Table
of Contents
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SECTION I |
INTRODUCTION |
1 |
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Chapter 1 |
Therapeutic Modalities—A Role in the Patient Care Management
Model James W. Bellew, PT, EdD, and Susan L. Michbvitz, PT, PhD, CHT |
3 |
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Therapeutic Modalities: Roles in Rehabilitation |
4 |
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Modalities as Part of the Comprehensive Plan |
5 |
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Types of Therapeutic Modalities |
5 |
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Thermal Modalities: Cold and Heat |
6 |
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Electromagnetic Modalities |
7 |
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Mechanical Modalities |
8 |
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Clinical Applications of Therapeutic Modalities |
9 |
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Modulation of Pain |
9 |
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Alteration of Skeletal Muscle Performance: Facilitation and Inhibition |
11 |
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Decreasing Inflammation and Facilitating Tissue Healing |
12 |
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Increasing Tissue Extensibility: Flexibility and |
12 |
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Assessing Clinical Effectiveness of Modalities |
13 |
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Using the Right Outcomes? |
14 |
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Overview of Contraindications and Precautions |
15 |
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Closing Comments from the Authors |
16 |
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SECTION II |
MODALITIES |
19 |
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Chapter 2 |
Cold Therapy Static J. Fruth, PT, DHS, and Susan L. Michlovitz,
PT.PhD, CHT |
21 |
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Physical Principles |
22 |
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Conduction |
22 |
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Convection |
25 |
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Evaporation |
25 |
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Biophysical Principles of Tissue Cooling |
26 |
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Hemodynamic Effects |
26 |
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Posttraumatic Edema and Inflammation |
28 |
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Peripheral Nerve Effects |
30 |
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Muscle Performance Effects |
32 |
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Neuromuscular Effects |
33 |
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Clinical Indications for Cold Therapy |
34 |
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Acute Musculoskeletal Trauma |
35 |
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Pain and Muscle Spasm |
37 |
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Myofascial Pain Syndrome |
38 |
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Guidelines for Cryotherapy |
39 |
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Selecting a Cooling Agent |
41 |
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Contraindications and Precautions for Cryotherapy |
41 |
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Contraindications |
41 |
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Precautions |
42 |
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Methods of Providing Cryotherapy |
43 |
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Cold Packs |
43 |
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Ice Massage |
46 |
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Vapocoolant Spray |
46 |
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Manual and Electric Cold Compression Units |
48 |
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Cold Baths |
50 |
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Cold Gel |
53 |
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Assessment of Effectiveness and
Expected Outcomes |
53 |
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Documentation |
55 |
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Chapter 3 |
Therapeutic Heat Sandy Rennie, PT, PhD, and Susan L. Michlovitz,
PT, PhD, CHT |
59 |
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Biophysical Effects of Temperature Elevation |
60 |
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Metabolic Reactions |
61 |
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Vascular Effects |
61 |
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Neuromuscular Effects |
64 |
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Connective Tissue Effects |
66 |
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Physical Principles of Heat |
67 |
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Heat Transfer |
67 |
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Conductive Heat Modalities |
68 |
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Convective Heating: Fluidotherapy
(Fluidized Therapy) |
74 |
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Clinical Application: Principles and Indications |
76 |
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Contraindications and Precautions to Thermotherapy |
78 |
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Clinical Decision-Making |
78 |
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Heat Versus Cold |
78 |
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Factors to Consider for Therapeutic Heat Techniques |
80 |
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Wet Versus Dry Heat |
80 |
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Home Application of Therapeutic Heat Modalities |
80 |
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Assessment of Effectiveness and Expected Outcomes |
81 |
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Documentation |
81 |
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Chapter 4 |
Therapeutic Ultrasound Susan L. Mkklovitz, PT, PhD, CHT, and Karen J. Sparrow, PT.PhD |
85 |
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Physical Principles |
85 |
