intro to biophysical agents

what are physical agents?

energy and materials applied to patients to assist in their rehabilitation

physical agents include

heat, cold, water, pressure, sound, electromagnetic radiation, and electrical currents

categories of biophysical agents

thermal, electromagnetic, mechanical

thermal agents transfer energy to a patient to

increase or decrease tissue temperature

thermal agents include

- hot packs

- paraffin baths

- cold packs

- ice bags

- ultrasound

- diathermy

- whirlpool

considered both thermal and mechanical agents

- ultraosund

- diathermy

- whirlpool

thermal agents may affect temp change in

either superficial or deep tissue

electromagnetic agents apply energy in the form of

electromagnetic radiation or electrical current

electromagnetic agents include

- infrared radiation (ER)

- UV radiation (ER)

- laser (ER)

- diathermy (ER)

- electrical stimulation (EC)

mechanical agents apply force to

increase or decrease pressure on the body

mechanical agents

- water/hydrotherapy

- traction

- compression

- sound (US and or shockwave)

types of thermal agents

- superficial heating agents

- deep heating agents

- cooling agents

clinical examples of thermal agents

- hot pack, paraffin

- ultrasound, diathermy

- ice pack

electromagnetic types

- electrical currents

- electromagnetic fields

clinical examples of electromagnetic

- TENS

- ultraviolet, laser

mechanical agent types

- sound

- water

- traction

- compression

mechanical clinical examples

- ultrasound, shock waves

- whirlpool

- mechanical traction

- elastic bandage, stockings

physical therapy is the

use of the physical, chemical, and other properties of heat, light, water, electricity, sound, massage, and active, passive, and resistive exercise, and shall include physical therapy

effects of physical agents

- reduce inflammation

- accelerate tissue healing

- relieve pain

- modify muscle tone

- alter collagen extensibility (motion)

damaged tissues usually respond predictably through

inflammation (1st phase), proliferation, maturation

thermal agents modify inflammation and healing by

changing rates of circulation and chemical reactions

mechanical agents _______ to contribute to inflammation and tissue healing

control motion and alter fluid flow

electromagnetic agents _________ during inflammation and tissue healing

alter cell function (membrane permeability and transport)

initial injury stage goals of treatment

- prevent further injury or bleeding

- clean open wound

initial injury stage effective agents

- static compression, cryotherapy

- hydrotherapy (immersion or non immersive)

initial injury stage contraindicated agents

- exercise

- intermittent traction

- motor level ES

- thermotherapy

chronic inflammation stage goals of treatment

- prevent/decrease joint stiffness

- control pain

- increase circulation

- progress to proliferation stage

chronic inflammation stage - prevent/decrease joint stiffness effective agents

- thermotherapy

- motor ES

- shock waves

- whirlpool

- fluidotherapy

chronic inflammation stage - contraindicated agents

cryotherapy

chronic inflammation stage - control pain effective agents

- thermotherapy

- ES

- shock waves

- photobiomodulation

chronic inflammation stage - increase circulation effective agents

- thermotherapy

- ES

- compression

- hydrotherapy (immersive or exercise)

