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PMod > Superficial Cold and Heat > Flashcards

Superficial Cold and Heat Flashcards

1
Q

Cryotherapy came from the word

A

Gk. Cryos=ice,cold + Therapy

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2
Q

Use of ice or cold applications for
therapeutic purposes

A

Cryotherapy

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3
Q

Effects of cold

A

HEMODYNAMIC EFFECTS
NEUROMUSCULAR EFFECTS
METABOLIC EFFECTS

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4
Q

Hemodynamic Effects of Cold

A
  1. Initial Decrease in blood flow
  2. Later Increase in blood flow
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5
Q

Direct decrease in blood flow via Hemodynamic effect of cold

A

dec in temp -> cutaneous thermoreceptor -> smooth muscle contraction -> vasoconstriction -> dec in blood flow

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6
Q

Indirect decrease in blood flow via Hemodynamic effect of cold

A
  1. dec temp -> cutaneous thermoreceptor -> DRG -> inc sympathetic adrenergic activation -> vasoconstriction -> dec. bloodflow
  2. dec. temp -> dec vasodilator (histamine + prostaglandin) release -> vasoconstriction -> de. blood flow
  3. dec. temp -> inc in blood viscosity -> dec blood flow
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7
Q

COLD-INDUCED
VASODILATION (CIVD) aka

A

HUNTING RESPONSE

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8
Q

Neuromuscular effects of cold

A
  1. Decrease in Nerve Conduction
  2. Increase in Pain Threshold
  3. Altered Muscle Strength
  4. Decrease Spasticity
  5. Facilitation of Muscle Contraction
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9
Q

Neuromuscular effects of cold

Decrease in Nerve Conduction (a delta vs c fibers)

A

↑ Effect = myelinated, small fibers (Aδ)
↓ Effect = unmyelinated & large fibers

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10
Q

Neuromuscular effects of cold

Explain Increase in Pain Threshold

A

Gate Control Theory
Interruption of Pain-Spasm Cycle
Reduction of sensory nerve NCV
Reduction of Edema

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11
Q

Neuromuscular effects of cold

Altered Muscle Strength

A

≤ 5 min = increased strength
> 5-30 min = decreased strength

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12
Q

Neuromuscular effects of cold

dec Spasticity

A

↓ gamma motor activity (initial)
↓ afferent spindle & GTO activity (later)

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13
Q

Neuromuscular effects of cold

Facilitation of Muscle Contraction

A

Quick application → facilitate alpha
motorneuron (for flaccid muscles)

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14
Q

Metabolic effects of cold

A

Decreased Metabolic Rate
–Controls acute inflammation
–Inhibits activity of cartilage-degrading enzymes (collagenase, elastase, hyaluronidase & protease) for osteoarthritis (OA)
–Reduced level of histamine in the blood for
rheumatoid arthritis (RA)

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15
Q

Methods of Heat Loss

A

✓ Conduction
✓ Convection
✓ Evaporation
✓ Radiation
✓ Respiration

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16
Q

Uses of Cryotherapy / Indications

A

-Inflammation Control
–Reduce Delayed-Onset Muscle Soreness (DOMS) after exercise
-Edema Control
-Pain Control
-Modification of Spasticity
-Symptom management in Multiple Sclerosis
Facilitation
-Cryokinetics and Cryostretch
-Treatment of acute burns
-Treatment in conjunction with joint mobilization, deep friction massage, strenuous workouts, and rest, compression, and elevation

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17
Q

Contraindications of Cryotherapy

A

Cold Hypersensitivity/Cold-induced Urticaria
Cold Intolerance
Cryoglobulinemia
Paroxysmal Cold Hemoglobinuria
Raynaud’s Disease / Raynaud’s Phenomenon
Over a regenerating peripheral nerve
Over an area with circulatory compromise or
peripheral vascular disorder (PVD)

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18
Q

Precautions of Hydrotherapy

A

Over the superficial main branch of a nerve
Over an open wound
Hypertension
Poor Sensation or Mentation
Extreme Ages of Patients

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19
Q

Adverse Effects of Cold

A

Tissue Death from Ischemia
Frostbite

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20
Q

Application of cryotherapy produces
FOUR STAGES of sensation:

A

Cold
Burning
Aching
Numbness/
Analgesia

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21
Q

PRICES

A

Protection
Rest
Ice
Compression
Elevation
Stabilization

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22
Q

Cryotherapy Application techniques

A
  • COLD PACKS / COLD-GEL PACKS
  • ICE PACKS
  • ICE MASSAGE
  • CONTROLLED COLD COMPRESSION UNIT
  • VAPOCOOLANT SPRAY
  • QUICK ICING/BRIEF ICING
  • CHEMICAL COLD PACKS
  • ICE TOWELS
  • COLD BATHS
  • COLD WHIRLPOOL
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23
Q

