Thermal Agents - Cryotherapy  Flashcards

1
Q

Definitions

  • Cryotherapy = ?
  • Thermotherapy = ?

Cryotherapy

A

(a) Cryotherapy

  • The therapeutic use of cold

(b) Thermotherapy

  • The therapeutic use of heat
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2
Q

Definitions

  • Superficial heating agents = ?
  • Deep heating agents = ?

Cryotherapy

A

Superficial heating agents:

  • Therapeutic use of heating agents typically used for pain control.

Deep heating agents:

  • Energy conversion into heat as it passes through body tissues
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3
Q

Definitions

Amount of energy required to raise the temperature of a given weight of a material by a given number of degrees = ?

Cryotherapy

A

(e) Specific Heat

  • Amount of energy required to raise the temperature of a given weight of a material by a given number of degrees
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4
Q

Effects of Cold

  • Hemodynamic Effects = ?
  • Metabolic Effects = ?

Cryotherapy

A

Effects of Cold:

(a) Hemodynamic Effects

Vasoconstriction

  • Less than 15-20 minutes application
  • Decreases release of vasodilator mediators

Cold-induced vasodilation (CIVD)

  • Though to be due to sympathetic inhibition
  • Hunting response: cyclic nature of extended cold

(b) Metabolic Effects

  • Decreased metabolic rate
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5
Q

Effects of Cold

  • Neuromuscular Effects = ?
  • Altered muscle strength = ?
  • Decreased spasticity = ?

Cryotherapy

A

(a) Neuromuscular Effects

Decreased nerve conduction velocity

  • 5 min reverses in 15 minutes
  • 20 minutes = 30+ minutes

Increased pain threshold

  • Sensory input to block pain receptors (Gate Control Mechanism)
  • Reduction of muscle spasm, nerve velocity, or edema

(b) Altered muscle strength

  • Decreased motor nerve conduction velocity, muscle spindle sensitivity, and muscle strength when applied directly to the muscle.
  • Increase after 5 minutes, decrease after 30 minutes
  • Consider – strength testing compared to timing of ice

(c) Decreased spasticity

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6
Q

Four uses of Cryotherapy = ?

Cryotherapy

A

(a) Inflammation Control

  • Pain, Microvessel bleeding, and DOMS
  • 15 mins or less.
  • Immediately after injury & during acute inflammatory phase.

(b) Edema Control:

  • Extravasation and permeability
  • Vasoconstriction vs vasodilation
  • P.R.I.C.E.
  • Acute Inflammation vs immobility, poor circulation

(c) Pain Control:

  • Cutaneous thermoreceptors help block pain signals via gait control.
  • Can help control pain spasm cycle.

(d) Muscle tone: Can reduce spasticity

  • Needs to be applied for 30 mins for spasticity reduction
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7
Q

A technique that combines cryotherapy with exercise = ?

Cryotherapy

A

Cryokinetics:

(a) A technique that combines cryotherapy with exercise.

  • Uses ice immersion, cold packs, or icemassage.

(b) Goal is to numb the injured part to the point of analgesia and then work toward achieving normal ROM through progressive active exercise.

(c) Exercises performed during periods of numbness should be pain-free and progressive in intensity,concentrating on both flexibility and strength.

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8
Q

Application of cooling agent prior to stretching = ?

Cryotherapy

A

Cryostretch:

  • Application of cooling agent prior to stretching
  • Reduce muscle spasm and allow for greater ROMwith stretching
  • Cold pack after hot pack > hot pack alone
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9
Q

Contraindications of Cryotherapy = ?

Cryotherapy

A

Contraindications of Cryotherapy:

  • Cold hypersensitivity (cold-induced urticaria)
  • Cold intolerance
  • Cryoglobulinemia - may be associated with multiple myeloma, systemic lupus erythematosus, rheumatoid arthritis, or other hyperglobulinemic states.
  • Paroxysmal Cold Hemoglobinuria
  • Raynaud’s disease or phenomenon
  • Over-regenerating peripheral nerves
  • Over an area with circulatory compromise or peripheral vascular disease
  • Determine cause of edema
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10
Q

Precautions of cryotherapy = ?

Cryotherapy

A

Precautions of Cryotherapy:

  • Over the superficial main branch of a nerve
  • Over an open wound
  • Hypertension
  • Poor sensation or mentation
  • Very young and very old patients
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11
Q

Adverse effects of cryotherapy = ?

Cryotherapy

A

Adverse Effects of Cryotherapy:

(a) Tissue death

  • Most severe adverse effect
  • Caused by prolonged vasoconstriction, ischemia, or thromboses in smaller vessels

(b) Temporary or permanent nerve damage

  • Results in pain, numbness, tingling, hyperhidrosis, or nerve conduction abnormalities
  • Limit cold application to under 15-20 minutes
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12
Q

Systematic Review of Cryotherapy = ?

