Ebook Therapeutic modalities in rehabilitation (4/E): Part 1

Part 1 book “Therapeutic modalities in rehabilitation” has contents: The basic science of therapeutic modalities, using therapeutic modalities to affect the healing process, the role of therapeutic modalities in wound healing, managing pain with therapeutic modalities, basic principles of electricity and electrical stimulating currents,… and other contents.

Therapeutic Modalities in Rehabilitation

Medicine is an ever-changing science As new research and clinical

experience broaden our knowledge, changes in treatment and drug therapy arerequired The authors and the publisher of this work have checked with

sources believed to be reliable in their efforts to provide information that iscomplete and generally in accord with the standards accepted at the time ofpublication However, in view of the possibility of human error or changes inmedical sciences, neither the authors nor the publisher nor any other partywho has been involved in the preparation or publication of this work warrantsthat the information contained herein is in every respect accurate or complete,and they disclaim all responsibility for any errors or omissions or for theresults obtained from use of the information contained in this work Readersare encouraged to confirm the information contained herein with other

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product information sheet included in the package of each drug they plan toadminister to be certain that the information contained in this work is accurateand that changes have not been made in the recommended dose or in the

contraindications for administration This recommendation is of particularimportance in connection with new or infrequently used drugs

Fourth Edition

William E Prentice, PhD, PT, ATC, FNATA

Professor, Coordinator of Sports Medicine ProgramDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel Hill

Chapel Hill, North CarolinaWith Case Studies and Lab Activities Contributed by:

William S Quillen, PhD, PT, SCS, FACSM

Associate Dean, College of Medicine Professor and Director, School of Physical Therapy and Rehabilitation Sciences University of South Florida

Tampa, Florida

Frank Underwood, PhD, MPT, ECS

Professor, Department of Physical Therapy

University of Evansville Clinical Electrophysiologist, Rehabilitation Service

Orthopaedic Associates, Inc.

Evansville, Indiana

reserved Except as permitted under the United States Copyright Act of 1976, nopart of this publication may be reproduced or distributed in any form or by anymeans, or stored in a database or retrieval system, without the prior written

permission of the publisher

ISBN: 978-0-07-173930-6

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Effects of Electromagnetic Radiations

Laws Governing the Effects of Electromagnetic Energy Electromagnetic Energy Modalities

How Should the Clinician Use Therapeutic Modalities in Rehabilitation?The Importance of Understanding the Healing Process

Separation and Amplification of Electromyographic Activity

Converting Electromyographic Activity to Meaningful Information Processing the Electromyographic Signal

Effects of Tissue Temperature Change on Muscle Spasm Effects of Temperature Change on Performance

Clinical Applications for Diathermy

Comparing Shortwave Diathermy and Ultrasound as Thermal ModalitiesDiathermy Treatment Precautions, Indications, and Contraindications

William S Quillen, PhD, PT, SCS, FACSM

Associate Dean, College of Medicine

Professor and Director, School of PhysicalTherapy and Rehabilitation Sciences

University of South Florida

Tampa, Florida

Ethan N Saliba, PhD, PT, ATC

Director for Sports Medicine,

Department of Athletics

Assistant Professor, Department of KinesiologyAdjunct Assistant Professor, Department ofPhysical Medicine and Rehabilitation

Physical therapists, athletic trainers, occupational therapists, physical therapyassistants, occupational therapy assistants, physical therapy aides, and

chiropractors use a wide variety of therapeutic techniques in the treatment andrehabilitation of their patients A thorough treatment regimen often involves theuse of therapeutic modalities At one time or another, virtually all cliniciansmake use of some type of modality This may involve a relatively simple

to possess knowledge regarding the scientific basis and the physiologic effects ofthe various modalities on a specific injury When this theoretical basis is applied

to practical experience, it has the potential to become an extremely effectiveclinical method

It must be emphasized that the use of therapeutic modalities in any treatmentprogram is an inexact science If you were to ask 10 different clinicians whatcombination of modalities and therapeutic exercise they use in a given treatmentprogram, you would likely get 10 different responses There is no way to

“cookbook” a treatment plan that involves the use of modalities Thus, what thisbook will attempt to do is to present the basis for use of each different type ofmodality and allow the clinician to make his or her own decision as to whichwill be most effective in a given situation Some recommended protocols

developed through the experiences of the contributing authors will be presented.The following are a number of reasons why this text should be adopted foruse

