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cryotherapy & thermal agents - exam 1 Flashcards

(53 cards)

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1
Q

what is conduction?

A

energy exchange by direct contact of stationary materials (tissues) at different temperatures

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2
Q

how is head conducted?

A

from the material at a higher temp to material at lower temp
– cold pack: heat transferred from patient’s skin to cold pack
– heat pack: heat transferred from hot pack to patient’s skin

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3
Q

what factors is rate of heat transfer dependent on?

A

area of contact
thermal conductivity
temperature difference

tissue thickness (decreases rate)

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4
Q

the greater the temp difference between two surfaces:

A

the faster the rate of heat transfer

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5
Q

what is a good use of materials to make sure you are creating a safe medium for heat transfer?

A

6-8 layers of towels between hot/cold pack and patient (trap air and have a low thermal conductivity to slow rate of heat transfer)

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6
Q

why should you remove metal from areas of contact?

A

metal has a high thermal conductivity

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7
Q

what is convection?

A

direct contact between circulating medium (not stationary) and another material of a different temp.

vector = moving

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8
Q

how would heat transfer occur more rapidly?

A

faster speed of movement between two materials (i.e. whirlpools vs immersion)

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9
Q

what is conversion?

A

converting a non-thermal form of energy into heat

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10
Q

does conversion require direct contact? if not, what does it require?

A

no
requires an intervening material to help transmit the certain type of energy (ultrasound gel or lotion)

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11
Q

regarding conversion, what does rate of transfer depend on?

A

the power of energy source not the temperature (US head does not need to be hot)

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12
Q

what form of energy is ultrasound?

A

mechanical form - can be “converted” to heat when sufficient intensity to a tissue absorbs the sound waves

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13
Q

what form of energy is diathermy?

A

electromagnetic form of energy - causes rotation of polar molecules, “converts” to heat when friction between the molecules increases tissue temp

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14
Q

what is specific heat?

A

amount of energy required to increase the temperature of a material by a “x” number of degrees (C)

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15
Q

tissues with high specific heat require ______ energy to heat and hold more energy compared to ______

A

more
materials with low specific heat

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16
Q

list the materials in order of heating up faster to heating up slower

A

air
bone
fat
average for human body
muscle
skin
water

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17
Q

what does a therapeutic use of cold do in rehab medicine?

A

control inflammation, pain and edema
reduce spasticity
control symptoms of MS
facilitate movement/ROM

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18
Q

what is abstraction?

A

removal of heat by means of conduction or evaporation

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19
Q

what ICF domain is cryotherapy categorized into?

A

basic structures and function

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20
Q

what are the hemodynamic effects of cryotherapy?

A
  • vasoconstriction (10-15 minutes) which decreases blood flow
  • most pronounced at area of direct skin contact
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21
Q

what is the cold induced vasodilation phenomenon?

A

following initial decrease in blood flow there is a later increase in blood flow, which cycles up and down
occurs when cold applied for > 15 minutes or when tissue temp reaches < 50 deg
** our goal is to vasoconstrict during the inflammatory healing phase

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22
Q

what are the neuromuscular effects of cryotherapy?

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A

neuro effects:
1. pain reduction
- decreased nerve conduction velocity –> sensory and motor nerves
2. increased pain threshold by stimulation of cold receptors
- block perception of painful stimuli

muscular effects:
1. decreased spasticity (effects lasting 1-1.5 hours)
2. increase muscle strength (facilitating muscle contraction)
– < 5 min ice massage isometric strength increases
– cryotherapy for 30 min initial decrease then increase in strength

23
Q

what are the metabolic effects of cryotherapy?

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A

reduces inflammatory activity
cold decreases the rate of all metabolic reactions:
- decreases rate of inflammation by decreasing the activity of cartilage degrading enzymes and level of histamines
- decreases inflammatory processes due to joint diseases such as OA and RA

24
Q

what does cryotherapy do during the acute inflammatory phase of healing?

