S1_L2: Superficial Cold and Heat Flashcards
TRUE OR FALSE: Cryotherapy is used as a first-aid measure after trauma. Cooling is accomplished by removing or abstracting heat from an object, rather than by adding cold.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Source: Michlovitz
The following statements are true about cryotherapy, EXCEPT:
A. Used to decrease the temperature of soft tissues
B. Used to increase the temperature of soft tissues
C. Used only as an adjunctive tool in the rehabilitation of musculoskeletal dysfunctions
D. Used in the rehabilitation of neuromuscular dysfunctions
E. None of the above
B. Used to increase the temperature of soft tissues
Match the following effects of cold.
- ↓ Spasticity
- ↓ Histamine level
- ↑ Pain threshold
- ↓ Nerve Conduction Velocity
- Hunting Response
A. Hemodynamic
B. Neuromuscular
C. Metabolic
- B
- C
- B
- B
- A
TRUE OR FALSE: Upon application of cryotherapy, there is an initial decrease in blood flow, followed by an increase in blood flow.
True
↓ blood flow and tissue metabolism results in (1)_____ in bleeding and (2)____ in inflammation.
A. increase; decrease
B. increase; increase
C. decrease; increase
D. decrease; decrease
D. decrease; decrease
Cold makes blood is more viscous. A decrease in blood flow decreases production and release of vasodilators.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
This is the alternating vasoconstriction and vasodilation happening during a long application of cold to the body. It is thought off as a safety feature of the body that happens to protect tissue from damage
Hunting Response
Cold has the greatest effect on conduction by (1)____ fibers and the least effect on conduction by (2)_____ fibers.
A. myelinated and large ; unmyelinated and small
B. myelinated and small ; unmyelinated and large
C. unmyelinated and small ; unmyelinated and large
D. unmyelinated and small ; myelinated and large
B. myelinated and small ; unmyelinated and large
Source: Cameron
Cryotherapy can (1)____ the pain threshold and (2)____ the sensation of pain
A. increase; decrease
B. increase; increase
C. decrease; increase
D. decrease; decrease
A. increase; decrease
TRUE OR FALSE: strength testing should be performed before cryotherapy application.
True
This is because muscle strength can be temporarily influenced by cryotherapy.
Prolonged cooling for ___ to ___ minutes can reduce spasticity for the following 60 to 90 minutes
10 to 30
Source: Cameron
Application of cryotherapy by 5 minutes or more may (1)____ tone. Application of cryotherapy using quick icing or brief cooling may (2)____ tone.
A. increase; decrease
B. increase; increase
C. decrease; increase
D. decrease; decrease
C. decrease; increase
What motor neuron is facilitated in brief application of cryotherapy?
alpha motor neuron
Source: Cameron
What motor neuron is facilitated in long cooling application of cryotherapy?
gamma motor neuron
Source: Cameron
Cold decreases local metabolic rate and therefore can slow inflammatory activity. Cold is not recommended when healing is delayed as it will prolong the healing process
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Enumerate the methods of heat LOSS.
Respiration, Radiation, Evaporation, Convection, Conduction
Match the examples of the following methods of heat loss
- Sweating
- Exhalation
- Placing an ice pack
- Immersing foot in water
- Through air
A. Respiration
B. Radiation
C. Evaporation
D. Convection
E. Conduction
- C
- A
- E
- E
- D
Cryotherapy may reduce the severity of delayed-onset muscle soreness (DOMS). It is used as a symptom management for multiple sclerosis
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Cryotherapy is not used when burns are in the acute stage. It is also contraindicated in pts c Raynaud’s disease
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
_______ is the application of a cooling agent before stretching.
Cryostretch
_______ is a technique that combines the use of cold and exercise to treat pathology or disease.
Cryokinetics
TRUE OR FALSE: When a pt has a history of being hypertensive, a PT must take precaution in applying cryotherapy.
True
Enumerate the 4 stages of sensation upon application of cryotherapy
- Cold
- Burning
- Aching
- Numbness/Analgesia
When using cryotherapy to control inflammation on the extremities, apply for no longer than ____ minutes at least ____ hour/s apart
- 15
- 1
Source: Cameron
TRUE OR FALSE: Superficial heating agents do not heat to the depth of most muscles. To heat deep muscles, use exercise or deep-heating modalities such as ultrasound or diathermy.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Source: Cameron
Nerve conduction velocity increase by (1)___ m/s for every (2)____ºC rise
- 2
- 1
Determine the LAW being described when applying radiation.
