Thera prelim

• Physical Agents


  • Heat
  • Cold
  • Water
  • Pressure
  • Sound
  • Electromagnetic radiation
  • Electrical currents
• Other names/terms used for Physical Agents


  • Physical Modality
  • Biophysical agent
  • Physical agent modality
  • Electrophysical agent
  • Modality
• It's not always necessary to apply modalities. IT ALWAYS VARY, DEPENDING ON THE CASE.
• Categories of physical agents


  • Thermal
  • Mechanical
  • Electromagnetic
• Thermal Agents


  • Increase or decrease tissue temperature
  • Examples: Ultrasound, diathermy, hot packs, cold packs
  • Heat transfer via conduction
• THERMOTHERAPY


  Application of HEAT
• CRYOTHERAPY


  Application of COLD
• Thermotherapy


  Decreases pain, increases circulation, metabolic rate, soft tissue extensibility, muscle will be hypotonic
• Cryotherapy


  Decreases pain, decreases circulation, metabolic rate, soft tissue extensibility, muscle will be hypertonic
• Mechanical Agents


  • Increase or decrease pressure on body
  • Examples: Mechanical traction, elastic bandage/stockings, whirlpool, ultrasound
  • Ultrasound can do phonophoresis
• Phonophoresis


  A technique by which therapeutic ultrasound is used to introduce pharmacologic agents
• Electromagnetic Agents


  • Apply energy in form of electromagnetic radiation or electrical current
  • Examples: Ultraviolet radiation/laser, diathermy, transcutaneous electrical nerve stimulation (TENS)
• TENS


  For pain modulation
• Electrical Stimulation (ES)


  Use for muscle grade 0-1 (from no muscle contraction to visible or palpable muscle contraction)
• Functional Electrical Stimulation (FES)


  Use for muscle grade 2-3 (from full range of motion against gravity eliminated to full range of motion against gravity)
• Effects of Physical Agents


  • Inflammation and healing
  • Pain
  • Collagen extensibility and motion restrictions
  • Muscle tone
• Process of healing


  1. Inflammation

  2. Proliferation

  3. Maturation
• Inflammatory Phase


  Lasts for 1 to 6 days, cells that remove debris and limit bleeding enter the traumatized area, characterized by heat, swelling, pain, redness, and loss of function
• Goals of treatment during Inflammatory Phase


  • Prevent further injury (bleeding)
  • Clean open wound
• PRICE


  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation
• POLICE


  • Protection
  • Optimal
  • Loading
  • Compression
  • Elevation
• Chronic Inflammation Phase


  First 3 days - 20 days, collagen is deposited in the damaged area to replace tissue that was destroyed
• Goals of treatment during Chronic Inflammation Phase


  • Prevent or decrease joint stiffness
  • Control pain
  • Increase circulation
• Maturation/Remodelling Phase


  Last phase, damaged collagen is now replaced, formation of hard callus
• Goals of treatment during Maturation/Remodelling Phase


  • Regain or maintain strength
  • Regain or maintain mobility
  • Control scar tissue formation
• Pain


  Controlled by modifying pain transmission or by changing the underlying process that is causing the sensation

  
• Ways to control pain


  • Modulating spinal cord level transmission
  • Changing the rate of nerve conduction
  • Altering the central or peripheral release of neurotransmitters

  
• Motion Restriction


  Agents can be effective adjuncts to the treatment of motion restrictions caused by muscle weakness, pain, soft tissue shortening, or a bony block
• Modalities for certain cases of motion restriction


  • Muscle weakness - ES/FES
  • Bony Block - Shock wave
  • Spastic patient - Thermotherapy
  • Hypotonic muscle - Cryotherapy
• Tone Abnormalities


  Agents can alter muscle tone directly by altering nerve conduction, nerve sensitivity, or biomechanical properties of muscle or indirectly by reducing pain or the underlying cause of pain
• General contraindications and precautions


  • Pregnancy
  • Malignancy
  • Pacemaker or other implanted electronic device
  • Impaired sensation
  • Impaired mentation
• Pregnancy


  Effects of energy produced by modalities on fetal development usually are unknown
• Malignancy


  Physiological effects may reach malignant tissue or alter the circulation to such tissue, potentially accelerating growth or metastasis
• Pacemaker or other implanted electronic devices


  May alter the functioning of the device
• Impaired sensation and mentation


  Patient may be unable to properly/accurately report sensation

  
• Considerations in selecting a physical agent


  • Goals and effects of treatment
  • Contraindications/precautions
  • Evidence
  • Cost, convenience, availability
• Pain Control Theories


  • Melzak and Wall's Gate Control Theory
  • Endogenous Opiates
  • Central Biasing
• Melzak and Wall's Gate Control Theory


  Ascending mechanism: Increased non-nociceptive stimuli from periphery into spinal cord = pain relief; Receptors from A-beta fibers can decrease the input of nociceptive stimuli from continuing to the second-order neuron
• Gate Control Theory: Opening and closing the gate


  Interaction of nonpain-carrying fibers (A-beta) and nociceptors (C fibers and A-delta) at secondary afferent neurons; More active nonpain tract = closing the gate on pain transmission
• Large and small afferent interaction


  The tract with the most activity will prevail and be allowed to continue up the spinal cord; The speed of transmission has nothing to do with opening and closing of the gate