Thermal Agents - Cryotherapy Flashcards
Definitions
- Cryotherapy = ?
- Thermotherapy = ?
Cryotherapy
(a) Cryotherapy
- The therapeutic use of cold
(b) Thermotherapy
- The therapeutic use of heat
Definitions
- Superficial heating agents = ?
- Deep heating agents = ?
Cryotherapy
Superficial heating agents:
- Therapeutic use of heating agents typically used for pain control.
Deep heating agents:
- Energy conversion into heat as it passes through body tissues
Definitions
Amount of energy required to raise the temperature of a given weight of a material by a given number of degrees = ?
Cryotherapy
(e) Specific Heat
- Amount of energy required to raise the temperature of a given weight of a material by a given number of degrees
Effects of Cold
- Hemodynamic Effects = ?
- Metabolic Effects = ?
Cryotherapy
Effects of Cold:
(a) Hemodynamic Effects
Vasoconstriction
- Less than 15-20 minutes application
- Decreases release of vasodilator mediators
Cold-induced vasodilation (CIVD)
- Though to be due to sympathetic inhibition
- Hunting response: cyclic nature of extended cold
(b) Metabolic Effects
- Decreased metabolic rate
Effects of Cold
- Neuromuscular Effects = ?
- Altered muscle strength = ?
- Decreased spasticity = ?
Cryotherapy
(a) Neuromuscular Effects
Decreased nerve conduction velocity
- 5 min reverses in 15 minutes
- 20 minutes = 30+ minutes
Increased pain threshold
- Sensory input to block pain receptors (Gate Control Mechanism)
- Reduction of muscle spasm, nerve velocity, or edema
(b) Altered muscle strength
- Decreased motor nerve conduction velocity, muscle spindle sensitivity, and muscle strength when applied directly to the muscle.
- Increase after 5 minutes, decrease after 30 minutes
- Consider – strength testing compared to timing of ice
(c) Decreased spasticity
Four uses of Cryotherapy = ?
Cryotherapy
(a) Inflammation Control
- Pain, Microvessel bleeding, and DOMS
- 15 mins or less.
- Immediately after injury & during acute inflammatory phase.
(b) Edema Control:
- Extravasation and permeability
- Vasoconstriction vs vasodilation
- P.R.I.C.E.
- Acute Inflammation vs immobility, poor circulation
(c) Pain Control:
- Cutaneous thermoreceptors help block pain signals via gait control.
- Can help control pain spasm cycle.
(d) Muscle tone: Can reduce spasticity
- Needs to be applied for 30 mins for spasticity reduction
A technique that combines cryotherapy with exercise = ?
Cryotherapy
Cryokinetics:
(a) A technique that combines cryotherapy with exercise.
- Uses ice immersion, cold packs, or icemassage.
(b) Goal is to numb the injured part to the point of analgesia and then work toward achieving normal ROM through progressive active exercise.
(c) Exercises performed during periods of numbness should be pain-free and progressive in intensity,concentrating on both flexibility and strength.
Application of cooling agent prior to stretching = ?
Cryotherapy
Cryostretch:
- Application of cooling agent prior to stretching
- Reduce muscle spasm and allow for greater ROMwith stretching
- Cold pack after hot pack > hot pack alone
Contraindications of Cryotherapy = ?
Cryotherapy
Contraindications of Cryotherapy:
- Cold hypersensitivity (cold-induced urticaria)
- Cold intolerance
- Cryoglobulinemia - may be associated with multiple myeloma, systemic lupus erythematosus, rheumatoid arthritis, or other hyperglobulinemic states.
- Paroxysmal Cold Hemoglobinuria
- Raynaud’s disease or phenomenon
- Over-regenerating peripheral nerves
- Over an area with circulatory compromise or peripheral vascular disease
- Determine cause of edema
Precautions of cryotherapy = ?
Cryotherapy
Precautions of Cryotherapy:
- Over the superficial main branch of a nerve
- Over an open wound
- Hypertension
- Poor sensation or mentation
- Very young and very old patients
Adverse effects of cryotherapy = ?
Cryotherapy
Adverse Effects of Cryotherapy:
(a) Tissue death
- Most severe adverse effect
- Caused by prolonged vasoconstriction, ischemia, or thromboses in smaller vessels
(b) Temporary or permanent nerve damage
- Results in pain, numbness, tingling, hyperhidrosis, or nerve conduction abnormalities
- Limit cold application to under 15-20 minutes
Systematic Review of Cryotherapy = ?
Cryotherapy
Systematic Review of Cryotherapy
(a) Recovery Characteristics
- DOMS, RPE, Objective markers (blood splama markers and cyotkines)
Pooled data from 27 articles revealed:
DOMS:
- Cooling and especially cold water immersions, reduced the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery.
