Therapeutic Modalities in Rehabilitation

by Prentice, William E.; Quillen, Willaim S., Ph.D. (CON); Underwood, Frank, Ph.D. (CON)

• ISBN13: 9780071441230
• ISBN10: 0071441239
• Edition: 3rd
• Format: Hardcover
• Copyright: 2005-05-18
• Publisher: McGraw-Hill Medical

Summary

The most comprehensive therapeutic modalities book. Provides a theoretically based but practically oriented guide to the use of therapeutic modalities. Perfect for the required course in the Physical Therapy curriculum or as a clinical reference, the text features extensive use of case studies, laboratory activities, and a renown illustration program.

Author Biography

William E. Prentice, PhD PT ATC, is Professor and Coordinator of the Sports Medicine Program; Clinical Professor, Division of Physical Therapy, Department of Medical Allied Professions; Associate Professor, Department of Orthopaedics, School of Medicine. He is at the University of North Carolina, Chapel Hill, North Carolina

Table of Contents

Contributors	xvii
Preface	xix
Part One Foundations of Therapeutic Modalities
The Science of Therapeutic Modalities	3	(11)
Wiiliam E. Prentice
Radiant Energy	3	(1)
Electromagnetic Radiations	4	(2)
Wavelength and Frequency	6	(1)
Laws Governing the Effects of Electromagnetic Radiations	6	(2)
Arndt-Schultz Principle	6	(1)
Law of Grotthus-Draper	7	(1)
Cosine Law	7	(1)
Inverse Square Law	8	(1)
The Application of the Electromagnetic Spectrum to Therapeutic Modalities	8	(3)
Electrical Stimulating Currents	9	(1)
Electromyographic Biofeedback	9	(1)
Shortwave and Microwave Diathermy	9	(1)
Infrared Modalities	9	(1)
Laser	10	(1)
Ultraviolet Light	10	(1)
The Acoustic Spectrum and Ultrasound	11	(3)
Extracorporeal Shock Wave Therapy (ESWT)	11	(1)
Summary	12	(2)
The Healing Process and Guidelines for Using Therapeutic Modalities	14	(14)
William E. Prentice
Understanding the Healing Process	15	(6)
Inflammatory-Response Phase	15	(2)
Fibroblastic-Repair Phase	17	(1)
Maturation-Remodeling Phase	18	(2)
Factors That Impede Healing	20	(1)
Injury Management Using Modalities	21	(3)
Initial Acute Injury Phase	21	(2)
Inflammatory-Response Phase	23	(1)
Fibroblastic-Repair Phase	23	(1)
Maturation-Remodeling Phase	24	(1)
Other Considerations in Treating Injury	24	(1)
Indications and Contraindications	25	(3)
Summary	26	(2)
The Role of Therapeutic Modalities in Wound Healing	28	(32)
Pamela E. Houghton
Superficial Hot and Cold	28	(1)
Hydrotherapy	29	(1)
Electrical Stimulation	30	(7)
Ultrasound	37	(3)
Laser	40	(2)
Ultraviolet Light	42	(3)
Pneumatic Compression Therapy	45	(1)
Choosing the Best Modality for the Treatment of Delayed or Nonhealing Wounds	45	(3)
Indications, Contraindications	45	(3)
Review of Clinical Research Evidence	48	(3)
Algorithm for Choosing the Appropriate Therapeutic Modality	51	(9)
Summary	53	(7)
Managing Pain with Therapeutic Modalities	60	(23)
Craig R. Denegar
Phillip B. Donley
Understanding Pain	60	(1)
Types of Pain	61	(1)
Pain Assessment	61	(4)
Pain Assessment Scales	62	(3)
Tissue Sensitivity	65	(1)
Goals in Managing Pain	65	(1)
Pain Perception and Neural Transmission	65	(1)
Sensory Receptors	65	(1)
Neural Transmission	66	(4)