Filled with a gel (silica or saline
+ gelatin) covered with vinyl
Gel

A

COLD PACKS / COLD-GEL PACKS

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24
Q

COLD PACKS / COLD-GEL PACKS

Filled with a gel (silica or saline
+ gelatin) covered with vinyl
Gel becomes semisolid at __ deg C
→ better conformity to body
Stored in a freezer at __ deg C (greater than or equal to ___ for initial use; at least ___
minutes for succeeding use)

A

Semisolid: 0-5 deg. C
Stored: -5 deg C
– Initial use: greater than or equal to 2 hours
– Succeeding use: at least 30 min.

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25
Q

Cold packs alternative

A

4:1 (water:rubbing alcohol) at home

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26
Q

Cold Packs Duration

A

10-20 minutes

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27
Q

Crushed ice in a plastic bag

A

ICE PACKS

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28
Q

More aggressive cooling

A

ICE PACKS

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29
Q

Ice Packs Duration

A

10-20 minutes

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30
Q

Advantages of Cold Packs

A

Easy to use
* Inexpensive materials
and equipments
* Brief use of clinician’s
time
* Low level of skill required
for application
* Covers moderate to large
areas
* Can be applied to
elevated limb

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31
Q

Disadvantages of Cold Packs

A
  • Pack must be removed to
    check the area
  • Patient may not tolerate
    the weight of the pack
  • Pack may have
    inadequate contact on
    certain areas
  • Longer duration
    compared to ice massage
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32
Q

Ice Cups or Frozen Water Popsicles

A

ICE MASSAGE

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33
Q

Usually done over a small area before deep
pressure massage

A

ICE MASSAGE

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34
Q

Ice massage

Skin temperature will not drop below __ deg C

A

15

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35
Q

Ice Massage Advantage

A
  • Treatment area can be
    observed during
    application
  • For small, irregular areas
  • Short duration
  • Inexpensive
  • Can be applied to an
    elevated limb
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36
Q

Disadvantage of Ice Massage

A
  • Time-consuming for
    large areas
  • Requires active
    participation by the
    clinician or patient
    throughout the
    application
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37
Q

Cooled water is circulated
through the sleeve which is
applied to the extremity which is
then inflated intermittently

A

CONTROLLED COLD COMPRESSION UNIT

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38
Q

Temperature of Controlled Cold Compression Unit

A

10 - 25°C

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39
Q

Controlled Cold Compression Unit is used for

A

inflammation and edema
post-operatively and in other
circumstances

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40
Q

Advantage of Controlled Cold Compression Unit

A
  • Allows simultaneous application of cold and compression
  • Temperature & compression force are easily and accurately controlled
    -Can be applied in large joints
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41
Q

Disadvantages of Controlled Cold Compression Unit

A
  • Treatment site can’t be seen during treatment
  • Expensive
  • Usable only for extremities
  • Cannot be used for trunk or digits
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42
Q

Types of Vapocoolant Spray

A
  • Ethyl Chloride
  • Fluorimethane
  • Spray and Stretch, Instant Ice & Pain Ease
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43
Q

Vapocoolant that is no longer recommended
(flammable)

A

Ethyl Chloride

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44
Q

Fluorimethane is a combination of:

A

15% dichlorodifluoromethane
85% trichloromonofluoromethane
Non-flammable but has CFC (destroys ozone
layer)

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45
Q

Spray and Stretch, Instant Ice & Pain Ease

A

1,1,1,3,3-pentafluoropropane
1,1,1,2-tetrafluoroethane

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46
Q

Vapocoolant Spray Application

bottle is ___ and held at an
___ angle (__) approximately ___ cm from the skin at a rate of __

A
  • upright
  • acute
    -30 deg
    -30-45 cm
  • 10cm/sec (4inches/sec)
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47
Q

Vapocoolant Spray Application

For trigger points

A

Unidirectional sweep along the muscle with trigger points then over the area of referred pain

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48
Q

Vapocoolant Spray Application

To increase ROM

A

The entire length of the muscle should be covered 2-3x at a rate of 10 cm/sec. If further treatment is required, the skin should be rewarmed first to avoid frosting

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49
Q

Vapocoolant Spray Advantage

A

Brief, localized,
superficial cooling before
stretching

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50
Q

Vapocoolant Spray Disadvantage

A
  • Limited use
  • Requires covering of the
    patient’s eyes, nose and
    mouth when treating
    close to the face
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51
Q

