Principles and Application of Therapeutic Modalities Flashcards
__________ _______ (________)- are energy and materal applied to patients to help assist in their rehabilitation
physical agents (modalities)
Name different types of physical agents
Heat
Cold
Water
Pressure
Sound
Electromagnetic radiation
Electrical currents
Physical agents are primarily used to???
Reduces tissue ________
Accelerates _________ healing
_________ management
_________ extensibility
_______ ________ spasticity
inflammation
tissue
pain
collagen
muscle tone
Modalities are used as a “______” in a _______ intervention
tool; clinical
Physical agents should be used in conjunction with other skilled ______ or educational interventions, not just as the ______ _______
therapeutic; sole intervention
Insurance requires two things, what are they?
- medical neccesity
- skilled intervention
In medical documentation, it is our job to ______ why we chose a specific treatment
justify
Ultrasound can be both _______ and _______ physical agents
thermal; mechanical
________ agents transfer energy to a patient to increase or decrease tissue temperature
thermal
What type of agents are these an example of…?
Ice packs, hot packs, ultrasound, whirlpool, and diathermy
Thermal
_________ is the therapeutic application of cold (ice packs)
Cryotherapy
__________ is the therapeutic application of heat
Thermotherapy
________ has both thermal and nonthermal effects
Ultrasound
__________ is defined as sound with a frequency greater than 20,000 cycles/second—too high to be heard by humans.
Ultrasound
___________ is a mechanical form of energy composed of alternating compression and rarefaction waves
Ultrasound
______ agents apply force to increase or decrease pressure on the body
Mechanical
What type of agents are these an example of…?
water, traction, compression, and sound
Mechanical
________ (water)- can provide resistance, hydrostatic pressure, and buoyancy for exercise or can apply pressure to clean wounds.
hydrotherapy
_________ decreases the pressure between structures
A. Compression
B. Distraction
C. Inflammation
B.
________ increases the pressure on and between structures
Compression
______ agents apply energy in the form of electromagnetic radiation or an electrical current
Electromagnetic
With electromagnetic or electrical therapeutic agents:
The variation of the ________ and intensity of electromagnetic ________ changes its effects and depth of ________
frequency
radiation
penetration
What type of agents are these an example of…?
UV radiation, infrared (IR) radiation, laser, diathermy, and electrical current
Electromagnetic or Electrical Therapeutic
With electromagnetic or electrical therapeutic agents:
_______- output monochromatic, coherent, directional electromagnetic radiation that is generally in the frequency range of visible light or IR radiation
Lasers
With electromagnetic or electrical therapeutic agents:
________ _________- produces heat in both superficial and deep tissues
Shortwave diathermy
With electromagnetic or electrical therapeutic agents:
_____________ is the use of electrical currents to induce muscle contractions, changes in sensation, and reduce edema, or accelerate tissue healing
Electrical Stimulation (EStim)
Which domain of the ICF model do modalities directly effect?
Body functions and structure
What are the steps to consider use of therapeutic modality?
- ______ and ______ of treatment
- ________ and precautions
- _______ for physical agent use
- ______, ________, and availability
goals; effects
contraindications
evidence
cost, convenience
What could some considerations be for choosing the appropiate modality?
Medical dx
Patient hx
subjective complaints
exam findings
pt. goals
previous interventions
Pt. reference anad cultural considerations
Contraindications are __________
a. relative
b. absolute
B.
Precautions are _______ contraindications
a. absolute
b. relative
B.
What are some contraindications and precautions for modalities?
