Modalities. A review of commonly used modalities

Size: px

Start display at page:

Download "Modalities. A review of commonly used modalities"

Clare Bradford
6 years ago
Views:

1 Modalities A review of commonly used modalities

Determine patient response Always monitor the

effects caused by the modality Determine both

2 Determine patient response Always monitor the patient s response to modalities Interview the patient and obtain verbal and non-verbal responses Identify complications or secondary effects caused by the modality Determine both positive and negative outcomes from the modality

3 Modalities Included Superficial Thermotherapy Hot packs Paraffin bath LASER Deep Thermotherapy Ultrasound (US) Phonophoresis Cryotherapy Cold packs Ice massage Electrotherapy Interferential Current (IFC) Functional Electrical Stimulation (FES) TENS Conventional Acupuncture-like Brief intense Burst mode Modulation mode Iontophoresis Intermittent Mechanical Compression Mechanical Spinal Traction

4 Superficial Thermotherapy Indications Joint hypomobility, musculoskeletal pain/spasm, preparation for exercise or electrical stimulation, subacute or chronic traumatic and inflammatory conditions Precautions Cardiac insufficiency, edema, impaired circulation, impaired thermal regulation, metal implants at treatment site, open wounds Contraindications DVT, impaired cognitive function, decreased circulation or sensation, malignant tumors, acute and early subacute traumatic and inflammatory conditions, tendency toward hemorrhage or edema, very young or very old patients

5 Superficial Thermotherapy: Hot Packs Hot packs Packs are placed between towels or covers to protect skin 8 layers of toweling should be used If heat is transferred too quickly, skin mottling or permanent burn damage may occur Patient s skin should be checked periodically during treatment Treatment time: minutes

6 Superficial Thermotherapy: Paraffin Paraffin Therapeutic application of liquid paraffin to a body part for the purpose of heat transmission Often used for small or irregularly shaped body parts such as the hand or foot Contraindications: open wounds, recent scars or sutures, skin infections, allergic rash Treatment time: minutes

7 Superficial Thermotherapy: LASER Light Amplification by Stimulated Emission of Radiation (LASER) The frequency of the laser light and the type of tissue determines the depth of light penetration Low intensity cold lasers are utilized in rehabilitation settings and may be biostimulative and facilitate healing Acute conditions: lower energy density ranges of 0.05 and 1 J/cm 2 are recommended Chronic conditions: higher dosages of up to 40 J/cm 2 are recommended

8 Deep Thermotherapy Indications Pain modulation, increase soft tissue extensibility, reduce or eliminate soft tissue inflammation or restriction, accelerate tissue healing Precautions Metal implants, osteoporosis, primary repair of tendons or ligaments or scar tissue, open epiphyses and healing fractures, acute inflammation Contraindications Impaired circulation or sensation, impaired cognitive function, thrombophlebitis, joint cement, plastic components, vital areas (brain, ear, eye, heart, cervical ganglia, carotid sinuses, reproductive organs, spinal cord, cardiac pacemaker, pregnant uterus), use of radium or radioactive isotopes

9 Deep Thermotherapy: US Ultrasound (US) Select appropriate sound head size with an effective radiating area (ERA) of approximately half the size of the treatment area Example: 1cm 2 = wrist; 5cm 2 = shoulder or leg Select the optimal parameters for either a thermal effect of non-thermal effect Must use a medium (such as US gel) to treatment area and move the sound head at approximately 4 cm/second

10 Deep Thermotherapy: US Thermal effect Intensity: W/cm 2 Frequency: 1 MHz for tissue up to 5 cm deep 3 MHz for tissue 1 to 2 cm deep Duty cycle: continuous, 100% Non-thermal effect Intensity: W/cm 2 Frequency: 1 MHz for tissue up to 5 cm deep 3 MHz for tissue 1 to 2 cm deep Duty cycle: pulsed, 20-50% Treatment time: 5 to 10 minutes for each treatment area that is twice the ERA of the transducer Example: an area of 20 cm 2 treated with a sound head with an ERA of 10 cm 2 should take 5-10 minutes

