Exam 1: Cryo, Thermo, Compression, Traction Flashcards
Energy and materials applied to patients to assist in their rehabilitation. They include heat, cold, water, pressure, sound, electromagnetic radiation, and electrical currents
Physical agents
What are the categories of physical agents?
Thermal, mechanical, and electromagnetic
Ex. Ultrasound, diathermy, cp, hp (thermal)
Mechanical traction, elastic bandage, whirlpool (mechanical)
Ultraviolet, laser, TENS (electromagnetic)
The application of physical agents primarily reduces tissue ____, accelerates tissue ____, relieves pain, alters collagen ____, or modifies muscle ___.
> tissue inflammation
Accel. tissue healing
Alters Collagen extensibility
Modifies muscle tone
What are the phases of tissue recovery and how many days do they typically last?
Inflammatory phase (1-6 days)
Proliferation Phase (3-20 days)
Maturation phase (9 days-2 years)
What is a contraindication for chronic inflammation?
Cryotherapy
What are the goals for treatment of chronic inflammation?
-Prevent/decrease joint stiffness
(Thermotherapy/Motion)
-Control pain
(Thermo, ES)
-Increase circulation
(Thermo, ES, compression, hydrotherapy, exercise)
Inflammatory phase of healing is characterized by heat, swelling, pain, redness, and loss of function.
Physical agents used during this phase help to do what?
Reduce circulation, reduce pain, reduce the enzyme activity right, control motion, and promote progression to proliferation phase.
Patient with a history of hypertension is using cold OK or not OK?
Not OK, because peripheral vascular resistance associated with vasoconstriction will cause an increase in blood pressure
Stage of healing when collagen deposits replace damaged tissue, epithelial cells resurface the wound, and physical agents will assist by increasing circulation, enzyme activity rate, and collagen deposits
Proliferation stage
What physical agent will help control scar tissue formation during the proliferation phase?
Static compression
During proliferation phase adequate circulation is required to provide oxygen and nutrients to newly forming tissue. Keeping that in mind, what would be a contraindication during this phase?
Immobilization
Does hot or cold increase collagen extensibility?
Hot
During what stage of healing do you use physical agents to regain/maintain strength/flexibility and help control formation of scar tissue?
Maturation phase
Strengthening/stretching/ES/Thermo/Cryo to help regain or maintain strength/flexibility
Compression to help with formation of scar tissue
Pain caused by malignancy: is heat okay to use? Be specific
Only superficial thermotherapy
(ES and cryo used too)
***DO NOT USE ultrasound or diathermy
(Physical agents for the treatment of tone abnormalities)
Hypertonicity:
Treatment goal?
Effective agents?
Contraindications?
Goal = Decrease tone
Effective agents = Neutral warmth, prolonged cryotherapy, or EMG biofeedback to hypertonic muscles
Contraindicated agents = Quick ice of agonists
Physical agents can alter muscle tone directly by altering nerve ____, _____, or bio mechanical properties of muscle.
Nerve conduction and nerve sensitivity
Contraindications for application of a physical agent:
- Pregnancy
- Malignancy
- Pacemaker or other implanted electronic device
- Impaired sensation
- Impaired mentation
INDICATIONS for use of physical agents:
Tissue healing, pain, motion restrictions, tone
What is the goal treatment for HYPOtonicity?
What agents are contraindicated?
Goal= Increase tone
Thermotherapy is contraindicated
*Use Quick ice, motor ES, or EMG biofeedback to agonists
What are the goals of treatment for fluctuating tone?
Normalize tone
*use functional ES
What physical agent would you want to use on someone with complex regional pain syndrome (CRPS)?
Low-level sensory stimulation; neutral warmth, mild cold, gentle agitation of fluidotherapy
Should physical agents ever be the sole intervention?
NO
Definition: causes and effects of diseases
Pathology
Definition: abnormality of structure or function of the body or an organ
Impairment
Definition: restriction of activities resulting from impairment
Disability
Definition: social level of consequences of the disease
Handicap
Definition: performance of activities in efficient, expected, or competent manner
Function
Definition: emphasizes function and considers the body, the person, and the person in society; emphasis on function rather than on the condition or disease
ICF
Definition: the conscientious, explicit, and judicious use of current best evidence and making decisions about the care of individual patients
Evidence-based practice
What is the goal of evidence-based practice?
Provide the best possible patient care of assessing available research and applying it to each individual patient
Amount of energy required to raise the temperature of a given weight of the material by a given number of degrees
Specific heat
Skin and muscle>fat or bone and water> air
Water transfers more heat than
___ at a lower temperature
Air
Fluidotherapy
An energy exchange by direct collision between the molecules of two materials a different temperatures.