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The Nature of Acoustic Energy |
85 |
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Production of Ultrasound Waves |
86 |
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Characteristics of the Ultrasound Wave |
87 |
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Frequency: 1 or 3 MHz |
87 |
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Mode: Continuous Wave or Pulsed |
87 |
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Intensity: Watts/cm2 |
88 |
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Ultrasound Interaction with Biological Tissues |
90 |
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Propagation of Ultrasound Waves in Tissue |
90 |
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Factors Influencing Energy Absorption |
91 |
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Effects of Ultrasound as a Basis for Therapeutic Use |
92 |
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Thermal and Mechanical Effects |
92 |
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Muscular Effects |
93 |
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Connective Tissue (Tendon/Ligament) Effects |
93 |
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Effects on Joint Pain |
94 |
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Hemodynamic Effects |
94 |
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Effects of US on Nerve |
96 |
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Posttraumatic Effects: Inflammation and Tissue Repair |
96 |
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Instrumentation for Delivering Therapeutic Ultrasound |
100 |
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Application Considerations |
101 |
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Application Techniques |
102 |
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Keep the Applicator Moving! |
102 |
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Direct Contact Coupling is Preferred |
103 |
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Indirect Coupling Methods Are Overrated |
104 |
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Assessment of Intervention Outcomes |
105 |
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Measurement and Expected Outcomes |
105 |
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Documentation of Ultrasound Treatment |
105 |
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Phonophoresis: Is It a Viable
Option? |
105 |
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Chapter 5 |
Hydrotherapy: The Use of Water as a Therapeutic Agent Elaine
L. Bukowski, PT, DPT, (D)
ABDA, and Thomas P. Nolan Jr., PT, DPT, OCS |
109 |
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Physical Properties of Water |
113 |
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Buoyancy |
113 |
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Viscosity and Hydrostatic Pressure |
115 |
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Hydrodynamics |
115 |
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Thermodynamics: Heat Transfer |
115 |
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Physiological Effects of Water |
116 |
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Hemodynamics |
116 |
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Effects of Water on the Respiratory System |
117 |
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Effects of Water on Renal Function |
117 |
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Effects of Water on the Neurological System |
117 |
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Effects of Water on the Muscular System |
117 |
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Mechanical Effects of Water |
117 |
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Aquatic (Pool) Therapy |
117 |
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Indications, Precautions, and Contraindications |
117 |
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Pools and Pool Area |
118 |
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Pool Care and Safety Precautions |
120 |
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Clinical Applications of Therapeutic Pools |
121 |
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A Word About Hot Tubs and Jacuzzis. |
122 |
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Whirlpools |
122 |
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Types of Whirlpools |
122 |
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Turbine |
123 |
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Electrical Safety |
124 |
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Clinical Applications for Whirlpools |
124 |
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Preparatory Considerations |
124 |
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Whirlpool Duration |
124 |
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Cleaning and Disinfecting Whirlpools |
124 |
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Lower Extremity Techniques |
125 |
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Upper Extremity Techniques |
125 |
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Full-Body Immersion |
126 |
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Contrast |
126 |
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Indications for Whirlpool Treatments |
127 |
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Musculoskeletal Conditions |
127 |
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Circulatory Conditions |
127 |
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Psychological Conditions |
128 |
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Wound Care |
129 |
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Nonimmersion Irrigation of
Wounds |
130 |
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Clinical Technique for PLWS |
130 |
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Assessment of Effectiveness and Expected Outcomes for Hydrotherapy |
131 |
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Clinical Decision-Making |
131 |
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Goals and Documentation |
131 |
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Chapter 6 |
Electromagnetic Waves: Laser, Diathermy, and Pulsed Electromagnetic
Fields Enrtco M.
