WK1- Intro, Healing, Interventions

Question 1

What are the 3 categories of physical agents ?

Answer 1

Thermal, Electromagnetic, and Mechanical Interventions

Question 1

What is the purpose of a physical agent ?

Answer 1

decrease pain, increase ROM, Improve tissue healing, improve muscle activation

Question 2

What are the benefits of cryotherapy ?

Answer 2

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

Question 3

What are the benefits of thermotherapy ( heat ) ?

Answer 3

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

Question 4

What are the benefits of electromagnetic therapy ?

Answer 4

strengthening or relaxing skeletal muscle, decreasing pain, facilitating neuromuscular re-education, augmenting ROM, attenuating disuse atrophy, promoting tissue and wound healing, reducing edema, increasing local blood flow, delivering medicinal ions transdermally

Question 5

What are the benefits of compression ?

Answer 5

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

Question 6

What are the benefits of traction ?

Answer 6

decrease pain, increase ROM, improve functional ability, increases blood flow, reduce pressure on anatomical structures, reduce muscle guarding, particularly on the spine

Question 7

List the major contraindications to therapeutic modalities and why

Answer 7

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

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

Lack of Sensation: for obvious reasons precautions should be taken

Diminished cognition: patient must be able to consent, and must be aware of what is happening to them

Electronic implants: especially with electrical interventions near the implanted device as it is feared that the signal could interrupt the devices function.

Pregnancy: unknown effects on the fetus

Presence of Malignancy: evidence is equivoal, but electrical stimulation is thought to proliferate malignant cells by altering blood flow and metabolic activity

Question 8

Describe the acute phase of healing, timeframe, clinical findings goals of interventions, and possible interventions for this phase

Answer 8

acute phase correlates with hemostasis, inflammation, and coagulation

onset to 7-10 days

characterized by inflammation, pain, redness, edema, heat, and impairment or loss of function

goals include control inflammation, avoid painful positions, minimize pain and edema, restore full PROM, maintain soft tissue joint integrity, reduce muscle atrophy through gentle isometrics, function as independently as possible

interventions: PRICEM-EM, rest, cryo, compression, electrical stimulation, pulsed ultrasound ( non-thermal effects), iontophoresis.

Question 9

What does the acronym PRICE-EM stand for ?

Answer 9

Protection: avoid excess tissue loading
Rest: relative rest, avoid immobilization when possible
Ice: cold/cryo-therapy to decrease pain and swelling
Compression: control swelling
Elevation: assist venous return and decrease swelling
Manual Therapy: move fluid, increase blood flow, inhibit pain perception
Early Motion: prevent adverse effects of immobolization

Question 10

Describe the subacute phase of healing, timeframe, clinical findings goals of interventions, and possible interventions for this phase

Answer 10

decrease pain and swellling and increased pain free AROM and PROM; associated with capillary growth and granulation tissue formation, fibroblast proliferation with collagen synthesis, increased macrophage and mast cell activity, development of wound tensile strength,

10 days to 6 weeks

goals include increased mobility within a safe range, promote healing through progressively applied forces according to the SAID principle

interventions may include: thermotherapy, ultrasound, electrical stimulus, iontophoresis, diathermy ( also applies for chronic stage)

Question 11

Describe the chronic phase of healing, timeframe, clinical findings goals of interventions

Answer 11

6 weeks to months/years

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

goals include progressive strengthening and endurance exercises, maximize independence and return to function

Question 12

which of the following is not a cardinal sign of inflammation ? heat, atrophy, redness, swelling

Answer 12

atrophy

Question 13

What type of energy does diathermy use to heat biological tissues?

Answer 13

Electromagnetic Radiation

Question 14

Why is cold therapy often used during the initial stages of injury?

Answer 14

Cold causes vasoconstriction, resulting in decreased blood flow to injured tissues.

Question 15

What modality can be used to facilitate recruitment of the quadriceps femoris muscle following knee surgery?