Facilitators and Inhibitors of Synaptic Transmission	67	(2)
Nociception	69	(1)
Neurophysiologic Explanations of Pain Control	70	(5)
Blocking Pain Impulses with Ascending A-Beta Input	71	(1)
Descending Pain Control Mechanisms	72	(1)
Beta-Endorphin and Dynorphin	73	(1)
Summary of Pain Control Mechanisms	74	(1)
Cognitive Influences	74	(1)
Pain Management	75	(8)
Summary	77	(6)
Part Two Electrical Modalities
Basic Principles of Electricity	83	(21)
William E. Prentice
Components of Electrical Currents	84	(1)
Electrotherapeutic Currents	85	(2)
Generators of Electrotherapeutic Currents	86	(1)
Waveforms	87	(7)
Waveform Shape	87	(1)
Pulses Versus Phases and Direction of Current Flow	87	(2)
Pulse Amplitude	89	(1)
Pulse Charge	90	(1)
Pulse Rate of Rise and Decay Times	90	(1)
Pulse Duration	91	(1)
Pulse Frequency	91	(1)
Current Modulation	92	(2)
Electrical Circuits	94	(2)
Series and Parallel Circuits	94	(2)
Current Flow Through Biologic Tissues	96	(1)
Physiologic Responses to Electrical Current	96	(1)
Safety in the Use of Electrical Equipment	97	(7)
Summary	99	(5)
Electrical Stimulating Currents	104	(61)
Daniel N. Hooker
Physiologic Response to Electrical Currents	105	(16)
Muscle and Nerve Responses to Electrical Currents	106	(5)
The Effects of Electrical Stimulation on Nonexcitable Tissues and Cells	111	(10)
Electrical Concepts: Effects of Changes in Current Parameters and Their Effect on Treatment Protocols	121	(6)
Biphasic Versus Monophasic Current	121	(1)
Tissue Impedance	122	(1)
Current Density	122	(1)
Frequency	123	(1)
Intensity	124	(1)
Duration	124	(1)
Polarity	125	(1)
Electrode Placement	126	(1)
Therapeutic Uses of Electrically Induced Muscle Contraction	127	(7)
Muscle Reeducation	128	(1)
Muscle Pump Contractions	129	(1)
Retardation of Atrophy	129	(2)
Muscle Strengthening	131	(1)
Increasing Range of Motion	131	(1)
The Effect of Noncontractile Stimulation on Edema	132	(2)
Stimulation of Denervated Muscle	134	(1)
Treatment Parameters for Stimulating Denervated Muscle	135	(1)
Therapeutic Uses of Electrical Stimulation of Sensory Nerves	135	(3)
Gate Control Theory	135	(1)
Descending Pain Control Theory (Central Biasing Theory)	136	(1)
Opiate Pain Control Theory	136	(2)
Placebo Effect of Electrical Stimulation	138	(1)
Clinical Uses of Low-Voltage Continuous Monophasic Current	138	(1)
Medical Galvanism	138	(1)
Iontophoresis	139	(1)
Treatment Precautions with Continuous Monophasic Currents	139	(1)
Functional Electrical Stimulation (FES)	139	(1)
Clinical Uses of FES	140	(1)
Specialized Electrical Currents	140	(7)
Low-Intensity Stimulators (LIS)	140	(3)
Russian Currents (Medium-Frequency Current Generators)	143	(2)
Interferential Currents	145	(2)
Conclusion	147	(18)
Summary	147	(18)
Iontophoresis	165	(17)
William E. Prentice
Iontophoresis Versus Phonophoresis	165	(1)
Basic Mechanisms of Ion Transfer	166	(2)
Pharmacokinetics of Iontophoresis	166	(1)
Movement of Ions in Solution	166	(1)
Movement of Ions Through Tissue	166	(2)
Iontophoresis Equipment and Treatment Techniques	168	(4)
Type of Current Required	168	(1)
Iontophoresis Generators	169	(1)
Current Intensity	169	(1)
Treatment Duration	170	(1)
Dosage of Medication	170	(1)
Electrodes	170	(1)
