The Modalities of Physical Therapy

Rehab Room

Physical therapy is the treatment of neurological, musculoskeletal, circulatory, and skin disorders using various physical therapy modalities. The goal of physical therapy intervention is for patients to regain maximum potential and to have a productive life with or without the presence of disability.

Physical therapists may use a number of different modalities for your problem(s) or condition for a variety of reasons, including:

• Reduction of pain
• Increasing range of motion
• Decreasing swelling
• Increasing the rate of healing
• Stabilizing areas needing support

“Four basic modalities are employed in physical therapy, each applied where and when it will do the most good. Not all of the modalities are used in every case.

 

Cold therapy

Cold therapy or cryotherapy is an effective means of reducing inflammation following an accident or injury. Cold therapy is applied in the form of ice packs, sometimes combined with massage, cold water bath of the injured area, and other methods. The reduced temperature will quell the firing of the nerve-muscle units and reduce muscle spasms, and that along with the anesthetic effect of the cold temperature will ease pain. Also, the cold reduces blood flow into the injury and reduces any bleeding that may be present and reduces oxygen demands of the injured tissue, thus preserving the muscle cells. An ice pack often is applied with a compression wrap to reduce swelling, and with elevation of the injured extremity above heart level for maximal reduction in swelling.

 

Heat therapy

Heat or thermotherapy may be employed only after the active swelling of the injury has abated, 24-48 hours following the injury. Heat is conveyed into the injured area by the use of moist heat packs, hot paraffin, hot air or hot water as in a whirlpool bath, by infrared lamp, and by conversion. Conversion is the development of heat brought about by the passage of sound waves or electric current through tissue. Diathermy is an example of electrical waves directed into tissue and converted into heat. Ultrasound, very high-frequency sound waves, bring about the vibration of the tissues, which increases the temperature within them. A form of application of sound waves called phonophoresis consists of application of a medication to the injured area followed by ultrasound to drive the medication deep into the tissues.

Heat increases blood flow to an area, so should not be used when internal bleeding accompanies an injury. However, like cryotherapy, heat reduces muscle spasms by increasing the blood flow to an area, which helps to wash out metabolic waste products and increase the amount of oxygen reaching the tissues.

 

Electrical stimulation

Application of electrical stimulation can restore muscle tone by stimulating muscles to contract rhythmically. This method is used often when an injured person has been confined to bed for a long period of time. Over time, muscles will atrophy and the patient will require long, arduous periods of exercise once he is mobile. The use of electrical stimulation can prevent muscle atrophy and reduce the necessary physical therapy regimen required later. Electricity is also used to drive molecules of medication through the skin into the tissues. This is called iontophoresis. A special machine called a TENS machine (transcutaneous electrical nerve stimulation) beams electric current through the skin (transcutaneously) into the injured area specifically to stop pain. Why TENS has this ability to assuage pain remains open to question, but it is thought that it prevents pain perception by the sensory nerves in the injured area. That is, the nerves that normally would detect pain and carry the impulse to the spinal cord do not sense pain. The electrical signal from the TENS machine can be adjusted for frequency and strength to achieve its effect without patient discomfort. All electrical stimulation is delivered by placing pads on or around the injured area to conduct the electrical current.

 

Mechanical manipulation

The use of massage, manipulation of the injured limb, traction, and weight lifting are part of the mechanical form of physical therapy. Massage is the rubbing, tapping, or kneading of an injured area to increase blood circulation and relieve pain. Manipulation consists of putting an injured joint through its movements from one extreme to the other. This is designed to restore full range of motion to the joint and eliminate pain from movement. Traction is the application of weight to stretch muscles or to help increase the space between vertebrae and relieve nerve compression. Manipulation may be carried out by a trained technician or by using a machine especially constructed to exercise the injured joint. Resistance can be altered in the machine to make joint extension or flexing more difficult, thus helping to build the muscles that control the joint movement.

Many forms of physical therapy can be carried out at home, but the exercises must first be carefully explained by a trained therapist. Incorrect application of a physical therapy modality can be as harmful as any traumatic injury. Most modalities are applied two or three times daily over a period of time to help restore movement, flexibility, or strength to an injured area.

