Chapter 2: Using Therapeutic Modalities to Affect the Healing Process Jennifer Doherty-Restrepo, MS,...
-
Upload
homer-wesley-simpson -
Category
Documents
-
view
222 -
download
1
Transcript of Chapter 2: Using Therapeutic Modalities to Affect the Healing Process Jennifer Doherty-Restrepo, MS,...
Chapter 2: Using Therapeutic Modalities to Affect the Healing
Process
Chapter 2: Using Therapeutic Modalities to Affect the Healing
Process
Jennifer Doherty-Restrepo, MS, LAT, ATCJennifer Doherty-Restrepo, MS, LAT, ATC
FIU Entry-Level ATEPFIU Entry-Level ATEP
Therapeutic ModalitiesTherapeutic Modalities
Physiological Responses to InjuryPhysiological Responses to Injury
Therapeutic modalities should be selected Therapeutic modalities should be selected and applied based on the ________ and applied based on the ________ ________ of the tissues to injury and on ________ of the tissues to injury and on the understanding of how various tissues the understanding of how various tissues ________________
Phases of the Healing ProcessPhases of the Healing Process
Inflammatory - Response PhaseInflammatory - Response Phase Fibroblastic - Repair PhaseFibroblastic - Repair Phase Maturation - Remodeling PhaseMaturation - Remodeling Phase
The ATC must understand the healing process to The ATC must understand the healing process to make decisions on how and when therapeutic make decisions on how and when therapeutic modalities may best be used to facilitate the modalities may best be used to facilitate the healing processhealing process
Healing Process ContinuumHealing Process Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response Phase
Healing Process ContinuumHealing Process Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response PhaseFibroblastic-Repair Phase
Healing Process ContinuumHealing Process Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response PhaseFibroblastic-Repair PhaseMaturation-Remodeling Phase
Inflammatory - Response PhaseInflammatory - Response Phase
S/SS/S RednessRedness ________________ PainPain ________________ TendernessTenderness ________________ Loss of FunctionLoss of Function
Vascular ReactionVascular ReactionInjury
Immediate ____________________________________ Of Vascular Walls
__________________________________________________ With Hyperemia
Stagnation and Stasis
Initial Effusion of Blood and Plasma Lasts 24-36 Hours
Immediate Vascular ReactionImmediate Vascular ReactionInjury
Vessels’ Endothelium is Disrupted
______________________________ Adhere To Exposed Collagen
Sticky Matrix For Platelets and Leukocytes
Formation of A ______________________
Obstructs Local Lymphatic Drainage
__________________________ Injury Response
Cellular ReactionChemical Mediators Released From Cell
Cellular ReactionChemical Mediators Released From Cell
Histamine Histamine ________________ Cell PermeabilityCell Permeability
Leucotaxin Leucotaxin ________ (Leukocytes Line Cell Wall)________ (Leukocytes Line Cell Wall)
Cell PermeabilityCell Permeability Forming ________Forming ________
Necrosin Necrosin Activates ________Activates ________
Clot Formation
Damaged Cell
Thromboplastin
Prothrombin
Thrombin
Fibrinogen
Fibrin ClotCompleted Within 48 Hours
Clot Formation
Damaged Cell
Thromboplastin
Prothrombin
Thrombin
Fibrinogen
Fibrin ClotCompleted Within 48 Hours
Inflammatory - Response PhaseInflammatory - Response Phase
Injured area is walled-offInjured area is walled-off Leukocytes phagocytize foreign debrisLeukocytes phagocytize foreign debris Sets stage for Sets stage for Fibroblastic-Repair PhaseFibroblastic-Repair Phase Lasts ________ after initial injuryLasts ________ after initial injury
Chronic InflammationChronic Inflammation
Occurs when _____ inflammatory-response Occurs when _____ inflammatory-response does not eliminate injuring agentdoes not eliminate injuring agent
Leukocytes replaced by _________, Leukocytes replaced by _________, ___________, and ________ ___________________, and ________ ________
Specific mechanism which causes conversion Specific mechanism which causes conversion to chronic inflammation is unknownto chronic inflammation is unknown ________or ________ with cumulative ________or ________ with cumulative
repetitive ____________ may be a causerepetitive ____________ may be a cause
Fibroblastic - Repair PhaseFibroblastic - Repair Phase
