Definitions Cryotherapy = ? Thermotherapy = ? Cryotherapy

(a) Cryotherapy The therapeutic use of cold (b) Thermotherapy The therapeutic use of heat

Effects of Cold Neuromuscular Effects = ? Altered muscle strength = ? Decreased spasticity = ? Cryotherapy

(a) Neuromuscular Effects Decreased nerve conduction velocity 5 min reverses in 15 minutes 20 minutes = 30+ minutes Increased pain threshold Sensory input to block pain receptors (Gate Control Mechanism) Reduction of muscle spasm, nerve velocity, or edema (b) Altered muscle strength Decreased motor nerve conduction velocity, muscle spindle sensitivity, and muscle strength when applied directly to the muscle. Increase after 5 minutes, decrease after 30 minutes Consider – strength testing compared to timing of ice (c) Decreased spasticity

Cryotherapy Types - Cold Pack ? min. = normally ? min. = spasticity Cryotherapy

Cold Pack - Duration: 20 minutes normally 30 minutes for spasticity Applied every 1-2 hours for inflammation and pain control Inspect skin after Red or dark pin Presence of wheals (welts) or a rash

Thermal Agents - Cryotherapy Flashcards by Benjamin Kozak

Definitions

Cryotherapy = ?
Thermotherapy = ?

Cryotherapy

(a) Cryotherapy

The therapeutic use of cold

(b) Thermotherapy

The therapeutic use of heat

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Definitions

Superficial heating agents = ?
Deep heating agents = ?

Cryotherapy

Superficial heating agents:

Therapeutic use of heating agents typically used for pain control.

Deep heating agents:

Energy conversion into heat as it passes through body tissues

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Definitions

Amount of energy required to raise the temperature of a given weight of a material by a given number of degrees = ?

Cryotherapy

(e) Specific Heat

Amount of energy required to raise the temperature of a given weight of a material by a given number of degrees

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Effects of Cold

Hemodynamic Effects = ?
Metabolic Effects = ?

Cryotherapy

Effects of Cold:

(a) Hemodynamic Effects

Vasoconstriction

Less than 15-20 minutes application
Decreases release of vasodilator mediators

Cold-induced vasodilation (CIVD)

Though to be due to sympathetic inhibition
Hunting response: cyclic nature of extended cold

(b) Metabolic Effects

Decreased metabolic rate

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Effects of Cold

Neuromuscular Effects = ?
Altered muscle strength = ?
Decreased spasticity = ?

Cryotherapy

(a) Neuromuscular Effects

Decreased nerve conduction velocity

5 min reverses in 15 minutes
20 minutes = 30+ minutes

Increased pain threshold

Sensory input to block pain receptors (Gate Control Mechanism)
Reduction of muscle spasm, nerve velocity, or edema

(b) Altered muscle strength

Decreased motor nerve conduction velocity, muscle spindle sensitivity, and muscle strength when applied directly to the muscle.
Increase after 5 minutes, decrease after 30 minutes
Consider – strength testing compared to timing of ice

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Four uses of Cryotherapy = ?

Cryotherapy

(a) Inflammation Control

Pain, Microvessel bleeding, and DOMS
15 mins or less.
Immediately after injury & during acute inflammatory phase.

(b) Edema Control:

Extravasation and permeability
Vasoconstriction vs vasodilation
P.R.I.C.E.
Acute Inflammation vs immobility, poor circulation

Cutaneous thermoreceptors help block pain signals via gait control.
Can help control pain spasm cycle.

(d) Muscle tone: Can reduce spasticity

Needs to be applied for 30 mins for spasticity reduction

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A technique that combines cryotherapy with exercise = ?

Cryotherapy

Cryokinetics:

(a) A technique that combines cryotherapy with exercise.

Uses ice immersion, cold packs, or icemassage.

(b) Goal is to numb the injured part to the point of analgesia and then work toward achieving normal ROM through progressive active exercise.

(c) Exercises performed during periods of numbness should be pain-free and progressive in intensity,concentrating on both flexibility and strength.

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Application of cooling agent prior to stretching = ?

Cryotherapy

Cryostretch:

Application of cooling agent prior to stretching
Reduce muscle spasm and allow for greater ROMwith stretching
Cold pack after hot pack > hot pack alone

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Contraindications of Cryotherapy = ?

Cryotherapy

Contraindications of Cryotherapy:

Cold hypersensitivity (cold-induced urticaria)
Cold intolerance
Cryoglobulinemia - may be associated with multiple myeloma, systemic lupus erythematosus, rheumatoid arthritis, or other hyperglobulinemic states.
Paroxysmal Cold Hemoglobinuria
Raynaud’s disease or phenomenon
Over-regenerating peripheral nerves
Over an area with circulatory compromise or peripheral vascular disease
Determine cause of edema

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Precautions of cryotherapy = ?

Cryotherapy

Precautions of Cryotherapy:

Over the superficial main branch of a nerve
Over an open wound
Hypertension
Poor sensation or mentation
Very young and very old patients

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Adverse effects of cryotherapy = ?

