth plates in the tibia.
Vitamin supplements don't affect LLLT. Some acne meds that increase a patient's photosensitivity, however, might be a precaution.
Your next patient has a pressure ulcer on the back of their heels. After 7 days of standard wound care, the granulation tissue has only just started to set in. Should you proceed to using HVPC?
If yes, what charge should you use and why? If no, why not?
Studies show that HVPC should be started if the "wound healing progress becomes very slow, stops, or regresses after 14-21 days of standard wound care" (Kloth 1996). So we shouldn't start HVPC just yet.
If we do end up needing HVPC, we should use a positive charge because fibroblasts have a negative charge. We need to recruit more fibroblasts to the wound to aid in the formation of the granulation tissue ("raw beef") and help the wound progress through the proliferation phase.
Your patient is getting pre-op PT for a TKA in their L knee due to OA. They can't wait for the operation ever since getting a TKA on their R knee last year. Would you recommend using diathermy for their OA pain?
Although diathermy is usually contraindicated for metal implants, we can still use it since the device will be placed close to the skin on the contralateral limb that is metal-free. Diathermy can be used for alleviating OA symptoms.
What is unstable cavitation?
BONUS 200 pts: Explain this concept to someone not affiliated with healthcare.
Full points for any answer that correctly describes unstable cavitation! :)
This is fully subjective so there is more than one answer. Below is just an example:
Cavitation is the phenomenon where gas filled bubbles are produced by the oscillating waves of cells from the ultrasound head, creating the therapeutic effects we witness with ultrasound application. If the applicator head isn’t moved, then the gas filled bubbles aren’t oscillating in size and end up getting larger and larger until they implode. Implosion of these bubbles can lead to free radical formation, temperature/pressure increase, tissue damage, and so on.
BONUS: Not moving the applicator head can cause burns and even tissue damage. This is because the cell frequencies sent out into the body start to overlap and grow bigger, leading to the tissue heating up more than it should.
Your patient is coming in for an acute shoulder injury they sustained three days ago, with some inflammation still present. You're teaching your patient how to apply cryotherapy to their shoulder using ice cups at home. They ask, "Why can't I do this for more than 10min? It feels so good." Explain in patient friendly language what may happen if the ice were to be left on for too long.
There were four different adverse effects mentioned in class (tissue necrosis/frostbite, nerve damage, unwanted vasodilation, and temporary impaired proprioception). In this question, the key piece of info is that this is an acute injury (less than 5 days ago) with inflammation still present, so our main concern is the cold-induced vasodilation (CIVD) because vasodilation is not what we're after when treating an injury where inflammation is still present. (But full points if any of the four effects are mentioned in patient friendly language)
Your next patient wants to use the pool for therapy. However, their chart notes say that their main complaints are due to osteopenia. Explain in patient friendly language why they would benefit more from doing therapeutic exercise on land than in water.
Full points for any explanation that incorporates bone density and Wolff’s law while using patient friendly language.
Example: Our main concern is to help you improve your bone density. The best way to do that is to load your bones on land via gravity to stimulate the cells in your bones to lay down more bone minerals. Because of buoyancy, you’re not going to get the same amount of loading in water as you would on land.