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Modalities > Lecture 3 (Thermotherapy) > Flashcards

Lecture 3 (Thermotherapy) Flashcards

1
Q

Modes of Heat Transfer

__________: direct contact

A

Conduction

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2
Q

Modes of Heat Transfer

____________: when particles move across the body

A

Convection

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3
Q

Modes of Heat Transfer

____________: emitting energy from some source in the form of waves

A

Radiation

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4
Q

Modes of Heat Transfer

____________: changing from one energy form into another

A

Conversion

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5
Q

Modes of Heat Transfer

_____________: Liquid state to gaseous state through reduction of thermal energy

A

Evaptoration

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6
Q

Heat is ________ from the material at the ______ temperature to the material at the _______ temperatures

A

Heat is CONDUCTED from the material at the HIGHER temperature to the material at the LOWER temperatures

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7
Q

what happens to molecules during conduction?

A

faster moving molecules in the warmer material collide with the molecules in the cooler material & causes them to accelerate
-heat transfer continues until the temp & speed of molecular action of both materials become equal

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8
Q

Conduction tools heats the epidermis by _________ degrees

A

2-5 degrees

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9
Q

Change occurs across a ______

A

Temperature Gradient

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10
Q

What happens when the temperature gradient is equal?

A

once the 2 sides have reached the same temperature there is no longer a transfer of energy
(stasis is reached)

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11
Q

What materials conduct heat highest, moderate and low?

A

Highest - metal
Moderate - Water
Low - Air

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12
Q

The ______the temperature difference between a heating or cooling agent and the body part, the ____ the heat transfer rate.

A

The GREATER the temperature difference between a heating or cooling agent and the body part, the FASTER the heat transfer rate.

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13
Q

The ____ the area of contact between the thermal agent and the patient, the ____ the total heat transfer.

A

The LARGER the area of contact between the thermal agent and the patient, the GREATER the total heat transfer.

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14
Q

The rate of temperature rise ______ in proportion to the tissue thickness. Therefore thermal agents in contact with the skin, heat ____ the most and deeper _____ is less affected.

A

The rate of temperature rise DECREASES in proportion to the tissue thickness. Therefore thermal agents in contact with the skin, heat SKIN the most and deeper TISSUE is less affected.

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15
Q

The rate of conduction is affected by:

A
  1. Dissipation of tissue heat and/or modality heating
  2. the size of the modality
  3. the length of application
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16
Q

What are Implications with regards to conduction?

A
  1. jewellery on patient - any affect with heat application
  2. Slim vs. obese patients w/hydrocollator pack
  3. contrast baths & the rate of heat transfer
  4. An athlete who has just exercised applying a hot pack vs. a cool athlete
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17
Q

What is Convection?

A

Heat transfer by circulation of a medium or a different temperature
E.g - whirlpool, fluidotherapy

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18
Q

Immersion in a whirlpool with the turbine on will heat a patient’s skin ______ than just immersion in the whirlpool statically

A

Immersion in a whirlpool with the turbine on will heat a patient’s skin MORE RAPIDLY than just immersion in the whirlpool statically

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19
Q

Blood circulating in the body transfers heat by _______ in order to change local tissue temperature

A

Blood circulating in the body transfers heat by CONDUCTION in order to change local tissue temperature

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20
Q

What is Radiation?

A

Heating by radiation involves the direct transfer of energy from material with a higher temperature to one with a lower temperature without the need for an intervening medium or contact.
-Rays, Waves or Particles

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21
Q

what are some examples of Radiation?

A

Infrared Lamp

Ultraviolet Light

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22
Q

What is Conversion?

A

Conversion of a non-thermal form of energy (mechanical, electrical or chemical) into heat

-Unlike convection & conduction, heat conversion is not affected by the temperature of the agent

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23
Q

What are some examples of Conversion?

A
  • Ultrasound
  • LLLT
  • Diathermy
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24
Q

When transferring heat by conversion, the rate of heat transfer depends on the_____ of the energy source.

A

When transferring heat by conversion, the rate of heat transfer depends on the POWER of the energy source.

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25
Q

What are U/S, shortwave & microwave diathermy & LLLT measured by?

A

Watts or joules per second

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26
Q

Conversion: Microwave Diathermy (___ degrees C) depth to __ cm

A

Microwave Diathermy (5 –7 degrees C) depth to 3 cm

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27
Q

Conversion: Ultrasound (___ degrees) ___ cm

A

Ultrasound (0-8 degrees) 3-9 cm

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28
Q

Heat transfer by conversion does not require _______ between the thermal agent and the body, usually it does require an ______ material to be a good conductor (ie. _______)

A

Heat transfer by conversion does not require DIRECT CONTACT between the thermal agent and the body, usually it does require an INTERVENING material to be a good conductor (ie. GEL/WATER)

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29
Q

What is Evaporation?