Requires direct contact of the targeted area with the heating or cooling agent.
Conduction
Ex.: Hot pack, ice pack, or warm paraffin
Heat transfer by direct contact between a circulating medium with another material of a different temperature.
*Transfers more heat than conduction.
Convection
Ex. Whirlpool and fluidotherapy
Circulating blood helps maintain physiologic temperatures by convection
Converts a non-thermal form of energy into heat.
Can be mechanical, electrical, or chemical energy
Conversion
Ex. Ultrasound causes mechanical vibration of molecules
Diathermy applies electromagnetic energy to the body
*Does not require direct contact; may have other electrical or mechanical effects besides heat on the body
Direct transfer of energy without the need for an intervening medium or contact
Radiation
*Infrared lamps transfer heat the radiation
Rate of temperature change depends on intensity, size of the source in treatment area, and the distance and angle of the radiation to the treatment area
When energy is absorbed to change a liquid into a gas or vapor
Evaporation
Ex. Vapocoolant spray
Contraindications for Thermotherapy
1) Recent or potential hemorrhage
2) Thrombophlebitis
3) Impaired sensation
4) Impaired mentation
5) Malignant tumor
6) IR irradiation of the eyes
Cryotherapy causes vaso____ which ____ local blood flow
Vasoconstriction
Reduces local blood flow
Cryotherapy can increase/decrease ? the pain threshold and increase/decrease ? the sensation of pain.
Increase pain threshold
Decrease sensation of pain
Because muscle strength can be temporarily influenced by cryotherapy, strength testing should be performed _____ cryotherapy application.
Before
Cryotherapy can temporarily
_____ spasticity
Reduce
*Prolonged cooling for 10 to 30 minutes can reduce spasticity for the following 60 to 90 minutes, providing a window for other therapeutic or functional activities
Cold ____ local metabolic rate and therefore can ___ inflammatory activity.
Decreases metabolic rate
Slows inflammatory activity
Apply cryotherapy immediately after injury and during ____ inflammatory phase of healing to help control bleeding, ____, and pain and to accelerate recovery
During ACUTE inflammatory phase
Edema
When using cryotherapy to control inflammation on the extremities, apply no longer than __ minutes at least __ hour apart.
No longer than 15 minutes
At least 1 hour apart
Cryotherapy, along with _____ and ____, reduces postinjury edema.
Compression and elevation
Does cooling or heat help with symptom management in patients with Multiple Sclerosis?
Cooling
Contraindications for Cryotherapy
1) Cold hypersensitivity (cold-induced urticaria)
2) Cold intolerance
3) Cryoglobulinemia
4) Paroxysmal cold hemoglobinuria
5) Raynaud disease
6) Overregenerating peripheral nerves
7) Compromised circulation or peripheral vascular disease
Cryotherapy PRECAUTIONS
1) Over the superficial main branch of a nerve
2) Over an open wound
3) Hypertension
4) Poor sensation or mentation
5) Very young and very old patients
____therapy Effects:
Hemodynamic effects (decrease in blood flow)
Neuromuscular effects (decreased nerve conduction velocity, facilitation of mm contraction, increased pain threshold, etc)
Metabolic effects (decreases it)
Cryotherapy
Decreased temperature (Cold)
increases or decreases ?
Blood viscosity
INCREASES blood viscosity
*which decreases blood flow
Decreased temp. (Cold) causes a decrease in vasodilator release (histamine & prostaglandin), which leads to vaso____ and _____ blood flow.
Vasoconstriction
Decreased blood flow
Decreased temp. (Cold) effects cutaneous thermoreceptors, which leads to ___ muscle contraction and then vasoconstriction causing decreased blood flow.
Also, spinal cord dorsal root ganglion leads to _____ sympathetic adrenergic activation which causes vasoconstriction and decreased blood flow.
Smooth muscle contraction
Increased symp. adrenergic activation
Uses of ____therapy:
-inflammation control
-edema control
-pain control
-modification of spasticity (prolonged use)
-symptom management in MS
-Facilitation
-
-
Cryotherapy
- cryokinetics (cooling mm and exercising)
- cryostretch (cooling mm then stretching)
Adverse effects of cryotherapy:
Tissue death or damage
Damaged __’C (59’F)
<15C
-4 to -15C
Always keep tissue >15C (59F)
Documentation of cryotherapy treatment includes:
Area treated Cooling agent Treatment duration Patient positioning Response to intervention
Effects of heat:
Hemodynamic effects- vaso___
Neuromuscular effects- ____ pain threshold, changes in mm strength, changes in nerve conduction velocity
Increased metabolic rate
____ tissue extensibility
Vasodilation
Increased pain threshold
Increased tissue extensibility
Thermotherapy causes a local release of chemical mediators of _____ (causing increased histamine and prostaglandin release) which cause blood vessels to vasodilate. Cutaneous thermal receptors cause smooth muscle _____ and indirectly inhibit spinal cord reflexes in the dorsal root ganglion DECREASING sympathetic output and reducing smooth muscle contraction in the blood vessels. This leads to vasodilation.