Study These Flashcards
A

bleeding decreased (vasoconstriction)
edema decreased (vasoconstriction and decreased metabolic activity)
pain reduced (neuromuscular effects of pain reduction, secondary pain effects of edema)

25
what does cryotherapy do?
directly decreases the heat and edema associated with inflammation by decreasing blood flow when tissue temp remains normal the acute inflammation has probably resolved (48-72 hours)
26
what are two other ways cryotherapy benefits inflammation control?
acute chronic inflammatory diseases post exercise - reduce DOMS
27
what is edema?
presence of abnormal amounts of fluid in the extracellular tissue spaces of the body
28
what is the process of edema?
inflammation --> intravascular fluid pressure --> vascular permeability --> exudate into the interstitium
29
how does cryotherapy control acute edema?
reduce the release of histamines increase blood viscosity decrease blood flow
30
what is most effective to minimize edema?
apply ice ASAP combine with compression and elevation (RICE) drives extravascular fluid into venous and lymphatic drainage systems
31
what is a situation where cryotherapy would not be effective in minimizing edema?
controlling edema caused by immobility and poor circulation
32
what effects does applying cryotherapy for 10-15 minutes to control pain have?
neuro physiological effects -- gates pain transmission hemodynamic physiological effects -- vasoconstriction
33
what is cryokinetics?
apply ice ASAP post injury until numbness allows painfree exercise during period of numbness, 3-5 minutes, until sensation returns repeat 5x used frequently in athletics to minimize loss of playing time
34
what is cryostretch?
vapocoolant spray used as cooling agent followed up with stretch to decrease muscle spasm, increase ROM
35
what are contraindications of cryotherapy?
cold hypersensitivity cold intolerance cryoglobulinemia paroxysmal cold hemoglobinuria Raynaud's disease over a regenerating peripheral nerve over an area with circulatory compromise
36
what are precautions of cryotherapy?
over the superficial main branch of a nerve over an open wound hypertension patient with poor sensation or mentation very young or old patients
37
what does the use of heat in rehab medicine do?
control pain increase soft tissue extensibility and circulation accelerate healing
38
what are effects of thermotherapy?
accelerates tissue healing pain management alters collagen extensibility
39
what are hemodynamic effects of thermotherapy?
increased blood flow (vasodilation) increased capillary permeability superficial heating agents do not heat to the depth of most muscles to heat deep muscles, use exercise or deep heating modalities
40
what are neuro effects of thermotherapy?
1. increased nerve conduction velocity 2. change frequency of nerve firing rate -- decrease muscle spasm --> muscle relaxation -- decreased spindle activity --> decreased resistance to passive stretch 3. increased pain threshold -- cutaneous thermoreceptors stimulated and gate pain (feels change in temp instead of pain)
41
what are muscular effects of thermotherapy?
altered muscle endurance and strength -- decrease during initial 30 min following heat -- after 30 min, for next 2 hours strength gradually recovers to above pretreatment levels
42
what are metabolic effects of thermotherapy?
increases rate of cellular biochemical reactions (increased metabolic rate) increased oxygen uptake; accelerate healing increase metabolic rate of destructive processes (avoid with inflammation)
43
increasing ______ of soft tissue increases its ________
temperature extensibility
44
extensibility: plastic deformation: elastic deformation:
- amount of stretch/deformation that can occur - can be achieved - tissue maintains increased length during stretching - collagenous tissue stretched without prior heating can lead to elastic deformation
45
what are effects of heating soft tissue before stretching?
increase stretch decrease risk of tearing tissue achieves greater increase in length when stretching force is applied less force is required to achieve the increased length
46
why would you use superficial heat in the clinic?
pain control increase ROM, decrease joint stiffness accelerated healing - increasing circulation and enzyme activity infrared radiation for psoriasis or dermal ulcers superficial muscle relaxation
47
what stages of healing are best to use heat with?
proliferative or remodeling stage or when chronic inflammation is present ** DO NOT apply during acute inflammation phase
48
what occurs with superficial muscle relaxation?
change frequency of nerve firing results in decreased firing frequency of alpha motor neurons (decreased muscle spasm) good for LBP and spasms
49
what are contraindications of thermotherapy?
acute trauma acute musculoskeletal and inflammatory conditions recent or potential hemorrhage thrombophlebitis impaired sensation impaired cognition malignancy
50
what are precautions of thermotherapy?
pregnancy poor circulation or thermal regulation edema cardiac insufficiency areas with metal over an open wound areas where topical counterirritants have recently been applied demyelinated nerves
51
what are adverse effects of thermotherapy?
1. burns -- use hot packs vs electrical heating pads -- make sure pt doesn't fall asleep 2. fainting -- vasodilation can lead to decreased blood flow to brain -- orthostatic effects following thermotherapy treatment 3. bleeding 4. always give a patient a way to stop treatment
52
what is the down side to hot packs?
errors in application can lead to adverse outcomes --> burns
53
what are things to consider before using a hot pack?
no reimbursement consider indications, contraindications & precautions know patient medical history monitor application of heat at all times don't fall into habit of using hot pack as passive modality

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