Used primarily in patients with CNS disorder

A

QUICK ICING/BRIEF ICING

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52
Q

QUICK ICING/BRIEF ICING

Quick swipes with an ice cube over the belly of
the involved muscle performed __ times have a facilitatory effect which might occur
immediately or __ minutes after application

A
  • 3-5 x
  • 27-42 min
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53
Q

A-icing:

A

3 swipes; wipe water after every swipe

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54
Q

C-icing:

A

hold ice for 3-5 seconds; wipe water after

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55
Q

Consists of 2 chemical substances, one in a
small vinyl bag within a larger bag

A

Chemical Cold Packs

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56
Q

Convenient for emergency use

A

Chemical Cold Packs

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57
Q

Chemical Cold Packs

Should remain in tank at least __ hours before
the first use and at least __ minutes for
subsequent uses

A

24 hrs, 30 min.

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58
Q

Chemical Cold Packs

Stored in refrigeration tank with temp at ___

A

-12.2 to -9.4 deg C

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59
Q

Duration of Chemical Cold Packs

A

10 - 15 minutes

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60
Q

Terry cloth towel soaked in a bucket of crushed ice or slush mixture

A

Ice Towels

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61
Q

Frozen wet Towels

A

Ice Towels

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62
Q

towels must be changed after __
minutes

A

4-5 min

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63
Q

Duration of ice towels

A

10-15 min

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64
Q

Most practical if cooling of
the distal extremities is
desired

A

Cold Baths

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65
Q

Ensures circumferential
cooling of the extremities

A

Cold Baths

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66
Q

Cold Baths

Water temperature for
immersion varies from

A

13 deg C to 18 deg C

67
Q

Lower temperature is used
in cryokinetics

A

Cold Bath

68
Q

Indicated for conditions in which exercise of the injured part during cold treatment is desired

A

COLD WHIRLPOOL

69
Q

Most intense application of cold

A

COLD WHIRLPOOL

70
Q

Temperature of Cold Whirlpool

A

10-16 deg C

71
Q

Duration of Cold Whirlpool

A

5 - 15 minutes

72
Q

Cryotherapy Documentation

A

P: < Cryotherapy application technique > on < body area > in < position > x < duration > to < rationale >

73
Q

Effects of Heat

A

Hemodynamic Effects
Neuromuscular Effects
Metabolic Effects
Altered Tissue Extensibility

74
Q

Neuromuscular Effects of Heat

A

Inc Nerve Conduction Velocity
Inc Pain Threshold
Altered Muscle Strength
Dec Firing Rate

74
Q

Neuromuscular Effects of Heat

Inc Nerve Conduction Velocity

A

↑ NCV by 2m/s for every 1deg C rise
↓ Conduction latency of nerves

75
Q

Neuromuscular Effects of Heat

Inc Pain Threshold

A

Direct: Gating effect
Indirect: ↓ ischemia and muscle spasm

75
Q

Neuromuscular Effects of Heat

Altered Muscle strength

A

Initial 30 min = decreased strength
> 30 min = strength normalizes

76
Q

Neuromuscular Effects of Heat

Dec Firing Rate

A

↓ firing rate of type II muscle spindle
efferents & gamma efferents
↑ firing rate of type 1b (GTO)

77
Q

Increased rate of endothermic chemical reactions (enzymatic activities)

A

39 deg C - 40 deg C

78
Q

protein constituents of enzymes begin to denature, and enzymatic activity decreases

A

> 45 deg C

79
Q

enzymatic activities cease

A

Beyond 50 deg C

80
Q

enzymatic activities cease

A

Heat Metabolic Effects

81
Q

Increase collagenase activity → destroy articular cartilage (RA)

A

Heat Metabolic Effects

82
Q

Shift of O2-Hgb dissociation curve to the right
Makes O2 available for tissue repair (wound healing)

A

Heat Metabolic Effects

83
Q

__ temp -> __ tissue extensibility

A

Increase

84
Q

– change in organization of the collagen and viscoelasticity of the fibers

A

Soft tissue heating prior to stretching

85
Q

Soft tissue heating Achieved when tissue heating is maintained at

A

40 deg C to 45 deg C for 5-10 min

86
Q

Methods of Heat Gain:

A

✓ Conduction
✓ Convection
✓ Radiation

87
Q

Superficial Heating Modalities

A
  • Hot moist Pack
  • Infrared Radiation
  • Fluidotherapy
  • Paraffin Wax Bath
88
Q