Inflammation
Smooth muscle relaxation
Uses of Superficial Heat
Pain control
Increase ROM and decreased joint stiffness
Accelerated healing
Infrared radiation for psoriasis
Increased soft tissue extensibility:
A maximum increase in residual length is achieved when the tissue is maintained at __’C to __’C (104 to 113F) for 5-10 minutes.
40-45’C
104-113 F
Thermotherapy PRECAUTIONS:
- Acute injury/inflammation
- Pregnancy
- Impaired circulation
- Edema
- Cardiac insufficiency
- Metal
- Open wounds
- Topical counterirritant
- Demyelinated nerves
Well increased temperature increases nerve conduction velocity it also DECREASES conduction of ____/____ nerves Because he changes the firing rate of specific nerve fibers. Therefore muscle strength/endurance decrease during the first 30 minutes and can take up to __ hours before the effects wear off. MMT _____ applying heat
Sensory/motor nerves
Up to 2 hours
MMT BEFORE applying heat
With heat, tissue is stretched and maintains most of the increase in length after cooling
Plastic deformation
*plasticity- ability to undergo permanent change
Without heat, _____ deformation occurs where the tissue length retracts when the force is removed.
Elastic
*change that is self reversing
Patients with RA or other inflammatory conditions:
Use heat or don’t use heat?
DON’T USE HEAT
*Heat increases local metabolic rate and can exacerbate inflammation
Heat increases enzymatic activity = _____ cell reactions = _____ oxygen uptake = accelerate _____
Increases cell reactions
Increases oxygen uptake
Accelerates healing
Hemoglobin release is twice as much oxygen at __ degrees C (106 F) than it does at __ degrees C (97 F)
2x as much O2 at 41 C
than at 36 C
What form of Thermotherapy is good for patients with Psoriasis?
Superficial heat by Infrared radiation
Cryotherapy versus Thermotherapy
Decrease or Increase? Pain Muscle spasm Blood flow Edema formation Nerve conduction velocity Metabolic rate Collagen extensibility Joint stiffness Spasticity
BOTH decrease pain
BOTH decrease muscle spasm
Cryo decreases blood flow
Thermo INCREASES blood flow
Cryo decreases edema formation
Thermo INCREASES “ “
Cryo decreases nerve conduction velocity
Thermo INCREASES “ “
Cryo decreases metabolic rate
Thermo INCREASES “ “
Cryo decreases collagen extensibility
Thermo INCREASES “ “
Cryo INCREASES joint stiffness
Thermo decreases “ “
Cryo decreases spasticity
Thermo has NO EFFECT on spasticity
What are some effects of external compression?
- Improves venous and lymphatic circulation
- Limits the shape and size of tissue
- Increases tissue temperature
Compression increases external ____ pressure which helps improve venous and lymphatic circulation.
Hydrostatic pressure
Causes of Edema:
- Imbalance between hydrostatic in osmotic pressure inside and outside of vessels
- Venous or lymphatic obstruction or insufficiency
- Increased capillary permeability
- Immobility
- Pregnancy
- Systemic diseases — *DO NOT treat with compression
Venous stasis ulcers are treated by _____ therapy. It can improve the rate of healing and improve ___ circulation.
Compression therapy
Improve venous circulation
*Multilayered comp. is more effective than single layer
Compression can increase circulation and reduce ___ formation
DVT
Compression is used for residual limb shaping after amputation, is static or intermittent compression faster at doing this?
Intermittent, Can reduce residual limb in approximately half the time as other techniques
To control hypertrophic scarring (common with deep burns), compression of __-__ mm Hg for 23 hours is recommended to reduce height.
20-30 mm hg
All forms of compression or contraindicated in patients with ____ ___ and in patients with a _____.
Symptomatic heart failure
Thrombus
Is static or intermittent compression indicated immediately after acute trauma?
STATIC compression, along with R.I.C.E method can be applied immediately after acute trauma.
DO NOT APPLY Intermittent compression bc it can aggravate bleeding or destabilize the site.
For all types of compression bandages, compression should be greatest ____ and gradually ____ proximally.
How much force is required for a joint distraction of lumbar region and cervical region?
