Part 1 book “Therapeutic modalities in rehabilitation” has contents: The basic science of therapeutic modalities, using therapeutic modalities to affect the healing process, the role of therapeutic modalities in wound healing, managing pain with therapeutic modalities, basic principles of electricity and electrical stimulating currents,… and other contents.
Therapeutic Modalities in Rehabilitation Notice Medicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work Readers are encouraged to confirm the information contained herein with other sources For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs Therapeutic Modalities in Rehabilitation Fourth Edition William E Prentice, PhD, PT, ATC, FNATA Professor, Coordinator of Sports Medicine Program Department of Exercise and Sport Science University of North Carolina at Chapel Hill Chapel Hill, North Carolina With Case Studies and Lab Activities Contributed by: William S Quillen, PhD, PT, SCS, FACSM Associate Dean, College of Medicine Professor and Director, School of Physical Therapy and Rehabilitation Sciences University of South Florida Tampa, Florida Frank Underwood, PhD, MPT, ECS Professor, Department of Physical Therapy University of Evansville Clinical Electrophysiologist, Rehabilitation Service Orthopaedic Associates, Inc Evansville, Indiana Copyright © 2011, 2005 by The McGraw-Hill Companies, Inc All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-173930-6 MHID: 0-07-173930-0 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-173769-2, MHID: 0-07-173769-3 eBook conversion by codeMantra Version 2.0 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please e-mail us at bulksales@mcgraw-hill.com TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc (“McGrawHill”) and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise Contents Contributors to This and Previous Editions Preface Acknowledgements Master Competency Checklist PART ONE Foundations of Therapeutic Modalities The Basic Science of Therapeutic Modalities William E Prentice and Bob Blake Forms of Energy Electromagnetic Energy The Relationship Between Wavelength and Frequency The Electromagnetic Energy Spectrum How Is Electromagnetic Energy Produced? Effects of Electromagnetic Radiations Laws Governing the Effects of Electromagnetic Energy Electromagnetic Energy Modalities Thermal Energy Thermal Energy Modalities Electrical Energy Electrical Energy Modalities Sound Energy Sound Energy Modalities Mechanical Energy Mechanical Energy Modalities Summary Using Therapeutic Modalities to Affect the Healing Process William E Prentice How Should the Clinician Use Therapeutic Modalities in Rehabilitation? The Importance of Understanding the Healing Process Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase Factors That Impede Healing How Should Therapeutic Modalities Be Used Throughout the Rehabilitation Process? Using Modalities in the Immediate First Aid Management of Injury Modality Use in the Inflammatory-Response Phase Modality Use in the Fibroblastic-Repair Phase Modality Use in the Maturation-Remodeling Phase Indications and Contraindications Other Considerations in Treating Injury Summary The Role of Therapeutic Modalities in Wound Healing Pamela E Houghton Introduction Superficial Hot and Cold Effects of Hot and Cold Agents on Blood Flow Hydrotherapy Electrical Stimulation Ultrasound Laser Effects of Laser on Tissue Repair Ultraviolet Light Pneumatic Compression Therapy Review of Clinical Research Evidence Choosing the Best Modality for the Treatment of Delayed or Nonhealing Wounds Contraindications Summary Managing Pain With Therapeutic Modalities Craig R Denegar and William E Prentice Understanding Pain Types of Pain Pain Assessment Pain Assessment Scales Goals in Managing Pain Pain Perception Sensory Receptors Cognitive Influences Neural Transmission Facilitators and Inhibitors of Synaptic Transmission Nociception Neurophysiologic Explanations of Pain Control The Gate Control Theory of Pain Descending Pain Control β-Endorphin and Dynorphin in Pain Control Summary of Pain Control Mechanisms Pain Management Summary PART TWO Electrical Energy Modalities Basic Principles of Electricity and Electrical Stimulating Currents Daniel N Hooker and William E Prentice Components of Electrical Currents Electrotherapeutic Currents Generators of Electrotherapeutic Currents Electrical Circuits LAB ACTIVITY HYDROCOLLATOR PACKS DESCRIPTION Commercially available hot packs (hydrocollator packs) are usually a canvas cover filled with a hydrophilic substance such as bentonite Hot packs are kept in a commercial water-filled container that maintains a temperature of approximately 71°C The packs are wrapped in six to eight layers of dry towels to protect the patient from burns; commercial hot pack covers provide approximately four thicknesses of toweling After use, the hot pack should be returned to the cabinet for at least 30 minutes to insure reheating Hot packs provide only superficial heating; the maximum depth of therapeutic heating is only about 1 cm, and occurs within 10 minutes of application PHYSIOLOGIC EFFECTS Vasodilation Decreased pain perception Increased local metabolism Increased connective tissue plasticity Decreased isometric strength (transient) THERAPEUTIC EFFECTS Decreased pain Increased soft-tissue extensibility INDICATIONS The principal indication for a hot pack is to provide therapeutic warming of superficial tissues Tissues that are deeper than 1 cm do not reach a therapeutic temperature range of 30–40°C Therefore, if the target tissue is deeper than 1 cm (e.g., the spinal facet joints), a hot pack will not be effective Other joints, such as the knee, wrist, and ankle, can be effectively heated with a hot pack The primary therapeutic effect of superficial heating is to increase the ability of the collagen to remodel Therefore, heating the tissue is beneficial following a period of reduced mobility if the soft tissue has shortened In addition, the tissue viscosity is reduced, resulting in a greater ease of motion through the available range of motion Although generally not a problem, in case of