Cryotherapy

A

Systematic Review of Cryotherapy

(a) Recovery Characteristics

  • DOMS, RPE, Objective markers (blood splama markers and cyotkines)

Pooled data from 27 articles revealed:

DOMS:

  • Cooling and especially cold water immersions, reduced the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery.
  • This effect remained significant after 48 hrs and 96 hrs

RPE

  • Studies favored cooling agents to control conditions after 24 hours of recovery
  • No significant difference after 48 hours

There was no evidence, that cooling affects any objective recovery variable

  • Cooling did not affect objective recovery variables such as lactate-levels, CK-levels or IL6-levels.
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13
Q

Cryotherapy Types - Cold Packs

  • Temp = ?

Cryotherapy

A

Cold Packs

(-) Temp

  • Cold packs should be between 0-5 deg. C / 32-41 deg. F
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14
Q

Cryotherapy Types - Cold Pack

  • ? min. = normally
  • ? min. = spasticity

Cryotherapy

A

Cold Pack - Duration:

  • 20 minutes normally
  • 30 minutes for spasticity
  • Applied every 1-2 hours for inflammation and pain control
  • Inspect skin after
  • Red or dark pin
  • Presence of wheals (welts) or a rash
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15
Q

Cryotherapy Types

Ice pack provides = ?, compared to cold pack

Cryotherapy

A

Ice Pack:

(-) Provides more aggressive cooling than cold packs at the same temperature.

  • Ice has a higher specific heat than most gels
  • Ice absorbs a large amount of energy when it melts
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16
Q

Ice/Cold Pack Time:

  • Reduce swelling = ? min.
  • Block pain = ? min.
  • Cool Muscles = ? min.
  • Decrease spasticity = ? min.

Cryotherapy

A

(-) Reduce swelling = 4-20 min

(-) Block pain = 4.5-15 min

(-) Cool Muscles = 15-30 min

(-) Decrease spasticity = 30-45 min.

17
Q

Cold Packs and Ice Packs

  • Advantages = ?
  • Disadvantages = ?

Cryotherapy

A

Cold Packs & Ice Packs

(-) Advantages:

  • Easy to use
  • Inexpensive
  • Short use of clinician’s time
  • Low level of skill required forapplication
  • Covers moderate to large areas
  • Can be applied to an elevatedlimb

(-) Disadvantages:

  • Pack must be removed tovisualize the treatment areaduring treatment
  • Patient may not tolerate weightof pack
  • Pack may not be able to maintaingood contract on small orcontoured areas
  • Long duration of treatmentcompared to massage with icecup
18
Q

Cryotherapy Types

Ice cups (Ice massage):

  • Time = ?
  • Skin Temp = ?

Cryotherapy

A

Ice cups (Ice massage):

(-) Time = 5-10 min.

(-) Temp = > 59 deg F

Notes:

  • Will cool tissue faster than other cryotherapy
19
Q

Ice cups (Ice massage)

  • Advantages = ?
  • Disadvantages = ?

Cryotherapy

A

Ice cups (Ice massage):

(a) Advantages:

  • Treatment area can be observedwell during application
  • Can be used for small andirregular areas
  • Short duration treatment
  • Inexpensive
  • Can be applied to elevated limb

(b) Disadvantages:

  • Too time-consuming for largeareas
  • Requires active participation bythe clinician or patient throughoutapplication
  • Messy
20
Q

Cryotherapy Types

Controlled Cold Compression Units:

  • Temp set between = ? deg. F

Cryotherapy

A

Controlled Cold Compression Units:

(-) Temperature of the water can be set between 50-77 deg. F (NPTE)

21
Q

Gameready:

  • Temp = ?
  • Compression = ?

Cryotherapy

A

Gameready:

(-) Temperature= 40-60 deg F

(-) Compression

  • None – Low : First 24-48 hours after surgery
  • Medium – High : When comfortable after the first 48 hours

Patient Preference is key!

22
Q

Cryo Cuff

  • How does this work = ?
  • Common for = ?

Cryotherapy

A

Cryo Cuff:

(-) Cold + Compression

(-) Should be elevated 15-28 in. above level of sleeve

(-) Provides mild cooling below intensity of other agents

(-) Common post-operative pain management

23
Q

Controlled Cold Compression Units

  • Advantages = ?
  • Disadvantages = ?

Cryotherapy

A

Controlled Cold Compression Units:

(a) Advantages:

  • Allows simultaneous applicationof cold & compression
  • Temperature & compressionforce are easily and accuratelycontrolled
  • Can be applied to larger joints

(b) Disadvantages

  • Treatment site CANNOT be visualized during treatment
  • Expensive
24
Q

Vapocoolant Sprays

  • Purpose = ?

Cryotherapy

A

Vapocoolant Sprays:

(-) Purpose is to provide a counterirritant stimulus to the cutaneous thermal afferents overlaying muscles to cause a reflex reduction in motor neuron activity and thus a reduction in resistance to stretch.

25
Q

Vapocoolant Sprays

  • Advantages = ?
  • Disadvantages = ?

