Ultraviolet Therapy. Part VI: Mechanical Agents Hydrotherapy Traction We are always looking for ways to improve customer experience on Elsevier. We would like to ask you for a moment of your time to fill in a short questionnaire, at the end of your visit. If you decide to participate, a new browser tab will open so you can complete the survey after you have completed your visit to this website. Thanks in advance for your time. About Elsevier. Set via JS. Thereis no underminingpresent.
The tissueis not demonstrating healingat this time. Tissuehealingmust be initiated at the inflammatory stage. It is also hoped that wound closure canbe achieved;howeve!
If it is not possible,the goalsof treatmentwould be to minimize wound progressionand reduce the risk of wound and systemicinfection. Dead tissuecannothealand canact asa mechanicalbarrierto tissue growth and as a nidus for infection.
Electrical stimulationor ulftasoundmay also be usedto facilitate healing. Nonimmersion hydrotherapy, such as pulsed lavage, is safest and most effective to use for wound debridement becausethis allows control of the water pressureand avoidssoakingthe wound in contaminated water. Although both electrical stimulation arld ultrasound have both been shown to enhancepressure ulcer healing, since the evidencefor the effectivenessof electricalstimulation for tlis application is stronger,electrical stimulation is recommendedfor treatrnent of this patient.
A supportsurface that optirnizespressuredistribution and moisture controlshouldalsobe used. However, there is no longer any necrotic tissue present, and the wound base is now red.
The area of the wound has also decreasedftom 7 cm by 5 cm to 3 cm by z cm. Elecuical stimulation may be continued to enhance tissuehealing. Although electricalstimulation may be continued to promotetissuehealing,a trial without this intervention is recommendedso that disturbanceof the lragilegranulation tissue is minimized. Tissue healine should be carefullyrnonitoredand electricalstimulati,cnresumed ifhealing plateausor regresses.
All Chapter Review It is recommended thatphysicalagentsbeselected for patienttreatmentwhen they canbe expectedto promote progressiontoward the goalsof treatment,can be appliedsafely,and when the support for their use hashigh scientificmedt.
However,for their applicationto be safe,physical agentsmust not be applied when contraindicated,and al1 recommendedprecautions must be adheredto. A ffeatmentcanbe consideredto havehigh scientific merit if its useis supportedby valid theories,if it is designedfor specifictypesotpatients,if its potentially adverseeffectsarepresented,andifits efficacyis supportedbyweil-designedstudiespublishedin peerreviewed joumals. If the application of a physical agentis expectedto promoteachievementof the goals of treatment,to be safe,and to have high scientific merit, the cost, convenience,and availability of that 't 3.
Wilkerson GB: Treatment of inversion ankle sprain through synchronousapplicationof focal compression and cold,AthleticTraixing , '. Lehmann J! WestonM, TaberC, Casgranda to trauultrasoundasmodified by dosageand volume of tissue bloodvolumeduringcoldgel packapplication. Wolf SL:Contralateral PhysTher', specificcoldstimulus, iradiation Kamm RD: Bioengineeringstudiesof periodic external of ultrasonic 3. BickfordRlI, Duff RS:Influence compression as prophylaxis against deep venous andbloodflow in humanskeletalmuson temperature Rheumatology againstdeep venous thrombosis:PartII: Experimental 5.
McCullochJ: Physicalmodalitiesin wound managevasopneumatic devicesand hydro- A reviewof dreclinical preisure,pulmonary blood distribution and heart rate 7.
IialkaV lcefteezes Arch,B. Benson Ariat SyaceErviox Med heatandiceon the painthresholdof the normalshouliectsat restand du ng exercise, Rehabil , der. Rheuuanl asentshouldalsobe consideredin treatmentselection. Although the applicationof a physicalagentmay be the only intervention used with a patient, generally physical agentsare used in conlunction with each other or in conjuncdonwith other intewentions,such as activeexercise,passivemobilization,or functional activities,in orderto optimize patientoutcome.
