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M Intro to Phys Agen

notes

QuestionAnswer
What is a physical agent/modality? examples:heat, cold, water, pressure, sound radiation, electricity - Any application that is applied designed to change underlying tissue-specifically promote tissue healing or decrease pain
what are the major categories of physical agents? Thermal, mechanical agents, electromagnetic
what are the types of thermal heat? superficial heat, deep heat and cold
what are mechanical agents designed to do? manipulate the tissues grossly and/or microscopically (traction, compression, water, sound)
what are electromagnetic agents designed to do? alter tissues to promote healing and decrease pain (TENS, inontophoresis, interferential current, diathermy)
why do you change water content in an area? decrease swelling
why do you change the rate at which nerves fire/depolarize? decrease pain
other examples of tissue changes modify cell membrane permeability, increase blood circulation to an area, increase pliability of tissues, relaxation of muscle tone
changes involving tissue healing change the rate at which tissue healing cells multiply or secrete healing chemicals, or change the numbers of healing cells in an area in order to decrease inflammation
role & decision making by PT consult w/MD, exam & eval of pt, determine goal & when max benefit achieved, determine benefits/contraindications of agent, develop POC
role of PTA follow rx plan of PT, review contraindications for the procedure, explain procedure to pt & answer ?, apply the agent, assess response to rx, report adverse reaction & dc rx prn, tell PT of pt response to rx, document procedure, necessity & response
Contraindications for nearly any physical agent pregnancy, cancer/malignancy, pacemaker, impairment of sensation, superficial metal in area, inability for pt to respond cognitively
examples of injuries/conditions commonly seen in PT stains, sprains, surgical interventions, bursitis, tendonitis
what is inflammation? a physiological response of the body to tissue injury. the purpose of the inflammatory response is to control the injurious agent and prepare the tissue for healing. this is a general term that can be applied to disease, injury, infection, ets.
what is an anti-inflammatory? an agent that controls/slows the inflammation process
what are the 3 stages of tissue repair? inflammatory(acute), proliferative(subacute), maturational(chronic)
what is the inflammation(acute) phase of healing characterized by? pain, edema, heat, redness, also muscle spasm. lasts 4-10 days.
what is the general purpose of the inflammatory state? to control blood loss, sequester bacteria or other harmful agents, and attract WBC's into area
what are the features of the inflammatory/acute phase? vasoconstriction followed by vasodilation, increased permeability of capillaries (results in edema), hyperemia, pain, chemotaxis
the chemical army secreted from various immune cells prosaglandins(vasodilator), histamines(vasodilator & attracts WBCs), bradykinins(vasodilator), norepinephrine(vasoconstrictor)
the cellular army(more important in inflammation/acute phase) macrophages/monocytes-phagocytes, mast cells-secrete histamines, neutrophils-phagocytes
features of proliferative/subacute phase 3-20 days, pain, redness, heat & edema all almost gone, function increases
proliferative stage in open wound wound covering (epithelialization) or scabbing. when combined w/new capillaries and new connective tissue is referred to as granulation tissue & is very fragile
proliferative stage in tendon or muscle injury cellular rebuilding, including new capillaries and muscle or tendon (connective tissue) cells
connective tissue consists of... cells and the three proteins they synthesize
the characteristic cell of connective tissue is... fibroblast
the proteins of connective tissue are... collagen(high in bone, tendons), elastin(higher in skin) and reticulin(mostly around organs)
what agent would move more fibroblasts into injury site and begin synthesizing more collagen and elastin? ultrasound
what agents would increase the rate that the normal tissue reproduces to form new capillaries (revascularization)? cold, heat, ultrasound, e-stim
wounds closed with sutures/stables or steristrips... called healing by Primary intention,these wounds heal without any contraction, very fragile initially & can be pulled apart (dehiss),usually results in less scarring & increased rate of healing
features of chronic/maturation state pain is a 1-3, day 9 & later, can persist for months, visible redness disappears, cellular & chemical healers decrease in numbers
in chronic/maturation phase the tissue remodels... the collagen fibers are initially disorganized according to stress placed on injured area. collagen increases in thickness & strength & cont to contract. stress is necessary for normal healing & elasticity in the new scar.
new collagen fibers replace those lain down in a disorganized fashion & tissue more closely resembles that of the host
application of heat & exercise in chronic/maturation stage are used to... reorganize tissue to increase it's elasticity
factors that effect scar formation and healing: age, nutritional stat, presence of infection, med status, foreign bodies in wound, immune sys status, blood supply, medical mgmt, extent of injury, stresses placed on tissue during healing
tissue specific issues: tissues w/good blood flow heal w/less scarring(epithelial tissues,skin & blood vessel coverings), tissues w/poor blood supplies heal slowly(cartilage & tendon),certain tissues dont regenerate (skeletal muscle, cardiac muscle,nerve tissues)
goals for acute stage control pain & edema, prevent or minimize effects of immobilization
treatment for acute stage 1)rest, ice, compression & elevation (protect) 2)PROM within pain free range, gentle isometrics
goals for subacute phase (clinical signs:1) inflammation decreasing 2)pain encountered w/tissue resistance @ end of available range 1)decrease pain 2)decrease edema 3)increase mobility-in pain free range 4)increase strength
goals for the chronic phase (clinical signs:1) no inflammatory signs 2)pain is after resistance is met. may have decreased strength, ROM & loss of function. restoration of function begins in this stage) 1)increase soft tissue and jt mobility 2)increase strength of supporting & related muscle 3) increase functional independence
effects of immobilization(longer immobile increases risk of problems) 1)adhesions-tissues heal together 2)contractures-tissues shorten or tighten 3)atrophy-decreased strength 4) poor jt nutrition-decreased circulation of synovial fluid
in acute stages, goal of PT is to... protect the healing tissue. treat with rest, immobilization, elevation, ice. tissue can be reinjured by PT easily
in subacute stage, goal is to... promote healing. decreased signs of acute inflammation
in chronic stage, goal is to... return to function. pt has minimal pn & no signs of acute inflammation
after 14 weeks, scar tissue... cannot be remodeled
it is possible to have inflammatory signs that persist well after the usual time, called... chronic inflammation. This occurs when there is excessive irritation of the tissues that are remodeling
when determining a patients acuity, you must follow... the signs, NOT the pt's self report of time of injury
Created by: jessigirrl4