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Phys agents > Cryotherapy > Flashcards

Cryotherapy Flashcards

1
Q

what is cryotherapy?

A

the therapeutic use of cold to control inflammation, reduce pain, reduce edema, reduce spasticity

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2
Q

what are some effects of cold?

A

hemodynamic effects
neuromuscular effects
metabolic effects

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3
Q

what are hemodynamic effects of cryotherapy?

A

initial decrease in blood flow-
vasoconstriction: contraction of smooth muscle in vessel walls
decreased production of vasodilator mediators: histamine and prostaglandin
increased sympathetic adrenergic activity: vasoconstriction near and distal to cold application
increase blood viscosity
decreased capillary permeability: decreased fluid in interstitial space

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4
Q

what is hunting response or rebound vasodilation

A

reduce cold induced injury if cold for a prolonged period. highly debatable and likely false minimal clinical significance

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5
Q

what are neuromuscular effects of cyrotherapy?

A

decreased nerve conduction velocity
physiologically, cooler temperatures result in delayed inactivation of sodium channels and subsequently prolong the time of depolarization
for myelinated fibers, conduction velocity is primarily determined by the time delay of depolarization that occurs at the nodes of Ranvier. Hence, prolonged depolarization times result in slowed conduction velocities for the nerve being studied
reduced pain and increased pain threshold
altered muscle strength
decreased spasticity
decreased metabolic rate
decreased rate of cellular oxidation

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6
Q

how are neuromuscular effects are greatest on myelinated fibers?

A

A-delta fibers nociceptive fibers
smallest effect on large unmyelinated fibers
effects directly depend on duration and degree of temperature changes
for motor and sensory conduction velocities, conduction velocity slows between 1.5-2.5 m/s for every 1º C drop in temperature

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7
Q

how does cryotherapy neuromuscular effects reduce pain and increase pain threshold?

A

counter irritation via the gate control theory
sensory nerve conduction slowing
cold depresses the excitability of free nerve endings and peripheral nerve fibers, thereby increasing the pain threshold
nociceptors are free nerve endings- cold decreases excitability so they dont get as excited as easily so it increases the pain threshold

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8
Q

how does cryotherapy immediately effect muscle strength?

A

there is an immediate increase in isometric strength (cooling for 5 mins or less)
motor nerve excitability and increase motivation

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9
Q

how does cryotherapy effect muscle strength after prolonged cooling?

A

there is a decrease in strength.
there is reduced blood flow to muscles, slowing of motor nerve conduction velocity (signals aren’t processed as quickly), increased muscle viscosity (not as smooth so takes longer), increase joint or muscle stiffness- decreased elasticity of collagen

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10
Q

how long may the effects of cryotherapy last on muscles after prolonged cooling?

A

up to an hour to regain strength to pre ice status

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11
Q

so why does it matter when we apply ice during a session?

A

we don’t want to apply ice before we test strength or do a reevaluation because we will grade them weaker than they are.

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12
Q

how does cryotherapy neuromuscular effects decrease spasticity?

A

there is a reduction in gamma motor neuron activity
decreased muscle spindle activity and golgi tendon organs
prolonged effects may last up to 30 minutes

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13
Q

how does cryotherapy neuromuscular effects decrease metabolic rate?

A

decreased collagenase, elastase, hyaluroindase, protease, and histamine with reduction in joint temperature

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14
Q

what are some clinical indications for cryotherapy?

A

control inflammation
control edema
pain control
modification of spasticity
cryokinetics/cryostretch
management of MS symptoms

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15
Q

how is cryotherapy used to control inflammation?

A

used to control acute inflammation because decreasing tissue temp slows the rate of chemical reactions. it decreases blood flow via vasoconstriction. it increase blood viscosity and decreases capillary permeability which reduces movement of fluid from capillaries to interstitial tissues

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16
Q

how is cryotherapy used to control edema?

A

its caused by increased capillary permeability into interstitial tissues and cryotherapy reduces histamine which is a vasoconstrictor

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17
Q

does cryotherapy stop new edema from forming and reduce present edema?

A

no it only stops new edema from forming we need compression, elevation, and active contraction to remove present edema

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18
Q

should we use heat or ice if edema is from immobility and or circulation?

A

heat

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19
Q

how is cryotherapy used to control pain?

