1. © 2008 LWW Chapter 1. Therapeutic Modalities: What They Are and Why They Are Used

2. © 2008 LWW Working Hard Is Important

3. © 2008 LWW Working Smart Is More Important

4. © 2008 LWW What Are Therapeutic Modalities?

5. © 2008 LWW No text or dictionary has yet to define them.

6. © 2008 LWW Taber’s Cyclopedic Dictionary (1997;19:1934) Pertains to results obtained from treatment Having medical or healing properties A healing agent Therapeutic

7. © 2008 LWW Taber’s Cyclopedic Dictionary (1997;19:1222) A method of application or the employment of any therapeutic agent Limited usually to physical agents and devices Any specific sensory stimulus such as taste, touch, vision, pressure, or hearing Modality

8. © 2008 LWW Put It All Together Therapeutic modality: A device or technique that delivers a physical agent to the body for therapeutic purposes

9. © 2008 LWW Physical Agents Heat Cold Light Electricity Exercise

10. © 2008 LWW What Therapeutic Purpose? Wound healing Pain relief Flexibility and range of motion Muscular strength Muscular endurance To promote:

11. © 2008 LWW What Therapeutic Purpose? (cont.) To promote (cont.): Muscular speed Muscular coordination or skill Power Agility Cardiorespiratory endurance

12. © 2008 LWW Classification of Therapeutic Modalities Therapeutic modalities have been classified in many different ways. But each is incomplete—that is, none includes all modalities.

13. © 2008 LWW Classification of Therapeutic Modalities (cont.) Mechanical: massage, mobilization, US, whirlpool Cryotherapy: ice pack, immersion, ice massage Thermotherapy: moist heat, dry heat, diathermy, US Hydrotherapy: whirlpool, contrast bath, aquatic pool Electrotherapy: muscle stimulation, TENS, diathermy Active exercise

14. © 2008 LWW Selecting Which Therapeutic Modality to Use Do you select? Or does a physician select?

15. © 2008 LWW An ISU Physician’s Prescription Physical therapy for _____ because of pain and swelling of the left ankle and foot.

16. © 2008 LWW Brockport Team Physician Often prescribed diathermy, but we didn’t have a diathermy machine

17. © 2008 LWW Sometimes PTs work with physiatrists, who are specialists in physical medicine and rehabilitation. They will usually get good prescriptions, but most PTs and ATs usually don’t get good prescriptions.

18. © 2008 LWW Need to educate the physician about what the AT is using

19. © 2008 LWW To Select Modality(ies) Intelligently You must: Have a correct diagnosis Have a definite conception of the pathological and physiological changes associated with the injury

20. © 2008 LWW To Select Modality(ies) Intelligently (cont.) Know what you want to accomplish with the modality—that is, have a therapeutic goal Understand the modalities effects, indications, and contraindications Match your therapeutic goal with a modality that will help you achieve that goal

21. © 2008 LWW Knobology The study of application without theory

22. © 2008 LWW Art vs Science Theory vs Application

23. © 2008 LWW Rehabilitation and Therapeutic Modalities To fully understand the role of therapeutic modalities you must: –Understand the overall rehabilitation process –Understand how each therapeutic modality fits into that process

24. © 2008 LWW See the BIG Picture

25. © 2008 LWW What Modality Is Used When?

26. © 2008 LWW With a systems approach, you must have a basis for choosing which therapeutic modality to use during various phases of rehabilitation. Must match the proper therapeutic modality with the therapeutic goal.

27. © 2008 LWW Efficacy of Modalities Rate modalities for effect during rehabilitation. 1.Direct effect (good choice) 2.Effective if used in a specific way 3.Somewhat effective; not the best choice; there are better modalities for developing this element of rehabilitation

28. © 2008 LWW

29. Modality Efficacy: Summary Traditional modalities (heat, light, sound, electricity) are used during only the first three phases. Exercise is needed for most phases of rehabilitation.

30. © 2008 LWW Note Therapeutic exercise is not covered in this class, except for cryokinetics and cryostretch.

31. © 2008 LWW What Rehabilitation Is Not Treat then rehabilitate Working with weights A cookbook approach

32. © 2008 LWW Treat Then Rehabilitate Treat with various therapeutic modalities (e.g., whirlpool, ultrasound) and then “rehabilitate” Rehabilitation = the entire process of returning an injured athlete to competition

33. © 2008 LWW Working with Weights Concept too narrow Rehabilitation = the entire process of returning an injured athlete to competition Much more than strength training

34. © 2008 LWW A Cookbook Approach Stages or phases established with specific time periods and exercises Optimal rehabilitation not planned by the calendar or by specific exercises

35. © 2008 LWW Re habilita tion Reagain, anew, restore habilitate to make suitable habitcharacteristic condition of mind or body tion the act of

36. © 2008 LWW Rehabilitation To restore to a normal or optimal state of health –For an athlete, to a high level of conditioning Process of returning an athlete to a high level of conditioning

37. © 2008 LWW Rehabilitation (cont.) More than progressing through various phases of conditioning For optimal results, rehabilitation must be planned and the plan executed systematically.

38. © 2008 LWW Rehabilitation (cont.) For optimal results, you must consider: Timing Goals Rate of progression Criteria for progression Psychological factors

39. © 2008 LWW Systems Approach to Total Rehabilitation Each patient and each injury is unique. Based on signs, symptoms, and needs Identify each phase of rehabilitation. Establish criteria for developing each phase. Carefully analyze the limitations imposed by the injury. Determine which phase of rehabilitation to begin with.

40. © 2008 LWW Ten Elements of Rehabilitation 1. Structural integrity 2. Pain-free joints and muscles 3. Joint flexibility 4. Muscular strength 5. Muscular endurance

41. © 2008 LWW Ten Elements of Rehabilitation (cont.) 6. Muscular speed 7. Muscular power (strength and speed) 8. Skill patterns (integrated and coordinated movement 9. Agility (speed and skill) 10. Cardiovascular endurance

42. © 2008 LWW Rehabilitation Principles The SAID principle Therapeutic goals Constant evaluation Functional progression Early exercise essential Rate of reconditioning Begin early, end late

43. © 2008 LWW The SAID Principle Specific adaptation to imposed demands dominates rehabilitation. The body responds to a given demand with a specific and predictable adaptation. Specific adaptation requires that specific demands be imposed.

44. © 2008 LWW The SAID Principle (cont.) Each physical attribute must be identified and specifically trained for. Optimize by using a goal-oriented approach.