List the modes of Heat transfer.
- Conduction
- Convection
- Conversion
- Evaporation
- Radiation
What is the concept of conduction? Give an example.
Gain or loss of heat from direct contact b/t two materials at different temperatures
Heat conducted from a material of higher temp to a material of lower temp
Heat transfers continues until both materials are equal
Ie.—ice pack/hot pack/ paraffin
True or false: heat transfers more quickly with materials with a high thermal conductivity (water, metal)
True
True or false: the greater the difference between a heating or cooling agent and the body part it is applied to, the faster the rate of het transfer
True
How many layers of towels should be placed between hotpack and patient’s skin
6-8+ layers to reduce the rate of heat conduction
True or false: Patients are allowed to keep jewelry on when using heating/cooling agent
False; Metal has high specific heat which means heat conducts to it quicker
What is meant by convection? Give an example.
Gain/loss of heat resulting from air or water moving in a constant motion across body
I.e. Whirlpools; fluidotherapy; blood circulating in body
Concept of convection.
New parts of the agent are constantly coming in contact w/ target area at initial temperature thus body gets heated quicker
More heat in the same period time than heat transfer by conduction
Which mode of heat transfer quicker convection or conduction
Convection (thus requires less amount of time)
True or false: the risk of thermal injury is increased when circulation is impaired
True: circulation moves heated blood out of area and cooler blood is replaced in area
Vasodilation that occurs in response to heat protects the tissues by reading the risk of burning
Explain conversion. Give an example
Heating that occurs when nothermal energy is absorbed into tissue and transformed into heat
I.e. US, diathermy
Concept of Conversion
Heat transfer from nonthermal source that vibrates molecules within tissue creating heat
True or false: heating by conversion is not affected by the temperature of the thermal agent (unlike convection/conduction) but rate of transfer depends on the power of energy source
True
How is the power of US and diathermy measure in?
Watts, which refers to the amount of energy in Joules/sec
True or false: Conversion agents don’t require direct contact but do require an intervening material (gel)
true
Describe evaporation.
material must absorb energy to evaporat and thus change from liquid to gas/vapor
I.e. Vapocoolant spray
Describe radiation. Give an example
Transfer of energy from one material to another without the need for direct contact or intervening medium
I.e. laser, UV
List the Physiological defects of general heat application that are increased.
- CO
- Metabolic rate
- Pulse rate
- RR
- Vasodilation
List the Physiological defects of general heat application that are decreased.
- BP
- Muscle activity (sedentary effect)
- Blood to internal organ
- Blood flow to resting muscle
- SV
List Contraindications for Superficial Thermotherapy.
- Acute/early subacute traumatic and inflammatory conditions
- Decreased circulation
- General contraindications
- Tendency toward hemorrhage or edema
- Very young and very old patients
Therapeutic effects of cryotherapy
- Decrease blood flow
- Decrease edema
- Decreased local temperature
- Decreased metabolic rate
- Decreased nerved conduction velocity
- Decreased tone
- Increased pain threshold
Contraindications for Cryotherapy
- Cold intolerance
- Cold urticaria
- Cryoglobulinemia
- Infection
- Over area of comprised circulation
- Over regenerating peripheral nerves
- Paroxysmal cold/hemoglobinuria
- PVD
- Raynauds
- Skin anesthesia
Indications for Cryotherapy
- Abnormal tone
- Acute or chronic pain
- Acute or subacute inflammation
- Bursitis
- Muscle spasm
- MS trauma
- Tendonitis
- Tenosynovitis
- Myofascial trigger points
List Physiological effects of general cold application that decrease
- Metabolic rate
- Pulse Rate
- RR
- Venous BP
List Physiological effects of general cold application that increase
- Blood flow to internal organs
- CO
- SV
- Arterial BP
Shivering occurs when core temperature drops
Which body structure exhibits greater temperature change with cold agents
Skin temperature falls rapidly
Then subcutaneous fat, followed by muscles
Describe hunting effect?
Vasodilation after >15 minutes of cryotherapy (which initially causes vasoconstriction) at temps <35F
What is temperature are packs maintained at in the refrigerated unit?
