Therapeutic Modalities Midterm Exam

Therapeutic Modalities

Purposes of modality use:
- Promote and improve wound healing, pain relief, flexibility, muscular strength, speed, coordination, power, agility, and cardiorespiratory endurance
The art and science of modality use involves considering:
- Tradition, experience, science, and theory
Modality selection criteria:
- Thorough evaluation resulting in a correct diagnosis
- Understanding of pathologic and physiologic changes associated with injury
- Treatment plan outlining therapeutic goals
- Understanding of modalities' effects, indications, and contraindications

Evidence-Based Practice

Definition of Evidence-Based Medicine (EBM):
- Medicine based on the latest and most rigorous scientific evidence, integrating with clinical experience and patient preferences
Definition of Evidence-Based Practice (EBP):
- Application of EBM principles to professional practice
Types of outcome measures:
- Clinician- or disease-oriented outcomes (e.g., physiological data, X-ray results, ROM measurements)
- Patient-oriented outcomes (e.g., patient's assessment of current health status, quality of life, symptoms)
Levels of evidence:
- Not specified in the provided text, but generally ranges from high-level evidence (e.g., systematic reviews, randomized controlled trials) to low-level evidence (e.g., expert opinions, case studies)
Best practices:
- Specific treatment plans to resolve a patient's condition in the most complete way
Standard of Care:
- Another term for best practices
Clinical Practice Guidelines:
- Systemically developed statements that describe the best and achievable practice for a specific area of care

General Application Procedures

Approaches to modality application:
- Cookbook approach: following a protocol for each injury without considering individual patient factors
- Critical thinking approach: organized procedural outline with broad guidelines that empowers the clinician
Standard operating procedures:
- Specific guidelines and protocols for performing a specific task
- Form of quality control
- Promotes consistency, but may have potential disadvantages (e.g., promoting a cookbook approach, being daunting to learn)
5-step application framework:
- Foundation: description, effects, advantages, disadvantages, indications, contraindications, and precautions
- Pre-application: selecting the proper modality, preparing the patient psychologically and physically, and equipment preparation
- Application: following procedures, adjusting parameters, and ensuring safety
- Post-application: equipment removal, patient cleanup, recording treatments, and providing instructions
- Maintenance: routine maintenance and repairs

Injury Record Keeping

Purpose of record keeping:
- Communication and quality control
- Legal protection
- Research
- History
- Traffic patterns
Types of SOAP notes:
- Initial note: written after the initial assessment
- Progress note: periodic documentation of treatment results
- Discharge note: written when treatment is discontinued
Initialing and dating notes:
- Always date and initial notes to establish when the entry was created and to identify the clinician responsible for the entry

Tissue Response to Injury

Cardinal signs of inflammation:
- Rubor (redness)
- Calor (heat)
- Edema (swelling)
- Dolor (pain)
- Funca laesa (functional loss)
Sequential events of the inflammatory process:
- Injury
- Ultrastructural changes
- Chemical changes
- Hemodynamic changes
- Metabolic changes
- Permeability changes
- Leukocyte migration
- Phagocytosis
Macro- vs microtrauma:
- Macrotrauma: caused by a large insult, resulting in immediate tissue disruption (acute injuries)
- Microtrauma: caused by small or low-grade stress, wearing away tissue over time (chronic injuries or overuse)
Neutrophils vs macrophages:
- Neutrophils: smaller, faster, and more numerous, arriving at the injury site first and providing a temporary first line of defense against bacterial infections
- Macrophages: larger, living for months, and reproducing, providing a long-lasting second line of defense and cleaning up cellular debris to prepare for repair
Recurring vs chronic inflammation:
- Recurring inflammation: reinitiated acute inflammation before the previous episode of acute inflammation has finished
- Chronic inflammation: begins in a slow, unnoticed manner, occurring when the inflammatory response cannot eliminate the cause of injury
Primary vs secondary injury:
- Primary injury: direct result of the initial physical forces
- Secondary injury: the body's response to the traumatized tissue
Secondary enzymatic and metabolic responses:
- Secondary enzymatic: release of enzymes from lysosomes to digest cellular debris
- Secondary metabolic: caused by prolonged local ischemia, resulting in a deficit of blood to the area
Edema vs swelling vs inflammation:
- Inflammation: local response to injury
- Edema: accumulation of fluid portion of blood in the tissues
- Swelling: increase in tissue volume due to extra fluid and cellular material

Immediate Care of Orthopedic Injury

RICES:
- Rest
- Ice
- Compression
- Elevation
- Stabilization
Immediate care vs acute care:
- Immediate care: 7-12 hours
- Acute care: 0-4 days
Cryotherapy in immediate care:
- Decreased blood flow theory
- Decreased secondary injury theory

The Healing Process

Phases of repair:
- Hemostasis and inflammation: lymphatic drainage
- Epithelialization: developing a membranous tissue covering exposed tissue
- Proliferation: angiogenesis, collagen synthesis, and wound contraction
- Remodeling: contraction, restructuring, and collagen reconstruction
Healing modifiers:
- Immediate care procedures
- Pain
- Wound closure
- Exercise
- Modalities
Therapeutic goals and corresponding modalities:
- Stimulate healing process: ultrasound, E-stim, hot packs
- Promote lymphatic drainage: massage, cryokinetics, edema pressure devices
- Moderate pain: cryokinetics, cryostretch, TENS

Understanding and Relieving Pain

Anatomy review:
- Hypothalamus: control station for the body's activities
- Thalamus: sensations such as heat, cold, pain, and touch
- Cerebral cortex: intensity and location of pain
- White and grey matter: afferent and efferent nerves
Pain perception modifiers:
- Heredity
- Psychosocial experience
- Prior pain experience
- General life stress
Pain pathway:
- Noxious stimuli travel to the spinal cord, entering through the dorsal horn, and exiting at the ventral horn into the thalamus, then to the cerebral cortex
Pain theories:
- Specificity: specific nociceptive receptors in the periphery, sending impulses on specific neural pathways
- Pattern: denies the existence of specific pain receptors, proposing that pain occurs when it reaches a certain threshold
- Gate control: operates at the spinal level, proposing a gate mechanism that allows only one sensation at a time
- Neuromatrix: pain is a multidimensional experience, unique to each person
- Fear Avoidance: proposes that acute back pain turns into chronic pain due to fear and avoidance behaviors
Origins of orthopedic pain:
- Nociceptive: response to injury to the body
- Neuropathic: complex, chronic pain, usually due to tissue damage
- Idiopathic: unknown origin
- Learned: developed from a patient's pain memories
Placebo and placebo effect:
- Placebo: a medically inactive substance that appears as the real thing
- Placebo effect: measurable, observable, or felt improvement in health not attributable to treatment