Physical Agents
Energy and materials applied to patients to assist in rehabilitation
3 Categories of Physical Agents
1. Thermal
2.Mechanical
3.Electromagnetic
What are Thermal Agents?
-Deep-heating agents
-superficial heating agents
-superficial cooling agents
What are Mechanical Agents?
-Traction
-Compression
-water
-sound
What are Electromagnetic agents?
-Electromagnetic fields and electrical currents
How do Thermal Agents work?
Transfers energy to a patient to produce an increase or decrease in tissue temperature.
Example: hot packs, ice packs, US, whirlpool, diathermy
What is Cryotherapy?
Therapeutic application of cold; it is applied to decrease circulation or pain
What is Thermotherapy?
Therapeutic application of heat; used to increase circulation, metabolic rate or to decrease pain.
What is US?
US, is a Thermal physical Agent that has both thermal and non-thermal effects. It is a sound with a frequency of greater than 20,000 cycles/sec.
How are deep and superficial tissue temperatures produced?
They are produced by continuous US waves of sufficient intensity.
How do Mechanical Agents work?
Apply force to increase or decrease pressure on the body
Example: water, traction, compression, sound.
The therapeutic use of water is called what?
Hydrotherapy
True or False: Traction is most commonly used to alleviate pressure on structures such as nerves or joints that produce pain..
TRUE
How is Hydrotherapy a benefit?
Because the movement in water produces local pressure that can be used as resistance for exercise when an area is immersed and for cleansing/debriding open wounds.
What is compression used for?
compression is used to counteract fluid pressure and control or reverse edema
How do Electromagnetic Agents work?
Apply energy in the form of electromagnetic radiation or an electrical current
Example: UV radiation, Infrared (IR) radiation, laser, diathermy
True or false; UV radiation produces erythema and tanning of the skin but does not produce heat
True
What is E-Stim?
the use of electrical current to induce muscle contraction and changes in sensation, reduce edema, or accelerate tissue healing.
What should you check before the application of any physical agents?
-MD's referral (if one is required)
-A medical history of the patients condition and and precautions
The PT's exam should include what?
-The pt's History
-current c/o
-a review of systems
-specific tests and measures
Contraindication
Conditions in which a particular treatment should NOT be applied- absolute contraindication
Precaution
Condition in which particular treatment should be applied with special care or limitations
What are the 4 Contraindications and Precautions you should consider?
- Pregnancy
- Malignancy
- Pacemaker or other implanted electronic device
- Impaired sensation or mentation
What is Rehabilitation?
a goal-oriented intervention designed to maximize independence
Impairment
Characterized as an abnormality of structure or function of body or organ
Disability
characterized as a restriction of activities resulting from an impairment
Describe the Nagi Model
a model that classified pathology progression as impairments, functional limitation and disabilities
What does ICF stand for?
International Classification of Functioning
What is Evidence Based Practice?
based on the application of the scientific method to clinical practice
What is Randomized Control Trial (RCT)?
Gold standard in research
What is Systematic Reviews?
Answer clearly formulated questions by systematically searching literature from a variety of sources.
What are Clinical practice Guidelines?
systematically developed statements that attempt to interpret current research to guide the practitioner decisions about appropriate health care for the specific clinical circumstance.
When should Evidence Based Practice (EBP) be applied?
While:
-Selecting valid reliable tests and measures
-Determining an accurate diagnosis and prognosis
-Applying effective interventions
What does PICO stand for?
-Patient
-Intervention
-Comparison intervention
-Outcome
Physical Agents that are used to modify the healing process include..
.Cryotherapy
-Thermotherapy
-Ultrasound
-Electromagnetic Radiation
-Light
-Electrical Currents
-Compression
How does Thermal agents modify inflammation and healing?
-It changes the rates of circulation and chemical reactions
-Accelerates the progress by limiting adverse consequences of the healing process
the APTA statement on physical therapy says that documentation must________of physical agents
Justify the necessity of physical agents
What model places emphasis on positive components of health rather than a disease or injury?
The ICF model
Poorly selected physical agents might______or______the healing process
Impair or Prevent
What is the first goal of a physical agents during the initial injury stage?
Prevent further injury or bleeding
True or False?..Smaller wound tissues heal faster than large tissues
True
what are the 3 stages of healing?
1. inflammation
2.Proliferation
3.Maturation
Describe the Inflammation stage of healing
Prepares the wound for healing
Describe the Proliferation phase of healing
Rebuilds damaged tissues and strengthens the wound
Describe the maturation phase of healing
Remodels the scar tissues
What is Vasoconstriction?
