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1) Foundations in Therapeutic Physical Agents Flashcards

1
Q

Deciding on treatment involves

A
  • Awareness of available options
  • Evidence-based literature
  • Stepwise exhaustion of conservative to increasingly invasive modalities
  • Consistent communication with your patient (expectations/outcomes)
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2
Q

Therapeutic Modality

A
  • Modality = form of stress applied to the body for the purpose of eliciting an involuntary response.
  • Therapeutic = must be conducive to the healing process of the injury in its current state of healing
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3
Q

Classifications of energy

A
  • Thermal
  • Electromagnetic
  • Electrical
  • Mechanical
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4
Q

Thermal energy types

A
  • Thermotherapy
  • Cryotherapy
  • Hydrotherapy
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5
Q

Electromagnetic energy types

A
  • Shortwave diathormy
  • Lol-level laser therapy
  • Ultraviolet
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6
Q

Electrical energy types

A
  • Neuromuscular electrical stimulation
  • Transcutaneous electrical nerve stimulation
  • Electrical stimulation for tissue healing and repair
  • Iontophoresis
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7
Q

Mechanical energy types

A
  • Spinal traction
  • Limb compression
  • Continuous passive motion
  • Ultrasound
  • Extracorporeal shock wave therapy
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8
Q

Electrophysical agents for pain

A
  • Cryotherapy
  • Thermotherapy
  • Hydrotherapy
  • Shortwave diathermy
  • Transcutaneous electrical nerve stimulation
  • Iontophoresis
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9
Q

Electrophysical agents for edema

A
  • Cryotherapy
  • Hydroptherapy
  • Limb compression
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10
Q

Electrophysical agents for joint motion restriction

A
  • Thermotherapy
  • Shortwave diathormy
  • Neuromuscular electrical stimulation
  • Spinal traction
  • Continuous passive motion
  • Ultrasound
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11
Q

Electrophysical agents for muscle spasm

A
  • Cryotherapy
  • Thermotherapy
  • Shortwave diathermy
  • Spinal traction
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12
Q

Electrophysical agents for muscle weakness/atrophy

A
  • Neuromuscular electrical stimulation
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13
Q

Electrophysical agents for dermatosis

A
  • Ultraviolet
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14
Q

Electrophysical agents for wound healing

A
  • Electrical stimulation for tissue healing and repair
  • Low-level laser therapy
  • Hydrotherapy
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15
Q

Electrophysical agents for bone healing

A
  • Ultrasound

- Extracorporeal shock wave therapy

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16
Q

Electrophysical agents for muscle, tendon, and ligament healing

A
  • Low-level laser therapy
  • Ultrasound
  • Extracorporeal shock wave therapy
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17
Q

Phases of healing

A
  • Acute inflammatory response (crucial, acute)
  • Proliferation phase (regeneration and repair)
  • Maturation phase (longest phase, remodeling)
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18
Q

Primary injury

A
  • Tissue destruction directly resulting from the traumatic force
  • Acute versus Chronic
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19
Q

Secondary injury

A
  • Inflammatory or hypoxia resulting from primary injury
  • Cell death caused by a blockage of the oxygen supply to the injured area (ischemia) or caused by enzymatic damage and mitochondrial failure
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20
Q

Inflammation

A
  • Necessary part of the healing process
  • Migration of phagocytes and fibroblasts
  • Formation of granulation tissue to isolate and localize the trauma
  • Histamine released = increases capillary permeability = resulting in swelling
21
Q

Proliferation phase

A
  • The number and size of fibroblasts increases, causing ground substance and collagen to collect in the traumatized area in preparation to rebuild the damaged tissues
  • Revascularization
  • Wound contraction
  • Wound remodeling
22
Q

Maturation phase

A
  • Final phase of the injury response process and may last a year or more
  • Number of fibroblasts, myofibroblasts, and macrophages is reduced to the preinjury level
  • Number of capillaries, the overall vascularity of the area, and the water content are reduced
  • Proportion of type I collagen continues to increase, replacing the existing type III collagen and other parts of the collagen lattice
23
Q

