WK1- Intro, Healing, Interventions Flashcards
What are the 3 categories of physical agents ?
Thermal, Electromagnetic, and Mechanical Interventions
What is the purpose of a physical agent ?
decrease pain, increase ROM, Improve tissue healing, improve muscle activation
What are the benefits of cryotherapy ?
reduced blood flow and tissue metabolism, decrease bleeding, reduce pain by desensitizing peripheral afferent nociceptors
What are the benefits of thermotherapy ( heat ) ?
Facilitate tissue healing, relax skeletal muscles, decrease spasms and pain, promote increased blood flow, prepare tissues for exercise.
What are the benefits of electromagnetic therapy ?
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
What are the benefits of compression ?
prevention, attenuation, or reversal of swelling, alter formation of scar tissue during proliferation and maturation phases of scarring,
What are the benefits of traction ?
decrease pain, increase ROM, improve functional ability, increases blood flow, reduce pressure on anatomical structures, reduce muscle guarding, particularly on the spine
List the major contraindications to therapeutic modalities and why
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
Describe the acute phase of healing, timeframe, clinical findings goals of interventions, and possible interventions for this phase
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.
What does the acronym PRICE-EM stand for ?
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
Describe the subacute phase of healing, timeframe, clinical findings goals of interventions, and possible interventions for this phase
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)
Describe the chronic phase of healing, timeframe, clinical findings goals of interventions
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
which of the following is not a cardinal sign of inflammation ? heat, atrophy, redness, swelling
atrophy
What type of energy does diathermy use to heat biological tissues?
Electromagnetic Radiation
Why is cold therapy often used during the initial stages of injury?
Cold causes vasoconstriction, resulting in decreased blood flow to injured tissues.
What modality can be used to facilitate recruitment of the quadriceps femoris muscle following knee surgery?
NMS
Why is pregnancy widely considered a contraindication to the use of modalities?
The effect of modalities on fetal development is unknown.
Which of the following modalities is capable of delivering heat to tissues? TENS, Intermittent Compression, Continous US, Handheld ice cups
US
What modality reduces blood flow to tissues ?
Cryotherapy
This stage of tissue healing involves rebuilding of damaged structures. It typically peaks at 2-3 weeks.
Proliferation
This stage of tissue healing modifies the scar into its mature form.
Remodeling
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.
Chronic
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)
compression with an ace wrap
cold pack
relative rest
electrical stimulation for pain control
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)
diathermy
hot pack
thermal US
One significant problem with using research to help determine when to implement a specific biophysical agent includes:
lack of good research
If your treatment goal is to improve neuromuscular performance, which measurement tool might you chose to assess the effectiveness of your treatment?
MMT
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.
side of treatment application
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
treatment is experimental or investigational
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 ?
Diagnostic Codes
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?
CPT code, procedure code
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 ?
Electrical stimulation may be used for pain control at this stage
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?
Lack of sensation may cause the patient to be unaware if the treatment is too hot and sustain a burn
The type of modality that uses sound waves to deliver energy to the tissues.
US