- This effect remained significant after 48 hrs and 96 hrs
RPE
- Studies favored cooling agents to control conditions after 24 hours of recovery
- No significant difference after 48 hours
There was no evidence, that cooling affects any objective recovery variable
- Cooling did not affect objective recovery variables such as lactate-levels, CK-levels or IL6-levels.
Cryotherapy Types - Cold Packs
- Temp = ?
Cryotherapy
Cold Packs
(-) Temp
- Cold packs should be between 0-5 deg. C / 32-41 deg. F
Cryotherapy Types - Cold Pack
- ? min. = normally
- ? min. = spasticity
Cryotherapy
Cold Pack - Duration:
- 20 minutes normally
- 30 minutes for spasticity
- Applied every 1-2 hours for inflammation and pain control
- Inspect skin after
- Red or dark pin
- Presence of wheals (welts) or a rash
Cryotherapy Types
Ice pack provides = ?, compared to cold pack
Cryotherapy
Ice Pack:
(-) Provides more aggressive cooling than cold packs at the same temperature.
- Ice has a higher specific heat than most gels
- Ice absorbs a large amount of energy when it melts
Ice/Cold Pack Time:
- Reduce swelling = ? min.
- Block pain = ? min.
- Cool Muscles = ? min.
- Decrease spasticity = ? min.
Cryotherapy
(-) Reduce swelling = 4-20 min
(-) Block pain = 4.5-15 min
(-) Cool Muscles = 15-30 min
(-) Decrease spasticity = 30-45 min.
Cold Packs and Ice Packs
- Advantages = ?
- Disadvantages = ?
Cryotherapy
Cold Packs & Ice Packs
(-) Advantages:
- Easy to use
- Inexpensive
- Short use of clinician’s time
- Low level of skill required forapplication
- Covers moderate to large areas
- Can be applied to an elevatedlimb
(-) Disadvantages:
- Pack must be removed tovisualize the treatment areaduring treatment
- Patient may not tolerate weightof pack
- Pack may not be able to maintaingood contract on small orcontoured areas
- Long duration of treatmentcompared to massage with icecup
Cryotherapy Types
Ice cups (Ice massage):
- Time = ?
- Skin Temp = ?
Cryotherapy
Ice cups (Ice massage):
(-) Time = 5-10 min.
(-) Temp = > 59 deg F
Notes:
- Will cool tissue faster than other cryotherapy
Ice cups (Ice massage)
- Advantages = ?
- Disadvantages = ?
Cryotherapy
Ice cups (Ice massage):
(a) Advantages:
- Treatment area can be observedwell during application
- Can be used for small andirregular areas
- Short duration treatment
- Inexpensive
- Can be applied to elevated limb
(b) Disadvantages:
- Too time-consuming for largeareas
- Requires active participation bythe clinician or patient throughoutapplication
- Messy
Cryotherapy Types
Controlled Cold Compression Units:
- Temp set between = ? deg. F
Cryotherapy
Controlled Cold Compression Units:
(-) Temperature of the water can be set between 50-77 deg. F (NPTE)
Gameready:
- Temp = ?
- Compression = ?
Cryotherapy
Gameready:
(-) Temperature= 40-60 deg F
(-) Compression
- None – Low : First 24-48 hours after surgery
- Medium – High : When comfortable after the first 48 hours
Patient Preference is key!
Cryo Cuff
- How does this work = ?
- Common for = ?
Cryotherapy
Cryo Cuff:
(-) Cold + Compression
(-) Should be elevated 15-28 in. above level of sleeve
(-) Provides mild cooling below intensity of other agents
(-) Common post-operative pain management
Controlled Cold Compression Units
- Advantages = ?
- Disadvantages = ?
Cryotherapy
Controlled Cold Compression Units:
(a) Advantages:
- Allows simultaneous applicationof cold & compression
- Temperature & compressionforce are easily and accuratelycontrolled
- Can be applied to larger joints
(b) Disadvantages
- Treatment site CANNOT be visualized during treatment
- Expensive
Vapocoolant Sprays
- Purpose = ?
Cryotherapy
Vapocoolant Sprays:
(-) Purpose is to provide a counterirritant stimulus to the cutaneous thermal afferents overlaying muscles to cause a reflex reduction in motor neuron activity and thus a reduction in resistance to stretch.
Vapocoolant Sprays
- Advantages = ?
- Disadvantages = ?
Cryotherapy
Vapocoolant Sprays:
(-) Advantages
- Brief duration of cooling
- Very localized area of application
(-) Disadvantages
- Limited to use for brief, localized,superficial application of coldbefore stretching
- Other means of applyingcryotherapy
Cold Whirlpools
- Indicated in = ?
