Physical Agent Modalities (PAM) Comprehensive Exam With 100% Answers.

Physical Agent Modalities (PAMs) - correct answer are those procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance. PAMs use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema or inflammation. PAMs are used in preparation for or concurrently with purposeful and occupation-based activities (Bracciano, 2008). PAM's - correct answer -Thermal agents: Cold and hot pack, paraffin. -Electrotherapeutic agents: Biofeedback, Neuromuscular electrical stim, Functional electrical stim, Galvanic (high voltage) stim, Iontophoresis, Phonophoresis, TENS -Mechanical devices NMES - correct answer he use of electrical current to the use of electrical current to increase ROM, decrease edema and increase ROM, decrease edema and increase strength FES - correct answer The use of NMES on innervated innervated ddmuscle to achieve functional or purposeful to achieve functional or purposeful movements or gain functional control. movements or gain functional control. do not use FES - correct answer • with patients who have certain types of pacemakers • over the carotid sinus area • over the heart or transthoracically • over the mouth/throat area • on open wounds or irritated skin • over cancerous lesions FES Contraindications - correct answer FES will not be effective on patients having significant peripheral nerve injury or pathologies such as: • problems in the cell body • problems in the axon • major damage to the myelin sheath • problems at the synapses between the muscle & the nerve • problems within the muscle Superficial thermal agents - correct answer include but are not limited to hydrotherapy/whirlpool, cryotherapy (cold packs, ice), Fluidotherapy™, hot packs, paraffin, water, infrared, and other commercially available superficial heating and cooling technologies factor that effect current flow (FES) - correct answer Impedence is opposition is opposition to flow of an electric to flow of an electric current current • Muscle = 75% water • Fat = 15% water • Bone = 10% water So, you want to place the electrode on the "motor point motor point", over the muscle, where the fibers are most dense • Electrode size - Smaller is more concentrated, or more powerful and sometimes more painful painful. Electrode orientation - Needs to be placed in line with the way in line with the way the muscle fibers run the muscle fibers run. FES physical setup - correct answer • Select electrode size • Clean the site • Gel or other medium • Electrode placement Electrode placement • Securing the electrodes FES clinical considerations - correct answer • Has the person been cleared for AROM? • Does he/she have sensory deficits? • Does he/she have metal implants? • Is the person cognitively aware and able to Is the person cognitively aware and able to work with the machine? Electronic muscle stimulator - correct answer Mode- Three choices -alternate -synchronous -constant ramp time on time and off time pulse rate- start at 40 pps • Pulse rate or pulses per second or "bursts"/sec • Low = "jumpy" contractions, less fatigue contractions, less fatigue • Higher = smoother contractions, more fatigue. Pulse width (duration): • Measured in microseconds ( Measured in microseconds (µs) • Adjustable from 50 - 300 • Range for strengthening between 100 and 600 µs • Start at 120 µs Waveform: -asymmetrical: is the most active 80/20 -symmetrical: more comfortable 50/50 fatigue - correct answer • It happens in the muscle fiber (not a nerve problem) • Is DIRECTLY affected by: - Intensity - Pulses per second (pulse rate) Pulses per second (pulse rate) - On/off times Hydrotherapy (whirlpool) - correct answer Cryotherapy - correct answer ↓ pain ↓ fever Control bleeding Prevent or ↓ swelling ↓ muscle spasticity physical changes Vasoconstriction Vasodilation/vasoconstriction (after 15 mins) ↓'ed blood to muscles ↑'es pain threshold ↓'es nerve conduction ↓'ed rate of healing ↓'es tissue extensibility cryotherapy therapeutic application - correct answer ice massage, usually a 3-7 minute tx, no sharp edges, keep it moving, dont press down. cold bath: 55-65 F, the lower the temp the shorter the exposure. Cold pack: use a moist towel 10-15 mins, may need to ace wrap, not messy. cold compression units - correct answer Temp ranges from 55-77°F Cooled water is circulated thru the sleeve Sleeve is inflated intermittently to ↓ edema precautions for cold therapy - correct answer Some pts are hypersensitive - check first Don't use on: Wounds that need to heal Poor circulation (diabetes) Cold sensitive pt's (Raynaud's) Cold urticaria or reddened, raised blotches Watch for systemic effects (↓bp, ↓pulse, syncope) convection - correct answer - transfer of heat to tissue by the movement of air, matter or liquids around the body part Fluidotherapy - correct answer • Is a type