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Modalities Spring Midterm > Thermal Agents > Flashcards

Thermal Agents Flashcards

1
Q

What are thermal agents?

A

Thermal agents transfer energy to a patient to increase or decrease tissue temperate

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2
Q

What is cryotherapy?

A

Is the therapeutic application of cold (ice packs)

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3
Q

What is thermotherapy?

A

Is the therapeutic application of heat

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4
Q

What is ultrasound?

A
  • Has both thermal and non-thermal effects
  • Defined as sound with frequency greater then 20,000 cycles/second (too high to be heard by humans)
  • Ultrasound is a mechanical form of energy composed of alternating compression and rarefaction waves
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5
Q

What are the different modes of heat?

A
  • Conduction
  • Convection
  • Conversion
  • Radiation
  • Evaporation
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6
Q

What is conduction?

A

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

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7
Q

How does heat move? (Conduction direction)

A

Heat is conducted from the material at a higher temp to the material at a lower temp.
Ex) Hot packs- Exchange of energy (Heat is transferred) from hot pack to patient’s Skin
Ex) Cold Pack- Exchange of energy (Heat is transferred) from patient’s skin to cold pack

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8
Q

The greater the temperature difference between a heating or cooling agent and the body part it is applied to, the _____ the rate of heat transfer.

A
  • Faster
  • Ex: the hotter the hot pack, the more rapidly the temperature of the area of skin in contact with the hot pack will rise
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9
Q

Materials w/ high thermal conductivity transfer heat _____ than those with low thermal conductivity.

A

Faster

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10
Q

Materials with low thermal conductivity can be used as _____ to limit the rate of heat transfer.

A

Insulators

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11
Q

The larger the area of contact, the _____ the total heat transfer

A

Greater

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12
Q

To avoid burns the temperatures of conductive agents should not be what?

A

Significantly different from patient’s skin temperature

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13
Q

What do you wash burns with?

A

Room temperature water from faucet and not cold water.

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14
Q

How many layers of towels are recommended for a hot pack?

A

6-8 layers of towels are recommended

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15
Q

Metal has a high thermal conductivity, because of this what should you do before applying a hot pack?

A

Remove metal jewelry from areas of contact.

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16
Q

What is convection?

A

Direct contact between circulating medium (opposed to stationary) and another material of a different temperature… it has a vector

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17
Q

What is a vector?

A

Vector = Movement with direction

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18
Q

With convection, what rate does heat transfer occur?

A

Heat transfer occurs more rapidly based on faster speed of movement between two materials.
Ex) Whirlpools and fluidtherapy agents, Hyperice X (contrast)

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19
Q

Which cools this pt’s soft tissue faster?
A) Ice bucket with Whirlpool @ 40 deg
B) Ice bucket immersion @ 40 deg

A

A) due to the movement (Convection)

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20
Q

What is conversion?

A

Converting a non-thermal form of energy into heat
(Mechanical, electrical, or chemical energy)

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21
Q

Does conversion require direct contact?

A

Does not require direct contact

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22
Q

What kind of contact does conversion require?

A

Does require an intervening material to help transmit the certain type of energy (Ultrasound Gel or lotion)

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23
Q

What does the rate of heat transfer depend on for conversion?

A

Rate of transfer depends on the power of the energy source not the temperature.
(Ultrasound head does not need to be hot)

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24
Q

What are examples of conversion?

A

Ex) Ultrasound is a mechanical form of energy- can be “converted” to heat when a sufficient intensity to a tissue absorbs the sound waves.
Ex) Diathermy is an electromagnetic form of energy which causes the rotation of polar molecules, “Converts” to heat when friction between the molecules increases tissue temperature.

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25
Q

What is specific heat?

A

Amount of energy required to increase the temperature of a material by a “x” number of degrees (Celsius).

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26
Q

Materials/Tissues with high specific heat require _____ energy to heat and hold more energy compared to materials with low specific heat.

A
  • More
  • Example) Water has high specific heat compared to Air, it takes longer for it to heat up and cool down with change of season.
  • Example) Muscle has a higher specific heat than fat. People with more adipose tissue will feel thermotherapy (heat) in their fatty tissue before the muscles (which you are trying to warm) beneath.
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27
Q

Cryotherapy is the therapeutic use of cold in rehab medicine used to:

A
  • Control inflammation
  • Control Pain
  • Control edema
  • Reduce spasticity
  • Control symptoms of MS
  • Facilitate movement/ROM.
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28
Q

What is “Abstraction”?

A

The removal of heat by means of conduction or evaporation.

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29
Q

What Domain of the ICF are thermo and cryotherapy categorized into?

A

Body Function/ Structure

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30
Q

What are types of Cryotherapy/ Application Techniques?

