The Basic Science of Therapeutic Modality
The Basic Science of Therapeutic Modality
Science of
Therapeutic
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Modality
Pembimbing : Prof. Dr. dr. Widjajalaksmi K., SpKFR-K, MSc
Introduction
Forms of Energy
Thermal Energy
Mechanical Energy
Forms of Energy
Energy is defined as the capacity of a system
for doing work and exists in various
forms. Energy is not ordinarily
created or destroyed, but it is often
transformed from one form to another
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E (Joule) = h x v
h = Planck’s constant and has a value of 6.626 × 10−34 Js
Electromagnetic radiation with higher frequency also has higher energy
Electromagnetic Energy
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Laws Governing the Effects of
Electromagnetic Energy
Reflected
The rays that rebound off the material
Refraction
The ray passes from one material to another, it changes its
path
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Transmitted
The ray passing through a material
Absorbed
A portion of the radiation may be absorbed by the material.
Prentice WE. Therapeutic Modalities in Rehabilitation. 4 th Ed. New York : McGraw-Hill Companies; 2011.
Arndt–Schultz Principle
Law of Grotthus–Draper
No reactions or changes can
occur in the body if the The inverse relationship that exist
amount of energy absorbed is between energy absorption by a
not sufficient to stimulate the tissue and energy penetration to
absorbing tissues deeper layers
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Prentice WE. Therapeutic Modalities in Rehabilitation. 4 th Ed. New York : McGraw-Hill Companies; 2011.
Cosine Law
Cosine Law
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Cuccurullo S. Physical medicine and rehabilitation board review. 1st ed. New York: Demos Medical Publishing; 2004 .
Thermal Energy
Rate of heat transfer
Proportional to Δ temp
Great temperature
differences, the heat
transfer will be very rapid
Cryotherapy
Conductive modalities 13
Those that produce a tissue temperature decrease
Used to produce a local and occasionally a generalized heating or
cooling of the superficial tissues with a maximum depth of penetration
of 1 cm or less
Thermotherapy
Those that produce a tissue temperature increase
Prentice WE. Therapeutic Modalities in Rehabilitation. 4 th Ed. New York : McGraw-Hill Companies; 2011.
Thermal Energy Modalities
Thermotherapy are used primarily to produce a tissue temperature increase for a variety of
therapeutic purposes
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Frequencies of electrical
currents range from 1 to 4000
Prentice WE. Therapeutic Modalities in Rehabilitation. 4 th Ed. New York : McGraw-Hill Companies; 2011.
Hz
Electrical Energy Modalities
Electrical Stimulating Currents
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Electrical Energy Modalities
Electromyographic Biofeedback
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Sound Energy
Sound Electromagnetic
VS
• Consists of pressure waves due to the • Carried by photons
mechanical vibration of particles • Travel at the speed of light.
• Travel at the speed of sound (more slowly) • Capable of traveling through space or
wavelengths are considerably shorter for vacuum. As the density of the transmitting
acoustic vibrations than for electromagnetic medium is increased, the velocity of
radiations at any given frequency electromagnetic radiation decreases
• Will not be transmitted at all through vacuum, 19
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Sound Energy Modalities
Ultrasound Extracorporeal Shock Wave Therapy
• 1-3 MHz 20
• Noninvasive modality used in the
• Deep penetration (greater than treatment of both soft-tissue and bone
electromagnetic energy) injuries.
• Increase heat -- cellular healing • Pulsed high-pressure, short-duration (<1
• Mechanical vibration, sound wave, m/s) sound waves.
produced from high frequency • Concentrated in a small focal area (2–8
electrical energy
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011. mm in diameter) and is transmitted
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Mechanical Energy
Use energy possessed by an object due to its motion (Kinetic Energy) or
position (Potential energy/ stored energy)
The kinetic energy created by a clinician’s hands moves to apply a force that
can stretch, bend, or compress skin, muscles, ligaments.
• Intermittent compression
• Traction
• Massage
Using Therapeutic Modalities to
Affect Healing Process
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Using Therapeutic Modalities in Rehabilitation
• swelling
• tenderness to touch
• increased temperature
• loss of function
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Healing Process
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Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Clinical Decision-Making on the Use of Various Therapeutic Modalities in Treatment
of Injury
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Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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PRICE
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Clinical Decision-Making on the Use of Various Therapeutic Modalities in Treatment
of Injury
Goals: control pain and Cold to heat using Goal: return to activity
reduce swelling. increased swelling as a
precautionary indicator. The deep-heating
Cryotherapy should still modalities, ultrasound, or
be used during the Thermotherapy techniques: 28
shortwave and microwave
inflammatory stage. Ice hydrocollator packs, paraffin, diathermy should be used
bags, cold packs, or ice or eventually warm whirlpool to increase circulation to
massages provide may be safely employed. the deeper tissues..
analgesic effects. increase circulation to the
injured area to promote
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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healing and analgesia.
Indications of Various Modalities
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Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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The Role of Therapeutic
Modalities in Wound Healing
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Heat Application
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Cold Application
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Ultrasound Application
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Short Diathermy Application
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Electrical Stimulation Application
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Low Laser Therapy Application
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Managing Pain with
Therapeutic Modalities
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Goal in Managing Pain
The clinician’s objectives are to encourage the body to heal through exercise
designed to progressively increase functional capacity and to return the patient to
work, recreational, and other activities as swiftly and safely as possible.
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Managing Pain With Therapeutic Modalities
Mechanisms of pain control
Blocking ascending pathways (gate control)
Stimulation from ascending Aβ afferents blocking
01 impulses at the spinal cord level of pain messages
carried along Aδ and C afferent fibers (gate control)
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
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Thank You
07. Using Therapeutic Modalities to Affect the Healing Process
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
Type of Tissue – Ephithelial Tissue
Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Type of Tissue – Adipose Tissue
Serves as insulation against heat and cold (and retains heat in the core) 🡪
effectiveness of thermal agents is reduced when they are applied over thick layers
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of adipose tissue.
Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Type of Tissue – Muscle Tissue
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Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Type of Tissue – Nerves Tissue
Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
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Type of Tissue – Connective Tissue
Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Cedera akut awal dan fase inflamasi