Intro to Therapeutic Modalities Flashcards
what is a therapeutic modality
their effectiveness is limited by what 3 things
tools designed to stimulate a specific body tissue to perform its normal function (ultrasound, laser, electrical current, heat and cold)
knowledge, skill, experience
treatment intervention can include what 4 things
should you only rely on one therapeutic modality?
manual therapy, therapeutic exercises, patient education, therapeutic modalities
no, a mixed approach of complimentary interventions is more likely to be efficient
selection of a modality and it’s application is based on what?
what does clinical decision making related to modality application start with
sound clinical decision making
a good understanding of the effects of the therapeutic modalities made available to the pt
what are the 4 effects of therapeutic modalities
modify the stages of tissue repair
relieve pain
alter collagen elasticity
modify muscle function
what are the 4 stages of tissue repair
what can the stages of healing be used as
hemostasis (bleeding), inflammation, proliferation, maturation/remodeling
a guideline on what you choose to do
T or F: there is not overlap between each stage of healing
F, there is overlap
what occurs in the hemostasis phase of healing (time course, function)
time: within seconds of the injury
function: to stop the bleeding via formation of a fibrin clot and vascular response (immediate vasoconstriction followed by vasodilation)
what occurs in the inflammation phase of healing (time course, function)
time: 1-3 days post injury but can last up to 3 weeks if there is overuse and the patient doesn’t allow for healing (time is variable from tissue to tissue and extent of damage as well)
function: natural debridement by identifying/removing foreign material (clean things up)
describe what each of the inflammation mediators do (mast cells, leukocytes, prostaglandins)
what inhibits prostaglandin synthesis and how
mast: affect degree of vasoconstriction/dilation in the region
leukocytes: phagocytosis and removal of debris caused by injury
prostaglandins: sensitize pain receptors, attract WBC, increase vascular permeability
aspirin, NSAIDs and steroids inhibit synthesis by deactivation of a key enzyme
why should you not use NSAIDs for longer than 1 week
what can long term use of NSAIDs result in
they may influence WBC or vascular permeability, should only be used for short term (< 1 week)
decreased recovery
what are the 5 cardinal signs of inflammation
what can chronic inflammation be caused by
red, hot, swollen, pain, loss of function
persistent necrotic tissues, infectious or foreign material and hypoxia
what causes redness, swelling and increased tissue temperature in injured tissues
what causes pain of the injured tissues
local vasodilation, fluid leakage into extracellular spaces, impaired lymphatic drainage
mechanical distention resulting in pressure on soft tissue, chemical irritation of specific nerve receptors
what occurs in the proliferation phase of healing (time course, function)
granulation tissue is made of what 3 things
time: 3-4 days post injury but may last 3 weeks
function: formation of granulation tissue (tissue that is still healing so it’s weak and irregular)
collagenous scar tissue (produced by fibroblasts)
angiogenesis/blood vessels (produced by endothelial cells
re-epithelization (produced by epithelial cells)
what occurs in the maturation phase of healing (time course, function)
in what 3 ways does collagen change in this stage
why can the healing timeframe in this stage be so variable?
