Chapter 2 Using Therapeutic Modalities to Affect the Healing Process PDF

Chapter 2 Using Therapeutic Modalities to Affect the Healing Process  Using Therapeutic Modalities to Affect the Healing Process Have a specific reason to use the modality Do NOT use them because, “this is what has always been done” No “cookbook” exists for modalities How Should the...

Chapter 2 Using Therapeutic Modalities to Affect the Healing Process  Using Therapeutic Modalities to Affect the Healing Process Have a specific reason to use the modality Do NOT use them because, “this is what has always been done” No “cookbook” exists for modalities How Should the AT Use Is this a modality? Modalities  Using Therapeutic Modalities to Affect the Healing Process Increase the physiological response of the tissue to injury Increase the healing process of tissues How Should the AT Use Modalities Is this a modality?  Using Therapeutic Modalities to Affect the Healing Process Acute Beginning point for the injury Caused by trauma Chronic Result from overuse Repetitive dynamics Descriptive Injury Terms Acute or Chronic?  Using Therapeutic Modalities to Affect the Healing Process Macrotraumatic Injury Caused by trauma Immediate pain & disability Microtraumatic Injury Most often overuse injuries Repetitive overloading Continuous incorrect mechanism Secondary Injury Results from primary injury Inflammation Secondary Hypoxic Injury Descriptive Injury Terms Macro or Micro?  TRAUMA PRIMARY INJURY Blood Greater risk of reinjury Damaged tissue Reduced risk of reinjury Hematoma SECONDAY RESPONSE Scab Edema Hypoxic damaged tissue Bleeding Return to activity INFLAMMATION Return to full activity Pain Guarding Less than optimal recovery REPAIR PHASES Optimal recovery Inflammation Fibroplastic Maturation Inadequate ATROPHY Adequate REHABILITATION Using Therapeutic Modalities to Affect the Healing Process Redness Swelling Tenderness to touch Increased temperature Loss of function Signs of Inflammation How many signs of inflammation can be identified? Using Therapeutic Modalities to Affect the Healing Process (Strong contracted scar develops, increasing strength and full return to function) 3 weeks-2years Fibroblastic-repair phase (diminishing pain & tenderness, gradual return to function) 2 days – 6 weeks) Inflammatory-response phase (Redness, swelling, tenderness increased temperature, loss of function) Initial 0-4 days Injury Time Using Therapeutic Modalities to Affect the Healing Process Show me: Epidermis Dermis Subcutis Veins Artery Nerves Lymph vessels Introduce Inflammation/Injury What happened? You Are Inflammation Skin attaches to underlying bone  Using Therapeutic Modalities to Affect the Healing Process Cellular injury results in altered metabolism & the liberation of materials to initiate the inflammatory response Signs & Symptoms Redness Swelling Tenderness Increased temperature Loss of function Inflammatory-Response Acute Injury Phase/Signs & Symptoms  Using Therapeutic Modalities to Affect the Healing Process Leukocytes A white blood cell that is the primary effector cell against infection & tissue damage that functions to clean up damaged cells Phagocytes Cell that has the ability to destroy & ingest other debris Exudate Fluid from circulatory system All of the above delivered to the tissue at injury time Inflammatory-Response Heavily Exuding Wound Phase/Cellular Response  Using Therapeutic Modalities to Affect the Healing Process Cellular response is protective Localizes or disposes injury by-products Sets the stage for repair Phagocytosis Prepares area to be repaired by removing debris Inflammatory-Response Phase/Cellular Response  Using Therapeutic Modalities to Affect the Healing Process Migration of leukocytes from the blood to the tissues Inflammatory-Response Types of Leukocytes Phase/Cellular Response  Using Therapeutic Modalities to Affect the Healing Process 3 chemical mediators Histamine Leukotrienes Cytokines All of these mediators limit the amount of exudate, thus limiting limiting swelling Inflammatory-Response Where are the Phase/Chemical Mediators histamines?  Using Therapeutic Modalities to Affect the Healing Process Histamines Leukotrienes & Released from injured mast Prostaglandins cells Leukocytes adhere along Cause Vasodilation cell walls Increases cell permeability Increase cell permeability Combine to form exudate Inflammatory-Response Phase/Chemical Mediators  Using Therapeutic Modalities to Affect the Healing Process Cytokines Attract leukocytes to inflammation site Attraction of these cells will occur in first several hours post-injury Inflammatory-Response Where are the cytokines? Phase/Chemical Mediators  Using Therapeutic Modalities to Affect the Healing Process Vasoconstriction of vessels leading away from the injury for 5-10 minutes Anemia followed by hyperemia when vasodilation takes place Initial effusion of blood & plasma lasts for 24 to 26 hours Inflammatory-Response Phase/Vascular Reaction  Using Therapeutic Modalities to Affect the Healing Process Platelets adhere to collagen fibers The above matrix adheres to vascular wall More platelets & leukocytes adhere & form a plug Act to localize injury Inflammatory-Response Phase/Function of Platelets  Using Therapeutic Modalities to Affect the Healing Process Protein molecule (thromboplastin) release from damaged cell Protein molecule causes firbronogen to convert to fibrin Fibrin forms a clot that shuts off blood supply to injured area Clot formation begins at 12 hours and is completed by 48 hours Inflammatory-Response Blood Clot Phase/Clotting Process  Using Therapeutic Modalities to Affect the Healing Process Injured area becomes walled off Area prepared for fibroblastic phase Inflammatory response last 2 to 4 days Inflammatory-Response Phase/Clotting Process  Using Therapeutic Modalities to Affect the Healing Process Occurs when the acute response does not eliminate the injuring agent and restore tissue to a normal state Low grade inflammation persists Connective tissue damage occurs with necrosis of healthy tissues Fibrosis perpetuates Inflammatory-Response Where is the Phase/Chronic Inflammation inflammation?  