Chapter 1: Therapeutic Modalities Past, Present, and Future: Their Role in the Patient Care Management Model

THERAPEUTIC MODALITIES: A RIGHTFUL PLACE IN REHABILITATION

Therapeutic modalities represent the administration of thermal, mechanical, electromagnetic, acoustic, and light energies to produce biophysical effects at the cellular, tissue, organic, and whole-body levels. These biophysical effects are aimed at achieving physiological and clinical effects that serve to maintain and optimize health.¹ The terms therapeutic modalities and physical agents are often used interchangeably to describe a wide array of interventions that provide a variety of therapeutic benefits. The term physical agents reflects the use of physical energies—such as thermal, mechanical, electromagnetic, or light—but fails to include the purpose or intention of their application. The term therapeutic modalities more appropriately reflects the ability of these interventions to provide therapeutic benefits.

Over the last several years, much discussion has taken place regarding the appropriate terminology or name for what this text, now into a 7th edition, has termed “therapeutic modalities.” In 2014, the American Physical Therapy Association (APTA) began recommending use of the term “biophysical agents” to collectively refer to physical agents and modalities. At a similar time, the World Confederation for Physical Therapy suggested the term “electrophysical agents” to reflect electrophysical and biophysical energies used for evaluative, therapeutic, and preventative purposes. Still others have advocated for use of the term “biophysical energies” to reflect the electromagnetic, acoustic, light, and mechanical energies used to produce biophysical effects. We, the editors of this text, recognize the efforts and advancements to better delineate and understand the role of these interventions in rehabilitation. To maintain consistency with the title of the previous six editions of this text, the term “therapeutic modalities” will be used interchangeably with “biophysical agents” throughout this edition.

Therapeutic modalities have long been, presently are, and will continue to be a part of rehabilitative care. When used properly, therapeutic modalities are skilled interventions used to complement other elements, or therapies, that are part of the more comprehensive patient care plan, such as therapeutic exercise, manual therapy, and patient education. Neuromuscular electrical stimulation (NMES) may be used to facilitate volitional recruitment of skeletal muscle until the patient can effectively contract the muscle and begin additional therapeutic activities.² Neuromuscular electrical stimulation may also be used to impart improvements in spasticity and range of motion (ROM) in patients after stroke.^2,3 Transcutaneous electrical stimulation (TENS) may be used to attenuate pain so a patient can more effectively engage in and complete other cotherapies.⁴ Continuous ultrasound or other heat therapies may be applied to improve elasticity of connective tissues, ligaments, or joint capsular structures before beginning ROM or manual therapy activities in a patient with deficient ROM.⁵ Mechanical traction may be used as part of a multimodal plan of care for a patient with cervical radiculopathy.⁶ These examples reflect the complementary use of therapeutic modalities to achieve clinically important goals.