NPTE - Therapeutic Modalities: Cryotherapy, Superficial and deep thermotherapy, Hydrotherapy Flashcards
Indications for use of modalities (4)
- Pain
- Inflammation and repair
- Restriction in motion
- Abnormal tone
Principles of Heat Transfer: (5)
- Conduction
- Convection
- Conversion
- Evaporation
- Radiation
Conduction
Gain or loss of heat resulting from direct contract between tow materials at different temps
Convection
The gain or loss of heat resulting from air or water moving in a constant motion across the body
- Capable of transferring large amounts of heat
Conversion
Heating that occurs when nonthermal energy (e.g. mechanical, electrical) is absorbed into tissue and transfored into heat
Rate of heat transfer with conversion is determined by:
The power of the energy source
Evaporation
Transfer of heat that occurs as a liquid absorbs energy and changes form into a vapor
Radiation
Direct transfer of heat from a radiation energy source of higher temp to one of cool temp
Rate of heat transfer with radiation is influenced by:
- Intensity and size of the energy source
- Target area
- Angle of the radiation to the target area
- the distance between the energy source and target area
Cryotherapy
Local or general use of low temperatures in rehab
Generates therapeutic effects by influencing hemodynamic (blood flow), metabolic (metabolic rate), and neuromuscular processes (nerve conduction)
Therapeutic Effects of Cryotherapy (7)
- Decreased blood flow to treatment area
- Decreased edema
- Decreased local temp
- Decreased metabolic rate
- Decreased nerve conduction velocity
- Decreased tone
- Increased pain threshold
Gain or loss of heat resulting from direct contract between tow materials at different temps
Conduction
The gain or loss of heat resulting from air or water moving in a constant motion across the body
- Capable of transferring large amounts of heat
Convection
Heating that occurs when nonthermal energy (e.g. mechanical, electrical) is absorbed into tissue and transfored into heat
Conversion
Transfer of heat that occurs as a liquid absorbs energy and changes form into a vapor
Evaporation
Direct transfer of heat from a radiation energy source of higher temp to one of cool temp
Radiation
Local or general use of low temperatures in rehab
Generates therapeutic effects by influencing hemodynamic (blood flow), metabolic (metabolic rate), and neuromuscular processes (nerve conduction)
Cryotherapy
Indications for Cryotherapy (9)
- Abnormal tone
- Acute or chronic pain
- Acute or subacute inflammation
- Bursitis
- Muscle spasm
- MSK trauma
- Myofascial trigger points
- Tendonitis
- Tenosynovitis
- Abnormal tone
- Acute or chronic pain
- Acute or subacute inflammation
- Bursitis
- Muscle spasm
- MSK trauma
- Myofascial trigger points
- Tendonitis
- Tenosynovitis
Indications for Cryotherapy (9)
Contraindications of Cryotherapy (10)
- Cold intolerance
- Cold urticaria
- Cryoglobulinemia
- Infection
- Over an area of compromised circulation
- Over regenerating peripheral nerves
- Paroxysmal corl hemoglobinuria
- Peripheral vascular disease
- Raynaud’s phenomenon
- Skin anesthesia
Ice massage
Applied directly to the treatment area
Ideal for small or contoured areas
Easily intigrated into an HEP
Pt in relaxed position, ideal elevated
Cold Pack
Should be cooled for at least 30 min between uses and 2+hrs before initial use
Should be applied over a moist towel
Approximately 20 min application
Can be applied every 1 to 2 hrs for inflammation and pain control
Extend to 30 min if goal is spasticity reduction (skin requires inspection every 10 min!)