Intensity of radiation is inversely proportional to the distance squared
Inverse Square Law
Determine the LAW being described when applying radiation.
Intensity and duration of the dose of radiant energy is inversely proportional
Bunsen Roscoe Law of Reciprocity
Determine the LAW being described when applying radiation.
There is an optimal amount of energy absorption per unit time for beneficial results to be expected
Arndt-Schultz Principles
Determine the LAW being described when applying radiation.
Waves must be absorbed to be induce chemical processes/changes
Law of Grothus Draper
NOTE: This is also known as the Principle of Chemical Activation
Determine the LAW being described when applying radiation.
Optimum radiation occurs when the source is perpendicular (right angle) to the center of the surface to be radiated
Lambert’s Cosine Law
NOTE: This is also known as the Right Angle Law
_____ is the use of electrical current to facilitate the delivery of specific drugs and ions to reduce tissue inflammation, decrease local pain, reduce calcium deposits, and reduce scar restrictions
Iontophoresis
Categorize the following findings in the application of cold.
- Open wound
- Inflammation
- Edema
- Over a regenerating peripheral nerve
- Over the superficial main branch of a nerve
A. Indication
B. Precaution
C. Contraindication
- B
- A
- A
- C
- B
TRUE OR FALSE: Applying a cold pack after a hot pack improves passive ROM (PROM) in patients with restricted knee ROM more effectively, rather than applying a hot pack alone.
True
Source: Cameron
This technique involves applying a cooling agent to the point of numbness shortly after an injury to reduce the sensation of pain, enabling the patient to exercise and work toward regaining range of motion (ROM) as early as possible
A. Cryokinetics
B. Cryostretch
A. Cryokinetics
The purpose of this sequence of treatments is to reduce muscle spasm
A. Cryokinetics
B. Cryostretch
B. Cryostretch
This approach is most commonly used to rehabilitate athletes.
A. Cryokinetics
B. Cryostretch
A. Cryokinetics
Explain how cryokinetics is performed.
- cold is applied for up to 20 minutes or until the patient reports numbing
- patient performs strengthening and stretching exercises for 3 to 5 minutes until sensation returns
- sequence is repeated for five times
______ is an uncommon disorder characterized by the aggregation of serum proteins in the distal circulation when the distal extremities are cooled.
Cryoglobulinemia
This reaction is marked by the transient appearance of smooth, slightly elevated patches, which are redder or more pale than the surrounding skin and are often attended by severe itching.
Cold Hypersensitivity/ Cold-induced Urticaria
_____ is a condition in which hemoglobin from lysed red blood cells is released into the urine in response to local or general exposure to cold.
Paroxysmal cold hemoglobinuria
_____ is a paroxysmal digital cyanosis resulting from some regional or systemic disorder.
Raynaud disease
TRUE OR FALSE: Too much exposure to radiation causes heat. Less exposure to radiation promote heat loss.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
The following are indications for cryotherapy, EXCEPT:
A. Inflammation Control
B. Edema Control
C. Pain Control
D. Modification of Spasticity
E. None of the above
E. None of the above
The following are indications for cryotherapy, EXCEPT:
A. Facilitation of Tone
B. Inhibition of Tone
C.
D.
E. None of the above
The following are indications for cryotherapy, EXCEPT:
A. Desensitization
B. Conjunction with deep friction massage
C. Conjunction with joint mobilization
D. Conjunction with strenuous workouts
E. None of the above
E. None of the above
Why is cryotherapy contraindicated to be applied directly over a regenerating peripheral nerve?
results to local vasoconstriction or altered nerve conduction that results to a delay in nerve regeneration
TRUE OR FALSE: Poor sensation or mentation becomes a contraindication in applying cryotherapy.
False
a PT must only take precautionary measures
TRUE OR FALSE: Extreme ages of patients is a precaution in applying cryotherapy.
True
Determine the time of application for the following cryotherapy modalities.
- whirlpool
- iced towel
- quick icing
A. 3 times
B. 3-5 mins
C. 10-15 mins
D. 10-20 mins
E. 5-15 mins
- E
- C
- A
Determine the time of application for the following cryotherapy modalities.
