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Chapter 1. Therapeutic Modalities: What They Are and Why They Are

Used

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Working Hard Is Important

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Working Smart Is More Important

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What Are Therapeutic Modalities?

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No text or dictionary has yet to define them.

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Taber’s Cyclopedic Dictionary (1997;19:1934)

• Pertains to results obtained from treatment• Having medical or healing properties• A healing agent

Therapeutic

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Taber’s Cyclopedic Dictionary (1997;19:1222)

• A method of application or the employment of any therapeutic agent

• Limited usually to physical agents and devices• Any specific sensory stimulus such as taste, touch, vision,

pressure, or hearing

Modality

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Put It All Together

Therapeutic modality: A device or technique that delivers

a physical agent to the body for therapeutic purposes

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Physical Agents

Heat Cold Light Electricity Exercise

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What Therapeutic Purpose?

Wound healing Pain relief Flexibility and range of motion Muscular strength Muscular endurance

To promote:

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What Therapeutic Purpose? (cont.)To promote (cont.):

Muscular speedMuscular coordination or skillPowerAgilityCardiorespiratory endurance

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Classification of Therapeutic Modalities

• Therapeutic modalities have been classified in many different ways.

• But each is incomplete—that is, none includes all modalities.

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Classification of Therapeutic Modalities (cont.)

• Mechanical: massage, mobilization, US, whirlpool• Cryotherapy: ice pack, immersion, ice massage• Thermotherapy: moist heat, dry heat, diathermy, US• Hydrotherapy: whirlpool, contrast bath, aquatic pool• Electrotherapy: muscle stimulation, TENS,

diathermy• Active exercise

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Selecting Which Therapeutic Modality to Use

Do you select? Or does a physician select?

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An ISU Physician’s Prescription Physical therapy for _____ because of

pain and swelling of the left ankle and foot.

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Brockport Team Physician Often prescribed diathermy, but we didn’t have a diathermy

machine

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Sometimes PTs work with physiatrists, who are specialists in physical medicine and rehabilitation.

They will usually get good prescriptions, but most PTs and ATs usually don’t get good prescriptions.

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Need to educate the physicianabout what the AT is using

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To Select Modality(ies) Intelligently

You must:• Have a correct diagnosis• Have a definite conception of the

pathological and physiological changes associated with the injury

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To Select Modality(ies) Intelligently (cont.)

• Know what you want to accomplish with the modality—that is, have a therapeutic goal

• Understand the modalities effects, indications, and contraindications

• Match your therapeutic goal with a modality that will help you achieve that goal

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KnobologyThe study of application without theory

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Art vs Science

Theory vs Application

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Rehabilitation and Therapeutic Modalities

• To fully understand the role of therapeutic modalities you must:– Understand the overall rehabilitation

process– Understand how each therapeutic

modality fits into that process

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See theBIG

Picture

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What Modality Is Used When?

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With a systems approach, you must have a basis for choosing which therapeutic modality to use during various phases of rehabilitation.

Must match the proper therapeutic modality with the therapeutic goal.

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Efficacy of Modalities

Rate modalities for effect during rehabilitation.

1. Direct effect (good choice)2. Effective if used in a specific way3. Somewhat effective; not the best choice; there

are better modalities for developing this element of rehabilitation

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Modality Efficacy: Summary

Traditional modalities (heat, light, sound, electricity) are used during only the first three phases.

Exercise is needed for most phases of rehabilitation.

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Note

Therapeutic exercise is not covered in this class, except for cryokinetics and cryostretch.

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What Rehabilitation Is Not

Treat then rehabilitate Working with weights A cookbook approach

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Treat Then Rehabilitate

Treat with various therapeutic modalities (e.g., whirlpool, ultrasound) and then “rehabilitate” Rehabilitation = the entire process of

returning an injured athlete to competition

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Working with Weights

Concept too narrow Rehabilitation = the entire process of

returning an injured athlete to competition

Much more than strength training

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A Cookbook Approach

Stages or phases established with specific time periods and exercises

Optimal rehabilitation not planned by the calendar or by specific exercises

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Re habilita tion

• Re again, anew, restore• habilitate to make suitable• habit characteristic condition

of mind or body• tion the act of

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Rehabilitation

• To restore to a normal or optimal state of health– For an athlete, to a high level of

conditioning• Process of returning an athlete to a high level

of conditioning

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Rehabilitation (cont.)

More than progressing through various phases of conditioning

For optimal results, rehabilitation must be planned and the plan executed systematically.

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Rehabilitation (cont.) For optimal results, you must consider:

Timing Goals Rate of progression Criteria for progression Psychological factors

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Systems Approach to Total Rehabilitation Each patient and each injury is unique.

Based on signs, symptoms, and needs Identify each phase of rehabilitation. Establish criteria for developing each phase. Carefully analyze the limitations imposed by the

injury. Determine which phase of rehabilitation to begin

with.

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Ten Elements of Rehabilitation

1. Structural integrity 2. Pain-free joints and muscles 3. Joint flexibility 4. Muscular strength 5. Muscular endurance

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Ten Elements of Rehabilitation (cont.) 6. Muscular speed 7. Muscular power (strength and speed) 8. Skill patterns (integrated and coordinated

movement 9. Agility (speed and skill)

10. Cardiovascular endurance

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Rehabilitation Principles The SAID principle Therapeutic goals Constant evaluation Functional progression Early exercise essential Rate of reconditioning Begin early, end late

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The SAID Principle Specific adaptation to imposed demands dominates rehabilitation. The body responds to a given demand with

a specific and predictable adaptation. Specific adaptation requires that specific

demands be imposed.

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The SAID Principle (cont.)

Each physical attribute must be identified and specifically trained for.

Optimize by using a goal-oriented approach.