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PHTY2240 MSE > L1/2: Introduction to Thermal Modalities > Flashcards

L1/2: Introduction to Thermal Modalities Flashcards

1
Q

What are the 4 uses of EPAs?

A
  1. Reduce pain
  2. Reduce swelling
  3. Stimulate healing (Eg. pressure wounds)
  4. Re‐educate muscles (Electrical stimulation to activate muscles )
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2
Q

____ are used in combination with other treatments.

A

EPAs

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3
Q

What are the four stages of healing?

A
  1. Bleeding
  2. Inflammation
  3. Proliferation
  4. Remodelling
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4
Q

When which of the 4 stages of tissue healing are EPAs particularly helpful?

A
  1. Bleeding
  2. Inflammation
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5
Q

Which 2 of the 4 stages of tissue healing are suited to heating agents?

A
  1. Proliferation
  2. Remodelling
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6
Q

What does the sensory appreciation of temperature look like?

A

Not a lot of range for temperature for heat and cold End of the spectum –> can be uncomfortable and painful

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7
Q

Applications of ____ and ____ are one of the earliest forms of physical therapy

A

heat; cold

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8
Q

Both heat and cold can have therapeutic effects such as _______ but this occurs by different mechanisms

A

pain relief

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9
Q

What are 2 types of therapeutic heat?

A
  1. Heat/hot pack
  2. Heat lamps
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10
Q

What is heat capacity?

A

How much energy it takes to warm up

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11
Q

Different materials have different heat _______ and ______.

A

capacity; conductivity

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12
Q

What is conduction (heat transfer)?

A

The kinetic motion of atoms and molecules being passed from one to the next

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13
Q

What is convection (heat transfer)?

A

By the movement of molecules (liquid or gas) from one place to another e.g. convection ovens

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14
Q

What is radiation (heat transfer)?

A

Conversion of heat energy to electromagnetic radiation

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15
Q

What are 6 physiological effects of heat?

A
  1. Increased metabolic activity (Can be useful in chronic injury but not useful for acute injuries (can be aggravating))
  2. Decreased viscosity
  3. Blood vessel changes (vasodilation)
  4. Collagen tissue changes (For contractures, arthritic joints (chronic))
  5. Pain relief and reduction in muscle spasm
  6. Tissue healing and resolution of inflammation
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16
Q

_______ thermoreceptors signal temperature change

A

Cutaneous

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17
Q

What are 6 characteristics increased metabolic activity from heating?

A
  1. Metabolic activity increased with rise in temperature (Can help with resistance to movement problems)
  2. Van’t Hoffs Law ‐ 13% increase in metabolism for each 1 degree (eg. 4° rise – 50% increase in metabolism)
  3. Increases O 2 uptake and healing process
  4. However, also increase activity of destructive process (enzymes) (Infection, cancer ..etc (acute injury)
  5. > 45° starts to decrease
  6. > 50° proteins (enzymes) denature
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18
Q

For therapy, temperature changes in deep tissues should be no greater than _____ ºC above or below core temperature.

A

5‐6

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19
Q

What are 4 characteristics of heat on viscosity?

A
  1. Decrease viscosity of fluid
  2. Therefore less resistance to flow and more blood into the area
  3. Affects blood, lymph and fluid movement within tissues, joints
  4. Clinical significance not clear but may help to flush out inflammatory products
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20
Q

What are 4 local blood vessel changes due to heat?

A
  1. Direct effects on local capillaries, arterioles, venules‐ dilate
  2. vasodilation of local blood vessels is an axon reflex triggered by stimulation of polymodal receptors in the skin
  3. Increased metabolism leading to more carbon dioxide and lactic acid
    • greater acidity provokes dilation of blood vessels
  4. a mild inflammatory reaction
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21
Q

What are 2 general blood vessel changes due to heat?

A
  1. 20 mins general warming of body
  2. drop in blood pressure (Eg. immersing person in hot bath –> can feel faint)
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22
Q

What are 3 collagen tissue changes due to heat?

