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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.