DPT 752

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DPT 752
2011-05-28 14:55:11
Physical Agents Notecards

DPT 752 Physical Agents Notecards
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  1. What are physical agents?
    Various forms and means of application of energy and materials to patients in order to produce a physiologic effect.
  2. Categories of physical agents
    Give an example of each
    • Thermal (hot or cold packs)
    • Mechanical (Ultrasound)
    • Electromagnetic (Diathermy)
  3. What are the three phases of inflammation?
    • Acute phase (1-6 days)
    • Proliferation phase (3-20 days)
    • Maturation phase (9 and on)
  4. Accute Phase
    • Heat
    • Redness
    • Swelling
    • Pain
    • Loss of function
  5. Proliferation Phase
    • Cover wound and strengthen injured site by:
    • epithelialization
    • fibroplasia occurs
    • wound contraction
    • neovascularization
  6. Maturation Phase
    • laying down of collegen to form scar
    • use of induction or tension theory to manipulate scar formation
  7. Induction theory
    scar mimics the characteristics of the tissue it is healing
  8. Tension theory
    • internal and external stresses placed on the injured tissue during the maturation phase determine the final tissue structure
    • The length and mobiltiy of the injured area may be modified by application of stress during appropriate phases of healing
  9. Chronic inflammation
    • acute inflammatory response
    • lasts for months or years
    • results in increased fibroblast proliferation
    • results in increased collagen production which can lead to adhesion formation
  10. Special needs for Musculoskeletal tissues
    Tendon and Ligaments
    Skeletal Muscle
    • Cartilage needs subchondral bone to be involved for production of chondrocytes
    • Tendon and ligaments need tension
    • Skeletal muscle cannot proliferat (but stem cells can)
    • Bone heals well on its own
  11. Goals for Rx of Pain
    • Resolve the underlying pathology
    • Modify patient prospective
    • Maximize function imposed by the source of pain
    • Modification of pain to facilitate participation in therapy
  12. Acute vs Chronic pain
    • < 6 months acute >6 months chronic
    • present only with stimulus vs present in absense of stimulus
    • protective function vs no function
  13. Referred pain
    • pain experience in a site distal from its origin
    • from a nerve to it area of innervation
    • from the same dermatome
    • from the same embryonic segment
  14. Pain Specificity theory
    pain depends on specific nerves firing to get the response

    fails to account for spinal cord and CNS modification of pain
  15. Pain Pattern Theory
    • Pain sensation results in frequency and intensity of any nerve firing
    • These sensations are then summed in the CNS to detect pain

    Fails to account for specific pain receptors found in the body
  16. A delta fiber
    • Sharp pain
    • small myelinated fibers
  17. C fibers
    • dull, long-lasting pain
    • unmeylinated
  18. Tissue quality of pain
    • Cutaneous- sharp, pricking, or tingling (easy to localize)
    • Musculoskeletal- dull, heavy, aching (more difficult to localize)
    • Visceral- like musculoskeletal (refers superficially rather than deep)
  19. Gate control theory
    • modulate pain by stimulating non-nociceptive pathways
    • inhibition of T-cells

