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Theories and Procedures > Lecture 1: Introduction to Physical Agents > Flashcards

Lecture 1: Introduction to Physical Agents Flashcards

1
Q

What are physical agents?

A

Energy and materials applied to patients. Ex: Thermal energy, ultrasound

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2
Q

What are the general categories of physical agents?

A

Thermal
Mechanical
Electromagnetic

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3
Q

What do thermal agents do?

A

Transfer energy to pt by changing tissue temperature

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4
Q

What are temperature change factors for thermal agents?

A

Type of agent
Type of tissue/application site (if pt has a lot of adipose tissue, it probably won’t be as effective as pt with a lot of lean tissue)

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5
Q

Thermo vs Cryotherapy

A 
Thermotherapy
↑ circulation 
↑ metabolic rate
↑ tissue extensibility (skin becomes more pliable after heat)
↓ pain 
Cryotherapy 
↓ circulation 
↓ metabolic rate
↓ pain
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6
Q

What do mechanical agents?

A

Forces applied to the body to exert a type of pressure on it

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7
Q

What are examples of mechanical agents?

A

Hydrotherapy: water exerts pressure, causes resistance and buoyancy
Traction: mechanical separation to alleviate pressure
Compression: provides pressure to control edema

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8
Q

Ultrasound uses what kind of energy?

A

Mechanical energy: compression and rarefaction
As sound wave is applied to tissue, there is compression and rarefaction of sound wave, which causes the mechanical energy
Sound frequency > 20,000 cycles/sec

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9
Q

Modify intensity and continuous/pulsed application of Ultrasound does what?

A

changes btwn thermal or nonthermal effects

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10
Q

What are Electromagnetic Agents?

A

Application of energy in form of electrical radiation or electrical current or magnetic forces

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11
Q

What are examples of electromagnetic agents?

A

UV, IR, laser, diathermy

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12
Q

The change in electrical current in electromagnetic agents allows for what?

A

Motor level vs sensory level
TENS - transcutaneous stimulation
NMES - Neuromuscular electrical stimulation

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13
Q

What is Iontophoresis?

A

transmission of drugs into the body via electrical current based on polarity

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14
Q

What are the phases of tissue healing?

A

Inflammation - only lasts a few days
Proliferation - starts to heal more
Maturation - remodeling of the scar, final phase
**Need to identify which phase a pt is in before choosing a modality and treatment

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15
Q

What are the Effects of physical agents on tissue healing?

A

Accelerate healing phase

Reduce adverse effects during phases (prolonged inflammation, pain, disuse)

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16
Q

What occurs in the Inflammatory phase?

A

1st stage of recovery- lasts 1-6 days
Cells that remove debris (macrophages) and limit bleeding enter the injured area
Characteristics: heat, swelling, pain, redness, and loss of function

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17
Q

What occurs in the Proliferation Phase?

A

Starts within 3 days of injury- lasts approx. 20 days (3 weeks), but there is overlap between inflamm and prolif phase
Collagen deposited to replace damaged tissue
Collagen= protein, found everywhere!
Myofibroblasts contract to accelerate closure
Epithelial cells migrate to resurface the wound

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18
Q

What occurs in the Maturation Phase?

A

Starts approx day 9 and can last up to 2 years
Collagen is deposited and reabsorbed
Remodeling of new tissue as close to original as possible - shape and structure for optimal function
Greater strength achieved with no change in mass (collagen matures)

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19
Q

What are the specific effects of each physical agent on tissue healing?

A

Thermal: circulation & chemical reactions
Mechanical: control motion & alter fluid flow
Electromagnetic: cell function, cell permeability, and transport

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20
Q

What are the main uses for Modalities?

A
  1. Tissue healing: acute and chronic inflammation
  2. Pain modulation
  3. Motion restrictions
  4. Muscle tone
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21
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Initial Injuries?

A

Goals of Treatment: prevent further injury or bleeding & clean open wound
Effective Agents: Static compression, cryotherapy & hydrotherapy
Contraindicated Agents: Exercise, Int. Traction, Motor level ES, and Thermotherapy

22
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Chronic Inflammation?

A

Goals of Treatment: Prevent/decrease joint stiffness, control pain, increase circulation, & progress to proliferative stage
Effective Agents: Thermotherapy, Whirlpool, Fluidotherapy, Compression, Hydrotherapy, Pulsed US, PSWD
Contraindicated Agents: Cryotherapy

23
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Remodeling?

A

Goals of Treatment: Regain or maintain strength, Regain or maintain flexibility, Control scar tissue formation
Effective Agents: Motor ES, Water Exercise, Thermotherapy, Brief ice massage, Compression
Contraindicated Agents: Immobilization

24
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Acute Pain?

A

Goals of Treatment: Control pain, inflammation, and prevent aggravation of pain
Effective Agents: sensory ES, cryotherapy, immobilization, low-load static traction
Contraindicated Agents: Thermotherapy, local exercise, and motor ES

25
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Referred Pain?

A

Goals of Treatment: Control pain
Effective Agents: ES, cryotherapy, thermotherapy
Contraindicated Agents: N/A

26
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Spinal radicular pain?

