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Principles & applications - exam 1 Flashcards

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1
Q

what are physical agents? (modalities)

A

energy and material applied to patient to assist in their rehab

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2
Q

what are physical agents primarily used for?

A

reduce inflammation
pain management
– inflammation, soft tissue or bony injury
– unpleasant sensory and emotional experience
– modulate transmission
accelerate tissue healing
alters collagen extensibility
reduce spasticity/modifies muscle tone

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3
Q

what does the APTA say about using modalities as a tool in clinical intervention?

A

physical agents should be used in conjunction with other skilled therapeutic or educational interventions, not as the sole intervention

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4
Q

what are some reasons that the APTA doesn’t allow the use of physical agents for exclusive use?

A

contain costs of delivery
feels patients can administer these treatments independently
PT can train unskilled clinicians to perform these interventions

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5
Q

what modalities does the APTA expect competency in as a PT graduate?

A

cryotherapy
hydrotherapy
ultrasound
thermotherapy
mechanical modalities (compression therapies, traction devices and electrotherapeutic modalities)

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6
Q

what are types and examples of thermal physical agents?

A

types:
deep heating agents
superficial heating agents
cooling agents

clinical examples:
ultrasound, diathermy
hot pack
ice pack

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7
Q

what are types and examples of mechanical physical agents?

A

types:
traction
compression
water
sound

examples:
mechanical traction
elastic bandage, stockings
whirlpool
ultrasound

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8
Q

what are types and examples of electromagnetic physical agents?

A

types:
electromagnetic fields
electrical currents

examples:
ultraviolet, laser
TENS

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9
Q

thermal agents transfer energy to:

A

increase or decrease tissue temperature

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10
Q

what is cryotherapy?

A

therapeutic application of cold (ice packs)

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11
Q

what is thermotherapy?

A

therapeutic application of heat

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12
Q

ultrasound has what effects?

A

thermal and nonthermal effects

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13
Q

what is ultrasound?

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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14
Q

mechanical agents apply force to:

A

increase or decrease pressure on the body

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15
Q

what can hydrotherapy do?

A

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

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16
Q

what does traction do?

A

decreases pressure between structures

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17
Q

what does compression do?

A

increases pressure on and between structures

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18
Q

what is ultrasound (nonthermal effects)

A

mechanical form of energy composed of alternating compression and rarefaction waves

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19
Q

electromagnetic agents apply energy in the form of:

A

electromagnetic radiation or an electrical current

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20
Q

what changes as a result of variation of frequency and intensity of electromagnetic radiation?

A

its effects and depth of penetration

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21
Q

what are lasers?

A

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

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22
Q

what does shortwave diathermy do?

A

produces heat in both superficial and deep tissues

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23
Q

what is electrical stimulation (ESTIM)?

A

use of electrical current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing

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24
Q

what is an example of a modality that is classified as two different categories?

