Modalities Flashcards
conduction=
heat transfer from a warmer object to a cooler object by means of direct molecular interaction of objects in physical conduct
conductive modalities: hot packs, paraffin
convection=
head transfer by movement of air or fluid from a warmer area to a cooler area
convection modalities: whirlpool, hubbard tank, fluidotherapy
raditation=
transfer of heat from a warmer object to a cooler object by means of transmission of electromagnetic energy without heating of an intervening medium
infrared waves absorbed by cooler body
radiation modality: infrared lamp
physiological effects of general heat application:
Increases:
- CO
- metabolic rate
- HR
- RR
- vasodilation
- elasticity
Decreases:
- BP
- muscle activity (sedentary effect)
- blood to internal organs
- BF to resting muscle
- SV
- joint stiffness
- muscle strength and spasm
- pain
Indications for superficial thermotherapy
- joint stiffness
- MS pain
- muscle spasm
- preparation for e-stim, passive and active exercises
- subacute and chronic traumatic and inflammatory conditions
- increase CT extensibility
- accelerate rate of tissue healing
Contraindications for superficial thermotherapy
- acute and early subacute traumatic and inflammatory conditions
- decreased circulation and/or sensation
- DVT
- impaired cognitive function
- malignant tumors
- tendency toward hemorrhage or edema
- very young and very old
Precautions:
- cardiac insufficiency
- edema
- impaired circulation
- impaired thermal regulation
- metal in tx site
- pregnancy
- areas where topical counterirritants have been recently applied
- demyelinated nerves
- open wounds
list of superficial heating agents
hot pack paraffin bath contrast baths hydrotherapy- whirlpool, hubbard tank aquatic therapy
hot pack
canvas pack filled with silica gel
heated by immersion in water 165-170 deg F
add 6-8 lays of toweling between
(terry cloth cover=4-6)
hot pack reaches peak heat w/in first 5 min- greatest risk for burn
if heat is transferred too quickly, mottling (red and white areas) occur and permanent burn damage may result
tx time: 20-30 min
Paraffin bath
contains a paraffin wax and mineral oil mixture in a 6:1 ratio
mixture melts between 118-130 deg F (self sterilizing)
treatment temp= 125-127 deg F
tx time: 15-20 minutes
indications:
- painful joints d/t arthritis or other inflammatory conditions in the subacute/chronic phase
- joint stiffness of the hands and wrists
contraindications:
- allergic rash
- open wounds
- recent scars/sutures
- skin infections
hydrotherapy
partial or total immersion baths in which the water is agitated and mixed with air to be directed against or around the affected part
-patients can move the extremities easily because of the buoyancy and therapeutic effect of water
convection heat
specific heat of water is about 4x that of air
types:
- whirlpool
- hubbard tank- full body immersion (don’t exceed 100 deg F)
- aquatic therapy (92-98 deg)
Indications:
- decubitus ulcers
- open burns/wounds
- postsurgical conditions or hip fractures
- subacute and chronic MS conditions of the neck, shoulders, back
- RA
- can be used for debridement and loosening of dressings.
- cleaning and disinfection are important!
Chronic conditions: do best b/w 99-104 deg F whirlpool: 103-110 deg F hubbard tank: 100 PVD: 95-100 deg open wounds: 92-96 deg F
Tx time: 20-30 minutes
abstraction =
the removal of head by means of conduction or evaporation
conduction= transfer of heat from a warm object to a cooler object by means of direct molecular interaction of objects in physical contact
-cold pack, ice pack, ice massage, cold bath
Evaporation= (heat of vaporization): highly volatile liquids that evaluate rapidly on contact with warm object.