Answer 15

NMS

Question 16

Why is pregnancy widely considered a contraindication to the use of modalities?

Answer 16

The effect of modalities on fetal development is unknown.

Question 17

Which of the following modalities is capable of delivering heat to tissues? TENS, Intermittent Compression, Continous US, Handheld ice cups

Answer 17

US

Question 18

What modality reduces blood flow to tissues ?

Answer 18

Cryotherapy

Question 19

This stage of tissue healing involves rebuilding of damaged structures. It typically peaks at 2-3 weeks.

Answer 19

Proliferation

Question 20

This stage of tissue healing modifies the scar into its mature form.

Answer 20

Remodeling

Question 21

Your patient reports lower back which started 6 months ago and has not resolved. The pain is described as a constant dull ache. The patient denies recent exacerbation and has tried both ice packs and heat to the area with minimal relief. Based on the time frame the injury started. The patient is most likely in this stage of healing.

Answer 21

Chronic

Question 22

Your patient reports an injury while playing soccer 3 days ago when he planted his R leg and twisted. He reports that he felt and heard a “pop” in his right knee and was unable to continue playing. Currently, the patient reports moderate to severe pain and there is visible edema in the R knee and lower extremity to the ankle. You determine that the patient is in the acute phase of treatment and decide that all of the following modalities would be appropriate choices: (select all that apply)

Answer 22

compression with an ace wrap
cold pack
relative rest
electrical stimulation for pain control

Question 23

Your patient is 4 weeks status post a moderate hamstring strain. She reports that her mobility is improving but that her knee still feels stiff. It is difficult to fully straighten her knee to end-range. Which of the following modalities would help improve tissue extensibility prior to therapeutic exercise? (select all that apply)

Answer 23

diathermy
hot pack
thermal US

Question 24

One significant problem with using research to help determine when to implement a specific biophysical agent includes:

Answer 24

lack of good research

Question 25

If your treatment goal is to improve neuromuscular performance, which measurement tool might you chose to assess the effectiveness of your treatment?

Answer 25

MMT

Question 26

In the following example, which important part of documenting a biophysical agent is missing?

The physical therapist applied cold pack to shoulder x 15 min with patient seated and arm supported.

Following treatment, the patient reports pain decreased from 6/10 to 3/10 on VAS. No significant redness or adverse reaction noted post-treatment.

Plan to continue with cold pack following exercise next session to decrease post activity soreness.

Answer 26

side of treatment application

Question 27

All of the following are part of the Medicare definition for “reasonable and necessary” physical therapy treatment EXCEPT the following:

treatment is appropriate to meet but not exceed the needs of the patient

treatment is experimental or investigational

treatment is appropriate in duration and frequency

treatment is safe and effective

Answer 27

treatment is experimental or investigational

Question 28

Coding used in documentation helps provide a standard system to communicate. One type of code used in physical therapy treatment documentation includes ICD-10 codes. What is another way of describing these codes ?

Answer 28

Diagnostic Codes

Question 29

You are working in an outpatient physical therapy clinic and reviewing a patient’s note. You see that the clinician before you provided ultrasound treatment. The corresponding ultrasound code of 97035 was billed to the patient’s insurance company. This numerical code is an example of what type of code?

Answer 29

CPT code, procedure code

Question 30

Your patient has end-stage bone cancer and is experiencing a lot of pain. The patient care team decides that palliative care needs to be a focal part of treatment. What modality is appropriate in this setting ?

Answer 30

Electrical stimulation may be used for pain control at this stage

Question 31

Your patient has impaired sensation on her feet and you notice that the PTA you are working with is preparing a hot pack for the patient’s L ankle to improve tissue extensibility prior to stretching. What is the concern with this scenario?

Answer 31

Lack of sensation may cause the patient to be unaware if the treatment is too hot and sustain a burn

Question 32

The type of modality that uses sound waves to deliver energy to the tissues.

Answer 32

US