11 Phonophoresis Indications Pain modulation, decrease inflammation in subacute and chronic musculoskeletal conditions Precautions and contraindications See US section

12 Phonophoresis Used to drive medication through the skin into the treatment area Common medications include Hydrocortisone, Dexamethasone, salicylates, Lidocaine, or other ointments Intensity: 1-3 W/cm 2 Treatment time: 5-10 minutes

13 Cryotherapy Indications Pain modulation, reduce or eliminate soft tissue inflammation or edema, reduce muscle spasm or spasticity, acute and chronic traumatic and inflammatory conditions, thermal burns Precautions Hypertension, impaired temperature sensation, open wounds, application over a superficial nerve, very old or very young patients Contraindications Cold hypersensitivity or intolerance, impaired temperature sensation, cryoglobulinemia, peripheral vascular disease, Raynoud s disease

14 Cryotherapy: Cold Packs Cold packs Keep the patient warm throughout treatment Dampen a towel with warm water and place cold pack on towel Place pack on patient and cover with dry towel to reduce warming Treatment time: minutes

15 Cryotherapy: Ice Massage Ice massage Use an ice cylinder formed by freezing water in a paper cup Patient will experience cold, burning, aching, and then numbness during treatment Avoid bony areas and superficial nerves Treatment time: 5-10 minutes or until analgesia occurs

16 Electrotherapy Indications Pain modulation, muscle spasm or re-education or weakness, impaired range of motion, soft tissue repair or wound healing, edema, spasticity, denervated muscle Precautions Areas of impaired sensation, severe edema Contraindications Healing fractures, areas of active bleeding, malignancies or phlebitis in the treatment area, superficial metal implants, pharyngeal or laryngeal muscles, demand-type pacemaker, myocardial disease

17 Electrotherapy: Interferential Current (IFC) Two sinusoidal waves are crossed to generate an amplitude modulated beat frequency Used for pain modulation or muscle strengthening Bipolar (premodulated IFC) Active and dispersive electrodes used over a small area Quadripolar (IFC) Two sets of electrodes placed diagonally to one another over a large area

18 Electrotherapy: Functional Electrical Stimulation (FES) Also known as neuromuscular electrical stimulation (NMES) Used for disuse atrophy, limited ROM, muscle re-education or spasm or spasticity Also used in combination with or instead of an orthotic device Alternating current is used to stimulate innervated muscle for general stimulation Direct current is used for denervated muscle

19 Electrotherapy: Functional Electrical Stimulation (FES) Duty cycle Current on:off time in seconds Ratio should increased as weakness or atrophy increases 1:1 to 1:2 ratio for minimal or no atrophy 1:3 to 1:4 ratio for moderate atrophy 1:5 to 1:10 ratio for severe atrophy

20 Electrotherapy: Transcutaneous Electrical Stimulation (TENS) Provides afferent stimulation for pain modulation Current Symmetrical or asymmetrical biphasic (AC) Monophasic (DC) Electrode placement Site of pain, dermatome, trigger point, proximal or distal to the pain site, segmental related myotome

21 Electrotherapy: Transcutaneous Electrical Stimulation (TENS) Conventional (high rate) TENS Indicated for temporary relief of acute or chronic pain Amplitude: comfortable tingling sensation, paresthesia without muscle activation Pulse rate: pps Pulse duration: µsec Treatment duration: minutes Pain relief duration: temporary

22 Electrotherapy: Transcutaneous Electrical Stimulation (TENS) Acupuncture-like (strong, low-rate) TENS Indicated for chronic pain Amplitude: strong, comfortable, rhythmic muscle twitches Pulse rate: 1-5 pps Pulse duration: µsec Treatment duration: minutes Pain relief duration: long lasting, possibly >1 hour

23 Electrotherapy: Transcutaneous Electrical Stimulation (TENS) Brief intense TENS Indicated to provide rapid onset, short-term pain relief during painful procedures Amplitude: patient tolerance Pulse rate: pps Pulse duration: µsec Treatment duration: 15 minutes Pain relief duration: temporary (30-60 minutes)