extreme pressure sensitivity, the weight of a hot pack may be more than the patient can tolerate In these cases, Fluidotherapy or a warm whirlpool may be helpful CONTRAINDICATIONS Lack of normal temperature sensibility Peripheral vascular disease with compromised circulation Over tumors HYDROCOLLATOR PACKS LAB ACTIVITY PARAFFIN BATH DESCRIPTION Paraffin baths consist of dipping and removing or immersing the body part in a mixture of wax and mineral oil The ratio of wax and mineral oil is about 7:1, which results in a substance with a melting point of about 47.8°C, a specific heat of about 0.65 cal/g/°C, and a therapeutic temperature range of 48–54°C Because of the low specific heat, much higher temperatures can be tolerated than if water is used The paraffin is kept in a thermostatically controlled cabinet Paraffin provides a superficial heat, with a depth of therapeutic heating of about 1 cm However, because paraffin is generally used only for the hands and feet, the depth of penetration is adequate to warm these joints to a therapeutic range The two basic techniques of application of paraffin involve repeated dipping of the body part in the mixture, then covering the body part with plastic and toweling The advantage of this method is that the body part can then be elevated, reducing the potential for swelling The second method involves dipping the body part in the paraffin once, letting it dry for a few seconds, then immersing the body part for the duration of the treatment The advantage of this technique is that the source of heat is constant, so the therapeutic temperature can be maintained for a longer period PHYSIOLOGIC EFFECTS Vasodilation Decreased pain perception Increased local metabolism Increased connective tissue plasticity Decreased isometric strength (transient) THERAPEUTIC EFFECTS Decreased pain Increased soft-tissue extensibility INDICATIONS The principal indication for a paraffin bath is to provide therapeutic warming of superficial tissues This is particularly effective in the hands and feet following a period of immobilization The increased connective tissue plasticity that occurs with warming will enhance the effectiveness of therapeutic exercise Paraffin baths are also helpful in alleviation of pain caused by arthritic changes in the hands and feet Caution should be exercised in using paraffin (or any heating agent) during an acute phase of arthritic pain and swelling CONTRAINDICATIONS Lack of normal temperature sensibility Peripheral vascular disease with compromised circulation Over tumors PARAFFIN BATH LAB ACTIVITY INFRARED LAMPS DESCRIPTION Infrared lamps provide superficial (1 mm or less) heating Because of the extremely limited penetration, they are not capable of elevating connective tissue temperatures to a therapeutic level Therefore, their primary effect is one of mild anal-gesia, and their use is very limited PHYSIOLOGIC EFFECTS Cutaneous vasodilation Decreased pain perception THERAPEUTIC EFFECTS Decreased pain INDICATIONS The principal indication for infrared lamp heating is localized pain Elevation of skin temperature may decrease the perception of pain for a short time CONTRAINDICATIONS Lack of normal temperature sensibility Peripheral vascular disease with compromised circulation Over tumors INFRARED LAMPS LAB ACTIVITY FLUIDOTHERAPY DESCRIPTION Fluidotherapy is a device manufactured by Henley International of Sugarland, TX Heated air is forced through a container filled with cellulose particles; when heated, the cellulose takes on fluidlike characteristics The body part to be treated is immersed in the cellulose particles, and the particles are circulated in the container, thus providing elevation of tissue temperature and a mechanical stimulation of the skin The temperature of the unit is adjustable within a range of about 39–48°C There are several advantages to using Fluidotherapy to treat affected hands or feet The source of heat is constant, so the tissue temperature can be maintained at a therapeutic level for the duration of the treatment The body part can be exercised during the treatment, either actively or passively by the therapist The mechanical stimulation of the skin with the cellulose particles may provide some analgesic effect and may help desensitize the injured area PHYSIOLOGIC EFFECTS Vasodilation Decreased pain perception Increased local metabolism Increased connective tissue plasticity Decreased isometric strength (transient) THERAPEUTIC EFFECTS Decreased pain Increased soft-tissue extensibility INDICATIONS The principal indication for Fluidotherapy is to provide therapeutic warming of a larger area of the body than can be achieved readily with a hot pack In addition, the patient can perform active exercise during the application, or the therapist can perform joint mobilization on the injured limb while in the unit The primary therapeutic effect of superficial heating is to increase the ability of the collagen to remodel Therefore, heating the tissue is beneficial following a period of reduced mobility if the soft tissue has shortened In addition, the tissue viscosity is reduced, resulting in a greater ease of motion through the available range of motion CONTRAINDICATIONS Lack of normal temperature sensibility Peripheral vascular disease with compromised circulation Over tumors Coronary artery disease FLUIDOTHERAPY ... Modality Use in the Maturation-Remodeling Phase Indications and Contraindications Other Considerations in Treating Injury Summary The Role of Therapeutic Modalities in Wound Healing Pamela E Houghton Introduction... A chapter that deals specifically with the role of therapeutic modalities in wound healing is followed by a discussion of pain in terms of the neurophysiologic mechanisms of pain and the role of therapeutic modalities in pain management Part II—Electrical Energy Modalities includes detailed discussions of the... Neurophysiologic Explanations of Pain Control The Gate Control Theory of Pain Descending Pain Control β-Endorphin and Dynorphin in Pain Control Summary of Pain Control Mechanisms Pain Management Summary PART TWO Electrical Energy Modalities