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Passive Care > Cryotherapy > Flashcards

Cryotherapy Flashcards

1
Q

What are the mechanisms of heat transfer?

A

Conduction, Convection, Evaporation, Radiation and Conversion.

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2
Q

What is cryotherapy?

A

Application of cold for therapeutic purposes

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3
Q

What is cryokinetics?

A

Combination of cold and exercise

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4
Q

What is CIVD?

A

CIVD – Cold Induced VasoDilation
– AKA: Hunting response (Hunting-Lewis response)
– Described by Lewis in 1930s
– Increase in tissue temp during cold therapy
– Approx 15 min into tmt and then alternating
– Not above baseline level

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5
Q

What are the goals of cryotherapy?

A
  • Relieve or decrease pain
  • Decrease blood flow and metabolism
  • Protect injured tissue
  • Decrease muscle spasm
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6
Q

What are the contraindications for the use of Cryotherapy?

A
  • Impaired cold sensation
  • Cold-induced urticaria (cold allergy)
  • Raynaud’s disease (Raynaud’s Phenomenon)
  • Cryoglobulinemia
  • Paroxysmal cold hemoglobinuria
  • Open wounds
  • Peripheral vascular disease
  • Confused and unreliable patients
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7
Q

What is Cold Urticaria?

A 
Allergic reaction to cold exposure
• Anaphylactic reaction
– hives
– itching
• Can result in systemic reaction
– Difficulty breathing
– Loss of consciousness
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8
Q

What is Raynauds?

A

Response to cold
– Constriction of arteries and arterioles usually in a distal extremity
– Restricts blood flow and results in color changes
• Classic color change
– White, blue red
– More common in women

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9
Q

What is Cryoglobinemia?

A

• Abnormal clumping of plasma proteins stimulated by cold application
• Rare
• Leads to skin discoloration and dyspnea
• Associated with multiple myeloma,
Waldenström macroglobulinemia, chronic
liver disease, infections (hepatitis), and
coexistent connective-tissue diseases
(SLE, Sjögren syndrome)

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10
Q

What is Cold induced Hemoglobinuria?

A

• AKA: Paroxysmal cold hemoglobinuria
• Rare
• Cold temperature activates antibody to RBCs
causing lysis
• Excess hemoglobin is excreted in the urine
• Darkened urine and back pain
• Acute disease affects mostly young children
– Commonly following an acute viral or upper respiratory illness
• Chronic disease is seen in the elderly.
– Secondary causes are usually neoplastic or infectious

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11
Q

What risks do you need to consider before applying cryotherapy?

A 
• Impaired circulation
• Thoracic area in pts with coronary artery disease
• Hypertensive patients
• Cardiovascular and Cardiorespiratory disorders
(take BP before, during, and after)
• Superficial peripheral nerves
• Hemiplegic
• Very young and very old
• Obesity
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12
Q

What are the stages of sensation?

A

Cold, Burning, Aching pain, Numbness (CBAN)

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13
Q

What are the different types of cryotherapy techniques?

A 
• Ice Pack (direct application)
– Ice bag
– Gel pack
– Chemical cold pack (only for emergencies)
• Cold whirlpool
• Ice bath (slush bucket)
• Ice massage
• Controlled continuous cold unit with compression
• Vapocoolant Spray
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14
Q

Which is better: crushed ice or ice cubes?

A

Crushed Ice! Cubes with water are better than cubes alone.

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15
Q

How do you apply Ice bags?

A

• Application:
– Position patient comfortably
– Apply ice directly to skin of injured area
– Drape patient with towels to keep clothes dry
– Apply for 10-20 min

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16
Q

A single layer of a ____ towel improves conduction and prevents frostbite.

A

WET

17
Q

What is the treatment time for cold whirlpool?

A

15-20 minutes

18
Q

What are some advantages to using cold whirlpool?

A

–Surrounds entire joint

–Can perform active exercises while cooling tissue

19
Q

What are disadvantages to using cold whirlpool?

A
  • Part cannot be elevated

- Not ideal for acute situation

20
Q

Will a thermopane be present in a cold whirlpool?

