Superficial Thermal Modalities Flashcards
explain direct relationships in superficial thermal modalities between a thermal stimulus and
- amount of tissue covered
- time applied
- temperature gradient
smaller amount of tissue = more intense exchange of heat
shorter duration = less absorption of heat
greater difference between temperature of soft tissue and thermal stimulus = more heat exchanged
explain the indirect relationship of distance between thermal stimulus and soft tissue
greater distance = less absorption/exchange of temperature
what is conduction thermal energy transfer
molecule vibration that causes interaction with the next molecule
what are examples of conduction thermal energy transfers
paraffin
hot packs
ice packs
what is convection thermal energy transfer
molecules being moved, not in prolonged static contact
examples of convection thermal energy transferred modalities
fluidotherapy
whirlpool with agitation
what is radiation thermal energy transfer
electromagnetic radiation that does not require molecules
examples of radiation thermal energy transfer
ultraviolet
diathermy
infrared
how many calories per gram of water is related to evaporation
0.58 cal/g of water
a localized addition of thermal energy of ______°F and ______°C causes physiological responses
91.4 / 33
what physiological responses are seen when localized temperature or core temperature increases
perspiration
erythema
metabolic rate
HR
RR
nerve conduction velocity
compare A-Beta and A-Delta/C fibers
A-B = faster traveling
- respond to nonpainful tactile stimulus like vibration and touch
A-Delta/C = slower traveling
- respond to painful stimuli
what is the gate control theory and how do modalities relate to it
idea of inhibiting painful stimuli and promoting nonpainful stimuli to the CNS
what are the physiological effects of superficial thermal modalities
increased blood flow
increased nerve conduction velocity
increase tissue metabolic activity
increase joint freedom
decrease muscle tone
physiologically speaking, how do superficial thermal modalities decrease muscle tone
cutaneous modulation of ventral horn motor neuron allows for decreased contractility sensitivity
how do superficial thermal modalities increase joint freedom?
decrease viscosity of periarticular tissue, allowing for less resisted motion at the joint
how deep do superficial thermal modalities reach
2 cm
temperature, timeframe, and depth of tissue associated with superficial thermal modalities
at 5-6°C or 41-42°F
for
6-8 min = 2 cm
10-15 min = slightly more than 2cm
>15 = marginal return
- rate of depth gained and temp lost nears breaking even
what are clinical uses of superficial thermal modalities
analgesia
decreased hyperesthesia
increased wound healing
decreased muscle spasm/guarding
decrease edema
increase A/PROM
how is analgesia obtained via superficial thermal modalities
gate control theory concept
- increased nonpainful stimuli to mask pain signal
what specific superficial thermal modalities can be used to decrease hyperesthesia
fluidotherapy
whirlpool
– will increase nerve conduction velocities
what stages in wound healing phases could superficial thermal modalities be indicated? why these stages vs others?
subacute and chronic
– not acute because of hemostasis and inflammation, would rather stimulate circulation and nerve healing later on
what is the idea behind the pain spasm circle? how do we combat that?
more pain = more spasms/guarding
– as pain increases, so does guarding and spasming
want to address either pain or spasming to decrease the other
hot packs are examples of ______ method of thermal modality
conduction
what are hotpacks made of
canvas/nylon cases that are filled with hydrophilic substance
what is the necessary temperature of water for hotpacks to be in
160-175° F
70-80° C
what is the amount of towel layers needed between patient and hot pack in a prone position
8
how many layers of coverage does one layer of a hot pack count as
3
what is something to keep in mind when making a hot pack for a body area while one is in a supine position
heat will follow the path of least resistance and
it will escape in the direction of the room easier than through the towels in the direction of the tissue
how to contain heat when a hot pack is placed on an individual in a supine position?
> 8 towel layers must be on the side opposite of tissue to contain the heat
average duration of superficial thermal modalities
15-20 minutes
advantages of superficial hot packs
quick / easy
inexpensive
can be done as part of HEP
easy to adjust heat via layers added or removed
different shapes and sizes for different body contours
disadvantages of superficial hot packs
does not always contour well to specific areas of the bdoy
temperature/heat level cannot be specifically measured
body part cannot be seen during treatment
indications of superficial thermal hot packs
subacute/chronic pain
increased muscle tension
preparation of area for other treatments
localized contraindications of superficial hot packs / fluidotherapy
acute inflammation
malignancies in the area
active bleeding
localized infection
systemic contraindications of superficial hot packs / fluidotherapy
fever
cardiac insufficiency
unreliable thermoregulatory systems
peripheral vascular disease
precautions of superficial hot packs
edema
diminished sensation
confusion
how to document superficial hot pack usage
modality applied - moist heat in this case
location
position
duration
pre/post treatment assessment
– skin condition
layers of padding (if different from standard)
what is the ratio associated with the mixture of paraffin
5 lbs of wax
1 pint of mineral oil
what is the temperature associated with paraffin storage
47-55°C / 115-130°F
what are the primary treatment methods of paraffin
dip and immerse
dip and wrap / glove method
what needs to be done prior to paraffin treatment
wash and dry skin
inspect for open wounds
assessment of sensation
jewelry removal
prepare supplies / educate patient on process and what to expect
explain the dip and wrap / glove method of paraffin wax application
body part dipped into wax and removed
– allow wax to solidify while maintaining position
repeat 7-10 times
wrap gloved part with plastic insulation followed by towel insulation
how long is paraffin left in place?