A
  1. Collagen becomes more extensible
  2. At 40‐45°C – collagen shown to be more extensible
  3. Only occurs if the tissue is simultaneously stretched
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23
Q

What are 3 results of heat and stretching on collagen tissue changes?

A
  1. greater increase in length
  2. less force required
  3. reduced risk of tissue tearing
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24
Q

What are 4 changes in nerve stimulation due to heat?

A
  1. Nerve activity is markedly affected by changes in temperature
  2. Heat stimulates sensory receptors
  3. Stimulation of afferent nerves may act on pain gate control mechanism
    • block pain
    • local analgesia
  4. Heat affects muscle spindle nerve endings and Golgi tendon organs and may result in reduced muscle spasm
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25
Q

What are the 4 changes of increased blood and tissue fluid (Increase in fluid exchange across capillary walls and cell membranes) due to heat?

A
  1. Increased metabolism
  2. Vasodilation
  3. Lowered blood viscosity
  4. Speeding up healing processes
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26
Q

What are 8 therapeutic effects of heat?

A
  1. Tissue healing
    1. In the sub acute to chronic phases of the inflammatory cycle
    2. Not well supported by recent literature but general agreement
  2. Relief of pain
    1. Most common reason for use
    2. Some evidence
  3. Reduction of muscle spasm
  4. Sedative effect
  5. Increase joint ROM
  6. Prophylaxis (prevention) of pressure sores
  7. Reduction of chronic oedema
  8. Precursor to other treatment (eg. stretching, joint mobilisation, massage)
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27
Q

What are 4 clinical scenarios for using heat?

A
  1. Generally avoided in acute phase ?potential for increasing bleeding
  2. Sub‐acute chronic musculoskeletal conditions e.g. osteoarthritis
  3. Following immobilisation for extended periods e.g. fractures (Start to get things “moving”)
  4. Prior to other Rx
28
Q

What are 3 EPAs that produce superficial heat?

A
  1. Hydrocollator/Hot packs (HP)
  2. Wax
  3. Aquatic therapy/hydrotherapy
29
Q

What are 3 EPAs that produce deep heat?

A
  1. Ultrasound (US)
  2. Shortwave diathermy (SWD)
  3. Microwave (MW)
30
Q

What is a EPA that produce radiant heat?

A

Heat lamps, infrared, ultraviolet (not used much these days)

31
Q

What are 4 characteristics of wax?

A
  1. Paraffin wax melts at around 54°C but this point is lowered by the addition of mineral oil
  2. Wax with mineral oil or paraffin
  3. Thermostatically controlled bath 42‐52°C
  4. Maintains wax in molten state
32
Q

What are 4 indications of wax?

A
  1. Hands/ feet
  2. Rheumatoid arthritis
  3. Dupuytrens contracture
  4. Post surgery/ fracture/ immobilisation
33
Q

What are the 8 steps in the method of application of wax?

A
  1. Check for contra‐indications and temperature of wax
  2. Test patients sensation (thermal) (Standard safety procedure)
  3. Explanation/ warning
  4. Wash part (wipes), remove jewellery
  5. Check for open wounds and contra‐indications
  6. Immerse part to be treated
  7. Repeat 6‐8 times (Dip into wax and add layers)
  8. Wrap in greaseproof paper/ towel for 15‐20 mins
34
Q

What are 3 safety aspects of wax?

A
  1. Wax is highly flammable
  2. Fire blanket and Carbon Dioxide fire extinguisher
  3. Slippery! Protective floor covering, be careful to avoid dropping bits of wax on the floor
35
Q

What are 5 characteristics of HOT PACKS (hydrocollator pads)?

A
  1. Silicate gel (e.g. bentonite) in canvas cover
  2. The gel absorbs large quantities of hot water which provides a considerable store of heat energy
  3. Different sizes
  4. Heated tank of water to 70‐80°C by a thermostatically controlled electric heater
  5. Packs take 30min – 2 hours to become heated
36
Q

What are the 6 steps in the method of application of wax?