Happens immediately following injury or trauma; minimizes blood loss (5-10 min) that is driven by norepinephrine and serotonin
What is Vasodilation?
The blood vessels and capillary permeability increases due to histamine, prostaglandins and other factors.
How long can Permeability last?
Up to 1 hour after tissue damage
What is permeability?
The state or quality of a membrane that causes it to allow liquids or gases to pass through it
In the Inflammation phase; as these cells accumulate, they lay down in layers in a process known as what?
Pavementing
What are the 5 Cardinal Signs of Inflammation?
1. Calor- heat
2. Rubor- redness
3. Tumor- swelling
4. Dolor- pain
5. Functio Laesa- loss of function
True or False?..Increased cellular permeability causes Edema
True
What is Chemotaxis?
The ability of a chemical to attract cells
What is Histamine?
one of the first inflammatory mediators released after tissue injury and is active for ~1hr after injury
Why is Permeability important?
It brings healing agents and oxygen in the blood and surrounding tissue to accelerate the healing process
What is the main supportive protein of skin, tendon, bone, and connective tissue?
Cartilage
Extensibility of collagen_____as tissue temperature increases
Increases
Describe Keloid scars
Extend BEYOND the original boundaries of an injury
Describe Hypertrophic scars
Extend TO the original boundaries of an injury
What are the 3 goals for physical agents during the Inflammation phase?
1. Control pain
2. Control Edema
3. Control bleeding
What are the 3 goals for physical agents during the Proliferation phase?
1. Control scar tissue formation
2. Improve local circulation
3. Gain as much strength and flexibility
What are the 2 goals of physical agents for the Maturation phase?
1. Regain or maintain strength and flexibility
2. Reverse and adverse effects of earlier stages of healing
Angiogenesis
The development of new blood supplies in an injured area
What is the primary purpose of Epithelialization?
To keep fluid and electrolytes in and keep infectious organisms out.
What produces Collagen?
Fibroblasts
true or false?...Type III collagen is weaker than Type I collagen
True
What are the most effective physical agents to prevent chronic inflammation?
Thermotherapy and Motion
One of the main goals of physical agents in the Chronic Inflammation phase is to what?
Prevent or decrease joint stiffness
What two ways can physical agents affect pain?
1. Modify tissue inflammation
2. Modify muscle tone
True or False?...Bed rest as a treatment for chronic pain should be discouraged?
True!
Cartilage has a limited ability to heal because of what?
1. poor blood supply
2. Lymphatics
3. Nerves
Do Intracapsular Ligaments heal slower than Extracapular ligaments?
Yes
________loading of healing ligaments is important for the healing process
Controlled
What are the 4 distinct stages of bone tissue healing?
1. Inflammation
2. Soft Callus
3. Hard Callus
4. Bone remodeling
During what stage in bone healing does fibrous tissue surround the bone fragments?
Soft Callus
Soft Callus serves as a scaffold to allow_____and_______
Vascularity and Proliferation
During what stage in bone healing does bone return to its original bony self
Hard Callus
Transudate
fluid with minimal cells and protein formed following initial inflammation, it is made of dissolved electrolytes and water
Exudate
more viscous and cloudy fluid due to high contents of lipids and cellular debris
Purulent Exudate (Pus)
when exudate concentration of leukocytes increases
How does physical agents help with the inflammation phase?
Reduces edematous circulation, pain, controlling motion, and promoting progression of the proliferation phase of healing
What is Epithelialization?
Reestablishment of the epidermis
Contractures
permanent tightening of nonbony tissues that results in the loss of motion in the affected joint
How does physical agents help with the Proliferation Phase?
Increases the circulation, promotion of collagen deposition, and progression of the remodeling phase of healing
True or False?...The Maturation phase in healing is the longest healing process
True; It can lasts 1-2 years
How fast an injury heals depends on what two things?
1.Collagen fiber orientation
2.Ratio of collagen synthesis to lysis
How does physical agents help with the Maturation phase?
Static compression garments to control superficial scar tissue, and circulation may be enhanced by thermotherapy, electrotherapy, compression, water immersion and exercise
What is Chronic Inflammation?
Simultaneous progression of active inflammation, tissue destruction and healing
Why is Cryotherapy NOT recommended for Chronic inflammation?
It increases the joint stiffness
Osteoblasts
Produce new bone tissue
Osteoclasts
Remove dead bone tissue
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