Chapter 23
Physical
Modalities
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Tip
Your medical practice may not provide services for physical modalities
or fitting of ambulation devices; however, it is important that the
medical assistant recognize improper fitting and use when patients
present with crutches, walkers, or canes. Information may be
obtained from durable medical equipment vendors or retailers.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview
Physical modalities are noninvasive therapeutic agents, procedures, and
preventive measures used in the following:
Physical medicine (physiatry)—diagnosis and treatment of disease
and disability using physical means, such as diathermy
■ Rehabilitative medicine—restores and improves function impaired
by disease or injury
■ Sports medicine—prevents and treats injuries and impairments that
are sports related
■ Preventive health—applies techniques and uses devices to prevent
injury and impairment (e.g., body mechanics)
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mobility Testing
■ Goniometry—measurement of degrees of joint motion using a
goniometer
■ Range of motion (ROM) test—exam requiring the patient to perform
various joint motions to determine the extent of movement
■ Strength tests—exams requiring the patient to perform select
muscle or muscle group actions to determine the strength of
function
■ Activities of daily living (ADL) tests—exams that determine the
patient’s ability to perform common tasks (e.g., opening doors,
brushing hair)
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies
Thermotherapy
Thermotherapy uses heat to reduce swelling and to decrease pain by
dilating blood vessels (vasodilation), increasing circulation to the
affected area; it is not used in the initial phase of injury treatment:
■
Dry heat—heat without moisture
• Heating pads—electrically or microwave-heated packs for
thermotherapy use; should always be covered with fabric before
placing on skin; check cords for safety and frequently monitor
temperature to avoid burns
• Chemical hot packs—heating pads filled with a chemical
compound that produce heat when activated (usually by
applying pressure); follow same precautions as for heating pads
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
• Infrared—heat produced by wavelengths in various lamp-like
structures; position a safe distance from skin and monitor
frequently to avoid burns
• Ultraviolet—sunlamps used to treat specific conditions (e.g.,
psoriasis, newborn jaundice); patient’s eyes should be covered
and length of exposure timed and monitored to avoid burns
■ Moist heat—heat with moisture sources
• Hot soaks—water or water with antiseptic or other solution is
warmed between 100ºF and 105ºF; affected area requiring
treatment is submerged for a specific period
• Hot compresses—fabric is wet with water or antiseptic or other
solutions and placed on affected area; plastic-type wrap may be
used to cover compress and conserve heat
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
■ Paraffin—hand
or foot is immersed in melted wax with additive such
as mineral oil; plastic bags or “mittens” are worn after wax is
applied to retain heat; when cool, the wax is peeled off; used for
relief of arthritis pain
■ Diathermy—deep heat therapy using a mechanical energy source
• Ultrasound—heat therapy using high-frequency sound waves; a
special gel substance is placed on the head of the ultrasound
attachment to improve conductivity
• Microwave—heat therapy using electromagnetic radiation for
tissues; should not be used with moisture or on patients with
pacemakers
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
Cryotherapy
Cryotherapy uses cold to prevent swelling and to reduce pain by causing
blood vessels to constrict (vasoconstriction); it is used in the initial
treatment of an injury:
■
Dry cold—cold therapy without moisture
• Ice pack—waterproof bag filled with ice; air should be removed
and bag covered with fabric before placing on skin; monitor to
prevent skin damage
• Chemical ice bag—pack filled with a chemical compound that
produces cold when activated (usually by applying pressure);
follow same precautions as with ice pack
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
■
Moist cold—cold therapy using moisture
• Cold soaks—water or water with antiseptic or other solution is
cooled with ice and affected area is submerged for a given
period
• Cold compresses—fabric is wet with cold water or antiseptic or
other solution and placed on affected area
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
Hydrotherapy
Hydrotherapy uses hot- or cold-water regimens for therapy:
Whirlpool—a bath or other container in which water is continually
circulated to provide massage and heat therapy
■ Hot-to-cold plunges—the affected area is alternately plunged
between hot and cold baths to contract and dilate vessels
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
Exercise
Exercise is an action to strengthen, develop, or maintain
muscle:
■ Active
exercise—an action to strengthen, develop, or maintain
muscle that is performed directly by the patient
• Isometric exercises—exercises that contract opposing muscles
without the muscles shortening
• Resistance exercise—exercises performed with counter
pressure applied to increase the effectiveness and determine
improvement
• Water exercises—exercises performed in water
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
■
Passive exercise—exercises performed on the patient by another
person or by a mechanical device
• Electrical stimulation—electrical device used to stimulate
muscles or nerves
• Passive motion device—a mechanical apparatus placed on a