HMP is usually made of

A

bentonite (hydrophilic silicate gel) covered with canvas

**Others (non-Bentonite) are made up of chemical heating pads

89
Q

HMP Storage and Preparation

A

Storage: HMP tank / hydro collator unit at 70 deg C to 75 deg C

Initial Heat:2 hours
Reheat bet uses: 30 min

90
Q

HMP Application

A

Wrap the hot pack in 6-8 layers of dry towels
🞂 Terry cloth (new): equivalent to 4 layers
🞂 Terry cloth (old): equivalent to 1-2 layers
Intensity: Mild comfortable moist warmth
Duration: 15 to 20 minutes

91
Q

Paraffin wax to mineral oil ratio

A

6:1 or 7:1
**To reduce melting temperature from 54deg C to 45deg C-50 deg C

92
Q

Low specific heat and thermal conductivity

A

PWB

93
Q

Advantageous to irregularly contoured areas

A

PWB

94
Q

PWB Storage

A

52 deg to 57 deg container

95
Q

Methods of PWB

A

Dip and wrap – 6-10 dips
Dip immersion – 20 minutes
Paint/Brush method

96
Q

PWB Intensity

A

Mild comfortable moist warmth

97
Q

PWB Duration

A

20 to 30 minutes

98
Q

Dry heating agent

A

Fluidotherapy

99
Q

Heat Transfer Fluidotherapy

A

Convection

100
Q

Fluidotherapy

Cabinet with finely ground cellulose particles made from __

A

corn cobs

101
Q

HMP Advantage

A

Inexpensive
* Easy application

102
Q

HMP Disadvantage

A
  • Declining heating pattern
  • Requires toweling
  • Radial heat distribution
  • No limb movement
    allowed
103
Q

PWB Advantage

A

Inexpensive
* Easy application
* Circumferential heating

104
Q

PWB Disadvantage

A
  • Declining heating pattern
  • Requires toweling
  • No limb movement
    allowed
105
Q

Fluidotherapy Advantage

A
  • Constant heating pattern
  • Circumferential heating
  • Free limb movement
106
Q

Fluidotherapy Disadvantage

A

Expensive
* Limited to extremities
* Bulky device

107
Q

emit electromagnetic radiation with a
wavelength of 770 to 10^6 nm lying between the visible light and microwaves

A

IR Lamps

108
Q

Laws in Applying Radiation

A

Lambert’s Cosine Law / Right Angle Law
🞂 Inverse Square Law
🞂 Law of Grotthuss Draper / Principle of Chemical
Activation
🞂 Arndt-Schultz Principles
🞂 Bunsen Roscoe Law of Reciprocity

109
Q

Optimum radiation occurs when the source is
perpendicular to the center of the surface to be radiated.

A

LAMBERT’S COSINE LAW / RIGHT
ANGLE LAW

110
Q

intensity of radiation is inversely proportional to the distance squared.

A

INVERSE SQUARE LAW

111
Q

Use the head perpendicularly

A

LAMBERT’S COSINE LAW / RIGHT
ANGLE LAW

112
Q

Appropriate distance of the machine for treatment

A

INVERSE SQUARE LAW

113
Q

Waves must be absorbed to be beneficial (induce chemical processes)

A

LAW OF GROTHUS-DRAPER / DRAPER
LAW / PRINCIPLE OF CHEMICAL
ACTIVATION

114
Q

Ensure proper absorption of radiation

A

LAW OF GROTHUS-DRAPER / DRAPER
LAW / PRINCIPLE OF CHEMICAL
ACTIVATION

115
Q

Waves must be absorbed to be beneficial (induce
chemical processes).

A

LAW OF GROTHUS-DRAPER / DRAPER
LAW / PRINCIPLE OF CHEMICAL
ACTIVATION

116
Q

There is an optimal amount of energy absorption
per unit time for beneficial results to be expected

A

ARNDT-SCHULTZ PRINCIPLE

117
Q

Dosage determination (Intensity = warmth)

A

ARNDT-SCHULTZ PRINCIPLE

118
Q

Intensity and duration of the dose of radiant energy
is inversely proportional.

