Lecture 1: principles of modalities Flashcards
another name for therapeutic modalities
physical agents
definition of physical agents
energy and materials applied to patient to assist in rehab
types of physical agents
heat
cold
water
pressure
sound
electromagnetic radiation
electrical currents
physical agents are primarily used to
reduce inflammation
accelerate healing
pain management
-inflammation, soft tissue, or bone injury
-unpleasant sensory and emotional experience
-modulate transmission
alter collagen extensibility
different points in history modalities were used
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
role of modalities in therapy
physical agents should be used in conjunction with other skilled therapeutic interventions not the sole intervention
according to APTA 1995
describe reimbursement for physical agents
hot/cold no longer a separate reimbursement
not always billable
why do we still learn modalities
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
3 major categories of physical agents
thermal
mechanical
electromechanical
what are thermal agents
transfer energy to a pt to increase/decrease temp
i.e. icepacks, hot pack, ultrasound, whirlpool, and diathermy
what is cryotherapy
therapeutic application of cold
what is thermotherapy
therapeutic applicaiton of heat
what is ultrasound
has thermal and non thermal effects
sound frequency grater than 20000 cycles/sec
mechanical form of energy composed of alternating compression and rarefaction waves
what do mechanical agents do
apply force to increase or decrease pressure on body
i.e. water, traction, compression, sound
what is hydrotherapy
water provides resistance, hydrostatic pressure, and bouyancy for ex or can apply pressure to clean wounds
what is traction
decreases pressure between structures
what is compression
increase pressure between structures
what do electromagnetic agents do
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
what do lasers do
output monochromatic, coherent, directional electromagnetic radiation that is generally the frequency range of visible light
what is short wave diathermy
produces heat in both superficial and deep tissues
what is estim
use of electric current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing
which domain of the ICF model do modalities directly effect
body structures and functions
direct effect here
what are the steps to consider the use of therapeutic modalities
1- goals and effects of treatment
2 - contraindications/precautions
3- evidence for physical agent use
4- cost, convenience, and availability
other considerations for modalities use
medical dx
pt hx
subjective complaints
pt goals
previous intervention
pt preference and cultural consideration
contraindications and precautions
differnece between contraindications and precautions
contra. = absolute
precautions = relative
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
3 pillars of evidence based practice
best available evidence
pt or client values/circumstances
clinical expertise
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
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
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
latin meaning of inflammation
inflamer
“to set fire”
examples of precautions/contraindications
pregnancy
malignancy
pacemaker
impaired sensation
impaired mentation
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
causes of inflammatory phase
soft tissue trauma
fx
foreign bodies
autoimmune
microbial agents
chemical agents
thermal agents
irradiation
4 cardinal signs of inflammation
calor - “heat”
rubor - “redness”
tumor - “swelling”
dolor - “pain”
5th characteristic of inflammation
loss of function
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
phases of inflammation
physical insult
inflammation phase
vasoconstriction
vasodilation
clot formation
phagosytosis
purpose of fibrin lattice
clot formation
limits blood loss
provides strength to wound
what is hyperemia
increase blood flow to an area
vasodilaiton
results in increased temp adn redness
what do histamines do
increase blood flow to an area (vasodilation)
increase vascular permeability
responsible for edema
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
what cells are involved in phagocytosis (removal of damaged tissue)
neutrophils
leukocytes
macrophages
what do neutrophils do
first to arrive
early phases to clear debris
what do leukocytes do
attracted by chemotaxis
clear injured site of debris to set stage of tissue repair
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
macrophages cause fibroblasts to do what
adhere to fibrin and make collagen
general goal for PT during inflammatory phase
decrease pain and swelling
improve PROM and AROM
which modalities are recommended for inflammatory phase
cryotherapy
compression
Protect
Rest
Ice
Compress
Elevate
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
purpose of proliferative phase
cover wound and impart strength to injury site
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
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
ultimate goal of maturation phase
restoration of the prior function of the injury site
return to activity
maturation phase is characterized by what
changes in size, form, and strength of the scar tissue
fiber orientation and collagen synthesis vs lysisase
some goals during maturation
return to activity
increase ROM
increase strength
decrease pain
increase circulation
3 phases of maturation
collagen synthesis/lysis balance
collagen fiber orientation
healed injury
normal time frame for subacute inflammation
4+ weeks is normal
normal acute inflammatory phase lasts no longer than
2 weeks
timeframe to be considered chronic inflammation
lasts months to years
continues as part of maturation phase (simultaneous collagen tissue destruction and healing)
2 methods of chronic inflammation
cumulative trauma or interference with normal healing
immune response to foreign material or result of an autoimmune disease
why does chronic inflammation cause increased scar tissue and adhesion formation
due to increased fibroblast proliferation and collagen production
local factors that affect healing process
type/size/location of injury
infection
vascular supply
external factors that affect healing process
movement
application of physical agents
systemic factors that affect healing process
age
disease
meds
nutrition
what to do in the inflammatory phase for tendons/ligaments
PRICE
what to do in the proliferation phase for tendons/ligaments
immobilization vs early controlled forces for tendons
collagen fibers > random alignment > organized
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
PT considerations for cartilage in adolescents
some capacity to heal
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
how well does skeletal muscle heal
regenerates well
restoration/function depends on injury
how to contusions/strains heal
follow general stages of healing
how do severe infections heal with skeletal muscle
muscle fibers are destroyed
how do transections of muscles heal
muscle fiber may regenerate
growth from undamaged fibers or development of new fibers
four distinct stages of bone healing
inflammatory
repair/proliferation (soft callous then hard callous)
bone remodeling
when do soft callouses form
begins when pain and swelling subside
increase in vascularity
hemotoma becomes organized with fibrous tissue cartilage and bone formaiton
when do hard callouses form
begins when bony fragments are united by fibrous tissue