A

No, Whirlpool constant circulation prevents warmer water layer around part
(thermopane)

21
Q

What is the application for Ice bath?

A 
• 1/2 ice, 1/2 water in bucket
• Tx time: 8-20 minutes
• Application
– position patient, seated or supine
– place treatment area in bucket
– monitor patient closely for
lightheadedness, nausea,
dizziness, syncope
22
Q

What is the application for Ice massage?

A

Application:
– Drape with towels to catch melted water
– Rub in small quick circles
– Treat small area
– 5-10 minutes or until numbness (10 min, max)

23
Q

When would you choose to use ice massage?

A
  • Superficial areas and bony prominence
  • Not in acute inflammation where compression is needed
  • Pre or post exercise pain relief
  • Desensitize trigger points
24
Q

How does vapocoolant spray create a cooling effect?

A

Through evaporation

25
Q

Indication for Vapocoolant sprays

A

Trigger points, Muscle spasms, Decrease ROM

26
Q

Precautions for Vapocoolant sprays

A

– Can cause frostbite
– Ethyl Chloride is extremely flammable
– Ethyl Chloride is a local anesthetic but if inhaled can become general
– It’s use is based on tradition rather than fact

27
Q

What are some contraindications for the use of Vapocoolant spray?

A 
– Allergy
– Open wounds
– Post/surgical
– Eyes
– All other cold contraindications plus any contraindications to passive stretch
28
Q

Cooling skin

A

– Rapid skin cooling initially
– Followed by a slower cooling rate
• Levels off a few degrees above ice bag/bath temperature

29
Q

Re-Warming skin

A

– Initial rapid rise in temperature, then slower
– Can remain cooler temp. for over 1 hr following 30 min
treatment, when inactive
– Faster re-warming with physical activity

30
Q

Cooling Deep tissue

A

– More slowly
• but continues to cool for several minutes after ice
is removed
– SubQ adipose makes big impact on depth
– Cooling in an ice bath will produce greater
reduction in interarticular temperature as
more surface area is exposed to the cold

31
Q

Re-warming deep tissue

A

– Can take up to 2.5 hours when at rest
– Should have a re-warming 2X that of the
cooling period
– Re-warming is much more rapid when patient
engages in activity

32
Q

Indications for cryotherapy

A

• Pain
– Headache, migraine, sprains, strains, mm
contusions, tendinitis, other ms pain, etc
• Spasm
• Acute injury
– Decreased metabolism, edema, pain, etc
• Chronic and inflammatory arthritis

33
Q

Describe the physiologic responses to pain regarding Cryotherapy

A

– Decreased nerve conduction velocity
– Bombard the CNS with cold signals
• counterirritation

34
Q

Describe the physiologic responses to spasm regarding Cryotherapy

A

– Affects mm spindle and golgi tendon organs
– Decreased efferent signals noted
– Decreased pain interrupts pain/spasm cycle

35
Q

Describe the physiologic responses to edema regarding Cryotherapy

A

– 1st reaction to cold is vasoconstriction of smooth muscle

– Therefore decreased blood flow and decreased edema

36
Q

Describe the physiologic responses to Metabolic rate regarding Cryotherapy

A

– Cold decreases metabolism
– Leads to decreased blood demand
– Longer survival of hypoxic tissue
– Less secondary injury

37
Q

Describe the physiologic responses to performance regarding Cryotherapy

A

– Vertical jumping is decreased
– Strength of contraction is decreased in some studies and unchanged in others
– Proprioception, balance, and agility –
evidence is mixed
– Good advice: re-warm tissue before returning
to sport participation or proprioception training

38
Q

What is Cryokinetics?

A

Active exercise during or immediately

following cryotherapy

39
Q

Describe how to perform cryokinetics

A 
– Apply cold (slush bucket, whirlpool, ice pack,
etc) until numb (15-20 min)
– ROM or stretching exercise for 3-5 minutes
– Re-numb tissue for 3-5 minutes
– Continue exercise
– Repeat up to 5 times
– Stop if painful
– Can perform sport specific activities

Passive Care (6 decks)

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