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Intro to Modalities + Tissue Healing Flashcards

1
Q

what are therapeutic modalities?

A

energy and material applied to a patient to assist in their rehabilitation

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2
Q

what is another name for therapeutic modalities?

A

physical agents

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3
Q

what are some types of physical agents?

A

heat
cold
water
pressure
sound
electromagnetic radiation
electrical currents

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4
Q

what are modalities/physical agents primarily used for?

A

reduce tissue inflammation
accelerate tissue healing
pain management
alters collagen extensibility
modifies muscle tone

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5
Q

what role do modalities play in physical therapy?

A

as a tool that can be used in clinical intervention

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6
Q

true or false: physical agents should be used in conjunction with other skilled therapeutic or educational interventions, NOT as the sole intervention

A

true

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7
Q

what are the 3 categories of physical agents?

A

thermal
mechanical
electromagnetic

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8
Q

what are thermal agents?

A

agents that transfer energy to a patient to increase or decrease tissue temperature

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9
Q

what are some examples of thermal agents?

A

ice packs
hot packs
ultrasound
whirlpool
diathermy

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10
Q

what is cryotherapy?

A

the therapeutic application of cold (ice packs)

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11
Q

what is thermotherapy?

A

the therapeutic application of heat

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12
Q

what is an ultrasound?

A

a mechanical form of energy composed of alternating compression and rarefaction waves + sound with a frequency greater than 20,000 cycles/second

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13
Q

true or false: an ultrasound has both thermal and nonthermal effects

A

true

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14
Q

what are mechanical agents?

A

agents that apply force to increase or decrease pressure on the body

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15
Q

what are some examples of mechanical agents?

A

water
traction
compression
sound

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16
Q

what is hydrotherapy?

A

an agent that can provide resistance, hydrostatic pressure, and buoyancy for exercise or can apply pressure to clean wounds

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17
Q

what is an example of hydrotherapy?

A

aquatic therapy

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18
Q

what is traction?

A

a mechanical agent that decreases the pressure between structures

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19
Q

what is compression?

A

a mechanical agent that increases the pressure on and between structures

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20
Q

what is an ultrasound with nonthermal effects?

A

mechanical form of energy composed of alternating compression and rarefaction waves

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21
Q

what are electromagnetic or electrical therapeutic agents?

A

agents that apply energy in the form of electromagnetic radiation or an electrical current

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22
Q

how do you change the effect and depth of penetration with electromagnetic agents?

A

by changing the frequency and intensity of the electromagnetic radiation

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23
Q

what are some examples of electromagnetic agents?

A

UV radiation
infrared (IR) radiation
laser
diathermy
electrical current

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24
Q

what is a laser?

A

output monochromatic, coherent, directional electromagnetic radiation that is generally in the frequency range of visible light or IR radiation