A

ultrasound

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25
what level of the ICF model is at which physical agents have direct effects?
body functions and structures
26
what are the steps to consider use of therapeutic modality?
goals and effects of treatment --> contraindications and precautions --> evidence for physical agent use --> cost, convenience and availability
27
what are components of evidence based practice?
best available evidence --> clinical expertise --> patient values and circumstances
28
what are other considerations to take into account for use of modalities?
medical dx patient hx subjective complaints exam findings patient's goals previous intervention patient preference and cultural considerations contraindications and precautions
29
what are contraindications?
absolutely not allowed absolute contraindications
30
what precautions?
take caution relative contraindications
31
what are some examples of contraindications? (5)
pregnancy malignancy pacemaker 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 do clinical practice guidelines give?
recommendations for diagnostic and prognostic measures and for preventative or therapeutic interventions for diagnosis
34
what is the goal for healing?
repair and restore function by eliminating pathology and replacing damaged tissue by promoting regeneration of normal tissue
35
what are PT considerations for choosing modalities?
signs and symptoms what physical agents are appropriate stage of healing how can healing be modified
36
what are the days post injury for the inflammation phase?
1-6 days
37
what are the days post injury for the proliferative phase?
3-20 days
38
what are the days post injury for the remodeling phase?
9 days and on
39
what is happening in the inflammation phase?
immediate protective response that attempts to destroy, dilute, or isolate the cells or agents that may be faulty
40
what are some causes of inflammation phase?
soft tissue trauma fractures foreign bodies autoimmune diseases microbial agents chemical agents thermal agents irradiation
41
what are the 4 signs of inflammation? what is the added 5th? what are the causes?
heat - increased vascularity redness - increased vascularity swelling - blockage of lymphatic drainage pain - physical pressure or chemical irritation of pain-sensitive structures loss of function - pain and swelling
42
what are the 3 purposes of inflammatory phase?
1 - to form a fibrin lattice that limits blood loss and provides some initial strength to wound (clot formation) 2 - remove damaged tissue (phagocytosis) 3 - recruit endothelial cells and fibroblasts (make collagen)
43
what is hyperemia? responsible for?
increase blood flow to area (vasodilation) responsible for increased temp and redness (acute inflammatory response)
44
what do histamines cause? what do they increase? responsible for?
cause vasodilation increase vascular permeability (fluid accumulation outside the vessels) responsible for edema (swelling in acute inflammatory response)
45
what is chemotaxis?
migration of other cells to the area through the process chemical attraction/recruitment
46
what do neutrophils do? when do they arrive?
first on the scene early phases of inflammation clear the site of debris and microorganisms (phagocytosis)
47
what do leukocytes do? when do they arrive?
clear the injured site of debris and microorganisms to set the stage for tissue repair later to the scene: attracted through chemotaxis
48
what are macrophages?
specific leukocytes (monocytes) convert into macrophages as they exit from the capillaries into the tissue spaces involved in a wide range of activities including phagocytosis and synthesis of extracellular matrix
49
what are the four responses of the inflammatory phase?
vascular hemostatic cellular immune
50
what are the two main goals for inflammatory phase? 3rd goal as appropriate?
decrease swelling decrease pain improve P/AROM
51
what are two factors to consider during inflammatory phase?
initial swelling time required for rehabilitation
52
what modalities are recommended during the inflammatory phase?
cryotherapy compression PRICE (protect, rest, ice, compression, elevate)
53
what is the purpose of the proliferative phase?
cover the wound impart strength to the injury site
54
what is a marker that suggests shift between inflammation and proliferative phase?
the shift from acute neutrophil cells infiltration and the replacement by longer term macrophages correlates to the transition between inflammation to proliferation
55
what are the 4 processes of the proliferation phase?
1. epithelization: provides protective barrier to prevent loss of fluid and risk of infection 2. collagen production: strength 3. wound contraction: closing wound 4. neovascularization: development of blood supply to the injured area
56
what are goals for therapist during the proliferative phase?
improve ROM, function decrease pain increase circulation mildly to the area decrease swelling protect wound promote appropriate alignment of collagen fibers - during wound contraction avoid contractures
57
what is the goal of the remodeling phase?
restoration of the prior function of the injured tissue
58
what is the goal of PT during remodeling phase?
return the patient to activity
59
which phase of healing process can last over a year?
remodeling
60
how is the remodeling phase characterized by?
the changes in size, form and strength of scar tissue -- fiber orientation -- collagen synthesis versus lysis
61
what are some goals during remodeling phase?
return to activity increase ROM increase strength decrease pain increase circulation
62
normal acute inflammatory process lasts:
no longer than 2 weeks
63
normal subacute inflammation lasts:
4+ weeks
64
chronic inflammation lasts:
last months or years (age or comorbidity related)
65
what continues as part of the remodeling phase? why?
chronic inflammation simultaneous collagen tissue destruction and healing
66
what are the two methods of chronic inflammation?
1. cumulative trauma or interference with normal healing 2. immune response to foreign material or result of an autoimmune disease
67
what does chronic inflammation lead to? due to?
leads to increased scar tissue and adhesion formation due to increased fibroblast proliferation and collagen production
68
what are factors that affect healing process?
1. local: -- type, size, location of injury, infection, vascular supply 2. external: -- movement, application of physical agents 3. systemic: -- age, disease, medications, nutrition 4. mental/emotional stress
69
what are PT considerations for tendons and ligaments during inflammatory phase?
PRICE
70
what are PT considerations for tendons and ligaments during proliferation/remodeling phase?
immobilization versus early controlled forces for tendons collagen fibrils --> random alignment --> organized
71
what are PT considerations for tendons and ligaments during maturation process?
physiological loading important -- promotes realignment recover full, normal ROM after injury or surgical repair normal strength human tissue --> 40-50 weeks post op
72
what are PT considerations for adolescents with damaged cartilage?
cartilage has some capacity to heal
73
what are PT considerations for adults with damaged cartilage?
limited ability to heal healing occurs by development of fibrous scar tissue or not at all cartilage with bone injury can form granulation tissue that acts like articular cartilage
74
what is physiology of skeletal muscle?
regenerates well restoration and function depend upon type of injury
75
what are type of injuries of skeletal muscle?
contusions, strains -- follow general stages of healing severe infections -- muscle fibers destroyed transection of muscle -- muscle fibers may regenerate -- growth from undamaged fibers or development of new fibers
76
what are the 4 stages of remodeling bone fractures?
1. inflammatory 2 & 3. reparative/proliferative -- 2: soft callus formation -- 3: hard callus formation 4. bone remodeling
77
soft callus formation begins with?
pain and swelling subside increase in vascularity hematoma becomes organized with fibrous tissue cartilage and bone formation
78
hard callus formation begins when?
bony fragments are united by fibrous tissue

Modalities (2 decks)

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