Introduction to Biophysical Agents: A Comprehensive Approach Flashcards
What are interventions
the purposeful interaction of the physical therapist with a individual to produce changes in the condition that are consistent with the diagnosis and prognosis
What are the 4 elements of movement
- Motion: muscles, joints, ligaments, nerves, and skin (stretching, dynamic warmups, hot packs, and cold packs)
- Force: strength and power
- Energy: circulation, endurance/aerobic capacity, vitals, and ventilation/respiration (endurance training and diet)
- Motor control: performance (obstacles and estim)
Therapeutic Intervention Framework
1) Tissue healing
2) Mobility
3) Performance initiation, stabilization, and motor control
4) Performance improvement
5) Advanced skill, coordination, and agility
Define biophysical agents
materials and energy applied to patients to assist in rehabilitation
List the physical agents
- Heat
- Cold
- Water
- Pressure
- Sound
- Electromagnetic radiation
- Electrical currents
Define thermotherapy
energy is transferred to the patient to increase/decrease tissue temperature
Purpose of thermotherapy
- increases circulation
- increases metabolic rate
- increases tissue extensibility
- decreases pain
Purpose of cryotherapy
- decrease circulation
- decrease metabolic rate
- decrease pain
List the mechanical therapy agents and their uses
- Water therapy: used to clean wounds
- Traction: used to alleviate pressure on structures such as joints and nerves
- Compression: used for edema control and management
Examples of electromagnetic energy
- UV radiation
- IR radiation
- Laser
- Diathermy
- Electrical stimulation
Uses of electrical stimulation
1) induce muscle contraction
2) alter sensation
3) decrease edema
4) accelerated tissue healing
General contraindications for direct application for all of the physical agents
1) Pregnancy (over fetus)
2) Malignancy (over tumor)
3) Pacemaker or other implanted device (directly over)
4) Impaired sensation (unable to accurately feel applied energy)
5) Impaired cognition (communication, consent, safety)
Define injury
damage to a body system produced by energy exchanges that have relatively sudden discernible effects
Stages of tissue healing
1) Hemostasis and degeneration
2) Inflammation (acute or chronic)
3) Proliferation and migration
4) Maturation and remodeling
Hemostasis Phase
- occurs immediately after an acute injury
- bleeding stopped via intrinsic/extrinsic cascade of events leading to coagulation and loose clot formation (“plug)
- wound matrix is established
Degeneration phase
characterized by the formation of a hematoma, necrosis of cells, and the start of the inflammatory cell response
5 signs of the inflammatory phase
1) Rubor (red)
2) Calor (heat)
3) Tumor (swelling)
4) Dolor (pain)
5) Funk laesa (impaired)
Normal inflammation timeframe
1 - 6 days no longer than 2 weeks
Subacute inflammation timeframe
> 4 weeks of inflammation
Chronic inflammation timeframe
inflammation that last for months or years
Proliferation phase
- starts within the first ~3 days after injury and can last up to ~20 days
- Angiogenesis: establish a vascular network
- extracellular matrix and granulation tissue develops
- O2 is critical for fibroblast growth
- Myofibroblasts contract to accelerate wound closure and epithelial cells migrate to resurface the wound
Maturation phase
- starts ~ 9 days after injury and can last for up to ~2 years
- deposition and reabsorption of collagen occur
Inflammatory phase pain pattern
pain at rest and with movement
Proliferation phase pain pattern
- minimal pain at rest
- pain towards end of ROM
Maturation phase pain pattern
- none to minimal pain at rest
- pain at end of range or with unaccustomed tissue loading
Goals and effective agents for initial injury
- Prevent further injury or bleeding: static compression and/or cryotherapy
- Clean open wound: hydrotherapy
Non-effective agents for initial injury
- exercise
- intermittent traction
- motor level electrical stimulation (ES)
- thermotherapy
Goals and effective agents for acute inflammation
- Control pain, limit edema and bleeding, control inflammatory mediators and facilitate progression to the proliferation phase: cryotherapy, hydrotherapy (cold), EE-STIM (Sensory), compression, contrast bath
Non-effective agents for acute inflammation
- thermotherapy
- intermittent traction
- motor level electrical stimulation
Goals and effective agents for proliferation and migration phases
- control scar tissue formation, ensure adequate circulation, maintain strength and flexibility to progress towards the remodeling phase: compression, thermotherapy, electrotherapy, water immersion, exercise, motor level ES
Goals and effective agents for remodeling/maturation phase
- regain or maintain strength: motor E-Stim, water exercise
- regain or maintain flexibility: thermotherapy
- control scar tissue formation: brief ice massage, compression
Non-effective agents for remodeling/maturation phase
immobilization
Goals and effective agents for chronic inflammation
- prevent/decrease joint stiffness, control pain, increase circulation: thermotherapy, motor E-Stim, whirlpool/hydrotherapy, fluidotherapy, laser, pulsed ultrasound, and diathermy
Non-effective agents for chronic inflammation
cryotherapy
Define ICE
Ice
Compression
Elevation
Define RICE
Rest
Ice
Compression
Elevation
Define PRICE
Protection Rest Ice Compression Elevation
Define POLICE
Protection Optimal Loading Ice Compression Elevation
Define PEACE & LOVE
Protection Elevation Avoid anti-inflammatories Compression Education & Load Optimism Vascularisation Exercise
How must a physical agent be documented
- Information on the physical agent used (type of modality)
- Details on the area of the body treated
- Intervention duration and parameters
- Outcomes (progress toward goals and regressions or complications arising from application of physical agent)
- Planning for future use and when to discharge the modality
