Module 2- Physical Agent Modalities (PAMS)

this is made from the PowerPoint created by Nikki Kardouni for an MUOTD course

what does the OTPF-4 say regarding PAMs?

modalities, devices, and techniques to prepare the client for occupational performance, such approaches should be part of a broader plan and not used

what AOTA say regarding PAMs?

ACOTE requires entry level educational programs prepare students to demonstrate the ‘safe and effective application of modalities as a preparatory measure to improve occupational performance, foundational knowledge, underlying, principles, indications, contraindications, and precaution’s for use

what is the NC board of occupational therapy position on PAMs?

the Occupational Therapy Practice Act does not mention PAMS, thus they are not specifically allowed or disallowed and the NC board allows the use of PAMS in practice if the OT is trained, competent, and that is documented

what are the stages of wound healing?

phase 1- inflammation

phase 2- proliferation

phase 3- maturation

what is phase 1 of the wound healing process?

inflammatory stage

last up to 72 hours

preparation for proliferative stage

what is phase 2 of the wound healing process?

proliferative stage

last approximate 3-14 days

collagen forms

wound heals bottom up; outside in

what is phase 3 of the wound healing?

maturation stage

lasts 21 days- 2 years

wound closure

sufficient tensile strength

return of function

why are PAMs used?

they a preparatory to facilitate efficiency in treatment

what are positive affects of using PAMs with a patient?

decrease pain

increase ROM

increase muscle strength

facilitate tissue healing

what are types of modalities?

superficial thermal agents

superficial cooling agents (cryotherapy)

deep thermal agent

electrotherapeutic agents

what is the therapeutic range of thermal agents? (superficial heat ones)

104-113 F

what are the analgesic effects of thermal agents?

reduce pain

what are the vascular effects of thermal agents?

pain relief and decrease muscle spasm and spasticity

causes mild inflammatory response

what are the metabolic effects of thermal agents?

influence tissue repair and modulate pain

increases O2 uptake

what is the connective tissue response to thermal agents?

tissues becomes easier to stretch

what are therapeutic indications (who this treatment is used with) of thermal agents?

subacute and chronic inflammation

subacute and chronic pain

subacute edema removal

resolutions of swelling

myofascial trigger points

muscle guarding

muscle spasm

subacute muscle strain

subacute ligament sprain

subacute contusion

infection

how does thermal agents affect pain?

gatekeeps transmission of pain by activation of cutaneous thermoreceptors

how does thermal agents affect muscle spasm?

decrease in spindle sensitivity to stretch

how does thermal agent affect connective tissue extensibility?

it causes increases due to changes in viscoelastic properties of tissue

once the area is heated it takes 30 minutes for the body to return to normal, during this time…

there could be a decrease in strength

what is the positive effect of having soft tissue at a temperature of 104-113 F?

increase in cell metabolism

what is thermal conductivity?

how different tissues absorb energy differently

it leads to temp change

what does it mean when the thermal agent is superficial?

it penetrates 1-2 cm deep

what does it mean when the thermal agent is deep?

it penetrates 5 cm

what are the benefits of thermal agents?

increase blood circulation

decrease pain

elongate tissue in preparation for movement

increase ROM and function

what are precautions for thermal agents?

area of malignancy

untreated infections

corn allergy (fluidotherapy)

wounds

passive or dependent position

what are contraindications of thermal agents?

decreased sensation to thermal stimuli

vascular disease- impaired circulation

what are age considerations of thermal agents?

cognition

skin integrity

what are examples of a superficial thermal agents?

hot packs

paraffin

fluidotherapy

whirlpool

what are things to consider when using a hot pack?

use FOUR to SIX layers

check the skin after 5 min

duration 15-20 min

hot packs are a _____ heat

moist

what is a hydrocollator?

158-168 F that warms a heat pack

what are precautions of superficial thermal agents?

monitor elderly closely

sensory loss

heat sensitivity

cognition

what is the temperature of paraffin?

122-125 F

what do you do when using paraffin wax?

have the client dip their hand 5-10 times

what is paraffin especially good for?

arthritis

what is the effect of paraffin?

increased blood flow

increased metabolic effect

pain modulation

how hot is a fluidotherapy machine?

102-118 F

the ________ of a fluidotherapy machine can be adjusted

blowers

fluidotherapy is a good option for those with ______________

hypersensitivity

what is the effect of fluidotherapy?

pain control

increases circulation

decrease stiffness

mechanical skin stimulation

what is the whirlpool used for?

healing tissue and open wounds

what does the whirlpool do?

loosens necrotic tissue

debridement

what is the water temp in the whirlpool?

92 F

why is the whirlpool not widely used?

due to poor sanitation

what are the effects of the whirlpool?

increased blood flow

vaso-dialation

water buoyancy for active movement

what are the precautions of the whirlpool?

skin graft or active infections

patient having a lack of sensation

how deep does a hot pack, parraffin, and fluidotherapy penetrate?

