W6 PPT- Modalities- Additional Physical Agents PDF

1 ©Stanbridge University 2023 PTA 1009- Modalities week 6 Additional Physical Agents Source: www.pexels.com  2...

1 ©Stanbridge University 2023 PTA 1009- Modalities week 6 Additional Physical Agents Source: www.pexels.com  2 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy (ESWT) Source: www.myankle.co.uk  3 ©Stanbridge University 2023 Objectives By the end of this section the student should be able to describe: Types of Extracorporeal Shockwave Therapy Physical principles of Extracorporeal Shockwave Therapy Physiological responses Indications, contraindications and side effects Advantages and Disadvantages Dosage and frequency  4 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy ESWT- High energy shock waves Original use: Lithotripsy for kidney stones (ESTL) Used by physicians and surgeons but slowly integrating into physical therapy Source: www.trademed.com  5 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy Shockwave generation by one of the following energies: ▫ Reverse piezoelectric ▫ Electromagnetic ▫ Electrohydraulic Treatment region must be targeted by ultrasound or fluoroscopic x-ray ▫ Successful treatment dependent on concentration of shock wave’s focus  6 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy- Physiological Effects Disintegrating calcium deposits Hyperstimulation analgesia Neovascularization Changes in cell permeability Source: www.wikicommons.com  7 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy Clinical applications # of shock-wave pulses + energy density = total energy of treatment ▫ Low intensity: 0.2 mJ/mm2 Duration: up to 30 min Side effects ▫ Hematoma ▫ Reddening ▫ Petechiae ▫ Local soft tissue swelling ▫ Transient pain Source: www.flickr.com  8 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy Michlovitz’s Modalities for Therapeutic Intervention pg. 482 Contraindications: Bleeding conditions Pacemakers Medications that prevent blood clotting Children Pregnancy Acute injuries  9 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy Evidence Successful in treating: Plantar fasciopathy Noncalcific tendinopathy of supraspinatus Calcifying tendonitis of the shoulder RCTs Achilles tendonopathy Lateral epicondylitis I▫ Schmitz et al., British Medical Bulletin, 2015 ▫ Martin et al., JOSPT, 2014 I  10 ©Stanbridge University 2023 Extracorporeal Shockwave Therapy  11 ©Stanbridge University 2023 Pulsed Electromagnetic Fields (PEMF) Source: Bellew 2016  12 ©Stanbridge University 2023 Pulsed Electromagnetic Field Therapy Non-thermal treatment introduced in the mid 1970’s as a tool for fracture healing Usually not utilized for fracture healing until non-union or late stage delayed union (16 weeks) is diagnosed Indications ▫ Fractures (non-union) ▫ Soft tissue trauma, acute inflammation ▫ Osteoarthritis ▫ Depression  13 ©Stanbridge University 2023 Pulsed Electromagnetic Field Therapy Are intended to: ▫ Reduce pain, inflammation, the effects of stress on the body, and platelet adhesion ▫ Improve energy, circulation, blood and tissue oxygenation, sleep quality, blood pressure and cholesterol levels, the uptake of nutrients, cellular detoxification and the ability to regenerate cells ▫ Balance the immune system and stimulate RNA and DNA ▫ Accelerate repair of bone and soft tissue ▫ Relax muscles.  http://www.doctoroz.com/videos/pulsed-electromagnetic-fields-how- they-heal  14 ©Stanbridge University 2023 Pulsed Electromagnetic Field Therapy Every living cell creates an electromagnetic field and they communicate with each other via these electromagnetic frequencies Disruption in this electromagnetic energy impairs cell metabolism PEMFs deliver health–enhancing EMFs and frequencies stimulating the chemical and electrical processes in the tissues In summary they improve cellular energy  15 ©Stanbridge University 2023 Pulsed Electromagnetic Field Therapy Contraindications: ▫ Pacemakers ▫ Insulin pumps Treatment time: ▫ Fractures- 8 hours a day ▫ Soft tissue treatment, osteoarthritis 2x- 15 minutes/day Frequency: Usually 1-50 Hz (=extremely low frequency) Speed: 50 T/sec; T=Tesla  16 ©Stanbridge University 2023 PEMF- Evidence I We et al; Effects of pulsed electromagnetic field on knee osteoarthritis: a systematic review; Rheumatology; 2013; 52: 815- 824 ▫ Improves knee function after 8 weeks of treatment and some support for pain alleviation I Dingemanse et al; Evidence for the effectiveness of electrophysical modalities for the treatment of medial and lateral epicondylitis: a systematic review; Br J Sports Med; 2014; 48: 957-965 ▫ PEMF provided no improvement in symptoms or function for the treatment of medial or lateral epicondylitis  17 ©Stanbridge University 2023 Electromagnetic Therapy Documentation should include: ▫ Modality used ▫ Method of application ▫ Duration of application ▫ Body area treated ▫ Patient position for intervention ▫ Special precautions or application concerns ▫ Patient response to treatment including adverse responses  18 ©Stanbridge University 2023 Electromagnetic Therapy Assessment and Effectiveness of thermotherapy can be achieved by using the following outcome measures: ▫ Pain- quantification via scales (VAS) ▫ Range of motion- goniometric measures ▫ Muscle guarding- reflected in joint ROM and muscle flexibility measures  19 ©Stanbridge University 2023 Now it’s your turn! Time for student presentations