PT9111 - Lecture 18 (Modalities 2)

Question 1

Cryotherapy

Answer 1

Application of ice/cold water

Question 2

Thermotherapy

Answer 2

Application of superficial heating agents

Question 3

Name the 5 heat transference mechanisms

Answer 3

1. Conduction
2. Convection
3. Radiation
4. Evaporation
5. Conversion

Question 4

Conduction and modality examples

Answer 4

Heat transfer by direct collision of molecules through different temperatures
eg. hot packs, cold packs, paraffin bath, ice massage

Question 5

Thermal conductivity and example

Answer 5

Rate at which heat is transferred by conduction
eg. metal conducts greater than water which conducts greater than air

Question 6

What 4 factors increase rate of heat transfer

Answer 6

1. Increased area of contact
2. Increased thermal conductivity
3. Increased temperature Difference
4. Decreased tissue thickness

Question 7

What 4 factors decrease rate of heat transfer

Answer 7

1. Decreased area of contact
2. Decreased thermal conductivity
3. Decreased temp difference
4. Increased tissue thickness

Question 8

T or F: Skin, adipose tissue, and muscle have same rate of thermal conductivity

Answer 8

F

Question 9

Convection and example

Answer 9

Heat transfer by movement of air or water around/past body eg. whirlpool/sauna

Question 10

Evaporation and example

Answer 10

Transformation from liquid to gas state and heat is given off eg. sweating during ANS response

Question 11

Conversion and example

Answer 11

Heat transfer by converting from a non-thermal form of energy (chemical, electrical, mechanical) into thermal energy eg. ultrasound

Question 12

Name 3 responses as a result of cryotherapy

Answer 12

1. Haemodynamic
2. Neuromuscular
3. Metabolic

Question 13

Describe the haemodynamic response (cryotherapy)

Answer 13

1. Vasoconstriction resulting in reduced edema and hydrostatic pressure and O2 delivery (15-20 min)
   2.Hunting response -> cold-induced vasodilation (4-6 minutes) and is then followed again by vasoconstriction

Question 14

T or F: Redness at skin level is caused by vasodilation (cryotherapy)

Answer 14

F, due to oxyheamoglobin

Question 15

What happens to the metabolic rate during cryotherapy

Answer 15

Decreases and reduces inflammation by decreasing cytokines, macrophages and histamines

Question 16

What 2 neuromuscular responses occur because of cryotherapy

Answer 16

1. Decreased nerve conduction velocity
2. Increased pain threshold

Question 17

Name 3 reasons why cryotherapy is preferred for the first 24-48 hours after injury

Answer 17

1. Vasoconstriction prevents swelling
2. Reduce pain through decreased nerve conduction
3. Manages inflammation by reducing cellular metabolic rate

Question 18

Name 5 indications of cryotherapy

Answer 18

1. Inflammatory control
2. Pain control
3. Spasticity
4. MS
5. Facilitate neuromuscular activity

Question 19

Name 4 contraindications of cryotherapy and describe

Answer 19

1.Vasoplastic pathologies -> vessel spasms that affect blood supply causing redness(Raynaud’s Syndrome)
2. Cold-hypersensitivity/Intolerance -> Vascular reaction to cold causing pain, numbness or itchiness (Rheumatic diseases, trauma, familial links)
3. Damaged nerves could result in over regeneration of these nerves
4. Blood conditions (Cryoglobulinemia: build up of serum protein with cooling causing ischemia and gangrene in individuals with myeloma, lupus or rheumatoid arthritis; haemoglobulinemia: Release of haemoglobin into urine making it purple)

Question 20

What are 6 precautions of cryotherapy

Answer 20

1. Using it over a superficial main branch of nerve
2. Open wound
3. Hypertension
4. Poor sensation
5. Altered mental state
6. Too young or old

Question 21

Name 4 safety considerations of cryotherapy

Answer 21

1. Frostbite
2. Exercise
3. Superficial nerve injury
4. Sensation

Question 22

How long should you use cryotherapy and the rest in between

Answer 22

Usually 30 minutes with 1-2 hours off, but depends on depth of penetration

Question 23

Cryotherapy flowchart review

Answer 23

Question 24

Name 3 responses involved in thermotherapy

Answer 24

1. Haemodynamic
2. Neuromuscular
3. Metabolic

Question 25

Describe the haemodynamic response for thermotherpay

Answer 25

Causes vasodilation and increased blow flow which uses convection to protect area from local tissue damage, relaxes smooth muscle contractions by inhibiting sympathetic neuron firing, and increase local release of chemical mediators

Question 26

What are the 3 effects of thermotherapy on the neuromuscular response

Answer 26

1. Increases nerve conduction velocity but decreases muscle spindle firing rate while increasing tendon organ firing rate 2. Increases pain threshold (Gate control theory) 3. Decreases muscle strength by increasing firing rate of GTO vs decrease rate of muscle spindle

Question 27

Describe how thermotherapy increases metabolic response

Answer 27

It increases endothermic reactions, shifts oxygen-hemoglobin dissociation curve more right to increase oxygen availability (decreased O2-O2 affinity) for tissue repairs causing increased oxygen uptake for healing, and increases the destruction of collagenase

Question 28

How does thermotherapy alter tissue extensibility

Answer 28

Plastic changes occur by changing organization and viscoelasticity of collagen

Question 29

Name 6 indications of thermotherapy

Answer 29

1. Pain control 2. decreased joint stiffness 3. Accelerated Healing 4. Increased Tissue extensibility 5. Psoriasis 6. Dermal Ulcers

Question 30

Name 6 contraindications of thermotherapy

Answer 30

1. Impaired sensation 2. Acute injury/inflammation 3. Over area of hemorrhage 4. Areas of thrombophlebitis 5. Malignancy 6. Areas of infection

Question 31

Name 7 precautions of thermotherapy

Answer 31

1. Poor circulation 2. edema 3. Hypertension (lower BP puts too much demand on heart) 4. Metal = conduction 5. Altered mental state 6. Open wound 7. Topical counterirritants (metal ions = conduction)

Question 32

Describe the difference between using a hot pack vs sauna for pregnant women

Answer 32

Hot pack = will not likely affect fetus because wont raise core temperature Sauna = raises core temperature and could cause fetal malformations

Question 33

Name 4 adverse reactions of thermotherapy

Answer 33

1. Burns 2. Fainting 3. Bleeding 4. Skin/Eye dammage from irridation (eg. heat lamps)

Question 34

Overview of thermotherapy diagram

Answer 34

Question 35

Comparison of when to use cryo vs thermotherapy

Answer 35