Superficial Cold and Heat Flashcards
(163 cards)
1
Q
Cryotherapy came from the word
A
Gk. Cryos=ice,cold + Therapy
2
Q
Use of ice or cold applications for
therapeutic purposes
A
Cryotherapy
3
Q
Effects of cold
A
HEMODYNAMIC EFFECTS
NEUROMUSCULAR EFFECTS
METABOLIC EFFECTS
4
Q
Hemodynamic Effects of Cold
A
- Initial Decrease in blood flow
- Later Increase in blood flow
5
Q
Direct decrease in blood flow via Hemodynamic effect of cold
A
dec in temp -> cutaneous thermoreceptor -> smooth muscle contraction -> vasoconstriction -> dec in blood flow
6
Q
Indirect decrease in blood flow via Hemodynamic effect of cold
A
- dec temp -> cutaneous thermoreceptor -> DRG -> inc sympathetic adrenergic activation -> vasoconstriction -> dec. bloodflow
- dec. temp -> dec vasodilator (histamine + prostaglandin) release -> vasoconstriction -> de. blood flow
- dec. temp -> inc in blood viscosity -> dec blood flow
7
Q
COLD-INDUCED
VASODILATION (CIVD) aka
A
HUNTING RESPONSE
8
Q
Neuromuscular effects of cold
A
- Decrease in Nerve Conduction
- Increase in Pain Threshold
- Altered Muscle Strength
- Decrease Spasticity
- Facilitation of Muscle Contraction
9
Q
Neuromuscular effects of cold
Decrease in Nerve Conduction (a delta vs c fibers)
A
↑ Effect = myelinated, small fibers (Aδ)
↓ Effect = unmyelinated & large fibers
10
Q
Neuromuscular effects of cold
Explain Increase in Pain Threshold
A
Gate Control Theory
Interruption of Pain-Spasm Cycle
Reduction of sensory nerve NCV
Reduction of Edema
11
Q
Neuromuscular effects of cold
Altered Muscle Strength
A
≤ 5 min = increased strength
> 5-30 min = decreased strength
12
Q
Neuromuscular effects of cold
dec Spasticity
A
↓ gamma motor activity (initial)
↓ afferent spindle & GTO activity (later)
13
Q
Neuromuscular effects of cold
Facilitation of Muscle Contraction
A
Quick application → facilitate alpha
motorneuron (for flaccid muscles)
14
Q
Metabolic effects of cold
A
Decreased Metabolic Rate
–Controls acute inflammation
–Inhibits activity of cartilage-degrading enzymes (collagenase, elastase, hyaluronidase & protease) for osteoarthritis (OA)
–Reduced level of histamine in the blood for
rheumatoid arthritis (RA)
15
Q
Methods of Heat Loss
A
✓ Conduction
✓ Convection
✓ Evaporation
✓ Radiation
✓ Respiration
16
Q
Uses of Cryotherapy / Indications
A
-Inflammation Control
–Reduce Delayed-Onset Muscle Soreness (DOMS) after exercise
-Edema Control
-Pain Control
-Modification of Spasticity
-Symptom management in Multiple Sclerosis
Facilitation
-Cryokinetics and Cryostretch
-Treatment of acute burns
-Treatment in conjunction with joint mobilization, deep friction massage, strenuous workouts, and rest, compression, and elevation
17
Q
Contraindications of Cryotherapy
A
Cold Hypersensitivity/Cold-induced Urticaria
Cold Intolerance
Cryoglobulinemia
Paroxysmal Cold Hemoglobinuria
Raynaud’s Disease / Raynaud’s Phenomenon
Over a regenerating peripheral nerve
Over an area with circulatory compromise or
peripheral vascular disorder (PVD)
18
Q
Precautions of Hydrotherapy
A
Over the superficial main branch of a nerve
Over an open wound
Hypertension
Poor Sensation or Mentation
Extreme Ages of Patients
19
Q
Adverse Effects of Cold
A
Tissue Death from Ischemia
Frostbite
20
Q
Application of cryotherapy produces
FOUR STAGES of sensation:
A
Cold
Burning
Aching
Numbness/
Analgesia
21
Q
PRICES
A
Protection
Rest
Ice
Compression
Elevation
Stabilization
22
Q
Cryotherapy Application techniques
