notes
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 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
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| what are the major categories of physical agents? | Thermal, mechanical agents, electromagnetic
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| what are the types of thermal heat? | superficial heat, deep heat and cold
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| what are mechanical agents designed to do? | manipulate the tissues grossly and/or microscopically (traction, compression, water, sound)
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| what are electromagnetic agents designed to do? | alter tissues to promote healing and decrease pain (TENS, inontophoresis, interferential current, diathermy)
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| why do you change water content in an area? | decrease swelling
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| why do you change the rate at which nerves fire/depolarize? | decrease pain
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| other examples of tissue changes | modify cell membrane permeability, increase blood circulation to an area, increase pliability of tissues, relaxation of muscle tone
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| 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
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| 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
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| 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
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| Contraindications for nearly any physical agent | pregnancy, cancer/malignancy, pacemaker, impairment of sensation, superficial metal in area, inability for pt to respond cognitively
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| examples of injuries/conditions commonly seen in PT | stains, sprains, surgical interventions, bursitis, tendonitis
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| 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.
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| what is an anti-inflammatory? | an agent that controls/slows the inflammation process
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| what are the 3 stages of tissue repair? | inflammatory(acute), proliferative(subacute), maturational(chronic)
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| what is the inflammation(acute) phase of healing characterized by? | pain, edema, heat, redness, also muscle spasm. lasts 4-10 days.
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| 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
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| what are the features of the inflammatory/acute phase? | vasoconstriction followed by vasodilation, increased permeability of capillaries (results in edema), hyperemia, pain, chemotaxis
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| the chemical army secreted from various immune cells | prosaglandins(vasodilator), histamines(vasodilator & attracts WBCs), bradykinins(vasodilator), norepinephrine(vasoconstrictor)
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| the cellular army(more important in inflammation/acute phase) | macrophages/monocytes-phagocytes, mast cells-secrete histamines, neutrophils-phagocytes
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| features of proliferative/subacute phase | 3-20 days, pain, redness, heat & edema all almost gone, function increases
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| 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
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| proliferative stage in tendon or muscle injury | cellular rebuilding, including new capillaries and muscle or tendon (connective tissue) cells
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| connective tissue consists of... | cells and the three proteins they synthesize
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| the characteristic cell of connective tissue is... | fibroblast
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| the proteins of connective tissue are... | collagen(high in bone, tendons), elastin(higher in skin) and reticulin(mostly around organs)
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| what agent would move more fibroblasts into injury site and begin synthesizing more collagen and elastin? | ultrasound
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| what agents would increase the rate that the normal tissue reproduces to form new capillaries (revascularization)? | cold, heat, ultrasound, e-stim
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| 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
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| 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
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| 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.
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| new collagen fibers replace those lain down in | a disorganized fashion & tissue more closely resembles that of the host
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| application of heat & exercise in chronic/maturation stage are used to... | reorganize tissue to increase it's elasticity
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| 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
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| 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)
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| goals for acute stage | control pain & edema, prevent or minimize effects of immobilization
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| treatment for acute stage | 1)rest, ice, compression & elevation (protect) 2)PROM within pain free range, gentle isometrics
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| 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
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| 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
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| 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
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| 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
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| in subacute stage, goal is to... | promote healing. decreased signs of acute inflammation
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| in chronic stage, goal is to... | return to function. pt has minimal pn & no signs of acute inflammation
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| after 14 weeks, scar tissue... | cannot be remodeled
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| 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
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| when determining a patients acuity, you must follow... | the signs, NOT the pt's self report of time of injury
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