Cryotherapy Flashcards
what are the uses of cryotherapy?
Control inflammation
Reduce pain
Reduce edema
Reduce spasticity
what is the hemodynamic effect of cold?
initial decrease in blood flow
what is involved in the initial decrease in blood flow after cold is applied?
- Vasoconstriction → contraction of smooth muscle in vessel walls
- Decreased production of vasodilator mediators → Histamines & Prostaglandin
- Increased sympathetic adrenergic activity
- Vasoconstriction near & distal to cold application
- Increase blood viscosity
what is involved in decreased capillary permeability after cold is applied?
Decreased fluid in interstitial space → can reduce any new edema
what is rebound vasodilation (Hunting Response)?
- Reduce cold induced injury if cold for prolonged period (injure tissues)
- Highly debated prob false
what does applying cryotherapy do nerve conduction ?
decreases it so when the area becomes numb & conduction can’t be brought to spinal cord
what effect do cooler temps have on sodium channels?
delayed inactivation of sodium channels & subsequently prolong the time of depolarization
what neurovascular within the body experience the greatest effect from applying cryotherapy?
Greatest effect on myelinated small fibers
A-Delta nociceptive fibers
what does cold have the smallest effect on within the body?
Smallest effect on large unmyelinated fibers
how does applying cryotherapy reduce pain & increase pain threshold?
- Counter irritation via control theory (stopping nerve conduction)
- Sensory nerve conduction slowing
- Cold depresses the excitability of free nerve endings & peripheral nerve fibers → increasing the pain threshold
what occurs to muscle strength after cooling for a short period?
- Immediate increase in isometric strength (cooling for 5 min or less)
- Motor nerve excitability
- Increased motivation
why is there a decrease in strength after prolong cooling?
- Reduced blood flow to muscles
- Slowing of motor nerve conduction velocity
- Increased muscle viscosity
- Increased joint or muscle stiffness
why is there decreased spasticity after applying cryotherapy?
Reduction in Gamma Motor Neuron Activity
Decreased muscle spindles activity & golgi tendon organs
Prolonged effects may last up to 30 min
how does cryotherapy decrease metabolic rate?
- Decreased collagenase, elastase, hyaluronidase, protease & histamine w/ reduction in joint temp
- Decreased rate of cellular oxidation (reduce inflammation)
how does cryotherapy control acute inflammation?
- Decrease tissue temp slows rate of chemical reaction
- Decrease blood flow via vasoconstriction
- Increase blood viscosity
- Decrease capillary permeability
Reduces movement of fluid form capillary to interstitial tissues
how does cryotherapy control edema?
Reduces histamine (which is a vasodilator) this causes vasoconstriction
what is the gate control theory?
Activation of cutaneous thermal receptors which gate keep nociception at spinal cord
how can the application of cold affect patients with motor neuron lesions?
- Application of cold for 5 minutes can decrease DTR/MSR
- Application of cold for 15-30 min can decrease resistance to stretch making it easier to participate in functional activities
what is cryokinetics?
Application of a cooling agent to reduce pain & allow exercise & ROM ASAP
what is cryostretch?
Apply cold to reduce muscle spasm, allowing greater increase in ROM w/ stretching
what are the contradictions to cryotherapy?
Cold Hypersensitive (Cold induced ulcers)
Cold Intolerance
Cryoglobulinemia
Paroxysmal Cold Hemoglobinuria
Reynaurd’s Disease/ Phenomena
Regenerating Peripheral Nerver
Area w/ impaired sensation
Area w/ compromised circulation or Peripheral Vascular Disease
why is one with cold hypersensitive be a contradiction?
Vascular skin reaction to cryotherapy
Smooth elevated patches which are more red or pale than surrounding tissue
Often very itchy
May be local or widespread
what is cryoglobulinemia?
- Aggravation or serum proteins in distal circulation when distal extremity is cooled
- Proteins can form gel which can impair circulation & result in ischemia
why is paroxysmal cold hemoglobinuria a contradiction to cold?
- Hemoglobin from RBS is released into urine in response to exposure ti cold
- Often seen in patients w/ Autoimmune Hemolytic Anemia
why is it dangerous to apply cryotherapy to someone w/ Regenerating peripheral nerves or over area w/ impaired sensation?
May delay nerve regeneration
Can not tell you if they are getting too cold
what is a precaution to cryotherapy?
Over main branch of nerve
Over an open wound
Hypertension
Poor sensation or mentation
Very young or very old patients
what are some adverse effects of cryotherapy?
- Cold Induced Urticaria
- Tissue death
- Nerve damage
what should a patient expect during cryotherapy?
Cold → cold sensation (occurs withing 3 min)
Burning → burning sensation (occurs b/w 2-7 min)
Aching → Aching sensation (occurs b/w 2-7 min)
Numb → Local Numbness or analgesia (occurs b/w 5-12 min)
what are the parameters for cryotherapy?
10-20 min
what are the advantages to ice pack/cold pack?
Easy to use
Inexpensive
Low Level of skill required
Covers moderate to large area
Can be applied to elevated limb
what are the disadvantage to ice pack/cold pack?
Must be removed from area to inspect skin
Can be heavy & pt may not tolerate resting weight
May be difficult to contour along small areas
what are the advantages to ice cup/ ice massage?
Treatment area can be observed during application
Good for small & or irregular areas
Short duration
Inexpensive
Can apply to elevated limb
what are the disadvantages to ice cups/ ice massage?
Time consuming for large area
Active participation required (time consuming)
what is a cold compression unit commonly used for?
control edema & inflammation
when is cold immersion indicated?
acute & subacute conditions when you want to exercise during treatment
what is the general procedure for cryotherapy?
Determine which cryotherapy to use
Intro
Explain procedure & reason (relate to function)
Expectations:
CBAN
Decrease in pain/inflammation/spasticity
Possible adverse reactions
Screen for contraindications
Much will come from records
May have to do sensation testing
Inspect area to be treated
Have pt remove jewelry & clothes from area
Check sensation (hot/cold)
what is the procedure for cold pack/ Ice pack?
Wrap cold pack or ice pack in a towel (can use pillowcase over cold pack)
Position patient comfortably & elevate area if edema is present
Apply cold pack to area to be treated → be sure to secure w/ wrap or bandage to make sure it is in good contact
Provide pt w/ call bell & timer
Check skin after 5 min to ensure no adverse event
If apply for 30 min, check every 10 min after initial 5 min check
Check again at end to note any adverse reactions
Interventions
what is the procedure for ice massage?
Place towel around treatment area to absorb any dripping water
Continue ice massage for 5-10 min or until numb
Check treatment area for any adverse reactions
Intervention
what is the procedure for cold compression?
Cover limb w/ stocking or towel
Wrap sleeve around an area to be treated
Elevate treatment area above heart
what is the procedure for cold whirlpool?
- Turn on turbine, adjust aeration, agitation & direction of the water being pumped
- Instruct pt to keep away from all parts
- Pad edge of tank w/ toweling, warn patient that water is cold, then put body part in water
- Check patient’s response verbally & visually about every 2 min. Remind them to tell you if area starts hurting or if sensation is lost
what is the documentation for cryotherapy?
Area
Type of cryotherapy
Treatment duration
Patient positioning
Response
Intervention / parameters
