Transcript Injury Treatment - williston.k12.sc.us

Injury
Treatment
Ms. Bowman
Injury Treatment
• 2 areas
o Therapeutic Modalities
o Therapeutic Exercise
Therapeutic Modalities
• Non-exercise treatment options
o Include the use of:
• Heat
• Cold
• Electrotherapy
• Massage
• Traction
• Ultrasound
• Compression
• Vocabulary
o Indications-reasons/injuries where it is appropriate to use the modality
o Contraindications-reasons/injuries where it is inappropriate to use the
modality
Thermal Modalities
• Transfer energy to or from the tissues; exchange of
energy based on a temperature gradient
• Energy transferred through
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Conduction-between two objects that are touching
Convection-movement of a medium (water, air)
Radiation-transfer without the use of a medium
Conversion-energy changed to another form
Evaporation-liquid to gas state
Thermal Modalities
• Cryotherapy-application of cold modalities
o Effects:
• Vasoconstriction
• Decreased rate of cell metabolism
• Decreased production of cell waste
• Reduction of inflammation
• Decreased nerve conduction
• Decreased pain
• Decreased muscle spam
• Decreased muscular force production
Thermal Modalities
• Cryotherapy
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Types:
o Ice bag
o Ice cup
o Cold whirlpool
o Ice immersion
o
Indications:
• Acute injury or inflammation
• Acute or chronic pain
• Small, superficial, first-degree
burns
• Postsurgical pain and edema
• Use in conjunction with
rehabilitation exercises
• Acute or chronic muscle spasms
• neuralgia
Contraindications:
• Cardiac or respiratory
involvement
• Uncovered open wounds
• Circulatory insufficiency
• Cold allergy/cold-induced
urticaria
• Anesthetic skin
• Advanced diabetes
• Peripheral vascular disease
• Raynaud’s phenomenon
• Lupus
Thermal Modalities
• Thermotherapy- application of superficial or deep
heating agents
o Effects• Vasodilation
• Increased rate of cell metabolism
• Increased delivery of leukocytes
• Increased capillary permeability
• Increased venous and lymphatic drainage
• Edema formation
• Removal of metabolic wastes
• Increased elasticity of collagen-rich tissues
• Analgesia and sedation of nerves
• Decreased muscle tone
• Decreased muscle spasm
• Decreased pain
• Increased nerve conduction and velocity
Thermal Modalities
• Thermotherapy
o Types:
• Superficial
o Heat pack
o Warm whirlpool
o Warm immersion
o Infrared lamps
o Paraffin baths
• Deep Heat
o Microwave diathermy
o Shortwave diathermy
o ultrasound
• Indications:
o Subacute or chronic
inflammatory conditions
o Reduction of subacute or chronic
pain
o Subacute or chronic muscle
spasm
o Decreased range of motion
o Hematoma resolution
o Reduction of joint contractures
• Contraindications:
o Acute injuries
o Impaired circulation
o Advanced arthritis (vigorous
heating)
o Poor thermal regulation
o Anesthetic areas
o Neoplasms
o thrombophlebitis
Deep Heating Agents
• Therapeutic Ultrasound-deep-penetrating modality
capable of producing changes in tissue through
both thermal and nonthermal mechanisms
o Uses acoustical energy
• Effects
o Deep-heating
o Increase rate of tissue repair
o Wound healing
o Increased blood flow
o Increased tissue extensibility
o Breakdown calcium deposits
o Reduction of pain
o Reduction of muscle spasm
o Deliver medications
Deep Heating Agents
• Ultrasound
o Continuous Output
• Used for heating tissues
o Pulsed Output
• Nonthermal effects
o The closer the duty cycle is to 100% the more thermal effects there are.
The lower the duty cycle, the less thermal effects
Deep Heating Agents
• Nonthermal Effects
o Increased cell membrane
permeability
o Altered rates of diffusion across
the cell membrane
o Increased vascular permeability
o Secretion of cytokines
o Increased blood flow
o Increased fibroblastic activity
o Stimulation of phagocytosis
o Production of healthy granulation
tissue
o Synthesis of protein
o Synthesis of collagen
o Reduction of edema
o Diffusion of ions
o Tissue regeneration
o Formation of stronger, more
deformable connective tissue
• Thermal Effects
o Increased sensory nerve
conduction velocity
o Increased motor nerve
conduction velocity
o Increased extensibility of
collagen-rich structures
o Increased collagen deposition
o Increased blood flow
o Reduction of muscle spasm
o Increased macrophage
activity
o Enhanced adhesion of
leukocytes to damaged
endothelial cells
Deep Heating Agents
• Indications
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Joint contractures
Muscle spasms
Neuroma
Scar tissue
Sympathetic nervous system
disorders
Trigger areas
Warts
Spasticity
Postacute reduction of myositis
ossificans
Acute inflammatory conditions
(pulsed)
Chronic inflammatory
conditions (pulsed or
continuous)
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Contraindications
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Acute conditions (continuous)
Ischemic areas
Areas of impaired circulation/artery
disease
Over areas of deep vein thrombosis
Anesthetic areas
Over cancerous tumors
Over sites of active infection of
sepsis
Over spinal cord or large nerve
plexus (high doses)
Exposed metal that penetrates skin