A
  • Cold Pack
  • Ice Cups (Massage)
  • Controlled cold compression units
  • Vapocoolant sprays
  • Frozen wet towels
  • Ice water (Bucket)
  • Contrast baths (cold whirlpool)
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31
Q

What are the hemodynamic effects of Cryotherapy? (blood vessels)

A

Vasoconstriction

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32
Q

What are the neuromuscular effects
effects of Cryotherapy? (muscle movement)

A

Pain Reduction

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33
Q

What are the metabolic
effects of Cryotherapy? (chemical reactions)

A

Decrease inflammatory activity

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34
Q

In rehab, cryotherapy is used to control what?

A

Pain, edema, and inflammation; reduce spasticity; control symptoms of MS and to facilitate movement

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35
Q

Vasoconstriction (15-20 min), with cryotherapy, which decreases blood flow, is most pronounced where?

A

At area of direct skin contact.

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36
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 min, or when tissue temp reaches <50 deg.
  • Primarily in fingers and toes
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37
Q

Does Cold-Induced Vasodilation Phenomenon
effect your treatment time?

A

Yes

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38
Q

How do you reduce pain with cryotherapy?

A
  • You decreased nerve conduction velocity to BOTH sensory and motor nerves
    (Myelinated, nociceptive (pain) fibers - A-delta)
  • You increased the pain threshold by stimulation of cold receptors (block perception of painful stimuli)
39
Q

What kind of effect does cold have on the muscle?

A
  • It causes decreased spasticity (effects lasting 1-1.5 hours) (decrease in Gamma motoneuron activity)
  • It increases muscle strength (facilitating muscle contraction)
  • <5 min ice massage = isometric strength increases
  • Cryotherapy for 30 min = initial decrease in isometric strength; then increase in strength an hour later sustained for 3 hours.
40
Q

What kind of effect does cryotherapy have on metabolic activity?

A
  • Cold decreases the rate of all metabolic reactions
  • Decreases the rate of inflammation by decreasing the activity of cartilage degrading enzymes and the level of histamines.
  • Decreases inflammatory processes due to joint diseases such as OA and RA.
41
Q

What are therapeutic use of cryotherapy?

A
  • Control inflammation
  • Control Pain
  • Control edema
  • Reduce spasticity
  • Control symptoms of MS
  • Facilitate movement.
42
Q

Cryotherapy during the acute inflammatory phase of healing helps to what?

A
  • Control bleeding, edema, and pain due to inflammation
  • Bleeding decreased (Vasoconstriction)
  • Edema decreased (Vasoconstriction and decreased metabolic activity)
  • Pain Reduced (Neuromuscular effects of pain reduction and secondary pain effects of edema)
43
Q

Cryotherapy directly decreases the heat and edema associated with inflammation by what?

A

Decreasing the blood flow

44
Q

How does cryotherapy help acute chronic inflammatory diseases?

A
  • Acute on chronic flare ups.
  • Reduces inflammation/pain associated with OA and RA.
45
Q

How does cryotherapy help post exercise?

A
  • Reduces the severity of DOMS
  • Possible DOMS causes include inflammation of muscle and connective tissue damage.
  • Benefits seen in Cryotherapy following eccentric exercises and High-Intensity exercise
46
Q

What is edema?

A

Presence of abnormal amounts of fluid in the extracellular tissue spaces of the body

47
Q

Cryotherapy reduces the release of histamines. What are histamines?

A

Histamines increase capillary permeability

48
Q

To minimize edema what do you do?

A
  • Minimize edema: apply ice ASAP post-injury
  • Most effective: Combine with compression and elevation (RICE)… Drives extravascular fluid into venous and lymphatic drainage systems
49
Q

How does cryotherapy control edema?

A
  • Reduces the release of histamines
  • Increases blood viscosity
  • Decrease blood flow (Vasoconstriction)
50
Q

How do you control pain with cryotherapy for 1 hour?

A

Applying cryotherapy for 10-15 min can control pain for 1 or more hours after treatment.

51
Q

What is Cryokinetics?

A
  • Apply ice ASAP post-injury til numbness
  • Allows painfree exercise during period of numbness, 3-5 min, until sensation returns.
  • Flexibility and strength exs
  • Repeat approx 5 X
  • Used frequently in athletics to minimize loss of playing time.
52
Q

What is Cryostretch?

A
  • Vapocoolant spray used as cooling agent.
  • Followed-up with stretch to decrease muscle spasm, increase ROM.
53
Q

What are contraindications for cryotherapy?

A
  • Cold hypersensitivity
  • Cold intolerance
  • Cryoglobulinemia
  • Paroxysmal cold hemoglobinuria
  • Raynaud’s disease or phenomenon
  • Over a regenerating peripheral nerve
  • Over an area with circulatory compromise or PVD
54
Q

What are precautions with cryotherapy?

