Principles and Application of Therapeutic Modalities Flashcards
What are physical agents (modalities)?
energy and material applied to patient to assist in their rehab
What are the types of physical agents?
Heat
Cold
Water
Pressure
Sound
Electromagnetic radiation
Electrical currents
What are physical agents primarily used for?
- accelerate tissue healing
- pain management
- alters collagen extensibility
- Modifies muscle tone
What do thermal agents do?
transfer energy to a patient to increase or decrease tissue temperature
What is cryotherapy?
therapeutic application of cold
What is thermotherapy?
Therapeutic application of heat
What is ultrasound?
Both thermal and non thermal effects- mechanical form of energy composed of alternating compression and refraction waves
What do mechanical agents do?
apply force to increase or decrease pressure on the body
Why is hydrotherapy mechanical?
water can provide resistance, hydrostatic pressure, and buoyancy for exercise or can apply pressure to clean wounds
What does traction do?
decrease pressure between structures
What does compression do?
increases the pressure on and between structures
How do electromagnetic agents apply energy?
in the form of electromagnetic radiation or an electrical current
What do LASERs do as an electromagnetic agent?
output monochromatic, coherent, directional electromagnetic radiation that is generally in the frequency range of visible light or IR radiation
How does shortwave diathermy work as an electromagnetic agent?
produces heat in both superficial and deep tissues
What does estim do as an electromagnetic agent?
electric current induces muscle contraction, changes in sensation, reduces edema, or accelerates tissue healing
What modality can be classified as two different categories?
Ultrasound - thermal and mechanical
What are some effects of physical agents (modalities)?
- reduce tissue inflammation
- accelerate tissue healing
- pain management
- alters collagen extensibility
- modifies muscle tone
Which domain of the ICF model do modalities directly effect?
Body function and structure
What are the steps to consider when using a therapeutic modalitiy?
- goals and effects of treatment
- contraindications and precautions
- evidence for physical agent use
- cost, convenience and availability
When in doubt, what should we use for evidence?
CPG
What is the goal for healing?
repair and restore function by eliminating pathology and replacing damaged tissue by promoting regeneration of normal tissue
When is the inflammation phase of healing?
1-6 days post injury
When is the proliferative/fibroblastic phase of healing?
3-20 days
When is the maturation/remodeling phase of healing?
9 days on
What happens during the inflammation phase?
Immediate protective response that…
immediate protective response that attempts to destroy, dilute, or isolate the cells or agents that may be faulty
What are some causes of the inflammation phase?
Soft tissue trauma
Fractures
Foreign bodies
Autoimmune diseases
Microbial agents
Chemical agents
Thermal agents
Irradiation
** not just trauma
What are the 4 cardinal signs of inflammation? and the 5th later added?
- heat
- redness
- swelling
- pain
- loss of function
What are the 3 purposes of the inflammatory phase?
- form a fibrin lattice that limits blood loss and provides strength
- remove damaged tissue
- recruit endothelial cells and fibroblasts
What is hypermia?
increase blood flow to area (vasodilation)
- increases temp
- redness
What causes vasodilation during clot formation?
histamines
- increase vascular permeability
- SWELLING
What is chemotaxis?
- migration of other cells to the area through the process of chemical attraction/recruitment
What cells remove damaged tissue?
- neutrophils (first on scene), phagocytosis
- leukocytes: attracted through chemotaxis
- macrophages (monocytes to macrophages, involved in phagocytosis and synthesis of the extracellular matrix)
What causes fibroblasts to adhere to fibrin to make collagen?
Macrophages
What are the general goals for PT during the inflammatory phase?
- decrease swelling
- decrease pain
- improve PROM and AROM
- more swelling = more time to heal
What are inflammatory phase modalities?
- cryotherapy
- compression
What is a marker that suggests a shift between phases? (inflammatory to proliferative)
acute neutrophil cell infiltration then the replacement by longer term macrophage corralates to the transition
What is the purpose of the proliferative phase?
- cover the wound and impart strength to the injury site
What are the four processes in the proliferative phase?
- epithelization (protective barrier)
- collagen production
- wound contraction
- neovascularization (blood supply to injured area)
What are the general goals during the proliferative phase?
- improve ROM
- decrease pain
- increase circulation
- decrease swelling
- protect wound
- promote alignment of collagen fibers, avoid contractures
What is the goal of the maturation phase?
- restoration of the prior function
Which phase of healing is the longest?
maturation
What are some goals of the maturation phase?
return to activity
- increase ROM
- increase strength
- decrease pain
- increase circulation
How long does a normal acute inflammatory process last?
- no more than 2 weeks
How long does normal subacute inflammation last?
4+ weeks
What are the two methods of chronic inflammation?
- cumulative trauma or interference with normal healing
- immune response to foreign material or result of an autoimmune disease
What local factors affect the healing process?
Type, size, location of injury
Infection
Vascular supply
What external factors affect the healing process?
Movement
Application of physical agents
What systemic factors affect the healing process?
Age
Disease
Medications
Nutrition
What are the PT considerations for the maturation phase?
Physiological loading important
Promotes realignment
Recover full, normal ROM after injury or surgical repair
Normal strength human tissue by 40-50 wks post-op
What are the PT considerations for the proliferation phase?
Immobilization versus early controlled forces for tendons
Collagen fibrils to random alignment to organized
What should we know about articular cartilage?
Aneural, avascular = Limited ability to
heal.
Can articular cartilage heal in adolescents?
yes, cartilage has some capacity to
heal
Can articular cartilage heal in adults?
less ability to heal
- heals by development of scar tissue or not at all
Can skeletal muscle regenerate?
yes, regenerates well
Will muscle fibers regenerate?
Yes, may regenerate
- growth from undamaged fibers or development of new fibers
What are the four distinct stages of bone fractures?
- inflammatory
- reparative/proliferative
(soft tissue callus formation)
(hard callus formation) - bone remodeling
When does a soft callus happen?
begins when pain and swelling subside
- increases vascularity; hematoma becomes organized with fibrous tissue cartilage and bone formation
When does a hard callus happen?
- begins when bony fragments are united by fibrous tissue
What is the maturation phase characterized by?
in regards to scar tissue
- the changes in the size, form and strength of the scar tissue
