Modalities in Physiotherapy

Learning Guide Modalities in physiotherapy

27466 Apply modalities in physiotherapy as a health Level 4 6 credits assistant

Issue 2.0 Name:

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Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 Contents

Introduction...... 2 Purpose of modalities in physiotherapy...... 4 Principles of modalities in physiotherapy...... 4 Application of modalities in physiotherapy...... 6 Thermal modalities...... 6 Cold modalities...... 7 Hot modalities...... 9 Conductive heating...... 9 Convective heating...... 9 Radiant heating...... 10 Customised standard splints and braces...... 13 How applying modalities contributes to a person’s care...... 16 Precautions to reduce the risks to people...... 18 Reducing risk and taking precautions...... 18 Responsibility of applying modalities in physiotherapy...... 21

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 1 Introduction

This learning guide is about the modalities used in physiotherapy to treat injuries, disabilities and disorders. How to use your learning guide This guide supports your learning and prepares you for the unit standard assessment. The activities and scenarios should be used as a general guide for learning. This guide relates to the following unit standard:  27466 Apply modalities in physiotherapy as a health assistant (level 4, 6 credits). This guide is yours to keep. Make it your own by writing notes that help you remember things, or where you need to find more information. Follow the tips in the notes column. You may use highlight pens to show important information and ideas, and think about how this information applies to your work. You might find it helpful to talk to colleagues or your supervisor. Finish this learning guide before you start on the assessment. What you will learn This topic will help you to:  describe the application of modalities in physiotherapy.  apply modalities in physiotherapy.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 2 What are modalities in physiotherapy? Physiotherapy is a discipline that works to develop, maintain or restore the functional ability of a person. Where a person has had their normal body function compromised through a health and/or disability condition, injury or other trauma, physiotherapists apply therapeutic treatments to ease discomfort or increase the person’s abilities to move and perform activities of daily living. A health assistant in physiotherapy is a person employed to assist a physiotherapist to provide physiotherapy services in a safe, effective and efficient manner. Therapeutic treatment can include the use of modalities. A modality (treatment) is a therapeutic agent or method used to treat an injury, disability or disorder and to promote, maintain or restore a person’s physical and psychological wellbeing. Physiotherapy modalities include:  standardised treatment programmes More info  thermal treatment (hot and cold). Standardised  application of orthoses (splints and braces). treatment programmes could  TENS (Transcutaneous Electrical Nerve Stimulation). include – Fitness and  electrotherapy agents. Mobility Exercise  paraffin wax baths. Program (FAME), Graded Repetitive Arm  laser therapy. Supplementary  ultrasonic therapy. Programme (GRASP) or others. An agent is the particular equipment or activity that is used with the person you are supporting. The method is how that equipment or activity is used with the person to bring about the desired therapeutic effect. As a health assistant, you will be working with physical agents. These include:  thermal modalities (hot and cold).  use of customised standard splints or braces.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 3 It is important to know that in your role as an assistant, you may see other modalities, such as electrotherapeutic modalities being used with people. The New Zealand Society of Physiotherapists advises that electrotherapeutic modalities that are connected to mains supply, such as ultrasound must not be undertaken by a physiotherapy assistant at any time as they are deemed core physiotherapy activities that are required to be undertaken by a registered physiotherapist. This resource only covers thermal modalities and standard splints and braces. Thermal modalities refer to simple heating and cooling agents and techniques, such as heat/ice packs that are applied to a person in order to produce a measurable change in tissue temperature. Customised standard splints and braces are devices that are fitted to perform a particular function for the person. A splint is a rigid device used to prevent motion of a joint or of the ends of a fractured bone. A brace supports or holds a movable part of the body in the correct position while still allowing that part to have some movement. Purpose of modalities in physiotherapy A physiotherapist will assess a person and identify whether a presenting symptom may be alleviated or improved by the application of a modality. The key purpose of modalities in physiotherapy is to improve the person’s physical and psychological wellbeing through the use of therapeutic methods. The use of therapeutic modalities may help to:  reduce pain or discomfort.  improve physical function and the person’s ability to complete activities of daily living and participate in life roles.  facilitate independence.  help the person adapt or adjust to the effects of an injury or health and/or disability condition so that they can have maximum wellbeing and achieve their goals. Principles of modalities in physiotherapy The use of therapeutic modalities is based on some key principles. These include:  respect for the person’s autonomy and rights.  informed consent is obtained.  selection and use of a modality that benefits the person.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 4  protocols are followed for the application of modalities.  prevention of further harm (ensuring that all equipment and methods are safe and fit for purpose).  use of a modality that is culturally appropriate to the person.  communication of information about the modality is done openly, honestly, unambiguously and in a way the person can understand; relayed in such a way as to allow the person with opportunities to participate effectively.  evaluation is completed following the use of modalities.