Pregnancy
Malignancy
Pacemaker
Impaired Sensation
Impaired Mentation
________ _______ ________ are systematically developed statements that attempt to interpret current research to provide evidence-based guidelines to guide practitioner and patient decisions about appropriate health care for specific clinical circumstances
Clinical Practice Guidelines
______ _______ ______ give recommendations for diagnostic and prognostic measures and for preventive or therapeutic interventions for diagnosis
Clinical Practice Guidelines
The goal for healing is to ________ and ______ function by eliminating pathology and replacing damaged tissue by promoting _______ of normal tissue
repair; restore
regeneration
Tissue healing phases:
The __________ phase is 1-6 days post injury
inflammation
Tissue healing phases:
The _______/_______ phase is 3-20 days post injury
Proliferative/Fibroblastic
Tissue healing phases:
The _______/________ phase is 9 days on
Maturation/Remodeling
With the tissue healing phases:
___________ is the immediate protective response that attempts to destroy, dilute or isolate the cells or agents that may be faulty
Inflammation
Name some causes for inflammation
Soft tissue trauma
Fractures
Foreign bodies
Autoimmune diseases
Microbial agents
Chemical agents
Thermal agents
Irradiation
4 cardinal signs of inflammation
- Calor- ______
- Rubor- ______
- Tumor- ______
- Dolor- ______
Heat
Redness
Swelling
Pain
What is the 5th characteristic of inflammation?
Loss of function
Cardinal signs of inflammation
- _______: increased vascularity
- _______: inceased vascularity
- _______: blockage of lymphatic drainage
- _______: physical pressure or chemical irritation of pain-sensitive structures
- ______ _____ ______: pain and swelling
Heat
Redness
Swelling
Pain
Loss of Function
3 purposes of the inflammatory phase
- To form a ________ lattice that _______ blood loss and provides some initial ______ to wound
- Remove _______ tissue
- Recruit _______ cells and ________
fibrin; limits; strength
damaged
endothelial; fribroblasts
What are the phases?
Vasoconstriction
Vasodilation
Clot formation
Phagocytosis
With purpose 1 of the inflammatory phase,
________ -increases blood flow to the area (vasodilation)
hyperemia
Hyperemia is responsible for increased ________ and _______ (acute inflammatory phase)
temperature and redness
Histamines cause _________ and increase vascular permeability (= fluid accumulation outside the vessels)
vasodilation
Histamines are responsible for ________ (swelling in the acute inflammatory phase)
A. edema
B. healing
A. edema
____________ is the migration of other cells to the area through the process chemical attraction/ recruitment
Chemotaxis
Other cells such as histamines attract _________….which are?
A. macrophages; WBC
B. leukocytes; RBC
C. leukocytes; WBC
C.
Cells involved in the removal of damaged tissue is known as?
phagocytosis
With purpose 2 of the inflammation phase, ________ are the first on the scene
neutrophils
With purpose 2 of the inflammation phase, _________ clear the inside of debris and microorganisms
neutrophils
With purpose 2 of the inflammation phase, ________ are attracted through chemotaxis
leukocytes
With purpose 2 of the inflammation phase, ________ clear the injured site of debris and microorganisms to set the stage for tissue repair
leukocytes
With purpose 2 of the inflammation phase, Specific leukocytes, ___________ convert into __________ as they exit from the capillaries into the tissue spaces
A. neutrophils; macrophages
B. macrophages; monocytes
C. monocytes; macrophages
C. monocytes; macrophages
With purpose 2 of the inflammation phase, macrophages are involved in a wide range of activities including ________ and synthesis of _________ _________
phagocytosis; extracellular matrix
With purpose 3 of the inflammation phase, _________ cause fibroblasts to adhere to fibrin and make ________
A. macrophages; collagen
B. monocytes; cartilage
A.
What are the general goals for the PT during the inflammatory phase?
decrease pain
decrease swelling
improve PROM/AROM
With general goals for the PT during the inflammatory phase, initial ______ and _______ are required for rehabilitation
swelling; time
Swelling reduces the ability for _______
ROM
What modalities are recommended during the inflammatory phase?
Cryotherapy (ice) and Compression (ex. GameReady)
aka P.R.I.C.E
With the tissue healing phases:
The __________ phase’s purpose is to cover the wound and impart strength to the injury site
proliferative
With the proliferative phase, the shift from acute _________ cells infiltration and replacement by longer term _______ correlates to the transition between inflammation to proliferation
A. neutrophil; macrophages
B. inflammation; monocytes
C. monocyte; leukocytes
A.
