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Physical Agents > Principles of thermal energy: Cryotherapy > Flashcards

Principles of thermal energy: Cryotherapy Flashcards

1
Q

Cryotherapy outside rehab used for:

A

Destruction of malignant and non-malignant tissue growths

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2
Q

Cryotherapy during rehab used for:

A
  • Control inflammation
  • control pain
  • control edema
  • reduce spasticity
  • control symptoms of MS
  • facilitate movement
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3
Q

Cryotherapy effects the following body systems

A
  • Hemodynamic (blood)
  • neuromuscular
  • metabolic
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4
Q

Cryotherapy hemodynamic direct effects

A

Cold applied to the skin will cause immediate constriction of cutaneous vessels and a reduction in blood flow

  • stimulation of cutaneous cold sensors directly stimulates smooth muscle in vessel walls to contract causing constriction
  • stimulation of cutaneous cold sensors directly decreases production and release of vasodilator mediators (histamine & prostaglandins)
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5
Q

cryotherapy hemodynamic indirect effects

A

Indirectly there is a reflex activation of sympathetic adernergic neurons resulting in vasoconstriction

  • reduce blood flow by increasing viscosity
  • helps keep core temp from falling
  • results in greater local cooling
  • vasoconstriction persists as long as application time is less than 15-20 mins
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6
Q

Cryotherapy hemodynamic effects: later increase in blood flow (CIVD)

A
  • CIVD= cold induced vasodilation
  • occurs when cold is applied for extended periods of time or if temp reaches less than 10 degree C (50 degree F)
  • reflex hyperemia with removal of cold source due to vasodilation to rewarm tissue
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7
Q

Hunting response

A

Process of alternating vasoconstriction and vasodilation in extremities exposed to the cold

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8
Q

Cryotherapy hemodynamic effects: erytherma

A

Reddening of skin secondary to cold application

  • due to increase in oxyhemoglobin concentration in blood
  • decrease in oxygen-hemoglobin dissociation
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9
Q

Cryotherapy hemodynamic effects: oxygen-hemoglobin dissociation curve

A
  • 43 degree C shifts curve right

- 20 degrees C shift curve left

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10
Q

Neuromuscular effects: four stages of Cold

A

CBAN

  • cold (intense)
  • burning
  • Aching
  • Numbness
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11
Q

Neuromuscular effects: decreased nerve conduction velocity (NCV)

A
  • NCV decreases in proportion to the degree and duration of the temp change
  • decreased NCV will occur with superficial cooling for 5 minutes
  • recovery time for NCV depends upon cooling time
    • 5 minutes cooling reverses in 15 minutes
    • 20 minutes reverses in 30 mins or longer
  • cold most inhibits myelinated, small diameter fibers (a-beta)
  • cold least inhibits large, unmyelinated fibers
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12
Q

Neuromuscular effects: increased pain threshold

A
  • Counter irritant via the gate control mechanism
  • reduction of muscle spasm
  • sensory NCV inhibition
  • decreased rate of reactions associated with acute inflammation (reduce secondary injury)
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13
Q

Neuromuscular effects: altered muscle strength after 5 mins of cooling

A
  • Isometric muscle strength increases directly after 5 minutes of cooling
    • facilitate motor nerve excitability
    • increase psychological motivation to move
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14
Q

Neuromuscular effects: altered muscle strength after 30 mins cooling

A
  • Isometric strength decreases initially after 30 mins of cooling then increases one hour later to greater than precooling strength
    • decreased blood flow to muscle
    • slowed motor nerve conduction
    • increased muscle viscosity
    • increased joint and soft tissue stiffness
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15
Q

Neuromuscular effects: Decreased spasticity

A
  • Decreased gamma motor neuron activity
    • reflex action to the stimulation of cutaneous cold receptors
  • decreased afferent spindle and GTO activity after 10-30 mins of cooling
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16
Q

Neuromuscular effects: facilitation of muscle contraction

A
  • Brief application of cold (seconds) may stimulate alpha motor neurons in pts with upper motor neuron lesion
  • response is short lived
17
Q

Metabolic effects:

A

Decreased metabolic rate

  • decreases metabolic reactions involved in the inflammatory processes
  • Decreases activity of collagenage, elastase, hyaluronidase, and protease (cartilage degrading enzymes)
    • reccomended for treating OA and RA
18
Q

Cryotherapy: ice

A

Limits secondary injury

  • decreased blood flow theory
  • decreased secondary injury theory
    • metabolic- O2 debt due to ischemia-ice decreases metabolism
    • chemical- ice limits permeability thus leakage of protein rich fluid into tissue thus edema formation
19
Q

Cryotherapy indications

A
  • immediate care of musculoskeletal injuries
  • edema control
  • pain control
  • modification of spasticity
  • symptom management in MS
  • emergency care for small burns
  • limitations in ROM secondary to pain
20
Q

Cryotherapy contraindications

A
  • impaired circulation (PVD)
  • cold hypersensitivity or cold-induced urticaria
  • Raynaud’s disease or phenomenon
  • hypertension
  • over a regenerating peripheral nerve
  • Paroxysmal cold hemoglobinuria
  • cryoglobulinemia
  • decreased cold sensitivity
  • open wound after 40-72 hours
21
Q

Cold/ice pack, ice massage, cold baths, and cryokinetics, and controlled cold compression classification

A

Infrared modality emitting electromagnetic radiation
-wavelength approx 111,000A
- Frequency approx 2.7 x 10^12 Hz
Thermal modality used to provide a superficial cooling of tissue
- maximum depth of penetration- 1cm
- cools via conduction

22
Q

Cold/ice pack description

A
  • Crushed ice pack in leak proof container generally near 30 degree F
  • Commercial ice pack- filled with hydrated gel
  • cooled in refrigerated unit to between 0-12 degree for at least 30 mins
  • easily conform to body part and hold cold for extended periods of time
  • not as effective as ice at lowering body temp
23
Q

Ice massage description

A
  • The application of cold by rubbing ice over a part of the body
  • ice should be smooth with rounded edges
  • may use frozen water in paper cup or cryocup
24
Q

Cold Bath description

A
  • can also be called ice immersion
  • placing a body part to be treated in water ranging from cold to icy
  • temps of water depends on the condition being treated
  • can be easily done on extremities
25
Q

Cold bath temperature ranges

A
  • cool 67-80 degrees F (19-27 degree C)
  • cold 55-67 degrees F ( 13-19 degree C)
  • very cold 32-55 degree F (0-13 degree C)
26
Q

Cryokinetics description

A
  • The application of cryotherapy to a part so as to numb the part prior to exercise
  • Patient must be able to differentiate between them
  • pre-existing pain
  • ice induced pain
  • exercise induced pain
27
Q

Controlled cold compression description

A
  • A nylon sleeve that connects via a tube to a one gallon cooler/jug
  • cool water flows from the cooler to a sleeve that is wrapped securely around a body part
  • water temp generally between 50-77 degree F
  • Will reduce swelling as well as control for secondary injury new swelling

Physical Agents (21 decks)

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