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Lecture 1: principles of modalities Flashcards

1
Q

another name for therapeutic modalities

A

physical agents

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2
Q

definition of physical agents

A

energy and materials applied to patient to assist in rehab

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3
Q

types of physical agents

A

heat
cold
water
pressure
sound
electromagnetic radiation
electrical currents

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4
Q

physical agents are primarily used to

A

reduce inflammation

accelerate healing

pain management
-inflammation, soft tissue, or bone injury
-unpleasant sensory and emotional experience
-modulate transmission

alter collagen extensibility

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5
Q

different points in history modalities were used

A

hot spring/steam room
-ancient greek romans
-msk/respiratory probs
-bouancy for joints

torpedo fish
-headache/gout
-45 volts

sunlight
-TB
-bone/joint disease

epsom salt
-sore/swollen

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6
Q

role of modalities in therapy

A

physical agents should be used in conjunction with other skilled therapeutic interventions not the sole intervention

according to APTA 1995

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7
Q

describe reimbursement for physical agents

A

hot/cold no longer a separate reimbursement

not always billable

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8
Q

why do we still learn modalities

A

APTA says that base entry knowledge should include use of physical agents such as cryotherapy, hydrotherapy, US, and thermotherapy as well as mechanical modalities such as compression therapies, traction, adn electrotherapeutic modalities

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9
Q

3 major categories of physical agents

A

thermal
mechanical
electromechanical

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10
Q

what are thermal agents

A

transfer energy to a pt to increase/decrease temp

i.e. icepacks, hot pack, ultrasound, whirlpool, and diathermy

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11
Q

what is cryotherapy

A

therapeutic application of cold

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12
Q

what is thermotherapy

A

therapeutic applicaiton of heat

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13
Q

what is ultrasound

A

has thermal and non thermal effects

sound frequency grater than 20000 cycles/sec

mechanical form of energy composed of alternating compression and rarefaction waves

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14
Q

what do mechanical agents do

A

apply force to increase or decrease pressure on body

i.e. water, traction, compression, sound

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15
Q

what is hydrotherapy

A

water provides resistance, hydrostatic pressure, and bouyancy for ex or can apply pressure to clean wounds

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16
Q

what is traction

A

decreases pressure between structures

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17
Q

what is compression

A

increase pressure between structures

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18
Q

what do electromagnetic agents do

A

apply energy in the form of electromagnetic radiation or electric current

variation on frequency/intensity as well as depth of penetration

i.e. UV radiation, infared radiation, laser, diathermy, and electrical current

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19
Q

what do lasers do

A

output monochromatic, coherent, directional electromagnetic radiation that is generally the frequency range of visible light

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20
Q

what is short wave diathermy

A

produces heat in both superficial and deep tissues

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21
Q

what is estim

A

use of electric current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing

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22
Q

which domain of the ICF model do modalities directly effect

A

body structures and functions

direct effect here

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23
Q

what are the steps to consider the use of therapeutic modalities

A

1- goals and effects of treatment
2 - contraindications/precautions
3- evidence for physical agent use
4- cost, convenience, and availability

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24
Q

other considerations for modalities use

A

medical dx
pt hx
subjective complaints
pt goals
previous intervention
pt preference and cultural consideration
contraindications and precautions