A
  1. Wrapped so 1‐2 cm (68 layers) of towelling between the pack and skin
  2. This provides thermal insulation so that although the pack is about 75°C, the skin temperature does not rise above 42°C or so
  3. Takes 8 mins for skin temp to reach maximum
  4. Pack temp falls but skin and superficial tissue temp rising as towelling and pack prevent the skin surface from losing heat
  5. CHECK patients response and skin colour about 10 mins after placing it
  6. Left on for 15‐20 mins
37
Q

What are 3 types of hydrotherapy?

A
  1. Pool
  2. Hubbard tank
  3. Whirlpool (arm, hip, leg)
38
Q

What are 5 indications of hydrotherapy?

A
  1. Pain
  2. Muscle spasm
  3. Superficial inflammation
  4. Chronic oedema
  5. Superficial adhesions
39
Q

What are the 5 safety aspects of hot packs?

A
  1. Care if lying a body part on a hot pack, better to apply on top
    • Eg. lumbar spine –> best in prone with heat pack on top
    • Do not lie on heat back
    • Neck –> okay to wrap around)
  2. Never use a hot pack with another machine
  3. Do not use water from the hydrocollator for skin testing! Too hot
  4. Check skin at regular intervals
  5. Extreme care on elderly, frail pts
40
Q

What are 5 contra-indications for heat treatment?

A
  1. Circulatory insufficiency
    • Identified using testing and/or clinical findings including presenting symptoms, past history and skin discolouration
  2. Risk of dissemination
    • Conditions with known or accepted risks including acute infections, tumours (benign or malignant), TB osteomyelitis
  3. Exacerbation of existing conditions (Risk of acceleration of condition)
    • Acute infective or inflammatory conditions, skin disorders such as eczema or dermatitis, regions treated within 3‐6 months by radiotherapy, haemorrhagic conditions, severe organs states such as cardiac failure
  4. To eyes or testes
  5. Open wound/if skin is broken
41
Q

What are 5 precautions for heat treatment?

A
  1. Patient unable to communicate
  2. Sensory loss
    • Must check more frequently (but not a contraindication
  3. Avoid BURNS
  4. Care with using other modalities in conjunction
  5. Extra care if lying a patient on a hot pack (Cervical spine)
42
Q

What are 4 processes that must be followed for recording with all of electrotherapy?

A
  1. Results of consent, sensation test and warnings given and understood (IC tick tick S tick tick W tick tick)
    • IC: Informed consent: Asked and given consent
    • S: Sensation Tested and okay
    • W: Warming Check and understood
  2. Details of Rx including dosage, details of electrode or hot pack position
  3. Immediate result of treatment (e.g. abnormal reaction,  P)
  4. Effect of treatment on both subjective and objective measures
43
Q

What are 3 characteristics of ice?

A
  1. Cooling the body surface with ice is a transfer of energy away from that region
  2. Lowers local tissue temperature
  3. Extent of temperature changes in the tissues depends on the rate and amount of heat energy removed
44
Q

What does RICER stand for?

A
  • Rest
  • Ice
  • Compression
  • Elevation
  • Referral
45
Q

What are 5 physiological changes of ice?

A
  1. Blood flow
  2. Metabolism
  3. Peripheral nervous system
  4. Motor system
  5. General effects
46
Q

What are 7 effects on blood flow when using ice?

A
  1. Inital vasoconstriction of cutaneous blood vessels (skin blanches)
    • restriction of blood flow to minimise heat loss
    • autonomic response from stimulation of thermoreceptors in the skin
    • direct effect of smooth muscle in arterioles
  2. dramatic reduction in blood flow through skin
  3. After 5‐10 mins ‐ vasodilation occurs which may last 15 mins
  4. then vasoconstriction
  5. termed “hunting reaction” (vessel ‘hunts’/oscillates around its mean constriction)
  6. serves to protect tissues from damage
  7. occurs more readily in the face, buttocks, hands, feet, olecranon
47
Q

What is the Lewis “Hunting Reaction”

A

Vasoconstriction –> vasodilation –> vasoconstriction

48
Q

What are 5 effects of reduction in muscle blood flow when using ice?