Cold Bath
Used for the immersion of the distal extemities
Allows for circumferential contact
Temps ranging from 55-64°F
15-20 min
Lower temp = shorter tx time
Controlled Cold Compression Unit
Circulates cooled water through a sleeve that is applied to an extremity
Temps ranging from 50-77°F
Combination is more effective than cold or compression alone in controlling inflammation
Cryo Cuff
Cold water circulating unit that combines benifits of cold with compression
Nylon sleeve and gallon container of ice water
Commonly used post-operatively with goal to decrease pain and need for analgesic meds
Advantages of Ice massage (4)
- Effective for small or irregular areas
- Target area can be observed during tx
- Short duration of tx
- Available for home use
Disadvantages of Ice Massage (3)
- Intensity of cooling may not be tolerated by pt
- Time consuming for large areas
- Requires active participation for the therapist or pt
Advantages of Cold pack (3)
- Covers moderate to large areas
- Can be applied in conjunction with elevation
- Available for home use
Disadvantages of Cold pack (3)
- May not maintain good contact on small or severely contoured ares
- Pt may not tolerate the weight of the pack
- Difficult to observe target area directly during tx
Advantages of Cold Bath (3)
- Effective for cooling the distal extremities
- Allows for circumferential contact with water
- Available for home use
Disadvantage of Cold bath
Requires the extremity to remain in a gravity dependent position
Advantages of Controlled Cold Compression Unit (3)
- Allows simultaneous application of cold and compression
- Temp and compression force can be accurately controlled
- Can be combined with other interventions, such as electrotherapy
Disadvantages of Controlled Cold Compression Unit (2)
- Difficult to observe targe area directly during tx
- Limited to extremity use
Advantages to Cryo Cuff (3)
- Allows simultaneous application of cold and compression
- Provides hours of mild cooling
- Available for home use
Disadvantage for Cryo Cuff
Difficult to precisely control temp and compression force
Advantages of Vapocoolant spray (4)
- Localized area of application
- Brief duration of cooling
- Effectively treats trigger points
- Increases ROM
Disadvantages of Vapocoolant spray (3)
- Difficult to apply spray uniformly
- Risk of frostbite if skin is not reward between repeated treatments
- Limited in scope of use
Advantages or disadvantages of:
- Effective for small or irregular areas
- Target area can be observed during tx
- Short duration of tx
- Available for home use
Advantages of Ice massage (4)
Advantages or disadvantages of:
- Intensity of cooling may not be tolerated by pt
- Time consuming for large areas
- Requires active participation for the therapist or pt
Disadvantages of Ice Massage (3)
Advantages or disadvantages of:
- Covers moderate to large areas
- Can be applied in conjunction with elevation
- Available for home use
Advantages of Cold pack (3)
Advantages or disadvantages of:
- May not maintain good contact on small or severely contoured ares
- Pt may not tolerate the weight of the pack
- Difficult to observe target area directly during tx
Disadvantages of Cold pack (3)
Advantages or disadvantages of:
- Effective for cooling the distal extremities
- Allows for circumferential contact with water
- Available for home use
Advantages of Cold Bath (3)
Advantages or disadvantages of:
Requires the extremity to remain in a gravity dependent position
Disadvantage of Cold bath
Advantages or disadvantages of:
- Allows simultaneous application of cold and compression
- Temp and compression force can be accurately controlled
- Can be combined with other interventions, such as electrotherapy
Advantages of Controlled Cold Compression Unit (3)
Advantages or disadvantages of:
- Difficult to observe targe area directly during tx
- Limited to extremity use
Disadvantages of Controlled Cold Compression Unit (2)
Advantages or disadvantages of:
- Allows simultaneous application of cold and compression
- Provides hours of mild cooling
- Available for home use
Advantages to Cryo Cuff (3)
Advantages or disadvantages of:
Difficult to precisely control temp and compression force
Disadvantage for Cryo Cuff
Advantages or disadvantages of:
- Localized area of application
- Brief duration of cooling
- Effectively treats trigger points
- Increases ROM
Advantages of Vapocoolant spray (4)
Advantages or disadvantages of:
- Difficult to apply spray uniformly
- Risk of frostbite if skin is not reward between repeated treatments
- Limited in scope of use
Disadvantages of Vapocoolant spray (3)
Vapocoolant spray
Produces rapid cooling through evaporation
Most commonly used in tx of trigger points
Produces a counter-irritant stimulus to the cutaneous thermal afferent nerves that overlay muscle (may break the pain cycle)
Conditions that respond: torticollis, neck or LBP caused by muscle spasm, acute bursitis, hamstrings tightness
Superficial Thermotherapy
Local or genral use of high temps in rehab with the goal of increasing skin temp and superficial subcutaneous tissue to depths of up to 2cm
Therapeutic Effects of Superficial Thermotherapy (10)
- Decreased muscle spasm
- Decreased tone
- Increased blood flow to the tx area
- Increased capillary permeability
- Increased Collagen Extensibility
- Increased local temp
- Increased metabolic rate
- Increased muslce elasticity
- Increased nerve conduction rate
- Increased pain threshold
Indications for Superficial Thermotherapy (7)
- Abnormal tone
- Decreased ROM
- Muscle gaurding
- Muscle spasm
- Myofascial trigger points
- Subacute or chronic pain
- Subacute or chronic inflammatory conditions
Contrainications for Superficial Thermotherapy (7)
- Acute MSK trauma
- Arterial disease
- Bleeding or Hemorrhage
- Over an area of compromised circulation
- Over an area of malignancy
- Peripheral vascular disease
- Thrombophlebitis (inflammation of the vein wall with thrombosis)
Hot pack
Moist heat!