A
  • A material must absorb energy in order to evaporate and thus change from a liquid to a gas or vapour
  • This energy is absorbed in the form of heat from the material itself or from an adjoining material resulting in a decrease in temperature
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30
Q

What are the 4 Effects of Heat?

A
  1. Hemodynamics Effect
  2. Neuromuscular effects
  3. Metabolic effects
  4. Altered tissue extensibility
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31
Q

Describe the Hemodynamic Effects?

A
  • Heat causes vasodilation and thus an increase in the rate of blood flow
  • This effect occurs locally where the heat is applied and systemically in areas a distance from the application site
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32
Q

Explain Superficial vs. Deep Heating…

A
  • Superficial heating agents primarily affect the skin and goes less than 2 cm deep
  • Deep heating modalities affects deeper tissues going 5 cm or deeper
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33
Q

What are Deep Heating Modalities?

A
  • Microwave Diathermy
  • Shortwave Diathermy
  • Therapeutic Ultrasound
  • Exercise
34
Q

What are the Neuromuscular Effects of Heat?

A
  • changes in nerve conduction velocity & firing rate
  • increased tissue temp has been shown to increase nerve conduction velocity & decrease the conduction latency of both sensory & motor nerves
35
Q

Elevation of temperature causes _____ activity in the muscle spindle which cause an ______ firing rate from Golgi tendon organs. This is believed to cause a ______ in muscle spasm

A

Elevation of temperature causes DECREASES activity in the muscle spindle which cause an INCREASE firing rate from Golgi tendon organs. This is believed to cause a DECREASE in muscle spasm

36
Q

The decrease in _______ activity causes the stretch of the muscle spindles to ______, reducing afferent firing from the spindles

A

The decrease in GAMMA NEURON activity causes the stretch of the muscle spindles to DECREASE, reducing afferent firing from the spindles

37
Q

The decreased spindle activity results in decreased _______ activity and thus in relaxation of muscle contraction

A

The decreased spindle activity results in decreased ALPHA MOTOR NEURON activity and thus in relaxation of muscle contraction

38
Q

Direct immediate reduction of pain by activation of the _________ by increased activity of the cutaneous ______

A

Direct immediate reduction of pain by activation of the SPINAL GATING MECHANISM by increased activity of the cutaneous THERMAL RECEPTORS

39
Q

Explain the Neuromuscular Effects of Heat and the Changes in Muscle Strength

A
  • Muscle strength and endurance have been found to decrease during the initial 30 min after deep or superficial heating agents
  • Over the next 2 hours, initial strength returns and then strength increases above the initial level
  • Believed due to decrease in motor neuron firing rate
40
Q

What are the Metabolic Effects of Heat?

A

Increased metabolic rate
•Heat increases the rate of all chemical reactions
•Rate of enzyme activity increased 13% for every 1 degree C increase in temp (39 –43 degrees)

41
Q

Increase in metabolic and enzymatic activity increases ______ uptake and accelerates healing but may also increase the rate of ______ process

A

Increase in metabolic and enzymatic activity increases OXYGEN uptake and accelerates healing but may also increase the rate of DESTRUCTIVE processes

42
Q

When should heat not be used?

A

Should not be used in the inflammatory phase or with inflammatory diesase

43
Q

How does Tissue Extensibility and Heat work together?

A
  • increased collagen extensibility
  • When soft tissue is heated prior to stretching, it maintains a greater increase in length after a stretching force is applied, less force is required to achieve an increase in length and the risk of tissue tearing is reduced
44
Q

When heat applied to tendon, ligament, scar tissue, capsule prior to stretching, plastic ______ can occur
•This increases tissue length and length is maintained after cooling

A

When heat applied to tendon, ligament, scar tissue, capsule prior to stretching, plastic DEFORMATION can occur
•This increases tissue length and length is maintained after cooling

45
Q

List the Effects of Heat Applications

A
  • Vasodilation
  • Increased metabolic rate
  • Increased leukocytes
  • Increased capillary permeability
  • Edema formation
  • Increased venous and lymphatic drainage
  • Removal of metabolic waste
  • Increased extensibility of collagen-rich tissues
  • Analgesia and sedation of nerves
  • Decreased spasm, pain, muscle tone
46
Q

What are the Systemic Effects of Heat Application?

A
  • Increased body temperature
  • Increased pulse rate
  • Increased respiration rate
  • Decreased blood pressure
47
Q

What are Therapeutic Uses of Heat?