Selecting the Appropriate Ion	171	(1)
Clinical Applications for Iontophoresis	172	(2)
Treatment Precautions and Contraindications	174	(8)
Treatment of Burns	175	(1)
Sensitivity Reactions to Ions	175	(1)
Summary	175	(7)
Biofeedback	182	(19)
William E. Prentice
Electromyography and Biofeedback	182	(1)
The Role of Biofeedback	183	(1)
Biofeedback Instrumentation	183	(2)
Peripheral Skin Temperature	183	(1)
Finger Phototransmission	184	(1)
Skin Conductance Activity	185	(1)
Electromyographic Biofeedback	185	(4)
Motor Unit Recruitment	185	(1)
Measuring Electrical Activity	186	(2)
Converting Electromyographic Activity to Meaningful Information	188	(1)
Biofeedback Equipment and Treatment Techniques	189	(3)
Electrodes	189	(2)
Displaying the Information	191	(1)
Clinical Applications for Biofeedback	192	(9)
Muscle Reeducation	192	(1)
Relaxation of Muscle Guarding	193	(1)
Pain Reduction	193	(1)
Summary	194	(7)
Principles of Electrophysiologic Evaluation and Testing	201	(58)
John Halle
David Greathouse
Introduction	202	(1)
Electrophysiologic Testing Equipment and Setup	203	(8)
Evaluation of the Peripheral Nervous System	211	(2)
Anatomy of the Spinal Nerve and Neuromuscular Junction	213	(2)
The Elements of the Spinal Nerve	215	(1)
Testing Procedures	215	(16)
Limb Temperature and Age Considerations	216	(1)
Nerve Conduction Study	216	(15)
The Electromyographic Examination	231	(13)
Somatosensory Evoked Potentials	242	(1)
Other Electrophysiologic Testing Procedures	243	(1)
Requesting NCS/EMG Examinations	244	(1)
Conclusion	244	(15)
Summary	245	(14)
Part Three Thermal Modalities
Shortwave and Microwave Diathermy	259	(31)
William E. Prentice
David O. Draper
Physiologic Responses to Diathermy	260	(1)
Thermal Effects	260	(1)
Nonthermal Effects	261	(1)
Shortwave Diathermy Equipment and Treatment Techniques	261	(11)
Shortwave Diathermy Generators	261	(2)
Shortwave Diathermy Electrodes	263	(6)
Pulsed Shortwave Diathermy	269	(2)
Treatment Time	271	(1)
Microwave Diathermy	272	(3)
Microwave Diathermy Generators	273	(1)
Microwave Diathermy Applicators	273	(1)
Microwave Treatment Technique	274	(1)
Clinical Applications for Diathermy	275	(1)
Diathermy Treatment Precautions and Considerations	276	(2)
Comparing Shortwave Diathermy and Ultrasound as Thermal Modalities	278	(2)
Guidelines for the Safe Use of Diathermy	280	(10)
Summary	280	(10)
Infrared Modalities	290	(70)
Gerald W. Bell
William E. Prentice
Mechanisms of Heat Transfer	290	(1)
Appropriate Use of the Infrared Modalities	291	(1)
Clinical Use of the Infrared Modalities	292	(3)
Effects of Tissue Temperature Change on Circulation	292	(1)
Effects of Tissue Temperature Change on Muscle Spasm	293	(1)
Effects of Temperature Change on Performance	294	(1)
Cryotherapy	295	(18)
Physiologic Effects of Tissue Cooling	295	(2)
Cryotherapy Treatment Techniques	297	(16)
Thermotherapy	313	(12)
Physiologic Effects of Tissue Heating	313	(1)
Thermotherapy Treatment Techniques	314	(11)
Counterirritants	325	(1)
Conclusions	325	(35)
Summary	326	(34)
Therapeutic Ultrasound	360	(49)
David O. Draper
William E. Prentice
Ultrasound as a Thermal Modality	361	(1)
Transmission of Acoustic Energy in Biologic Tissues	361	(2)