Areas around eyes, heart, skull, or
genitals
Over the thorax (pacemaker)
Pregnancy when over pelvic or
lumbar areas
Over fracture site before healing is
complete
Stress fracture sites or sites of
osteoporosis
Over the pelvic of lumbar area in
menstruating patients
Deep Heating Agents
Temperature Increases and Their Desired Effect
Classification of
Ultrasound
Temperature
Increase
Used for Thermal Effects
Mild
1ºC
Mild inflammation, accelerating metabolic
rate
Moderate
2°-3°C
Decreasing muscle spasm, decreasing pain,
increasing blood flow, reducing chronic
inflammation
Vigorous
3°-4°C
Tissue elongation, scar tissue reduction,
inhibition of sympathetic activity
Deep Heating Agents
Rate of Ultrasound Heating (temperature increase per minute)
Intensity Tissue Depth
1MHz
3MHz
0.5
0.04°C
0.3°C
1.0
0.2°C
0.6°C
1.5
0.3°C
0.9°C
2.0
0.4°C
1.4°C
Deep Heating Agents
• Shortwave diathermy-uses high frequency
electromagnetic energy to produce deep heat
within the tissue
o Effects similar to thermal and nonthermal ultrasound
Deep Heating Agents
• Effects
o Thermal• Increased microvascular perfusion
• Activation of fibroblast growth factors
• Increased macrophage activity
o Nonthermal• Heating of large area of tissue
o Heat retained 3 times longer than ultrasound
Deep Heating Agents
• Indications
o Acute trauma (nonthermal)
o Acute inflammation
(nonthermal)
o Edema reduction (nonthermal)
o Subacute inflammation
o Pain syndromes
o Muscle spasms
o Chronic inflammation
o Increase blood flow
o Stretching collagen-rich tissues
• Contraindications
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Ischemia
Hemorrhage
Acute inflammation (thermal)
Metal within the output field
Pacemaker
Presence of moisture
Moist dressing, adhesive tape,
skin creams
Skull (extreme caution)
Contact lenses must be
removed before application
over head
Pregnancy (over pelvis,
abdomen, or lumbar)
Menstruating females (over
pelvis, abdomen, or lumbar)
Unfused epiphyseal plates
Deep Heating Agents
Precautions Against Metal Within the Field of Shortwave Diathermy
In the Environment
Beds
Treatment tables
Chairs
Wheelchairs
Metal stools
CPM Units
Splints
Braces
Medical instruments
Electrical modalities
Near or On the Patient
Jewelry
Body piercings
Earrings
Watches
Metal in pockets (keys,
etc.)
Belt buckles
Zippers
Metal underwire bras
Hearing aids
In the Patient
Orthodontic braces
Dental fillings
Implanted fixation
devices
External fixation devices
Metal heart valves
Artificial joints
Metal IUDs
Body piercings
Cardiac pacemakers
Implanted bone growth
generators
Phrenic pacers
Electrical Stimulation
• Electrical stimulation-modality that utilizes electrical
currents
• Electricity-force created by an imbalance in the number
of electrons at two points (poles)
o Electrons flow in an attempt to equalize difference in charges—this creates an
electrical current
• Negative pole-area of high electron concentration
• Positive pole-area of low electron concentration
o Closed circuit-formed when a complete path is formed between the
2 poles
o Electrical Currents
• Direct Current-uninterrupted, one directional flow of electrons; square
wave
• Alternating Current-direction of flow changes from positive to negative in
a cyclical manner; no true positive or negative poles; electrons go back
and forth between electrodes
• Pulsed Current-one direction of flow that is interrupted by periods of no
current flow
Electrical Stimulation
• Vocabulary
o Electrode leads-wires that conduct the current to and from the generator,
electrodes, and patient
o Electrodes-introduce the current into the body; point where the electrode
contacts the skin is where the electrons are converted into ions
• When placed closer together, current flows superficially
• When places farther apart, the deeper the current flows
Stimulation Levels
Subsensory
Between the point at which the output rises from zero to the
point where the patient first receives an electrical sensation
Sensory
Stimulation of only sensory nerves
Motor
Stimulation that produces a visible muscle contraction
Noxious
Stimulation of pain fibers
Electrical Stimulation
• Contraindications
• Indications
o Controlling acute and chronic
pain
o Reducing edema
o Reducing muscle spasm
o Reducing joint contractures
o Inhibiting muscle spasms
o Minimizing disuse atrophy
o Facilitation tissue healing
o Facilitating muscle reeducation
o Facilitating fracture healing
o Strengthening muscle
o Cardiac disability
o Pacemakers
o Pregnancy (over abdomen,
pelvis, and lumbar regions)
o Menstruation (over abdomen,
pelvis, and lumbar regions)
o Cancerous lesions
o Sites of infection
o Exposed metal implants
o Areas of nerve sensitivity
• Carotid sinus
• Esophagus
• Larynx
• Pharynx
• Around or on eyes
• Upper thorax
• Temporal region
o Severe obesity
o Epilepsy
o Electronic monitoring
equipement
Electrical Stimulation
• Types
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High-Voltage Pulsed Stimulation
Transcutaneous Electrical Nerve Stimulation (TENS)
Interferential Stimulation
Neuromuscular Electrical Stimulation
Iontoporesis
Microcurrent Electrical Stimulation
Mechanical and Light
Modalities