A
- COLD PACKS / COLD-GEL PACKS
- ICE PACKS
- ICE MASSAGE
- CONTROLLED COLD COMPRESSION UNIT
- VAPOCOOLANT SPRAY
- QUICK ICING/BRIEF ICING
- CHEMICAL COLD PACKS
- ICE TOWELS
- COLD BATHS
- COLD WHIRLPOOL
23
Q
Filled with a gel (silica or saline
+ gelatin) covered with vinyl
Gel
A
COLD PACKS / COLD-GEL PACKS
24
Q
COLD PACKS / COLD-GEL PACKS
Filled with a gel (silica or saline
+ gelatin) covered with vinyl
Gel becomes semisolid at __ deg C
→ better conformity to body
Stored in a freezer at __ deg C (greater than or equal to ___ for initial use; at least ___
minutes for succeeding use)
A
Semisolid: 0-5 deg. C
Stored: -5 deg C
– Initial use: greater than or equal to 2 hours
– Succeeding use: at least 30 min.
25
Cold packs alternative
4:1 (water:rubbing alcohol) at home
26
Cold Packs Duration
10-20 minutes
27
Crushed ice in a plastic bag
ICE PACKS
28
More aggressive cooling
ICE PACKS
29
Ice Packs Duration
10-20 minutes
30
Advantages of Cold Packs
Easy to use
* Inexpensive materials
and equipments
* Brief use of clinician’s
time
* Low level of skill required
for application
* Covers moderate to large
areas
* Can be applied to
elevated limb
31
Disadvantages of Cold Packs
* Pack must be removed to
check the area
* Patient may not tolerate
the weight of the pack
* Pack may have
inadequate contact on
certain areas
* Longer duration
compared to ice massage
32
Ice Cups or Frozen Water Popsicles
ICE MASSAGE
33
Usually done over a small area before deep
pressure massage
ICE MASSAGE
34
Ice massage
Skin temperature will not drop below __ deg C
15
35
Ice Massage Advantage
* Treatment area can be
observed during
application
* For small, irregular areas
* Short duration
* Inexpensive
* Can be applied to an
elevated limb
36
Disadvantage of Ice Massage
* Time-consuming for
large areas
* Requires active
participation by the
clinician or patient
throughout the
application
37
Cooled water is circulated
through the sleeve which is
applied to the extremity which is
then inflated intermittently
CONTROLLED COLD COMPRESSION UNIT
38
Temperature of Controlled Cold Compression Unit
10 - 25°C
39
Controlled Cold Compression Unit is used for
inflammation and edema
post-operatively and in other
circumstances
40
Advantage of Controlled Cold Compression Unit
- Allows simultaneous application of cold and compression
- Temperature & compression force are easily and accurately controlled
-Can be applied in large joints
41
Disadvantages of Controlled Cold Compression Unit
- Treatment site can't be seen during treatment
- Expensive
- Usable only for extremities
- Cannot be used for trunk or digits
42
Types of Vapocoolant Spray
- Ethyl Chloride
- Fluorimethane
- Spray and Stretch, Instant Ice & Pain Ease
43
Vapocoolant that is no longer recommended
(flammable)
Ethyl Chloride
44
Fluorimethane is a combination of:
15% dichlorodifluoromethane
85% trichloromonofluoromethane
Non-flammable but has CFC (destroys ozone
layer)
45
Spray and Stretch, Instant Ice & Pain Ease
1,1,1,3,3-pentafluoropropane
1,1,1,2-tetrafluoroethane
46
Vapocoolant Spray Application
bottle is ___ and held at an
___ angle (__) approximately ___ cm from the skin at a rate of __
- upright
- acute
-30 deg
-30-45 cm
- 10cm/sec (4inches/sec)
47
Vapocoolant Spray Application
For trigger points
Unidirectional sweep along the muscle with trigger points then over the area of referred pain
48
Vapocoolant Spray Application