The selectionand application of physical agents may vary under differenthealthcaredeliverysystems due to differencesin practical and financial constraints.
Although under all systems the clinician should seek to provide the best possible care for patients, cuffent health care delivery systems frequendy requirethat suchcarealsobe providedin the most cost-effectivemarner.
Costsmay be controlled by havingpatientsorpractitionerswith lowerskill levelsapply Eeatmentsunderthe directionof a therapist, when this can be done correcdyand safelyand when effectivenesscan be maximized by evaluating the effectsof specificinterventionson Patientfunctional outcome and selectingthose that are shown to produce the greatestbenefiq however, the potential for conflict beween minimizing cost and maximizing benefit can make ffeatment seiectiona complexand difficult process. Ward RS: Pressuretherapy for tl:e control of hypertrophic scar formation after burn injury: a hisrory and review,J BurnCateRehabil,j.
I97 1. Brunner GD, Stow RW pain threshold measurementsafter therapeuticapplication of ultrasound, microwaves and,inftared, ArchphysMed Rehabil , Hood LB, Chrisman D: Intemittent pelvic traction in the ueatment of the ruptured ilterverteb nl disc,phvs Thet, Sicard-Rosenbaum i, Lord D, Danoff JV et al: Effectsof continuous tlerapeutic ultrasound on growttr and metastasisof subcutaneousr,]r]uineturIlors,phvs Thet 75 l ll, Burr B: Heatasa theu?
Bethesda,MD, ,U. B, Downey, CA. Carmick Jr Clinical use of neuromuscularelectrical stimulation for children wirh cerebral palsy, phys Ther 73t , CarmickJ: Use of neuromuscularelectricalstimulation and a dorsalwrist splint to improve hand function of a child with spastichemiparesrs, PhysThet77 eI, PhysTher76 2 I8!
Hand fW: Biophysicsand technology of electromagnetic hyperthemia. Golden GS: Nonstandardtherapiesin developmental disabiliti. Summarizethe methodolosical characteristics requaed for researchon phjzsicalagentsto guide progressin clinical practiie. This has resultedin variability in practice among practitioners with different trainingandpersonalexperienceandftom different locations,andhasprobablyalsoresultedinlack ofoptimalcareandsuboptimaloutcomesfor somepatients.
Because this physical agent is unlikely to produce different effectsin these different regions,it is probable that either some patientsin Europeare receivingtrearments that are not effectiveor that some patientsin the United Statesare not receivins treatrnentsthat could benefit chem. Iurther reseirch will help Lo ascertainwhich interventionsare effectiveandwhich are not, which methodsand treatmentparametersto use for optimal results, the benefits that can be expected from these interventions, and who will receive the greatest benefit from them.
This will enhanceclinical practiceby improving patient outcomes,increasingthe consistencyand efficienry of care, and supporting reimbursementfor treatments usingphysicalagents. It is recommendedthat future researchon ohvsical agentsfocuson applications where empiricaiclinical evidence,pdor studies,andanecdotalreportssuggest, but do not definitively prove, that certain interventions are effective. Iuture researchshould attempt to determine if current practiceis effective,and if so, how it canbe optimized,and ifnot, which alternative interventionswould be effective.
As further research is performed,it is expectedthat the findingswill support many cuffent applicationsof physical agents; however, it is also likely that future researchwill directmodificationsin the applicationof somephysicalagentsandfail to supportthe continueduseof oth- ers.
Studiesmay fail to support presentpracticeif an intervention is found to be ineffective or to be less effectivethan other availabletreatmentoptions. It is also expectedthat future researchwill promote the developmentof new applicationsof physicalagents.
Onceappropriateareasfor researchare selected,it is alsoessentialthat future studiesbe designedto permit readyinterpretationand applicationof their findings. In many areas,moreresearch is neededbecause flaws in the availablestudies,such as inappropriate design,the use of inappropriatetypes or numbersof subjects,lack of or poor controls,the useof measures that havenot beenshown to be valid or reliable,limited assessment of outcome,or poor reportingof the preciseintervention used, restrict the applicationof their findings.