    fails to take in to account modulation from higher centers
  20. Endogenous opiate system
    • pain is modulated in peripheral, spinal cord, and cortical levels by this system
    • thought to inhibit the release of substance P
  21. Effects of cryotherapy
    • hemodyanmic effects
    • neuormuscular effects
    • increased pain threshold
    • altered muscle strength
    • decreased spasticity
    • metabolic effects
  22. Use of cryotherapy
    • inflamation control
    • pain control
    • modify spasticity
  23. Cryotherapy contraindications
    • cold hypersensitivity
    • cold intolerance
    • cryoglobulinemia
    • paroxysmal cold hemoglobinuria
    • Raynaud's disease and phenomenon
    • over a regenerating peripheral nerve
    • over an area with circulatory compromise
  24. cryotherapy precautions
    • over superficial main branch of a nerve
    • over an open wound
    • when treating patients with hypertension
    • when treating patients with poor sensation or mentation
    • when treating very old or very young patients
  25. Thermotherapy effects
    • hemodynamic effects
    • neuromuscular effects
    • metabolic effects
    • altered tissue extensibility
  26. Uses for superficial heat
    • Pain control
    • increase ROM and decrease stiffness
    • accelerate healing
    • IR for psoriasis (not common any more)
  27. Thermotherapy contraindications
    • acute injury or inflammation
    • recent or potential hemorrhage
    • thrombophlebitis
    • imparied sensation or mentation
    • malignancy
    • infared irradiation of the eyes
  28. Thermotherapy precautions
    • Pregnancy
    • imparied circulation or poor thermal regulation
    • edema
    • cardiac insufficency
    • metal in the area
    • over an open wound
    • over areas where topical counterirritants have recently been applied
  29. Transducer
    Sound head - crystal that converts electrical energy to sound
  30. power
    amount of acoustic energy per unit time (W)
  31. intenstity
    power per unit area of the sound head (W/cm2)
  32. spatial average intensity
    average intensity of US output over the area of the transducer
  33. spatial peak intensity
    peak intensity of US output over the area of the transducer
  34. beam nonuniformity ratio (BNR)
    ratio of the spatial peak intenisty to the spatial average intensity
  35. duty cycle
    proportion of the total treatment time the the US is on (% or ratio)
  36. spatial average temproal peak intensity (SATP)
    spatial average intensity of the US during the on time of the pulse
  37. spatial average temporal average intensity (SATA)
    SATP x duty cycle
  38. effective radiating area (ERA)
    area of the transducer from which the US energy radiates
  39. near field/far field
    • near Fresnel zone
    • far Fraunhofer zone
    • human treatment lies in the near zone 2-5 cm
  40. cavitation
    • formation, growth and pulsation of gas or vapor filled bubbles caused by US
    • stable cavitation has been proposed as a mechanism for the nonthermal effects of US
  41. microstreaming
    microscale eddying around gas bubbles that oscillate due to cavitation
  42. acoustic streaming
    steady, circular flow of cellular fluids induced by US
  43. phonophoresis
    application of US with a topical drug to facilitate transdermal drug delivery
  44. Effects of US
    • thermal effects
    • tissues affected
    • nonthermal effects
  45. Clinical application of US
    • soft tissue stretching
    • pain control
    • tendon injuries
    • resorption of calcium deposits
    • bone fractures
    • phonophoresis
    • plantar warts and herpes zoster
  46. US Contraindications
    • malignant tumor
    • pregnancy
    • central nervous system tissue
    • over joint cement or plastic
    • over a pacemaker
    • thrombophlebitis
    • over the eyes
    • reproductive organs
  47. US precautions
    • acute inflammation
    • epiphyseal plates
    • fractures
    • breast implants
  48. Contraindications for stretching, dynamic splinting, or CPM
    • dislocation or unhealed fracture
    • presence of myositis ossificans
  49. Precautions for stretching, dynamic splinting, or CPM
    • Infection in or around the joint
    • Pain medications
    • Osteoporosis
    • Hypermobile joints
    • Hematoma region
  50. Uses for spinal traction
    • disc bulge or herniation
    • nerve root impingement
    • joint hypomobility
    • subacute joint inflammation
    • paraspinal muscle spasm
  51. Contraindications for Spinal traction
    • apply in a less aggressive manner when first applied
    • if condition worsens or does not improve within 2-3 Rx
    • where motion is contraindicated
    • acute injury or inflammation
    • hypermobility or instability
    • peripheralization of symptoms with Tx
    • uncontrolled HTN (with inversion)
  52. Precautions to spinal traction
    • structural disease or condition affecting the bones of the spine
    • when pressure of the belts may be hazardous
    • displacement of a fragment of annulus
    • medial disc protrusion
    • for whom severe pain resolves fully with Tx
    • Patients experiencing claustrophobia or other psychological aversion
    • cannot tolerate prone or supine positions
    • disoriented patients
    • patients with TMJ problems
    • patients who wear dentures
  53. Traction: Force, Duration, Frequency
    • Force: intermittent 3:1 ivd 1:1 joint, start 25-50 lbs increase to 60% body weight
    • Duration: 5 min for severe Sx and 10 for moderate
    • Frequency: no set limit
  54. Effects of external compression
    limits the shape and size of tissues
  55. Clinical indications for external compression
  56. Contraindications for external compression
    • hear faliure or pulmonary edema
    • recent or acute DVT or the like
    • when lymphatic or venous return is obstructed
    • severe peripheral arterial disease or ulcers due to arterial insufficiency
    • acute local skin infection
    • significant hypoproteinemia
    • acute trauma or fracture
  57. Precautions for external compression
    • impaired sensation or mentation
    • uncontrolled HTN
    • cancer
    • stroke or significant cerebrobascular insufficiency
    • area of superficial peripheral nerve
  58. Effects of Hydrotherapy
    • cleansing
    • musculoskeletal
    • cardiovascular
    • respiratory
    • renal
    • psychological
  59. Contraindications for hydrotherapy (full body immersion)
    • cardiac instability
    • infectious conditions that may be spread by water
    • bowel incontinence
    • severe epilepsy
    • suicidal patients
  60. Contraindications for hydrotherapy (local immersion)
  61. Precautions for hydrotherapy (full immersion)
    • confusion or disorientation
    • after ingestion of alcohol
    • limited strength, endurance, balance, or ROM
    • medications
    • urinary incontinence
    • fear of water
    • respiratory problems
    • pregnancy (hot)
    • MS (hot)
    • poor thermal regulation (hot)
  62. Precautions for hydortherapy (local immersion)
    • impaired thermal sensation
    • infection
    • confusion or impaired cognition
    • recent skin grafts
    • maceration (non immersion)
  63. Clinical use for UVR
    psoriasis (UVB alone or UVA with psoralen sensitization)

