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1

what is a physical agent ?

any of the various means of applying energy and materials to patients

2

What is physical agents also referred as?

physical modality or biophysical agent

3

A physical agent includes what?

heat, cold, water, pressure, sound, electromagnetic radiation, light and electrical currents

4

What is the role of physical agents?

to COMPLEMENT other physical, medical, and surgical interventions with minimal to no side effects

5

What therapeutic effects do physical agents want to achieve?

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

6

what are the 3 categories of physical agents

Thermal, Mechanical, & Electromagnetic

7

Can a physical agent fall into more than one category?

yes, depends on system used

8

What do thermal physical agents do?

transfer energy to a patient to produce an increase/decrease in tissue temp

9

An increase in tissue temp causes what?

increase circulation, metabolic rate, and soft tissue extensibility or decrease pain

10

A decrease tissue temp causes what?

decrease circulation, metabolic rate or pain

11

Types of thermal PA

Deep heating agents, superficial heating agents, cooling agents

12

clinical examples of deep heating agents

Ultrasound and diathermy

13

Clinical examples of superficial heating agents

hot packs, paraffin

14

clinical examples of cooling agents

ice pack

15

What do mechanical physical agents do?

apply mechanical force to increase/decrease pressure on the body

16

Types of mechanical physical agents?

Traction, compression, water, sound

17

Clinical examples of traction

mechanical traction

18

clinical examples of compression

Elastic bandages, stockings

19

Clinical examples of water

whirlpool

20

Clinical examples of sound

Ultrasound

21

What does Electromagnetic PA do?

utilize application of electromagnetic energy in the form of electromagnetic radiation and electrical current

22

Electromagnetic PA utilize application of electromagnetic energy in the form of what?

electromagnetic radiation & electrical current

23

Vacation of the frequency and intensity of electromagnetic radiation changes what?

effects and depth of penetration

24

what can Vacation of the frequency and intensity of electromagnetic radiation changes effect and depth of penetration do?

Depolarize nerves
sensory and motor responses to control pain or increase muscle strength and control

25

Types of electromagnetic PA

Electromagnetic field and electrical currents

26

Clinical examples of electromagnetic field

ultraviolet, laser

27

Clinical examples of electrical currents

TENS

28

What are general contraindications for PA

Pregnancy
Malignancy
Pacemaker/ other implanted electronic device
Impaired sensation
Impaired mental status

29

what are 3 reasons why PA fall out of favor?

-Lack of evidence to support effectiveness
-Greater effectiveness with other treatment options
-Laziness on the part of the community using the PA

30

What are the 4 things that need to be considered when choosing a PA

Goals and effects of treatment
Contraindications & precautions
Evidence for PA use
Cost, convenience and availability

31

Top 3 requirements for cost effective use of PA

1. Assess and analyze the presenting problem
2.Know when physical agents can be an effective form of tx
3. Know when and how to use PA most effectively
-Reassess tx often & adjust POC accordingly

32

what does physical agents have direct effects on?

LEVEL OF IMPAIRMENT that can prompt improvements over the level of functional limitation and disability

33

Optimally PA are used in conjunction with or in preparation for what ?

-Therapeutic exercise
-Functional training

34

Purpose of PA ?

Increase efficacy of the intervention

35

Treat inflammatory conditions that are results of what?

-Trauma
-Surgical procedures
-Problematic healing

36

Treatments of inflammatory conditions are?

PA
TE
Manual Therapy

37

PA can reduce/eliminate soft tissue what?

inflammation or circulatory dysfunction

38

PA can increase the healing rate of ?

Soft tissue injury

39

PA can modulate?

Pain

40

PA can modify ?

Tone

41

PA can increase connective tissue what?

Extensibility and length

42

PA can remodel

scar tissue

43

PA can treat

Skin conditions

44

When tissue damage occurs due to trauma or disease, the response is what?

generally similar and predictable

45

the 4 primary determinants to the outcome of any injury?

-type and extent of injury
-Regenerative capacity of tissue involved
-Vascular supply to injured site
-Extent of damage to the extracellular framework

46

When selected and applied appropriately, PA can? (5)

-Accelerate the completion and resolution of the phases of tissue healing
-Stimulate necessary processes to resume if they are stopped
-Accelerate overall recovery
-Improve final patient outcome
-Minimize risk of adverse effects from delayed or incomplete healing

47

When selected and applied INAPPROPRIATELY, PAs may ? (4)

-prolong inflammation
-Increase severity of associated symptoms
-Prevent or delay healing
-Increase probability of adverse consequences and therefore, a poor overall pt outcome

48

what do clinicians need to understand to choice PA appropriately?