Detkgatta, PT, DPT, MEd, and Thomas
P. Nolan Jr., PT, DPT, OCS |
135 |
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Electromagnetic Waves |
137 |
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Lasers |
138 |
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State of |
138 |
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History |
138 |
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Physical Properties of Lasers |
138 |
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Physiological Effects of Lasers |
142 |
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Instrumentation and Clinical Application of Lasers |
143 |
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Indications for the Use of Lasers |
145 |
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Contraindications and Precautions for Lasers |
148 |
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Assessment of Effectiveness of Lasers |
148 |
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Diathermy |
150 |
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Physical Principles of Diathermy |
150 |
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Therapeutic Diathermy Devices: Delivery of Radio Frequency Waves to the Patient |
150 |
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Physiological Effects of Diathermy |
154 |
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Clinical Application of Diathermy |
158 |
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Indications for Diathermy |
161 |
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Precautions and Contraindications for Diathermy |
164 |
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Clinical Decision-Making: When Is Diathermy the Treatment of Choice? |
166 |
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Chapter 7 |
Spinal Traction Charh Hade, PT, MS, PhD |
173 |
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Foundations of Traction |
173 |
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Biomechanical and Physiologic Effects - of Traction |
173 |
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Cervical Spine |
173 |
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Lumbar Spine |
174 |
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Basic Applications of Clinical Traction |
175 |
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Components of the Traction Table |
175 |
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Cervical Spine Traction: Procedures and Practice |
177 |
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Lumbar Spine Traction: Procedures and Practice |
182 |
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Patient Safety |
186 |
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Indications for Traction |
187 |
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Contraindications for Traction |
188 |
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Precautions |
191 |
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Home Traction |
191 |
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Cervical Spine |
191 |
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Lumbar Spine |
192 |
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Patient Outcome Evidence |
193 |
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Spinal Decompression |
194 |
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Inversion |
195 |
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Chapter 8 |
Intermittent Pneumatic Compression Ellen Lowe, PT, MHS, and James W. Bdlew, PT, EdD |
199 |
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Physical Principles |
199 |
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Indications for Intermittent Pneumatic Compression |
200 |
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Edema |
200 |
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Traumatic Edema |
200 |
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Venous Stasis Ulcers |
200 |
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Stump Reduction in Amputated Limbs |
200 |
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Prevention of Deep Vein Thrombosis |
200 |
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Wound Healing |
200 |
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Arterial Insufficiency |
201 |
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Lymphedema |
201 |
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Contraindications |
201 |
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Acute Pulmonary Edema |
201 |
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Congestive Heart Failure |
201 |
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Recent or Acute Deep Vein Thrombosis |
201 |
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Uncontrolled Hypertension |
201 |
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Acute Fracture |
201 |
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Acute Local Dermatologic Infections |
201 |
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General Description and Operation of the Unit |
201 |
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Equipment |
201 |
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Clinical Parameters |
202 |
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Preparation for IPC Treatments |
203 |
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Treatment Application Guidelines |
204 |
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Possible Complications of Treatment |
205 |
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Intermittent Pneumatic Compression: Evidence of Effectiveness |
205 |
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Chapter 9 |
Foundations of Electrotherapy James W. Bellew, PT, EdD |
209 |
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Overview of Electrotherapy |
209 |
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Principles of Electricity: Making the Physics Make Sense |
210 |
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Charge |
210 |
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Polarity and the Electric Field |
210 |
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Voltage |
211 |
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Conductors and Insulators |
212 |
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Current |
212 |
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Ohm's Law: Resistance, Capacitance, and Impedance |
213 |
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Currents and Waveforms |
214 |
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The Basic Currents |
214 |
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Direct Current |
215 |
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Alternating Current |
215 |
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Pulsed Current |
216 |
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Physiological Response to Electrical Current |
221 |
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Electrochemical Effects |
222 |
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Electrothermal Effects |
223 |
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Electrophysical Effects |
223 |
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Response of Excitable Tissues to Stimulation |
224 |
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Levels of Response to Electrical Stimulation |
227 |
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Therapeutic Currents by Name: Variations of the Basic Currents |
227 |
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Russian Current |
228 |
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High-Volt Pulsed Current |