Cryotherapy

A

Vapocoolant Sprays:

(-) Advantages

  • Brief duration of cooling
  • Very localized area of application

(-) Disadvantages

  • Limited to use for brief, localized,superficial application of coldbefore stretching
  • Other means of applyingcryotherapy
26
Q

Cold Whirlpools

  • Indicated in = ?
  • Time = ?

Cryotherapy

A

Cold Whirlpools:

(-) Indicated in acute & subacute conditions in which exercise of the injured part during cold treatment is desired.

(-) Choose temperature and time based on treatment

  • 10-30 min.

Cleaned and disinfected after every treatment

27
Q

Cold Bath

  • Time = ?
  • Temp = ?

Cryotherapy

A

Cold Bath:

(-) Time 15-20 min.

(-) Temperature: 55-64 deg.

Notes:

  • Less time for colder temperatures
28
Q

Cold Bath Temps

  • Acute Inflammation of distal extremities = ?
  • Exercise = ?
  • Wound case, spasticity = ?
  • Cardiopulmonary compromise, treatment of burns = ?
  • Pain Management = ?
  • Chronic RA/OA, increased ROM = ?

Cryotherapy

A

Water Temperatures:

  • Acute Inflammation of distal extremities = 32-79
  • Exercise = 79-92
  • Wound case, spasticity = 92-96
  • Cardiopulmonary compromise, treatment of burns = 96-98
  • Pain Management = 99-104
  • Chronic RA/OA, increased ROM = 104-110
29
Q

Contrast Baths

Hot & Cold:

  • Time(s) = ?
  • Temp(s) = ?

Cryotherapy

A

Contrast Baths

(-) Hot bath = 104-106 deg F / x 3-4 minutes

(-) Cold bath = 50-60 deg F / x 1 minute

(-) Repeat hot & cold x 25-30 minutes

Notes: Other indications

  • Arthritis of small joints
  • MSK sprains/strains
  • CPRS
  • Limb desensitization
30
Q

Application Process

  • First, evaluate the patient and set the goals of treatment
  • Then = ?

Cryotherapy

A

Application Process:

(a) Evaluate the patient and set the goals of treatment.

  • What do you want to do?
  • Why?

(b) Determine whether cryotherapy is the most appropriate intervention.

  • What is your goal for cryotherapy?
31
Q

Application Process

You’ve asked theappropriate questions, NO contraindications orprecautions, what next = ?

Cryotherapy

A

Application Process:

(-) You’ve askedappropriate questions on contraindications andprecautions and determined that cryotherapy is NOT contraindicatedfor this patient orcondition.

(-) NEXT =

  • Inspect the areato be treated
  • Look for open wounds andrashes

(-) Assess sensation

  • Check thepatient’s chart for any recordof previous adverse responses to cold and for any diseases thatwouldpredispose the patient to an adverse response.
32
Q

Application Process

Things to consider when selecting the appropriate cooling agent = ?

Cryotherapy

A

Application Process:

(a) Select the appropriate cooling agent

  • Appropriate intensity of cold for desired outcomes
  • Best fit for location and size of area being treated
  • Contours to skin and able to make good contact
  • Best application for duration and position
  • Readily available and affordable

(b) Options

  • Cold packs or ice packs
  • Ice cups for ice massage
  • Controlled cold compression units
  • Vapocoolantsprays or brief icing
  • Frozen towels
  • Ice water immersion
  • Cold whirlpool
  • Contrast bath

(c) Considerations

  • With agentsthat cool by conduction or convection, such as cold packs or a coldwhirlpool,good contactmust bemaintained between the agent and thepatient’s body at all timesto maximize the rate of cooling.
  • Forbrief cooling, thebest choice is an agent that is quick to apply and remove.
  • The patient can readily use icepacks, ice cups, and cold packsat home.
  • Ice packs and ice massage are the least expensive means of providing cryotherapy
  • Controlled cold compression units are the most expensive.
33
Q

Application Process

  • What should be included when we explain the procedure & reason for applying cryotherapy = ?
  • STAGES of sensation in Cryotherapy = ?

Cryotherapy

A

Application Process:

(-) Explain the procedure and the reason for applying cryotherapy

  • Describe the sensations the patientcan expect to feel.
  • Educate on what sensations they need to notify you for (Too cold/not cold enough).

(-) STAGES of sensation in Cryotherapy

  1. COLD
  2. Burning/tingling
  3. Achey/Pain
  4. Numb
34
Q

Application Process

After applying the appropriate cooling agent, what should we do = ?

Cryotherapy

A

Application Process:

(a) Apply the appropriate coolingagent.

  • Place patient in idea position for comfort and agent application
  • Provide bell or other safety device near patient

(b) Check on patient response frequently

35
Q

Cryotherapy - Application Process

  • Assess the outcome of the intervention = ?
  • Documentation = ?

Cryotherapy

A

Application Process:

(a) Assess the outcome of the intervention.

  • Reassess the patient
    • Progress toward the set goals of treatment and for any adverseeffects of the intervention.
    • Re-measurequantifiable subjective conditions andobjectivelimitatios, andreassess function and activity.
  • Check skin for response to treatment

(a) Document

  • Note patient set up, modality use, and response