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Skills3 PAMs Shirish
Skills 3 PAMs SRM
| Question | Answer |
|---|---|
| What are the 3 classifications of PAMs | Superficial Thermal Agents, Deep Thermal Agents, Electrotherapeutic Agents |
| Why do we use PAMs | As adjunct treatment preparatory to intervention to enhance occupation and performance (TO GET PAID) |
| Name situations/reasons or conditions in which you would use Ultrasound (US) | wound healing & pain management: painful muscle spasms, soft tissue contractures, bursitis, tendinitis, scar tissue, calcific deposits, first 24-48 hours of edema, healing wounds. |
| What condition would need FES (Functional Elec Stim) or NMES (Neuromuscular Elec Stim) treatment | Edema |
| What are examples of superficial thermal agents | hot packs, whirlpools, ice packs, US less than 2.3cm |
| What are deep thermal agents? | Ultrasound more than 1" (inch) |
| What is TENS (transcutaneous electrical nerve stimulation) FES, & NMES | electrotherapeutic agents |
| What is TENS used for? | Pain relief....numbs the NERVE |
| FES is used for? | Electrodes to illicit contraction & produce movement (like handbike stims agonist/antagonist) |
| T/F: It's your first day on clinical rotations & the OT tells you to hurry up & go get ice packs for Mrs. Jones before she throws a fit because they are 20 minutes behind. This is ok for you to do. | True. Hot/Cold packs are allowed at entry level under direct supervision. |
| What is referred pain? | Unrelated pain that shows up in another body part. |
| Describe acute pain | Less than 3 months |
| Describe chronic pain | over 6 months |
| What is sub acute | 3-6 month range |
| What are thermal modalities | any modality applied to the skin that can increase or decrease skin and superficial subcutaneous tissue temperature (warm or cold) |
| What are the objectives of superficial thermal agents | decrease pain & stiffness (ex-post traumatic joint from fx)improve range of motion & tendon excursion, improve viscosity of synovia (increase lubrication in joint), promote healing & relaxation (inhibitory/Roods) |
| WE WANT HOT PACKS...WHEN DO WE WANT THEM...NOW>>>NOW>>>NOW! WHO'S GONNA GET THEM..YOU ARE... | (Just a little chant I am hearing in my head after today...welcome to fieldwork...LOL...do I get to warm my hands up in them? |
| Name conditions that would benefit from superficial thermal agents:(MSS.CNS TWC) | Muscle spasm, Subcutaneous adhesion/scars, Sympathetic nervous syst disord, Contractures, Neuromas, Subacute & chronic inflammation, Trauma, Wounds-nonopen, Chronic Arthritis |
| What type of US do you use on wounds? | Low temperature, low frequency, low threshold ultrasound (3 MHz) |
| What do you need in the PAM dosage guidelines? | parameters: temperature, time, frequency(US), or current (stim) |
| What do you need in the PAM treatment plan? | dosage guidelines/parameters, primary effects, modality selection |
| What is fluidotherapy | warm convection device that circulates heated dry corn husk particles and air. The bombardment by the particles stimulates circulation & sensation. |
| What conditions are deep thermal agents used to treat? | wounds, tendonitis, low threshold spasms/spasticity; medication distribution (phonophoresis) plantar fasciitis (low-level laser) |
| Electrotherapy agents and their uses: | NMES (nerves), TENS (nerves), ESTR--tissue repair (wounds), FES (muscles), EMS (muscles), Iontophoresis (stim patches), sEMG (induce relaxation) |
| What conditions is sEMG used for? | OCD, anxiety, depression---watch neuro waves on machine and try to change the motion |
| T/F: As a new graduate, you are eligible to treat patients with electrotherapy? | NO!! Get outta town! Go back to school & get that (R) behind your name! You need the principles of electricity (chemistry, physics, biology) rise/decay times, frequency, and more :) |
| What is a hand bike called? | Ergometer or Restorator |
| What MUST you document for PAMs? | What PAM & ALL Parameters, site/where applied, duration, physiological responses elicited from tx, subjective responses from pat such as tolerance reaction and clinical effectiveness (KNOW THIS SLIDE) remember...give a handout to get paid!! |
| Where do you never put PAMs (beside the obvious places)? | NO belly for cramps or head for headaches |
| HOT Pack Precautions (be very careful!): | Edema--weigh benefits vs. possible effect of increased swelling:elevate extremity if possible! |
| HOT Pack ContraIndications (when don't you use them) | abnormal or poor sensation, vascular disease (DVTs), bleeding/open areas/new scars, infection, cancer, acute trauma |
| What do you call the machine that warms the hot packs? & what temperature is normal? | Hydrocirculator /150°F |
| When do you NOT use Cryotherapy? | PVD or any circulatory compromised area, Raynaud's, R/A, SLE (scleroderma), Lupus, FMS, cold Urticaria, cryoglobinemia, paroxysmal cold hemoglobinurias, HPB, psych reactions to cold, |
