Modalities and Assistive Devices Used in Physical Therapy

Modalities and assistive devices used by the physical therapist to accomplish the necessary treatments to reduce symptoms and maximize function include:

Assistive Devices

A variety of implements or equipment used to aid patients in performing tasks or movements. Assistive devices include crutches, canes, walkers, wheelchairs, power devices, long-handled reachers and static and dynamic splints.

Therapists will fit and instruct the patient in the use and care of the assistive device with the goal being optimal independence and safety.

Traction

The therapeutic use of manual or mechanical tension created by a pulling force to produce a combination of distraction and gliding to relieve pain and increase tissue flexibility.

Indications for traction therapy include, but are not limited to, decreased sensation that temporarily improves with manual traction, increased muscle tone that is reduced with manual traction, extremity pain or tingling that is temporarily relieved with manual traction, spinal nerve root impediment due to bulging, herniated or protruding disc and muscle spasms that are causing nerve root impingement and general hypomobility of lumbar or cervical spine regions.

Electric traction units exert a pulling force through a rope with various halters and straps.

Ultrasound

Ultrasound is a name given to sound waves that are of such high frequency that they are not detectable by the human ear.

The sound waves when applied to human tissue are absorbed by the various tissues with the production of heat. Ultrasound does penetrate heat into human tissues deeper that any other heat modality, 4-6 cm.

The benefits of beat from ultrasound include promotion of muscle relaxation, increased local metabolism and reduction of pain by sedating nerve endings.

Ultrasound waves also have non-thermal benefits resulting from vibration of molecules. These effects include increases in the flexibility of connective tissues such as joint capsules, ligaments, tendons, adhesions, scars and cellular membrane permeability that accelerates healing.

Therapeutic ultrasound is a safe and effective tool for treating a variety of conditions that a physical therapist commonly encounters.

Pulsed and continuous modes allow for ultrasound to be used for both acute and chronic cases and ultrasound is most effective as part of an overall treatment plan, including stretching, therapeutic exercise and mobilization.

Electric Muscle Stimulation

Intervention through the application of electricity -- electrical stimulation of individual muscles is a means of providing exercise to muscles that the patient is unable to contract voluntary.

If the muscle has lost its physical connection with its nerve supply (is denervated), electrical stimulation can maintain nutrition of the muscle through promoting blood flow, decrease fibrotic changes and retard denervation atrophy.

Electric stimulation used on muscles that have a nerve supply (are innervated) can strengthen healthy muscle, prevent or reverse disuse atrophy, maintain or improve mobility, promote peripheral circulation and prevent fibrotic changes.

There are various types of electrical stimulation in use today and the type used and its specific application depends on the goals of treatment.

TENS

Transcutaneous Electrical Nerve Stimulation is a generic name for a method of nerve stimulation designed to control pain.

There are now a variety of TENS units designed for specific modes of application. The different modes are identified by their parameter ranges of amplitude, frequency and pulse width.

The units are small, battery powered and light weight weighing only a few ounces. Electrodes are placed on the skin near the area of pain and are attached to the TENS unit.

A physical therapist/assistant instructs the patient on the positioning of the electrodes and the duration and frequency of the treatment and also sets the parameters for the amplitude, frequency and pulse width based on the patient's individual needs.

The TENS unit is used at home by the patient for use as instructed as part of a comprehensive treatment program designed for the appropriate management of pain.

Therapeutic Exercise

A broad range of activities intended to improve strength, range of motion (including muscle length), cardiovascular fitness, flexibility, or to otherwise increase a person's functional capacity.

An individualized program is established, taught and monitored by a physical therapist/assistant that is based on an initial evaluation and aimed at achieving specific goals.

Home Exercise Programs

Positive physical therapy results are largely dependent on a person's adherence to a specific exercise regime that is established by a physical therapist.

Individual home programs are written, taught and monitored closely by the therapist through the duration of one's therapy with progressive modifications that are based on the individual's needs, progress and established goals.

Prosthetic/Orthotic Training

A prosthesis is an artificial device, often mechanical used to replace a missing part of the body.

Prosthetic training involves working with an amputee on overall conditioning as well as specific stretching and strengthening of the involved limb and training in the use and wearing of the prosthesis.

Therapy also emphasizes care of the amputation site and performance of tasks of daily living with the prosthesis

An orthosis is a device that supports weak or ineffective joints or muscles, such as a splint, brace, shoe insert or cast.Orthotic training concentrates on the increase of motion, function and use of a limb that requires an orthosis for support. Therapy also emphasizes balance and coordination of activities.


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William G. Stanley
Physical Medicine & Rehabilitation