A
  • Decrease pain
  • Increase range of motion
  • Decrease joint stiffness
  • Accelerate healing by creating an ideal environment for this to occur
48
Q

What are the General Indications for Heat Therapy?

A
  • Demolition phase to Return to sport
  • Reduction of pain
  • Decreased range of motion
  • Hematoma resolution
  • Reduction of joint restrictions or contractures
  • Reduction of muscle spasm
49
Q

What are Maximum Therapeutic Benefits of Heat Application?

A
  • skin temperature rapidly increases
  • increasing the excitability of local temperature receptors
  • active release of vasoactive mediators
50
Q

During the first 5-6 mins of heat application…

A

-body absorbs heat faster than the body can dissipate it

51
Q

After 7-9 mins of heat application…

A
  • temperature gradient begins to even out & slightly decline

- body has enough circulation to cool the area & the tissue temperatures stabilize

52
Q

When maximal ______ has occurred about 20 min, the blood vessels begin to constrict –rebound vasoconstriction

A

When maximal VASODILATION has occurred about 20 min, the blood vessels begin to constrict –rebound vasoconstriction

53
Q

What is Mottling?

A

Mottling of the skin is a warning that the tissue temperatures are raising to a dangerous level
-ghost white areas & beet-red blotches

54
Q

What are Contraindications for Heat?

A
  • Acute injury or inflammation
  • Recent or potential hemorrhage
  • Impaired circulation
  • Impaired mentation
  • Thromobophlebitis
  • With deep heating modalities, should not be applied over area of malignancy
  • With IR laser irradiation of the eyes
55
Q

What precautions do you need to be aware of when applying heat?

A
  • Pregnancy
  • Impaired circulation
  • Poor thermal regulation
  • Edema
  • Cardiac insufficiency
  • Metal in the area
  • Over an open wound
  • Over areas where topical counterirritants have recently been applied
56
Q

List the Adverse Effects of Thermotherapy…

A
  • Burns
  • Fainting
  • Bleeding
  • Skin & eye Damage (IR laser)
57
Q

Describe Hot Packs

A
  • Made of bentonite(clay), a hydrophilic silicate gel, covered with canvas
  • holds large quantity of water
  • efficient delivery of heat
  • Water temp kept at 70 –75degrees C
  • Take 2 hours to heat and 30 min to reheat between applications
  • Different shaped pads for different areas of the body
58
Q

how do you apply a hot pack?

A
  • Wrap the hot pack in 6 –8 layers of towels
  • Hot pack covers can substitute
  • Need more towels if patient complains of feeling too warm
  • Place the hot pack over the lesion site
  • Towel over top to hold heat in
  • Secure hot pack in place
59
Q

What can you tell your patients to do for heat application at home?

A
  • hot water bottles wrapped in a damp towel act as cheap hot packs
  • warming towel in microwave (warm not hot)
60
Q

What is the Hot Pack Application Protocol?

A
  • Provide patient with means to reach you if the pack becomes too hot
  • Use more towels if too hot
  • Timer set at 20 minutes
  • Check skin after 5 minutes
  • May need to replace the pack throughout the treatment
  • After 20 minutes remove the pack and inspect the skin
  • Begin ROM or other rehabilitation
61
Q

Explain Hot Whirlpool…

A
  • Whirlpools are an effective method of applying heat or cold to irregularly shaped areas
  • Energy is transferred by convection
  • Turbine to control the water flow and the aeration of the water
  • Temperature of water depends on amount of body part immersed
62
Q

During hot whirlpool treatments, the temperature of the water is ______ as the total body area immersed increases.

A

During hot whirlpool treatments, the temperature of the water is DECREASED as the total body area immersed increases.

63
Q

Because we cool our bodies through ________ and ______, full immersion can increase the core temperature and cause________

A

Because we cool our bodies through EVAPORATION and RESPIRATION, full immersion can increase the core temperature and cause HYPERTHERMIA

64
Q

What is the Temperature of the Hot Whirlpool?

A

90-110*F

32-49*C

65
Q

What is the Hot Whirlpool Protocol?

A
  • Remove all jewelry and inspect area to be treated
  • Explain aims of treatment
  • Test for heat and cold sensations
  • Contraindications –drugs (alcohol), seizure disorders, heart or circulatory problems
  • Permission from patient
  • Ensure temperature of whirlpool, depth of water, ground fault circuit interrupter and treatment area
66
Q

What must the therapist do when a patient is in a Hot Whirlpool?