0-10F or 25 F (SB)
How long should cold packs/ice packs be applied?
10-20 minutes
If for inflammation; no loner than 20 minutes 1 hr apart
What is the physiological stages that will be felt by patient when performing ice massage
- Cold
- Burn
- Ache
- Analgesia
- Numbness
Which Cryotherapy modality can be used to stimulate or facilitate a desired motor response in patients with impaired motor control ?
Ice massage
Apply to muscle belly for 3-5 sec or stroke to enhance contraction
How long should ice massages be performed?
5-10 minutes or until analgesia occurs
Apply ice massage to area no larger than ____ x _____ inches in slow (___inches/sec) overlapping circles
4x6 inches; (2inches/sec)
Describe cryokinetics.
Applying ice for 20 minutes or until analgesia, exercising 3-5 mins or until sensation returns and then reapplying ice until analgesia is reached again
Repeated 5x
What is cryostretch?
Apply cooling agent prior to stretching
Usually used to reduce spasm
True or false: applying cold pack after hot pack is more effecting improving PROM
True
Big advantage of controlled cold compression?
More effective for controlling inflammation due to simultaneous cold and compression
Temperature ranges for ___ to ____ degrees for controlled cold compression
55-70 F degrees
Cold bath?
Immersion of distal extremities
Allows for circumferential contact
What degree should a cold bath be?
55-64 F degrees
50-59 F
Compression 5-75 mm Hg
How long should the extremities be immersed in cold bath?
15-20 minutes
What is cryo cuff?
Circulates cold water and combines compression
Consisted of nylon sleeve
The gallon container should be elevated how high to drain into the sleeve.
15-18 inches above
What cryotherapy modality is used for trigger points/tight muscles
Vapocoolant Spray
What temperature is vapocoolant spray?
32-79 F
How long should treatment last when using vapoocoolant
20 minutes
During contrasts bath, what temperature should the baths be?
Hot Bath: 100-111 F for 4 minutes transfer to cold for 1 minute
Cold Bath: 55-65 F degrees
End with warm water
How long should the treatment time be for contrast bath?
20-30 minutes
True or False: Superficial agents only heat the superficial muscles (only penetrates 2cm); Therefore to reach the deeper muscles use exercise or Diathermy/US
True
Hot packs should be emerged in what temperature water?
165-170 F
When does the hot pack reach peak heat?
Wishing 5 minutes
When is the patient at the greatest risk for burns?
Within the first 5 minutes
When should the therapist check the skin?
Within the first 5 minutes and periodically after especially if patient is lying on the hot pack
How long should the hot pack be applied?
20-30 minutes
What is the paraffin wax and mineral oil mixture ratio?
6:1 or 7:1
At what temperature does the paraffin/mineral oil melts and when are temperatures considered sterilizing?
Melts 118-130F *immerse
Sterilizing 175-180F
Where is paraffin primarily applied?
Wrist, hand, foot
Describe the dip-wrap method (for wrist and hand) is known as ?
Glove method
Dip 6-10 times
Then wrap in a plastic bag
how long should the paraffin remain in place
10-15 mins
Describe the dip immersion method
Dip and leave in paraffin for 20 minutes
Describe the paint application method for paraffin
Paint paraffin onto area with brush; repeat 6-10 x
Tepid/nonthermal temperature for hydrotherapy
79-92F (26-33.3C)
Temperature for exercise in water
Neutral water temperature for hydrotherapy
92-96F (33.3C-35.5C)
Temperature for open wounds
Thermal temperature for hydrotherapy
96-104F (35.5-40C)
Causes stress on CP and nervous system
Lower ranges increase tissue mobility
Treatment time for hydrotherapy
20 minutes
When is hydrotherapy indicated
Subacute to chronic MS conditions
What are contraindications for full-immersion in hydrotherapy.
- Unstable cardiac disorder
- Bowel incontinence
- Severe epilepsy
- Suicidal
- Potential for cross contamination
Cryotherapy or thermotherapy has an effect on spasticity?
Cryotherapy