To increase ROM
The entire length of the muscle should be covered 2-3x at a rate of 10 cm/sec. If further treatment is required, the skin should be rewarmed first to avoid frosting
49
Vapocoolant Spray Advantage
Brief, localized,
superficial cooling before
stretching
50
Vapocoolant Spray Disadvantage
* Limited use
* Requires covering of the
patient’s eyes, nose and
mouth when treating
close to the face
51
Used primarily in patients with CNS disorder
QUICK ICING/BRIEF ICING
52
QUICK ICING/BRIEF ICING
Quick swipes with an ice cube over the belly of
the involved muscle performed __ times have a facilitatory effect which might occur
immediately or __ minutes after application
- 3-5 x
- 27-42 min
53
A-icing:
3 swipes; wipe water after every swipe
54
C-icing:
hold ice for 3-5 seconds; wipe water after
55
Consists of 2 chemical substances, one in a
small vinyl bag within a larger bag
Chemical Cold Packs
56
Convenient for emergency use
Chemical Cold Packs
57
Chemical Cold Packs
Should remain in tank at least __ hours before
the first use and at least __ minutes for
subsequent uses
24 hrs, 30 min.
58
Chemical Cold Packs
Stored in refrigeration tank with temp at ___
-12.2 to -9.4 deg C
59
Duration of Chemical Cold Packs
10 - 15 minutes
60
Terry cloth towel soaked in a bucket of crushed ice or slush mixture
Ice Towels
61
Frozen wet Towels
Ice Towels
62
towels must be changed after __
minutes
4-5 min
63
Duration of ice towels
10-15 min
64
Most practical if cooling of
the distal extremities is
desired
Cold Baths
65
Ensures circumferential
cooling of the extremities
Cold Baths
66
Cold Baths
Water temperature for
immersion varies from
13 deg C to 18 deg C
67
Lower temperature is used
in cryokinetics
Cold Bath
68
Indicated for conditions in which exercise of the injured part during cold treatment is desired
COLD WHIRLPOOL
69
Most intense application of cold
COLD WHIRLPOOL
70
Temperature of Cold Whirlpool
10-16 deg C
71
Duration of Cold Whirlpool
5 - 15 minutes
72
Cryotherapy Documentation
P: < Cryotherapy application technique > on < body area > in < position > x < duration > to < rationale >
73
Effects of Heat
Hemodynamic Effects
Neuromuscular Effects
Metabolic Effects
Altered Tissue Extensibility
74
Neuromuscular Effects of Heat
Inc Nerve Conduction Velocity
Inc Pain Threshold
Altered Muscle Strength
Dec Firing Rate
74
Neuromuscular Effects of Heat
Inc Nerve Conduction Velocity
↑ NCV by 2m/s for every 1deg C rise
↓ Conduction latency of nerves
75
Neuromuscular Effects of Heat
Inc Pain Threshold
Direct: Gating effect
Indirect: ↓ ischemia and muscle spasm
75
Neuromuscular Effects of Heat
Altered Muscle strength
Initial 30 min = decreased strength
> 30 min = strength normalizes
76
Neuromuscular Effects of Heat
Dec Firing Rate
↓ firing rate of type II muscle spindle
efferents & gamma efferents
↑ firing rate of type 1b (GTO)
77
Increased rate of endothermic chemical reactions (enzymatic activities)
39 deg C - 40 deg C
78
protein constituents of enzymes begin to denature, and enzymatic activity decreases
> 45 deg C
79
enzymatic activities cease
Beyond 50 deg C
80
enzymatic activities cease
Heat Metabolic Effects
81
Increase collagenase activity → destroy articular cartilage (RA)
Heat Metabolic Effects
82
Shift of O2-Hgb dissociation curve to the right
Makes O2 available for tissue repair (wound healing)
Heat Metabolic Effects
83
__ temp -> __ tissue extensibility
Increase
84