A
  • Over the superficial main branch of a nerve
  • Over an open wound
  • Inspect skin closely for wounds, cuts, or abrasions
  • Hypertension
    transient increases in BP
  • Patient with poor sensation or mentation
  • Very young or old patients
55
Q

Therapeutic use of heat in rehab medicine is used to:

A
  • Control Pain
  • Increase soft tissue extensibility and circulation
  • Accelerate healing
56
Q

Physical agents are primarily used to:

A
  • Reduces tissue inflammation
  • Accelerates tissue healing
  • Pain management
  • Inflammation, soft tissue or bony injury
  • Unpleasant sensory and emotional experience
  • Modulate transmission
  • Alterscollagenextensibility
  • Modifiesmuscle tone
57
Q

What are types of thermotherapy?

A
  • Hot Pack
  • Paraffin
  • Ultrasound (Conversion heating effects)
  • Diathermy (Conversion heating effects)
  • Fluidotherapy (No longer tested on NPTE)
  • Infrared lamps (No longer tested on NPTE)
  • Hydrotherapy (Whirlpool/Hubbard tank)
  • Contrast bath (Whirlpool)
  • Aquatic Therapy (warm water)
58
Q

What are the hemodynamic effects of Thermotherapy?

A

Vasodilation

59
Q

What are the neuromuscular effects of Thermotherapy?

A

“Pain gating”

60
Q

What are the metabolic effects of Thermotherapy?

A

Increased metabolic rate

61
Q

Does thermotherapy alter tissue extensibility?

A

Yes

62
Q

What tissue rises in temperature rapidly?

A

Subcutaneous tissues temperature rises less rapidly and exhibit less change (Greater depth = decrease in heat energy)

63
Q

What tissue shows the least temperature change?

A

Muscle and joint show least temperature change (if any) depending on size and structure. (Depth and specific heat)

64
Q

How should you heat deep muscles?

A

To heat deep muscles, use exercise or deep heating modalities such as US or diathermy.

65
Q

Does thermotherapy increase nerve conduction velocity in both motor and sensory nerves?

A

Yes

66
Q

How does thermotherapy change the frequency of nerve firing rate?

A
  • Relaxes muscles during stretch and spasm
  • Results in decreased firing rate muscle spindles
  • Decrease muscle spasm = muscle relaxation
  • Decreased spindle activity = decreased resistance to passive stretch
67
Q

How does thermotherapy increased the pain threshold (reduced pain)?

A
  • Cutaneous thermoreceptors stimulated and “gate” pain
  • Nociceptor signals become blocked by thermoreceptor signals
  • Body feels change in temperature instead of pain
68
Q

When does muscle strength and endurance decrease with thermotherapy?

A

Muscle strength and endurance decrease during the initial 30 min following heat agents.

69
Q

When does muscle strength gradually recover with thermotherapy?

A
  • Following the 30 min time period for the next 2 hours muscle strength gradually recovers to above pretreatment levels.
  • Patient demonstrates transient increase in strength for 2- hour time period.
70
Q

T/F: Heat is used for strengthening

A

False

71
Q

What kind of metabolic effects does thermotherapy have?

A
  • Increases rate of cellular biochemical reactions (increased metabolic rate)
  • Increased oxygen uptake; accelerate healing
  • More oxygen available for tissue repair (Chronic wound healing)
  • Increase metabolic rate of destructive processes
72
Q

Where should you avoid putting heat for patients with OA or RA?

A

Avoid in areas of inflammation or patients with acute on chronic inflammatory disease OA and RA.

73
Q

What is tissue extensibility?

A

Extensibility- the amount of stretch/deformation that can occur

74
Q

What is plastic deformation?

A

Plastic deformation can be achieved- tissue maintains increased length during stretching.

75
Q

What leads to plastic deformation?

A

Collagenous tissue stretched without prior heating leads to elastic deformation of tissue.

76
Q

What happens when soft tissue is heated before stretching?

A
  • Increase stretch
  • Achieves a greater increase in length when the stretching force is applied
  • Less force is required to achieve the increased length
  • Decrease risk of tearing tissue
77
Q

What are the clinical uses of superficial heat?

A
  • Pain control
  • Increase ROM, decrease joint stiffness
  • Accelerated healing
  • Increasing circulation and enzyme activity
  • Infrared radiation for psoriasis or dermal ulcers
  • Integumentary (not covered in this course)
  • Superficial muscle relaxation
78
Q

What thermoreceptor gates pain?

A
  • Cutaneous thermoreceptors “gate” pain
  • Nociceptor signals become blocked by thermoreceptor signals
  • Body feels change in temperature instead of pain
79
Q

What amount of time of continuous low level heat helps with DOMS?