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25
what is shortwave diathermy?
an agent that produces heat in both superficial and deep tissues
26
what is electrical stimulation (Estim)?
the use of electrical current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing
27
ture or false: some modalities can be classified as two different categories based on the goal for therapy and setting use
true
28
what domain of the ICF model do modalities directly effect?
body functions and structures
29
what are the steps to consider when choosing the use of therapeutic modalities?
goals and effects of treatment contraindications and precautions evidence for physical agent use cost, convenience and availability
30
what are some other considerations that should be made when choosing the use of therapeutic modalities?
medical dx and patient hx subjective complaints exam findings patient goals, preference, and cultural considerations previous intervention contraindications + precautions
31
what are some examples of contraindications or precautions for therapeutic modalities?
pacemaker cancer/malignancy pregnancy impaired sensation impaired mentation
32
what are clinical practice guidelines?
systematically developed statements that attempt to interpret current research to provide evidence-based guidelines to guide practitioner and patient decisions about appropriate health care for specific clinical circumstances
33
what is a benefit of clinical practice guidelines?
they give recommendations for diagnostic and prognostic measures and for preventive or therapeutic interventions for diagnosis
34
what is the goal for tissue healing?
repair and restore function by eliminating pathology and replacing damaged tissue by promoting regeneration of normal tissue
35
what are some physical therapy considerations for rehabilitation?
patient S&S stage of healing (time frames) appropriateness of physical agents how healing can be modified
36
how long does the inflammation phase last?
1-6 days post injury
37
how long does the proliferative/fibroblastic phase last?
3-20 days
38
how long does the maturation/remodeling phase last?
9 days to possibly a year
39
what is the inflammation phase?
the immediate protective response that attempts to destroy, dilute, or isolate the cells or agents that may be faulty
40
what are the causes of the inflammation phase?
soft tissue trauma fractures foreign bodies autoimmune diseases microbial agents chemical agents thermal agents irradiation
41
what are the four cardinal signs of inflammation?
calor (heat) rubor (redness) tumor (swelling) dolor (pain).
42
what is the 5th characteristic of inflammation that was later added?
loss of function
43
what are the 3 purposes of the inflammatory phase?
vasoconstriction + vasodilation (recruit endothelial cells and fibroblasts) clot formation (fibrin lattice for strength + limit blood loss) phagocytosis (remove damaged tissue)
44
what is hyperemia?
increased blood flow to the area (vasodilation), responsible for increased temperature and redness (acute inflammatory response)
45
what role do histamines play in the initial reaction to protect the wound?
cause vasodilation and increase vascular permeability (= fluid accumulation outside the vessels), responsible for edema (swelling in acute inflammatory response)
46
what is chemotaxis?
migration of other cells to the area through the process chemical attraction/recruitment (other cells such as histamines release chemical to attract leukocytes)
47
what are the 3 cells that are involved in the removal of damaged tissue/phagocytosis?
neutrophils leukocytes macrophages
48
what cells are first on the scene after an injury + clear the injury site of debris and microorganisms in the early phases of the inflammation phase?
neutrophils
49
what cells show up later in the inflammation phase, are attracted through chemotaxis, and clear the injury site of debris and microorganisms to set the state for tissue repair?
leukocytes
50
what cells are converted from monocytes (specific leukocytes) as they exit from the capillaries into the tissue spaces?
macrophages
51
what cells are involved in a wide range of activities including phagocytosis and synthesis of extracellular matrix?
macrophages
52
macrophages cause fibroblasts to adhere to fibrin to make what?
collagen
53
what are the general goals for physical therapists during the inflammatory phase?
decrease swelling decrease pain improve AROM + PROM
54
how are initial swelling and the time required for rehabilitation related?
swelling reduces the ability for ROM, can decrease the speed of rehabilitation, and if not treated can start to affect other systems
55
which modalities are recommended during the inflammatory phase?
cryotherapy compression PRICE (protect, rest, elevate)
56
what is the purpose of the proliferative phase?
to cover the wound and impart strength to the injury site
57
what is a marker that suggests shift between phases?
the shift from acute neutrophil cell infiltration and the replacement by longer term macrophages correlates to the transition between inflammation to proliferation phase
58
what are the four processes in the proliferative phase?
epithelialization collagen production wound contraction neovascularization
59
what is epithelialization in the proliferative phase?
a process that provides a protective barrier to prevent loss of fluid and risk of infection
60
what is neovascularization?
development of blood supply to the injured area
61
what are the general goals for physical therapists during the proliferative phase?
improve ROM + function!! (that was lost from the inflammatory phase) decrease pain and swelling increase circulation mildly protect wound (assist with closure) promote appropriate alignment of collagen fibers during wound contraction to avoid contractures!!
62
what is the ultimate goal of the maturation phase?
restoration of prior function of the injured tissue
63
what is the longest phase of the healing process?
maturation phase
64
the maturation phase is characterized by the changes in the size, form, and strength of?
scar tissue (fiber orientation + collagen synthesis versus lysis)
65
what are the general goals for physical therapists during the maturation phase?
return to activity!! increase ROM increase strength decrease pain increase circulation
66
what is the time period of a normal acute inflammatory process?
no longer than 2 weeks
67
how long does subacute inflammation last?
~4+ weeks
68
what is chronic inflammation?
inflammation that lasts months or years (can be abnormal or age/comorbidity related) and continues as a part of the maturation phase (simultaneous collagen tissue destruction and healing)
69
what are the two methods of chronic inflammation?
cumulative trauma or interference with normal healing immune response to foreign material or result of an autoimmune disease
70
why does chronic inflammation lead to increased scar tissue and adhesion formation?
increased fibroblast proliferation and collagen production
71
what are some examples of local factors that affect the healing process?
type, size, and location of injury infection vascular supply
72
what are some examples of external factors that affect the healing process?
movement application of physical agents (to increase healing)
73
what are some examples of systemic factors that affect the healing process?
age disease medications nutrition
74
what are some examples of mental/emotional factors that affect the healing process?
stress anxiety depression
75
how should physical therapists treat tendons and ligaments in the inflammatory phase?
PRICE
76
how should physical therapists treat tendons and ligaments in the proliferative/remodeling phase?
immobilization (versus early controlled forces for tendons)
77
how should physical therapists treat tendons and ligaments in the maturation phase?
physiological loading is important to promote realignment recover full, normal ROM
78
when do tendons and ligaments typically return to normal strength human tissue?
40-50 weeks post op
79
what is the physiology of articular cartilage?
aneural + avascular = limited ability to heal
80
how does articular cartilage healing occur?
development of fibrous scar tissue or not at all (cartilage with bone injury can form a granulation tissue that acts like articular cartilage)
81
healing potential of articular cartilage in adolescents? adults?
adolescents: some capacity adults: limited ability
82
what is the physiology of skeletal muscle?
regenerates well due to good vascularity, but restoration of function depends upon type of injury
83
how do muscle contusions and strains heal?
follow the general stages of healing
84
what happens to the muscle with severe infections?
muscle fibers are destroyed
85
how transection of muscle injuries heal?
muscle fibers regenerate growth from undamaged fibers development of new fibers
86
what are the four distinct stages of regeneration and remodeling of bone fractures?
inflammatory reparative proliferative bone remodeling
87
how long does it take bone fractures to heal?
6-8 weeks
88
what are the two types of formation in the reparative/proliferative phases of bone fractures?
soft callus formation hard callus formation
89
what is soft callus formation?
begins when pain and swelling subside + increase in vasculatory, hematoma becomes organized with fibrous tissue cartilage and bone formation
90
what is hard callus formation?
begins when bony fragments are united by fibrous tissue

Modalities (4 decks)

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