DPT 752

Various forms and means of application of energy and materials to patients in order to produce a physiologic effect.

• Thermal (hot or cold packs)
• Mechanical (Ultrasound)
• Electromagnetic (Diathermy)

• Acute phase (1-6 days)
• Proliferation phase (3-20 days)
• Maturation phase (9 and on)

• Heat
• Redness
• Swelling
• Pain
• Loss of function

• Cover wound and strengthen injured site by:
• epithelialization
• fibroplasia occurs
• wound contraction
• neovascularization

• laying down of collegen to form scar
• use of induction or tension theory to manipulate scar formation

scar mimics the characteristics of the tissue it is healing

• internal and external stresses placed on the injured tissue during the maturation phase determine the final tissue structure
• The length and mobiltiy of the injured area may be modified by application of stress during appropriate phases of healing

• acute inflammatory response
• lasts for months or years
• results in increased fibroblast proliferation
• results in increased collagen production which can lead to adhesion formation

• Cartilage needs subchondral bone to be involved for production of chondrocytes
• Tendon and ligaments need tension
• Skeletal muscle cannot proliferat (but stem cells can)
• Bone heals well on its own

• Resolve the underlying pathology
• Modify patient prospective
• Maximize function imposed by the source of pain
• Modification of pain to facilitate participation in therapy

• < 6 months acute >6 months chronic
• present only with stimulus vs present in absense of stimulus
• protective function vs no function

• pain experience in a site distal from its origin
• from a nerve to it area of innervation
• from the same dermatome
• from the same embryonic segment

pain depends on specific nerves firing to get the response

fails to account for spinal cord and CNS modification of pain

• Pain sensation results in frequency and intensity of any nerve firing
• These sensations are then summed in the CNS to detect pain

Fails to account for specific pain receptors found in the body

• Sharp pain
• small myelinated fibers

• dull, long-lasting pain
• unmeylinated

• Cutaneous- sharp, pricking, or tingling (easy to localize)
• Musculoskeletal- dull, heavy, aching (more difficult to localize)
• Visceral- like musculoskeletal (refers superficially rather than deep)

• modulate pain by stimulating non-nociceptive pathways
• inhibition of T-cells

fails to take in to account modulation from higher centers

• pain is modulated in peripheral, spinal cord, and cortical levels by this system
• thought to inhibit the release of substance P

• hemodyanmic effects
• neuormuscular effects
• increased pain threshold
• altered muscle strength
• decreased spasticity
• metabolic effects

• inflamation control
• pain control
• modify spasticity

• cold hypersensitivity
• cold intolerance
• cryoglobulinemia
• paroxysmal cold hemoglobinuria
• Raynaud's disease and phenomenon
• over a regenerating peripheral nerve
• over an area with circulatory compromise

• over superficial main branch of a nerve
• over an open wound
• when treating patients with hypertension
• when treating patients with poor sensation or mentation
• when treating very old or very young patients

• hemodynamic effects
• neuromuscular effects
• metabolic effects
• altered tissue extensibility

• Pain control
• increase ROM and decrease stiffness
• accelerate healing
• IR for psoriasis (not common any more)

• acute injury or inflammation
• recent or potential hemorrhage
• thrombophlebitis
• imparied sensation or mentation
• malignancy
• infared irradiation of the eyes

• Pregnancy
• imparied circulation or poor thermal regulation
• edema
• cardiac insufficency
• metal in the area
• over an open wound
• over areas where topical counterirritants have recently been applied

Sound head - crystal that converts electrical energy to sound

amount of acoustic energy per unit time (W)

power per unit area of the sound head (W/cm²)

average intensity of US output over the area of the transducer

peak intensity of US output over the area of the transducer

ratio of the spatial peak intenisty to the spatial average intensity

proportion of the total treatment time the the US is on (% or ratio)

spatial average intensity of the US during the on time of the pulse

SATP x duty cycle

area of the transducer from which the US energy radiates

• near Fresnel zone
• far Fraunhofer zone
• human treatment lies in the near zone 2-5 cm

• formation, growth and pulsation of gas or vapor filled bubbles caused by US
• stable cavitation has been proposed as a mechanism for the nonthermal effects of US

microscale eddying around gas bubbles that oscillate due to cavitation

steady, circular flow of cellular fluids induced by US

application of US with a topical drug to facilitate transdermal drug delivery

• thermal effects
• tissues affected
• nonthermal effects

• soft tissue stretching
• pain control
• tendon injuries
• resorption of calcium deposits
• bone fractures
• phonophoresis
• plantar warts and herpes zoster