    wound healing (UVC most common band chosen)
  64. Contraindications for UVR
    • to the eyes
    • skin cancer
    • pulmonary TB
    • cardiac patients
    • kidney
    • liver disease
    • lupus
    • fever
  65. Precautions for UVR
    • patient is using photosensitizing medication
    • photosensitivity
    • recent x-ray radiation therapy
    • until the effects of the final dose have disappeared
  66. Dose-response assessment for UVR
    • same lamp for treating as testing
    • four spots exposed for progressive ammounts of time
    • suberythemal (SED) - no change in skin after 24 hrs
    • minimal erythemal (MED) - red within 8 hrs and dissapears within 24hrs
    • 1st degree eyrthema (E1) - red within 6hrs lasts 1-3 days
    • 2nd degree eyrthema (E2) - red and peeling within 2 hrs
    • 3rd degree eyrthema (E3) - severe blistering, peeling and exudation
  67. LASER
    light amplified by stimulated emssion of radiation
  68. Effects of LASER
    • cellular effects
    • nerve conduction and regeneration
    • vasodilation
  69. Use of cold LASER
    • wound and fracture healing (weakly supported)
    • musculoskeletal disorders (better than placebo)
    • pain management (no strong evidence)
  70. Contraindications for LASER
    • directly to the eyes
    • within 4-6 months after radiotherapy
    • over hemorrhaging areas
    • locally to the endocrine glands
  71. Precautions for LASER
  72. Shortwave diathermy (SWD)
    • 27.12 MHz
    • most common
  73. Microwave Diathermy
    2450 MHz
  74. Benefits over other thermotherapy
    • heat deeper
    • heat larger area than US
    • SWD not reflected by bones
    • Doesn't need direct clinician contact for Rx period
  75. Three types of diathermy
    • inductive coil
    • capacitive plates
    • magnetron
  76. Effects of diathermy
    • Thermal effects are the same as other heat applying modalities
    • increased microvascular perfusion
    • altered cell membrane function and cellular activity
  77. Use of diathermy (thermal effects)
    same indicators for use of thermal agents
  78. Use of diathermy (non-thermal PSWD)
    • control pain and edema
    • wound healing
    • nerve healing
    • bone healing
  79. contraindications for any use of diathermy
    patient with implanted or transcutaneous neural stimulatros
  80. contraindications for thermal diathermy
    • metal implants or pacemakers
    • areas of malignancy
    • pregnancy
    • eyes
    • testes and ovaries
    • growing epiphyses
  81. Precautions for all types of diathermy
    • electronic or magnetic equipment should not be used near the machine
    • obesity (heat fat excessively)
    • copper-bearing interuterine contraceptive devices