-vapo-coolant sprays
contrast bath
use alternating hot and cold immersion to help decrease pain, increase circulation and decrease swelling
-produce vascular exercise through active vasodilation and vasoconstriction of the blood vessels
water temps:
- hot 104 degF
- cold 59 deg F
in the subacute stage, begin with hot immersion for 3-4 minutes and then cold for 1 min
alternate hot/cold for 20-30 minutes, ending in hot
indications:
- any condition requiring stimulation of peripheral circulation in limbs
- PVD
- sprains, strains
- acute trauma
Contraindications:
- advanced arteriosclerosis
- arterial insufficiency
- loss of sensation to heat and cold
physiological effects of general cold applications
Decreased:
- metabolic rate
- HR
- RR
- venous BP
- BF to periphery (vasoconstriction of arteries)
- capillary permeability (decreased fluids into interstitial tissue)
- elasticity/extensibility of collagen tissue
- NCV and synaptic transmission
Increased:
- BF to internal organs
- CO
- SV
- arterial BP, shivering (occurs when core temp drops)
- joint stiffness- decreased extensibility
- pain threshold
- vasoconstriction resulting in blanching
- if cold >20 min, reflex vasodilation will occur with reddening of the skin
adverse effects of cryotherapy d/t hypersensitivity
cold urticaria: erythema of the skin with wheal formation, associated with severe itching d/t histamine reaction
facial flush, puffy eyelids, respiratory problems
-severe cases: anaphylaxis (decreased BP, increased HR) with syncope are also related to histamine release
indications for cryotherapy
acute and chronic traumatic and inflammatory conditions
edema
muscle spasm/spasticity
MS pain
thermal burns
MS symptoms
general contraindications for cryotherapy
impaired circulation
impaired sensation
peripheral vascular disease
prolonged application over superficial nerves could result in neuropraxia, Raynaud’s phenomenon, sensitivity (urticaria) or allergic reaction to cold
Precautions:
- HTN
- impaired temp sensation
- open wound
- very old/ very young
- cognitive changes
cold packs
temp: 0-10 deg F
time: 10-20 minutes
ice massage
ice cylinder formed by freezing water in paper cup
physiological response stages: 1-cold 2-burning 3-aching 4-numbness
tx time: 5-10 min or until numbness
vapocoolant spray
liquid that produces rapid cooling when a fine spray is applied to the skin
used to reduce muscle spasm by desensitizing trigger points
tx tim: 10-15 min
spray and stretch
passively stretch before spray
Ultrasound
conversion=
mechanical energy produced by sound waves at frequencies between 0.8-3MHz and delivered at intensities between 1-3 w/cm2 is absorbed by body tissues and changed to thermal energy
3MHz used for superficial
1MHz used for deeper conditions
Intensity: 0.3-1.5 w/cm2
- lower intensities and pulsed are used for acute conditions or thin tissues
- higher intensities and continuous US may be used for chronic conditions or thick tissue
- if tissue is high in fat or water content, the US penetrates more deeply with less attenuation
- if there is more protein content (muscle or CT) the US penetrates more but penetrates less
US transducer
applicator contains a piezoelectric crystal (transducer)
transducer converts electrical energy into acoustical energy by means of reverse piezoelectric effect
- alternating voltage causes mechanical deformation of the crystal
- crystal resonates (vibration) at current frequency
- oscillating crystal produces sound waves with little dispersion of energy (collimated beam)
- oscillating sound wave produces mechanical pressure waves in the tissue fluid medium. The molecules within the tissue vibrate, and the resulting friction produces heat
Transducer size: 1-10 cm2
- should be relative to the size of the treatment area
- Effective radiating area (ERA)- area of the faceplate (crystal size) which is smaller than the sounded (chose ERA 1/2 of tx area)
characteristics of US
continuous:
- thermal effects (chronic conditions)
Pulsed:
-nonthermal effects (acute soft tissue injuries)
uneven intensity produces a high level of energy in the center of the US beam relative to the surrounding areas= “hot spot” (peak spatial intensity) in the be a
-moving the soundhead or switching to pulsed US tends to reduce it
spatial average intensity= total power (watts)/area (cm2)
duty cycle:
-fraction of time the US energy is on over 1 pulse period