• malignant tumor
• pregnancy
• central nervous system tissue
• over joint cement or plastic
• over a pacemaker
• thrombophlebitis
• over the eyes
• reproductive organs

• acute inflammation
• epiphyseal plates
• fractures
• breast implants

• dislocation or unhealed fracture
• presence of myositis ossificans

• Infection in or around the joint
• Pain medications
• Osteoporosis
• Hypermobile joints
• Hematoma region

• disc bulge or herniation
• nerve root impingement
• joint hypomobility
• subacute joint inflammation
• paraspinal muscle spasm

• apply in a less aggressive manner when first applied
• if condition worsens or does not improve within 2-3 Rx
• where motion is contraindicated
• acute injury or inflammation
• hypermobility or instability
• peripheralization of symptoms with Tx
• uncontrolled HTN (with inversion)

• structural disease or condition affecting the bones of the spine
• when pressure of the belts may be hazardous
• displacement of a fragment of annulus
• medial disc protrusion
• for whom severe pain resolves fully with Tx
• Patients experiencing claustrophobia or other psychological aversion
• cannot tolerate prone or supine positions
• disoriented patients
• patients with TMJ problems
• patients who wear dentures

• Force: intermittent 3:1 ivd 1:1 joint, start 25-50 lbs increase to 60% body weight
• Duration: 5 min for severe Sx and 10 for moderate
• Frequency: no set limit

limits the shape and size of tissues

edema

• hear faliure or pulmonary edema
• recent or acute DVT or the like
• when lymphatic or venous return is obstructed
• severe peripheral arterial disease or ulcers due to arterial insufficiency
• acute local skin infection
• significant hypoproteinemia
• acute trauma or fracture

• impaired sensation or mentation
• uncontrolled HTN
• cancer
• stroke or significant cerebrobascular insufficiency
• area of superficial peripheral nerve

• cleansing
• musculoskeletal
• cardiovascular
• respiratory
• renal
• psychological

• cardiac instability
• infectious conditions that may be spread by water
• bowel incontinence
• severe epilepsy
• suicidal patients

none

• confusion or disorientation
• after ingestion of alcohol
• limited strength, endurance, balance, or ROM
• medications
• urinary incontinence
• fear of water
• respiratory problems
• pregnancy (hot)
• MS (hot)
• poor thermal regulation (hot)

• impaired thermal sensation
• infection
• confusion or impaired cognition
• recent skin grafts
• maceration (non immersion)

psoriasis (UVB alone or UVA with psoralen sensitization)

wound healing (UVC most common band chosen)

• to the eyes
• skin cancer
• pulmonary TB
• cardiac patients
• kidney
• liver disease
• lupus
• fever

• patient is using photosensitizing medication
• photosensitivity
• recent x-ray radiation therapy
• until the effects of the final dose have disappeared

• same lamp for treating as testing
• four spots exposed for progressive ammounts of time
• suberythemal (SED) - no change in skin after 24 hrs
• minimal erythemal (MED) - red within 8 hrs and dissapears within 24hrs
• 1st degree eyrthema (E₁) - red within 6hrs lasts 1-3 days
• 2nd degree eyrthema (E₂) - red and peeling within 2 hrs
• 3rd degree eyrthema (E₃₎ - severe blistering, peeling and exudation

light amplified by stimulated emssion of radiation

• cellular effects
• nerve conduction and regeneration
• vasodilation

• wound and fracture healing (weakly supported)
• musculoskeletal disorders (better than placebo)
• pain management (no strong evidence)

• directly to the eyes
• within 4-6 months after radiotherapy
• over hemorrhaging areas
• locally to the endocrine glands

epilepsy

• 27.12 MHz
• most common

2450 MHz

• heat deeper
• heat larger area than US
• SWD not reflected by bones
• Doesn't need direct clinician contact for Rx period

• inductive coil
• capacitive plates
• magnetron

• Thermal effects are the same as other heat applying modalities
• increased microvascular perfusion
• altered cell membrane function and cellular activity

same indicators for use of thermal agents

• control pain and edema
• wound healing
• nerve healing
• bone healing

patient with implanted or transcutaneous neural stimulatros

• metal implants or pacemakers
• areas of malignancy
• pregnancy
• eyes
• testes and ovaries
• growing epiphyses

• electronic or magnetic equipment should not be used near the machine
• obesity (heat fat excessively)
• copper-bearing interuterine contraceptive devices