24 Electrotherapy: Transcutaneous Electrical Stimulation (TENS) Burst mode TENS Indicated for stimulation of endogenous opiates, analgesia Amplitude: comfortable, intermittent paresthesia Pulse rate: pps delivered in bursts of 1-4 pps Pulse duration: µsec Treatment duration: minutes Pain relief duration: long lasting (hours)

25 Electrotherapy: Transcutaneous Electrical Stimulation (TENS) Modulation mode TENS Used to prevent neural or perceptual adaptation Frequencies, pulse widths, intensities can be altered by ten or more percent, one or two times per second

26 Electrotherapy: Iontophoresis Continuous direct current is used to drive chemical ions through the skin Therapeutic ion must be placed under an electrode of similar charge Cathode (negative pole) used for salicylate, acetate, dexamethasone, iodine Anode (positive pole) used for hydrocortisone, Lidocaine, magnesium, calcium, lithium, zinc, copper Contraindications Impaired skin sensation, allergy or sensitivity to therapeutic agent or direct current, metal in or near treatment site, recent scars, cuts, bruises or broken skin

27 Electrotherapy: Iontophoresis Clean and inspect the skin before treatment Dose: product of time and current intensity Anode: 1.0 ma/cm 2 Cathode: 0.5 ma/cm 2 Duration: minutes Intensity: turn up slowly to selected level Observe treatment area every 3-5 minutes and after treatment

28 Intermittent Mechanical Compression Indications Chronic edema, postmastectomy lymphedema, stasis ulcer, traumatic edema, venous insufficiency, amputation Precautions Uncontrolled hypertension, impaired sensation, malignancy, obstructed lymph or venous return Contraindications Acute infection, acute inflammation in treatment area, acute DVT, acute pulmonary edema, arterial insufficiency, cancer, diminished sensation, edema with cardiac or renal impairment, cardiac or renal insufficiency, impaired cognition, infection in treatment area, obstructed lymph channels, very young and frail elderly patients

29 Intermittent Mechanical Compression Assess patient s blood pressure in order to determine device settings Elevate the limb Inflation:deflation ratio is approximately 3:1 Edema reduction at seconds:15-30 seconds 4:1 is often used to shape a residual limb Treatment duration: varies depending on patient tolerance Lymphedema: 2 hours to two 3 hour sessions Traumatic edema: 2 hours Venous ulcers: 2.5 hours 3x/week to 2 hour periods Residual limb reduction: 1 hour to 3 hour sessions, totaling 4 hours

30 Mechanical Spinal Traction Indications Joint disease or hypomobility, meniscoid blocking muscle spasm, degenerative disc, discogenic pain, herniated nucleus pulposis, nerve root impingement, subacute or chronic joint pain Precautions Acute inflammation aggravated by traction, claustrophobia, acute strains or sprains, hiatus hernia, joint instability, osteoporosis, pregnancy, TMD with halter use Contraindications Rheumatoid arthritis, impaired cognitive function, spinal tumors, spinal infections, spondylolisthesis, vascular compromise, vertebral artery syndrome, very young or very old patients

31 References Cameron MH, Physical Agents in Rehabilitation: From Research to Practice. St. Louis, MO; Elsevier; O Sullivan SB, Siegelman RP, IER s National Physical Therapy Examination Review & Study Guide. Evanston, IL; International Educational Resources, Ltd.; Siegelman R, Bianco T, Dirkes A, Chavez E, IER/TherapyEd Exam Preparation: Physical Therapy Course Manual version 4.0. Evanston, IL; International Educational Reources, Ltd.; American Physical Therapy Association. Minimum required skills of physical therapist assistant graduates at entry-level BOD G Available at: olicies/bod/education/minreqskillsptagrad.pdf#search =%22pta%20minimum%20skills%22. Accessed December 20, 2012.

Chapter 23 Unit 28. Therapeutic Modalities

Chapter 23 Unit 28. Therapeutic Modalities Chapter 23 Unit 28 Therapeutic Modalities Chapter Objectives Discuss the purpose of therapeutic modalities Explain the legal implications associated with the use of therapeutic modalities List the different