A
  1. Response of muscle blood flow less dramatic than skin
  2. Increased blood viscosity and vasoconstriction reduce blood flow in muscles
  3. How deeper tissues are cooled will depend on overlying adipose tissue.
  4. Adipose tissue insulates deeper structures against temperature change
  5. The location of the tissue being targeted therefore affects the time of application
    • Very superficial eg 5‐8 minutes
    • Deeper tissue may require longer 10‐20 minutes (and even longer applications eg ice for 20 mins then a new pack for another 20 mins)
49
Q

What are 5 effects of reduction in metabolic rate when using ice?

A
  1. Van’t Hoffs law
  2. After injury, there are two sources of damage:
    • Primary injury – causes cell death and disruption of micro architecture including blood supply
    • Secondary hypoxia and post trauma enzyme activity
  3. Surviving cells may be at risk of hypoxic death as they may be deprived of oxygen supply.
  4. Reduced metabolic rate and rate of necrotic enzyme release and activity at lower temps enhances the survival of these cells
  5. Reduced metabolic rate ‐less O2 requirement
  6. In addition, reduction in oedema reduces secondary damage
50
Q

What are 3 effects on the peripheral nervous system when using ice?

A
  1. Strong sensory stimulus activates cold receptors (Aβ and Aδ fibres) – gives pain relief via gating
  2. Reduces conduction velocity of peripheral nerves particularly Aβ and Aδ fibres
  3. Strong cold sensation
    • endorphin and encephalin release
51
Q

What are 3 effects on the motor system when using ice?

A
  1. Long applications of ice (>30 mins) ‐ reduces muscle strength
  2. Cooling reduces motor skills and coordination
    • Reduction in nerve conduction
  3. Short applications (< 10 mins) increase isometric muscle strength and endurance
52
Q

What are the 9 therapeutic uses of ice?

A
  1. Acute soft tissue injuries (Can use for whiplash but more for peripheral joints)
  2. Acute inflammatory joint effusion
  3. Post‐surgery
  4. Reduces muscle spasm (due to pain relief)
  5. Muscle spasticity
    • Reflex inhibition of muscle activity
    • Affects muscle spindle by prolonged cooling
    • Increase viscosity which may diminish rapid stretch reflexes
  6. Muscle strengthening
    • Facilitates a muscle contraction (brief application)
    • Short application‐ increase isometric strength
  7. Chronic inflammation, oedema and joint effusion
    • OA/RA in chronic phases
    • Long immersions (30 mins) for chronic oedema
    • Ice and compression for joint effusion (Compression sock/sleeve with cold pack/ice).
  8. Ice massage for pressure sores
  9. Ice and stretching (in conjunction with Trigger point therapy)
53
Q

What are 4 general effects using ice?

A
  1. Decreased bleeding via constriction and viscosity
  2. Decreased by limiting oedema and pain nerve irritants
  3. Decreased metabolic rate and hence secondary cell necrosis
  4. Decreased joint effusion / oedema
54
Q

What are the 6 methods of applications for ice packs?

A
  1. Ice pack – crushed ice
  2. Commercial ice packs
    • Single use – endothermic chemical reaction
    • Reusable gel packs
    • Ice wraps
    • Ice gels
    • Ice sprays
  3. Flaked ice is folded into a damp towel
  4. Can use plastic bag inside the towel
  5. Protect bony prominences
  6. Frozen peas cool the skin more than gel packs
55
Q

What are 4 characteristics of an ice bucket or bath?

