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					Modalities

How to use a modality during treatment:
Introduce yourself
Overview of modality
What are the effects of the modality?
Goal
What should the patient feel?
What should the patient do if they do not have the expected feelings
Contraindications
Subjective and objective measurements
Proper positioning and draping
Bell/timer
Initial and final inspection of the treatment area

Conversions
Celsius to Fahrenheit conversion 9/5 C + 32 = degrees in F
Fahrenheit to Celsius conversion 5/9 (F-32) =C
1 lb= 45 kg
1 in = 2.5 cm
1 kg = 2.2 lbs
1 cm = .4 in

Cryotherapy
Types/Treatment temperatures
Cold/ice packs Ice massage
Ice soaked towels
Vapocoolant
Cold baths
Cryocuff Controlled compression unit

Indications
Reduce acute inflammation
Reduce/control pain
Reduce spasticity
Reduce muscle spasm

Contraindications
Cold hypersensitivity
Cold intolerance
Over a regenerating nerve
Cryoglobulinemia
Raynaud’s syndrome
Impaired circulation/ peripheral arterial disease
Proxysmal cold hemoglobinuria
Physiological effects
Vasoconstriction
Decrease nerve conduction
Increase pain threshold
Alter muscle strength
Reduce spasticity
Decrease metabolic reactions

Therapeutic Heat
Types/Treatment temperatures
Superficial: hot pack
Paraffin
Fluidotherapy
Infrared lamp
Warm whirlpool

Deep: Ultrasound
Diatheramy

Indications
Pain control
Reduce muscle spasm/ guarding
Increase soft tissue extensibility
Facilitate healing
Subacute and chronic inflammation

Contraindications
Acute inflammation
Acute hemorrhage
Impaired sensation
Impaired mentation
DVT/thrombophlebitis
Severe peripherial vascular disease
Existing fever Malignancy/ cancer
Radiation therapy
Infrared lamp over eyes

Physiological Effects
Increase collagen extensibility
Vasodilatation
Increase rate of local metabolism
Reduce muscle spasm
Temporarily reduce strength
Reduce pain

Intermittent Compression Pump (ICP)
Indications
Edema
Venous insufficiency
Lymphodemia

Contraindications
Heart failure or pulmonary edema
DVT/ thrombophelbitis
Obstructed lymphatic or venous return
Severe PAD Acute infection
Acute fracture or trauma
Pain during compression
Cellulitis Malignancy

Physiological Effects
Improve venous and lymphatic circulation
Limits shape and size of tissue
Increase tissue temperature

Massage
Indications
Chronic edema
Muscle soreness, aching, tension
Tension headaches
Amputees residual limb desensitization and shaping
Scar tissue Chronic muscle strains
Acute muscle spasm
Tendonitis

Contraindications
Acute inflammationFever
Acute bleeding/ bruising
Hemophilia
Skin disease or condition
Cancer or TB Severe sensitivity to touch or pain
Presence of foreign bodies
DVT/thrombophelbitis/ blood clot
Edema with unknown cause

Types of Strokes
Effleurage-use to start and finish
Petrissage- kneading, picking up, wringing, and skin rolling
Deep friction- targets tendons, ligaments, and muscles

Physiological Effects
Increase blood flow and lymph flow
Increase flow of nutrients
Removal of waste products and metabolites
Stimulation of the healing process
Resolution of chronic edema and hematoma
Increase extensibility of connective tissue
Pain relief
Increase joint movement
Facilitation of muscle activity
Stimulation of autonomic functions
Stimulation of visceral functions
Removal of lung secretions
Sexual arousal
Promotional of local and generalized relaxation

Ultrasound
Types
Pulsed (non thermal) 5-10 min
Continuous (thermal) 8-10 min Immersion

Characteristics

Frequency
1 MHz = 2-5 cm deep
3 MHz = 1-2 cm deep

Effective radiating area (ERA) is slightly smaller than the sound head.
Treatment area should be two times the ERA.