-physiology of inflammation and healing: stages of healing
-Patho behind impairments
-Biomechanics of affected area
-Effects of immobilization and therapeutic interventions on healing process
-how PA will modify the present level of healing

49

How do PA's assist in decreasing inflammation and increasing tissue healing by?

Thermal, mechanical, electromagnetic

50

How does thermal PA decrease inflammation and increasing tissue healing?

Change the rate of circulation and rate of chemical reactions

51

How does mechanical PA decrease inflammation and increasing tissue healing?

control motion and alter fluid flow

52

How does electromagnetic PA decrease inflammation and increasing tissue healing?

Alter cell function particularly membrane permeability and transport

53

3 phases of inflammation

inflammation, proliferation, maturation

54

4 things that happen during inflammation phase?

-Vasoconstriction
-Vasodilation
-clot formation
-Phagocytosis

55

4 things that happen during proliferation phase?

-epithelialization
-fibroplasia/ collagen production
-Wound contracture
-Neovascularization

56

3 things that happens during maturation phase

-Collagen synthesis/ lysis balance
-collagen fiber orientation
-Healed injury

57

Inflammation stage prepares wound for what?

healing

58

what days does inflammation phase occur?

days 1-6

59

Proliferation phase rebuilds what and strengthens what?

rebuilds: damaged structures
strengthens: wound

60

What days does proliferation phase occur?

days 3 to 20

61

Maturation phase modifies what?

the scar tissue into its mature form

62

what day does maturation phase occur?

day 9 onward

63

what is necessary for healing ?

inflammation phase

64

When does inflammation phase begin?

when normal physiology of tissue is altered by disease or trauma

65

what happens when inflammation phase becomes inappropriate?

damage and excessive scarring

66

What is the vascular response of inflammation phase

swelling and redness

67

the vascular response is mediated by what?

histamine, kinins, and prostaglandins

68

The immune response of inflammation phase activates what?

neutrophils and other infection fighting cells

69

What does the hemostatic response of the inflammation phase do?

stops bleeding

70

What does the proliferation phase do?

cover wound and strengthens injury site

71

What four simultaneous process does the proliferation phase involve?

-epithelialization
-collagen production (granulation tissue)
-Wound contracture
-Formation of new blood vessels

72

What is the longest phase of inflammation ?

maturation

73

what two things is required for normal remodeling of scar?

balanced synthesis and lysis of collagen

74

what happen when production is greater than lysis

keloid or hypertrophic scar

75

High oxygen exposure favors what?

hypertrophy

76

Type III collagen is replaced by what?

type I

77

How many weeks is acute?

no more than 2 weeks

78

how many weeks is subacute

more than 4 weeks (2-4)

79

How long is chronic

months or years

80

Chronic inflammation

simultaneous progression of active inflammation, tissue destruction and healing

81

chronic inflammation can arise from what two situations

-persistance of injuries or other interference with normal tissue healing
-Immune response to either an altered host tissue or a foreign material or autoimmune disease

82

3 factors that affect the healing process?

local, external, and systemic

83

Infection accounts for what percent of the complication of wound healing?

50%

84

Local factors include?

-type, size, location of injury
-infection
-vascular supply

85

what may delay healing?

early movement

86

continuous passive motion used in conjunction with what may be helpful?

short-term immobilization

87

what are systemic factors?

age, disease, medications, nutrition

88

healing is rapid & robust in what age group?

children

89

what diseases can impair healing ?

diabetes and immune or vascular system diseases

90

What is "fuel" for inflammation and repair?

nutrition

91

What can result in accelerated pt progress toward active participation and goal achievement ?

modification of inflammation and tissue healing

92

what are the 4 cardinal signs of inflammation ?

heat, redness, swelling, pain

93

Stages of tissue healing determines what 2 things?

treatment goals
choice of PA

94

what is the firsts stage in tissue healing?

initial injury- control bleeding and inflammation

95

What is the approach of choice for sports med after acute tissue injury

PRICE

96

What are tx goals for initial injury?

prevent further injury or bleeding
clean open wound

97

effective agents for prevention of further injury or bleeding?

static compression
cryotherapy

98

effective agents for clean open wound

hydrotherapy

99

Treatment goals for acute inflammation

control: pain, edema, bleeding, release & activity of inflammatory mediators, and facilitate progression to proliferation phase

100

What PA would you use for pain in acute stage

Cryotherapy
hydrotherapy
ES
PSWD

101

what PA would you use for edema in acute stage

cryotherapy
compression
sensory level ES
PSWD
Contrast Bath

102

What PA would you use for bleeding in acute stage

Cryotherapy
compression

103

what PA would you use for release of inflammatory mediators in acute stage?

cryotherapy

104

What are the treatment goals during chronic inflam during tissue healing?