1-2 cm

what is the only difference between moist heat and dry heat?

high temperatures can be tolerated with dry heat as moist heat feels hotter

what are deep thermal agents?

ultrasound

an ultrasound can be…

thermal or nonthermal

what is the frequency of ultrasound measured in?

MHz

what is the intensity of an ultrasound measured in?

w/cm (2)

the duty cycle of an ultrasound can be….

continued or pulsed

what are the effects of an ultrasound?

main purpose is to raise temp of structures such as tendons, ligaments, and joint capsules

promote tissue healing by increasing blood flow and oxygenation

assist with wound healing

how do ultrasounds work?

its a rapid generation of sound waves, where molecules are pushed back and forth. the pressure wave is transmitted in a small volume of tissue causing the molecules to vibrate

each tissue layer transmits and absorbs ultrasound according to its acoustical ___________

properties

what elements have the lowest acoustic absorption?

fluid

what has the highest acoustic absorption?

bone

what has a high acoustic absorption?

scar tissue (collagen)

what does the frequency of a ultrasound describe?

the number of complete cycles or waves per second

frequency entails…

the amount of energy absorbed

a higher frequency entails more…

work

when is the ultrasound set to 3Mhz?

superficial- elbow to hand

when is the ultrasound set to 1 Mhz?

deep- humerus up

the area being targeted by the ultrasound should be ___ the size of the head shape

2x

what is the intensity of an ultrasound?

strength of acoustic energy at the application site

as the intensity increases so does the…

movement of molecules

what is the intensity range?

.2-2.0

the lower the intensity the longer it will take for…

an increase in temperature

the duty cycle is…

continuous(heat) or pulse(heal)

what are the percentages of a duty cycle?

10

20

50

100

what is 10% of a pulsed ultrasound?

10 sec on, off 90 secs- for fragile conditions

what is the common percent of pulsed ultrasound?

20%- used for healing

what percentage of pulsed ultrasound is used for wound healing?

50%

what percentage of pulsed ultrasound is used for thermal effects?

100%

what is the duration of an ultrasound?

time of treatment: duty cycle x intensity x treatment time= degrees ( C) temp increase

what are the contraindications of deep thermal agents?

reproductive organs

impaired sensation

over electronic implants such as a pacemaker

over spinal cord after laminectomy

cancerous areas

what are the precautions of deep thermal agents?

acute inflammation

epiphyseal plates

fracture healing

orthopedic hardware

what is phonophoresis?

a deep thermal agent, US with a topical medication, that treats inflammation and pain in a person’s muscles, ligaments, and joints. it helps the topic medication absorb better in the tissue underneath

what is diathermy?

a deep thermal agent that electrically induces heat or high-frequency electromagnetic

what are superficial cooling agents?

cold packs

gameready- ice massage

when are cold packs used?

after acute injuries

what are cold packs used for?

pain control

muscle spasm

what are the precautions of superficial cooling agents?

loss of sensitivity

cold sensitivity

what are the contraindications of superficial cooling agents?

Raynaud’s

compromised circulation

what are the physiological effects of superficial cooling agents?

vasoconstriction

decreases metabolism

decreases delivery of leukocytes and phagocytes

decreases lymphatic and venous drainage

decreased pain

what are types of electrotherapy?

NMES

TENS

IFC

iontophoresis

what is NMES used for?

activating muscles through nerve stimulation

what is the TENS used for?

pain control by stimulating nerve fibers, the current is periodically interrupted

what is the IFC used for?

to penetrate deep tissue for pain control

what is iontophoresis?

a modulation that uses a low voltage current to direct medication into tissues, the current is continuous

what are the uses of electrotherapy (NMES)?

strengthening of weak muscles

increase ROM

relaxation of spastic muscles

muscle re-education

reduce pain associated with shoulder spasticity/subluxation

what are the protocol around electrotherapy (NMES)?

power- 1:3 on/off cycle, do functional activities after

re-education- 1:1 on/off, do functional activities after

shoulder subluxation- 1:3 or higher to allow for muscle recovery

what are the frequency of pulses when using electrotherapy (NMES) on shoulder subluxation?

25-35 pulses

what is the frequency of treatment of electrotherapy(NMES) on shoulder subluxation?

5-7 sessions per week for 3-4 weeks

how does IFC work?

there are two channels used simultaneously and cause a tissue current amplitude modulation

what are the effects of IFC?

pain relief

muscle stimulation

increased local blood flow- reduction of edema, stimulating healing and repair

what is low-level laser therapy (LLLT)?

near infrared light to facilitate healing and decrease pain

what is biofeedback?

external mechanism for monitoring a special function