Ior example,if the effectsof an intervention have been monitored without comparison with a control group who did not receivethat interventiory it cannot be determined whether the observedeffects were causedby the interventiontherebysupportingits use,or whetler they were due to chanceor normal progressionof the problembeing treated, thus not supporting its use. Appropdately designedstudieson the useof physicalagentsin rehabilitation will demonstratewhether or not specific interventionswith physicalagentscan promote progressiontoward the goals of treatment for specific problemsand how suchbenefitscanbe optimized.
High-qualityresearchin the appropriateareaswill improvethe qualityofpatientcareandprovidesupport for reimbursement for treatments using physicai agentsbasedon provenpositivefunctionaloutcomesIn the absence ofsuch studiesitis possiblethat patiens will not receiveoptimal care,and it is likely that, over time, payeff will not continueto reimbursefor irrterventionsthat havenot beenprovento be effective.
Although for most physical agents there is some researchin all of these ateas,more researchis neededin order to optimize clinicalapplicationsin rehabilitation. In general, the physical properties and effects of physical agents are well understood, but their interactionswith, and their effectson, physiological processesare less clear. In most areas,even less is known aboutthe specificeffectsof physicalagentson patient function.
While further understandingof the physicalpropertiesand effectsofphysical agentsmay provevaluablein the developmentof treatmentapplications,studies regardingthe changesproduced in physiologicalprocessesand the resultantclinicaloutcomes are likely to provide the most guidancefor advancing andimprovingclinicalpractice.
Another areawhere researchon the physicalpropertiesand effectsof physicalagentshasbeenvaluable is in the developmentof new physicalagents. Most devicesdevelopedin recentyearsdeliverthe sameor similartypesof energyasthat deliveredbypreviously available physical agents.
However, these newer devicestake advantageof technologicaland theoretical advancesto provide greaterrangesand control of the energyintensify or frequencyaswell asimproved safety and convenience.
Researchusing thesenewer devicesis neededto gain a better understandingof their physical properties, potential applications in rehabilitation, and possible advantagesover older devices.
In addition, further basic scienceand engineedng studiesmay yield other physicalagentsand further deviceimprovements. The low-energycold laseris an exampleof a physical agentthat was developedin recentyearsand that is now being applied clinically in rehabilitation in somesettings.
Alaserproducesa beamof electromagPhysical Properties andEffects of Physical netic energythat has the unique physicalproperties Agents of being monochromatic,coherent,and directional. Although the physical properties of most physical At this time, low-energy laserdevicesproduceelecagentsare generallywell understoodand have been tromagnetic radiation with frequenciesand waveclearlydescribed,further researchis neededto clarify lengthsthat penetratethrough only a few millimeters the nature and magnitudeof their physicaleffectson of human tissue.
Forexample,althoughit is known that therpropertieso[ low-energylasersmay promo; the mal energyis producedby friction betweenparticles, development of devices that can penetrate more qeepry. This type of ultrasoundhasa much lower frerial varies with the specific heat of that material, quency and a longer wavelength than traditionally without further researchthe temperature increase usedultrasound,resultingin deeperpenetration.
This and the distribution of heat in a patient'sbody when type of ultrasoundwas designedto be usedfor treatdifferenttherrnalagentsare appliedcannotbe readily ment of deep tissues;however, at this time, there is or accuratelypredicted.
Takingthe specificexamples controversyin the literature concerningthe distribuof short wave diathermy and microwave diathermy, tion of the energywhen such low frequencies are both of which produce thermal energy and have used.
Furtherresearchon the physical Directions for Fxture Researchand Apylicatiotr properties of this frequency range of ultrasound is neededto ascertainhow the energyis distdbutedand what clinicaleffectsit has. Iurther technicaldevelopments may also allow focusing of the beam while maintainingthe deeperpenetration. Another newer device. This devicekeepsthe wound environmentwit-l-rina limited temperaturerangeat all times and is thus thought to promote wound healing.
