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Modalities > Principles & applications - exam 1 > Flashcards

Principles & applications - exam 1 Flashcards

1
Q

what are physical agents? (modalities)

A

energy and material applied to patient to assist in their rehab

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2
Q

what are physical agents primarily used for?

A

reduce inflammation
pain management
– inflammation, soft tissue or bony injury
– unpleasant sensory and emotional experience
– modulate transmission
accelerate tissue healing
alters collagen extensibility
reduce spasticity/modifies muscle tone

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3
Q

what does the APTA say about using modalities as a tool in clinical intervention?

A

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

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4
Q

what are some reasons that the APTA doesn’t allow the use of physical agents for exclusive use?

A

contain costs of delivery
feels patients can administer these treatments independently
PT can train unskilled clinicians to perform these interventions

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5
Q

what modalities does the APTA expect competency in as a PT graduate?

A

cryotherapy
hydrotherapy
ultrasound
thermotherapy
mechanical modalities (compression therapies, traction devices and electrotherapeutic modalities)

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6
Q

what are types and examples of thermal physical agents?

A

types:
deep heating agents
superficial heating agents
cooling agents

clinical examples:
ultrasound, diathermy
hot pack
ice pack

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7
Q

what are types and examples of mechanical physical agents?

A

types:
traction
compression
water
sound

examples:
mechanical traction
elastic bandage, stockings
whirlpool
ultrasound

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8
Q

what are types and examples of electromagnetic physical agents?

A

types:
electromagnetic fields
electrical currents

examples:
ultraviolet, laser
TENS

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9
Q

thermal agents transfer energy to:

A

increase or decrease tissue temperature

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10
Q

what is cryotherapy?

A

therapeutic application of cold (ice packs)

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11
Q

what is thermotherapy?

A

therapeutic application of heat

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12
Q

ultrasound has what effects?

A

thermal and nonthermal effects

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13
Q

what is ultrasound?

A

mechanical form of energy composed of alternating compression and rarefaction waves
sound with a frequency greater than 20,000 cycles/second

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14
Q

mechanical agents apply force to:

A

increase or decrease pressure on the body

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15
Q

what can hydrotherapy do?

A

can provide resistance, hydrostatic pressure, and buoyancy for exercise or an apply pressure to clean wounds

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16
Q

what does traction do?

A

decreases pressure between structures

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17
Q

what does compression do?

A

increases pressure on and between structures

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18
Q

what is ultrasound (nonthermal effects)

A

mechanical form of energy composed of alternating compression and rarefaction waves

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19
Q

electromagnetic agents apply energy in the form of:

A

electromagnetic radiation or an electrical current

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20
Q

what changes as a result of variation of frequency and intensity of electromagnetic radiation?

A

its effects and depth of penetration

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21
Q

what are lasers?

A

output monochromatic, coherent, directional electromagnetic radiation that is in the frequency range of visible light or IR radiation

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22
Q

what does shortwave diathermy do?

A

produces heat in both superficial and deep tissues

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23
Q

what is electrical stimulation (ESTIM)?

A

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

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24
Q

what is an example of a modality that is classified as two different categories?

A

ultrasound

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25
Q

what level of the ICF model is at which physical agents have direct effects?

A

body functions and structures

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26
Q

what are the steps to consider use of therapeutic modality?

A

goals and effects of treatment –> contraindications and precautions –>
evidence for physical agent use –>
cost, convenience and availability

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27
Q

what are components of evidence based practice?

A

best available evidence –> clinical expertise –> patient values and circumstances

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28
Q

what are other considerations to take into account for use of modalities?

A

medical dx
patient hx
subjective complaints
exam findings
patient’s goals
previous intervention
patient preference and cultural considerations
contraindications and precautions

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29
Q

what are contraindications?

A

absolutely not allowed
absolute contraindications

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30
Q

what precautions?

A

take caution
relative contraindications

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31
Q

what are some examples of contraindications? (5)

A

pregnancy
malignancy
pacemaker
impaired sensation
impaired mentation

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32
Q

what are clinical practice guidelines?

A

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

33
Q

what do clinical practice guidelines give?

A

recommendations for diagnostic and prognostic measures and for preventative or therapeutic interventions for diagnosis

34
Q

what is the goal for healing?

A

repair and restore function by eliminating pathology and replacing damaged tissue by promoting regeneration of normal tissue

35
Q

what are PT considerations for choosing modalities?

A

signs and symptoms
what physical agents are appropriate
stage of healing
how can healing be modified

36
Q

what are the days post injury for the inflammation phase?

A

1-6 days

37
Q

what are the days post injury for the proliferative phase?

A

3-20 days

38
Q

what are the days post injury for the remodeling phase?

A

9 days and on

39
Q

what is happening in the inflammation phase?

A

immediate protective response that attempts to destroy, dilute, or isolate the cells or agents that may be faulty

40
Q

what are some causes of inflammation phase?

A

soft tissue trauma
fractures
foreign bodies
autoimmune diseases
microbial agents
chemical agents
thermal agents
irradiation

41
Q

what are the 4 signs of inflammation? what is the added 5th? what are the causes?

A

heat - increased vascularity
redness - increased vascularity
swelling - blockage of lymphatic drainage
pain - physical pressure or chemical irritation of pain-sensitive structures

loss of function - pain and swelling

42
Q

what are the 3 purposes of inflammatory phase?