The 4 processes of the proliferative phase
- __________ - provides protective barrier to prevent loss of fluid or risk of infection
- __________ production
- ________ contraction
- _________- development of blood supply to the injured area
Epithelization
Collagen
Wound
Neurovascularization
What are the general goals for the PT during the proliferative phase?
Improve ________ function
Decrease ________
Increase _________ mildly to the area
Protect _______- assist with closure
Avoid ________
ROM
Pain
Circulation
wound
contractures
The ultimate goal of the maturation phase is ________ of the injured tissue?
restoration of the prior function
With the maturation phase, the ultimate goal of the PT is what?
returning the client/patient to activity
Out of all the tissue healing stages, which one is the longest and how long can it last?
maturation; can last over a year
The _________ phase is characterized by the changes in the size, form, and strength of the scar tissue
maturation
_______ orientation and ______ synthesis are involved with changes in size, form, and strength of scar tissue in the maturation phase
fiber; collagen
The 3 levels of the maturation phase?
Collagen synthesis/ lysis basis
Collagen fiber orientation
Healed injury
The normal acute inflammation process lasts no longer than ____ weeks
2
Subacute inflammation is ____ weeks
4+
Chronic inflammation can last how long?
months or years
Chronic inflammation continues as part of the ________ phase
maturation
The two methods of chronic inflammation:
- _________ trauma or interference with normal ________
- ________ response to foreign material or result of an ________ disease
Cummalitive; healing
Immune; autoimmune
Chronic inflammation leads to increased ______ _____ and _______ formation
scar tissue; adhesion
Increased fibroblast proliferation and collagen production causes increased ______ ______ and ______ formation
scar tissue; adhesion
What kind of factors are these that affect the healing process?
Type, size, location of injury
Infection
Vascular supply
Local
What kind of factors are these that affect the healing process?
Movement
Application of physical agents
External
What kind of factors are these that affect the healing process?
Age
Disease
Medications
Nutrition
Systemic
What kind of excess stress can affect the healing process?
mental/emotional
With tissue healing of tendons and ligaments:
Inflammatory process should focus on??
P.R.I.C.E.
With tissue healing of tendons and ligaments:
Proliferation/Remodeling
_________ versus early controlled forces for tendons
_______ fibrils–> _______ alignment–> organized
Immobilization
collagen; random
With tissue healing of tendons and ligaments:
Maturation Process:
Physiological loading imporant for promoting __________
realignment
With tissue healing of tendons and ligaments:
Patients typically recover ______ and have ______ ROM after injury or surgical repair
fully; normal
With tissue healing of tendons and ligaments, how long does it take normal strength of human tissue to to recover?
40-50 wks post-op
With tissue healing involving cartilage, it is _______ , avascular and has a ________ ability to heal
aneural; limited
With tissue involving cartilage, adolescents have some ________ to heal
capacity
With tissue involving cartilage, healing occurs by the development of fibrous _____ _______
scar tissue
Cartilage with a bone injury can form a _________ tissue that acts like ________ cartilage
granulation; articular
With tissue involving the skeletal muscle, it _____ well
*Restoration and function depend on what?
regenerates
type of injury
Involving the skeletal muscle:
Contusions, strains follow the ________ stages of healing
general
Involving the skeletal muscle:
Severe infections involve the _______ ______ being destroyed
A. articular cartilage
B. tendon structures
C. muscle fibers
C. muscle fibers
Involving the skeletal muscle:
Transection of the muscle fibers may _______
Transection of muscle may experience _____ from undamaged fibers or development of _____ fibers
A. degenerate; ROM; old
B. regenerate; growth; new
B.
Bone fractures deal with _______ and _______
regeneration; remodeling
What are the 4 distinct stages of bone fractures?
- Inflammatory
2 and 3. Reparative/Proliferative - Bone Remodeling
During the four distinct stages of bone fractures, which stage does a soft callus form?
2
During the four distinct stages of bone fractures, which stage does a hard callus form?
3
With bone fractures, a _____ ______ begins when pain and swelling subside, increase in vascularity, hematoma becomes organized with fibrous tissue cartilage and bone formation
soft callus
With bone fractures, a _____ ______ begins when bony fragments are united by fibrous tissue
hard callus
