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The Basic Science of Therapeutic Modality

The document discusses different forms of energy used in therapeutic modalities, including electromagnetic, thermal, electrical, and sound energy. It provides details on the properties and effects of each type of energy. For electromagnetic energy, it describes the electromagnetic spectrum and how different wavelengths penetrate tissues. It also outlines several laws governing the effects of electromagnetic energy, such as the inverse square law. The document then explains thermal energy and lists examples of thermotherapy and cryotherapy modalities. Finally, it briefly introduces electrical energy and electrotherapeutic devices.

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0% found this document useful (0 votes)
88 views52 pages

The Basic Science of Therapeutic Modality

The document discusses different forms of energy used in therapeutic modalities, including electromagnetic, thermal, electrical, and sound energy. It provides details on the properties and effects of each type of energy. For electromagnetic energy, it describes the electromagnetic spectrum and how different wavelengths penetrate tissues. It also outlines several laws governing the effects of electromagnetic energy, such as the inverse square law. The document then explains thermal energy and lists examples of thermotherapy and cryotherapy modalities. Finally, it briefly introduces electrical energy and electrotherapeutic devices.

Uploaded by

NQoriana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 52

The Basic

Science of
Therapeutic
1

Modality
Pembimbing : Prof. Dr. dr. Widjajalaksmi K., SpKFR-K, MSc
Introduction
Forms of Energy

Using Therapeutic Modalities to Affect


Healing Process
Content
The Role of Therapeutic Modalities in
2 Wound Healing

Managing Pain With Therapeutic


Modalitites
Electromagnetic Energy

Thermal Energy

Forms of Electrical Energy

Energy Sound Energy


3

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
4

or transferred from one location to


another
Electromagnetic Energy
Radiation
Process by which electromagnetic energy travels from its source
outward through space

The energy carrier that composes all electromagnetic radiation


Travel as waves at the speed of light, (± 3 x 108 m/s)
distinguished by their of wavelength and frequency, as well as the
5

amount of energy carried by each photon

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

If a ray of sunlight is passed through a prism, it will be


broken down into various colors  Spectrum
Longest wavelength & shorter frequency  good
penetration
Electromagnetic Energy
Effects of Electromagnetic Radiations

• Depend on the wavelength, frequency, and energy of


the electromagnetic waves that penetrate those
tissues

• Longer wavelengths are the most penetrating.


• The basic effect is to heat tissues.

• The electromagnetic radiation with higher amounts


7

of energy per photon can have different, more


dramatic effects on tissues.

• Diathermies  The large regions of radiation with


longer wavelengths than infrared radiations
Electromagnetic
Energy Spectrum*

8
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
9

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
10

Prentice WE. Therapeutic Modalities in Rehabilitation. 4 th Ed. New York : McGraw-Hill Companies; 2011.
Cosine Law
Cosine Law

Any reflection of electromagnetic


radiation or other waves will reduce
the amount of energy that is
available for therapeutic purposes

Inverse Square Law Inverse Square Law


11

The intensity of the radiation striking a


particular surface is known to vary
inversely with the square of the
distance from the source
Electromagnetic Energy Modalities
Diathermy Low-Power Laser Ultraviolet Light Infrared

12

Tambah poin utama Tambah poin utama


Uraikan singkat hal yang ingin Anda bahas. Uraikan singkat hal yang ingin Anda bahas.