- chemical cold packs
- ice massage
- ice packs
A. 3-5 seconds, 3x
B. 3-5 mins
C. 10-15 mins
D. 10-20 mins
E. 5-15 mins
- C
- B
- D
- Convenient for emergency use
- Used primarily in patients with CNS disorder
A. cold packs
B. ice packs
C. ice massage
D. quick icing
E. chemical cold packs
- E
- D
- Usually done over a small area before deep pressure massage
- Technique developed by Rood
A. cold packs
B. ice packs
C. ice massage
D. quick icing
E. chemical cold packs
- C
- D
- Usually effective on flaccid/hypotonic muscles only
- Rapid application of ice as a stimulus to elicit desired motor patterns
A. cold packs
B. ice packs
C. ice massage
D. quick icing
E. chemical cold packs
- D
- D
- Indicated for conditions in which exercise of the injured part during cold treatment is desired
- Most practical if cooling of the distal extremities is desired
A. cold baths
B. cold whirlpool
C. vapocoolant spray
- B
- A
- Most intense application of cold
- Used for trigger points
A. cold baths
B. cold whirlpool
C. vapocoolant spray
- B
- C
- used to increase ROM
- Ensures circumferential cooling of the extremities
A. cold baths
B. cold whirlpool
C. vapocoolant spray
- C
- A
Enumerate the methods of heat GAIN.
- Conduction
- Convection
- Radiation
How many layers of towel must a hot moist pack be wrapped with?
6-8 layers
The following are ADVANTAGES of ICE OR COLD PACKS, EXCEPT:
A. Low level of skill required for application
B. Covers small areas
C. Can be used for POLICE principle
D. Can be applied to elevated limb
E. None
B. Covers small areas
It may cover moderate to large areas, which is its advantage.
The following are ADVANTAGES of ICE MASSAGE, EXCEPT:
A. For small, irregular areas
B. Treatment area can be observed during application
C. Clinician has an active participation throughout application
D. Can be applied to an elevated limb
E. None
C. Clinician has an active participation throughout application
The following are ADVANTAGES of a COLD COMPRESSION UNIT, EXCEPT:
A. Temperature and compression force are easily and accurately controlled
B. Can be applied on large joints
C. Can be applied on trunk and digits
D. Allows simultaneous application of cold and compression
E. None
C. Can be applied on trunk and digits
The following are ADVANTAGES of FLUIDOTHERAPY, EXCEPT:
A. Easy application
B. Free limb movement
C. Circumferential heating
D. Constant heating pattern
E. None
A. Easy application
TRUE OR FALSE: HMPs have a circumferential heat distribution. During application, no limb movement is allowed.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
It has a radial heat distribution
TRUE OR FALSE: Fluidotherapy is limited to the extremities only. Both HMP and PWB required toweling upon application.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Which of the following the direct hemodynamic effect of cold?
A. smooth muscle contractions
B. reflex activation of sympathetic adrenergic neurons
C. Both
D. Neither
A. smooth muscle contractions
NOTE: Option B is the INDIRECT effect
TRUE OR FALSE: Cold-Induced Vasodilation (CIVD) happens after prolonged application of cold temperature
True
_____ fibers, which are small-diameter, myelinated, pain transmitting fibers, undergo the greatest decrease in conduction velocity in response to cooling.
a-delta
Which nerve fiber is responsible for chronic pain?
c fibers
Which nerve fiber is responsible for acute pain?
a-delta
This concept is based on counterirritation via the gate control mechanism and reduction of muscle spasm, slowing of sensory nerve conduction velocity, or reduction of postinjury edema
Gate Control Theory
Application of cold for less than or equal to 5 minutes result in _____ strength
increase
Application of cold for more than or 5 minutes result in _____ strength
decrease
Application of cold Inhibits activity of (1)_____ enzymes for OA pts and reduces level of (2)____ in the blood for RA pts
- cartilage-degrading
- histamine
What Mnemonic is used as a principle in applying cold? Name all.
MNEMONIC: PRICES
Protection
Rest
Ice
Compression
Elevation
Stabilization
NOTE: use POLICE to add optimal loading
When applying a vapocoolant spray, the bottle must be (1)____ and held at an (2)____ angle approximately (3)____ cm from the skin at a rate of (4)_____ cm/sec
- upright
- acute (or >30)
- 30-45
- 10 (or 4 inches/sec)
Determine which is documented correctly.
A. Cryotherapy using cold-gel packs on (R) posterior buttocks in supine x 10 mins to decrease inflammation
B. Cryotherapy using
C. Cryotherapy using
D. All
E. None
CORRECT FORMAT: Cryotherapy using <application> on <body area> in <position> x <duration> to <rationale></rationale></duration></position></application>
Cryotherapy yields more on what kind of pain?
acute
Cryotherapy (1)_____ gamma motor activity and (2)_____ afferent spindle & GTO activity.
