اجعل لسانك رطباً بذكر الله

2. اجعل لسانك رطباً بذكر الله

3. Therapeutic modalities د. سامح رفعت احمد قسم العلاج الطبيعي كلية التأهيل الطبي/ جامعة طيبة

4. المحتوى • التعريف: Definition • انواعه: Types of physical agents • العلاج الحراري وانوعه ووسائل الانتقال Thermotherapy • الجلد ومكوناته ووظائفه Skin structure and function

5. PHYSIOTHERAPY Physiotherapy is a branch of medical science where physical measures such as heat, light, ultrasound, water, electricity and exercises are used in the diagnosis and treatment of orthopaedic injuries.

6. PHYSIOTHERAPY • Passive Physiotherapy directed toward the alleviation of symptoms • Active Physiotherapy directed toward restoration of function by activity

7. Aims • To treat disability and deformity. • To correct disability and deformity • To prevent disability and deformity

8. CATEGORIES Depending on severity of the ailment 1. Short term physiotherapy 2. Long term physiotherapy

9. Short Term Physiotherapy • Includes patients with minor neuromuscular-skeletal lesions like • Simple soft tissue injuries • Simple fractures • Non traumatic lesions

10. Long term physiotherapy • Refers to more complicated diseases of musculoskeletal origin • Includes condition like • Fractures of major bones • Spinal trauma resulting in physical disability and complications like paraplegia, quadriplegia etc. • Surgical procedures involving major joints • Chronic conditions like RA

11. Modalities • APTA’s position statement (1995): • “Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities in the absence of other skilled therapeutic or education intervention, should not be considered physical therapy.”

12. Physical Agents the physical agents in use today can be classified according to their specific effects on biological tissues

13. Classification of physical agents

14. Classification of physical agents

15. Modes of use Conduction Convection Radiation Types of Applications Whirlpools Hot tubs Jacuzzis Moist heat packs Paraffin baths Ultrasound Phonophoresis Diathermy heat Thermotherapy

16. Transfer of Energy • Energy moves from an area of HIGH concentration to an area of LOW concentration. • Radiation • Conduction • Convection • Conversion • Evaporation

17. Radiation • When the surrounding environment is hotter that the body the radiant heat is absorbed. No-contact is made. • Short-wave Diathermy • Microwave Diathermy

18. Conduction • Direct transfer of energy between two objects in physical contact with each other. Energy is transferred from the area of high temp. to the area of low temp. • Ice packs • Moist heat packs • Paraffin

19. Convection • Much like conduction, but the medium moves across the body causing variations. • Fluidotherapy • Whirlpools

20. Conversion • Changes other energy forms into Heat. • Ultrasound • Microwave • Liniments or Balms

21. Evaporation • Heat is absorbed by the liquid on the skins surface and cools the skin as it turns into a gaseous state. • Vapocoolant sprays • Alcohol

22. Factors Affecting Transfer of Energy • Density of Medium • Reflection • Refraction • Absorption • Law of Grotthus-Draper

23. Healing Process • Three Phases: • 1. Inflammatory • 2. Fibroplastic/Proliferative • 3. Maturation/Remodeling

24. Inflammatory Response Phase • Injury Destruction of tissue Cellular injury. • Cardinal Signs of Cellular injury : redness, edema, tenderness (pain), increased temperature. • There is a delivery of leukocytes and other phagocytes and exudate are present at the injured tissue. • Vascular Reaction involves vascular spasm, formation of a platelet plug, coagulation & growth of fibrous tissue

25. Inflammatory Response Phase • Up to day 6 • Clinically should see a decrease in edema and pain is still present. • Modalities are used to : Control pain and decrease edema. • Cryotherapy is still appropriate

26. Clot formation • To form a clot fibrinogen must be converted to fibrin • Clot formation begins around 12 hours following injury and is completed by 48 hours • Summary:during the inflammatory stage the injured area is walled off, lasts 2-4 days.