Absorption of ultrasound energy-
Poor=blood, fat, and water
Better= muscle, collagen
Best= bone (10x more than soft tissue)

Reflection- 99% of waves are reflected back into the sound head

Refraction- happens when the sound head is not parallel to the tissue

Attenuation- as ultrasound waves pass through media and tissue layers, there is a
definite reduction in amplitude and power outlet

Parameters:
Superficial & chronic continuous 3 MHz, .5-1.0 w/cm squared
Superficial & acute pulsed 3 MHz, .5-1.0 w/cm squared
Deep & chronic continuous 1 MHz, 1.5-2.0 w/cm squared
Deep & acute pulsed 1 MHz .5-1.0 w/cm squared
 Effects
Pulsed: promotes healing (collagen formation and protein synthesis)
Increase membrane permeability
Promotes tissue regeneration
Can reduce pain in an acute lesion
Decrease inflammation

Continuous: aids in the resorption of exudate
Decrease pain by increasing pain threshold
Increase extensibility of connective tissue and contractile tissue by altering the
visco- elasticity of connective tissue
Increased blood flow

Indications
Soft tissue shortening
Pain control
Dermal ulcers
Surgical skin incisions
Tendon injury
Bone fractures
Carpal tunnel syndrome
Plantar warts & herpes zoster

Contraindications
Malignant tumor
Pregnancy
CNS tissue
Methylmethacrylate (cement used for some joint replacements)
Pacemaker
Thrombophlebitis
Eyes
Reproduction organs

Aseptic Technique
Procedures or methods used to create or maintain a sterile field

Guidelines
All items within the boundary of a sterile field must be sterile
Once the sterile package is opened the edges are not considered sterile
Once donned properly, sterile gowns are considered to be sterile in the front from
should level to tabletop level, including the sleeves.
You must keep hands and arms above table level.
Tables are only considered to be sterile ate the table top level
Only sterile items and personnel in sterile attire may enter a sterile area or touch
sterile items without causing contamination.
Unsterile personnel may not reach across into a sterile area.
Everyone is responsible to maintain the sterile field.
Penetration of a sterile covering or barrier is considered to be contamination of a
sterile field.
When there is doubt about the sterile quality of an area, fields, or an item,
consider it unsterile.

Cleanliness
Cleaning- the physical removal of organic material or soil from objects
Disinfecting- performed by using pasteurization or chemical germicides
Sterilizing- destruction of all forms of microbial life by steam under pressure,
liquid, or gaseous chemicals, or dry heat.

Universal Precautions
Hand washing- number one way to prevent the transmission of diseases
Protective equipment- gloves, gowns, masks, protective goggles, scrub suits,
accessories Disposal- any waste that is saturated with any body substances will be
considered infectious waste and disposed of properly.

Wound Care
A wound is an injury in which the skin is torn, pierced, cut, or otherwise broken.

Wound Types
Pressure ulcer- caused by external forces
Arterial insufficiency- results from arteriosclerosis
Venous insufficiency- caused by obstruction or decreased competence of venous
valves
Neurotrophic ulcer-occurs in many patients with Diabetes or Leprossy with a
peripheral neuropathy
Post-surgical wounds
Trauma wounds
Skin disorders due to allergic reactions

Conditions/ Diseases associated with chronic wounds
Poor sensation
Poor circulation
Contamination/ infection
Malnutrition
Trauma Diabetes/ PVD

Wound Terms
Necrotic- dead tissue, progresses from white/gray to tan/yellow to brown/black
Eschar- black/gray/brown dead tissue adhered to wound tissues
Slough- yellow/tan dead tissue, stringy or non loosely adherent to healthy tissue
Granulation- laying down of collagen matrix, pink buds to bright red tissue
Scab- collection of dried blood cells and serum on top of the skin surface
Full thickness- through the skin; may include muscle, nerve, or bone
Partial thickness- includes the epidermis; may include part of the dermis but
does not extend through the dermis

Physical Therapy Intervention
Hydrotherapy
Electrical stimulation
Ultrasound
CPM machine
Early controlled ROM
Positioning to protect healthy tissue
Debridement

Dressings
Gauze- absorbs exudates while allowing topical agent to be in close contact with
wound.

Impregnated dressings- prevents tissue adherence while absorbing exudates.

Films- helps to keep wound bed moist in non-infected shallow wounds with
minimal exudates. Maintains moist wound environment to facilitate debridement
by autolysis and encourage epitheal migration.

Foams- combines benefits of moist wound environment for non-infected wounds
with absorbency for moderate to high amounts of exudates.

Hydrogel- keeps tissues moist as this dressing absorbs exudates. Used with
shallow or deep wounds with minimal to moderate exudates.

Hydrocolloid- protective covering that combines with wound exudates to form a
gel protection of the wound.

Calcium alignates- for wound with moderate to heavey exudates and uneven
(tunneling) ulcers, as they can absorb up to 100 times their weight in wound
fluid.

