CHAPTER 7. THERAPEUTIC MODALITIES
A patient has just had a cast removed 6 weeks post Colles fracture. Which of the following modalities would be the best modality to increase ROM in the wrist and fingers?
Although all modalities would provide heating for an increase in tissue extensibility, fluidotherapy and paraffin would allow increased exposure of irregular surfaces of fingers to heat over hot packs or heating pad. In addition, fluidotherapy is the only modality that allows the patient to exercise during the treatment for the optimal increase in ROM.
Which of the following are the optimal electrode placements for motor stimulation?
A. One electrode on the functional motor point and the other over a more distal site on the extremity
B. Electrodes as far away from each other as possible
C. Distal to the muscle fibers
D. One electrode on the functional motor point and the other on the muscle belly
The answer is D.2
When placing electrodes for motor stimulation, a common mistake is placing one electrode over a motor point and placing the other over a distal site on the extremity. The problem with this can be that the distal electrode is often placed away from the motor nerve region where the optimal response is obtained, rendering the stimulus less effective. Also, the distal electrode is often placed in a region where there is significantly less or no polarized muscle.
Increasing the distance between the electrodes increases the depth of penetration. If the muscle or muscle group is very superficial, as in the wrist flexors, placing the electrodes too far apart can activate wrist extensors.
During muscle stimulation, if the patient’s sensation goes straight from sensory to noxious, it is probably because one of the electrodes is not over an area of muscle tissue.
Motor points are where the greatest motor response is found for a given amount of stimulus. The other electrode should be placed over the muscle group rather than the tendon area.
A patient with severe rheumatoid arthritis has an acute exacerbation resulting in neck pain and accompanying muscle guarding and spasm. Which of the following modalities and settings would be the best modality for pain control?
A. Intermittent cervical traction at 12 lb with 1:1 duty cycle for 20 minutes