Transverse Versus Longitudinal Waves	361	(1)
Frequency of Wave Transmission	361	(1)
Velocity	362	(1)
Attenuation	362	(1)
Basic Physics of Therapeutic Ultrasound	363	(11)
Transducer	365	(2)
Frequency of Therapeutic Ultrasound	367	(2)
The Ultrasound Beam	369	(2)
Pulsed Versus Continuous Wave Ultrasound	371	(1)
Amplitude, Power, and Intensity	372	(2)
Physiologic Effects of Ultrasound	374	(2)
Thermal Effects	374	(1)
Nonthermal Effects	375	(1)
Ultrasound Treatment Techniques	376	(7)
Frequency of Treatment	377	(1)
Duration of Treatment	377	(1)
Coupling Methods	378	(1)
Exposure Techniques	379	(2)
Moving the Transducer	381	(2)
Recording Ultrasound Treatments	383	(1)
Clinical Applications for Therapeutic Ultrasound	383	(6)
Soft-Tissue Healing and Repair	383	(2)
Scar Tissue and Joint Contracture	385	(1)
Stretching of Connective Tissue	385	(2)
Chronic Inflammation	387	(1)
Bone Healing	387	(1)
Pain Reduction	388	(1)
Plantar Warts	388	(1)
Placebo Effects	388	(1)
Phonophoresis	389	(2)
Using Ultrasound in Combination with Other Modalities	391	(2)
Ultrasound and Hot Packs	391	(1)
Ultrasound and Cold Packs	391	(1)
Ultrasound and Electrical Stimulation	392	(1)
Treatment Precautions	393	(1)
Guidelines for the Safe Use of Ultrasound Equipment	393	(16)
Summary	394	(15)
Part Four Light Therapy
Low-Level Laser Therapy	409	(24)
Ethan Saliba
Susan Foreman-Saliba
Physics	410	(2)
Stimulated Emissions	410	(2)
Types of Lasers	412	(1)
Laser Generators	413	(2)
Helium Neon Lasers	413	(1)
Gallium Arsenide Lasers	414	(1)
Laser Treatment Techniques	415	(4)
Lasing Techniques	416	(1)
Dosage	417	(2)
Depth of Penetration	419	(1)
Clinical Applications for Lasers	419	(4)
Wound Healing	420	(2)
Pain	422	(1)
Bone Response	423	(1)
Suggested Treatment Protocols	423	(2)
Pain	424	(1)
Wound Healing	424	(1)
Scar Tissue	425	(1)
Edema and Inflammation	425	(1)
Safety	425	(1)
Precautions and Contraindications	426	(1)
Conclusion	426	(7)
Summary	426	(7)
Ultraviolet Therapy	433	(20)
J. Marc Davis
Ultraviolet Radiation	433	(1)
Effect on Cells	434	(1)
Effect on Normal Human Tissue	434	(3)
Short-Term Effect on Skin	434	(2)
Tanning	436	(1)
Long-Term Effect on Skin	437	(1)
Effect on Eyes	437	(1)
Systemic Effects	438	(1)
Ultraviolet Generators	438	(2)
Ultraviolet Treatment Techniques	440	(2)
Determining the Minimal Erythemal Dose	440	(1)
Positioning the Lamp	441	(1)
Clinical Applications for Ultraviolet	442	(2)
Psoriasis	442	(1)
Disturbances of Calcium and Phosphorus Absorption	443	(1)
Pressure Sores	444	(1)
Sterilization	444	(1)
Diagnosis	444	(1)
Conclusion	444	(9)
Summary	444	(9)
Part Five Mechanical Modalities
Spinal Traction	453	(31)
Daniel N. Hooker
The Physical Effects of Traction	453	(5)
Effects on Spinal Movement	453	(1)
Effects on Bone	454	(1)
Effects on Ligaments	454	(1)
Effects on the Disk	455	(1)
Effects on Articular Facet Joints	456	(1)
Effects on the Muscular System	456	(1)
Effects on the Nerves	456	(1)
Effects on the Entire Body Part	457	(1)
Traction Treatment Techniques	458	(1)
Lumbar Positional Traction	458	(3)
Inversion Traction	461	(1)
Manual Lumbar Traction	462	(3)
Level-Specific Manual Traction	462	(1)
Unilateral Leg Pull Manual Traction	463	(2)
Mechanical Lumbar Traction	465	(10)