| Why DO you use Cryotherapy? | reduces pain, decreases metabolism, edema, & plasticity (regeneration), facilitates muscle contraction (quickly/"quick icing")(musculoskeletal & joint pain, muscle guarding, spasticity, acute inflammation, edema, post surgical swell, myofacial trigger pts |
| T/F: You can use hot packs on subacute inflammation? | True--Just not acute! |
| T/F: We use diagnostic US in therapy? | NO! That's what they use in radiology...we use therapeutic. |
| How is the easiest way to ruin the ultrasound machine? | By turning to talk to Betty on the other side of the treatment room and losing contact with the skin while still sending power through the head. |
| 3mhz US is used to treat what conditions | MGE & LTE (medial "golfer's" epilcondylitis & Lateral "tennis") |
| What is a main difference between superficial 3Mhz & deep 1 MHz US? | Superficial goes much faster and is absorbed quicker and is seen longitudinally |
| What is the depth range on deep US | 2-5cm |
| What is intensity? | The amount of sound we are producing expressed in W/cm² in US regulated by the WHO |
| What is non-thermal US? What is the avg. cycle? | Pulse or deliver US only during a portion of the treatment. Usually 20 or 50% also called a duty cycle |
| Why do we choose non-thermal US? | To speed up the inflammation or wound healing process. |
| What is the correct procedure to start US? | Apply gel, start moving head, then turn up intensity, never more than 2x size of the head |
| What is important to know about TENS | Must be applied along the pathway of the nerve |
| T/F: you should heat up the US gel for Mrs. Jones because she is always complaining about the cold and how bad she hurts | NO! decreases the conductivity |
| what modality would you use to treat wrist extension | IFC (Interfenential current): always place diagonally |
| T/F: Mrs. Jones is really complaining today about her pain. Let's give her a hot pack to warm up those arthritic bones and place some E-stim on her to help relax her muscles too so she will have more ROM for therapy this week. | NO! Never give a pat more than one modality--it changes the feedback & you may damage Mrs. Jones with the second treatment. Make sure to talk to her during her PAM about what she has been doing in her HEP this week & go over a new handout so you get paid! |
| Why does TENS work? | You cannot feel 2 things at once: the sensory fibers OVERRIDE the pain fibers |
| What do we use NMES for? | making a muscle contract that cannot generate enough force on it's own to move thru ROM |
| T/F: Do Med's have polarities? | YES! very important when using Iontophoresis (current has polarity as well!) |
| What are the 3 most common drugs used in OT with Iontophoresis (think A.I.D.) | Acetic acid (breaks up calcifications), Iodine (scar tissue), Desamethosone (tendonitis inflammation)...all negative polarity |
| Contraindications for fluidotherapy & precautions | NO open area/infections. Precautions: edema-exercise while in device; Labile BP, vertigo, & seizure disorders don't leave alone! |
| Precautions for Hydrotherapy | Labile BP, vertigo, & seizures-don't leave alone (since when do you leave your patient alone???) Monitor sensory deficit, vascular conditions, & edema pat's for excessive heating; SANITIZE (& clean/fill) after EVERY pat!!!!!!!!!!! |
| Indications for paraffin wax bath | arthritis, contractures, etc. |
| What should you tell Mrs. Jones about the paraffin bath? | It's pre-mixed w/mineral oil, it's @ 120°F. Go thoroughly wash/dry her hands and remove any jewelry from the area to be dipped/brushed. Used to increase circulation, decrease joint stiffness & pain in distal extremities. test with meat thermometer! |
| Contraindications for paraffin spa? | abnormal sensation, vascular disease, bleeding or open areas, infection, acute trauma, cancer, edema |
| What else should you know about the paraffin spa? | It is billable!!! :) |
| How cold are cold packs? | 22°F |
| What is the name of the thermos looking like cold water unit | Controlled cold compression unit (uses ice/water/gravity up to 4 hours-recirculate after 1 hr unless has pump) |
| T/F: Modalities must be used by practitioners skilled in their use. The OTA should not employ any modality until service competency is established. | True |
| Adjunctive modalities are used as a preliminary step toward purposeful activities to prepare pt. for occupational performance. Name some examples: | Therapeutic exercise; Orthotics; Sensory stimulation; Physical agent modalities (PAMs) |
| Why is 3Mhz US used for superficial areas | only penetrates up to 2.3cm; good for superficial tendons/tissues |
| What are 2 conditions of the elbow that 3mhz US: | Medial Epicondylitis (MGE)--golfer's; Lateral Epicondylitis (LTE)--tennis |
| Which frequency goes faster 1 or 3Mhz? | 3-superficial/fast (1 is long/deep) |
| What conditions benefit from superficial thermal agents | Muscle spasms, subcutaneous adhesions, SNS disorders, contractures, neuromas, chronic arthritis, trauma, wounds, subacute/chronic inflammation (NOT acute!) |
Created by:
RadGirl13
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