Cryotherapy and Thermotherapy Flashcards
What temperature is a gel hot pack administered?
120-140ºF
What is the temperature for ICE WATER IMMERSION?
30-40ºF
What are the methods for Heat/Cold transfer?
- Convection
- Conduction
- Evaporation
- Radiation
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
What temperature is the hydrocollator kept at?
160° to 167°F
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.
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
What are biophysical agents used for?
- Edema
- Pain
- Spasm
These modalities work on impairments
For Ice Massage when do you stop the treatment?
60 seconds after numbness!
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
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
What temperature is paraffin kept at?
126-134°F
How is cryotherapy thought to reduce pain?
By decreasing the activity level of A-Delta pain fibers and gating at the spinal cord level.
At what temperature does cold-induced vasodilation occur?
50ºF
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.
Where is CIVD most likely to occur?
In the distal extremities and at temperatures below 1ºC for longer than 15 minutes.
What are the physiological effects of soft tissue on thermotherapy?
Increased collagen extensibility
How long (typically) until acute inflammation resolves?
48-72 hours
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?
- Burns
- Bleeding
- Fainting
- 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?
- An increase in blood flow-vasodilation
- Counter-irritant-bombared thermoreceptors to close the gate to some nociceptors
- Decrease sympathetic nervous system activity
- General relaxation
- 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?
- 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
- Show the patient the tool you will be using
- On the hand and with the patient’s eyes open define the sensations as you touch the tool on the skin of the patient
- Move to area of treatment
- Have patient close eyes and call out sensation felt
- Repeat with Hot and Cold
What is the process for circulation testing?
- Look at the natural coloration
- Squeeze area near modality placement and observe
- 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)
- Mark an “x” on trigger point for before and after temperature collection
- Spray onto skin (three passes)
- manually have the patient goto end range of motion
- Spray from origin to insertion of the muscle.
- stretch further
- 3 passes
- stretch and hold
- Place hot pack on area
What are the hemodynamic effects of heat?
- Vasodilation
- Increased blood flow
What is the process for cryocuff?
- Fill machine with ice
- use appropriate sleeve
- elevate area above heart
- 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?
- Edema control
- Pain control
- Joint stiffness or ROM loss
- Muscle spasm
- Promotion of healing (after initial inflammation)