– change in organization of the collagen and viscoelasticity of the fibers
Soft tissue heating prior to stretching
85
Soft tissue heating Achieved when tissue heating is maintained at
40 deg C to 45 deg C for 5-10 min
86
Methods of Heat Gain:
✓ Conduction
✓ Convection
✓ Radiation
87
Superficial Heating Modalities
- Hot moist Pack
- Infrared Radiation
- Fluidotherapy
- Paraffin Wax Bath
88
HMP is usually made of
bentonite (hydrophilic silicate gel) covered with canvas
**Others (non-Bentonite) are made up of chemical heating pads
89
HMP Storage and Preparation
Storage: HMP tank / hydro collator unit at 70 deg C to 75 deg C
Initial Heat:2 hours
Reheat bet uses: 30 min
90
HMP Application
Wrap the hot pack in 6-8 layers of dry towels
🞂 Terry cloth (new): equivalent to 4 layers
🞂 Terry cloth (old): equivalent to 1-2 layers
Intensity: Mild comfortable moist warmth
Duration: 15 to 20 minutes
91
Paraffin wax to mineral oil ratio
6:1 or 7:1
**To reduce melting temperature from 54deg C to 45deg C-50 deg C
92
Low specific heat and thermal conductivity
PWB
93
Advantageous to irregularly contoured areas
PWB
94
PWB Storage
52 deg to 57 deg container
95
Methods of PWB
Dip and wrap – 6-10 dips
Dip immersion – 20 minutes
Paint/Brush method
96
PWB Intensity
Mild comfortable moist warmth
97
PWB Duration
20 to 30 minutes
98
Dry heating agent
Fluidotherapy
99
Heat Transfer Fluidotherapy
Convection
100
Fluidotherapy
Cabinet with finely ground cellulose particles made from __
corn cobs
101
HMP Advantage
Inexpensive
* Easy application
102
HMP Disadvantage
* Declining heating pattern
* Requires toweling
* Radial heat distribution
* No limb movement
allowed
103
PWB Advantage
Inexpensive
* Easy application
* Circumferential heating
104
PWB Disadvantage
* Declining heating pattern
* Requires toweling
* No limb movement
allowed
105
Fluidotherapy Advantage
* Constant heating pattern
* Circumferential heating
* Free limb movement
106
Fluidotherapy Disadvantage
Expensive
* Limited to extremities
* Bulky device
107
emit electromagnetic radiation with a
wavelength of 770 to 10^6 nm lying between the visible light and microwaves
IR Lamps
108
Laws in Applying Radiation
Lambert’s Cosine Law / Right Angle Law
🞂 Inverse Square Law
🞂 Law of Grotthuss Draper / Principle of Chemical
Activation
🞂 Arndt-Schultz Principles
🞂 Bunsen Roscoe Law of Reciprocity
109
Optimum radiation occurs when the source is
perpendicular to the center of the surface to be radiated.
LAMBERT’S COSINE LAW / RIGHT
ANGLE LAW
110
intensity of radiation is inversely proportional to the distance squared.
INVERSE SQUARE LAW
111
Use the head perpendicularly
LAMBERT’S COSINE LAW / RIGHT
ANGLE LAW
112
Appropriate distance of the machine for treatment
INVERSE SQUARE LAW
113
Waves must be absorbed to be beneficial (induce chemical processes)
LAW OF GROTHUS-DRAPER / DRAPER
LAW / PRINCIPLE OF CHEMICAL
ACTIVATION
114
Ensure proper absorption of radiation
LAW OF GROTHUS-DRAPER / DRAPER
LAW / PRINCIPLE OF CHEMICAL
ACTIVATION
115
Waves must be absorbed to be beneficial (induce
chemical processes).
LAW OF GROTHUS-DRAPER / DRAPER
LAW / PRINCIPLE OF CHEMICAL
ACTIVATION
116
There is an optimal amount of energy absorption
per unit time for beneficial results to be expected
ARNDT-SCHULTZ PRINCIPLE
117
Dosage determination (Intensity = warmth)
ARNDT-SCHULTZ PRINCIPLE
118
Intensity and duration of the dose of radiant energy
is inversely proportional.