Lumbar = 50% of body weight
Cervical = 7% of body weight
Clinical indications for traction:
- Spinal disc bulge or herniation
- Spinal nerve root impingement
- Joint Hypomobility
- Subacute joint inflammation
- Muscle spasm
Type of traction used if the area being treated is inflamed, if the patient symptoms are easily aggravated by motion, or if the patient symptoms are related to a disc protrusion
Static traction
Type of traction where long hold times are used to treat symptoms related to disc protrusion, while shorter hold and relax times are recommended for symptoms related to join dysfunction.
Intermittent traction
Parameters for the application of lumbar spinal traction:
Initial/Acute phase-
Force = ___-___lbs
Hold/Relax times = Static
Total traction time = 5-10 min.
Joint distraction-
Force = __ lbs ; ___% of body weight
H/R times = 15/15
Total traction time = 20-30 min.
Decreased muscle spasm-
Force = __% of body weight
H/R times = 5/5
Total time = 20-30 min.
Disc problems or stretch of soft tissue-
Force = __% of body weight
H/R times = 60/20
Total time = 20-30 min.
29-44 lbs
50 lbs; 50% body weight
25% body weight
25% body weight
(Traction)
Neutral/extension localizes forced to what area of the spine?
Lower lumbar
During traction, increased flexion localizes force to what area of the spine?
Upper and lower thoracic
Contraindications for traction:
1) Where motion is contraindicated
Ex. Unstable fracture, cord compression, immediately after spinal surgery
2) Acute injury or inflammation (safe after ~72 hrs)
3) Joint hyper mobility or instability
Ex. Dislocated joint, pregnant, have RA, Down syndrome, Marfan syndrome
4) Peripheralization of symptoms with traction
* Let me know if you notice increased pain or other symptoms further down your arms or legs
5) Uncontrolled hypertension
* Do you have high BP? If so, is it well controlled with medication?
Parameters for the application of Cervical spine traction:
Initial/acute phase
Force: _-_lbs (3-4 kg)
H/R time: Static
Total traction time: 5-10 min.
Joint Distraction
Force: _-_lbs (9-13 kg)
H/R time: 15/15
Total time: 20-30 min.
Decreased muscle spasm
Force: - lbs (5-7kg)
H/R time: 5/5
Total time: 20-30 min.
Disc problems or stretch of soft tissue
Force: - lbs (5-7kg)
H/R time: 60/20
Total time: 20-30 min.
7-9 lbs
20-29 lbs
11-15 lbs
11-15 lbs
Whirlpools and fluidotherapy transfer heat by:
Convection
Diathermy and ultrasound heat patients by:
Conversion
Heat transfer by _____ occurs only between materials of different temperatures that are in direct contact with each other.
Conduction
*heat transfer continues until the temperature and the speed of molecular movement of both materials become equal
Infrared lamps transfer heat by:
Radiation
Vapocoolant sprays transfer heat from the patient by:
Evaporation
Cryotherapy is most effective in slowing nerve impulses transmitted the what type of nerve fibers?
A-Delta fibers (small, myelinated)
Traction application techniques recommended and available for current use include:
Weighted mechanical traction, self-traction, electric mechanical traction
To modify scar formation, compression garments should be worn how often?
24 hours a day, except when bathing
Lymphedema may be caused by any of the following EXCEPT:
A. Hypoproteinemia
B. Thrombophlebitis
C. Mechanical obstruction of the lymphatics
D. Abnormal distribution of the lymphatic vessels
B. Thrombophlebitis
High stretch bandage: High ___ pressure
Low stretch bandage: High ___ pressure
High stretch: high RESTING pressure
Low stretch: high WORKING pressure
Lymphedema from secondary causes includes all of the following EXCEPT:
A. Milroy’s disease
B. Obstruction of tumor
C. Removal of lymph nodes
D. Obstruction by inflammation
A. Milroy’s disease (cause of primary lymphedema)
Rank the types of compression in order of efficacy: sequential, intermittent, static compression
Static
An energy exchange by direct collision between the molecules of two materials at different temperatures. Requires direct contact of the targeted area with the heating or cooling agent.
Conduction
Ex. HP, paraffin, ice pack
Heat transfer by direct contact between a circulating medium with another material of a different temperature. Transfers more heat than conduction
Convection
Ex. Fluidotherapy, whirlpool
Converts a non-thermal form of energy into heat; mechanical, electrical, or chemical energy. Does not require direct contact and may have other electrical or mechanical effects besides heat on the body.
Conversion
Temperature setting for Fluidotherapy:
100-118 degrees F
Temperature setting for Paraffin:
126-134 degrees F
6-10 dips
10-15 min.
Hot packs stored in water between ___ and ___ F
158-167 F
