Physical Agents Exam 1

• Physical Agents Indications:

  • Modify tissue inflammation and healing
  • Relieve pain
  • Alter collagen extensibility
  • Modify muscle tone
• The most important way to monitor a patient's response to thermal modalities is by checking the skin and feedback.
• Chronic pain is pain lasting typically 3-6 months or in the absence of tissue damage
• Red Flags for using Thermal Agents:

  • Pregnancy
  • Impaired sensation
  • Impaired mentation
  • Thrombosis
  • Hemorrhage
  • Irradiation of eyes
  • Malignant tumor
• Phase 1 Healing (Inflammation 1-6 days):

  • Cells remove debris and control bleeding
  • Symptoms include heat, swelling, pain, redness, and loss of function
• Phase 2 Healing (Proliferation day 3 to approx 20):

  • Collagen is deposited to replace destroyed tissue
  • Myofibroblasts accelerate closure
  • Epithelial cells resurface the wound
• Phase 3 Healing (Maturation day 9 up to 2 years):

  • New tissue is remodeling itself
• Physiological ROM is the movement of one segment in relation to an adjacent segment
• Passive ROM is when external force moves the limb for you
• Cardinal Signs of inflammation:

  • Heat (calor)
  • Redness (rubor)
  • Swelling (tumor)
  • Pain (Dolor)
  • Loss of function (functio laesa)
• Jaundice is a yellow tint
• Erythema is superficial reddening caused by dilation and congestion of blood vessels
• Erythema Ab Igne is a condition caused by long-term exposure to heat
• Mottled Erythema presents as white and red splotches
• Cyanosis is a bluish discoloration
• Blisters are skin bubbles
• Decubitus ulcers are pressure sores or wounds
• Wheals are red swollen hives
• Rashes are changes in the skin that affect color, appearance, or texture
• Neurogenic Pain is long-term mechanical and histochemical pain changes in brain chemicals, managed with drugs, stress management, and aerobic exercise
• Mechanical Pain is a physical cause, localized, and easily recreated, managed with physical agents, stretching, mobilization, and stabilization
• Effects of Superficial Heat:

  • Vasodilation
  • Changes in nerve conduction velocity and firing rate
  • Increased pain threshold
  • Muscle strength increase
  • Increased metabolic rate
  • Increased collagen extensibility
• Effects of Superficial Cold:

  • Decrease blood flow initially then increase later
  • Decrease nerve conduction velocity
  • Reduced pain and increased pain threshold
  • Altered muscle strength
  • Decreased spasticity
  • Facilitation of muscle contraction
  • Decreased metabolic rate
• CIVD is Cold-induced vasodilation, triggered when tissue reaches less than 50 degrees causing vasodilation
• Convection involves direct contact between circulating medium and other material, examples include whirlpool and fluidotherapy
• Conduction is energy transfer by direct collision, examples include hot pack and paraffin
• Conversion involves non-thermal forms of energy converted into heat, examples include ultrasound and diathermy
• Radiation is the transfer of energy from material with a higher temperature to one with a lower temperature, examples include infrared lamp
• Evaporation involves energy absorption as a liquid evaporates, examples include cold spray and spray and stretch
• Cryo contraindications include blue-ish skin and unusual reactions
• Advantages of using paraffin vs. hot pack:

  • Paraffin allows direct contact to contours
  • Conditions skin
  • Can be easily elevated
  • Can be done at home
• Concerns when applying heat to someone with PVD include inadequate vasodilation and insufficient blood flow increase to protect from burning
• Contraindications and disadvantages for using fluidotherapy:

  • Expensive
  • Dependent position
  • Overheating possible
  • Fall risk if spilt onto the floor
  • Swelling
  • Open Wounds
• Application considerations for infrared:

  turn on and let it heat up

  cover wounds with plastic barrier

  Temperature: 100-118
• Superficial heat depth is less than 1cm
• Deep Heat Depth is 3-5 cm
• Cold depth is 2cm
• Indications of heat include pain control, increased ROM, decreased joint stiffness, infrared radiation for psoriasis, and accelerated healing
• Precautions of heat include pregnancy, poor circulation, edema, acute injury/inflammation, impaired thermoregulation, metal in the area, cardiac insufficiency, over topical counterirritants, over open wounds, and demyelinated nerves
• Contraindications of heat include thrombosis, recent/possible hemorrhage, impaired sensation, impaired mentation, IR irradiation of eyes, and malignant tumor