patient to passively exercise the affected area; frequently used
on knees after surgery; speed and flexion may be increased or
decreased according to the patient’s pain tolerance
• Massage—rubbing, stroking, kneading, and tapping tissue with
hands or devices to alleviate pain and improve function
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
Range of Motion
Range of motion (ROM) can be passive or active; the patient or
caregiver exercises joints by performing standard joint motions such as
flexion and rotation to maintain or improve the extent of movement.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
Other Common Physical Therapies
Manipulation—maneuvers to realign affected area; frequently used
on joint dislocations or spinal injuries
■ Immobilization—prevention of movement, usually of joint or bone,
through the use of splints, casts, and other devices to reduce pain
and allow healing to occur
■ Traction—application of a slow pulling force; commonly used to
realign fractured bones
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
Common Assist Devices
■
Cane—a rod-type device used for minimal standing or walking
support as a reasult of weakness on one side or balance problems;
the handle may be candy cane shaped or straight and
perpendicular to the rod
• Types—single-pronged, tripod, or four-pronged (quad); the
length may be adjustable or nonadjustable
• Fit—the patient’s elbow should be at a 30 angle when standing
to obtain proper cane length
• Gait—cane is held on patient’s strongest side, tip 4 inches to 6
inches lateral to the foot, tip flat on the ground; cane moves
forward approximately 12 inches followed by the affected limb,
which stops at the cane; the stronger limb moves forward to the
cane, and steps are repeated
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
• Caution—stronger limb is first going up stairs, weaker limb first
going down
■ Crutches—assistive walking devices, used singly or as a pair, which
transfer weight bearing to upper extremities
• Common types—standard or axillary crutches usually used for
temporary conditions; Lofstrand or forearm crutches usually
used for long-term disability
• Fit—measure with the shoes patient will be wearing; patient
standing; normally crutch tips are placed 4 inches to 6 inches
lateral to each foot and 2 inches in front of feet; allow 2 to 3
finger widths between the axilla and the axillary support on
crutches; adjust crutch height to accommodate; adjust
handgrips to 30º of elbow flexion
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
• Common gaits—crutches placed on ground 4 inches to 6 inches
lateral and 2 inches in front of feet
- Swing-to gait—patient moves both crutches forward
simultaneously, plants them, and lifts body to crutches;
repeat steps
- Swing-through gait—patient moves both crutches forward
simultaneously, plants them, and lifts body past crutches;
repeat steps
- Two-point gait—the patient moves one crutch forward and
the opposite foot at the same time, followed by the other
crutch and other foot
- Three-point gait (most commonly taught in medical office)—
for weight bearing on one leg; patient moves both crutches
and affected leg forward simultaneously and follows with
unaffected leg; repeat steps
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
- Four-point gait—the patient moves right crutch forward,
followed by the left crutch, and then the left leg forward
parallel to the left crutch, followed by the right leg forward
parallel to the right crutch; repeat steps
• Caution—shoes should be flat and nonskid; avoid throw rugs,
wet areas, and other hazards; to avoid axilla nerve damage,
support weight using handgrips, not crutch underarm pads
■ Gait or transfer belt—a wide woven belt used to assist in lifting or
steadying the patient during ambulation or transfer (e.g., car or
wheelchair)
• Placement—buckled over patient’s clothes around waist at midabdominal area; allow room for two fingers to fit between the
waist and the belt
• Caution—the belt should not be used if patient has no use of
lower extremities; check for abdominal, back, or rib conditions
and ostomy or feeding devices
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
■
Walker—waist-high assistive walking device with four legs, used
when a cane is not enough support; may be folded when not in use
• Types—standard (fixed) with rubber-tipped legs; or can roll on
wheels
• Fit—client’s elbows flexed at 30ºangle; hand rests should be
approximately at top of patient’s femur
• Gait—patient steps into the walker and grasps handgrips,
moves walker forward 6 inches to 12 inches then moves one
foot at a time back into walker; repeat steps
• Caution—walkers should not be used on stairs or narrow
passages
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapies, cont’d.
■
Wheelchair—a mobile chair with adjustable or nonadjustable
footrests and brakes, used when a patient cannot ambulate
• Types—nonmechanical or mechanical, standard size or custom
fitted to patient
• Caution—always lock brakes when patient is getting into or out
of chair; do not allow patient to place arms around your neck
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Body Mechanics
Body mechanics is defined as the efficient use of the body to prevent
injury to the health care provider or patient. The general guidelines
follow:
Keep the back straight
■ Keep abdominal muscles tight
■ Bend from knees, not back
■ Maintain a broad base with one foot slightly forward
■ Use the feet, not the body, to pivot
■ Carry heavy objects close to your body
■ Synchronize lifting, such as “on three—one, two, three”
■ Know your limits
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins