According to AOTA’s position paper Physical Agents and Mechanical Modalities and the Occupational Therapy Practice Framework: Domain and Process, which of the following clinical treatment sessions includes an inappropriate use of physical agent modalities in the context of occupational engagement?
Application of a hot pack to the hand followed by an activity that involves making a cord bracelet
Use of fluidotherapy for the upper extremity followed by passive stretch
Use of a transcutaneous electrical nerve stimulation unit for the back during homemaking activities
Use of a cold pack to the elbow after a game of checkers
Solution: The correct answer is B.
A treatment session consisting of fluidotherapy followed by passive stretch does not include occupational engagement as part of the session. AOTA’s position paper on physical agent modalities states that “exclusive or stand-alone use of [physical agent modalities] without linking it to a client-centered, occupation-based intervention plan and outcomes is not occupational therapy” (p. 1). The OTPF-4 states, “Intervention implementation must always reflect the occupational therapy scope of practice; occupational practitioners should not perform interventions that do not use purposeful and occupation-based approaches” (p. 25).
A, C, D: The use of each modality is combined with some form of occupational engagement.
Paraffin & Hotpacks
- 20 mins
- Conduction transfer
- Heats superficial structure up to 1 cm
Superficial thermal
Paraffin
- provides superficial heat as a therapeutic modality
- Ideal for use in hands and digits
- Used to increase circulation and promote healing
Benefits of superficial thermal therapy
- relieves pain
- increases tissue extensibility (Increases ROM)
- Assts with wound healing (increase blood flow)
- Decreases muscle spasm
Fluidotherapy
- 20 min treatment in combination of exercise hand and wrist
- Convection
Superficial thermal
Contraindications for heat
- postsurgical repairs
- acute injuries
- impaired sensation
- edema
- impaired vascular supply
- tumor/active cancer
- MS
- lymphedema
- DVT
Benefits of Cryotherapy
- relieves pain
- controls edema
- decrease abnomal tone
- facilitats muscle tone
- commonly used to treat acute injuries and postsurgical repairs
Ice packs, ice massage
Contraindication of Cryotherapy
- people with sensory deficis (including hypersensitivty
- Impaired circulation or Raynaud’s disease
Cold packs
- Skin checks after 3-5 mins
- Remains cold up to 10 mins
Ice massage
- for smaller areas
- applied in cicular motion directly on skin for 3-5 mins
Benefits of Ultrasound
(2 types)
- Mechanotherapy
- continuous (thermal effects) and pulsed (non-thermal effects)
- Applies heat deep into tissue
- Used to treat joint contractures, scarring and associated adhesions, and muscle spasms
Benefits of continuous type:
1. increases ROM, decreases joint stiffness
2. reduces pain
3. increases BP and tissue permability
4. reduces muscle spasm
5. reaches deeper tissues (up to 5 cm)
Benefits of pulse type:
1. decrease inflammation
2. heals tissue
Contraindication for ultrasound
- pregnant ppl
- active malignant tumor
- some joint replacements (cemented or plastic
- thrmbophlebitis fx
- infections
- over spinal cord
Consult with surgeon with tendon and ligament repairs (soft itssues)
Neuromuscular electrical stimulation
(NMES)
1.Use of electrical current to activate muscles
2. Applied through an electrode
3. Increase ROM, facilitates muscle contractions, and strengthens muscles
4. Promotes nerve injury repair
5. Contraindication: pacements or cardiac conditions
Electrical stimulation (E-STIM)
Transcutaneous electrical nerve stimulator (TENS)
- decreases pain (bsed on gate theory)
- Uses electrical current
- Provides constant electrical stimulation with a modulated current that is directed to the peripheral nerves through electrode placement
- Contraindication: pacements or cardiac conditions
Electrical stimulation (E-STIM)
Benefits of E-STIM
- pain control
- decrease swelling
- stimulates and strengthens muscles
- muscle re-education
- stimulates denervated muscle
Contraindication of E-STIM
- cardiac pacemaker
- phrenic/urinary bladder stimulators
- thrombosis/thrombophlebitis
- carotid sinus
An OTR® decides to use desensitization techniques in structured practice within the context of daily activities for a client with hypersensitivity secondary to peripheral nerve injury. Which desensitization technique would be the MOST therapeutic initially?
Begin using desensitization at the least sensitive area to be treated with a texture that is irritating to the client, but tolerable, for short periods several times per day
Begin using desensitization at the most sensitive area to be treated with a texture that is irritating to the client, but tolerable, for short periods several times per day
Instruct the client to use the desensitization techniques one or two times a day for 30 minutes each as part of a home program
Instruct the client in use of a transcutaneous electrical nerve stimulation (TENS) unit during desensitization activities
Solution: The correct answer is A.
Desensitization begins with an irritating but tolerable texture applied to the least sensitive area.
B: Desensitization begins with the least irritating texture in the least sensitive area to be treated; applying a texture to the most sensitive area is counterproductive.
C: Desensitization is best used for short periods (3 to 5 minutes five or six times per day).
D: If desensitization is poorly tolerated, the activity can be combined with use of a TENS unit to decrease the client’s perception of pain. Use of a TENS unit is not the initial approach.
Which outpatient treatment intervention is contraindicated for decreasing the arm edema and stiffness associated with complex regional pain syndrome (CRPS) of the upper extremity?
Instruction in the use of contrast baths several times a day
Instruction in performing gentle, pain-free AROM movements several times a day
Provision of an arm sling to wear during the day
Provision of a compression garment to wear during the day
Solution: The correct answer is C.
Wearing an arm sling will increase stiffness and edema because it places the extremity in a dependent and static position for long periods of time.
A, D: Taking contrast baths and using a compression garment are beneficial for edema control of the arm in a client with CRPS.
B: Gentle, pain-free AROM encourages circulation, decreases stiffness, and may assist in interrupting the pain cycle.
10.8% complete
Question
State laws vary with regard to use of physical agent modalities (PAMs) by OTR®s. When explaining how PAMs fit within the scope of occupational therapy practice in their state, which description of PAMs should OTRs use, provided in the Occupational Therapy Practice Framework: Domain and Process?
A.Modalities, devices, and techniques to prepare the client for occupational performance
B.Occupation-based interventions that are systematically applied to modify specific client factors that may be limiting occupational performance
C.Activities that support performance skills and patterns
D.Preparatory tasks that target specific client factors or performance skills
Solution: The correct answer is A.
Physical agent modalities (PAMs) are described in the OTPF-4 as “modalities, devices, and techniques to
prepare the client for occupational performance” (AOTA, 2020, p. 59). PAMs are part of a broader treatment plan and should not be used exclusively.
B, C, D: PAMs are interventions to support occupations. They are not purposeful activities or occupation-based treatment; rather, they precede client engagement in purposeful and occupation-based therapy.
An OTR® has been working with a client recently diagnosed with complex regional pain syndrome of the upper extremity secondary to an improperly casted distal radius fracture. Which modality is BEST to reach the treatment goal of pain control for this client?
Cold spray
Neuromuscular electrical stimulation (NMES)
Transcutaneous electrical nerve stimulation (TENS)
Iontophoresis
Solution: The correct answer is C.
A TENS unit will best aid the client in reaching the treatment goal of pain control.
A: Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit.
B: NMES is best used to facilitate muscle contraction.
D: Iontophoresis is used to control inflammatory conditions.
