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Chapter 2: Using Therapeutic Modalities to Affect the Healing Process . Jennifer Doherty-Restrepo, MS, LAT, ATC FIU Entry-Level ATEP Therapeutic Modalities.

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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, ATC

FIU Entry-Level ATEP

Therapeutic Modalities

physiological responses to injury
Therapeutic modalities should be selected and applied based on the ________ ________ of the tissues to injury and on the understanding of how various tissues ________Physiological Responses to Injury
phases of the healing process
Inflammatory - Response Phase

Fibroblastic - Repair Phase

Maturation - Remodeling Phase

The ATC must understand the healing process to make decisions on how and when therapeutic modalities may best be used to facilitate the healing process

Phases of the Healing Process
healing process continuum6
Inflammatory-Response Phase

Fibroblastic-Repair Phase

Healing Process Continuum

Injury Day 4 Week 6 2-3 Years

healing process continuum7
Inflammatory-Response Phase

Fibroblastic-Repair Phase

Maturation-Remodeling Phase

Healing Process Continuum

Injury Day 4 Week 6 2-3 Years

inflammatory response phase
S/S

Redness

________

Pain

________

Tenderness

________

Loss of Function

Inflammatory - Response Phase
vascular reaction
Injury

Immediate __________________ Of Vascular Walls

_________________________ With Hyperemia

Stagnation and Stasis

Initial Effusion of Blood and Plasma Lasts 24-36 Hours

Vascular Reaction
immediate vascular reaction
Injury

Vessels’ Endothelium is Disrupted

_______________ Adhere To Exposed Collagen

Sticky Matrix For Platelets and Leukocytes

Formation of A ___________

Obstructs Local Lymphatic Drainage

_____________ Injury Response

Immediate Vascular Reaction
cellular reaction chemical mediators released from cell
Histamine

________

 Cell Permeability

Leucotaxin

________ (Leukocytes Line Cell Wall)

 Cell Permeability

Forming ________

Necrosin

Activates ________

Cellular ReactionChemical Mediators Released From Cell
slide12
Clot FormationDamaged Cell Thromboplastin Prothrombin Thrombin Fibrinogen Fibrin ClotCompleted Within 48 Hours
inflammatory response phase13
Injured area is walled-off

Leukocytes phagocytize foreign debris

Sets stage for Fibroblastic-Repair Phase

Lasts ________ after initial injury

Inflammatory - Response Phase
chronic inflammation
Occurs when _____ inflammatory-response does not eliminate injuring agent

Leukocytes replaced by _________, ___________, and ________ ________

Specific mechanism which causes conversion to chronic inflammation is unknown

________or ________ with cumulative repetitive ____________ may be a cause

Chronic Inflammation
healing process continuum16
Inflammatory-Response Phase

Fibroblastic-Repair Phase

Maturation-Remodeling Phase

Healing Process Continuum

Injury Day 4 Week 6 2-3 Years

fibroblastic repair phase17
S/S

Signs and symptoms of inflammatory response subside

Proliferative, regenerative activity which leads to a period of ________ ________ (fibroplasia) and repair of injured tissue

Fibroblastic - Repair Phase
fibroplasia
Begins within the first few _____ following injury

Signs of inflammation subside

Pain and tenderness to touch

May last ________ weeks

Fibroplasia
vascular reaction19

Vascular Reaction

Growth of Endothelial Capillary Buds (Stimulated By Lack of Oxygen)

________Blood Flow

Increased Delivery of Essential ________ for Tissue Regeneration

cellular reaction

Cellular Reaction

Breakdown of Fibrin Clot

Formation of ________ Tissue

(Fibroblasts, Collagen, Capillaries)

Fibroblasts Accumulate Along Capillary Beds

Synthesizes Extracellular Matrix

(________, ________, ________)

by day 6 or 7
Fibroblasts begin producing ______, which is deposited randomly throughout the scar

________ _______ increases proportionally to collagen synthesis

By Day 6 or 7
normal sequence
Formation of minimal ________

Increase in tensile strength and a decrease in the number of fibroblasts signals the beginning of the __________________ ________

Normal Sequence
healing process continuum25
Inflammatory-Response Phase

Fibroblastic-Repair Phase

Maturation-Remodeling Phase

Healing Process Continuum

Injury Day 4 Week 6 2-3 Years

maturation remodeling phase26
Long-term process

Realignment of collagen fibers along lines of ________ ________

Ongoing _________________ of collagen

Increase in tensile strength of scar matrix

At 3-weeks a contracted, non-vascular scar exists

May require several years to complete

Maturation - Remodeling Phase
the role of controlled mobility in the maturation remodeling phase

The Role of Controlled Mobility in the Maturation – Remodeling Phase

_________________

Bone and soft tissue will respond to the physical demands placed on them, causing them to remodel along lines of ________ ________

Injured structures must be exposed to __________ loads during the Maturation -Remodeling Phase

controlled mobility is superior to immobilization
Controlled mobility…

________ scar formation

________ revascularization

________ muscle regeneration

________ muscle and ligament fibers

Immobilization; however, during the Inflammatory - Response Phase will facilitate ________ by controlling inflammation

Controlled Mobility is Superior To Immobilization
factors that impede healing
Extent of Injury

Edema

Hemorrhage

_________________

Separation of Tissue

________ ________

Atrophy

Corticosteroids

Keloids and Hypertrophic Scars

________

Humidity, Climate

Age, Health, Nutrition

Factors That Impede Healing
inflammatory response phase31
Immediate first aid management of injury

Minimize the early effects of excessive inflammation by:

________ ________

________ ________

________ ________

Initial goal should be to limit ________

Limiting the amount of ________ will reduce the time required for rehabilitation

Inflammatory – Response Phase
controlling edema immediate first aid management
Protection

Restricted Activity

Ice

Compression

Elevation

Controlling Edema: Immediate First Aid Management
slide33
Protection from additional injury by applying appropriate splints, braces, or other immobilization devices

Restricted activity to allow the Inflammatory - Response Phase to elicit its effects

Rest does not mean ________

Ice for __ _______ to decrease metabolism and elicit analgesic effects

Compression for ___ _______ to reduce space for swelling to accumulate

Elevation to reduce blood pooling in the extremities and facilitate ________ and ________ drainage

modulating pain
________ and/or ________ ____________ Currents are typically used for analgesia

Low-Power LASER may also be used for pain modulation

Modulating Pain
facilitating healing
Low intensity _________ may be effective in facilitating the healing process

_________ may be used safely immediately following injury

Facilitating Healing
fibroblastic repair phase36
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 Phase
fibroblastic repair phase37
____________ ____________ 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

Fibroblastic - Repair Phase
maturation remodeling phase38
___________ 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 ________

Maturation - Remodeling Phase
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