Healing Process ContinuumHealing Process Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response PhaseFibroblastic-Repair PhaseMaturation-Remodeling Phase
S/SS/S Signs and symptoms of inflammatory response Signs and symptoms of inflammatory response
subsidesubside Proliferative, regenerative activity which Proliferative, regenerative activity which
leads to a period of ________ ________ leads to a period of ________ ________ (fibroplasia) and repair of injured tissue(fibroplasia) and repair of injured tissue
Fibroblastic - Repair PhaseFibroblastic - Repair Phase
FibroplasiaFibroplasia
Begins within the first few _____ following Begins within the first few _____ following injuryinjury
Signs of inflammation subsideSigns of inflammation subside Pain and tenderness to touchPain and tenderness to touch May last ________ weeksMay last ________ weeks
Vascular ReactionVascular Reaction
Growth of Endothelial Capillary Growth of Endothelial Capillary Buds (Stimulated By Lack of Buds (Stimulated By Lack of
Oxygen)Oxygen)
________Blood Flow________Blood Flow
Increased Delivery of Essential Increased Delivery of Essential ________ for Tissue Regeneration________ for Tissue Regeneration
Cellular ReactionCellular ReactionBreakdown of Fibrin ClotBreakdown of Fibrin Clot
Formation of ________ TissueFormation of ________ Tissue
(Fibroblasts, Collagen, Capillaries)(Fibroblasts, Collagen, Capillaries)
Fibroblasts Accumulate Along Capillary BedsFibroblasts Accumulate Along Capillary Beds
Synthesizes Extracellular MatrixSynthesizes Extracellular Matrix
(________, ________, ________)(________, ________, ________)
By Day 6 or 7By Day 6 or 7
Fibroblasts begin producing ______, which Fibroblasts begin producing ______, which is deposited randomly throughout the scaris deposited randomly throughout the scar
________ _______ increases proportionally ________ _______ increases proportionally to collagen synthesisto collagen synthesis
Normal SequenceNormal Sequence
Formation of minimal ________Formation of minimal ________ Increase in tensile strength and a decrease Increase in tensile strength and a decrease
in the number of fibroblasts signals the in the number of fibroblasts signals the beginning of the __________________ beginning of the __________________ ________________
Abnormal ResponseAbnormal Response
Persistent Persistent Inflammatory Response PhaseInflammatory Response Phase causes extended ___________ and causes extended ___________ and __________________________
Maturation - Remodeling PhaseMaturation - Remodeling Phase
Healing Process ContinuumHealing Process Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response PhaseFibroblastic-Repair PhaseMaturation-Remodeling Phase
Maturation - Remodeling PhaseMaturation - Remodeling Phase Long-term processLong-term process Realignment of collagen fibers along lines Realignment of collagen fibers along lines
of ________ ________of ________ ________ Ongoing _________________ of collagenOngoing _________________ of collagen Increase in tensile strength of scar matrixIncrease in tensile strength of scar matrix At 3-weeks a contracted, non-vascular scar At 3-weeks a contracted, non-vascular scar
existsexists May require several years to completeMay require several years to complete
The Role of Controlled Mobility in the Maturation – Remodeling PhaseThe Role of Controlled Mobility in the Maturation – Remodeling Phase
__________________________________ Bone and soft tissue will respond to the physical Bone and soft tissue will respond to the physical
demands placed on them, causing them to remodel demands placed on them, causing them to remodel along lines of ________ ________along lines of ________ ________
Injured structures must be exposed to Injured structures must be exposed to __________ loads during the __________ loads during the Maturation -Maturation -Remodeling PhaseRemodeling Phase
Controlled Mobility is Superior To Immobilization
Controlled Mobility is Superior To Immobilization
Controlled mobility…Controlled mobility… ________ scar formation________ scar formation ________ revascularization________ revascularization ________ muscle regeneration________ muscle regeneration ________ muscle and ligament fibers________ muscle and ligament fibers
