INTRODUCTION TO PHYSICAL AGENTS (AKA Modalities)

What are physical agents or modalities?

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.

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

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.

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

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

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)

Categories of Physical Agents Table 1-1, pg 2

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

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)

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.

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

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

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.

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

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

Collagen Extensibility and Motion Restrictions

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

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

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

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

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

Fig 1-3, p 8

Evidence-Based Practice and Physical Agents

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