Write In your role, what is one way you can show respect for the person’s autonomy and rights?

How do you ensure that you are using the correct modality as recommended by the physiotherapist?

In your role, how do you ensure that any equipment you are using is safe and fit for use?

How do you ensure that you communicate effectively with the people that you support?

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 5 Application of modalities in physiotherapy

In your role as a health assistant, your role will include applying (using) modalities as a part of a person’s treatment plan/programme. This learning guide will look at the following modalities:  thermal modalities are heating and cooling agents and techniques.  use of customised standard braces and splints. Thermal modalities Thermal modalities are readily available and widely used treatment options. They can be used with:  people of all ages.  people with different levels of activity.  at different injury stages.

The reason for using thermal modalities includes:  relieving pain.  reducing swelling.  improving range of motion.

Thermal modalities include the use of:  cold modalities.  hot modalities.

Thermal modalities are readily available and widely used treatment options.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 6 Cold modalities The most common form of cold modality is the use of ice in some form. Cold modalities decrease the temperature of the tissue in the affected body part for a variety of therapeutic purposes. The cold makes the veins in the tissue contract (vasoconstriction) reducing circulation. Once the cold is removed, the veins overcompensate and dilate (expand). This allows blood to rush into the area. The blood brings the necessary nutrients to allow the injured muscles, ligaments and tendons to heal. Types of cold modalities are shown in the following table:

Type of cold modality Explanation

Ice packs or gel packs These are a plastic sack of ice, refrigerant gel or liquid.

Ice water immersion This involves immersing (putting) the part of the body into ice water (used with acute injuries such as ankle sprain).

Cold whirlpool Cold whirlpools allow large areas of the body or parts of the body that are difficult to ice to be cooled. The whirlpool action has an additional massaging benefit that helps to reduce swelling in sub-acute conditions (sub-acute is between acute and chronic).

Ice massage Ice (for example, in a paper cup) is applied to the specific body part and then gently massaged in a circular motion until the skin is numb. It can be used in conjunction with stretches.

Cryokinetics Combining the use of the low temperature with exercise. The part of the body is immersed in a cold water bath for a short time followed by exercise and/or compression and elevation. The cycle is then repeated. This can also be done multiple times throughout a day. It is used in the treatment and rehabilitation of the person by re- educating the injured body part.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 7 Benefits of cold modalities include:  reducing inflammation, swelling and oedema.  reducing pain.  slowing nerve impulses to the injured area which in turn interrupts the pain/spasm reaction (reduces muscle spasms).  decreasing tissue damage.  facilitating muscle contraction.  allowing increased range of motion (ROM).

Cold modalities should not be used with people who have:  rheumatoid arthritis or other arthritic conditions.  Raynaud’s Syndrome.  cold allergic conditions.  paralysis.  areas of impaired sensation.  confusion.

Write What cold modalities have you used in your role?

Why were these modalities used with the people you support?

What were the benefits to the person from the use of these modalities?