COMPREHENSIVE COVERAGE OF

THERAPEUTIC MODALITIES USED IN A

The purpose of this text is to provide a theoretically based but practically

oriented guide to the use of therapeutic modalities for the practicing clinicianand their students It is intended for use in courses where various clinically

oriented techniques and methods are presented

The chapters in this text are divided into six parts Each chapter discusses (1)the physiologic basis for use, (2) clinical applications, (3) specific techniques ofapplication through the use of related laboratory activities, and (4) relevant

individual case studies for each therapeutic modality

Part I—Foundations of Therapeutic Modalities begins with a chapter thatdiscusses the scientific basis for using therapeutic modalities and classifies themodalities according to the type of energy each uses Guidelines for selecting themost appropriate modalities for use in different phases of the healing process arepresented A chapter that deals specifically with the role of therapeutic

modalities in wound healing is followed by a discussion of pain in terms of theneurophysiologic mechanisms of pain and the role of therapeutic modalities inpain management

Part II—Electrical Energy Modalities includes detailed discussions of theprinciples of electricity, and electrical stimulating currents, iontophoresis, andbiofeedback A chapter that deals with the principles of electrophysiologic

evaluation and testing is included Although this is not a therapeutic modalityper se, electrophysiologic testing is commonly taught in classes that cover

electrical modalities and thus the decision was made to include this topic in thistext

Part III—Thermal Energy Modalities discusses those modalities that produce

a change in tissue temperatures through conduction, including thermotherapyand cryotherapy

Part IV—Sound Energy Modalities discusses those modalities that utilizeacoustic energy to produce a therapeutic effect These include therapeutic

ultrasound and a lesser known modality, extracorporal shockwave therapy

Part V—Electromagnetic Energy Modalities includes chapters on both thediathermies and low-level laser therapy

Part VI—Mechanical Energy Modalities includes chapters on traction,

intermittent compression, and therapeutic massage

BASED ON SCIENTIFIC THEORY

by scientific research, factual evidence, and previous experience of the authors

in dealing with various conditions The material presented in this text has beencarefully researched by the contributing authors to provide up-to-date

information on the theoretical basis for employing a particular modality in aspecific injury situation Additionally, the manuscript for this text has been

carefully reviewed by educators, researchers, and practicing clinicians who areconsidered experts in their field to ensure that the material reflects factual andcurrent concepts for modality use

TIMELY AND PRACTICAL

Certainly, therapeutic modalities used in a clinical setting are important tools forthe clinician This text provides a comprehensive resource that should be used instudent instruction on the theoretical basis and practical application of the

various modalities It should serve as a needed guide for the student who is

interested in knowing not only how to use a modality but also why that particularmodality is most effective in a given situation

The authors who have contributed to this text have a great deal of clinicalexperience Each of these individuals has also at one time or another been

involved with the formal academic preparation of the student clinician Thus,this text has been directed at the student who will be asked to apply the

theoretical basis of modality use to the clinical setting

Several other texts are available that discuss the use of selected physical

modalities in various patient populations This is the most comprehensive text ontherapeutic modalities available in any specific discipline

application The initial performance of a therapeutic procedure should proceed in

a logical stepwise fashion They are structured to allow both the instructor orsupervisor and the student the ability to assess competency in a partial or

complete fashion culminating in the independent ability to safely and effectivelyprovide a therapeutic modality treatment

completion Space is provided for up to three separate instructors/supervisors to

“sign off” (initial and date) the successful completion and demonstration of eachelement of the complete application A Master Competency Check List is

provided to document the successful completion of the individual therapeuticmodality checklist and when the student is deemed competent to independentlyprovide that treatment This system documents the acquisition of skills necessaryfor effective physical agent modality application and ensures accountability bythe student and instructor/supervisor to patients and other concerned parties.Competency in the skillful application of therapeutic modalities is gainedthrough diligent and frequent practice Use of these activities in the mannerdescribed will guide the user in productive practice and successful acquisition ofessential skills Students are encouraged to practice each of the procedures onthemselves first, thereby gaining an appreciation of the sensations associatedwith that particular modality Further practice with a variety of lab partners willresult in the development of the desired competence and confidence with anymanufacturer’s equipment

I would like to thank my editor at McGraw-Hill, Joe Morita, for his assistance inthis project from the very beginning His advice and direction have certainlyhelped in its completion

I would also like to thank my wife, Tena, and our two boys, Brian and

Zachary, for putting up with me when I get going with a project like this

Sometimes it’s not easy

CHECKLIST

Foundations of Therapeutic Modalities

electromagnetic energy

Discuss the electromagnetic spectrum and how various modalities that useelectromagnetic energy are related

mechanical energy to produce a therapeutic effect

For the clinician who chooses to incorporate a therapeutic modality into his orher clinical practice, some knowledge and understanding of the basic sciencebehind the use of these agents is useful.1 The interactions between energy andmatter are fascinating, and they are the physical basis for the various therapeuticmodalities that are described in this book This chapter will describe the differentforms of energy, the ways energy can be transferred, and how energy transferaffects biologic tissues A strong theoretical knowledge base can help cliniciansunderstand how each therapeutic modality works

modalities are electromagnetic energy, thermal energy, electrical energy, sound energy, and mechanical energy.2 Shortwave and microwave diathermy, infraredlamps, ultraviolet light therapy, and low-power lasers utilize electromagneticenergy Thermotherapy and cryotherapy transfer thermal energy The electricalstimulating currents, iontophoresis and biofeedback, utilize electrical energy.Ultrasound and extracorporal shockwave therapy utilize sound energy.