A. increase; decrease
B. increase; increase
C. decrease; increase
D. decrease; decrease
D. decrease; decrease
This method of energy transfer happens when 2 surfaces of different temperatures come into contact w/ one another, then heat is lost to balance temperature.
Conduction
The following conditions makes cryotherapy contraindicated, EXCEPT:
A. Cold-induced Urticaria
B. Cold Intolerance
C. Cold Hypersensitivity
D. Cryoglobulinemia
E. None
E. None
The following conditions makes cryotherapy contraindicated, EXCEPT:
A. Paroxysmal Cold Hemoglobinuria
B. Peripheral Vascular Disorder (PVD)
C. Koebner’s Phenomenon
D. Raynaud’s Phenomenon
E. None
C. Koebner’s Phenomenon
A tissue must not be cooled to (1)_____ degrees Celsius to prevent tissue death from ischemia
15
TRUE OR FALSE: Spasm is being reduced by cold temperature. Quick cryotherapy facilitates gamma motor neurons
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
It facilitates alpha motor neurons for flaccid muscles
Delayed-Onset Muscle Soreness (DOMS) occurs (1)______ after exercise due to (2)______
- 24-48 hours
- lactic acid accumulation
TRUE OR FALSE: Cryotherapy reduces effects of DOMS
True
TRUE OR FALSE: Cryotherapy is not indicated when edema is caused by poor circulation.
True
TRUE OR FALSE: Raynaud phenomenon may be associated with thoracic outlet syndrome, carpal tunnel syndrome, or trauma.
True
Lowering skin-surface temperature to _____ is sufficient to produce local analgesia
13.6°C (56.5°F)
Source: Michlovitz
This is a disorder c cyanotic changes on distal extremities and usually affects small arteries. it arises from cold exposure or too much stress.
Raynaud’s Disease
Cold packs are filled with a gel covered with (1)____. Gel becomes (2)_____ at 0-5ºC, thus making it have a better conformity to body, resulting in equal distribution
- vinyl
- semi-solid
What ratio of water and rubbing alcohol may be used as an alternative to cold packs
4: 1 (water : rubbing alcohol)
TRUE OR FALSE: In performing ice massage, skin temperature will not drop below 25ºC because you are continuously moving the modality.
False
it drops until 15 degrees
What is the recommended temperature range when using a controlled cold compression unit?
10-25 ºC
_____ and _____ technique is used to treat trigger points by spraying a vapocoolant spray in parallel strokes along the skin overlying the muscle with the trigger points and then immediately stretching the muscle
Spray and stretch
TRUE OR FALSE: Ethyl chloride is the recommended chemical formula used in vapocoolant sprays
False
Ethyl chloride is no longer recommended (flammable)
To increase ROM using a vapocoolant spray, the entire length of the muscle should be covered (1)____x at a rate of (2)_____ cm/sec.
- 2-3
- 10
Identify the two kinds of technique using quick icing and its parameters.
- A-icing: 3 swipes; wipe water after every swipe
- C-icing: hold ice for 3-5 seconds, 3x; wipe water after
Chemical cold packs should remain in tank at least (1)____ hours before the first use and at least (2)____ minutes for subsequent uses
- 24
- 30
________ are frequently used clinically when the treatment goal is to achieve the benefits of heat, including decreased pain and increased flexibility, while avoiding increased edema.
Contrast baths
- Small and gradual rise in temperature
- 3x108 m/s velocity
- 1400-3000 nm wavelength
- Long/ Far
- 1-3 mm penetration
A. Luminous IRR
B. Non-Luminous IRR
C. Both
D. Neither
- B
- C
- B
- B
- A
- More perspiration
- Extends until the Epidermis and dermis
- Short MIRE
- IRA
- Extends until the Stratum corneum
A. Luminous IRR
B. Non-Luminous IRR
- A
- A
- A
- A
- B
NOTE: MIRE stands for Monochromatic Infrared Energy
Match the effects of HEAT.
- NCV
- Pain threshold
- Muscle strength
- Firing Rate
- Metabolic Rate
A. Increase
B. Decrease
- A
- A
- B
- B
- A
Heat decreases strength. However, it normalizes strength >30 minutes, as pain threshold has already increased
Heat increases local metabolic rate and therefore can exacerbate ______.
inflammation
TRUE OR FALSE: Heat increases tissue extensibility. This is achieved when tissue heating is maintained at 40ºC-45ºC for 5-10 mins
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
True
Hot moist packs are usually made of (1)_____ (hydrophilic silicate gel) covered with (2)_____
- bentonite
- canvas
HMPs are stored in (1)_____ tanks at 70ºC to 75ºC. Initial heating must be done for (2)____ hrs, while reheating must be done for (3)_____ mins
- hydrocollator
- 2
- 30
What is the expected intensity and recommended duration of HMPs?
