Download MBBS Physical Medicine and Rehabilitation Presentations 14 Physical Agent Modalities 1 Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Physical Medicine and Rehabilitation 14 Physical Agent Modalities 1 PPT-Powerpoint Presentations and lecture notes


Physical Agent Modalities

Definition

n Modalities are physical agents that are used to produce

therapeutic responses in tissue.

- Cold

- Heat

- Sound

- Electromagnetic waves

- Electric currents

- Water

n Adjunctive treatments rather than primary cure.
Cold ( Cryotherapy )

Physiological Effects

n Hemodynamic

? Immediate cutaneous vasoconstriction

? Delayed reactive vasodilatation

? Decreased acute inflammation

n Neuromuscular

? Slowing of conduction velocity

? Increased maximal isometric strength

? Decreased muscle fatigue

? Temporarily reduced spasticity
Physiological Effects

n Joint and connective tissue

? Increased joint stiffness
? Decreased tendon extendibility
? Decreased col agenase activity

n Miscellaneous (acute conditions)

? Decreased pain
? General relaxation

General uses of cryotherapy

n Acute musculoskeletal conditions (sprains, strains, tendinitis,

tenosynovitis, bursitis, capsulitis, etc)

n Myofascial pain
n Fol owing certain orthopedic surgeries
n Component of spasticity management
n Emergency treatment of minor burns


General precautions for use of cold

n Cold intolerance
n Cryotherapy induced neurapraxia/ axonotmesis
n Arterial insufficiency
n Impaired sensation
n Cognitive or communication deficits that preclude

reporting of pain.

n Cryopathies
n Cryoglobulinemia
n Paroxysmal cold hemoglobinuria
n Cold hypersensitivity
n Raynaud's disease/ phenmenon

Cryotherapy agents

1. Cold packs

- Hydrocol ator packs: Cooled in freezer to -12? C

and applied over a moist towel.

- Ice packs: Easily used at home and best applied

with elastic bandage or tape.

n

Duration 20 to 30 min.

n

skin is cooled immediately,

n

sc tissue within mins &

n

muscle at depth of 2 cm cooled by 5? C after 20 min.


Cryotherapy agents

2. Ice massage

n

The direct application of ice to skin using gentle

stroking motions

n

Combines therapeutic effects of cooling with

mechanical effects of massage

n

Water is frozen in a paper cup, with ice being exposed

by tearing the top rim of paper off as the ice melts.

n

Used for localized symptoms and applied for 5 to 10

min per site.

Cryotherapy agents

3. Cryotherapy compression units
n Cuff or boot through which cold water is circulated

and can be pneumatically compressed statically or

serially

n distal to proximal pumping action.
n Combine beneficial effects of cryotherapy with

advantages of pneumatic compression.

n Used primarily after acute musculoskeletal injury with

soft tissue swelling, and after some surgical

procedures.

n Typical temperatures of 7.2? C and pressures up to

60 mm Hg are used.
Cryotherapy agents

4. Cold water immersion

n

Best suited for circumferential cooling of the limbs,

localised burns

n

5 - 13? C.

n

Often uncomfortable and poorly tolerated

HEAT
Physiological effects

Hemodynamic
- Increased blood flow

- Increased edema

- Increased bleeding

- Increased acute inflammation

- Decreased chronic inflammation

Neuromuscular

- Increased nerve conduction velocity





Physiological effects

Joint &connective tissue
- Increased tendon extensibility
- Increased col agenase activity
- Decreased joint stiffness
Miscel aneous (chronic conditions)
- Decreased pain
- General relaxation

General uses of heat

1. Musculoskeletal conditions (tendinitis, tenosynovitis,

bursitis, capsulitis, etc)

2. Pain (neck, low back, myofascial, neuromas,

postherpetic neuralgia, etc)

3. Arthritis

4. Contracture

5. Muscle relaxation

6. Chronic inflammation





General precautions for use of heat

n Acute trauma, inflammation
n Impaired circulation
n Bleeding diatheses
n Edema
n Large scars
n Impaired sensation
n Malignancy
n Cognitive or communication deficit that preclude reporting of

pain.


Classification of various types of

heating
SUPERFICIAL HEAT
1. Hot packs and heating pads (conduction)
2. Paraffin wax baths (conduction)
3. Fluidotherapy (convection)
4. Whirlpool bath (convection)
5. Radiant heat (radiation)

DEEP HEAT
6. Ultrasound (conversion)
7. Shortwave diathermy (conversion)
8. Microwave diathermy (conversion)

Superficial heat

n

Superficial heating agents achieve their maximum tissue

temperature in skin and subcutaneous fat.

n

Deeper tissue heating is limited by vasodilatation and insulating

fat.

n

Used in OA, RA, neck pain, LBP, muscle pain syndromes, and

variety of musculoskeletal conditions.




Superficial heat

1. Hot packs
n Commercial y available hot packs (Hydrocol ator packs) contain

silicon dioxide encased in canvas pack.

n They are immersed in tanks at 74.5 C and applied over several

layers of insulating towels.

n Total treatment time is usual y 30 min.
n In addition to general heat precautions, patient should not lie on

the packs.

n They are among the more common causes of burn in physical

modalities



Superficial heat

2. Heating pads

n Two types :

1) electric heating pads (control heat output by regulating current

flow)

2) circulating fluid pads (control heat output thermostatical y)

n Peak temperature of nearly 52? C achieved with electric heating pad

set on lowest setting.

n In case of electric heating pads, potential of electric shock with moist

toweling.

n Patient should not lie on heating pad, as it can lead to burns (Of

particular concern in slender or cachectic patients)


Superficial heat

3. Paraffin wax bath

n

Paraffin wax: Mineral - 6:1 or 7:1.

n

52.2? C to 54.4? C

n

Methods of application are:

1) Dipping: 7 to 12 dips fol owed by wrapping in plastic and

towels or insulated mitts,

2) Immersion: Several dips to form a thin glove of paraffin

fol owed by immersion for 30 min. Produces greatest quantity and

duration of temperature increase.