Primary therapeutic effects: pain reduction, increased tissue extensability, reduced muscle spasm
6-8 layers of towels between pack and skin
Skin check after 5 min
Approx 15-20 min tx
Fluidotherpay
Container that ciculates warm air and small cellulose particles
Generates dry heat through forced convection
Open wounds should be covered with a plastic barrier
15-20 min tx
Infrared Lamp
- Produces superficial heating of tissue through radiant heat
- Wavelength: 780-1500 nm
- Majority of radiation is abosrbed within the first few mm of human tissue
- Maximum penetration with 1200 nm wavelength
- Therapeutic effect: Improved tissue healing
- Opaque goggles should be worn by pt and PT
- Towels to cover areas out side of target area
Paraffin
Common used heating source for distal extremities
Removal of all jewelry and thoroughly wash the body part being tx
Cannot be applied to areas with open wounds or infections
3 application techniques: dip-wrap, dip-reimmersion, paint application
Paraffin
Dip-wrap
Pt maintains a static postion as distal extremity is dipped into paraffin bath and then removed
After allowing to harden, extremity should be redipped 6-10 more times
Then immediately placed in a placed back
Towel wrapped around back
10-15min
Paraffin
Dip-reimmersion
After initial 6-10 dips, distal extremity remains in the paraffin bath for the duration of the tx
Unit should be turned off during tx
May need to use a temp closer to 113°F (lower end of the 113-122 range)
up to 20min
Paraffin
Paint Application
Used for body parts taht cannot be immersed into the paraffin bath
6-10 layers, waiting in between each for paraffin to harden
Area covered by plastic bag/wrap and towel
approx 20 min
Deep Thermotherapy
Local of general use of energy in rehab with the goal of increase tissue temp
Agents are capable of heating to depths of 3-5cm
Ultrasound
Common deep heating agent that transfers heat through conversion and elevates tissue temp to depths up to 5 cm
Therapeutic frequency: 0.75 - 3 megahertz (MHz)
Tx area should not be more than 4x the size of the effective radiating area (ERA)
Ultrasound
Thermal effects
- Acceleration fo metabolic rate
- Modulation of pain
- Reduciton of muscle spasm
- Decreased joint stiffness
- Alteration of nerve conduction velocity
- Increased ciculation
- Increased soft tissue extensibility
Ultrasound
Nonthermal Effects
- Increased cell and skin membrane permeability
- Increased intracellular calcium levels
- Facilitation of tissue repair
- Promotion of normal cell fucntion
Effects occur as a result of cavitation (formation of gas-filled bubbles) and acoustic microstreaming (unidirectional movement of fluids along the boundaries of cell membranes)
Ultrasound Parameters
Technique
Transducer used with a coupling agent
Coupling agens decrease acoustical impedance by limiting the amount of air between transducer and skin (gels, gel pads, mineral oil, water, lotions)
Direct coupling agents: applied directly to the transducer and/or skin
Indirection: water immersion, transducer moved parallel to area (0.5-3cm away) Increased intensity (as much as 50%) may be needed
Ultrasound Prameters
Intensity
Quantity of energy delivered per unit of are
Effective radiating area (ERA) - area of the transducer that transmits ultrasound energy
Indications for Ultrasound (12)
- Acute and post-acute conditions (ultrasound with non-thermal effects)
- Calcium deposits
- Chronic inflammation
- Delayed soft tissue healing
- Dermal ulcers
- Joint contracture
- Muscle spasm
- Myofascial trigger points
- Pain
- Plantar warts
- Scar tissue
- Tissue regeneration
Contrainidations for Ultrasound (16)
- Acute and post-acute conditions (ultra-sound with thermal effects)
- Areas of active bleeding
- Areas of decreased temp sensation
- Areas of decreased circulation
- DVT
- Infection
- Malignancy
- Over breast implants
- Over carotid sinus or cervical ganglia
- Over epipheseal areas in young children
- Over eyes, heart and genetalia
- Over metyl methacrylate cement or plastic (?)