Mild comfortable moist warmth c 15-20 minutes
Using a new terry cloth with be equivalent to how many layers of towel?
4
Using an old terry cloth with be equivalent to how many layers of towel?
2
The following is a CONTRAINDICATION in using superficial heating modalities, EXCEPT:
A. Recent hemorrhage
B. Thrombophlebitis
C. Metal in the area
D. Erythema ab igne
E. None
D. Erythema ab igne
This is only specific to IRR
The following is a PRECAUTION in using superficial heating modalities, EXCEPT:
A. Acute injury or inflammation
B. Pregnancy
C. Impaired circulation
D. Edema
E. None
E. None
Which of the following is a CONTRAINDICATION in using IRR:
A. Malignant tumor
B. Cardiac insufficiency
C. Acute dermal conditions
D. Superficial metals in the area
E. None
B, C, D
NOTE: A is for superficial modalities
Enumerate the 3 possible adverse effect of heat.
- burn injuries
- blister formation
- blanching skin
Which of the following is a PRECAUTION in using superficial heating modalities:
A. Metal close to the target area
B. Demyelinated nerves
C. Over areas with recently applied topical counterirritants
D. Poor thermal regulation
E. Impaired sensation
All
What is the parameters used for contrast bath?
- Hot (3-4 mins) → Cold (1 min)
- Repeat the cycle for 5-6 times
- total duration: 25-30 mins
- End with warm water
Choose the temperature used for Contrast Bath for warm water.
A. 30-36ºC
B. 34-37.5ºC
C. 38-44ºC
D. 40-44ºC
C. 38-44ºC
Choose the temperature used for Contrast Bath for cold water.
A. 10-18ºC
B. 12-21ºC
C.10-28ºC
D.14-24ºC
A. 10-18ºC
Heat has a (1)_____ effect d/t release of (2)_____ and (3)_____
- vasodilatory
- histamine
- prostaglandins
What is the direct effect of heat when cutaneous receptors become activated?
relax smooth muscles of blood vessels
this happens through the release of nitrous oxide w/ help of bradykinin
What is the indirect effect of heat when cutaneous receptors become activated?
activation of spinal cord reflexes
this decreases sympathetic adrenergic activity, resulting in vasodilation
What is the direct effect of heat on an individual’s pain threshold?
Gating effect and activation of a-beta fibers
What is the indirect effect of heat on an individual’s pain threshold?
↓ ischemia and muscle spasm, breaking pain-spasm-pain cycle
Upon using head, firing rate of type II muscle spindle efferents & gamma efferents _____, while firing rate of type Ib (GTO) _____.
A. increase; decrease
B. increase; increase
C. decrease; increase
D. decrease; decrease
C. decrease; increase
What is the Paraffin wax to mineral oil ratio?
6:1 or 7:1
TRUE OR FALSE: PWB has low specific heat and low thermal conductivity of the wax
True
What is the parameters for using dip and wrap method when applying PWB?
6-10 dips
What is the parameters for using dip immersion method when applying PWB?
20 mins
What is the total duration of using PWB?
20-30 mins
What method of heat transfer is used in fluidotherapy?
convection
IR lamps emit electromagnetic radiation with a wavelength of 770 to 106 nm lying between the (1)____ and (2)____
- visible light
- microwaves
Angle of rays during application of IRR must be?
perpendicular
TRUE OR FALSE: Luminous IRR must be warmed up for 5-10 minutes
False.
This is used immediately while non-luminous IRR are preheated.
What are the 3 main indications in using IRR?
- Psoriasis
- Pressure sores
- ↓ skin impedance(adjunct to ES)
TRUE OR FALSE: The warmth of the sun’s rays is a well-known example of heat transfer via ultraviolet energy.
True
Source: Michlovitz
TRUE OR FALSE: superficial heating modalities are indicated to be applied on stiff structures. it is also indicated to accelerate tissue healing
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
TRUE OR FALSE: superficial heating modalities are indicated for acute and subacute conditions. it is also indicated to treat pain and muscle spasm
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
The following are indications for superficial heating modalities, EXCEPT:
A. Stiff structures
B. Muscle spasm
C. Pain
D. Subacute and chronic conditions
E. None
E. None
TRUE OR FALSE: IRR is used as an adjunct to electrical stimulation to prevent electricity from flowing through inside the individual.
True