time: 3 weeks to 3 years
function: increase scar strength through continual collagen changes
increase in the number of collagen cross links, orientation of collagen fibres along directions of mechanical force, balance between collagen synthesis and degradation
variable because some people have co-morbidities that slow down the healing process (poor O2 intake due to lung condition)
what is acute pain caused by
pain is considered chronic when it lasts longer than ___ months
stimulation of the pain receptors and free nerve endings of A delta and C fibres by the chemicals present at the site and the mechanical pressure of the edema
3
the extent to which pain is perceived and responded to may be a function of the influence of what 4 factors
how do physical agents control pain by modifying transmission or perception
biological, psychological, behavioural, neurochemical factors
modulate pain transmission at the level of the spinal cord, alter nerve conduction rate, alter NTs (central or peripheral)
what is an example of physical agents modifying transmission or perception of pain
after stubbing your toe you grab your toe right away to stimulate touch receptors which overlie the pain experience
where is collagen found
soft tissue shortening alters ___
extensibility of tissue is dependent on what
skin, tendon, bone, cartilage, connective tissue
function
temperature, applied modalities can promote appropriate extensibility (heat)
after 3 weeks of immobilization there can be a ___% reduction in normal ROM
an increase in intermolecular cross links leads to ___
67.5%
contracture
define muscle tone
what 3 things can alter muscle tone
underlying tension that serves as a background to contraction
CNS injury, peripheral nerve injury, local injury (pain from trauma causes a withdrawal response and muscle guarding to prevent further damage)
in what 3 ways do physical agent alter muscle tone
it’s important to do what before and after applying a therapeutic intervention
why is it important to do the above
alter nerve conduction velocity or sensitivity (electrical stimulation/muscle engages on it’s own), alter biomechanical properties of a muscle (heat causes increase in BF and reduces tone), reducing pain
palpate the area
to determine whether the treatment technique produced any changes in muscle tone
how can you be certain about the effectiveness of a therapeutic modality
what individual differences may affect the therapeutic modality you choose to use
evaluate results post treatment with an appropriate outcome measure (NPRS, goniometer)
some people are more sensitive to hot or cold, some will respond to one treatment and not another
name and define the two types of physical agents
define radiation
electromagnetic spectrum: frequencies and wavelengths associated with radiant energy
acoustic spectrum: frequencies and wavelengths associated with sound waves
the process by which energy in various forms travels through space
therapeutic modalities produce radiant energy by movement of ___
what are the 4 common characteristics of electromagnetic radiations
electrons (laseres, UV, electrical stimulating modalities)
1. they can be produced with sufficiently intense electrical or chemical forces applied to any material (need to plug it in or use a battery)
2. they all travel through space at an equal velocity
3. the direction of travel is always a straight line
4. they can be reflected, absorbed or transmitted depending on the medium they strike
explain the arndt schultz principle that governs electromagnetic radiation
no reactions or changes can occur in the body tissues if the amount of energy absorbed is insufficient to stimulate the absorbing tissues
the aim is to deliver sufficient energy to stimulate the target tissues and promote normal function, and not too much that it might impair normal function
explain the law of grotthus draper that governs electromagnetic radiation
if the energy is not absorbed by superficial tissues it will penetrate to deeper tissues
a portion of energy at the surface will be reflected so there is no physiological response
at tissue interfaces (skin/fat/muscle) the difference in density of the two tissues can cause energy to be refracted (alter its direction)
the main goal is absorption of energy by the muscle tissues
- individuals differ on the amount of intensity of the machine needed to penetrate to the muscle tissues
explain the cosine law that governs electromagnetic radiation
radiant energy is more easily transmitted to deeper tissues if the source of radiation is at a right angle to the area being radiated
when further away from the right angle, a greater amount of energy will be reflected and not absorbed by the tissues (important for UV light and lasers)
- this is true for ultrasound too (need to keep it flat on the skin)
explain the inverse square law that governs electromagnetic radiation
this law applies especially to use of what two therapeutic modalities
the intensity of radiation striking a material varies inversely with the square of the distance from the source
heating lamp or UV lamp (the farther away from the lamp the greater the spread)
- this is NOT true for laser
name the 4 therapeutic modalities in the electromagnetic spectrum
name the therapeutic modality in the acoustic spectrum
electrical stimulating currents, electromyographic feedback (biofeedback), laser, ultraviolet light
ultrasound
what type of vibration is ultrasound
in what 3 ways is ultrasound different from electromagnetic radiation
mechanical
travels at a significantly lower velocity, has shorter wavelengths, cannot travel through a vacuum because it depends on molecular collisions (the more dense the medium the greater the velocity of travel)
when therapeutic penetration to deeper tissues is required, which modality should you use and why
ultrasound because it travels well through homogenous (fat) tissue whereas electromagnetic radiation is almost entirely absorbed by fat tissue
