Week 1: Biophysical Agents, Contraindications, Healing, Interventions

Question 1

Define Biophysical Agents

Answer 1

1. Physical Agents
2. Modality
3. Therapeutic Modality

Question 2

PURPOSE of physical agents

Answer 2

• decrease pain
• decrease inflammation
• increase ROM
• improve tissue healing
• improve muscle activation
• to complement and facilitate HEALING!!!

Question 3

Modality Choice is based on

Answer 3

• current best evidence
• information
• experience
• judgements
  (indications, contraindications, patient preference)

Question 4

What are the three categories of biophysical agents

Answer 4

1. thermal
2. electromagnetic
3. mechanical

Question 5

Cryotherapy Benefits

Answer 5

• reduced blood flow and tissue metabolism
• decrease bleeding
  -reduce pain by desensitizing peripheral afferent nociceptors

Question 6

Thermotherapy Benefits

Answer 6

• Facilitate tissue healing
• relax skeletal muscles
• decrease spasms and pain
• promote increased blood flow
• prepare tissues for exercise

Question 7

Electrotherapy Benefits

Answer 7

• pain control
• facilitate muscle contraction in atrophied muscle
• stimulate contraction in denervated muscle
• deliver medication thru iontophoresis
• increasing blood flow

Question 8

Mechanical modalities include

Answer 8

• compression
• traction
• hydrotherapy
• ultrasound - sound waves

Question 9

Compression Benefits

Answer 9

• prevention,
• attenuation, or
• reversal of swelling,
• alter formation of scar tissue during proliferation and maturation phases of scarring,

Question 10

List and Describe general contraindications and precautions for each biophysical agents

Answer 10

…

Question 11

Active DVT precautions/contraindications

Answer 11

Active deep vein thrombosis or thrombophlebitis: energies applied to areas of thrombosis may dislodge or disrupt a thrombus which may lead to to occlusion of vital tissues

Question 12

Hemorrhagic conditions precautions/contraindications

Answer 12

Hemorrhagic conditions: application of physical energies may disrupt platelet formation and uncontrolled bleeding

Question 13

Impaired Sensation precautions/contraindications

Answer 13

• they cant feel sensation, temp, position, time properly so take precautions duhhhh

Question 14

Impaired Cognition precautions/contraindications

Answer 14

• pt cant give proper feedback and consent
• its a precaution and may become contraindication

Question 15

Electronic Implants precautions/contraindications

Answer 15

Contraindications: modalities that may interfere w/ the function of the electronic implant are contraindicated (Ultrasound, E-stim, Diathermy
Precaution: hot/cold packs, compression, traction

Question 16

Pregnancy precautions/contraindications

Answer 16

Contraindication if energy delivered may reach low back, abdominal, and pelvic areas
- largely due to unknown effect on fetal development

Question 17

Presence of Malignancy precautions/contraindications

Answer 17

Contraindication: if in LOCAL area if it may alter blood flow or metabolic activity in area of malignant tissue
- estim to manage cancer related pain is used in palliative care in late stage cancer

Question 18

Phases of Tissue Healing: Homeostasis

Answer 18

0-6-8 hrs
- stop the bleeding

Question 19

Phases of Tissue Healing: Inflammation

Answer 19

0-2-3 weeks
- clean up wound site
- prepare for healing

Question 20

Phases of Tissue Healing: Proliferation

Answer 20

4-22 days (peak 2-3 weeks)
- rebuild damaged structures
- strengthen wound

Question 21

Phases of Tissue Healing: Remodeling

Answer 21

days - 2 yrs
- modify the scar into its mature form

Question 22

Acute Phase of Healing: Timeline, Symptoms, Goals, Tx

Answer 22

• Onset to 7-10 days
• Symptoms: Inflammation (pain & swelling, redness, heat, loss of function), chemical mediators and vascular changes, initial vasoconstriction and hypoxia leading to vasodilation

Goals: PROTECTION
- minimize pain & swelling
- ctrl inflammation and restore Full ROM
- prevent atrophy, maintain soft tissue joint integrity, enhance function

Tx: Cryotherapy, Compression, E-stim, Pulsed ultrasound, Iontophoresis (deliver meds) PRICEM-EM (protection, rest, ice, compression, elevation, manual therapy, early motion)

Question 23

Subacute Phase of Healing: Timeline, Symptoms, Goals, Tx

Answer 23

• 10 days - 6 weeks

Symptoms: capillary growth and granulation tissue formation, fibroblast proliferation with collagen synthesis, increased macrophage and mast cell activity, development of wound tensile strength

Goals: increased mobility within a safe range, promote healing through progressively applied forces according to the SAID principle (specific adaptation to imposed demands)

Tx: thermotherapy, ultrasound, electrical stimulus, iontophoresis, diathermy ( also applies for chronic stage)

Question 24

Chronic Phase of Healing: Timeline, Symptoms, Goals, Tx

Answer 24

• 6 weeks to months/yrs

Symptoms: includes healing to scar tissue, wound contraction, tissue remodeling, increasing tensile strength of the wound

Goals: progressive strengthening and endurance exercises, maximize independence and return to function

Tx: thermotherapy, ultrasound, electrical stimulus, iontophoresis, diathermy

Question 25

Pain Impairment: what modalities & measurements

Answer 25

Modality: Cyro, Thermo, E-Stim, US
Measurement: Pain VAS, Functional measures

Question 26

Swelling Impairment: what modalities & measurements

Answer 26

Modality: Cryo, Compression
Measurement: Girth, Volumetric

Question 27

Decreased ROM: what modalities & measurements

Answer 27

Modality: Cryo, Compression, Thermo, US, E-Stim, Diathermy
Measurement: Goni, Incl, Muscle length

Question 28

Decreased Strength/ atrophy: what modalities & measurements

Answer 28

Modality: E-Stim, Biofeedback
Measurement: MMT, Dynamometry

Question 29

Tissue Healing: what modalities & measurements

Answer 29

Modality: Estim, US
Measurement: Wound assessment