3) Brushing: brushing on several coats of paraffin, fol owed by

covering with towels.

- More cumbersome.

- Improves treatment compliance in children.

- Useful for areas difficult to immerse.
n

Open wounds and infected areas should be avoided.



Superficial heat

4. Radiant heat
n

Luminous infrared heat lamps emit radiation in the near ?infrared

spectrum (wavelength 770 to 1500 nm) and non-luminous infrared

lamps emit radiation in the far infrared spectrum (wavelength 1500 to

12500 nm)

n

Infrared radiation produces heating by inducing molecular vibration.

n

Preferable in patients who cannot tolerate the weight of hot packs.

n

Caveats for radiant heat use: General heat precautions, light sensitivity,

skin drying and dermal photoaging.


Deep Heat (Diathermy)

n Deep heat or diathermy, unlike superficial heat, affects the target

tissues like muscle, tendon, ligament, bone without significant

heating of skin and subcutaneous tissue.

n Therapeutic target temperature ranges from 40? C to 45? C.

Deep Heat

1. Ultraound

n >20,000 Hz.
n Reverse piezoelectric effect.

n Most commonly clinically used frequencies are in

the range of 0.8 to 1.1 MHz, although up to 3.0 MHz

are used.

n Ultrasonic energy is absorbed by the tissues ( esp. at

interface) and is ultimately converted into heat via

molecular vibrations, a phenomenon of conversion.
Deep Heat

n A coupling agent is used to prevent reflection of

greater fraction of acoustic

n Commonly used are: Degassed water, mineral oils,

encased silicon gel commercially available coupling

gels .

n Temperatures of upto 46 C are achieved in deep

tissues.

n Duration is generally 5 to 10 min per site
n Ideal for very deep heating e.g hip joint, in such cases

superior to shortwave and microwave diathermy.

Deep Heat

Precautions for Ultrasound
1. General heat precautions
2. Near brain, eye, reproductive organs
3. Gravid or menstruating uterus
4. Near pacemaker near spine, laminectomy sites
5. Malignancy
6. Skeletal immaturity
7. Arthroplasties
8. Methyle methacrylate or high density polyethylene


Other Modalities

2. Phonophoresis

n

Standard ultrasonic coupling gel is mixed with various

chemical substances to produce phonophoresis

coupling agent.

n

Local analgesic gels, corticosteroids

n

Anti-inflammatory effects of ultrasonic and

corticosteroids act synergistically.

Deep Heat

3. Shortwave diathermy

n

Oscillation of high frequency electrical and magnetic

fields produces movement of ions, rotation of polar

molecules and distortion of non-polar molecules,

resulting in heat generation.

n

Most commonly used frequency is 27.12 MHz &

treatment time is 20-30 min

n

Heating produced depends on type of shortwave unit,

and on the water content and electrical properties of

tissues.


Deep Heat

n Precautions:

- General heat precautions

- Metal (jewelry, IUD's, surgical implants, deep brain stimulator

and pacemaker which is absolute contraindication).

- Contact lenses (Potential for focal heating).

- Gravid or menstruating uterus

- Skeletal immaturity

Hydrotherapy

n

External application of hot or cold water, in any form, for treatment

of disease.

n

Arthritis and variety of musculoskeletal conditions, and in

cleansing and debridement of burns and other dermal injuries.

Whirlpool baths and Hubbard tanks
n

Typical y used for treatment of a limb or localized lesion.


Hydrotherapy

3. Contrast baths

n

Consists of alternating immersion of the distal limbs

in hot (42 - 45 C) ,then cold (8.5 ? 12.5 C) water.

n

30 min treatment session are typical, beginning with

10 min immersion in hot, followed by alternating

immersions of 1 min cold and 4 min hot, ending

with cold immersion.

n

Especially suited for rheumatological disease,

neuropathic pain, other chronic pain syndromes like

complex regional pain syndrome.

Other Modalities

Interferential current therapy (IFT)

n

Periodic interference of two AC signals of slightly

different frequency, results in a new wave with cyclic

modulation of amplitude, due to cyclic constructive and

destructive interferencere.

n

IFT machines typically uses medium frequency

currents of 4000 ? 5000 Hz.

n

Most machines use 2,4 or 6 applicators, which can be

arranged in same plane (planar) as in lumbar area or in

different planes (coplanar) as in the shoulder.

n

Useful in variety of musculoskeletal conditions,

neurological conditions and management of urinary

incontinence.
Other Modalities

n

Precautions :

- near implanted stimulators (pacemakers,

intrathecal pumps, spinal cord stimulators)

- near sympathetic ganglia or carotid sinus
- near open incision or abrasions
- near gravid uterus
- in the presence of venous thrombosis
- near SWD.

Factors to consider in

Modality Selection
1.

Target tissue

2.

Depth of heating/cooling/therapeutic response desired

3.

Intensity of heating or cooling desired

4.

Body habitus ( i.e amount of subcutaneous adipose)

5.

Co-morbid conditions ( e.g. malignancy, vascular disease,

neuropathy ,etc)

6.

Associated pt. specific features ( e.g. metal implants,

pacemaker, cold al ergy etc)

7.

Age (e.g. Open epiphysis)

8.

Sex (e.g. pregnant female)
Thank you

This post was last modified on 08 April 2022