Cuccurullo S. Physical medicine and rehabilitation board review. 1st ed. New York: Demos Medical Publishing; 2004 .
Thermal Energy
Rate of heat transfer

Very close in temperature,


the transfer of heat will be
slow

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

14

Warm whirlpool Warm hydrocollator packs Paraffin baths Fluidotherapy


Thermal Energy Modalities
Cryotherapy techniques are used primarily to produce a tissue temperature decrease for a variety
of therapeutic purposes

15

Ice Massage Cold Spray Contrast Bath Ice immersion Cryo-cuff

• Cold hydrocollator packs


• Cold whirlpool
• Cryokinetics
Electrical energy  Flow of
Electrical electrons or other charged
particles through an electric field
Energy Electrotherapeutic devices
generate current capable of
producing specific physiological
Use of electricity to stimulate a nerve changes when introduced into
biologic tissue
or muscle transcutaneously using
electrodes Electrical currents that pass
through tissues will warm the
16
tissues based on the resistance
of the tissues to the flow of
electricity

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

The nerve and muscle stimulating currents are capable of :


1) Modulating pain through stimulation of cutaneous sensory nerves at high frequencies
2) Producing muscle contraction and relaxation
3) Facilitating soft-tissue and bone healing (subsensory microcurrents low-intensity stimulators)
4) Producing a net movement of ions through the use of continuous direct current 🡪 eliciting a chemical
change in the tissues (iontophoresis)

• Transcutaneous nerve stimulation (TENS) 17

• Neuromuscular electrical stimulation (NMES)

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
Electrical Energy Modalities
Electromyographic Biofeedback

• Uses electronic or electromechanical


instruments to accurately measure, process,
and feed back reinforcing information via
auditory or visual signals.
• Give neuromuscular relaxation, muscle re-
education  greater voluntary control
18

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
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

since they propagate through molecular


collisions. The more rigid the transmitting
medium, the greater the velocity of sound will
be (ex : Bone tissue)

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
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
.
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.

The stretched, bent, or compressed structure possesses potential energy that


can be released when the force is removed
21

• Intermittent compression
• Traction
• Massage
Using Therapeutic Modalities to
Affect Healing Process
22
Using Therapeutic Modalities in Rehabilitation

• No “cookbook” for modality use  make your own


decision about which modality will be most effective
• Competent clinicians 🡪 based on a combination of
theoretical knowledge and practical experience

Rehabilitation protocols and progressions must be


based primarily on the physiological responses of
23
the tissues to injury and on an understanding of how
various tissues heal 🡪 understand the healing
process

Acute  Traumatic (mostly macrotrauma)


Chronic  Overuse (mostly microtrauma)
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
Healing Process

The healing process is a continuum consisting


of three phases:
• inflammatory-response phase
• fibroblastic-repair phase
• maturation-remodeling phase
Signs of inflammation:
• redness 24

• swelling
• tenderness to touch
• increased temperature
• loss of function
Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
Healing Process

25

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
Clinical Decision-Making on the Use of Various Therapeutic Modalities in Treatment
of Injury

Immediate First Aid Management of Injury


The injured part
should be rested
and protected for
at least the first 48–
72 hours to allow
the inflammatory
phase of the healing
process to do what
it is supposed to do.

26

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
PRICE

27
Clinical Decision-Making on the Use of Various Therapeutic Modalities in Treatment
of Injury

Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodelling Phase

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.
.
healing and analgesia.
Indications of Various Modalities

29

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
The Role of Therapeutic
Modalities in Wound Healing
30
Heat Application

31

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Cold Application

32

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Ultrasound Application

33

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Short Diathermy Application

34

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Electrical Stimulation Application

35

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Low Laser Therapy Application

36

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Managing Pain with
Therapeutic Modalities
37
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.

38
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)

Blocking descending pathways


Stimulation of descending pathways in the dorsolateral Example: TENS
tract of the spinal cord by Aδ and C fiber
02
afferent input  blocking of the impulses carried along
the Aδ and C afferent fibers. 39

Release of β-endorphin and dynorphin.


03 The stimulation of Aδ and C afferent fibers  release of
endogenous opioids (β- endorphin)  a prolonged
activation of descending analgesic pathways

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
.
40

Blocking of the impulses carried along the Aδ and


Blocking impulses at the spinal cord level
C afferent fibers

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
41

β-Endorphin released from


the hypothalamus, and
dynorphin released from the
periaqueductal gray and the
medulla modulate.

