Chapter 1. Therapeutic Modalities: What They Are and Why They Are Used

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• Chapter 1. Therapeutic Modalities What They Are
  and Why They Are Used

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Working Hard Is Important
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Working Smart Is More Important
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What Are Therapeutic Modalities?
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No text or dictionary has yet to define them.
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Tabers Cyclopedic Dictionary (1997191934)
Therapeutic

• Pertains to results obtained from treatment
• Having medical or healing properties
• A healing agent

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Tabers Cyclopedic Dictionary (1997191222)
Modality

• A method of application or the employment of any
  therapeutic agent
• Limited usually to physical agents and devices
• Any specific sensory stimulus such as taste,
  touch, vision, pressure, or hearing

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Put It All Together

• Therapeutic modality
• A device or technique that delivers a physical
  agent to the body for therapeutic purposes

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Physical Agents

• Heat
• Cold
• Light
• Electricity
• Exercise

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What Therapeutic Purpose?
To promote

• Wound healing
• Pain relief
• Flexibility and range of motion
• Muscular strength
• Muscular endurance

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What Therapeutic Purpose? (cont.)
To promote (cont.)

• Muscular speed
• Muscular coordination or skill
• Power
• Agility
• Cardiorespiratory endurance

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Classification of Therapeutic Modalities

• Therapeutic modalities have been classified in
  many different ways.
• But each is incompletethat is,
• none includes all modalities.

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Classification of Therapeutic Modalities (cont.)

• Mechanical massage, mobilization, US, whirlpool
• Cryotherapy ice pack, immersion, ice massage
• Thermotherapy moist heat, dry heat, diathermy,
  US
• Hydrotherapy whirlpool, contrast bath, aquatic
  pool
• Electrotherapy muscle stimulation, TENS,
  diathermy
• Active exercise

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Selecting Which Therapeutic Modality to Use

• Do you select?
• Or does a physician select?

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An ISU Physicians Prescription

• Physical therapy for _____ because of pain and
  swelling of the left ankle and foot.

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Brockport Team Physician

• Often prescribed diathermy,
• but we didnt have a diathermy machine

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• Sometimes PTs work with physiatrists, who are
  specialists in physical medicine and
  rehabilitation.
• They will usually get good prescriptions, but
  most PTs and ATs usually dont get good
  prescriptions.

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• Need to educate the physicianabout what the AT
  is using

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To Select Modality(ies) Intelligently

• You must
• Have a correct diagnosis
• Have a definite conception of the pathological
  and physiological changes associated with the
  injury

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To Select Modality(ies) Intelligently (cont.)

• Know what you want to accomplish with the
  modalitythat is, have a therapeutic goal
• Understand the modalities effects, indications,
  and contraindications
• Match your therapeutic goal with a modality that
  will help you achieve that goal

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Knobology
The study of application without theory
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Art vs Science Theory vs Application
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Rehabilitation and Therapeutic Modalities

• To fully understand the role of therapeutic
  modalities you must
• Understand the overall rehabilitation process
• Understand how each therapeutic modality fits
  into that process

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• See theBIGPicture

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What Modality Is Used When?
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• With a systems approach, you must have a basis
  for choosing which therapeutic modality to use
  during various phases of rehabilitation.
• Must match the proper therapeutic modality with
  the therapeutic goal.

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Efficacy of Modalities

• Rate modalities for effect during rehabilitation.
• Direct effect (good choice)
• Effective if used in a specific way
• Somewhat effective not the best choice there
  are better modalities for developing this element
  of rehabilitation

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(No Transcript)
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Modality Efficacy Summary

• Traditional modalities (heat, light, sound,
  electricity) are used during only the first three
  phases.
• Exercise is needed for most phases of
  rehabilitation.

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Note

• Therapeutic exercise is not covered in this
  class, except for cryokinetics and cryostretch.

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What Rehabilitation Is Not

• Treat then rehabilitate
• Working with weights
• A cookbook approach

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Treat Then Rehabilitate

• Treat with various therapeutic modalities (e.g.,
  whirlpool, ultrasound) and then rehabilitate
• Rehabilitation the entire process of returning
  an injured athlete to competition

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Working with Weights

• Concept too narrow
• Rehabilitation the entire process of returning
  an injured athlete to competition
• Much more than strength training

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A Cookbook Approach

• Stages or phases established with specific time
  periods and exercises
• Optimal rehabilitation not planned by the
  calendar or by specific exercises

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Re habilita tion

• Re again, anew, restore
• habilitate to make suitable
• habit characteristic condition of mind or
  body
• tion the act of

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Rehabilitation

• To restore to a normal or optimal state of health
• For an athlete, to a high level of conditioning
• Process of returning an athlete to a high level
  of conditioning

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Rehabilitation (cont.)

• More than progressing through various phases of
  conditioning
• For optimal results, rehabilitation must be
  planned and the plan executed systematically.

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Rehabilitation (cont.)

• For optimal results, you must consider
• Timing
• Goals
• Rate of progression
• Criteria for progression
• Psychological factors

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Systems Approach to Total Rehabilitation

• Each patient and each injury is unique.
• Based on signs, symptoms, and needs
• Identify each phase of rehabilitation.
• Establish criteria for developing each phase.
• Carefully analyze the limitations imposed by the
  injury.
• Determine which phase of rehabilitation to begin
  with.

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Ten Elements of Rehabilitation

• 1. Structural integrity
• 2. Pain-free joints and muscles
• 3. Joint flexibility
• 4. Muscular strength
• 5. Muscular endurance

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Ten Elements of Rehabilitation (cont.)

• 6. Muscular speed
• 7. Muscular power (strength and speed)
• 8. Skill patterns (integrated and coordinated
  movement 9. Agility (speed and skill)
• 10. Cardiovascular endurance

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Rehabilitation Principles

• The SAID principle
• Therapeutic goals
• Constant evaluation
• Functional progression
• Early exercise essential
• Rate of reconditioning
• Begin early, end late

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The SAID Principle

• Specific adaptation to imposed demands
• dominates rehabilitation.
• The body responds to a given demand witha
  specific and predictable adaptation.
• Specific adaptation requires that specific
  demands be imposed.

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The SAID Principle (cont.)

• Each physical attribute must be identified and
  specifically trained for.
• Optimize by using a goal-oriented approach.