229 |
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Interferential Current |
231 |
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Low-Intensity Direct Current (Microcurrent) |
234 |
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Symmetrical and Asymmetrical Biphasic Pulsed Currents |
236 |
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The Bottom Line for Electrotherapy |
238 |
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Chapter 10 |
Clinical Electrical Stimulation: Application and
Techniques James W Bellew,
PT, EdD |
241 |
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Instrumentation for Electrotherapy |
241 |
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Classifying Electrotherapeutic Devices |
241 |
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Control of Electrical Stimulation: The Dials and Buttons |
242 |
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Electrodes: Types and Choices |
244 |
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Applying Electrodes |
246 |
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Placement of Electrodes |
247 |
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Electrode Configurations |
249 |
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Electrotherapy Application and Techniques: Why Use Electrotherapy? |
253 |
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Deciphering the "Electro Lingo Code" |
253 |
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Electrotherapy for Activation of Skeletal Muscle: Strengthening and Reeducation |
253 |
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Strengthening: NMES |
253 |
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Reeducation and Retraining: |
254 |
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Electrical Stimulation of Denervated
Muscle |
256 |
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Electrotherapy for Modulating of Pain |
258 |
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Electrotherapy for Preventing or Reducing Edema |
260 |
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Electrotherapy for Increasing Circulation |
263 |
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Electrotherapy for Promoting Tissue Healing |
264 |
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Biofeedback |
266 |
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Iontophoresis |
267 |
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Physiology of Iontophoresis |
268 |
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Application of Iontophoresis |
269 |
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Selecting an Ion |
269 |
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Electrode Selection and Placement |
269 |
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Dosage and the lontophoretic Equation |
270 |
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Adverse Effects: Current not Drugs |
271 |
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Recent Advances in Iontophoresis |
271 |
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Iontophoresis Versus Tap Water
Galvanism |
272 |
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Precautions and Contraindications |
272 |
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Safety With Electrotherapeutics: "Primum
Non Nocere" |
274 |
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SECTION III |
CLINICAL APPLICATIONS OF MODALITIES |
279 |
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Chapter 11 |
Electrotherapy for Musculoskeletal Disorders C. Scott
Bkkel, PT, PhD, Chris M. Gregory, PT, PhD, and
James W Bellew, PT, EdD |
281 |
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Rationale for NMES |
281 |
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NMES for Muscle Strengthening |
282 |
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Examination, Evaluation, and Prognosis |
286 |
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Intervention |
286 |
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Voluntary Versus NMES Exercise:
Differences in Muscle Recruitment |
286 |
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Selecting a Stimulator |
287 |
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Stimulation Parameters |
287 |
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Electrode Placement |
289 |
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Intensity or Dosage |
289 |
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Monitoring Treatment |
290 |
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NMES and Motor Unit Recruitment |
292 |
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Limitations of NMES |
294 |
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Electrical Muscle Stimulation ( |
295 |
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Examination, Evaluation, and Prognosis |
296 |
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Intervention |
296 |
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Biofeedback |
297 |
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Recording and Displaying the EMG Signal |
298 |
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Electrode Type and Electrode Placement Considerations for EMG
Biofeedback |
298 |
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Patient Training Strategies With EMG
Biofeedback |
299 |
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Chapter 12 |
NMES and FES in
Patients with Neurologic
Diagnoses |
303 |
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Examination Needs |
303 |
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Neuromuscular Electrical Stimulation (NMES) |
304 |
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NMES for Muscle Strengthening |
304 |
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NMES for Increasing |
307 |
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NMES for Decreasing Spasticity |
310 |
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NMES for Decreasing Urinary Incontinence |
311 |
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Functional Electrical Stimulation |
314 |
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314 |
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316 |
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318 |
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321 |
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Biofeedback |
324 |
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Chapter 13 |
Pain and Limited Motion Stephanie C. Petterson, PT, MPT, PhD, and Susan L Michiovits,
PT, PhD, CHT |
333 |
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Clinical Reasoning |
333 |
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Sources of Pain Mediation |
333 |
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Peripheral Nociceptive |
334 |
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Peripheral Neurogenic |
334 |
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Central Pain |
335 |
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Pain Related to Sympathetic Nervous System |
335 |
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Affective Pain |
335 |
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Sources of Loss of Mobility and |
335 |
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Edema and Pain Following Injury |
335 |
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Joint Stiffness Associated With Arthritis |
336 |
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Joint Contracture Following Injury and Immobilization |
337 |
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Assessment of Pain and Loss of Motion |
337 |