Intermittent compression, traction, and massage utilize mechanical energy (Table1–1)

Each of these therapeutic agents transfers energy in one form or another into

or out of biologic tissues Different forms of energy can produce similar effects

in biologic tissues For example, tissue heating is a common effect of severaltreatments that utilize different types of energy Electrical currents that passthrough tissues will generate heat as a result of the resistance of the tissue to thepassage of electricity Electromagnetic energy such as light waves will heat anytissues that absorb it Ultrasound treatments will also warm tissues through

which the sound waves travel Although the electrical, electromagnetic, andsound energy treatments all heat tissues, the physical mechanism of action foreach is different.3

Table 1–1 Classification of Therapeutic Modalities Under the Various Forms of

EnergyELECTROMAGNETIC ENERGY MODALITIES

Electrical energy is stored in electric fields and delivered by the movement ofcharged particles Acoustic vibrations produce sound waves that can pass

through a medium Each form of energy and the mechanism of its transfer will

be discussed in more detail to provide the scientific basis for understanding thetherapeutic modalities.4

Exercise 1–1 Clinical Decision-Making

Several modalities can be used to manage pain Of the modalities discussed,which may be used to modulate pain and which should a clinician recommend

ELECTROMAGNETIC ENERGY

Radiation is a process by which electromagnetic energy travels from its source

outward through space.5 Sunlight is a visible type of radiant energy, and weknow that it not only makes objects visible but also produces heat The sun emits

a spectrum of visible and invisible massless radiant energy and ejects high-energy particles as a result of high-intensity chemical and nuclear reactions The

massless radiant energy emissions from the sun are called photons A photon is

the energy carrier that composes all electromagnetic radiation Photons travel aswaves at the speed of light, approximately 300 million meters per second Sincephotons all travel at the same speed, they are distinguished by their wave

properties of wavelength and frequency, as well as the amount of energy carried

by each photon

The Relationship Between Wavelength and Frequency

Wavelength is defined as the distance between the peak of one wave and the peak of either the preceding or succeeding wave Frequency is defined as the

number of wave oscillations or vibrations occurring in a particular time unit and

is commonly expressed in Hertz (Hz) One Hertz is one vibration per second(Figure 1–1)

Since all forms of electromagnetic radiation travel at a constant velocity

through space, photons with longer wavelengths have lower frequencies andphotons with shorter wavelengths have higher frequencies.6 The following

equation is useful for doing calculations involving the speed, wavelength, andfrequency of waves

An inverse or reciprocal relationship exists between wavelength and frequency.The longer the wavelength of a wave, the lower the frequency of the wave has to

be The velocity of electromagnetic radiation is a constant, 3 × 108 m/s If weknow the wavelength of any wave, the frequency of that wave can also be

calculated Whenever we are dealing with electromagnetic energy of any kind,

we can use the speed of light, 3.0 × 108 m/s in that equation That speed is notappropriate for electrical energy waves or sound energy waves, which do nottravel at the speed of light.7

The other equation that is important with electromagnetic radiation is the

energy equation The energy of a photon is directly proportional to its frequency.

This means that the electromagnetic radiation with higher frequency also hashigher energy We will relate this to the effects that each form of electromagnetic

E = h × v

(The letter h is known as Planck’s constant and has a value of 6.626 × 10−34 Js.When Planck’s constant is multiplied by a frequency in vibrations per second,the result has the standard scientific energy unit of Joules.)

The Electromagnetic Energy Spectrum

If a ray of sunlight is passed through a prism, it will be broken down into variouscolors in a predictable rainbow-like pattern of red, orange, yellow, green, blue,indigo, and violet (Figure 1–2) The range of colors is called a spectrum The

colors that we can detect with our eyes are referred to as visible light or luminous radiations Each of these colors represents a photon of a different energy They

appear as different colors because the various forms of radiant energy are

refracted or change direction as a result of differences in wavelength and

frequency of each color When passed through a prism, the type of radiant

energy refracted the least appears as the color red, whereas that refracted themost is violet.7 The longest wavelength light is red in color and low in energy,whereas the shortest wavelength light is violet and relatively higher in energy.This beam of electromagnetic radiation from the sun that passes through theprism also includes propagating forms of radiant energy that are not visible toour eyes.2 If a thermometer is placed close to the red end of the visible lightspectrum, the thermometer will rise in temperature This is because there is

invisible radiation with longer wavelengths than red light, called infrared

radiation, which is absorbed by the thermometer When the infrared radiation is

absorbed by the thermometer, it heats the thermometer, just like the light fromthe sun can warm your skin as your skin absorbs the light Likewise,