A

Goals of Treatment: Decrease nerve root inflammation, and decrease nerve root compression
Effective Agents: traction
Contraindicated Agents: N/A

27
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Pain caused by malignancy?

A

Goals of Treatment: control pain
Effective Agents: ES, cryotherapy, superficial thermotherapy
Contraindicated Agents: N/A

28
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Muscle weakness?

A

Goals of Treatment: increase muscle strength
Effective Agents: water exercise
Contraindicated Agents: immobilization

29
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Pain at rest and motion?

A

Goals of Treatment: control pain
Effective Agents: ES, cryotherapy, thermotherapy, PSWD, and spinal traction
Contraindicated Agents: Exercise

30
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Pain with motion only?

A

Goals of Treatment: control pain, promote tissue healing
Effective Agents: ES, cryotherapy, thermotherapy, and PSWD
Contraindicated Agents: exercise into pain

31
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Soft tissue shortening?

A

Goals of Treatment: increase tissue extensibility, and increase tissue length
Effective Agents: thermotherapy or brief ic massage and stretch
Contraindicated Agents: prolonged pain

32
Q

What are the goals of treatment, the effective agents, and contraindicated agents for a Bony Block?

A

Goals of Treatment: remove block and compensate
Effective Agents: (no way to remove block) exercise thermotherapy or brief ice massage and stretch
Contraindicated Agents: stretching blocked joint

33
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Hypertonicity?

A

Goals of Treatment: decrease tone
Effective Agents: neutral warmth or prolonged cryotherapy to hypertonic muscles, and motor ES or quick ice of antagonists
Contraindicated Agents: quick ice on agonists

34
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Hypotonicity?

A

Goals of Treatment: increase tone
Effective Agents: quick ice or motor ES of Agonists
Contraindicated Agents: Thermotherapy

35
Q

What are the goals of treatment, the effective agents, and contraindicated agents for Fluctuating Tone?

A

Goals of Treatment: Normalize tone
Effective Agents: functional ES
Contraindicated Agents: N/A

36
Q

What are general contraindications?

A

Pregnancy (is modality going to affect fetus? If not, it’s probably ok.)
Malignancy (is modality going to affect the malignant cells? If not, it’s probably ok.)
Pacemaker/Implanted electronic device (is the electronic function going to be altered by the modality?)
Impaired sensation/mentation (pt can’t tell if modality is too hot/pt can’t communicate how its affecting them)

37
Q

How do you select a physical agent?

A

Prioritized problem list
What are you trying to effect?
Considerations of goals, precautions, contraindications, risk, evidence of use, cost, convenience, & availability

38
Q

How do you determine the use of a Physical Agent?

A 
Check MD Rx 
Identify medical dx 
Examination
Identification of contraindications/precautions
Evaluation
Integrate modality into POC
39
Q

Why would you combine Physical Agents?

A

Combined uses:
-When modalities have similar effects
-When they address different aspects of a common array of symptoms
Used more during initial rehab phase (like when trying to control pain, inflammation, etc)
Know when to discontinue use

40
Q

What is important to include in Note format in regards to treatment chosen?

A 
Area of treatment
Time
parameters (frequency, intensity)
Patient position 
Reaction to tx
41
Q

Why is it important to do Pretreatment/posttreatment comparison?

A

Ex: if going to use modality to increase hamstring flexibility, measure flexibility before and after. Also can show changes in pain rating.

42
Q

Direct effects vs Indirect effects of Physical Agents in Rehab?

A

Direct: will affect the body structure/ impairment level
Indirect: will affect function (activity and participation level)

43
Q

Who uses physical agents?

A 
PT/PTA
OT/OTA
ATC
Physiatrists 
Patients
44
Q

What are the 3 components of Evidence-based Practice?

A

3 components: best research evidence, clinical experience, and the patient (physiology, history, and response)

45
Q

What is the goal of evidence-based practice?

A

provide best possible patient care by researching and applying it to each individual patient

46
Q

What are the 4 components of a question?

A

P: patient/population
I: Intervention
C: Comparison of intervention/measure
O: Outcomes

47
Q

P in PICO

A

Patient/Population: - question should apply to specific population
Ex: adults with LBP, kids with LE spasticity

48
Q

I in PICO

A

Intervention:- should be specific
Ex: specified exercises applied for a specified period of time at a specified freq

49
Q

C in PICO

A

Comparison interventions/measure- Should be compared with some current commonly used treatment (gold standard) or with no intervention if no intervention is usually provided

50
Q

O in PICO

A

Outcomes- Should be defined as precisely as possible, ideally using clinically relevant, reliable, and validated measures
Ex: walking speed, level of independence with ADLs

51
Q

What are the Requirements for Cost Effective Use of Physical Agents?

A

Assess and analyze the presenting problem
Know when physical agents can be an effective component of treatment
Know when and how to use physical agents most effectively
Know the skill level required for the application of different physical agents
Optimize use of the skill levels of different practitioners
Use home programs when appropriate
Treat in groups when appropriate
Reassess patients regularly to determine the efficacy of treatments provided
Adjust the plan of care according to the findings of reassessments

Theories and Procedures (5 decks)

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