Principles & applications - exam 1 Flashcards
what are physical agents? (modalities)
energy and material applied to patient to assist in their rehab
what are physical agents primarily used for?
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
what does the APTA say about using modalities as a tool in clinical intervention?
physical agents should be used in conjunction with other skilled therapeutic or educational interventions, not as the sole intervention
what are some reasons that the APTA doesn’t allow the use of physical agents for exclusive use?
contain costs of delivery
feels patients can administer these treatments independently
PT can train unskilled clinicians to perform these interventions
what modalities does the APTA expect competency in as a PT graduate?
cryotherapy
hydrotherapy
ultrasound
thermotherapy
mechanical modalities (compression therapies, traction devices and electrotherapeutic modalities)
what are types and examples of thermal physical agents?
types:
deep heating agents
superficial heating agents
cooling agents
clinical examples:
ultrasound, diathermy
hot pack
ice pack
what are types and examples of mechanical physical agents?
types:
traction
compression
water
sound
examples:
mechanical traction
elastic bandage, stockings
whirlpool
ultrasound
what are types and examples of electromagnetic physical agents?
types:
electromagnetic fields
electrical currents
examples:
ultraviolet, laser
TENS
thermal agents transfer energy to:
increase or decrease tissue temperature
what is cryotherapy?
therapeutic application of cold (ice packs)
what is thermotherapy?
therapeutic application of heat
ultrasound has what effects?
thermal and nonthermal effects
what is ultrasound?
mechanical form of energy composed of alternating compression and rarefaction waves
sound with a frequency greater than 20,000 cycles/second
mechanical agents apply force to:
increase or decrease pressure on the body
what can hydrotherapy do?
can provide resistance, hydrostatic pressure, and buoyancy for exercise or an apply pressure to clean wounds
what does traction do?
decreases pressure between structures
what does compression do?
increases pressure on and between structures
what is ultrasound (nonthermal effects)
mechanical form of energy composed of alternating compression and rarefaction waves
electromagnetic agents apply energy in the form of:
electromagnetic radiation or an electrical current
what changes as a result of variation of frequency and intensity of electromagnetic radiation?
its effects and depth of penetration
what are lasers?
output monochromatic, coherent, directional electromagnetic radiation that is in the frequency range of visible light or IR radiation
what does shortwave diathermy do?
produces heat in both superficial and deep tissues
what is electrical stimulation (ESTIM)?
use of electrical current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing
what is an example of a modality that is classified as two different categories?
ultrasound
what level of the ICF model is at which physical agents have direct effects?
body functions and structures
what are the steps to consider use of therapeutic modality?
goals and effects of treatment –> contraindications and precautions –>
evidence for physical agent use –>
cost, convenience and availability
what are components of evidence based practice?
best available evidence –> clinical expertise –> patient values and circumstances
what are other considerations to take into account for use of modalities?
medical dx
patient hx
subjective complaints
exam findings
patient’s goals
previous intervention
patient preference and cultural considerations
contraindications and precautions
what are contraindications?
absolutely not allowed
absolute contraindications
what precautions?
take caution
relative contraindications
what are some examples of contraindications? (5)
pregnancy
malignancy
pacemaker
impaired sensation
impaired mentation
what are clinical practice guidelines?
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
what do clinical practice guidelines give?
recommendations for diagnostic and prognostic measures and for preventative or therapeutic interventions for diagnosis
what is the goal for healing?
repair and restore function by eliminating pathology and replacing damaged tissue by promoting regeneration of normal tissue
what are PT considerations for choosing modalities?
signs and symptoms
what physical agents are appropriate
stage of healing
how can healing be modified
what are the days post injury for the inflammation phase?
1-6 days
what are the days post injury for the proliferative phase?
3-20 days
what are the days post injury for the remodeling phase?
9 days and on
what is happening in the inflammation phase?
immediate protective response that attempts to destroy, dilute, or isolate the cells or agents that may be faulty
what are some causes of inflammation phase?
soft tissue trauma
fractures
foreign bodies
autoimmune diseases
microbial agents
chemical agents
thermal agents
irradiation
what are the 4 signs of inflammation? what is the added 5th? what are the causes?
