Modalities LectureLab I

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Modalities Lecture/Lab I

• General Considerations/Terminology
• The Healing Process
• Electromagnetic Spectrum
• Infrared modalities

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Introduction

• What are modalities?
• What are they used for?

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What you need to know about each modality

• Physiologic effect
• Physics of the unit
• Indications
• Precautions
• Contraindications
• Practical application

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Healing Process

• Three Phases
• 1. Inflammatory
• 2. Fibroplastic/Proliferative
• 3. Maturation/Remodeling

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Inflammatory Response Phase

• Injury? Destruction of tissue? Cellular injury.
• Cardinal Signs of Cellular injury redness,
  edema, tenderness (pain), increased temperature.
• There is a delivery of leukocytes and other
  phagocytes and exudate are present at the injured
  tissue.
• Vascular Reaction involves vascular spasm,
  formation of a platelet plug, coagulation
  growth of fibrous tissue

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Clot formation

• To form a clot fibrinogen must be converted to
  fibrin
• Clot formation begins around 12 hours following
  injury and is completed by 48 hours
• Summaryduring the inflammatory stage the injured
  area is walled off, lasts 2-4 days.

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Fibroplastic repair phase

• Scar formation is referred to as fibroplasia.
  Begins within the first few hours following
  injury and may last 4-6 weeks.
• Breakdown of the fibrin clot allows the
  development of granulation tissue.
• Development of a new scar

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Maturation-Remodeling Phase

• Can last over 1 year.
• Collagen remodels or realigns in accordance with
  the tensile forces placed on it

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FACTORS THAT IMPEDE HEALING
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Using Modalities Injury Management

• Active Inflammation R_I_C_E
• Classify injury by evaluating existing SS
• Injuries are considered chronic when Cardinal
  signs of it is are no longer apparent

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Acute Injury Phase

• PT Goal limit/decrease edema decrease pain.
• If there is less edema usually less time is
  required in rehab.
• Modality of choice is ICE
• Physiologic effects of Ice superficial
  vasoconstriction, analgesia

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Acute Injury Phase

• Compression limits swelling.
• Examples Compressive dressings, ICP, Cryocuff.
• Compression works best with elevation.

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Inflammatory Response Phase

• Up to day 6
• Clinically should see a decrease in edema and
  pain is still present.
• Modalities are used to Control pain and
  decrease edema.
• Cryotherapy is still appropriate

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Fibroplastic Repair Phase

• May start heat.
• Physiologic effects Increase circulation,
  vasodilatation
• PT Goals Decrease pain, Promote healing

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Maturation/Remodeling Phase

• Can last years.
• Goal Return pt to previous levels of function
• All modalities can be used safely.

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Progressive Controlled Mobility During Maturation
Phase

• Wolffs law bone and soft tissue respond to
  physical demands placed on them, causing them to
  remodel or realign along lines of tensile force.

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Electromagnetic Spectrum

• This is the range of frequencies and wavelengths
  associated with radiant energy.
• Each wavelength is color specific, the colors of
  the rainbow.R_O_Y_B_G_I_V
• Modalities that use electromagnetic radiation are
  E Stim, UV, Low power laser, shortwave/microdiathe
  rmy, infrared .

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Radiant Energy

• Radiation is the process by which energy in
  various forms travels through space.
• Radiant energy in the form of sunlight travels
  through space at 300 million meters/ sec and
  eventually reaches earth where its effects can
  be seen.

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Electromagnetic Spectrum

• IR VISIBLE UV
• 150,000? 7700? 4000?1800A
• 7700A 3900A XRAY,
  GAMMA RAY
• DIATHERMY NEAR?FAR
• FARlt--NEAR

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Elecromagnetic spectrum

• Forms of radiant energy are refracted or change
  direction as a result of differences in
  wavelength and frequency of each color, forming
  the spectral bands of color.
• Visible (luminous)light is what we can see.
• Infrared thermal effects
• Ultraviolet chemical effects

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Characteristics of emr

• 1. May be produced when sufficient electrical or
  chemical force is applied to any material.
• 2. Travel readily through space at equal
  velocities
• 3. Direction of travel is always in a straight
  line.
• 4. May be reflected, refracted, absorbed or
  transmitted depending on the medium they strike

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Some definitions

• Wavelength the distance between the peak of 1
  wave and the peak of either the preceding or
  succeeding wave.
• Frequency the of wave oscillations or
  vibrations occurring in 1 second and is expressed
  in units Hz.
• (v) velocity wavelength X frequency. Velocity
  is a constant of 3x10 8 m/s

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Laws governing the effects of electromagnetic
radiations

• EMR
• Generally the longer the wavelength the greater
  the penetration regardless of the frequency
• Arndt Schultz principle
• Law of Grottheus- Draper
• Law of Cosine
• Inverse Square law I1
• D2

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Examples of infrared modalities

• Cold packs, hot packs, WP, paraffin, IR lamps,
  baths, contrast baths
• Action produce local and occasionally
  generalized heating/cooling of the superficial
  tissues.
• Analgesia results from stimulation of the
  cutaneous n endings.
• Outcomes are based on attainment of goals
  regardless of the modality wavelength.

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Infrared modalities

• -found between the visible light and microwave
  diathermy portions of the ems.
• Purpose of these modalities is to decrease pain .
• Considered superficial heat

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Infrared transmission

• Conduction direct contact HP
• Convection movement of particles across the
  body. WP
• Radiation transfer of heat without warming the
  intervening surface.IR lamp
• Conversion change of mechanical energy to
  thermal. US

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Tissue heating physiologic effects

• Used in subacute conditions to decrease pain and
  inflammation through analgesic effects.
• Later in pts. Recovery deeper heat is desirable.
• Heat causes vasodilatation of the capillaries to
  increase circulation