A
  1. Useful for distal extremities
  2. Immerse between 5‐15 mins.
  3. Use with caution for too much cooling
  4. May need to remove at intervals
56
Q

What are 3 characteristics of an ice massage?

A
  1. small areas eg tendon (eg. Achilles tendon) –> localised cooling)
  2. small circular motion
  3. can also be used to stimulate muscle contraction
57
Q

What are 4 characteristics of contrast bath?

A
  1. Hot and cold water baths
  2. Hot = 40‐45°C, 3‐4 mins
  3. Cold = 15‐20°C, 1 min
  4. To reduce swelling, pain
58
Q

What are 3 characteristics of the spray and stretch?

A
  1. Myofascial techniques and trigger point therapy
  2. Vapocoolant spray
  3. Passive sustained stretch
59
Q

What are 5 contraindications for ice?

A
  1. *Circulatory insufficiency (“Do you have any circulatory problems or cold sensitivity problems?”)
  2. *Exacerbation of existing condition
  3. Cold Sensitivity
    • (Can’t tolerate cold (eg. whote fingers or toes)
    • Vasospasm e.g. Raynauds disease – excessive vasoconstriction in the digital arteries triggered by cold.
  4. Cryoglobinaemia
    • An abnormal protein is present in blood.
    • Can form a precipitate at low temperatures that blocks vessels and causes ischaemia
    • Not common but associated with Systemic lupus (SLE) and Rheumatoid (RA)
  5. Cold Urticaria
    • ‘cold allergy’
    • Cold causes release of histamines from mast cells – local weal and erythema
    • Sometimes systemic symptoms such as lowered BP and raised PR
60
Q

What are 3 precautions of ice (same as heat)?

A
  1. Unable to communication
  2. Sensory loss (thermal or anaesthetic)
    • If big area –> no Localised area –> okay just be more cautious
    • Note, sensation test
    • If sensory loss, also check capillary return and skin reaction after 5 mins of application
  3. Emotional and psychological features (Some people do not like cold (can’t tolerate))
61
Q

What are 6 precautions/dangers of ice burns?

A
  1. Mild form causes erythema and tenderness for 2‐3 hours after ice
  2. Severe form ‘ice burn with fatty necrosis’ shows bruising as well and tenderness may last for up to 3 weeks
  3. Cause is usually from large piece of uncrushed ice directly held against the skin
  4. Avoid using solid, uncrushed ice application eg. ice cubes or ice bricks
  5. Always use a damp towel or cloth between ice source and skin
  6. Rare in the clinical setting but need to monitor
62
Q

What are 3 processes done for sensation testing (ice reaction test) prior to cold therapy?

A
  1. Ice cube massage for 30 seconds OR
  2. Apply ice pack and check for local response after 5 minutes
  3. Examine for excessive redness, inflammatory weal or systemic reaction including increased blood pressure or heart rate.
63
Q

What are 7 characteristics for either using heat and cold?

A
  1. Stage of inflammation (Acute or chronic)
  2. Collagen extensibility
  3. Muscle spasm (Try to relax or activate)
  4. Muscle contraction
  5. Area to be treated
  6. Ease of use (To apply (patient in hospital…etc)
  7. Patient preference
64
Q

What are 5 questions that you must ask for the application of heat?

A
  1. How long does it take before your patient can feel any heat?
  2. How does this change over time?
  3. What is the optimum time for a treatment?
  4. What is the effect of reducing layers of towelling? Measure thickness of 4 , 8 layers
  5. How does body type change the effect of heat sensation? How might this be important in the clinical situation?
65
Q

What are 5 questions that you must ask for the application of cold?

A
  1. How long does it take before your patient can feel cold when applying ice to an ankle?
  2. Is the sensation even over the whole ankle?
  3. Compare the time to feel a sensation of cold between people of different body types?
  4. How might this affect your application?
  5. Does the application of a damp cloth between the ice pack and skin change the time of level of sensation?

PHTY2240 MSE (17 decks)

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