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Modalities > cryotherapy & thermal agents - exam 1 > Flashcards

cryotherapy & thermal agents - exam 1 Flashcards

1
Q

what is conduction?

A

energy exchange by direct contact of stationary materials (tissues) at different temperatures

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2
Q

how is head conducted?

A

from the material at a higher temp to material at lower temp
– cold pack: heat transferred from patient’s skin to cold pack
– heat pack: heat transferred from hot pack to patient’s skin

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3
Q

what factors is rate of heat transfer dependent on?

A

area of contact
thermal conductivity
temperature difference

tissue thickness (decreases rate)

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4
Q

the greater the temp difference between two surfaces:

A

the faster the rate of heat transfer

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5
Q

what is a good use of materials to make sure you are creating a safe medium for heat transfer?

A

6-8 layers of towels between hot/cold pack and patient (trap air and have a low thermal conductivity to slow rate of heat transfer)

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6
Q

why should you remove metal from areas of contact?

A

metal has a high thermal conductivity

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7
Q

what is convection?

A

direct contact between circulating medium (not stationary) and another material of a different temp.

vector = moving

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8
Q

how would heat transfer occur more rapidly?

A

faster speed of movement between two materials (i.e. whirlpools vs immersion)

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9
Q

what is conversion?

A

converting a non-thermal form of energy into heat

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10
Q

does conversion require direct contact? if not, what does it require?

A

no
requires an intervening material to help transmit the certain type of energy (ultrasound gel or lotion)

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11
Q

regarding conversion, what does rate of transfer depend on?

A

the power of energy source not the temperature (US head does not need to be hot)

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12
Q

what form of energy is ultrasound?

A

mechanical form - can be “converted” to heat when sufficient intensity to a tissue absorbs the sound waves

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13
Q

what form of energy is diathermy?

A

electromagnetic form of energy - causes rotation of polar molecules, “converts” to heat when friction between the molecules increases tissue temp

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14
Q

what is specific heat?

A

amount of energy required to increase the temperature of a material by a “x” number of degrees (C)

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15
Q

tissues with high specific heat require ______ energy to heat and hold more energy compared to ______

A

more
materials with low specific heat

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16
Q

list the materials in order of heating up faster to heating up slower

A

air
bone
fat
average for human body
muscle
skin
water

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17
Q

what does a therapeutic use of cold do in rehab medicine?

A

control inflammation, pain and edema
reduce spasticity
control symptoms of MS
facilitate movement/ROM

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18
Q

what is abstraction?

A

removal of heat by means of conduction or evaporation

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19
Q

what ICF domain is cryotherapy categorized into?

A

basic structures and function

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20
Q

what are the hemodynamic effects of cryotherapy?

A
  • vasoconstriction (10-15 minutes) which decreases blood flow
  • most pronounced at area of direct skin contact
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21
Q

what is the cold induced vasodilation phenomenon?

A

following initial decrease in blood flow there is a later increase in blood flow, which cycles up and down
occurs when cold applied for > 15 minutes or when tissue temp reaches < 50 deg
** our goal is to vasoconstrict during the inflammatory healing phase

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22
Q

what are the neuromuscular effects of cryotherapy?

A

neuro effects:
1. pain reduction
- decreased nerve conduction velocity –> sensory and motor nerves
2. increased pain threshold by stimulation of cold receptors
- block perception of painful stimuli

muscular effects:
1. decreased spasticity (effects lasting 1-1.5 hours)
2. increase muscle strength (facilitating muscle contraction)
– < 5 min ice massage isometric strength increases
– cryotherapy for 30 min initial decrease then increase in strength

23
Q

what are the metabolic effects of cryotherapy?

A

reduces inflammatory activity
cold decreases the rate of all metabolic reactions:
- decreases rate of inflammation by decreasing the activity of cartilage degrading enzymes and level of histamines
- decreases inflammatory processes due to joint diseases such as OA and RA

24
Q

what does cryotherapy do during the acute inflammatory phase of healing?

A

bleeding decreased (vasoconstriction)
edema decreased (vasoconstriction and decreased metabolic activity)
pain reduced (neuromuscular effects of pain reduction, secondary pain effects of edema)

25
Q

what does cryotherapy do?

A

directly decreases the heat and edema associated with inflammation by decreasing blood flow
when tissue temp remains normal the acute inflammation has probably resolved (48-72 hours)

26
Q

what are two other ways cryotherapy benefits inflammation control?

A

acute chronic inflammatory diseases
post exercise
- reduce DOMS

27
Q

what is edema?

A

presence of abnormal amounts of fluid in the extracellular tissue spaces of the body

28
Q

what is the process of edema?

A

inflammation –> intravascular fluid pressure –> vascular permeability –> exudate into the interstitium

29
Q

how does cryotherapy control acute edema?