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 8 Hot modalities Hot modalities are used to increase the tissue temperature in specific body parts. This temperature change brings about a range of therapeutic benefits, including:  increasing motion.  decreasing joint stiffness.  relief of muscle spasms.  increasing blood flow  reducing pain and inflammation.  assisting with the reabsorption of exudates and oedema in chronic conditions.  acceleration of healing.

Hot modalities that are within the scope of a health assistant to apply include conductive, convective and radiant heating. Conductive heating This is the exchange of thermal energy between two surfaces when they are in physical contact with each other. Typically, direct contact takes place between the heat source and the target tissues. These methods include:  hot packs.  heated wheat bags.  electric heating pads.  paraffin baths. Convective heating This form of heating occurs by the movement of the heat medium (usually air or fluid) across the body or around the tissues. These methods include:  fluidotherapy.  whirlpools.

Other types of hot modalities that you may see being used by a physiotherapist include: Radiant heating

Heat is transferred directly without the use of a heat medium. This type of dry heat increases circulation to

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 9 the area and is used to provide relief from musculoskeletal pain and to accelerate healing. It is used for pain relief and for open wounds such as ulcers.

These methods include:

 Infrared lamps.  UV therapy.

Types of hot modalities are listed in the following table.

Conduction heating

Heating modality Application

Hot packs, heated These are heated and directly applied to the specific wheat bags or electric body part. They give instant warmth. heating pads

Hydrocollator packs These are moist hot packs that are filled with silicone gel that holds heat efficiently. It is generally used before ultrasound as it may improve the effectiveness of the ultrasound in heating deep tissues. They also hold their heat for a long time. There can be no pressure applied to the hydrocollator pack, such as lying on top of the bag. It is used to increase local blood flow, reduce pain and spasm and improve range of movement.

Paraffin baths These involve the application of heat to a specific area of the body through the use of paraffin (wax). The body part is quickly immersed in heated liquid wax and then withdrawn so the wax solidifies to form an insulating layer. This is repeated until the layer is between 5 and 10mm thick. The entire area is then wrapped in an insulating material, such as a loose fitting plastic bag. It is used for heating traumatised and inflamed areas, especially hands, feet and wrists. It is mostly used with people who have arthritis, rheumatism and joint conditions.

Convection heating

Heating modality Application

Fluidotherapy Fluido-therapy uses a machine that agitates ground cellulose. This cellulose is heated and circulated by air to deliver dry heat to the particular part of the body. It is a dry whirlpool that applies heat, has a

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 10 massaging effect and provides sensory stimulation. It is used with the extremities, including, hands, fingers, wrists, ankles and toes. Fluido-therapy cannot be used with a person who has infections or open wounds.

Whirlpools Whirlpools are baths of warm water where the water swirls. They are often used before therapeutic massage to increase the range of motion in the affected area.

Benefits of hot modalities include:  improving tissue healing in the sub-acute stage of inflammation.  reducing pain.  helping muscle relaxation.  reducing stiffness.  increasing range of motion.  alleviating muscle spasm.  helping with the removal of metabolic waste that has accumulated as a result of the inflammatory process.

Heat modalities should not be used when there is:  impaired skin sensation.  impaired vascular structures.  an acute condition.  malignancies.

Heat modalities should also not be used with the very young or the very old.

Write What hot modalities have you used in your role?

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 11 Why were these modalities used?

What were the benefits to the people you support from the use of these modalities?

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 12 Cold and hot modalities Both cold and hot modalities relieve pain. The differences between cold and hot modalities include:  blood flow increases with heat and decreases with cold.  the formation of oedema is facilitated by heat and is decreased by cooling.  the tendency to bleed increases with heat and decreases with cold.  a longer time is necessary for cooled muscle to return to normal temperature. The application of heat increases blood flow, helping a heated muscle return to normal temperature after a few minutes.  heated muscle tissue can sustain a contraction for a shorter period of time.  joint stiffness decreases with heating but increases with cooling. Risks associated with cold and hot modalities Risks associated with cold and heat modalities include:  burns.  scalds.

