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Physical Agent Modalities (PAM)
Physical Agent Modalities (PAMs) - correct answer are those procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance. PAMs use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema or inflammation. PAMs are used in preparation for or concurrently with purposeful and occupation-based activities (Bracciano, 2008). PAM's - correct answer -Thermal agents: Cold and hot pack, paraffin. -Electrotherapeutic agents: Biofeedback, Neuromuscular electrical stim, Functional electrical stim, Galvanic (high voltage) stim, Iontophoresis, Phonophoresis, TENS -Mechanical devices NMES - correct answer he use of electrical current to the use of electrical current to increase ROM, decrease edema and increase ROM, decrease edema and increase strength FES - correct answer The use of NMES on innervated innervated ddmuscle to achieve functional or purposeful to achieve functional or purposeful movements or gain functional control. movements or gain functional control. do not use FES - correct answer • with patients who have certain types of pacemakers
- over the carotid sinus area
- over the heart or transthoracically
- over the mouth/throat area
- on open wounds or irritated skin
- over cancerous lesions FES Contraindications - correct answer FES will not be effective on patients having significant peripheral nerve injury or pathologies such as:
- problems in the cell body
- problems in the axon
- major damage to the myelin sheath
- problems at the synapses between the muscle & the nerve
- problems within the muscle Superficial thermal agents - correct answer include but are not limited to hydrotherapy/whirlpool, cryotherapy (cold packs, ice), Fluidotherapy™, hot packs, paraffin, water, infrared, and other commercially available superficial heating and cooling technologies factor that effect current flow (FES) - correct answer Impedence is opposition is opposition to flow of an electric to flow of an electric current current
- Muscle = 75% water
- Fat = 15% water
- Bone = 10% water So, you want to place the electrode on the "motor point motor point", over the muscle, where the fibers are most dense
- Electrode size
- Smaller is more concentrated, or more powerful and sometimes more painful painful.
- Adjustable from 50 - 300
- Range for strengthening between 100 and 600 μs
- Start at 120 μs Waveform: -asymmetrical: is the most active 80/ -symmetrical: more comfortable 50/ fatigue - correct answer • It happens in the muscle fiber (not a nerve problem)
- Is DIRECTLY affected by:
- Intensity
- Pulses per second (pulse rate) Pulses per second (pulse rate)
- On/off times Hydrotherapy (whirlpool) - correct answer Cryotherapy - correct answer ↓ pain ↓ fever Control bleeding Prevent or ↓ swelling ↓ muscle spasticity physical changes Vasoconstriction Vasodilation/vasoconstriction (after 15 mins) ↓'ed blood to muscles ↑'es pain threshold ↓'es nerve conduction ↓'ed rate of healing ↓'es tissue extensibility
cryotherapy therapeutic application - correct answer ice massage, usually a 3-7 minute tx, no sharp edges, keep it moving, dont press down. cold bath: 55-65 F, the lower the temp the shorter the exposure. Cold pack: use a moist towel 10-15 mins, may need to ace wrap, not messy. cold compression units - correct answer Temp ranges from 55-77°F Cooled water is circulated thru the sleeve Sleeve is inflated intermittently to ↓ edema precautions for cold therapy - correct answer Some pts are hypersensitive - check first Don't use on: Wounds that need to heal Poor circulation (diabetes) Cold sensitive pt's (Raynaud's) Cold urticaria or reddened, raised blotches Watch for systemic effects (↓bp, ↓pulse, syncope) convection - correct answer - transfer of heat to tissue by the movement of air, matter or liquids around the body part Fluidotherapy - correct answer • Is a type of dry heat
- Heats the body by convection
paraffin contraindication (precaution) - correct answer Don't use over open wounds Don't use with infected skin Don't use if there's already swelling Monitor the temp of the paraffin This unit cost about $3, infrared - correct answer contraindications heat - correct answer Impaired circulation Prone to bleeding Areas of malignancy Impaired sensation Acute inflammation Acute edema Over ointments benefit from heat - correct answer Stiff joints Subcutaneous adhesions Contractures Chronic arthritis Neuromas Muscle spasms deep thermal agents - correct answer include but are not limited to therapeutic ultrasound, phonophoresis, short-wave diathermy, and other commercially available technologies. Short-wave diathermy - correct answer Can be subthermal (healing) or thermal (heating)
Has an affinity for water (blood vessels, synovium, muscles) SWD = short wave diathermy subthermal (pulsed) sw diathermy (healing) - correct answer Used to heal tissues, decrease acute pain, decrease edema, decrease inflammation associated with: OA, ligaments, wounds, muscle or cartilage 30 day old pressure ulcers, diabetic wounds Can be delivered through a plastic boot or brace Absorbs hematomas thermal (heating) diathermy - correct answer decreases subacute (5-14 days) and chronic ( 14 day) pain, muscle spasms, contractures, circulation problems 1t= 1° rise in tissue temp 2t= 2° rise in tissue temp (recommended for elders) 4t= 4° rise in tissue temp (vigorous) 20 min tx, pt has to be still, use towel to absorb sweat 5-10 min window for stretching afterwards short wave diathermy precautions and contraindications - correct answer Precuations Same as with any other modality that heats tissues PLUS Pregnant therapists should avoid using it, according to Bracciano
- decrease muscle tone (micromassage promotes relaxation and GTO sensitivity)
- increase circulation - decreases edema and heals tendons, ligaments, etc.)
- accelerate fx healing time Can be used underwater for irregular surfaces like the hand Use gloves, plain water at room temp Any condition ending in "itis" is a candidate for subthermal ultrasound Thermal (Continuous) Ultrasound - correct answer Used for heating tissues Uses: decrease chronic pain, decrease contractures, increase ROM, increase blood flow, decrease muscle spasm, remodeling collagen, 1 = mild 2 = moderate 3 =vigorous Can provide stretch during us or 5 minute window afterwards ultrasound precautions and contraindication - correct answer *Precautions Acute inflammation Breast implants Pts with cognition, sensation and language *Contraindications Pregnancy Thrombophlebitis Pacemaker Spine or CNS tissue Malignancy or tumors Areas with active bleeds or infections
electrotherapeutic agents - correct answer use electricity and the electromagnetic spectrum to facilitate tissue healing, improve muscle strength and endurance, decrease edema, modulate pain, decrease the inflammatory process, and modify the healing process. Electrotherapeutic agents include but are not limited to neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS), high-voltage galvanic stimulation for tissue and wound repair (ESTR), high-voltage pulsed current (HVPC), direct current (DC), iontophoresis, and other commercially available technologies Neuromuscular Electrical Stimulation (NMES) - correct answer Functional Electrical Stimulation (FES) - correct answer transcutaneous electrical nerve stimulation (TENS) - correct answer high voltage/galvanic stimulation (ESTR ) - correct answer for tissue and wound repair. High Voltage Pulsed Current (HVPC) - correct answer direct current (DC) - correct answer iontophoresis - correct answer mechanical devices - correct answer include but are not limited to vasopneumatic devices and continuous passive motion (CPM)
heat (effectiveness) - correct answer The extent of temperature rise (conductivity of the tissues) Rate of energy transfer (how hot is the hotpack, what is the intensity level?) Volume of area exposed (how big is the hotpack or transducer head?) Time of exposure (how long it is applied? 41-45 C 105-113 F - correct answer In order to be therapeutic, tissue temp should be raised to_____ _____. Below this ineffective, above this could cause tissue damage Blood vessels (Heat) - correct answer Capillary dilation Because heated blood flows around the body, heating one area (esp. a big area) causes the whole body temp to ↑, increasing heart rate, metabolism, etc.) It brings the blood to the target area Muscle and Nerves (Heat) - correct answer ↑'es pain threshold (pt tolerates pain better) Nerves send signals faster (quicker response) ↓'es muscle spindle firing rate so it promotes RELAXATION Prolonged use↓'es muscle tension and sustained use, therefore ↓'ing___________ and _________ connective tissue (heat) - correct answer ↑'es elasticity, so it makes sense to combine
heat with slow, sustained __Stretch_____ to ↑ ROM Heating ↓'es joint stiffness by ↑'ing joint capsule and other soft tissue ELASTICITY Superficial Heat - correct answer conductive heat: hot pack and paraffin. ↑'es tissue temp about 1-3cm from the surface to their warmest in about 6-8 mins Keep hot packs on for 15 mins. Fat insulates against surface heat so the heat may be ____________. Hot packs lose heat over time electric heating pad - correct answer Provide comfortable dry heat Can cause a burn if the patient falls to sleep with pad turned on air-activated heat wraps - correct answer Contours to the body Contains natural ingredients (iron, charcoal, table salt and water) that heat up when exposed to oxygen in the air Reaches its therapeutic temperature w/in 30 mins Lasts up to 8 hours