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
what are the 3 purposes of inflammatory phase?
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)
what is hyperemia? responsible for?
increase blood flow to area (vasodilation)
responsible for increased temp and redness (acute inflammatory response)
what do histamines cause? what do they increase? responsible for?
cause vasodilation
increase vascular permeability (fluid accumulation outside the vessels)
responsible for edema (swelling in acute inflammatory response)
what is chemotaxis?
migration of other cells to the area through the process chemical attraction/recruitment
what do neutrophils do? when do they arrive?
first on the scene
early phases of inflammation clear the site of debris and microorganisms (phagocytosis)
what do leukocytes do? when do they arrive?
clear the injured site of debris and microorganisms to set the stage for tissue repair
later to the scene: attracted through chemotaxis
what are macrophages?
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
what are the four responses of the inflammatory phase?
vascular
hemostatic
cellular
immune
what are the two main goals for inflammatory phase? 3rd goal as appropriate?
decrease swelling
decrease pain
improve P/AROM
what are two factors to consider during inflammatory phase?
initial swelling
time required for rehabilitation
what modalities are recommended during the inflammatory phase?
cryotherapy
compression
PRICE (protect, rest, ice, compression, elevate)
what is the purpose of the proliferative phase?
cover the wound
impart strength to the injury site
what is a marker that suggests shift between inflammation and proliferative phase?
the shift from acute neutrophil cells infiltration and the replacement by longer term macrophages correlates to the transition between inflammation to proliferation
what are the 4 processes of the proliferation phase?
- epithelization: provides protective barrier to prevent loss of fluid and risk of infection
- collagen production: strength
- wound contraction: closing wound
- neovascularization: development of blood supply to the injured area
what are goals for therapist during the proliferative phase?
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
what is the goal of the remodeling phase?
restoration of the prior function of the injured tissue
what is the goal of PT during remodeling phase?
return the patient to activity
which phase of healing process can last over a year?
remodeling
how is the remodeling phase characterized by?
the changes in size, form and strength of scar tissue
– fiber orientation
– collagen synthesis versus lysis
what are some goals during remodeling phase?
return to activity
increase ROM
increase strength
decrease pain
increase circulation
normal acute inflammatory process lasts:
no longer than 2 weeks
normal subacute inflammation lasts:
4+ weeks
chronic inflammation lasts:
last months or years (age or comorbidity related)
what continues as part of the remodeling phase? why?
chronic inflammation
simultaneous collagen tissue destruction and healing
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 does chronic inflammation lead to? due to?
leads to increased scar tissue and adhesion formation
due to increased fibroblast proliferation and collagen production
what are factors that affect healing process?
- local:
– type, size, location of injury, infection, vascular supply - external:
– movement, application of physical agents - systemic:
– age, disease, medications, nutrition - mental/emotional stress
what are PT considerations for tendons and ligaments during inflammatory phase?
PRICE
what are PT considerations for tendons and ligaments during proliferation/remodeling phase?
immobilization versus early controlled forces for tendons
collagen fibrils –> random alignment –> organized
what are PT considerations for tendons and ligaments during maturation process?
physiological loading important
– promotes realignment
recover full, normal ROM after injury or surgical repair
normal strength human tissue –> 40-50 weeks post op
what are PT considerations for adolescents with damaged cartilage?
cartilage has some capacity to heal
what are PT considerations for adults with damaged cartilage?
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
what is physiology of skeletal muscle?
regenerates well
restoration and function depend upon type of injury
what are type of injuries of skeletal muscle?
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
what are the 4 stages of remodeling bone fractures?
- inflammatory
2 & 3. reparative/proliferative
– 2: soft callus formation
– 3: hard callus formation - bone remodeling
soft callus formation begins with?
pain and swelling subside increase in vascularity
hematoma becomes organized with fibrous tissue cartilage and bone formation
hard callus formation begins when?
bony fragments are united by fibrous tissue