Through the use of tests, evaluations, exercises, treatments with modalities, screening programs, as well as educational information, physical therapists:

• increase, restore or maintain range of motion, physical strength, flexibility, coordination, balance and endurance
• recommend adaptations to make the home accessible and safe
• teach positioning, transfers, and walking skills to promote maximum function and independence within an individual's capability
• increase overall fitness through exercise programs
• prevent further decline in functional abilities through education, energy conservation techniques, joint protection, and use of assistive devices to promote independence
• improve sensation, joint proprioception and reduce pain

 

Common Conditions

A vast number of conditions are treated effectively with physical therapy intervention. Examples of specific diseases and conditions that may be improved with physical therapy include:

• arthritis
• sports/orthopedic injuries
• joint replacements
• cerebral vascular accident (stroke)
• coordination and balance disorders
• Alzheimer disease”

See: science.jrank.org

To ensure the best treatment outcome for the patient, the physiatrist and the physical therapist must ensure that the correct physical therapy modalities are prescribed.

Many researches supported that treatment outcome differ from patient to patient depending upon the severity and extent of the disability, methods used, and also the level of cooperation of the patient to rehabilitation.

See: ncbi.nlm.nih.gov

       acupunturabrasil.org

Image Credit: prorehabchiropractic.com

Benefits of Home Physical Therapy

There are many settings that physical therapists practice their craft.  Schools, hospitals, private outpatient clinics, nursing homes, and private homes are some of these settings.  The most common setting for a patient that is unable to commute to an outpatient clinic or for patients that are homebound is home care physical therapy.  New trend in physical therapy such as the clinic is brought to the patient is now a common practice. Some models are being used. One model is that some physical therapists have a mobile clinic in the form of an RV.  Equipments such as treatment tables, exercise equipments and the typical modalities you would find in a PT outpatient clinic can be found in the RV. A second model which is cheaper would be a physical therapist coming to the patient’s home with a portable treatment table and other hand-held physical therapy modalities such as ultrasound machine, ES, TENS, walking aids and more.

What are the benefits of treating patients in their homes?

• Patients will not miss any treatment sessions thereby improving compliance.
• Evaluation of patients by physical therapist in their REAL natural environment.
• More time efficient since patients don’t have to travel to the clinic
• Patient’s privacy with their family
• Elimination of disruptions such as other clients/patients being treated, etc.
• Physical therapist can have a quality time with the patient as it is a one on one treatment session.
• Allows effective treatment sessions and reduces the risk of injury
• Your whole family is present to support you throughout the treatment session
• Can eliminate complications of driving or riding a car or a public vehicle and the hassle of going to an outpatient physical therapy clinic after a surgery.

Why is home physical therapy right for you?

You must consider some few questions if the home physical therapy is right for you. 

Are you comfortable with a stranger in your home? 

The first few minutes in a therapy session is the adjustment period.  After the physical therapist has introduced him and the treatment approach, you may now be comfortable with him since you are divulging personal information regarding your medical history.

Can you concentrate without any distractions in your home?

Just enough space for the therapy session is required by the physical therapist.  They just need to set up the treatment table and may require an outlet for modalities.  Therapists are trained to be creative in such a way to take advantage of a small area to achieve the required room for exercise.  In addition, most equipments and modalities required for therapy is light and portable.  Thus requires just a little space.

In my experience, patients prefer home therapy because it is more comfortable, more convenient, and promote patient compliance.  They can also take advantage of not going to travel anymore.  It is typical for the patients who undergo home physical therapy to have their therapy sessions scheduled in the morning before going to work or late in the evening after office or working hours.

What about insurance coverage?

Your insurance coverage is dependent on your physical therapist.  Some therapists are connected with Medicare and other commercial plans while others are out of network. It is important to communicate with the therapist prior to the first visit to find out how your treatment sessions will be covered.

Not all patients are candidates for home therapy program.  Physiatrists and physical therapists may advice outpatient care.  However, if you are enjoying your home therapy program you can ask your physiatrist and physical therapist so that they can provide adjustments in your treatment program.