Methods of application
Dry to dry
Wet to wet
Wet to dry
Occlusive Rigid

Continuous Passive Motion


Benefits
Can maintain or gain ROM
Keeps soft tissue elongated
Increased nutrition to joint
Promotes healing
Decreases edema
Decreases possibility of scar tissue adhesions
Decreases pain
Decreases sense of stiffness
Cost- effective

Indications
Post fracture
Post joint injury
Post joint surgery
After immobilization of any type
Soft tissue contractures

Contraindications
Unstable fractures
If ROM is contraindicated

Taping
Uses
Provides stability
Reduce pain
Re-align structures more optimally
Provide feedback

Types
Athletic tape
Micropore/ transpore
McConnell

Common areas taped
Ankle
Knee
Scapula
Back
Wrist
Fingers

Hydrotherapy
Types
Whirlpool (102 degrees F)
Extremity whirlpool
High boy
Low boy
Hubbard tank (97- 100 degrees F)
Contrast bath warm-(80-104 degrees F/ cold 55-67 degrees F)
Irrigation devices
Exercises pool (79- 97 degrees F)

Benefits
High specific heat- retains heat well
Ability to provide buoyancy (upward thrust on the body in the opposite direction
to the force of gravity)
Ability to provide resistance
Hydrostatic pressure to the body

Indications
Water exercise
Orthopedic problems
Cardiac fitness
Exercise during pregnancy
Exercise- induced asthma
Conditions benefiting from superficial heat
Conditions benefiting from superficial cold
Wounds
Pain
Edema

Contraindications
Local- maceration around the wound
Bleeding

Full body immersion-
cardiac instability
Infectious conditions that may be spread by water
Bowel incontinence
Severe epilepsy
Suicidal patients

Temperatures
Cold- 32-79 degrees F acute inflammation
Tepid- 79-92 degrees F exercise/ subacute inflammation
Neutral warmth- 92-96 degrees F open wounds
Mild warmth- 96-98 degrees F increase mobility in burn pts
Hot- 99-104 degrees F decrease chronic pain, increase relaxation
Very hot- 104-110 degrees F increase soft tissue extensibility (limited body area
only)
NEVER GO ABOVE 110 DEGREES F
Traction
Types
Intermittent
Static
Manual
Mechanical
Over the door cervical traction
90/90
lumbar traction
Self- traction
Positional traction-lumbar spine

Effects
Joint distraction
Reduction of disc protrusion
Soft tissue stretching
Muscle relaxation
Joint mobilization
Immobilization

Indications
Disc bulge or herniation
Nerve root compression
Nerve root impingement
Joint hypomobility
Subacute joint inflammation
Paraspinal muscle spasm

Contraindications
When motion is contraindications
Acute injury or inflammation
Joint hypermobility or instability
Traction peripheralizes symptoms
Uncontrolled hypertension

Patient positions
Supine- cervical or lumbar
Prone- lumbar (posterior disc herniation)
Sitting- cervical or self- lumbar
Sidelying- lumbar (positional)

Equipment Needed
Head halter or Saunders belt
Harness or belts
 Placed directly on skin
 Top of thoracic belt at xiphoid belt
 Top of lumbar belt superior to iliac crests

Spreader bar Split traction table
 Area treated should be over split of table

Parameters
Static for inflammation, when symptoms are aggravated by motion, and muscle
stretch
Intermittent for DJD or facet joint problems
Static or intermittent for long hold time for disc protrusions
For static the first treatment should be 25-50 pounds for lumbar and 8-10
pounds for cervical

To decrease symptoms related to compression problems use up to 50% of body
weight for lumbar and 7% for cervical

To decrease muscle spasms, stretch soft tissue, or promote reduction of disc
herniation use 25% of body weight for lumbar and 12-15 pounds for cervical

For intermittent traction the off cycle force should be about half the amount of
force of the on cycle

The first treatment should last 5-10 min.

Treatments should not last more than 40 min.

Biofeedback
Uses of electronic instruments to accurately measure, process, and feed back
reinforcing information about muscle contraction via auditory or visual signals.
 Indirect way of measuring muscle activity
 Measured in microvolts

Uses
The goal is to help patients develop more voluntary control of muscle function
Neuromuscular relaxation (inhibition)
Muscle re-education (recruitment)

Equipment
Biofeedback machine
Electrodes sized depends on muscle
Conduction medium (usually built into electrode)
Clean the skin with alcohol
Place the electrode over muscle, and parallel to the directions of the fibers
Will have visual or auditory feedback

Sensitivity
Threshold goal for the patient
Gain/sensitivity
High gain= more sensitive for muscle re-education
Low gain= less sensitivity to promote relaxation.

				
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Description: Modalities collagen