Immobilization; however, during the Immobilization; however, during the Inflammatory - Response PhaseInflammatory - Response Phase will facilitate will facilitate ________ by controlling inflammation ________ by controlling inflammation
Factors That Impede HealingFactors That Impede Healing
Extent of InjuryExtent of Injury EdemaEdema HemorrhageHemorrhage __________________________________ Separation of TissueSeparation of Tissue ________ ________________ ________
Atrophy Atrophy CorticosteroidsCorticosteroids Keloids and Keloids and
Hypertrophic ScarsHypertrophic Scars ________________ Humidity, ClimateHumidity, Climate Age, Health, NutritionAge, Health, Nutrition
Using Specific Modalities During Different Phases of
Healing
Using Specific Modalities During Different Phases of
Healing
Inflammatory – Response PhaseInflammatory – Response Phase
Immediate first aid management of injury Immediate first aid management of injury Minimize the early effects of excessive Minimize the early effects of excessive
inflammation by:inflammation by: ________ ________________ ________ ________ ________________ ________ ________ ________________ ________
Initial goal should be to limit ________Initial goal should be to limit ________ Limiting the amount of ________ will reduce the Limiting the amount of ________ will reduce the
time required for rehabilitationtime required for rehabilitation
Controlling Edema: Immediate First Aid Management
Controlling Edema: Immediate First Aid Management
PProtectionrotection
RRestricted Activityestricted Activity
IIce ce
CCompressionompression
EElevationlevation
PProtection from additional injury by applying rotection from additional injury by applying appropriate splints, braces, or other immobilization appropriate splints, braces, or other immobilization devicesdevices
RRestricted activity to allow the estricted activity to allow the Inflammatory - Inflammatory - Response PhaseResponse Phase to elicit its effects to elicit its effects Rest does not mean Rest does not mean ________________
IIce for __ _______ to decrease metabolism and ce for __ _______ to decrease metabolism and elicit analgesic effectselicit analgesic effects
CCompression for ___ _______ to reduce space for ompression for ___ _______ to reduce space for swelling to accumulateswelling to accumulate
EElevation to reduce blood pooling in the extremities levation to reduce blood pooling in the extremities and facilitate ________ and ________ drainageand facilitate ________ and ________ drainage
Modulating PainModulating Pain
________ and/or ________ ____________ ________ and/or ________ ____________ Currents are typically used for analgesiaCurrents are typically used for analgesia
Low-Power LASER may also be used for Low-Power LASER may also be used for pain modulationpain modulation
Facilitating HealingFacilitating Healing
Low intensity _________ may be effective Low intensity _________ may be effective in facilitating the healing process in facilitating the healing process
_________ may be used safely immediately _________ may be used safely immediately following injuryfollowing injury
Fibroblastic - Repair PhaseFibroblastic - Repair Phase
Treatments may change from cryotherapy to thermotherpy
Thermotherapy techniques are used to ________________ circulation to the injured area to promote healing
Heat modalities may also produce some degree of ________________
Fibroblastic - Repair PhaseFibroblastic - Repair Phase ____________ ________________________ ____________ may be used to
facilitate removal of injury by-products ________________ __________________ currents may be used…
To elicit muscle contractions (_______ ______________ _______) to reduce swelling
For modulation of ________________ Low-powered LASER may be used for
modulation of pain
Maturation - Remodeling PhaseMaturation - Remodeling Phase ______________________ modalities are beneficial to the
healing process during this phase __________________, shortwave and microwave diathermy
may be used to increase circulation to deeper tissues Electrical stimulating currents may be used for
________ ________________ ________ and to stimulate muscle contractions for increasing both ________________ and ________________
Goal For Using Therapeutic Modalities
Goal For Using Therapeutic Modalities
Assist the natural healing process while Assist the natural healing process while doing no harmdoing no harm