-prevent or decrease joint stiffness
-Control pain
-Increase circulation
-progress to proliferation phase

105

what PA would you use to prevent/ DC joint stiffness is chronic

Thermotherapy
Motor ES
Whirlpool
Fluidotherapy

106

What PA would you use to control pain in chronic

thermotherapy
ES
Laser

107

What PA would you use to increase circulation in chronic

Thermotherapy
ES
Compression
Hydrotherapy

108

What PA would you use to progress to proliferation phase in chronic

pulsed US
ES
PSWD

109

What are the treatment goals for remodeling/ maturation stage of healing ?

-regain or maintain strength
-regain or maintain flexibility
-control scar tissue formation

110

what PA would you use to regain. maintain strength in maturation

motor ES
water exercise

111

What PA would you use to regain/maintain flexibility in maturation

Thermotherapy

112

what PA would you use to control scar tissue formation in maturation

Brief ice massage
compression

113

Cutaneous noxious stimulation pain is?

well localized
sharp, pricking, tingling

114

Musculoskeletal structure pain is?

poorly localized
dull, heavy, aching

115

Visceral pain is?

refers superficially
aching quality

116

Goals of care for pain management ? (3)

-resolving underlying patho when possible
-modifying discomfort and suffering
-max function within the limitations imposed by pt's condition

117

Persistent pain may need to be integrated by what?

multidisciplinary treatment (psycho, psychosocial, PA and exercise)

118

Benefits for using PA for pain management?(4)

-directly moderates inflammation, modulates pain at the spinal cord, alters nerve conduction, or increases endorphins
-reslove underlying cause
-allow pt to interact with their injured body parts and practice indep pain management skills
-avoids medication related side effects

119

PA commonly used for pain reduction ?

cryotherapy
thermotherapy
electrical stimulation
traction

120

what can you use to measure pain for documentation

-visual analog
-numeric scales
-comparison with predefined stimulus
-face scale

121

what is Muscle tone

underlying tension in the muscle that serves as a background for contraction

122

what is hyptonicity

abnormally low tone

123

flaccidity

total absence of tone

124

examples of hypotonicity

Down syndrome, poliomyelitis

125

hypertonicity

abnormally high tone

126

rigidity

velocity independent resistance to stretch

127

Spasticity

velocity dependent resistance to stretch

128

Clonus

rhythmic oscillations or beats of involuntary contraction in response to quick stretch

129

PA are used to alter muscle tone directly or indirectly

both

130

PA are used to alter muscle tone directly by

altering nerve conduction or sensitivity

131

PA are used to alter muscle tone indirectly by

reducing pain or underlying cause of pain

132

quantitative measure for measuring muscle tone are?

-Dynamomter or myometer
-Isokinetic testing systems
-Electromypgraphy

133

what does an EMG record?

electrical activity sampled from muscles at rest and during contraction, using surface, fine wire or needle electrodes

134

What are pathologies that can cause motion restrictions?

contracture, edema, adhesion, mechanical block, spinal disc herniation, adverse neural tension, weakness

135

PA are generally not sufficient to do what?

reverse or prevent motion restrictions

136

PA are used as what?

adjuncts

137

PA are used as adjusts to treatment to help do what?

-increase soft tissue extensibility
-control inflammation and adhesion formation
-control pain during stretching
-facilitate motion

138

Role of PA in motion restriction ?

-Increase soft tissue extensibility
-Control inflammation and adhesion formation
-control pain during stretching/PROM
-Faciliate Motion

139

How does PA play a role to increase soft tissue extensibility ?

increase temp can alter viscoelasticity of soft tissue fibers, allowing plastic deformation to occur

140

How does PA play a role in control inflammation and adhesion formation ?

limit edema during acute inflammatory stage. limits degree of immobilization

141

How does PA play a role in controlling pain during stretching/PROM

to allow for increased stretching and sooner imitation of motion

142

How does PA play a role in facilitate motion ?

principles of buoyancy, muscle contraction (russian ES) to initiate motion

143

what are two stage of tissue healing determines?

-goals
-types of PA