- Time = ?
Cryotherapy
Cold Whirlpools:
(-) Indicated in acute & subacute conditions in which exercise of the injured part during cold treatment is desired.
(-) Choose temperature and time based on treatment
- 10-30 min.
Cleaned and disinfected after every treatment
Cold Bath
- Time = ?
- Temp = ?
Cryotherapy
Cold Bath:
(-) Time 15-20 min.
(-) Temperature: 55-64 deg.
Notes:
- Less time for colder temperatures
Cold Bath Temps
- Acute Inflammation of distal extremities = ?
- Exercise = ?
- Wound case, spasticity = ?
- Cardiopulmonary compromise, treatment of burns = ?
- Pain Management = ?
- Chronic RA/OA, increased ROM = ?
Cryotherapy
Water Temperatures:
- Acute Inflammation of distal extremities = 32-79
- Exercise = 79-92
- Wound case, spasticity = 92-96
- Cardiopulmonary compromise, treatment of burns = 96-98
- Pain Management = 99-104
- Chronic RA/OA, increased ROM = 104-110
Contrast Baths
Hot & Cold:
- Time(s) = ?
- Temp(s) = ?
Cryotherapy
Contrast Baths
(-) Hot bath = 104-106 deg F / x 3-4 minutes
(-) Cold bath = 50-60 deg F / x 1 minute
(-) Repeat hot & cold x 25-30 minutes
Notes: Other indications
- Arthritis of small joints
- MSK sprains/strains
- CPRS
- Limb desensitization
Application Process
- First, evaluate the patient and set the goals of treatment
- Then = ?
Cryotherapy
Application Process:
(a) Evaluate the patient and set the goals of treatment.
- What do you want to do?
- Why?
(b) Determine whether cryotherapy is the most appropriate intervention.
- What is your goal for cryotherapy?
Application Process
You’ve asked theappropriate questions, NO contraindications orprecautions, what next = ?
Cryotherapy
Application Process:
(-) You’ve askedappropriate questions on contraindications andprecautions and determined that cryotherapy is NOT contraindicatedfor this patient orcondition.
(-) NEXT =
- Inspect the areato be treated
- Look for open wounds andrashes
(-) Assess sensation
- Check thepatient’s chart for any recordof previous adverse responses to cold and for any diseases thatwouldpredispose the patient to an adverse response.
Application Process
Things to consider when selecting the appropriate cooling agent = ?
Cryotherapy
Application Process:
(a) Select the appropriate cooling agent
- Appropriate intensity of cold for desired outcomes
- Best fit for location and size of area being treated
- Contours to skin and able to make good contact
- Best application for duration and position
- Readily available and affordable
(b) Options
- Cold packs or ice packs
- Ice cups for ice massage
- Controlled cold compression units
- Vapocoolantsprays or brief icing
- Frozen towels
- Ice water immersion
- Cold whirlpool
- Contrast bath
(c) Considerations
- With agentsthat cool by conduction or convection, such as cold packs or a coldwhirlpool,good contactmust bemaintained between the agent and thepatient’s body at all timesto maximize the rate of cooling.
- Forbrief cooling, thebest choice is an agent that is quick to apply and remove.
- The patient can readily use icepacks, ice cups, and cold packsat home.
- Ice packs and ice massage are the least expensive means of providing cryotherapy
- Controlled cold compression units are the most expensive.
Application Process
- What should be included when we explain the procedure & reason for applying cryotherapy = ?
- STAGES of sensation in Cryotherapy = ?
Cryotherapy
Application Process:
(-) Explain the procedure and the reason for applying cryotherapy
- Describe the sensations the patientcan expect to feel.
- Educate on what sensations they need to notify you for (Too cold/not cold enough).
(-) STAGES of sensation in Cryotherapy
- COLD
- Burning/tingling
- Achey/Pain
- Numb
Application Process
After applying the appropriate cooling agent, what should we do = ?
Cryotherapy
Application Process:
(a) Apply the appropriate coolingagent.
- Place patient in idea position for comfort and agent application
- Provide bell or other safety device near patient
(b) Check on patient response frequently
Cryotherapy - Application Process
- Assess the outcome of the intervention = ?
- Documentation = ?
Cryotherapy
Application Process:
(a) Assess the outcome of the intervention.
- Reassess the patient
- Progress toward the set goals of treatment and for any adverseeffects of the intervention.
- Re-measurequantifiable subjective conditions andobjectivelimitatios, andreassess function and activity.
- Check skin for response to treatment
(a) Document
- Note patient set up, modality use, and response