A

1 - to form a fibrin lattice that limits blood loss and provides some initial strength to wound (clot formation)
2 - remove damaged tissue (phagocytosis)
3 - recruit endothelial cells and fibroblasts (make collagen)

43
Q

what is hyperemia? responsible for?

A

increase blood flow to area (vasodilation)
responsible for increased temp and redness (acute inflammatory response)

44
Q

what do histamines cause? what do they increase? responsible for?

A

cause vasodilation
increase vascular permeability (fluid accumulation outside the vessels)
responsible for edema (swelling in acute inflammatory response)

45
Q

what is chemotaxis?

A

migration of other cells to the area through the process chemical attraction/recruitment

46
Q

what do neutrophils do? when do they arrive?

A

first on the scene
early phases of inflammation clear the site of debris and microorganisms (phagocytosis)

47
Q

what do leukocytes do? when do they arrive?

A

clear the injured site of debris and microorganisms to set the stage for tissue repair
later to the scene: attracted through chemotaxis

48
Q

what are macrophages?

A

specific leukocytes (monocytes) convert into macrophages as they exit from the capillaries into the tissue spaces
involved in a wide range of activities including phagocytosis and synthesis of extracellular matrix

49
Q

what are the four responses of the inflammatory phase?

A

vascular
hemostatic
cellular
immune

50
Q

what are the two main goals for inflammatory phase? 3rd goal as appropriate?

A

decrease swelling
decrease pain

improve P/AROM

51
Q

what are two factors to consider during inflammatory phase?

A

initial swelling
time required for rehabilitation

52
Q

what modalities are recommended during the inflammatory phase?

A

cryotherapy
compression
PRICE (protect, rest, ice, compression, elevate)

53
Q

what is the purpose of the proliferative phase?

A

cover the wound
impart strength to the injury site

54
Q

what is a marker that suggests shift between inflammation and proliferative phase?

A

the shift from acute neutrophil cells infiltration and the replacement by longer term macrophages correlates to the transition between inflammation to proliferation

55
Q

what are the 4 processes of the proliferation phase?

A
  1. epithelization: provides protective barrier to prevent loss of fluid and risk of infection
  2. collagen production: strength
  3. wound contraction: closing wound
  4. neovascularization: development of blood supply to the injured area
56
Q

what are goals for therapist during the proliferative phase?

A

improve ROM, function
decrease pain
increase circulation mildly to the area
decrease swelling
protect wound
promote appropriate alignment of collagen fibers - during wound contraction avoid contractures

57
Q

what is the goal of the remodeling phase?

A

restoration of the prior function of the injured tissue

58
Q

what is the goal of PT during remodeling phase?

A

return the patient to activity

59
Q

which phase of healing process can last over a year?

A

remodeling

60
Q

how is the remodeling phase characterized by?

A

the changes in size, form and strength of scar tissue
– fiber orientation
– collagen synthesis versus lysis

61
Q

what are some goals during remodeling phase?

A

return to activity
increase ROM
increase strength
decrease pain
increase circulation

62
Q

normal acute inflammatory process lasts:

A

no longer than 2 weeks

63
Q

normal subacute inflammation lasts:

A

4+ weeks

64
Q

chronic inflammation lasts:

A

last months or years (age or comorbidity related)

65
Q

what continues as part of the remodeling phase? why?

A

chronic inflammation
simultaneous collagen tissue destruction and healing

66
Q

what are the two methods of chronic inflammation?

A
  1. cumulative trauma or interference with normal healing
  2. immune response to foreign material or result of an autoimmune disease
67
Q

what does chronic inflammation lead to? due to?

A

leads to increased scar tissue and adhesion formation
due to increased fibroblast proliferation and collagen production

68
Q

what are factors that affect healing process?

A
  1. local:
    – type, size, location of injury, infection, vascular supply
  2. external:
    – movement, application of physical agents
  3. systemic:
    – age, disease, medications, nutrition
  4. mental/emotional stress
69
Q

what are PT considerations for tendons and ligaments during inflammatory phase?

A

PRICE

70
Q

what are PT considerations for tendons and ligaments during proliferation/remodeling phase?

A

immobilization versus early controlled forces for tendons
collagen fibrils –> random alignment –> organized

71
Q

what are PT considerations for tendons and ligaments during maturation process?

A

physiological loading important
– promotes realignment
recover full, normal ROM after injury or surgical repair
normal strength human tissue –> 40-50 weeks post op

72
Q

what are PT considerations for adolescents with damaged cartilage?

A

cartilage has some capacity to heal

73
Q

what are PT considerations for adults with damaged cartilage?

A

limited ability to heal
healing occurs by development of fibrous scar tissue or not at all
cartilage with bone injury can form granulation tissue that acts like articular cartilage

74
Q

what is physiology of skeletal muscle?

A

regenerates well
restoration and function depend upon type of injury

75
Q

what are type of injuries of skeletal muscle?

A

contusions, strains
– follow general stages of healing
severe infections
– muscle fibers destroyed
transection of muscle
– muscle fibers may regenerate
– growth from undamaged fibers or development of new fibers

76
Q

what are the 4 stages of remodeling bone fractures?

A
  1. inflammatory
    2 & 3. reparative/proliferative
    – 2: soft callus formation
    – 3: hard callus formation
  2. bone remodeling
77
Q

soft callus formation begins with?

A

pain and swelling subside increase in vascularity
hematoma becomes organized with fibrous tissue cartilage and bone formation

78
Q

hard callus formation begins when?

A

bony fragments are united by fibrous tissue

Modalities (2 decks)

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