A

8 Hours of continuous, low-level heat has been shown to decrease pain associated with DOMS and back pain

80
Q

Why does heat increase ROM?

A
  • Due to increased soft tissue extensibility that occurs with increased tissue temperature.
  • Heat therapy enables greater increases in soft tissue length, while decreases the likelihood of injury when a passive stretch is applied.
  • Maximum increase in length with low risk of injury 5 to 10 min of low-load prolonged stretch while heating.
81
Q

Why does heat decrease joint stiffness?

A
  • Increasing tissue temperature by placing the hands in a warm water bath or warm paraffin or heating the surface with an infrared (IR) lamp has been shown to decrease finger joint stiffness.
  • Due to increased extensibility and viscoelasticity of joint capsule and surrounding ligaments
82
Q

Why does heat accelerate tissue healing?

A
  • Increasing circulation and the enzymatic activity rate
    Accelerates the delivery of blood to the tissues, brings in oxygen and other nutrients, and removes waste products.
  • Increasing the temperature of the blood also increases the dissociation of oxygen from hemoglobin, making more oxygen available for the processes of tissue repair
83
Q

When is the best treatment time to use heat for healing?

A

Best treatment time is during the proliferative or remodeling stage of healing or when chronic inflammation is present

84
Q

During what stage of healing do you not apply heat?

A
  • Do not apply during acute inflammatory phase
  • Heat can prolong this phase due to increase in edema and delay healing.
85
Q

How does heat help with superficial muscle relaxation?

A
  • Changes the frequency of the nerve firing
  • Decreases spindle afferent activity
  • Results in decreased firing frequency of alpha motor neurons
  • Decrease muscle spasm = muscle relaxation
  • Good for LBP and spasms
86
Q

What are contraindications to heat?

A
  • Acute trauma
  • Acute musculoskeletal and inflammatory conditions
  • Recent or potential hemorrhage
  • Thrombophlebitis (DVT)
  • Impaired sensation
  • Impaired cognition (very young or very old patients)
  • Malignancy (tumors) (acute stage – more later)
87
Q

What questions can you ask your patient before applying heat for contraindications?

A
  • “When did this injury occur?”
  • “Did you have any bruising or bleeding?”
  • “Do you have a blood clot in this area?”
  • “Do you have normal feeling in this area?”
  • “Are you under the care of a physician for any major medical problem? If so, what is the problem?”
  • “Have you experienced any recent unexplained weight loss or gain?”
  • “Do you have constant pain that does not change?”
  • “Do you know if you have a tumor in this area?”
  • Note: If the patient has experienced recent unexplained changes in body weight or has constant pain that does not change, defer thermotherapy until a physician has performed a follow-up evaluation to rule out malignancy.
88
Q

What are precautions for heat?

A
  • Pregnancy…No research done. Avoid abdomen and low back.
  • Poor circulation or thermal regulation
  • Very young, very old
  • Edema
  • Cardiac insufficiency
  • Areas with metal: jewelry, staples
  • Over an open wound
  • Areas where topical counterirritants have recently been applied: capsaicin.
  • Demyelinated nerves
89
Q

What questions can you ask your patient before applying heat for precutions?

A
  • “When did this injury occur?”
  • “Do you have any problems with your heart?
  • “Are you pregnant”
  • “Do you have any metal inside of you in this area, such as staples or bullet fragments?”
  • “Can you remove your jewelry in the area to be heated?”
  • “Have you applied any cream or ointment to this area today? If so, what type?”
  • “Do you have carpal tunnel syndrome or ulnar nerve entrapment?”
90
Q

What should you know about burns when it comes to heat?

A
  • Excessive heat can cause cell death (Burns)
  • Superficial heating agents whose temperature decreases with application= Safer.
  • Versus heating agents whose temperature output remains same.
  • Ex) Hot packs vs. electrical heating pad
  • Make sure patient does not fall asleep during treatment.
91
Q

What should you know about fainting when it comes to heat?

A
  • Vasodilation in other parts of the body lead to decrease blood flow to brain
  • Orthostatic effects following thermotherapy treatment
  • Have patients head elevated during treatment and wait a few minutes following treatment before rising.
92
Q

What should you know about bleeding when it comes to heat?

A
  • May aggravate bleeding in areas of acute trauma or hemophilia
  • Re-open recent lesion
93
Q

T/F: You should always give a patient a way to stop treatment.

A

True. Have the stop button or a bell to alert someone.

94
Q

T/F: Insurance no longer views this as skilled treatment.

A

True. Reimbursement for hot pack/cold pack is limited

Modalities Spring Midterm (6 decks)

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