BPA Unit 3: Therapeutic Heat Flashcards
What are different Thermal Modalities to increases tissue temperature within 1 to 3 cm depth?
- Moist heat pack
- Paraffin wax bath
- Fluidotherapy
- Warm whirlpool
- Microwavable gel pack
- Air-activated heat wraps
- Electric heating pads
What are different Thermal Modalities to increases tissue temperature within 1 to 5 cm depth?
- Continuous ultrasound
- Continuous shortwave diathermy
To meet therapeutic levels, what should the tissue temperature be elevated to?
- 104 and 113°F
Anything above this range has potential for tissue damage
What are the Metabolic Effects of Temperature Elevation?
- Increase Cell activity and metabolic rate (two-to-three-fold for each 50°F increase in temperature)
- Increase oxygen uptake by tissues
What are the Vascular Effects of Temperature Elevation?
An Axon Reflex
- This is when the skin stimulates cutaneous thermoreceptors and carries the afferent impulses to the spinal cord and vasoactive mediators are released
There is a release of chemical mediators
{Chemicals like Prostoglandins, histamine and Kallikrein}
- Prostoglandins and histamine cause vasodilation in small arteries and arterioles
- Kallikrein (from sweat glands) causes bradykinin that increases vascular permeability
Local Spinal Cord reflex
- The vasodilatory effects are not limited to the area being heated, ex. if the low back is being heated there can be an increase in skin blood flow that occurs in the distal extremities (usually safe with PVD)
What are the Neuromuscular Effects of Temperature Elevation?
This elevates pain threshold, changes muscle spindle firing rate, and alters nerve conduction velocity; These all decrease pain and this will also lead to decrease muscle spasm
What are the Connective Tissue Effects of Temperature Elevation?
- Increases elasticity
- Decreases viscosity
- Decreases joint stiffness
- Increases muscle flexbility
Physical Principles of Heat
What is Conduction?
A method of heat transfer where the kinetic motion of atoms and molecules of one subject is passed on to another object
Ex:
- Moist heat
- Paraffin wax
- Heating Pads
Physical Principles of Heat
What is Convection?
The bulk movement of moving molecules, either in liquid or gaseous form, such that heat is transferred from one place to another
Ex:
- Fluidotherapy
Physical Principles of Heat
What is Radiation?
The conversion of heat energy to
electromagnetic radiation
With the physical principles of heat, changes in surface tissue temperature from heating depend on what?
- the intensity of the heat applied
- the time of heat exposure
- the thermal medium (product of thermal conductivity, density, and specific heat) for surface heat
With the physical principles of heat, what will heat first in 6 - 8 min?
Skin and the subcutaneous tissues within 0.5 to 2 cm
With the physcial principles of heat, how long will it take to for heat to reach the muscle?
Muscle temp at depths of 1 to 2 cm will require a longer duration of exposure (15 - 30 min) to reach peak values (1°C at 2cm)
Where are Hot Packs stored and what is the application process?
- Moist heat packs are stored in a thermostatically controlled cabinet of water at a temperature between 158°F and 167°F
- 6-8 layers of towel for protection (prone or supine)
- Monitor the patient after 5 minutes
- Application: 15-20 min
What is something the pt should not do with Hot Packs?
Lie on them with their full body weight
Clinically, how can a Hot Pack help a patient?
- Reduce pain
- Reduce muscle spasm
- Help tissue extensibility
What are the advantages of using a Moist Hot Pack?
What are the Disadvantages of using a Moist Hot Pack?
Describe the application process for both Paraffin Techniques.
Dip and Wrap, (more practical)
- Wax temp: 113 - 129°F
- 8-10 layers of wax - making a glove or sock
- Extremity is placed in a plastic bag and wrapped with towel
- Application: 15 to 30 min
Dip and Reimmerse
- After the glove or sock has formed, reimmerse, and keep in there for the full duration
- Application: 10 to 20 min
After removal, the patient can do light grip exercises before discarding wax
Where do we normally apply Paraffin?