- Over pelvic, lumbar or abdominal areas of pregnant women
- Over a pacemaker
- thrombophlebitis
- Vascular insufficiency
Ultrasound
Frequency
Primary determinant in the depth of ultrasound penetration
Higher frequency = absorbed more rapidly than lower frequency
Higher frequencies affects more superficial tissues
Lower frequencies affects deeper tissues
Frequency of 1 MHz used for deeper tissues (up to 5 cm)
3 MHz = superfical tissus (1-2cm)
Ultrasound
Duty Cycle
Continuous or pulsed modes
- Continuous - intensity remains constant throughout tx
- 100% duty cycle
- Thermal effects: higher intensities
- Nonthermal effects: lower intensities
- More effective at elevating tissue time
- Pulsed - intensity is periodically interrupted
- Below 100% duty cycle
- Results in a reduced average heating of tissues –> primary for nontermals!
- Recommend 20% or less
Duty cycle = (on time)/(on time + off time) x 100
Ultrasound
Duration
Determined based on:
- size of tx area
- Depth of penetration
- Desired therapeutic effects
Area 2-3x size of transducer typically requires 5min
Ultrasound
of Txs
Primarily dependent on the establist therapeutic objects, level of acuity, and the pt response
Thermal - applied later in healing process, 2-3x/week
Nonthermal - earlier in healing process, as much as once/day
Positive response should be evident within 3 sessions
Greater than 14 tx within single episode of care –> reduce RBC and WBC counts
Diathermy
Deep heating agent that converts high frequency electromagnetic engergy into therapeutic heat
Produces a molecular vibration within the tissue that generats heat (elevates tissue temp)
Therapeutic effects of Diathermy (9)
- Altered cell membrane function
- Increased collagen extensibility
- Increase edema
- Increased metabolic rate
- Increased muscle elasticity
- Increased nerve conduction velocity
- Increased pain threshold
- Increased temp
- Vasodilation
Indications for Diathermy (12)
- Bursitis
- Chronic inflammation
- Chronic inflammatory pelvic disease
- Decreased collagen extensibility
- Degenerative joint disease
- Increased metabolism
- Joint stiffness
- Muscle guarding
- Myofascial trigger points
- Pain
- Peripheral nerve regeneration
- Tissue healing
Contraindications for Diatherpy (14)
- Acute infection
- Acute inflammation
- Cardiac pacemaker
- Hemophilia
- Internal and external metal objects
- Intrauterine device
- Ischemic tissue
- Low back, abdomen, pelvis of pregnant woman
- Malignant area
- Moist wound dressing
- over hemorrhagic region
- Over the eyes
- Over the testes
- Pain and temp sensory deficits
Advantages of Fluidotherpay (4)
- Temp and agitation of the dry particles can be controlled
- Pt can perform active exercise during tx
- Minimal pressure applied to the tx area
- Can be used for desensitization of distal extremities
Disadvantages of Fluidotherapy (3)
- Constant heat source can result in overheating
- Some pts are intolerant of the dry particles and the enclosed container
- Some units require the extremity to be in a dependent position
Advantages to Hot pack (3)
- Moist, comfortable heat
- Variety of shapes and sizes
- Available for home use
Disadvantages to Hot Pack (3)
- May not maintain good contact on small or contoured areas
- Pt may not tolerate the weight of the pack
- difficult to observe target area directly during tx
Advantages of Infrared Lamp (2)
- Target area can be observed during tx
- Does not require direct contact with the tx area
Disadvantages of Infrared lamp (3)
- Difficult to ensure uniform heating in all tx areas
- Difficult to localize to a specific tx area
- Tends to dry skin more than other agents
Advantages to Paraffin (4)
- Low specific heat allows for application at higher temps than water
- Low thermal conductivity allows for slower heating of tissues which reduces the risk of overheating
- Maintains good contact with controured areas
- Oils used add moisture to the skin
Disadvantages of Paraffin (3)
- Effective only in distal extremities
- Risk of cross-contamination if the paraffin is reused
- Cannot be used over an open skin lesion
Advantages to Diathermy (5)
- Capable of reaching deeper tissues
- Can produce thermal and nonthermal effects
- Covers large areas
- Heat is applied in a more uniform fashion
- Rate of tissue cooling is slower than other agents
Disadvnatages of Diathermy (3)
- Difficult to targe small tx areas
- Requires pt to subjectively classify their heat sensation response
- Relatively large # of contraindications
Advantages to ultrasound (5)
- Cpable of reaching deeper tissues
- Can produce thermal and nonthermal effects
- Amount of energy delivered per unit area can be quantified
- Covers small areas effectively
- Shourt duration of tx
Disadvantages of Ultrasound (3)
- May not maintain good contact on small or contoured areas, causing uneven heating
- Pt may not tolerate direct contact with the transducer
- Rate of tissue cooling is faster than other agents
Advantages or disadvantages of:
- Temp and agitation of the dry particles can be controlled
- Pt can perform active exercise during tx
- Minimal pressure applied to the tx area
- Can be used for desensitization of distal extremities
Advantages of Fluidotherpay (4)
Advantages or disadvantages of:
- Constant heat source can result in overheating
- Some pts are intolerant of the dry particles and the enclosed container
- Some units require the extremity to be in a dependent position
Disadvantages of Fluidotherapy (3)
Advantages or disadvantages of:
- Moist, comfortable heat
- Variety of shapes and sizes
- Available for home use
Advantages to Hot pack (3)
Advantages or disadvantages of:
- May not maintain good contact on small or contoured areas
- Pt may not tolerate the weight of the pack
- difficult to observe target area directly during tx
Disadvantages to Hot Pack (3)
Advantages or disadvantages of:
- Target area can be observed during tx
- Does not require direct contact with the tx area
Advantages of Infrared Lamp (2)
Advantages or disadvantages of:
- Difficult to ensure uniform heating in all tx areas
- Difficult to localize to a specific tx area
- Tends to dry skin more than other agents
Disadvantages of Infrared lamp (3)
Advantages or disadvantages of:
- Low specific heat allows for application at higher temps than water
- Low thermal conductivity allows for slower heating of tissues which reduces the risk of overheating
- Maintains good contact with controured areas
- Oils used add moisture to the skin
Advantages to Paraffin (4)
Advantages or disadvantages of:
- Effective only in distal extremities
- Risk of cross-contamination if the paraffin is reused
- Cannot be used over an open skin lesion
Disadvantages of Paraffin (3)
Advantages or disadvantages of:
- Capable of reaching deeper tissues
- Can produce thermal and nonthermal effects
- Covers large areas
- Heat is applied in a more uniform fashion
- Rate of tissue cooling is slower than other agents
Advantages to Diathermy (5)
Advantages or disadvantages of:
- Difficult to targe small tx areas
- Requires pt to subjectively classify their heat sensation response
- Relatively large # of contraindications
Disadvnatages of Diathermy (3)
Advantages or disadvantages of:
- Cpable of reaching deeper tissues
- Can produce thermal and nonthermal effects
- Amount of energy delivered per unit area can be quantified
- Covers small areas effectively
- Shourt duration of tx
Advantages to ultrasound (5)
Advantages or disadvantages of:
- May not maintain good contact on small or contoured areas, causing uneven heating
- Pt may not tolerate direct contact with the transducer
- Rate of tissue cooling is faster than other agents
Disadvantages of Ultrasound (3)
Ultraviolet light
Divided into UV-A, UV-B, UV-C according to wavelength and location on the electromagnetic spectrum
Absorbed 1-2 mm into the skin
Most commonly used to tx skin disorders
Therapeutic effects of Ultraviolet Light (6)
- Bacteriocidal effects
- Exfoliation
- Facilitate healing
- Increased pigmentation
- Thickening of the epidermis
- Vitamin D production
Indications for Ultraviolet Light (6)
- Acne
- Chronic ulcer/wound
- Osteomalacia
- Psoriasis
- Sinusitis
- Vitamin D deficiency
Contraindications for Ultraviolet Light (8)
- Areas receiving radiation
- DM
- Herpes simplex
- Pellagra
- Photosensitive medications
- Skin cancer
- Systemic lupus erythematosus
- Tuberculosis
Hydrotherapy
Transfers heat through conduction or convention and is administered in tanks
Therapeutic effects of Hydrotherapy (7)
- Decreased abnormal tone
- Increased blood flow
- Increased core temp
- Pain relief
- Relaxation
- Vasodilation
- Wound debridement
Indications for hydrotherapy (11)
- Arthritis
- Burn care
- Edema
- Decreased ROM
- Desensitization of residual limb
- Joint stiffness
- Muscle spasm/spasticity
- Muscle strain
- Pain
- Sprain
- Wound care
Contraindications for Hydrotherapy (11)
- Advacned cardiovascular/pulmonary disease
- Active bleeding
- Diminished sensation
- gangrene
- Impaired circulation
- Incontinence
- Maceration
- Peripheral vascular disease
- Renal infection
- Severe infection
- Severe mental disorders
Properties of Water (6)
- Buoyancy
- Resistance
- Specific Gravity
- Specific Heat
- Total Drag Force
- Viscosity
Bouyancy
Archimedes’ prciiple
There is an upward force on the body when immersed in water equal to the amount of water that has been displaced by the body
Resistance
Water molecules attraction towards each other creates ________ to movement
Increases in proportion to the speed of motion
Specific Gravity
______ of water = 1.0
Human body is typically
therefore, a person will generally flote when fully submerged in water
Specific Heat
Measure of the ability of a fluid to store heat
Water retains heat 1,000x mroe than an equivaltent volume of air
Total drag force
Comprosed of profile drag, wave drag, surface drag forces
Hydromechanic force exerted on a person submered in water that normally opposes the direction of the body’s motion
Viscosity
Magnitude of the cohesive forces between the molecules specific to the fluid
Archimedes’ prciiple
There is an upward force on the body when immersed in water equal to the amount of water that has been displaced by the body
Bouyancy
Water molecules attraction towards each other creates ________ to movement
Increases in proportion to the speed of motion
Resistance
______ of water = 1.0
Human body is typically
therefore, a person will generally flote when fully submerged in water
Specific Gravity
Measure of the ability of a fluid to store heat
Water retains heat 1,000x mroe than an equivaltent volume of air
Specific Heat
Comprosed of profile drag, wave drag, surface drag forces
Hydromechanic force exerted on a person submered in water that normally opposes the direction of the body’s motion
Total drag force
Magnitude of the cohesive forces between the molecules specific to the fluid
Viscosity
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
32-79°F
Acute inflammation of distal extremities
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
79-92°F
Exercise
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
92-96°F
Wound care, spasticity
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
96-98°F
Cardiopulmonary compromise
Tx of burns
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
99-104°F
Pain Management
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
104-110°F
Chronic rheumatoid or OA
increase ROM
What temp is suggested to for this purpose?
Acute inflammation of distal extremities
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
32-79°F
What temp is suggested to for this purpose?
Exercise
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
79-92°F
What temp is suggested to for this purpose?
Wound care, spasticity
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
92-96°F
What temp is suggested to for this purpose?
Cardiopulmonary compromise
Tx of burns
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
96-98°F
What temp is suggested to for this purpose?
Pain Management
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
99-104°F
What temp is suggested to for this purpose?
Chronic rheumatoid or OA
increase ROM
Hydrotherapy Tx temp Guidelines:
Tx purpose if -
104-110°F