chronic inflammation stage - progress to proliferation stage effective agents

- pulsed ultrasound

- ES

- SWT

- shock waves

remodeling stage goals of treatment

- regain or maintain strength

- regain or maintain flexibility

- control scar tissue formation

remodeling - regain or maintain strength effective agents

- motor ES

- water exercise

- EMG biofeedback

remodeling - regain or maintain flexibility effective agents

thermotherapy

remodeling - control scar tissue formation effective agents

brief ice massage

compression

remodeling stage contraindicated agent

immobilization

acute pain goals of treatment

- control pain

- control inflammation

- prevent aggravation of pain

acute pain effective agents

- sensory ES, cryotherapy

- cryotherapy

- immobilization, EMG biofeedback

- low-load static traction

acute pain contraindicated agents

- thermotherapy

- local exercise

- motor ES

referred pain goals of treatment

control pain

referred pain effective agents

- ES

- cryotherapy

- thermotherapy

spinal radicular pain goals of treatment

- decrease nerve root inflammation

- decrease nerve root compression

spinal radicular pain effective agent

traction

pain caused by malignancy goals of treatment

control pain

pain caused by malignancy effective agents

- ES

- cryotherapy

- superficial thermotherapy

inflammation treatment

cryotherapy or E stim

modify perception to decrease pain-->

cryotherapy

compression to decrease pain

traction

modify pain transmission decrease pain by

sensory level E stim

hypertonicity goal of treatment

decrease tone

hypertonicity effective agents

- neutral warmth

- prolonged cryotherapy

- EMG biofeedback to hypertonic muscles

- motor ES

- quick ice of antagonists

hypotonicity goal of treatment

increase tone

hypotonicity effective agents

- quick ice

- motor ES

- EMG biofeedback to antagonists

fluctuating tone goal of treatment

normalize tone

fluctuating tone effective agent

functional ES

muscle weakness goal of treamtent

increase muscle strength

muscle weakness effective agents

- water exercise

- motor ES

- EMG biofeedback

contraindicated agent for muscle weakness

immobilization

pain at rest and with motion goals of treatment

control pain

pain at rest and with motion effective agents

- ES

- cryotherapy

- thermotherapy

- SWT

- spinal traction

- EMG biofeedback

pain at rest and with motion contraindication

exercise

pain with motion only goals of treatment

- control pain

- promote tissue healing

pain with motion only - control pain effective agents

- ES

- cryotherapy

- thermotherapy

- SWT

pain with motion only - contraindicated agent

exercise into pain

pain with motion only - promote tissue healing effective agents

- ultrasound

- ES

- SWT

- shock waves

soft tissue shortening goals of treatment

- increase tissue extensibility

- increase tissue length

soft tissue shortening effective agent 1) increase tissue extensibility

thermotherapy

soft tissue shortening effective agent 2) increase tissue length

thermotherapy or brief ice massage and stretch

contraindication of soft tissue shortening

prolonged cryotherapy

bony block goals of treatment

- remove block

- compensate

effective agents of bony block

- none for remove block

- compensate --> exercise; thermotherapy or brief ice massage and stretch

contraindication of bony block

stretching blocked joint

general contraindications and precautions

- pregnancy

- malignancy

- pacemaker or other implanted electronic device

- impaired sensation

- impaired mentation

physical agent selection

address primary problems or problems most likely to respond to available interventions first

order of physical agent selection

- 1A: primary underlying probem

- 1B: problem most likely to respond to treatment

- 2: treatment that address more than one problem simultaneously

- 3: symptomatic treatment only

if swelling contributes to lack of mobility

- reduce swelling through ice

- precaution: reduced sensation

attributes to consider during selection of physical agents

- goals and effects of treatment

- contraindications and precautions

- evidence for physical agent use

- cost, convenience and availability

interventions are generally combine when

- they have similar effects

- address different aspects of a common array of symptoms

- i.e: rest, ice, elevation, compression are combined for treatment of inflammation

documentation - effective, accurate, and complete communication to other health care professionals regarding:

- examination findings

- evaluations

- interventions

- plans

- serves as a long term record

- supports reimbursement

Eastern medicine practices

acupuncture 2200 years ago

ancient romans and greeks

use of heat and water to treat musculoskeletal and respiratory problems

400 BC and early innovations

electrical stimulation via electrical torpedo fish for headaches and arthritis, spinal traction techniques

diathermy

generation of heat in body tissues through high-frequency electric currents for medical purposes

APTA most important recommendation

don't employ passive physical agents except when necessary to facilitate participation in an active treatment program

role of physical agents in rehabilitation

the use of biophysical agents as a standalone is not considered physical therapy

physical agents are used by

- PTS and PTAs

- OTS and OTAs

- ATs

- physiatrists

- chiro

- accupuncturists

- patients

evidence based practice EBP

- requires clinical decisions to be guided by the best available relevant clinical research data

- combined with clinician's experience and patient pathology/preference

levels of evidence from highest quality to lowest

1. Meta-analyses (highest)

2. systematic reviews

3. randomized controlled trials

4. cohort studies

5. case-control study (lowest)

PICO - P

patient or population ( specific person or group)

PICO - I

intervention (specific intervention, exercise, specific frequency)

PICO- C

comparison or control (compare selected intervention with gold standard treatment or no intervention at all)

PICO - O

outcome (state clearly the desired outcome from the intervention)

PICO example

- P: patients with symptoms due to soft tissue shortening

- I: ultrasound therapy

- C: no ultrasound therapy

- O: increased ROM

clinical practice guidelines CPGs

- systemically developed statements that attempt to interpret current research

- give recommendations for diagnostic and prognostic measures and for preventive or therapeutic interventions

- specific guidelines for the use of physical agent can be found on APTA

using physical agents within different health care delivery systems

- use of resources in most cost effective manner, be efficient

- reduced reimbursement ex medicare

- increased requirements for documentation

- assessment of functional outcomes in response to interventions

ICF model components

1. body structures / functions: system impairments, ex: right sided weakness

2. activities: activity restrictions, ex: ambulation

3. participation: participation restrictions, ex: grocery shopping

4. environmental factors: environment, ex: distance from parking lot to store

5. personal factors: work, family, ex: lack of family support

6. health conditions: diagnosis and co-morbidities, ex: CVA, HTN