Both hot and cold materials, such as wheatbags, hydro-collator packs or paraffin wax can burn the skin. Burns can occur from:  the initial temperature of the material being too hot or too cold.  the hot or cold material being left on the skin for too long.

It is very important that you always check the temperature of any material before applying it to the skin and have a method of ensuring that the material is not left on the skin for too long. Customised standard splints and braces Customised splints are used to immobilise an injured joint or body part, such as soft tissue and skeletal injuries. Braces are most commonly used to support a part of the body while still allowing some movement. They are designed to prevent injury and stop re-injury from occurring. Standard splints and braces come ready made and need to be fitted and adjusted to the particular person (customised). The most common braces are for the leg, knee and thigh. Splints and braces can be adjusted using Velcro, hooks and fastenings or straps.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 13 Splints and braces can be used on a wide range of body parts to:  protect, support or immobilise a body part.  position and maintain alignment.  correct deformity or prevent further deformity.  substitute for weak or absent muscle function.  maximise range of motion (ROM).  facilitate healing.  reduce pain by restricting movement.  increase a person’s ability to perform activities of daily living.  treat and prevent physical impairments.

In particular, braces can be used to:  to correct overuse deformities and treat repetitive strain injuries.  to immobilise a joint or body segment to promote rapid healing.  help replace the function and encourage the mobility of the body.

Splints and braces may be used:  during the day.  at night.  for certain activities.  all the time.

Splints and braces can:  deliver gentle compression that can reduce pain.  have graduated compression to reduce pain or swelling.  be thermoactive (provide hot/cold compression support).  come with accessories such as, reusable gel packs and inflatable pumps.  provide consistent and uniform pressure.  help speed up recovery time.  be adjusted for a precision fit.  absorb and divert pressure that causes pain or stress.  eliminate feelings of numbness, tingling or pain.  promote the correct postural position of the body part.  distribute weight and relieve discomfort. Risks associated with splints and braces Skin integrity may be compromised by:

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 14  friction  rubbing  blisters Circulation may be compromised by incorrect fitting or use of splints or braces.

Write What splints and/or braces have you used in your role?

Why were these splints and/or braces used?

What were the benefits to the person from the use of these splints and/or braces?

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 15 How applying modalities contributes to a person’s care

The application of modalities is targeted at improving the function a person has or preventing the loss of function. A person will have goals that relate directly to restoring, improving or maintaining their ability to complete activities and participate in life roles. The application of modalities contributes to these goals by:  relieving pain or discomfort that prevents people from completing tasks or participating in life roles.  reducing swelling, inflammation, spasms or oedema.  improving range of motion.  improving confidence or feelings of reassurance because a splint or brace has been applied to a weak area of the body.  promoting healing.  helping to allow a person to be independent and have autonomy.

The physiotherapist will have assessed the person’s needs and recommended the modalities that will form the person’s treatment and/or rehabilitation. These modalities will be used to facilitate the treatment and the achievement of the person’s goals. It is important that you understand how the modality that is being applied helps to meet the person’s goals. It is with this understanding that you can provide the right type of support. Knowing how the modality contributes to that person achieving their goals helps you to provide appropriate support. For example:  making sure you understand how the modality is to be applied.  ensuring any equipment, materials or spaces, for example, treatment rooms are available or accessible.  checking any equipment or materials are clean, safe to use and in good condition.  providing appropriate instructions to the person as per the physiotherapist’s recommendations.  reminding or prompting the person to use any equipment such as braces or splints correctly.  reporting any problems that you discover or observe to the physiotherapist in accordance with your workplace’s policies and procedures.

Your role is to work with and support the use of the modality to meet each person’s needs under the supervision of the physiotherapist and in accordance with your organisation’s policies and procedures.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 16 Write Think about a person you are supporting that is currently having a physiotherapy modality. Consider how the person’s goals are being met by using physiotherapy modalities.

