Cryotherapy

Question 1

Biophysical Agents/Energies

Answer 1

delivery or removal of energy from biologic tissues

Question 2

Types of modalities/agents

Answer 2

• Thermal
• Cryotherapy
• Mechanical
• Acoustic
• Electrical
• Electromagnetic
• Hydrotherapy

Question 3

Cryotherapy

Answer 3

use of cold to remove heat/energy from tissues

heat abstraction/cooling

Question 4

cryotherapy is commonly used for:

Answer 4

first aid
reduce spasms and spasticity
elevation of pain threshold

Question 5

Physical Principles

Modes of heat abstraction used in PT

Answer 5

• conduciton
• evaporation
• convection

Question 6

Conduction

Answer 6

Rate of heat abstraction (heat transfer)

Question 7

Conduction equation

Answer 7

D= Area x k x (T1-T2)/tissue thickness
D=rate of heat loss in cal/s
Area=amount of body surface are cooled in cm2
k=thermal conductivity of tissues in cal/s/cm2
T1 and T2 are the temperatures of the cold modality and the tissues

Question 8

Thermal Conductivity
Greatest to least

Answer 8

Water, Bone, Muscle, Fat

Question 9

Key to effectiveness for conduction agents

Answer 9

Contact!

Question 10

Evaporation

Answer 10

use of a liquid or spray applied to the skin that abstracts heat by evaporating

Question 11

Most common method of evaporation

Answer 11

Vapocoolant sprays such as Spray and Stretch

Question 12

Evaporation effects on tissue

Answer 12

effective in cooling skin, minimal effects on tissues below skin

Question 13

Biophysical effects of tissue cooling

Hemodynamic effects

Answer 13

immediate vasoconstriction of cutaneous blood vessels resulting in blood flow reduction & increased blood viscosity

Question 14

Biophysical effects of tissue cooling

Short time application of cold ≤ 15 min:

Answer 14

Results in vasoconstriction of arterioles and venules secondary to direct action of cold on smooth muscles & reflex cutaneous vasocontriction

Question 15

Effects of cold on local blood flow

Fig 2.5

Answer 15

• Increase in blood viscosity & smooth muscle tone
• Stimulates DRG
• Decrease histamine and bradykinin

These factors lead to vasoconstriction and reduced blood flow

Question 16

Define

Hunting response

Answer 16

vasodilation that follows the initial period of vasoconstriction

Question 17

Hunting response

Occurs with:

Answer 17

prolonged >15 min application of cold or when the temperature of the tissues falls below 10 degrees Celcius

Question 18

Hunting response

Predominantly occurs in what areas?

Answer 18

Apical areas
(hands, fingers, feet, toes, and face)

Question 19

Vasodilatio following cold application

Overall clinical effect of cold application:

Answer 19

Dramatic reduction of tissue temperature and blood flow

Question 20

Water temperature that causes vasodilation following cold application

Answer 20

Water temperatures ≤50°C

Question 21

Cold effects on post-traumatic edema and inflammation

Answer 21

First 24-48 hours after injury
Decreases:
* Fluid filtration into interstitial tissue (edema formation)
* Decrease inflammation
* Decrease metabolic rate

Question 22

Cold effects on peripheral nerves

Answer 22

• Decrease in sensory and motor conduction velocites
• Increased threshold for nerve depolarization

Question 23

Cold effects on peripheral nerves

Prolonged intense application may cause:

Answer 23

failure of nerve to conduct impulses

(neurapraxia or axonotmesis)

Question 24

Cold effects on muscle strength

(short term application)

Answer 24

may enhance muscle strength

Question 25

Cold effects on muscle strength | (prolonged applications)

Answer 25

may decrease muscle strength

Question 26

Neuromuscular effects of cold

Answer 26

local or regional cooling may be beneficial for neurologic conditions

Question 27

# Neuromuscular effects of cold Short duration application

Answer 27

Decrease spasticity, DTR, and frequency of clonus

Question 28

# Neuromuscular effects of cold Why do people w/ MS or myasthenia gravis wear cooling vests?

Answer 28

* improve balance * less spasticity and fatigue

Question 29

Indications for cryotherapy

Answer 29

Acute trauma (first 24-48 hrs) Subacute and chronic conditions Trigger points Reduction of spasticity

Question 30

PRICE(S)

Answer 30

Protection Rest Ice Compression Elevation Stabilization

Question 31

Contraindications for cryotherapy

Answer 31

Patients with cold sensitivity Cold urticaria Cryoglobulinemia Raynaud's phenomena Paroxysmal cold hemoglubinuria Over areas of comprimised circulation such as PVD

Question 32

# Contraindications Cold utricaria

Answer 32

formation of wheals on skin

Question 33

# Contraindications Cyroglobulinemia

Answer 33

abnormal blood proteins in pts w/ multiple myeloma, some viral bacterial infections, CLD, SLE and other rheumatic diseases

Question 34

# Contraindications Raynaud's disorder

Answer 34

vasospastic disorder

Question 35

# Contraindications Paroxysmal cold heoglubinuria

Answer 35

Blood in the urine

Question 36

Precautions of cryotherapy

Answer 36

HTN Impaired circulation Thermoregulatory disorders Open wounds Over superficial peripheral nerves Psychologic aversion to cold

Question 37

Methods of cryotherapy

Answer 37

Packs Ice Ice massage Baths Spray Compression Devices Gels/creams Vests/chambers

Question 38

# Effectiveness and Outcomes Objective measurements

Answer 38

* Circumferential measurements of swollen limb * Pain levels * ROM of joint(s) * Muscle spasm

Question 39

# Effectiveness and Outcomes Functional measurements

Answer 39

* Use of limbs to walk/run/jump * Use of hands for ADL/work/sports * Functional questionnaires

Question 40

Cold advantages

Answer 40

May prevent further swelling Decrease pain

Question 41

Cold disadvantages

Answer 41

Increase stiffness Decrease tissue extensibility