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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
What are the goals of treatment, the effective agents, and contraindicated agents for Referred Pain?
Goals of Treatment: Control pain Effective Agents: ES, cryotherapy, thermotherapy Contraindicated Agents: N/A
26
What are the goals of treatment, the effective agents, and contraindicated agents for Spinal radicular pain?
Goals of Treatment: Decrease nerve root inflammation, and decrease nerve root compression Effective Agents: traction Contraindicated Agents: N/A
27
What are the goals of treatment, the effective agents, and contraindicated agents for Pain caused by malignancy?
Goals of Treatment: control pain Effective Agents: ES, cryotherapy, superficial thermotherapy Contraindicated Agents: N/A
28
What are the goals of treatment, the effective agents, and contraindicated agents for Muscle weakness?
Goals of Treatment: increase muscle strength Effective Agents: water exercise Contraindicated Agents: immobilization
29
What are the goals of treatment, the effective agents, and contraindicated agents for Pain at rest and motion?
Goals of Treatment: control pain Effective Agents: ES, cryotherapy, thermotherapy, PSWD, and spinal traction Contraindicated Agents: Exercise
30
What are the goals of treatment, the effective agents, and contraindicated agents for Pain with motion only?
Goals of Treatment: control pain, promote tissue healing Effective Agents: ES, cryotherapy, thermotherapy, and PSWD Contraindicated Agents: exercise into pain
31
What are the goals of treatment, the effective agents, and contraindicated agents for Soft tissue shortening?
Goals of Treatment: increase tissue extensibility, and increase tissue length Effective Agents: thermotherapy or brief ic massage and stretch Contraindicated Agents: prolonged pain
32
What are the goals of treatment, the effective agents, and contraindicated agents for a Bony Block?
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
What are the goals of treatment, the effective agents, and contraindicated agents for Hypertonicity?
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
What are the goals of treatment, the effective agents, and contraindicated agents for Hypotonicity?
Goals of Treatment: increase tone Effective Agents: quick ice or motor ES of Agonists Contraindicated Agents: Thermotherapy
35
What are the goals of treatment, the effective agents, and contraindicated agents for Fluctuating Tone?
Goals of Treatment: Normalize tone Effective Agents: functional ES Contraindicated Agents: N/A
36
What are general contraindications?
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
How do you select a physical agent?
Prioritized problem list What are you trying to effect? Considerations of goals, precautions, contraindications, risk, evidence of use, cost, convenience, & availability
38
How do you determine the use of a Physical Agent?
``` Check MD Rx Identify medical dx Examination Identification of contraindications/precautions Evaluation Integrate modality into POC ```
39
Why would you combine Physical Agents?
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
What is important to include in Note format in regards to treatment chosen?
``` Area of treatment Time parameters (frequency, intensity) Patient position Reaction to tx ```
41
Why is it important to do Pretreatment/posttreatment comparison?
Ex: if going to use modality to increase hamstring flexibility, measure flexibility before and after. Also can show changes in pain rating.
42
Direct effects vs Indirect effects of Physical Agents in Rehab?
Direct: will affect the body structure/ impairment level Indirect: will affect function (activity and participation level)
43
Who uses physical agents?
``` PT/PTA OT/OTA ATC Physiatrists Patients ```
44
What are the 3 components of Evidence-based Practice?
3 components: best research evidence, clinical experience, and the patient (physiology, history, and response)
45
What is the goal of evidence-based practice?
provide best possible patient care by researching and applying it to each individual patient
46
What are the 4 components of a question?
P: patient/population I: Intervention C: Comparison of intervention/measure O: Outcomes
47
P in PICO
Patient/Population: - question should apply to specific population Ex: adults with LBP, kids with LE spasticity
48
I in PICO
Intervention:- should be specific Ex: specified exercises applied for a specified period of time at a specified freq
49
C in PICO
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
O in PICO
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
What are the Requirements for Cost Effective Use of Physical Agents?
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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