1. INTRODUCTION TO PHYSICAL AGENTS
(AKA Modalities)

2. What are physical agents or modalities?

3. What are physical agents or modalities?
Various forms of energy and material applied to a patient to achieved a goal by the means of their application
Include heat, cold, water, pressure, sound, electromagnetic radiation, and electrical currents.

4. History of Modalities
Ancient Rome and Greece used heat and water (steam rooms, hot & cool pools) to treat ailments
Late 19th Century Europe – natural hot springs
400 B.C. Torpedo fish were used to apply electrical shock

5. Sunlight was used to treat TB, bone & joint diseases, dermatological problems & infection
Over time new uses and techniques have developed due to better understanding of the body, disease,and recovery. Also practice has change with the development of new technology.

6. Modalities is a constantly changing area of practice due to a variety of reasons. It is not a black and white area of study

7. Definition Review (page 18 & 19)
Impairment
Functional Limitations
Pathology
Disability

8. ROLE OF MODALITIES IN REHAB
The days of “shake & bake” are long gone in rehab.
Modalities alone DO NOT constitute a skilled treatment
Modalities should be used in conjunction with other therapeutic techniques to reach an established goal of rehab.
(see APTA statement on page 5)

9. Categories of Physical Agents
Table 1-1, pg 2

10. Category
Types
Clinical Examples
Thermal
Deep Heating Agents
Ultrasound, Diathermy
Superficial Heating Agents
Hot Pack, Paraffin
Cooling Agents
Ice Pack
Mechanical
Traction
Compression
Mechanical Traction
Elastic Bandage, Stocking
Water
Whirlpool
Sound
Ultrasound
Electromagnetic
Electromagnetic Fields
Electric Current
Ultraviolet, laser
TENS, NMES, HVG

11. THERMAL AGENTS
THERMAL AGENTS – transfer energy to a pt. to cause an increase or decrease in tissue temp.
Different agents will produce different changes in temp. (I.e. Deep heating agents, superficial agents, cooling agents)

12. Why use thermal agents? Increase circulation Increase metabolic rate
Increase soft tissue extensibility
Decrease pain through sedation of nerve endings
When cryotherapy (cold)is used you will see the opposite effect. Pain is decreased through numbing of the tissue.

13. MECHANICAL AGENTS
These modalities apply a mechanical force to increase or decrease pressure on the body.
Examples: Traction, compression, hydrotherapy (water), ultrasound

14. ELECTROMAGNETIC AGENTS
Modalities that apply electromagnetic energy in the form of electromagnetic radiation, fields and electrical current
Examples: electromagnetic fields, all types of E-stim

15. GENERAL EFFECTS of PHYSICAL AGENTS
Inflammation & Healing – when used appropriately they can modify & promote healing by modifying the rates of circulation and chemical reactions associated with inflammation and healing.

16. Physical Agents for Tissue Healing
The stage of tissue healing determines the goals of intervention and the physical agents used.
Review Phases of Healing (page 9)
Table 1-2, page 9

17. Physical Agents for Pain Modulation
The choice of a physical agent for treating pain depends on the type of etiology of the pain.
Table 1-3, page 11

18. Collagen Extensibility and Motion Restrictions

19. Physical Agents for the Treatment of Motion Restrictions
Physical agents can be effective adjuncts to the treatment of motion restrictions caused by mm weakness, pain, sift tissue shortening, or a bony block.
The appropriate interventions for each of these will vary.
Table 1-4, page 13

20. Physical Agents for Tone Abnormalities
Physical agents can temporarily modify muscle hypertrophy, hypotonicity, or fluctuating tone.
Table 1-5, page 14

21. Consideration when using Physical Agents
Indications – situations that indicate or are safe to use a modality.
Contraindication (absolute) – conditions that render a particular Rx undesirable or improper (when not to use the modality)
Precautions - conditions that require a particular Rx to be done with limitations or special care
General CI’s & Precautions – pregnancy, malignancy, impaired sensation & mentation

22. General Contraindications and Precautions
Pregnancy
Malignancy
Pacemaker or other implanted electronic device
Impaired sensation
Impaired mentation

23. Choosing a Physical Agent (fig 1-2, p 8)

24. Fig 1-3, p 8

25. Evidence-Based Practice and Physical Agents

26. Terms to know (page 18-19) Functional limitations
Impairments
Indications
Mechanical agents
Pathology
Physical agents
Precautions
Rehabilitation
Thermal Agents
Clinical practice guidelines
Contraindications
Disability
Electromagnetic agents
Evidence-based practice
Systemic Reviews