Superficial heat Flashcards
superficial heat includes
hot packs, paraffin wax bath, contrast bath, fluidotherapy, infrared lamps, whirlpool
indications for using superficial heat
- Promotes soft tissue healing
- Promotes general relaxation
- decrease joint stiffness
- decrease /control pain
- skin conditions
way superficial heat is transfer
convection
conduction
radiation
examples of Convection superficial heat
fluidotherapy
whirlpool
examples of conduction superficial heat
hot packs, paraffin, contrast baths, cold pack
examples of radiation superficial heat
infrared lamps
Optimum dosage of therapeutic range
Skin temp, between 104-113 F
effects of heat include
hemodynamic effects
Neuromuscular effects
Increased metabolic rate
increase tissue extensibility
Hemodynamic effects
vasodilation
during hemodynamic effects, application of heat to an area will trigger what
local response of vasodilation
How does vasodilation occur
depolarization of sympathetic cholinergic nerve fibers through cutaneous thermoreceptors
what neurotransmitters are released during vasodilation
acetylcholine
bradykinin
nitrous oxide
nitrous oxide acts as
vasoactive mediators on the cholinergic receptors of smooth muscles surrounding blood vessels
indirect effect of heat through cutaneous thermoreceptors
project via dorsal root ganglion to synapse with interneurons in dorsal horn gray matter of spinal cord
Indirect effect of heat by interneurons
- synapse with sympathetic neurons in lateral gray horns of thoracolumbar segments of spinal cord
- inhibit their firing
indirect effects of heat causes a reduction in what
smooth muscle contraction resulting in vasodilation both at site of heat application and in cutaneous vessels of the distal extremities
What is the benefit of thermotherapy and distal vasodilative effect
-increase cutaneous blood flow to area difficult or unsafe to apply heating agent directly
neuromuscular effect
- change in nerve conduction velocity
- Changes in firing temp rate at temp
An increase in temp causes what to nerve conduction velocity
and increase
An increase in temp causes a decrease in what
conduction latency in sensory and motor nerves
An increase in temp causes a decrease in firing rate of
type II muscle spindle efferent & gamma efferents
increase in firing rate of type Ib fibers from golgi tendon organs causes a decrease in
muscle spasm and relaxation of muscle contraction
superficial heat causes increased pain threshold by
an increase activation of cutaneous thermoreceptors
superficial heat increases cutaneous thermoreceptors (increase pain threshold) by
a direct and IMMEDIATE REDUCTION OF PAIN ,by inhibition of spinal gating mechanism to spinal cord level and an indirect, later, and more prolonged decrease of pain by , DECREASE OF ISCHEMIA (decrease in blood flow) AND MUSCLE SPASM OR FACILITATION TISSUE HEALING
There is a decrease in muscle strength and endurance for how long after application of heating agent?
30 minutes
why is there changes in muscle strength
changes in firing rates of type II muscle spindles efferent, gamma efferent, and type Ib fibers from golgi tendon organs
When is there a gradual strength after heating an area
next 2 hours
When should you measure muscle strength and endurance?
BEFORE heating modality
What are the metabolic effects of superficial heat
an increase in metabolic rate
explain how heat increases the metabolic rate
Increase in enzymatic activity = increase rate of cellular biochemical runs = increases oxygen availability and uptake and acceleration of healing of a chronic wound
why do you have to use caution in pts with acute inflammatory disorders like RA when using heat
heat has been shown to increase the activity of collagenase and may accelerate the destruction of articular cartilage
to increase collagen extensibility tissue heat need to be maintain at what temp and for how long
104-113 deg for 5-10 mins
what are the benefits of increased collagen extensibility
- increase in length after stretch applied
- Less force required ro achieve lengthening
- Decreased risk of tissue tearing
- at tendon, ligament, scar tissue or jt capsule, plastic deformation maintains new length after calling due to reorganization of collagen fibers and changes in viscoelasticity
an increase of temp causes what to extensibility
increase
Duration of application for moist heat packs
20 mins. check for redness after 5 mins
Temp ranges for moist heat packs
158-167 deg F
Advantages of Hot packs
- easy & inexpensive
- brief demand on DPT time
- low level of skill application
- can be used to cover large moderate areas
- safe- cool upon removal
- available for pt to purchase at home
disadvantages of hot packs
- removal necessary to inspect tx area during treatment
- pt. may not tolerate weight of HP
- contact may b limited for small/contoured areas
- active motion during tx not practical
- hot water cabinet moderately expensive
heating temp of paraffin
126-134 deg F
Optimum tx temp of paraffin
125-127 deg F
advantages of paraffin
- maintains good contact with contoured areas and skin
- easy and inexpensive
- body part can be elevated
- lubricates and conditions skin
- can be used at home
Continuous immersion/ dip immersion
1 dip for coating
dry
immerse up to 20 mins
Dip Immersion w/ wrapping
6-10 dips dry cover with plastic elevate extremity wrap in towel for 10-15 mins or until cool
painting / brushing w/ wrapping
-brush melted wax onto tx area 6-10x
dry
cover with plastic
wrap in town for 20 min
what is a contrast bath
use of alternate immersion hot/cold
procedure of contrast bath
alternate hot/cold 25-30 mins
-end with warm water
what are indications for contrast bath
- subacute trauma/ chronic conditions
- inflammatory conditions (sprains, strains, tendinitis)
- reflex sympathetic dystrophy (hypersensitivity/ hyperalgesia )
advantages of contrast bath
- promote more vigorous circulatory effect than heat/cold
- good contact with contoured areas
- pain control without aggravating edema
- allows movement with application for increasing circulatory effects
disadvantages of contrast bath
- dependent limb position
- pt might not be able to tolerate cold
- evidence is lacking
contraindications of thermotherapy
- area of recent or potential hemorrhage
- impaired sensation
- impaired mentation
- over malignant area/tumor
- Thrombophlebitis
- IR irradiation of the eyes
- pregnant women: over abdominal, pelvic and low back
precautions of thermotherapy
- acute injury or inflation
- pregnancy
- poor thermoregulation
- edema
- over areas where tropical counterirritants recently been applied
- demylinated nerve (carpal tunnel, ulnar nerve entrapment)
- over an area of reduced peripheral blood circulation
- pts with cardiac insufficiency
- over body with superficially located implants
- over superficial closed and open wounds
- body part resting on hot back decreases cooling
when should you reevaluate use of heat or refer to MD for reevaluation
pt conditions worsen or there is no improvement after 2-3 treatments
adverse effects of thermotherapy
- burns
- fainting
- bleeding
- skin/eye damage from IR
what is the 2 cause of malpractice suits
burns
how to avoid tissue damage when using thermal agents
- use superficial agents that get cooler during their application
- limit initial temp of agent
- use enough insulation between the agent and the pt skin
- provide a means for py to call you, bell
documentation of superficial heating agents
- area treated
- heating agent type
- treatment parameter(temp/power, insulation/distance)
- pt positioning
- response to intervention