Using Therapeutic Modalities to Affect the Healing Process Scar tissue formation & repair of injured tissue Scar formation referred to as fibroplasia Begins in the first few of post-injury and may last 4 to 6 weeks Fibroblastic-Repair Phase Excessive Fibroblastic Proliferation  Using Therapeutic Modalities to Affect the Healing Process Signs and Symptoms of inflammatory phase subside Complaints of pain or tenderness subside Fibroblastic-Repair Phase/Signs & Symptoms  Using Therapeutic Modalities to Affect the Healing Process Capillary budding begins Increased blood flow brings increased oxygen, nutrients, & healing Fibroblastic-Repair Capillary Budding Phase/Revascularization  Using Therapeutic Modalities to Affect the Healing Process Granulation tissue forms with the breakdown of the fibrin clot Appears as the reddish granular mass that fills the gaps during the healing process On day 6 or 7 fibroblasts begin producing collagen fibers Collagen fibers deposited at random forming a scar A mature scar is devoid of physiologic function Fibroblastic-Repair Mature Scar Phase/Formation of Scar  Using Therapeutic Modalities to Affect the Healing Process Stress & Strain realign scar tissue parallel to the lines of tension Scar tissue rarely as strong as uninjured tissue Scar tissue nonvascular Maturation of scar tissue is 3 weeks to 2 years Maturation-Remodeling Putting it all together Phase  Using Therapeutic Modalities to Affect Extent of Injury the Healing Process Edema Separation of tissue Inhibits neuromuscular control Impedes Nutrition Hemorrhage Same as Edema Poor Vascular Supply Less phagocytic cells Less fibroblasts Separation of Tissue Smooth wound edges – good healing Jagged wound edges – poor healing Factors That Impede Jagged or Smooth? Healing  Using Therapeutic Modalities to Affect the Healing Process Muscle Spasm Separates torn tissue Atrophy Corticosteriods Remains controversial Steroids Inhibits fibroplasia, capillary proliferation, collagen synthesis, tensile strength of scar tissue Keloids or Hypertrophic Scars Keloids – hyperproduction of scar tissue Hypertrophy of scar tissue Raised, firm, thick scar Factors That Impede High Keloid Count Healing  Using Therapeutic Modalities to Affect the Healing Process Infection Humidity, Climate, & Oxygen Tension Proper humidity translates to wound regeneration twice as fast Scab formation = dehydration of wound Scab traps drainage which leads to infection Most wounds promote shedding of necrotic tissue Oxygen enables the tissue to gain maximal tensile strength Factors That Impede Is This Wound Infected? Healing Using Therapeutic Modalities to Affect the Healing Process Health, Age, & Nutrition Health Poor health or sickness prolongs healing Age < skin elasticity > chance of other disease or other illnesses Nutrition General good nutrition > healing Vitamin C, K, A, E & amino acids are important Factors That Impede A Meal Meant for Healing Healing Using Therapeutic Modalities to Affect the Healing Process Initial Phase Time Frame Signs & Symptoms Injury to day 3 Swelling Pain to touch Pain on Movement Possible Modalities Cryotherapy < swelling < pain E-stim < pain Intermittent Compression < swelling Low-power laser < pain Ultrasound < healing with nonthermal effects Using Therapeutic Modalities to Affect the Healing Process Inflammatory Response Phase Time Frame Signs & Symptoms Day 1 – Day 6 Swelling subsides Warm to touch Discoloration Pain to touch Pain on motion Possible Modalities Rest Cryotherapy < Swelling < Pain E-stim < Pain Intermittent Compression < Swelling Low-power laser < Pain Ultrasound > healing with nonthermal effects Using Therapeutic Modalities to Affect the Healing Process Fibroblastic-repair Time Frame Signs & Symptoms Day 4 – Day 10 Pain to touch Pain on motion Swollen Possible Modalities Range of Motion Thermotherapy > circulation E-STIM < PAIN Low-power laser < pain Intermittent Compression Facilitate lymphatic flow Ultrasound > healing with nonthermal effects Using Therapeutic Modalities to Affect the Healing Process Maturation-remodeling Time Frame Signs & Symptoms Day 7 – Recovery Swollen No pain to touch < pain on motion Possible Modalities ROM & Strengthening Ultrasound > circulation - thermal E-stim > ROM > Strength Low-power laser < Pain Shortwave Diathermy < Pain Micowave Diathermy Deep Heating / > circulation ROM, Strengthening, Functional Activity Deep heating to > circulation  Using Therapeutic Modalities to Affect the Healing Process Wolf’s Law Bone will respond to the physical demands place upon it, causing it to remodel along lines of tension force Modality Use in Maturation- Wolf’s Law? Remodeling Phase Yes or No