A

reduce the release of histamines
increase blood viscosity
decrease blood flow

30
Q

what is most effective to minimize edema?

A

apply ice ASAP
combine with compression and elevation (RICE)
drives extravascular fluid into venous and lymphatic drainage systems

31
Q

what is a situation where cryotherapy would not be effective in minimizing edema?

A

controlling edema caused by immobility and poor circulation

32
Q

what effects does applying cryotherapy for 10-15 minutes to control pain have?

A

neuro physiological effects
– gates pain transmission
hemodynamic physiological effects
– vasoconstriction

33
Q

what is cryokinetics?

A

apply ice ASAP post injury until numbness
allows painfree exercise during period of numbness, 3-5 minutes, until sensation returns
repeat 5x
used frequently in athletics to minimize loss of playing time

34
Q

what is cryostretch?

A

vapocoolant spray used as cooling agent
followed up with stretch to decrease muscle spasm, increase ROM

35
Q

what are contraindications of cryotherapy?

A

cold hypersensitivity
cold intolerance
cryoglobulinemia
paroxysmal cold hemoglobinuria
Raynaud’s disease
over a regenerating peripheral nerve
over an area with circulatory compromise

36
Q

what are precautions of cryotherapy?

A

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

37
Q

what does the use of heat in rehab medicine do?

A

control pain
increase soft tissue extensibility and circulation
accelerate healing

38
Q

what are effects of thermotherapy?

A

accelerates tissue healing
pain management
alters collagen extensibility

39
Q

what are hemodynamic effects of thermotherapy?

A

increased blood flow (vasodilation)
increased capillary permeability
superficial heating agents do not heat to the depth of most muscles
to heat deep muscles, use exercise or deep heating modalities

40
Q

what are neuro effects of thermotherapy?

A
  1. increased nerve conduction velocity
  2. change frequency of nerve firing rate
    – decrease muscle spasm –> muscle relaxation
    – decreased spindle activity –> decreased resistance to passive stretch
  3. increased pain threshold
    – cutaneous thermoreceptors stimulated and gate pain (feels change in temp instead of pain)
41
Q

what are muscular effects of thermotherapy?

A

altered muscle endurance and strength
– decrease during initial 30 min following heat
– after 30 min, for next 2 hours strength gradually recovers to above pretreatment levels

42
Q

what are metabolic effects of thermotherapy?

A

increases rate of cellular biochemical reactions (increased metabolic rate)
increased oxygen uptake; accelerate healing
increase metabolic rate of destructive processes (avoid with inflammation)

43
Q

increasing ______ of soft tissue increases its ________

A

temperature
extensibility

44
Q

extensibility:
plastic deformation:
elastic deformation:

A
  • amount of stretch/deformation that can occur
  • can be achieved - tissue maintains increased length during stretching
  • collagenous tissue stretched without prior heating can lead to elastic deformation
45
Q

what are effects of heating soft tissue before stretching?

A

increase stretch
decrease risk of tearing tissue
achieves greater increase in length when stretching force is applied
less force is required to achieve the increased length

46
Q

why would you use superficial heat in the clinic?

A

pain control
increase ROM, decrease joint stiffness
accelerated healing - increasing circulation and enzyme activity
infrared radiation for psoriasis or dermal ulcers
superficial muscle relaxation

47
Q

what stages of healing are best to use heat with?

A

proliferative or remodeling stage
or when chronic inflammation is present
** DO NOT apply during acute inflammation phase

48
Q

what occurs with superficial muscle relaxation?

A

change frequency of nerve firing
results in decreased firing frequency of alpha motor neurons (decreased muscle spasm)
good for LBP and spasms

49
Q

what are contraindications of thermotherapy?

A

acute trauma
acute musculoskeletal and inflammatory conditions
recent or potential hemorrhage
thrombophlebitis
impaired sensation
impaired cognition
malignancy

50
Q

what are precautions of thermotherapy?

A

pregnancy
poor circulation or thermal regulation
edema
cardiac insufficiency
areas with metal
over an open wound
areas where topical counterirritants have recently been applied
demyelinated nerves

51
Q

what are adverse effects of thermotherapy?

A
  1. burns
    – use hot packs vs electrical heating pads
    – make sure pt doesn’t fall asleep
  2. fainting
    – vasodilation can lead to decreased blood flow to brain
    – orthostatic effects following thermotherapy treatment
  3. bleeding
  4. always give a patient a way to stop treatment
52
Q

what is the down side to hot packs?

A

errors in application can lead to adverse outcomes –> burns

53
Q

what are things to consider before using a hot pack?

A

no reimbursement
consider indications, contraindications & precautions
know patient medical history
monitor application of heat at all times
don’t fall into habit of using hot pack as passive modality

Modalities (2 decks)

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