Patient Setup and Equipment	465	(3)
Body Position	468	(3)
Traction Force	471	(1)
Intermittent Versus Sustained Traction	472	(1)
Duration of Treatment	473	(1)
Progressive and Regressive Steps	473	(2)
Manual Cervical Traction	475	(1)
Mechanical Cervical Traction	476	(2)
Indications and Contraindications	478	(6)
Summary	479	(5)
Intermittent Compression Devices	484	(19)
Daniel N. Hooker
The Lymphatic System	485	(1)
Purposes of the Lymphatic System	485	(1)
Structure of the Lymphatic System	485	(1)
Peripheral Lymphatic Structure and Function	485	(1)
Injury Edema	486	(3)
Formation of Pitting Edema	487	(1)
Formation of Lymphedema	487	(2)
The Negative Effects of Edema Accumulation	489	(1)
Treatment of Edema	489	(1)
Intermittent Compression Treatment Techniques	490	(4)
Inflation Pressures	491	(1)
On-Off Sequence	491	(1)
Total Treatment Time	491	(1)
Patient Setup and Instructions	492	(2)
Cold and Compression Combination	494	(1)
Sequential Compression Pumps	494	(2)
Indications and Contraindications for Use	496	(7)
Summary	496	(7)
Part Six Other Modalities
Therapeutic Massage	503	(34)
William E. Prentice
Clairbeth Lehn
The Value of Manual Therapy Techniques	503	(1)
The Evolution of Massage as a Treatment Modality	503	(1)
Physiologic Effects of Massage	504	(3)
Reflexive Effects	504	(1)
Mechanical Effects	505	(2)
Psychologic Effects of Massage	507	(1)
Massage Treatment Considerations and Guidelines	507	(5)
Equipment	509	(1)
Preparation of the Patient	510	(2)
Massage Treatment Techniques	512	(17)
Hoffa Massage	512	(6)
Friction Massage	518	(1)
Connective Tissue Massage	518	(2)
Acupressure and Trigger Point Massage	520	(4)
Myofascial Release	524	(1)
Strain/Counterstrain	525	(1)
Positional Release Therapy	526	(1)
Active Release Technique	526	(2)
Rolfing	528	(1)
Trager	528	(1)
The Current Role of Massage in Physical Therapy	529	(8)
Summary	529	(8)
Extracorporeal Shock Wave Therapy	537	(14)
Charles Thigpen
History of ESWT	537	(1)
Physical Characteristics of Extracorporeal Shock Wave	538	(2)
Shock Wave Generation	540	(1)
Physical Parameters of Shock Waves	540	(1)
Biologic Effects	541	(2)
Bone	542	(1)
Tendon	542	(1)
Clinical Applications	543	(2)
Plantar Fasciitis	543	(1)
Medial/Lateral Epicondylitis	544	(1)
Calcific Tendinitis of the Shoulder	544	(1)
Evaluation of ESWT Literature for Evidence-Based Practice	545	(6)
Summary	545	(6)
Part Seven Summary
The Physiologic Effects of Therapeutic Modality Intervention on the Body Systems	551	(19)
Eric Shamus
Stanley H. Wilson
Systems Approach	552	(1)
Electrical Stimulating Currents	552	(3)
Interferential Current (IFC)	552	(1)
Neuromuscular Electrical Stimulation (NMES)	553	(1)
Transcutaneous Electrical Nerve Stimulation (TENS)	554	(1)
Iontophoresis	555	(1)
Biofeedback	556	(1)
Cryotherapy Techniques	557	(1)
Thermotherapy Techniques	558	(3)
Warm Whirlpool Hot Packs	558	(2)
Paraffin	560	(1)
Infrared Lamps	560	(1)
Fluidotherapy	561	(1)
Therapeutic Ultrasound (US)	561	(1)
Ultraviolet Therapy (UV)	562	(1)
Traction (Manual and Mechanical)	563	(1)
Compression Devices	564	(1)
Massage	565	(5)
Appendix A-1. Locations of the Motor Points	570	(3)
Appendix A-2. Units of Measure	573	(2)
Index	575