Iurther researchon the physical properties of this device,suchasits rangeof operatingtemperatureand its effecton local moisture,is neededto direct its clinical application. It is likely that in the future other physicalagents and devicesthat offer further control of energydelivery to patients will be developed.
Ior example, devicesthat deliverheat for set amountsof time or at controlied but varying temperatures,devices that deliver electromagneticenergy with different pulse durationsand duty cyclesor with different ty? As new devicesbecomeavailable,researchwill be neededto determinetheir physicalpropertiesand effectsand to ascertain whether they promote physiological changesthat produceclinicalbenefits. Effects of Physical Agents Physiological tions such as the use of ultrasoundor electricalcurrentsto facilitateftansdermaldrug deliveryand accelerate tissue healing or the use of thermotherapy, cryotherapy, or electrotherapy to control pain.
Studiesconcemingthe effectsof physical agentson bacterialinfectionmay be particularlyvaluableat this time since many bacteriaare becoming resistantto availableantibiotics,necessitatingthe development of alternativetreatmentapproaches.
Progressin these areaswill require examination of the physiological processesinvolved in both normal and abnormal function and the changesproducedin theseprocesses by the applicationof physicalagents. In orderto provide clinicianswith infomation that allows them to apply physicalagentswith more predictable results,future studiesshould seekto determine both the natureand the magnitudeof the effects of physical agents on physiological processesand attempt to determinehow theseeffectsvary with tissue t?
While prior researchgenerally evaluated the effects of physical agents at a macroscopiclevel, such as the effectsof heat on soft tissue extensibility or on arterial circulation, since current technologyalso permits examinationat the microscopiclevels of the cell, cellular components, and molecules,future researchshould also evaluate the physiologicaleffects of physical agentsat these levels.
This will lead to an improved understanding of the mechanisms underlying the macroscopic effects of physical agents,thereby providing guidelinesforpredictingand controllingthe effectsofphysical agentson physiologicalprocesseswith greater precision. Studiesshould examine the effectsof physicalagentson the physicaiproperties of tissue,such as muscleor tendon extensibility and cell membrane permeability, their effects on physiological processessuch as tissue healing and nerve conduction, and their effects on pathological statessuch as bacterialinfection.
Iurther researchin these areas may delineate the magnitude of the effects produced by physical agents and the ideal treatmentparametento use to achievetheseeffects.
Suchresearchwill also guide specificclinicalapplica- Although researchon the physical properties and physiologicaleffectsof physicalagentswiil indicate which interventionsmay be effectiveand may clarily the mechanismsofinterventionsthatare known to be effective, clinical studies are needed to ascertainif interventionswith physicalagentsactually promote progress toward treatment goals.
Clinical studies shouldalsoexaminethe effectsof differenttreatment parametersJsuch as method of application, treatment duration,intensity,and frequency. Ior example, when studyingthe effectsof electricalstimulationon musclestrengthening,a rangeof parametersmust be evaluated,including current waveform and parameters, electrodeplacement,and treatmentduration.
In Thrce. Thesetypes of studiesare neededto optimize the applicationof physicalagentsandmaximize the accuracyof predictionsconcemingthe natureand extentof the benefitsof suchinterventions. It is recommendedthat clinical studies examine applicationsofphysical agentsthat arein frequentuse at this time but in which the dataregardingtreatment efficacyandoptimaltreatmentparameters areinconclusive.
Novel applicationsof commonly usedphysi cal agents and possible applications of recently developedphysicalagentsshould also be evaluated. For example. Takingthe example of phonophoresis, studies should first attempt to ascertainwhether, when using the common curent application techniques,phonophoresis reducesthe impairments and functional limitations associatedwith inflammation.
If phonophoresisis found to be effective,one ,houid then evaluate whether changingany of the treatment parametersl such as the ultrasoundduty cycle,intensity and frequency,drug type and vehicle,or treatmentduration and frequency,altersthe effects. Your rating has been recorded. You may have already requested this item.
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