INTRODUCTION TO PHYSICAL AGENTS

(AKA Modalities)

What are physical agents or modalities?

What are physical agents or modalities?

Various forms of energy and material applied to a patient to achieved a goal by the means of their application

Include heat, cold, water, pressure, sound, electromagnetic radiation, and electrical currents.

History of Modalities• Ancient Rome and

Greece used heat and water (steam rooms, hot & cool pools) to treat ailments

• Late 19th Century Europe – natural hot springs

• 400 B.C. Torpedo fish were used to apply electrical shock

• Sunlight was used to treat TB, bone & joint diseases, dermatological problems & infection

• Over time new uses and techniques have developed due to better understanding of the body, disease,and recovery. Also practice has change with the development of new technology.

• Modalities is a constantly changing area of practice due to a variety of reasons.

It is not a black and white area of study

Definition Review (page 18 & 19)

• Impairment• Functional Limitations• Pathology• Disability

ROLE OF MODALITIES IN REHAB

The days of “shake & bake” are long gone in rehab.

Modalities alone DO NOT constitute a skilled treatment

Modalities should be used in conjunction with other therapeutic techniques to reach an established goal of rehab.

(see APTA statement on page 5)

Categories of Physical Agents

Table 1-1, pg 2

Category Types Clinical Examples

Thermal Deep Heating Agents Ultrasound, Diathermy

Superficial Heating Agents

Hot Pack, Paraffin

Cooling Agents Ice Pack

Mechanical TractionCompression

Mechanical TractionElastic Bandage, Stocking

Water Whirlpool

Sound Ultrasound

Electromagnetic

Electromagnetic FieldsElectric Current

Ultraviolet, laserTENS, NMES, HVG

THERMAL AGENTSTHERMAL AGENTS –

transfer energy to a pt. to cause an increase or decrease in tissue temp.

Different agents will produce different changes in temp. (I.e. Deep heating agents, superficial agents, cooling agents)

Why use thermal agents?

• Increase circulation• Increase metabolic rate• Increase soft tissue extensibility• Decrease pain through sedation of

nerve endings

When cryotherapy (cold)is used you will see the opposite effect. Pain is decreased through numbing of the tissue.

MECHANICAL AGENTS

• These modalities apply a mechanical force to increase or decrease pressure on the body.

• Examples: Traction, compression, hydrotherapy (water), ultrasound

ELECTROMAGNETIC AGENTS

• Modalities that apply electromagnetic energy in the form of electromagnetic radiation, fields and electrical current

• Examples: electromagnetic fields, all types of E-stim

GENERAL EFFECTS of PHYSICAL AGENTS

• Inflammation & Healing – when used appropriately they can modify & promote healing by modifying the rates of circulation and chemical reactions associated with inflammation and healing.

Physical Agents for Tissue Healing

• The stage of tissue healing determines the goals of intervention and the physical agents used.

• Review Phases of Healing (page 9)

• Table 1-2, page 9

Physical Agents for Pain Modulation

• The choice of a physical agent for treating pain depends on the type of etiology of the pain.

• Table 1-3, page 11

Collagen Extensibility and Motion Restrictions

Physical Agents for the Treatment of Motion Restrictions• Physical agents can be effective

adjuncts to the treatment of motion restrictions caused by mm weakness, pain, sift tissue shortening, or a bony block.

• The appropriate interventions for each of these will vary.

• Table 1-4, page 13

Physical Agents for Tone Abnormalities

• Physical agents can temporarily modify muscle hypertrophy, hypotonicity, or fluctuating tone.

• Table 1-5, page 14

Consideration when using Physical Agents• Indications – situations that indicate or are

safe to use a modality.

• Contraindication (absolute) – conditions that render a particular Rx undesirable or improper (when not to use the modality)

• Precautions - conditions that require a particular Rx to be done with limitations or special care

• General CI’s & Precautions – pregnancy, malignancy, impaired sensation & mentation

General Contraindications and Precautions

• Pregnancy• Malignancy• Pacemaker or other implanted

electronic device• Impaired sensation• Impaired mentation

Choosing a Physical Agent (fig 1-2, p 8)

Fig 1-3, p 8

Evidence-Based Practice and Physical Agents

Terms to know (page 18-19)

• Clinical practice guidelines

• Contraindications• Disability• Electromagnetic

agents• Evidence-based

practice• Systemic Reviews

• Functional limitations

• Impairments• Indications• Mechanical agents• Pathology• Physical agents• Precautions• Rehabilitation• Thermal Agents