A

the gate control theory: activation of cutaneous thermal receptors which gate nociception at spinal cord. effects may last up to one hour after a 15 min application

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20
Q

how is cryotherapy for 5 mins used to modify spasticity?

A

can decrease DTR/MSR

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21
Q

in what patients can cryotherapy modify spasticity?

A

those with an upper motor neuron lesion

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22
Q

how is cryotherapy for 15-30 mins used to modify spasticity?

A

can decrease resistance to stretch

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23
Q

what is cryokinetics?

A

application of a cooling agent to reduce pain and allow exercise and ROM ASAP

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24
Q

what is cryostretch?

A

apply cold to reduce muscle spasm, thus allowing greater increase in ROM with stretching

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25
Q

what is the procedure for cryokinetics?

A

apply cold 15-20 mins
patient exercises for 3-5 mins
re-apply cold for 15-20 mins
repeat whole process 3-5 times

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26
Q

what are some contraindications to cryotherapy?

A

cold hypersensitivity (cold induced urticaria)
cold intolerance
cryoglobulinemia
paroxysmal cold hemoglobulinuria
reynaud’s disease
regenerating peripheral nerves over area with impaired sensation
over an area with compromised circulation or peripheral vascular disease

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27
Q

what is cold hypersensitivity (cold induced urticaria)?

A

vascular skin reaction to cryotherapy, smooth elevated patches which are more red or pale than surrounding tissue, often very itchy, maybe local or widespread. essentially hives from cold therapy

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28
Q

what is cold intolerance?

A

severe pain numbness, and color changes in responses to cold (they just don’t like it)

29
Q

what is cryoglobulinemia?

A

an uncommon, aggravation of serum proteins in distal circulation when distal extremity is cooled. proteins can form gel which can impair circulation and result in ischemia

30
Q

who typically has cryoglobulinemia?

A

patients with: hep C, lupus, rheumatoid arthritis, sjorgens syndrome, and or lymphoma

31
Q

what is paroxysmal cold hemoglobulinuria?

A

hemoglobin from RBCs is released into urine in response to exposure to cold, most often seen in patients with autoimmune hemolytic anemia

32
Q

what is reynaud’s disease?

A

digital cyanosis most commonly in women. it is a contraindication because they have poor bloodflow

33
Q

why is it a contraindication to apply cryotherapy over an area with impaired sensation or regenerating peripheral nerves?

A

may delay nerve regeneration. need to check to make sure they can differentiate between hot and cold before applying if they cant apply proximally

34
Q

why is it a contraindication to apply cryotherapy over an area with compromised circulation or peripheral vascular disease?

A

area is white and cool vs warm and red

35
Q

what is the difference between a precaution and a contraindication?

A

contraindication if they have it you do not give that modality, precautions be careful incase in case they have adverse reaction

36
Q

what are some precautions to cryotherapy?

A

over main branch of a nerve
over an open wound
hypertension
poor sensation or mentation
very young or very old patients

37
Q

why is it a precaution to place ice over main branch of a nerve?

A

may cause conduction block (neuropraxia)

38
Q

why is hypertension a precaution to cryotherapy?

A

transient increases in systolic or diastolic BP, should carefully monitor

39
Q

why is a patient with poor sensation or mentation a precaution to cryotherapy?

A

they cant report an abnormal response

40
Q

why is a patient that is very young or very old a precaution to cryotherapy?

A

they may have limited sensation/mentation or blood flow

41
Q

what are some questions to ask patients before continuing with cryotherapy?

A

do you have any unusual responses to cold?
do you develop a rash when cold?
do you have severe pain, numbness, and color changes in your fingers when exposed to cold?
do you see blood in your urine after being cold?
do you have poor circulation?
do you have any nerve damage in this area?

42
Q

when do adverse effects occur of cryotherapy?

A

when cryotherapy is inappropriately applied

43
Q

what is the most common adverse effect to cryotherapy?

A

cold induced urticaria

44
Q

what is cold induced urticaria?

A

erythema of skin with wheal formation (wheal= raised, itchy area of skin that is sometimes an overt sign of allergy)

45
Q

what is the most severe adverse effect to cryotherapy?

A

tissue death from prolonged vasoconstriction and ischemia

46
Q

what else can occur as an adverse effect of cryotherapy?

A

nerve damage

47
Q

how do we avoid adverse effects of cryotherapy?

