Modalities and healing

Scar management

Technique best used 6 to 12 weeks after wound closure to minimize the risk of adhesions, contracture, hypertrophy or hypersensitivity.

Adhesions

a band of scar-like tissue that forms between two internal surfaces that aren’t normally connected

Contracture

a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to restricted joint mobility

Hypertrophy

a thick, raised scar that forms when the body produces excessive collagen during wound healing

Interventions for scar management

• mobilization orthoses (e.g., applying sub-maximal stretch)
• massage (e.g., graded vibration, manual)
• compression (e.g., gloves, tubular gauze)
• desensitization (e.g., graded touching, textures)
• ROM (e.g., active exercise and passive stretch)
• thermal modalities (e.g., ultrasound, moist heat)

Conduction

Transfer of energy between two connected surfaces of contrasting temperatures

Examples of conduction

• paraffin wax
• cryotherapy
• hot pack

Convection

Transfer of energy from a circulating source in contact with a body part

Examples of convection

• Fluidotherapy®
• whirlpool

Evaporation

Physiological response resulting from the topical application of a vapocoolant

Examples of evaporation

• cold spray
• cooling cream

Hot pack

Superficial, moist heat, conduction modality

Precautions to take with hot pack

• overheating of the client
• localized burns to the body part being treated
• discomfort from the weight of the pack

Fluidotherapy

Superficial, dry heat, convection modality that involves inserting a distal extremity into a thermostatically-controlled machine of circulating particles, typically used for:
• desensitization
• edema and pain reduction
• improving range of motion

Paraffin therapy

Superficial, conduction, heat modality that involves use of thermostatically controlled, warmed wax and mineral oil, methods include:
• immersion
• dip immersion
• pouring

Cryotherapy

Superficial, conduction, cold modality that may be used to address:
• spasticity
• pain
• edema

Electrotherapeutic physical agent modalities

Physical agent modalities (PAM) that require essential knowledge of electrical principles, electrode selection and placement, indications, and contraindications

Examples of Electrotherapeutic physical agent modalities

• neuromuscular electrical stimulation (NMES)
• functional electrical stimulation (FES)
• transcutaneous electrical nerve stimulation (TENS)

Neuromuscular Electrical Stimulation (NMES)

A type of physical agent modality that provides electrical stimulation to a peripheral nerve

Potential uses include:
• strengthen a muscle
• increase ROM
• decrease spasms
• manage edema

Functional electrical stimulation (FES)

Form of electrotherapy to:
• maintain muscle mass
• gain range of motion
• facilitate voluntary movement
• manage spasticity

Transcutaneous electrical nerve stimulation (TENS)

Form of electrotherapy used as a component of a comprehensive pain management program Techniques of application include:
• sub sensory
• sensory
• motor

Ultrasound (US)

Mechanical acoustic modality that uses energy conversion to influence:
• tissue length
• pain
• inflammation
• tissue healing

Wound healing: Maturation phase

Final phase of wound healing that may continue for months or years that includes:
• collagen remodeling
• scar softens while its tensile strength increases
• erythema lessens

Erythema

superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries

Wound healing: Proliferation phase

Second stage of wound healing that begins by day three after injury, includes:
• wound revascularization
• scab formation
• wound re-epithelialization (new skin layer)
• fibroblasts initiating contraction
• erythema and beginning of scar formation

Wound healing: Inflammatory phase

Initial stage of wound healing that includes:
• clot formation
• blood vessel dilation allowing neutrophils and monocytes to initiate debridement and attack bacteria
• changes in skin color, temperature, pain, swelling and function