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
42

Thank You
07. Using Therapeutic Modalities to Affect the Healing Process

• No “cookbook” for modality use 🡪 make


your own decision about which modality will
be most effective
• Competent clinicians 🡪 based on a
combination of theoretical knowledge and
practical experience

Rehabilitation protocols and progressions must be


based primarily on the physiological responses of
the tissues to injury and on an understanding of
how various tissues heal 🡪 understand the healing
43
process

Acute 🡪 Traumatic (mostly macrotrauma)


Chronic 🡪 Overuse (mostly microtrauma)

Prentice WE. Therapeutic Modalities in Rehabilitation. 4th Ed. New York : McGraw-Hill Companies; 2011.
Type of Tissue – Ephithelial Tissue

Excellent potential to regenerate

Stratum corneum as barier

Most forms of energy produced by the


therapeutic modalities must pass through the
stratum corneum and the remainder of the
epidermis, dermis, and adipose tissues to
affect the target tissues
44
Thermal 🡪 Conduction
US 🡪 pass easyly
Electrical 🡪 Electrical stimulus is resisted by
the Stratum corneum
Trandermal 🡪 pass trough the pore (hair
follicle)

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Type of Tissue – Adipose Tissue

Protection for the hard blow 🡪 Palm & heel

High water content 🡪 ideal medium for ultrasound

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
45

of adipose tissue.

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Type of Tissue – Muscle Tissue

Smooth, cardiac & skeletal Muscle

Thermal energy comes to muscle via


conduction

Elcetrical energy 🡪 depolarizing motor


nerves 🡪 contraction

46

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Type of Tissue – Nerves Tissue

CNS & PNS

Afferent & Efferent

Thermal agents and ultrasound 🡪


altering conduction velocities 🡪 Slowing
the rate of painful nerve transmission
or activating touch and pressure 🡪
decrease the perception of pain and 47
can reduce muscle spasm

Electrical stimulation 🡪 causes a


depolarization of nerves in an orderly,
predictable manner.

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
48
Type of Tissue – Connective Tissue

Provides strength, structure, nutrition,


and defense against trauma for the other
tissues

Connective tissues’ elasticity is


determined by the ratio of inelastic
collagen fibers to elastic yellow elastin
fibers.

Superficial collagen 🡪 heated using moist heat


49
Deeper collagen 🡪 heated by ultrasonic
energy or diathermy.
Permanently elongate (stretch) collagen 🡪
Mechanical Streching

Starkey C. Therapeutic Modalities, 4th ed. USA: F.A. Davis Company; 2013
Cedera akut awal dan fase inflamasi

• Tanda-tanda inflamasi jelas: nyeri, bengkak, kemerahan


• Target: menurunkan nyeri dan bengkak
• Modalitas yang dapat digunakan:
1. PRICE
2. Cryotherapy🡪 vasokonstriksi 🡪 batasi perdarahan dan bengkak (c/o: ice bag, cold
packs, ice massage)
3. Alat kompresi 🡪 untuk meredakan bengkak
4. Low intensity US (non thermal physiologic effect) 🡪 memfasilitasi proses
50

penyembuhan bila digunakan pada 48 jam awal cedera


5. Low power laser 🡪 stimulating trigger point
Fase fibroblastik

• Fase pembentukan jaringan ikat


• Mulai dilakukan latihan LGS dan penguatan
• Terapi dari dingin ke panas
• Contoh modalitas yang dapat diberikan:
1. Thermotherapy 🡪 meningkatkan sirkulasi sehingga mempercepat
penyembuhan (c/o: parrafin, hydrocolar pack, warm whirpool)
2. Kompresi intermiten 🡪 untuk “membersikan” area cedera
51

3. Stimulasi elektrik 🡪 menimbulkan kontraksi otot 🡪 “bersihkan” area


cedera; sekaligus memodulasi nyeri
52

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