10-20 min
how is thermal energy translated from modality to soft tissue in paraffin wax application
wax will start at 115-130°F once applied and slowly decrease from there
explain the dip and immerse method of paraffin application
body part is submerged and a layer of wax is solidified
- then that same process is repeated but is not removed from wax for 10-20 min
pros and cons of dip and emersion paraffin application
pro = temperature is maintained for entire intervention
con = body is left in dependent position / can be inconvenient
–> edema precautions may contraindicate dependent position
why is paraffin an effecient source of heat
low melting point
low specific heat
conducts heat slowly
advantages of paraffin
can be done as part of an HEP due to inexpensive nature
can contour to body areas
disadvantages of paraffin
slightly more messy
more time involved
open wound contraindication
indications of paraffin
subacute/chronic traumatic and inflammatory conditions
compare moist heat and paraffin contraindications
all the same, but paraffin has open wounds
precautions of paraffin
edema
diminished sensation
impaired local circulation
local anesthesia
documentation of paraffin
body part treated
method of treatment
duration of treatment
pre/post treatment assessment
what specifically needs to be documented with paraffin treatment method?
amount of layers
glove vs painting vs immersion method
fluidotherapy is an example of a ______ thermal modality
convection
explain how fluidotherapy works
cellulose particles are enclosed in a vacuum in which heated air is circulated
what is turbulence? how does this relate to treatment?
amount of movement of cellulose particles in fluidotherapy chamber
– more turbulence = more thermal and mechanoreceptor stimulation
what is the temperature associated with fluidotherapy
room temperature to 130-140°F
treatment time associated with fluidotherapy
10-20 min
what is different about fluidotherapy compared to heat/paraffin?
fluido = active treatment option
can do A/PROM or mobilizations during treatment
indications of fluidotherapy
subacute / chronic traumatic and inflammatory conditions
hyperesthesia
precautions associated with fluidotherapy
open wounds need to be protected
impaired local circulation
peripheral vascular disease
how to document fluidotherapy
body part treated
temperature
agitation/airflow
duration
if A/PROM was completed
pre/post treatment assessments
how does infrared work?
short and visible infrared waves generate heating response in tissues when absorbed
relationship of distance between infrared and soft tissue and heat generation
closer = more warm
further = less warm
what is the angle in which infrared must be in comparison to the skin?
what is the associated time frame of infrared intervention?
perpendicular
15-30 min
indications of infrared
subacute and chronic traumatic and inflammatory conditions
wound care
contraindications of infrared
acute inflammatory conditions
fever
malignancies
active bleeding
cardiac insufficiency
unreliable thermoregulatory systems
peripheral vascular disease
precautions of infrared
existing edema
sensory loss / sensory impairments
confusion on treatment
documentation of infrared intervention
modality / method
body part treated
duration
pre/post treatment assessment
how does cryotherapy work?
removal of thermal energy
cryotherapy benefits
decreased:
metabolic rate
blood flow
nerve conduction velocity
how does cryotherapy affect edema
reduces it via
- arteriole vasoconstriction
- decreased metabolic activity leading to less inflammation
relationship between fatty tissue and thermal penetration
higher areas of fatty tissue = lower rate of thermal penetration
how does cryotherapy affect nerve conduction velo
increased stimulus necessary for nerve depolarization that can decrease muscle excitability
causing
decreased pain and spasm
how does timing of cryotherapy application affect muscle force
short term = increased
long term = decreased for 10 or so minutes, then increased
timing associated with increased/decreased muscle force via cryotherapy application
short term = 1-2 = increased
long term = 30 minutes = decreased then increased
depth of penetration associated with cryotherapy
1-4 cm
staging of sensation related to cryotherapy
cold –> stinging –> analgesia –> anesthesia
cryotherapy relationship to pain threshold
increases pain threshold
relationship between cryotherapy and tissue elasticity/viscosity
decreased elasticity
increased viscosity
Hunting Response
initial vasoconstriction causing a drop in temperature until smooth muscle relaxes
vasodilation occurs and then a slight increase in temperature occurs
what does the hunting response create in the tissue being iced
indirect muscle pump due to vasoconstriction/dilation
indications of cryotherapy
trigger/myofascial points
decrease hyperesthesia
edema
spasm/cramps
ligament sprain
acute/chronic pain
inflammation
neuro-facilitation
timing of cryotherapy in relation to acute inflammation
0-48/72 hrs
maximum treatment area and time associated with ice massage
150 cm²
5-10 min
what makes cold pack application optimal?
- time wise
- adjunct treatment
5-20 min
in combination with elevation/compression
contraindications of cryotherapy
raynaud’s
cold urticaria
cold precipitating antibodies
decreased sensation/blood flow
major tissue disruption
severe hypertension
frostbite
gout
Cardio-Pulm involvement
regenerating peripheral nerves
what is cold uritcaria
breaking out into hives when cold is applied
what is cryoglobulinemia
antibodies in the blood that coagulate when cold is applied
temperatures associated with contrast bath
warm water = 38-44°C / 100-110°F
cool water = 10-18°C / 50-60°F
explain treatment protocol of contrast bath
ratio of 3:1 or 4:1
– hot to cold
for 20-30 min
end with warm water
goal of contrast bath
facilitate blood flow via indirect pumping mechanism
vasoconstriction/dilation
indications for contrast bath
impaired venous circulation
subacute/chronic traumatic and inflammatory conditions
edema
sinus/congestive HA
contraindications for contrast bath
malignancies
hemorrhage / active bleeding
cold hypersensitivity
PAD
cardiac/respiratory instability
fever
reduced thermoregulatory systems
small vessel disease
– diabetes, buerger’s disease, arteriosclerotic endarteritis