Pain

A
  • “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”
24
Q

Nociception

A
  • From the Latin word nocere, to harm
  • Neural processes of encoding and processing noxious stimuli
  • Neurophysiological process that may be interpreted as pain
25
Dimensions of pain perception
- Cerebral cortex alters a person’s perception and reaction to pain - Pain perception varies from person to person and from day to day in the same person - “Battlefield conditions” - An athlete may be so focused on the competition that when an injury occurs, its magnitude may not be immediately recognized
26
Influences on pain perception
- Past experiences - Expectations - Sociocultural - Personality, age, and gender - Cognitive influences (anxiety, attention, depression, etc.)
27
Pain modulation can be modified by
- Excitement, happiness, positive feeling | - Focusing, hypnosis, suggestion
28
Specialized sensory neurons
- First-order neurons (peripheral nerves) - Afferents’ entrance in the dorsal horn - Second-order neurons (transmit stimulus up the spinal cord to the higher centers) - Higher centers (cerebral cortex, amygdala, sensory homunculus)
29
Primary pain control techniques
- Removing or reducing the mechanical and/or chemical stimuli that triggers the nociceptor by encouraging healing and return of normal function
30
Secondary pain control
- Interrupting the transmission of noxious impulses and/or the interpretation of these impulses in the brain. - Often used for patient comfort between interventions or to remove pain to allow for active exercise
31
Melzak and Wall’s Gate Control Theory (ascending mechanism)
- Increasing non-nociceptive stimuli from the periphery to the spinal cord to elicit pain relief - Example: Rubbing your arm after you’ve been hit by a pitch - A-beta fibers can decrease the input of nociceptive stimuli
32
Melzak and Wall’s Gate Control Theory (descending mechanism)
- Small diameter nociceptive pathway and stimuli are transmitting to higher centers - The influence of stimulating non-nociceptive, large diameter afferents is not part of these mechanisms - Descending mechanisms are initiated by specific higher center structures - Endogenous opiates
33
Optimal environment (intervention strategy development)
- Must recognize signs and symptoms and aware of the time frame associated with different phases - Few, if any, modalities actually speed the healing of an injury
34
Promoting healing
- Application of the correct form of energy [modality] based on stage of inflammation that best promotes healing - Application of a modality at an improper point in its recovery may hinder, if not set back, the healing process
35
Acute injury
- Primary goal during early injury management = decrease the formation of edema and remove swelling from the injury site - Less initial swelling = shorter the rehab - Minimize excessive swelling by controlling for edema, modulating pain, and facilitating healing
36
Early injury management (PRICE or PRINCE)
- Cryotherapy (vasoconstriction) - Cold Bath/Whirlpool - Compression (limit swelling) - Electrical Stimulation (pain reduction) - Low Intensity Ultrasound (non-thermal effect to alter permeability of cell membrane)
37
TENS or massage (pain modulation)
- Ttimulate large-diameter afferent fibers | - Stimulate endogenous opioids through small-diameter - afferent fiber stimulation
38
Cold or ultrasound (pain modulation)
- Decrease pain fiber transmission velocity
39
Deep massage or acupressure (pain modulation)
- Stimulate small-diameter afferent fibers (descending pathway mechanism)
40
Low-power laser (healing facilitation)
- Stimulation of trigger points | - Can be used acutely
41
Low intensity ultrasound (healing facilitation)
- Non-thermal | - Alters cell membrane permeability (very crucial for healing, Na-, Ca++)
42
Fibroblastic repair phase
- Treatment can progress from cold to heat - Theramotherapy - Intermittent Compression - Electrical Stimulation - Continue with ROM exercise and strengthening
43
Thermotherpay (fibroblastic repair phase)
- Increase circulation and promote healing | - Hot packs, warm whirlpool, paraffin bath
44
Intermittent compression (fibroblastic repair phase)
- Can be used to facilitate the removal of injury by-products
45
Electrical stimulation (fibroblastic repair phase)
- Pain modulation and to | - Elicit muscle contraction (pumping action)
46
Maturation remodeling phase
- Thermotherapy - Electrical stimulation - Continue with strengthening exercises
47
Thermotherapy (maturation repair phase)
- Most beneficial to healing (specifically, DEEP heating) | - Ultrasound and Diathermy to increase circulation to deeper tissue
48
Electrical stimulation (maturation remodeling phase)
- Oain modulation | - Muscle contraction

Physical Medicine (5 decks)

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