Cryotherapy and Thermotherapy Flashcards by Wayne Ayerscreech

What temperature is a gel hot pack administered?

120-140ºF

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What is the temperature for ICE WATER IMMERSION?

30-40ºF

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What are the methods for Heat/Cold transfer?

Convection
Conduction
Evaporation
Radiation

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What is the process for GEL PACK

Put the pack into a pillowcase
Wet pillowcase (if needed)
Wrap tightly around the limb
Check after 10-15 minutes

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What temperature is the hydrocollator kept at?

160° to 167°F

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Explain/Describe cryokinetic and cryostretching.

These modalities involve the use of ice to facilitate either movement or ranges of motion.

The goal is to reduce pain in so that exercise/stretching intervention can be done.

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When using cryotherapy modalities what needs to be documented?

Area of the body being treated
Type of cooling agent used
Treatment duration
Patient Positioning
Response of the intervention

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What are biophysical agents used for?

Edema
Pain
Spasm

These modalities work on impairments

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For Ice Massage when do you stop the treatment?

60 seconds after numbness!

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What are the contraindications for cryotherapy usage?

Cold hypersensitivity (URTICARIA)
Cold intolerance
Cryoglobulinemia
Hemoglobinuria
Raynaud’s disease
Regenerating peripheral nerve
Area of circulatory compromise/ PAD

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You treated JACK last week with a cryotherapy modality, this week during his appointment he reports

“I went home last week after PT and had blood in my urine”

What did Jack experience?

Paroxysmal cold hemoglobinuria

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What temperature is paraffin kept at?

126-134°F

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How is cryotherapy thought to reduce pain?

By decreasing the activity level of A-Delta pain fibers and gating at the spinal cord level.

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At what temperature does cold-induced vasodilation occur?

50ºF

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What is the process for ICE WATER IMMERSION?

Take a baseline temperature
allow the tub to get to 30-40°F
As patient has the limb in the ice bath have them continuously move the limb around

*CHECK TEMPERATURE AFTER 10min.

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Where is CIVD most likely to occur?

In the distal extremities and at temperatures below 1ºC for longer than 15 minutes.

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What are the physiological effects of soft tissue on thermotherapy?

Increased collagen extensibility

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How long (typically) until acute inflammation resolves?

48-72 hours

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What is the neuromuscular physiological effect of thermotherapy?

Increased nerve conduction velocity
Increased pain threshold
Muscle relaxation
- decrease in alpha motor neuron activity
Decreased muscle strength (over 30 minutes of application)

What are the 4 different sensation stages in cold treatment?

Cold sensation
burning/tingling
deep ache
numbness

What is the rate of increase for nerve conduction velocity during THERMOtherapy

2m/s for every 1ºC (1.8ºF)

What are the physiological effects of cold?

As Temperature decreases:

Blood viscosity increases
Vasodilation decreases
Sympathetic adrenergic activation increases
Blood flow decreases
Decrease in enzyme activity and inflammation mediators
Decrease in nerve conduction velocity
- Decreases pain perception

What are adverse reactions to cold?

Frostbite
Permanent or temporary nerve damage
Unwanted vasodilation

Why would you not want to apply thermotherapy modalities to a patient with a blood clot?

This could result in an unlodging of the clot due to increased circulation rate and vasodilation resulting in THROMBOPHLEBITIS

What are the adverse effects of thermotherapy?

1. Burns 2. Bleeding 3. Fainting 4. Eye & Skin damage

What is the equation for Rate of Transfer?

A patient tells you that the last time they received cryotherapy their physical therapist told them they might suffer side effects associated with cryoglobulinemia, what does this mean?

This indicates that with the application of cold, serum proteins in the area begin to clump and create a gel consistency which impedes circulation. **Also, that they might have hepatitis (not relevant but hopefully helps you remember)**

What do we turn red after cold modality treatment?

This is due to decreases in oxyhemoglobin ability to disassociate

How is heat proposed to control pain?

1. An increase in blood flow-vasodilation 2. Counter-irritant-bombared thermoreceptors to close the gate to some nociceptors 3. Decrease sympathetic nervous system activity 4. General relaxation 5. Stimulate GTOs to cause muscle inhibition

A patient experiences elevated patches of skin and severe itching after a cryotherapy treatment, what is likely the cause?

The patient has a cold hypersensitivity (**COLD-INDUCED URTICARIA)**

What happens to blood pressure during thermotherapy?

Blood pressure drops

What are the metabolic physiological effects of thermotherapy?

1. Increased production of enzymes

When using a thermotherapy modality what needs to be documented?

* Area of the body treated * Type of heating agent used * Treatment parameters * Temperature or power of the agent * Number and type of insulation layers used * Distance of the agent from the patient * Patient position or activity * treatment duration * Response to Intervention

What is the process for sensation checking?

ALWAYS ASK FOR CONSENT 1. Show the patient the tool you will be using 2. On the hand and with the patient's eyes open define the sensations as you touch the tool on the skin of the patient 3. Move to area of treatment 4. Have patient close eyes and call out sensation felt 5. Repeat with Hot and Cold

What is the process for circulation testing?

1. Look at the natural coloration 2. Squeeze area near modality placement and observe 1. Skin color should return within 30 seconds

What temperature does collagen need to reach in order to break down scar tissue and allow stretching of collagen?

An increase in 4-5º

What temperature is utilized for **Hot Water Immersion?**

100-104ºF

What is the process for Spray and Stretch? (cold therapy)

1. Mark an "x" on trigger point for before and after temperature collection 2. Spray onto skin (three passes) 1. manually have the patient goto end range of motion 2. Spray from origin to insertion of the muscle. 3. stretch further 4. 3 passes 5. stretch and hold 6. Place hot pack on area

What are the hemodynamic effects of heat?

1. Vasodilation 2. Increased blood flow

What is the process for cryocuff?

1. Fill machine with ice 2. use appropriate sleeve 3. elevate area above heart 4. lift tank above to fill the sleeve

Which stage of healing would thermotherapy be appropriate?

Proliferation

What are the **CONTRAINDICATIONS** for thermotherapy?

* Recent or potential hemorrhage * Thrombophlebitis * Impaired sensation * Impaired mentation * Malignant tumor * IR irradiation of the eyes

What temperature is the fluid therapy thermotherapy kept at?

110-118°F

When control of muscle spasticity is the desired outcome, how long should cryo modalities be administered?

30 minutes

What are the indications for thermotherapy?

1. Edema control 2. Pain control 3. Joint stiffness or ROM loss 4. Muscle spasm 5. Promotion of healing (after initial inflammation)