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Physical Medicine > 1) Foundations in Therapeutic Physical Agents > Flashcards

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
Q

Dimensions of pain perception

A
  • 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
Q

Influences on pain perception

A
  • Past experiences
  • Expectations
  • Sociocultural
  • Personality, age, and gender
  • Cognitive influences (anxiety, attention, depression, etc.)
27
Q

Pain modulation can be modified by

A
  • Excitement, happiness, positive feeling

- Focusing, hypnosis, suggestion

28
Q

Specialized sensory neurons

A
  • 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
Q

Primary pain control techniques

A
  • Removing or reducing the mechanical and/or chemical stimuli that triggers the nociceptor by encouraging healing and return of normal function
30
Q

Secondary pain control

A
  • 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
Q

Melzak and Wall’s Gate Control Theory (ascending mechanism)

A
  • 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
Q

Melzak and Wall’s Gate Control Theory (descending mechanism)

A
  • 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
Q

Optimal environment (intervention strategy development)

A
  • 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
Q

Promoting healing

A
  • 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
Q

Acute injury

A
  • 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
Q

Early injury management (PRICE or PRINCE)

A
  • 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
Q

TENS or massage (pain modulation)

A
  • Ttimulate large-diameter afferent fibers

- Stimulate endogenous opioids through small-diameter - afferent fiber stimulation

38
Q

Cold or ultrasound (pain modulation)

A
  • Decrease pain fiber transmission velocity
39
Q

Deep massage or acupressure (pain modulation)

A
  • Stimulate small-diameter afferent fibers (descending pathway mechanism)
40
Q

Low-power laser (healing facilitation)

A
  • Stimulation of trigger points

- Can be used acutely

41
Q

Low intensity ultrasound (healing facilitation)

A
  • Non-thermal

- Alters cell membrane permeability (very crucial for healing, Na-, Ca++)

42
Q

Fibroblastic repair phase

A
  • Treatment can progress from cold to heat
  • Theramotherapy
  • Intermittent Compression
  • Electrical Stimulation
  • Continue with ROM exercise and strengthening
43
Q

Thermotherpay (fibroblastic repair phase)

A
  • Increase circulation and promote healing

- Hot packs, warm whirlpool, paraffin bath

44
Q

Intermittent compression (fibroblastic repair phase)

A
  • Can be used to facilitate the removal of injury by-products
45
Q

Electrical stimulation (fibroblastic repair phase)

A
  • Pain modulation and to

- Elicit muscle contraction (pumping action)

46
Q

Maturation remodeling phase

A
  • Thermotherapy
  • Electrical stimulation
  • Continue with strengthening exercises
47
Q

Thermotherapy (maturation repair phase)

A
  • Most beneficial to healing (specifically, DEEP heating)

- Ultrasound and Diathermy to increase circulation to deeper tissue

48
Q

Electrical stimulation (maturation remodeling phase)

A
  • Oain modulation

- Muscle contraction

Physical Medicine (5 decks)

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