A
  • Patients should be in view of therapist at all times
  • Patient should get in a comfortable position and in a position to be able to exercise
  • Decrease whirlpool temperature if total immersion, or vigorous exercise involved
  • Turn the turbine on and direct aeration appropriately
  • Monitor the patient continually
  • Set timer and explain exercises completely
  • Check treatment area and range after treatment
67
Q

What are Contrast Baths (Hot & Cold)

A

Alternating hot and cold treatments
•Stationary water immersion
•Tandem whirlpools
•Moist heat and cold pack
Alternating heat and cold is thought to produce a kind of vascular exercise.
Vasodilation –vasoconstriction –vasodilation ….

68
Q

Contrast Bath Protocol?

A
  • Same protocol as hot or cold WP
  • 50 –60 degrees F (10 –16 C) The temperature can increase depending on proportion of body are immersed
  • 105 –110 degrees F (40.6 –43.3 C) The temperature is decreased as the proportion of the body area treated increases
69
Q

describe paraffin wax…

A

-Paraffin is mixed with mineral oil to allow the paraffin to melt at between 45 –50 degrees C. (7 parts wax /1 part mineral oil)

70
Q

why use paraffin wax used?

A

paraffin is used for distal extremities b/c it can heat irregularly contoured areas - especially useful for hands & feet

71
Q

Explain the Paraffin Wax Application Methods…

A

3 different methods

  1. Dip –wrap
  2. Dip –immersion
  3. Paint
    - The wrap and immersion are used for distal extremities
    - Paint is for other areas of body
72
Q

List the Paraffin Wax Protocol

A
  • Remove all jewelry from the area to be treated
  • Test hot and cold sensation
  • Explain purpose of application
  • Get permission to apply
  • Avoid moving fingers in wax
  • Avoid touching the bottom or sides of tank
73
Q

What is the Dip & Wrap Protocol?

A
  • Dip hand in paraffin as far as possible and remove
  • Wait briefly for the layer of paraffin to harden and become opaque
  • Re-dip the hand, with fingers apart
  • Repeat at least 6 times
  • Wrap the hand in plastic bag or wax paper and then in towel
  • Elevate the extremity
  • Leave the paraffin 10 –15 minutes or until it cools
  • When completed peel off the wax and discard or back in container
  • Check the skin and begin stretching exercises
74
Q

describe the dip immersion method

A
  • With fingers apart, dip the hand into the paraffin and remove
  • Wait 5 –15 seconds for the wax to harden
  • Re-dip 6 times, keeping fingers apart
  • Allow the hand to remain in the paraffin for up to 20 minutes then remove it
  • Wax should be at lower end of range for this method
75
Q

What is the Paint method?

A
  • Paint a layer of paraffin onto the treatment area with a brush
  • Wait for the layer of paraffin to become opaque
  • Paint another layer of wax and repeat 3 –6 times over the same area
  • Cover the area with plastic or wax paper and toweling
  • Leave in place for 20 minutes
  • Remove paraffin
  • Check skin and continue with rest of rehab program
76
Q

What is Fluidotherapy?

A
  • Dry heating modality that transfers heat by convection
  • A cabinet containing finely ground cellulose particles made from corn cobs
  • Heated air is circulated through the particles moving them like a liquid
  • The patient puts body part in cabinet
77
Q

Hemodynamic Effects of Cryotherapy?

A
  • Vasocontriction
  • increase in blood viscosity
  • decrease in blood flow
  • decrease in vasodialation mediators
  • decrease in edema formation
  • decrease in metabolic activity (decrease in O2)
78
Q

Neuromuscluar Effects of Cryotherapy?

A
  • decrease in nerve conduction
  • increase in pain threshold
  • altered muscular strength
  • decrease in spasticity
  • facilitation of muscular contraction
  • gate control for pain
  • decrease in muscle spasm
  • DECREASE IN PAIN
79
Q

Tissue Extensibility and Cryotherapy?

A

-increase in joint stiffness & less elasticity

80
Q

Hemodynamic Effects of Thermotherapy?

A
  • Vasodialation
  • increase in rate of blood flow
  • local increase with superficial heat
  • increase in metabolic rate
  • increase in enzyme activity which accelerates healing process
81
Q

Neuromuscular Effect of Thermotherapy?

A
  • increase in nerve conduction velocity
  • decrease in conduction latency (both sensory & motor)
  • decrease in firing rate of muscle spindle & gamma efferent
  • increase firing from Golgi tendon
  • decrease in muscle spasm
  • increase pain threshold-gate control
  • decrease muscle strength initially, then increase 2 hours later
  • DECREASE PAIN
82
Q

Tissue Extensibility and Thermotherapy?

A

-Increase in tissue extensibility

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