Paraffin is most commonly used for the distal extremities, including the fingers, hand, wrist, and perhaps elbow in the upper limb and the toes, foot, and ankle in the lower limb
What is Fluidotherapy? What is it beneficial for? What is the Temp and treatment time?
- Fluidotherapy system used air-fluidized solids as the heat transfer medium. Warm air is uniformly circulated through the bottom of a bed of finely divided cellulose particles in a container
- Better for distal joints, the patient places the body part through the entrance sleeve of the unit
- Temp: 102 - 118°F
- Tx time: 15 to 30 min
When deciding Heat vs Cold therapy, what factors should the PT consider?
- Stage of injury
- Area of body treated
- Medical status
- Patient preference, which may be determined by cold or heat hypersensitivity
- Decision to use thermal modalities as part of a home program
What are the Advantages and Disadvantages of Heat Therapy?
Advantages
- Decreased pain
- Increased tissue extensibility
- Decreased stiffness
Disadvantages
- May cause increase in swelling
What are the Advantages and Disadvantages of Cold Therapy?
Advantages
- May prevent further swelling
- Decreases pain
Disadvantages
- Increases stiffness
- Decreases tissue extensibility
What are Factor to consider for Therapeutic Heat Techniques?
- Deep heat is usually selected during the remodeling phase of an injury of a disease when tissue contractures persist or when heat is required deep into a joint
Factors to consider Home Application of Therapeutic Heat Modalities?
- Gel Packs, sand packs, and bead packs
- Home-use sizes units for paraffin wax baths and fluidotherapy
Instructions should be written down: Intervention time, method, frequency of application, and any special instructions and precautions to prevent inadvertent burns from excess heat
What are Heat Contraindications?
- Lack of intact thermal sensation
- Vascular insufficiency or vascular discease
- Recent hemorrhage or potential hemorrhage
- Known malignancy
- Acute inflammation
- Infected area
- Where liniments or heat rubs have recenetly been applied
- Situations deemed unreliable
What should be documented with heat therapy?
- The thermal modality used
- The method of application, including duration
- Body area treated
- Patient position for intervention
- Special precautions or application concerns
Which of the following patient reassessment procedures should not be performed following paraffin treatment?
A. ROM
B. MMT
C. MLT
D. Joint Play
B. MMT
Which of the followng modalities BEST provides thermo-stimulation and mechano-stimulation during treatment?
A. Paraffin Bath
B. Moist Hot Pack
C. Contrast bath
D. Fluidotherapy
D. Fluidotheapy
Which of the following effects of ehat on a peripheral nerve has been demonstrated by research studies?
A. Maintenance of normal conduction and blockage of skin receptor function
B. Selective decrease of sensory nerve conduction velocities withut affecting motor nerve conduction velocities
C. Increase Motor and Sensory Nerve Conduction Velocities
D. Decrease Motor and sensory nerve conduction velocities
C. Increase Motor and Sensory Nerve Conduction Velocities
The use of heat for treatment of post bicep muscles strain SHOULD NOT be performed during which of the following stages of healing?
A. Acute
B. Subacute
C. Chronic
D. Maturation
A. Acute
During the PT evaluation, the patient has decreased muscle length of munus (-) 10° of knee extension. Which of the following muscle groups SHOULD receive MHP treatment to address the decrease in muscle length?
A. Rectus Fem and Vastus Lateralis
B. Bicep Fem and Semitendinosus
C. Vastus Lateralis and Semimembranosus
D. Vastus Medialisand Semitendinosus
B. Bicep Fem and Semitendinosus
The patient presents with decreased ROM 3 weeks post right ankle sprain, which of the following physiological effects of heat is the MOST likely to improve ROM?
A. Increased metabolism
B. Increased cell permeability
C. Increased nerve conduction velocity
D. Increased tissue extensibility
D. Increased tissue extensibility
Which of the following temp. readings is the MOST appropriate when using Paraffin treatment?
A. 110°
B. 145°
C. 125°
D. 135°
C. 125°