What are the modalities that are being used with that person?

What are the person’s goals?

In your own words, describe how the modality contributes towards the person achieving their goals. It may be helpful to consider what the modality is helping the person to do or have, for example:

 tasks the person can complete independently.  pain relief.  reduction of swelling or inflammation.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 17 Precautions to reduce the risks to people Reducing risk and taking precautions Your organisation will have policies and procedures that you are expected to follow when assisting with modalities in physiotherapy. These policies and procedures will exist to keep you and the person safe. Risks of modalities Any modality used in physiotherapy will have risks for the person. Risks can include:  incorrect or unsafe use of equipment or materials.  equipment that is faulty or materials that have not been checked to ensure they are safe for use with the person, for example, paraffin wax that is too hot and is not checked before being used.  instructions of the physiotherapist not being checked, understood or followed correctly.  distraction, forgetfulness or inattention to the person that leads to injury, for example hot or cold packs being left on for too long or being used at the wrong temperature.  hot/cold packs not being strapped on tightly enough and falling loose, meaning the right area does not get the therapeutic benefit.  splints and/or braces being applied too tightly and restricting blood flow or causing the skin to break down.  infections or cross contamination from hygiene and infection control procedures not being correctly completed.  records not being properly kept or incorrect information being recorded.  not reporting incidents or accidents that occur during the session.  breaches of the person’s privacy.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 18 Precautions to reduce the risk of modalities In your role, it is important that you are able to take precautions to reduce the risk to people. These precautions include:  completing circulation and sensation tests prior to application of modalities.  assessing for skin integrity and skin wounds prior to application of modalities.  checking that you are using the equipment or materials correctly and safely with the person and checking with the physiotherapist if you are not sure.  paying attention to risk areas, for example, bony protuberances.  staying focused on the person and not allowing yourself to be distracted to ensure the person is not at risk of becoming injured.  observing the person so you can respond quickly and appropriately if there is a problem, for example the person reporting pain or discomfort.  checking comfort and that there is good blood flow when applying braces or splints.  following all hygiene and infection control procedures, such as washing your hands, wearing gloves.  ensuring only accurate data is recorded.  ensuring documentation is kept private, for example, not discussing the person in front of others.

Use of any modality in physiotherapy has potential risks for the person and it is your responsibility to ensure that you are observant and attentive when working with modalities, especially hot and cold modalities that can quickly cause burns. It is good practice to:  regularly check in with the person to make sure they are feeling comfortable.  watch the person’s body language for any signs that they are experiencing discomfort.  pay attention to the area of the person’s body being treated to identify any physical signs that injury may be occurring, such as redness, change in temperature or a blue tinge that may indicate blood flow is being restricted.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 19 Write What are some of the risks to people in the physiotherapy modalities that you assist with? Describe each risk and identify at least one precaution that you take.

Risk to the person Precaution that I take

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 20 Responsibility of applying modalities in physiotherapy

As a health assistant, you will have an important role in the application of modalities in physiotherapy. At all times, you will need to follow the instructions of the physiotherapist and act in accordance with the boundaries of your role. Your organisation will also have policies and procedures that you will need to know and follow. Your role in applying modalities in physiotherapy includes responsibilities to do with:  privacy.  occupational health and safety.  infection control.  identifying hazards.  Treaty of Waitangi principles.  Code of Rights.

Modalities in physiotherapy (US 27466) Learning Guide © Careerforce – Issue 2.0 | July 2015 21 Write For a person you are currently supporting, answer the questions below.

What is the injury?

What modality is being applied?

Where, and why?

What cultural considerations do you need to be aware of?

What preparation do you do for this modality?

How do you prepare the person?

What considerations do you need to be aware of with any equipment/materials/environment?

What precautions did you take?

What follow up do you need to undertake – such as records to complete?