BUNSEN-ROSCOE LAW OF
RECIPROCITY
119
Adjustment of parameters in treatment
BUNSEN-ROSCOE LAW OF
RECIPROCITY
120
Near IR Desc
Short /
Luminous
121
Near IR Wavelength
770-1,400 nm
122
Near IR Velocity
3x10^8 m/s
123
Near IR Absorption
Epidermis and
dermis
124
Near IR Penetration
1-3 mm
125
Near IR Rise in Temp
Vigorous
126
Near IR Perspiration
More
127
Mid/Far IR Desc
Long /
Non-luminous
128
Mid/Far IR Wavelength
1,400-3,000 nm
129
Mid/Far IR Velocity
3x10^8 m/s
130
Mid/Far IR Absorption
Stratum corneum
131
Mid/Far IR Penetration
0.1 mm
132
Mid/Far IR Rise in Temp
Small and gradual
133
Mid/Far IR perspiration
Less
134
IRC Wavelength
3,000-10^6
nm
135
MIRE
Monochromatic Infrared Energy
136
From a glowing source like tungsten or carbon
filament material
Luminous IRR
137
From a non-glowing source like
carborundum with metal
reflector
Non-luminous
IRR
138
IRR Absorption and angle of rays
Perpendicular
139
IRR L Distance
45-60 cm / 18-24” (24-36”)
140
IRR NL Distance
= 74-91 cm / 29-36” (30-42”)
141
IRR L PRe heat
may be used immediately (no warm-up)
OR do 5 minutes warm-up
142
IRR NL Pre heat
5-10 minutes warm-upI
143
IRR Intensity
Mild, Comfortable, Dry Warmth
144
IRR Duration
15-30 min
145
IRR Application
--If dry heat is uncomfortable → better to use a wet thin towel over the area that is being treated
--Periodically check for perspiration to avoid -spot burns
--Other areas, including hairs, may be covered with dry towel
--Cover eyes with cotton balls, gauze or goggles if the area to be treated is near or at the face
146
IRR Advantages
Does not require any contact
Area can be easily observed
Can be used to treat larger areas
147
Disadvantages of IRR
Need for localizer to prevent dispersion of the
radiation heat
Dry heat may be uncomfortable for some patients
Dehydration due to excessive perspiration
148
Indications for all Superficial Heating Mod
Subacute and Chronic Conditions
Pain
Muscle spasm
Stiff structures (tissue extensibility)
Accelerate tissue healing (circulation and enzymatic
activities)
149
Indications specific to IRR
Pressure sores
Adjunct to electrical stimulation, to
skin impedance
Psoriasis
150
Contraindications for all Superficial Heating Mod
Recent or potential hemorrhage
Thrombophlebitis
Malignant tumor
Metal in the area
151
Contraindications specific to IRR
Acute dermal conditions
Superficial metals in the area
Erythema ab igne
Over the eyes
Cardiac insufficiency
152
Precautions for all Superficial Heating Mod
Acute injury or inflammation
Pregnancy
Impaired circulation
Poor thermal regulation
Edema
Metal close to the target area
Over areas with recently applied topical counterirritants
Demyelinated nerves
Impaired sensation
Impaired mentation
153
Precautions Specific to IRR
🞂 Too much
perspiration
154
Adverse Effect of Heat
Burn Injuries
Blister formation
155
Heat Docu
156
Hydrotherapy
approach using
warm and cold
water
CONTRAST BATH
157
Contrast Bath Temp
Warm water: 38-
44degC (100-1110F)
Cold water: 10-18degC
(50-64degF)
158
Contrast Bath Technique
Hot (3-4 minutes) →
Cold (1 minute)
Repeat the cycle for
5-6 times → (25-30
minutes)
End with warm
water
159
Contrast Bath Advantage
More vigorous circulatory effect
Good contact for distal extremities
Provides pain control without aggravating the edema
Allows movement in water for better circulatory effects
160
Contrast Bath Disadvantage
Limb is independent position
Some cannot tolerate cold immersion
161
Contrast Bath Docu
Contrast Bath on in x
for warm x for cold x to