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25
differnece between contraindications and precautions
contra. = absolute precautions = relative
26
what are clinical practice guidelines
statements that interpret research and provide evidence based guidelines to guide decisions for appropriate health care give recommendations for diagnostic and prognostic measures for preventative or therapeutic interventions for dx
27
3 pillars of evidence based practice
best available evidence pt or client values/circumstances clinical expertise
28
goal for healing in relation to tissue repair
repair and restore function by eliminating pathology and replacing damaged tissue by promoting regeneration of normal tissue
29
PT considerations for rehab related to the healing process
what are the S&S what physical agents are appropriate what stage of healing (what are the timeframes/tissue type) how can healing be modified
30
what are the 3 stages of healing and their time frames
inflammation = 1-6 days post injury proliferative/fibroblastic = 3-20 days maturation/remodeling = 9 days on
31
latin meaning of inflammation
inflamer "to set fire"
32
examples of precautions/contraindications
pregnancy malignancy pacemaker impaired sensation impaired mentation
33
what is the purpose of the inflammatory phase
immediate protective response that attempts to destroy, dilute, or isolate the cells/agents that may be faulty
34
causes of inflammatory phase
soft tissue trauma fx foreign bodies autoimmune microbial agents chemical agents thermal agents irradiation
35
4 cardinal signs of inflammation
calor - "heat" rubor - "redness" tumor - "swelling" dolor - "pain"
36
5th characteristic of inflammation
loss of function
37
3 purposes of inflammatory phase
to form fibrin lattice that limits blood loss and provides some initial strength to wound remove damaged tissue recruit endothelial cells and fibroblasts
38
phases of inflammation
physical insult inflammation phase vasoconstriction vasodilation clot formation phagosytosis
39
purpose of fibrin lattice
clot formation limits blood loss provides strength to wound
40
what is hyperemia
increase blood flow to an area vasodilaiton results in increased temp adn redness
41
what do histamines do
increase blood flow to an area (vasodilation) increase vascular permeability responsible for edema
42
what is chemotaxis
migration of other cells to the inflamed area through the process chemical attraction/recruitment i.e. cells like histamines release chemical to attract leukocytes
43
what cells are involved in phagocytosis (removal of damaged tissue)
neutrophils leukocytes macrophages
44
what do neutrophils do
first to arrive early phases to clear debris
45
what do leukocytes do
attracted by chemotaxis clear injured site of debris to set stage of tissue repair
46
what do macrophages do
specific leukocytes (monocytes) convert into macrophages as the exit from capillaries into the tissue space involved in a wide range of activities including phagocytosis and synthesis of extracellular matrix
47
macrophages cause fibroblasts to do what
adhere to fibrin and make collagen
48
general goal for PT during inflammatory phase
decrease pain and swelling improve PROM and AROM
49
which modalities are recommended for inflammatory phase
cryotherapy compression Protect Rest Ice Compress Elevate
50
steps of proliferative phase
epithelialization = protective barrier to prevent fluid loss and risk of infection collagen production wound contracture neovascularization = development of new blood vessels to area
51
purpose of proliferative phase
cover wound and impart strength to injury site
52
what is the marker that suggests a shift between inflammation to proliferation
shift from acute neutrophil cells infiltration and the replacement by longer term macrophages
53
general PT goals for proliferative phase
main goal = improve ROM/function decrease pain increase circulation decrease swelling protect wound promote appropriate collagen alignment and prevent contractures
54
ultimate goal of maturation phase
restoration of the prior function of the injury site return to activity
55
maturation phase is characterized by what
changes in size, form, and strength of the scar tissue fiber orientation and collagen synthesis vs lysisase
56
some goals during maturation
return to activity increase ROM increase strength decrease pain increase circulation
57
3 phases of maturation
collagen synthesis/lysis balance collagen fiber orientation healed injury
58
normal time frame for subacute inflammation
4+ weeks is normal
59
normal acute inflammatory phase lasts no longer than
2 weeks
60
timeframe to be considered chronic inflammation
lasts months to years continues as part of maturation phase (simultaneous collagen tissue destruction and healing)
61
2 methods of chronic inflammation
cumulative trauma or interference with normal healing immune response to foreign material or result of an autoimmune disease
62
why does chronic inflammation cause increased scar tissue and adhesion formation
due to increased fibroblast proliferation and collagen production
63
local factors that affect healing process
type/size/location of injury infection vascular supply
64
external factors that affect healing process
movement application of physical agents
65
systemic factors that affect healing process
age disease meds nutrition
66
what to do in the inflammatory phase for tendons/ligaments
PRICE
67
what to do in the proliferation phase for tendons/ligaments
immobilization vs early controlled forces for tendons collagen fibers > random alignment > organized
68
what to do in the maturation phase for tendons/ligaments
physiological loading important (promotes realignment) recover full, normal ROM after injury/surgery normal strength = 40-50 wks post op
69
PT considerations for cartilage in adolescents
some capacity to heal
70
PT considerations for cartilage in adults
limited ability to heal helaing occurs by development of fibrous scar tissue to not at all cartilage with bone injury can form granulation tissue that acts like articular cartilage
71
how well does skeletal muscle heal
regenerates well restoration/function depends on injury
72
how to contusions/strains heal
follow general stages of healing
73
how do severe infections heal with skeletal muscle
muscle fibers are destroyed
74
how do transections of muscles heal
muscle fiber may regenerate growth from undamaged fibers or development of new fibers
75
four distinct stages of bone healing
inflammatory repair/proliferation (soft callous then hard callous) bone remodeling
76
when do soft callouses form
begins when pain and swelling subside increase in vascularity hemotoma becomes organized with fibrous tissue cartilage and bone formaiton
77
when do hard callouses form
begins when bony fragments are united by fibrous tissue

Modalities (7 decks)

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