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Pain Assessment |
337 |
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Pain Interview |
338 |
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Pain Rating Scales |
338 |
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Body Diagrams or Pain Drawings |
339 |
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The McGill Pain Questionnaire |
339 |
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Reduction in Pain Medications |
339 |
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Mobility and |
339 |
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Modality Interventions: Use of Modalities for Pain Modulation |
340 |
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Cryotherapy |
342 |
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Thermotherapy |
343 |
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Ultrasound |
344 |
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Electroanalgesia |
345 |
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Laser Therapy |
347 |
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Transdermal Delivery of
Medications or Other Substances |
348 |
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Associated Impairments |
352 |
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Use of Modalities to Increase Motion |
352 |
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Contractures From Burn Scar |
354 |
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Further Clinical Considerations: Contraindications and Precautions |
354 |
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Home Use Versus Clinic Use of Modalities for Pain Control and Loss of Motion |
354 |
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Selection of the Appropriate Modality for Pain Modulation or Loss of Motion |
355 |
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Chapter 14 |
Therapeutic Modalities for Tissue Healing EdMahoney, PT, DPT, CWS |
361 |
|
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The |
361 |
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Conventional Ultrasound: Therapeutic Ultrasound at 1 and 3 MHz |
362 |
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Low-Frequency Ultrasound |
363 |
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Ultraviolet Light |
364 |
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Electrical Stimulation |
367 |
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Infrared Energy |
370 |
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Intermittent Pneumatic Compression |
372 |
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Superficial Heating Modalities |
373 |
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Cryotherapy |
374 |
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Hydrotherapy |
376 |
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Laser Therapy |
377 |
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Negative-Pressure Wound Therapy |
379 |
|
SECTION IV |
ALTERNATIVE MODALITIES AND ELECTRO
PHYSIOLOGIC TESTING |
387 |
|
Chapter 15 |
Alternative Modalities for Pain and Tissue Healing Thomas
P. Nolan Jr., PT, DPT, OCS,
and Susan L Mkhlovitz, PT, PhD, CHT |
389 |
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Magnet Therapy |
389 |
|
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Physical Principles of Magnets |
390 |
|
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Pulsed Magnetic Fields |
390 |
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Proposed Physiological Effects of Magnets |
390 |
|
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Review of the Literature on Magnet Therapy |
391 |
|
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Clinical Applications of Magnet Therapy |
393 |
|
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Monochromatic Infrared Photo Energy |
393 |
|
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Physical Principles of MIRE |
393 |
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Proposed Physiological Effects of MIRE |
394 |
|
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Review of the Literature on MIRE |
394 |
|
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Clinical Applications of MIRE |
395 |
|
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Hyperbaric Oxygen Therapy |
395 |
|
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Physical Principles of HBOT |
396 |
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Proposed Physiological Effects of HBOT |
396 |
|
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Review of the Literature on HBOT |
397 |
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Clinical Applications of HBOT |
398 |
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Extracorporeal Shock Wave Therapy |
398 |
|
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Physical Principles of ESWT |
399 |
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Proposed Physiological Effects of ESWT |
399 |
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Review of the Literature on ESWT |
399 |
|
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Clinical Applications of ESWT |
400 |
|
Chapter 16 |
Electrophysiological Testing of Nerves and Muscles Arthur
J. Nitz, PT, PhD, and James W. Bellew,
PT, EdD |
403 |
|
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What Is Electroneuromyography? |
403 |
|
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Anatomy and Physiology Review |
403 |
|
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Peripheral Nerve Structure |
403 |
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Peripheral Nerve Function |
404 |
|
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Equipment to Conduct ENMG |
406 |
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Indications: Who Needs ENMG Testing? |
407 |
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Clinical Examples of Diagnostic Dilemma for Which ENMG Testing Is Important |
408 |
|
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Precautions |
410 |
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Nerve Conduction Studies |
410 |
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General Influencing Factors |
410 |
|
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Motor Nerve Conduction Study |
411 |
|
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Sensory Nerve Conduction Study |
414 |
|
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Central Conduction and Long-loop Responses (F-wave and H-reflex) |
416 |
|
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Coming to Some Conclusions: What
Do We Know So Far? |
418 |
|
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Clinical Electromyography (EMG) |
421 |
|
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What Can Be Learned by Needle EMG that
has not Already Been Determined by the NCS? |
422 |
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Insertion |
424 |
|
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Rest |
424 |
|
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Minimal Activation |
428 |
|
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Maximal Activation (Recruitment) |
429 |
|
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Interpretation of Electrophysiological Evaluation Findings |
431 |
|
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Reporting Results |
433 |
|
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Does ENMG Bear Any Relationship to EMG Biofeedback? |
434 |
|
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Glossary |
437 |
|
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Index |
447 |
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