27. Fibroplastic repair phase • Scar formation is referred to as fibroplasia. Begins within the first few hours following injury and may last 4-6 weeks. • Breakdown of the fibrin clot allows the development of granulation tissue. • Development of a new scar

28. Maturation-Remodeling Phase • Can last over 1 year. • Collagen remodels or realigns in accordance with the tensile forces placed on it

29. FACTORS THAT IMPEDE HEALING

31. Structure of the skin • The skin is one of the largest organs of the body. It comprises about 16% of our body mass. The skin covers the body and protects the deep tissues. Its free surface is not smooth, but is marked by delicate groove

35. Epidermis • Composed of keratinized stratified squamous epithelium, consisting of four distinct cell types and four or five layers • Cell types include keratinocytes, melanocytes, Merkel cells, and Langerhans’ cells • Outer portion of the skin is exposed to the external environment and functions in protection

37. Layers of the Epidermis: 1. Stratum Basale (Basal Layer) • ƒ Deepest epidermal layer firmly attached to the dermis • Consists of a single row of the youngest keratinocytes • Cells undergo rapid division, hence its alternate name, stratum germinativum

38. Layers of the Epidermis: 2. Stratum Spinosum (Prickly Layer) • ƒ Cells contain a weblike system of intermediate filaments attached to desmosomes • ƒ Melanin granules and Langerhans’ cells are abundant in this layer 3. Stratum Granulosum (Granular Layer) • ƒ Thin; three to five cell layers in which drastic changes in keratinocyte appearance occurs • ƒ Keratohyaline and lamellated granules accumulate in the cells of this layer

39. Layers of the Epidermis: 4. Stratum Lucidum (Clear Layer) • ƒ Thin, transparent band superficial to the stratum granulosum • ƒ Consists of a few rows of flat, dead keratinocytes • ƒ Present only in thick skin

40. Layers of the Epidermis: 5. Stratum Corneum (Horny Layer) • ƒ Outermost layer of keratinized cells • ƒ Accounts for three quarters of the epidermal thickness • ƒ Functions include: • ƒ Waterproofing • ƒ Protection from abrasion and penetration • ƒ Rendering the body relatively insensitive to biological, chemical, and physical assaults

41. Cells of the Epidermis • ƒ Keratinocytes – produce the fibrous protein keratin • ƒ Melanocytes – produce the brown pigment melanin • ƒ Langerhans’ cells – epidermal macrophages that help activate the immune system • ƒ Merkel cells – function as touch receptors in association with sensory nerve endings

42. Dermis • ƒ Second major skin region containing strong, flexible connective tissue • ƒ Cell types include fibroblasts, macrophages, and occasionally mast cells and white blood cells • ƒ Composed of two layers – papillary and reticular • The Dermis helps us to control our body temperature: N.B A. On a cold day when the body needs to conserve heat, the Blood Vessels in the Dermis NARROW.

43. Layers of the Dermis: 1. Papillary Layer • ƒ Areolar connective tissue with collagen and elastic fibers • ƒ Its superior surface contains peglike projections called dermal papillae • ƒ Dermal papillae contain capillary loops, Meissner’s corpuscles, and free nerve endings

44. Layers of the Dermis: 2. Reticular Layer • ƒ Accounts for approximately 80% of the thickness of the skin • ƒ Collagen fibers in this layer add strength and resiliency to the skin • ƒ Elastin fibers provide stretch-recoil properties

45. DERMIS . The dermis is composed of two layers: the papillary layer and reticular layer . • The papillary layer is closest to the epidermis. • Connective tissue here is less dense than in the reticular layer. • There are numerous sections of blood vessels (arterioles, venules, and capillaries) in the • dermis.

46. Hypodermis • ƒThe hypodermis is the innermost and thickest layer of the skin • ƒ Subcutaneous layer deep to the skin • ƒ Composed of adipose and areolar connective tissue • ƒ The hypodermis is used mainly for fat storage. • ƒIt invaginates into the dermis and is attached to the latter, immediately above it, by collagen and elastinfibres. • ƒ It is essentially composed of a type of cells specialised in accumulating and storing fats, known as adipocytes. • ƒ These cells are grouped together in lobules separated by connective tissue .

47. END OF SESSION Q & A

48. THANKS