A

do not apply for longer than 45 minutes

48
Q

what should we tell the patients they should expect?

A

CBAN:
cold- cold sensation, which usually occurs within 3 minutes
burning- burning sensation, which usually occurs between 2-7 minutes
aching- aching sensation, which usually occurs between 2-7 minutes
numb- local numbness or analgesia which usually occurs between 5-12 minutes

49
Q

what are the applications of cryotherapy?

A

ice packs/cold packs
ice cups/ice massage
vapocoolant sprays
cold compression unit
cold immersion

50
Q

what are the parameters for cryotherapy?

A

pretty much for all acute 10-20 minutes

51
Q

what are cold packs?

A

filled with silica gel 0-10ºF
should be cooled minutes between uses and 2 hours or longer before initial use
quicker to apply over ice pack

52
Q

what are ice packs?

A

filled with crushed ice
more aggressive cooling because ice has higher specific heat absorbs a large amount of energy when melting
needs more insulation
less expensive to use

53
Q

what are some cold packs that can be used at home?

A

frozen peas
4:1 water alcohol mixture

54
Q

what are some advantages to cold packs/ice packs?

A

easy to use
inexpensive
low level of skill required
covers moderate to large area
can be applied to elevated limb

55
Q

what are some disadvantages to cold packs/ice packs?

A

must be removed from area to inspect skin
can be heavy and patient may not tolerate resting weight
may be difficult to contour along small areas

56
Q

what is the general procedure for cryotherapy?

A

determine which cryotherapy application is best
introduction
explain the procedure and why (relate to impairments)
expectations (CBAN, decrease in pain/inflammation/spasticity, possible adverse effects)
screen for contraindications
inspect area to be treated
have pt remove jewelry and clothing from area to be treated
check sensation (hot vs cold)

57
Q

what is the specific procedure for cold packs/ice packs?

A

wrap the cold pack or ice pack in a towel. if cold pack, can use pillowcase
position patient comfortably and elevate area if edema is present
apply cold pack to area to be treated, be sure to secure with wrap or bandage to make sire it is good contact
provide patient with call bell and timer
check skin after 5 minutes to ensure no adverse reaction
intervention

58
Q

what is an ice cup or ice massage?

A

frozen water in styrofoam or paper cup

59
Q

what are advantages of the ice cup/ice massage?

A

treatment area can be observed during application
good for small and or irregular areas
short duration
inexpensive
can apply yo elevated limb

60
Q

what are disadvantages of the ice cup/ice massage?

A

time consuming for large area
active participation of PT/PTA/AT/OT throughout application

61
Q

what is the specific procedures for an ice massage?

A

place towels around the treatment area to absorb any dripping water
continue ice massage for 5-10 minutes or until numb
check treatment area for any adverse reactions
intervention

62
Q

what is a cold compression machine?

A

pumps cold water (50-59ºF) and air into sleeve
compression is applied intermittently (5-75 mmHg)
commonly used to control edema and inflammation

63
Q

what is the specific procedures for cold compression?

A

cover limb with stocking or towel
wrap sleeve around area to be treated
elevate treatment are above the heart

64
Q

when is the cold whirlpool indicated?

A

in acute and subacute conditions in which you want to exercise during treatment

65
Q

what is the cold whirlpool?

A

it should be filled with cold water and ice (32-79ºF)- ice needs to be completely melted
this is the most intense application of the cryotherapy techniques- the body cant develop a thermal barrier on the skin bc of the convection effect of the whirlpool

66
Q

what patients do we need to be careful with in the cold whirlpool?

A

patients with edema because the body part is in dependent position which will increase edema (so make sure they do ankle pumps to counteract gravity)

67
Q

when should the cold whirlpool be cleaned?

A

cleaned and drained after each treatment to minimize the potential risks of spreading fungal, viral, or bacterial infections, especially in those with open lesions

68
Q

what is the specific procedure for the cold whirlpool?

A

turn on the turbine, adjust the aeration, agitation, and direction of the water being pumped
instruct patient to keep away from all parts of the turbine
pad edge of tank with toweling, warn patient that the water is cold, then place body part in water
check the pts response verbally and visually about every2 mins
remind patients to tell you if the area starts hurting or sensation is loss

69
Q

what is the SOAP documentation format?

A

area
type of cryotherapy
treatment duration
patient positioning
response
interventions/parameters

Phys agents (12 decks)

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