A

BUNSEN-ROSCOE LAW OF
RECIPROCITY

119
Q

Adjustment of parameters in treatment

A

BUNSEN-ROSCOE LAW OF
RECIPROCITY

120
Q

Near IR Desc

A

Short /
Luminous

121
Q

Near IR Wavelength

A

770-1,400 nm

122
Q

Near IR Velocity

A

3x10^8 m/s

123
Q

Near IR Absorption

A

Epidermis and
dermis

124
Q

Near IR Penetration

A

1-3 mm

125
Q

Near IR Rise in Temp

A

Vigorous

126
Q

Near IR Perspiration

A

More

127
Q

Mid/Far IR Desc

A

Long /
Non-luminous

128
Q

Mid/Far IR Wavelength

A

1,400-3,000 nm

129
Q

Mid/Far IR Velocity

A

3x10^8 m/s

130
Q

Mid/Far IR Absorption

A

Stratum corneum

131
Q

Mid/Far IR Penetration

A

0.1 mm

132
Q

Mid/Far IR Rise in Temp

A

Small and gradual

133
Q

Mid/Far IR perspiration

A

Less

134
Q

IRC Wavelength

A

3,000-10^6
nm

135
Q

MIRE

A

Monochromatic Infrared Energy

136
Q

From a glowing source like tungsten or carbon
filament material

A

Luminous IRR

137
Q

From a non-glowing source like
carborundum with metal
reflector

A

Non-luminous
IRR

138
Q

IRR Absorption and angle of rays

A

Perpendicular

139
Q

IRR L Distance

A

45-60 cm / 18-24” (24-36”)

140
Q

IRR NL Distance

A

= 74-91 cm / 29-36” (30-42”)

141
Q

IRR L PRe heat

A

may be used immediately (no warm-up)
OR do 5 minutes warm-up

142
Q

IRR NL Pre heat

A

5-10 minutes warm-upI

143
Q

IRR Intensity

A

Mild, Comfortable, Dry Warmth

144
Q

IRR Duration

A

15-30 min

145
Q

IRR Application

A

–If dry heat is uncomfortable → better to use a wet thin towel over the area that is being treated
–Periodically check for perspiration to avoid -spot burns
–Other areas, including hairs, may be covered with dry towel
–Cover eyes with cotton balls, gauze or goggles if the area to be treated is near or at the face

146
Q

IRR Advantages

A

Does not require any contact
Area can be easily observed
Can be used to treat larger areas

147
Q

Disadvantages of IRR

A

Need for localizer to prevent dispersion of the
radiation heat
Dry heat may be uncomfortable for some patients
Dehydration due to excessive perspiration

148
Q

Indications for all Superficial Heating Mod

A

Subacute and Chronic Conditions
Pain
Muscle spasm
Stiff structures (tissue extensibility)
Accelerate tissue healing (circulation and enzymatic
activities)

149
Q

Indications specific to IRR

A

Pressure sores
Adjunct to electrical stimulation, to 
skin impedance
Psoriasis

150
Q

Contraindications for all Superficial Heating Mod

A

Recent or potential hemorrhage
Thrombophlebitis
Malignant tumor
Metal in the area

151
Q

Contraindications specific to IRR

A

Acute dermal conditions
Superficial metals in the area
Erythema ab igne
Over the eyes
Cardiac insufficiency

152
Q

Precautions for all Superficial Heating Mod

A

Acute injury or inflammation
Pregnancy
Impaired circulation
Poor thermal regulation
Edema
Metal close to the target area
Over areas with recently applied topical counterirritants
Demyelinated nerves
Impaired sensation
Impaired mentation

153
Q

Precautions Specific to IRR

A

🞂 Too much
perspiration

154
Q

Adverse Effect of Heat

A

Burn Injuries
Blister formation

155
Q

Heat Docu

A

<Modality> on <body> in <position> x
<duration> to <rationale>

IRR
<Type> at <distance> on <body> in <position> x <duration> to <rationale>
</rationale></duration></position></body></distance></Type></rationale></duration></position></body></Modality>

156
Q

Hydrotherapy
approach using
warm and cold
water

A

CONTRAST BATH

157
Q

Contrast Bath Temp

A

Warm water: 38-
44degC (100-1110F)
Cold water: 10-18degC
(50-64degF)

158
Q

Contrast Bath Technique

A

Hot (3-4 minutes) →
Cold (1 minute)
Repeat the cycle for
5-6 times → (25-30
minutes)
End with warm
water

159
Q

Contrast Bath Advantage

A

More vigorous circulatory effect
Good contact for distal extremities
Provides pain control without aggravating the edema
Allows movement in water for better circulatory effects

160
Q

Contrast Bath Disadvantage

A

Limb is independent position
Some cannot tolerate cold immersion

161
Q

Contrast Bath Docu

A

Contrast Bath on <body area> in <position> x</position>

<temperature> for warm x <temperature> for cold x <total> to <rationale>
</rationale></total></temperature></temperature>

PMod (10 decks)

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