Cryotherapy

Adverse Effects of Cryotherapy:

(a) Tissue death

Most severe adverse effect
Caused by prolonged vasoconstriction, ischemia, or thromboses in smaller vessels

(b) Temporary or permanent nerve damage

Results in pain, numbness, tingling, hyperhidrosis, or nerve conduction abnormalities
Limit cold application to under 15-20 minutes

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Systematic Review of Cryotherapy = ?

Cryotherapy

Systematic Review of Cryotherapy

(a) Recovery Characteristics

DOMS, RPE, Objective markers (blood splama markers and cyotkines)

Pooled data from 27 articles revealed:

DOMS:

Cooling and especially cold water immersions, reduced the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery.
This effect remained significant after 48 hrs and 96 hrs

RPE

Studies favored cooling agents to control conditions after 24 hours of recovery
No significant difference after 48 hours

There was no evidence, that cooling affects any objective recovery variable

Cooling did not affect objective recovery variables such as lactate-levels, CK-levels or IL6-levels.

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Cryotherapy Types - Cold Packs

Temp = ?

Cryotherapy

Cold Packs

(-) Temp

Cold packs should be between 0-5 deg. C / 32-41 deg. F

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Cryotherapy Types - Cold Pack

? min. = normally
? min. = spasticity

Cryotherapy

Cold Pack - Duration:

20 minutes normally
30 minutes for spasticity
Applied every 1-2 hours for inflammation and pain control
Inspect skin after
Red or dark pin
Presence of wheals (welts) or a rash

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Cryotherapy Types

Ice pack provides = ?, compared to cold pack

Cryotherapy

Ice Pack:

(-) Provides more aggressive cooling than cold packs at the same temperature.

Ice has a higher specific heat than most gels
Ice absorbs a large amount of energy when it melts

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Ice/Cold Pack Time:

Reduce swelling = ? min.
Block pain = ? min.
Cool Muscles = ? min.
Decrease spasticity = ? min.

Cryotherapy

(-) Reduce swelling = 4-20 min

(-) Block pain = 4.5-15 min

(-) Cool Muscles = 15-30 min

(-) Decrease spasticity = 30-45 min.

Cold Packs and Ice Packs

Advantages = ?
Disadvantages = ?

Cryotherapy

Cold Packs & Ice Packs

(-) Advantages:

Easy to use
Inexpensive
Short use of clinician’s time
Low level of skill required forapplication
Covers moderate to large areas
Can be applied to an elevatedlimb

(-) Disadvantages:

Pack must be removed tovisualize the treatment areaduring treatment
Patient may not tolerate weightof pack
Pack may not be able to maintaingood contract on small orcontoured areas
Long duration of treatmentcompared to massage with icecup

Cryotherapy Types

Ice cups (Ice massage):

Time = ?
Skin Temp = ?

Cryotherapy

Ice cups (Ice massage):

(-) Time = 5-10 min.

(-) Temp = > 59 deg F

Notes:

Will cool tissue faster than other cryotherapy

Ice cups (Ice massage)

Advantages = ?
Disadvantages = ?

Cryotherapy

Ice cups (Ice massage):

(a) Advantages:

Treatment area can be observedwell during application
Can be used for small andirregular areas
Short duration treatment
Inexpensive
Can be applied to elevated limb

(b) Disadvantages:

Too time-consuming for largeareas
Requires active participation bythe clinician or patient throughoutapplication
Messy

Cryotherapy Types

Controlled Cold Compression Units:

Temp set between = ? deg. F

Cryotherapy

Controlled Cold Compression Units:

(-) Temperature of the water can be set between 50-77 deg. F (NPTE)

Gameready:

Temp = ?
Compression = ?

Cryotherapy

Gameready:

(-) Temperature= 40-60 deg F

(-) Compression

None – Low : First 24-48 hours after surgery
Medium – High : When comfortable after the first 48 hours

Patient Preference is key!

Cryo Cuff

How does this work = ?
Common for = ?

Cryotherapy

Cryo Cuff:

(-) Cold + Compression

(-) Should be elevated 15-28 in. above level of sleeve

(-) Provides mild cooling below intensity of other agents

(-) Common post-operative pain management

Controlled Cold Compression Units

Advantages = ?
Disadvantages = ?

Cryotherapy

Controlled Cold Compression Units:

(a) Advantages:

Allows simultaneous applicationof cold & compression
Temperature & compressionforce are easily and accuratelycontrolled
Can be applied to larger joints

(b) Disadvantages

Treatment site CANNOT be visualized during treatment
Expensive

Vapocoolant Sprays

Purpose = ?

Cryotherapy

Vapocoolant Sprays:

(-) Purpose is to provide a counterirritant stimulus to the cutaneous thermal afferents overlaying muscles to cause a reflex reduction in motor neuron activity and thus a reduction in resistance to stretch.

# *Vapocoolant Sprays* * Advantages = **?** * Disadvantages = **?** ## Footnote *Cryotherapy*

**Vapocoolant Sprays**: (**-**) **Advantages** * Brief duration of cooling * Very localized area of application (**-**) **Disadvantages** * Limited to use for brief, localized, superficial application of cold before stretching * Other means of applying cryotherapy

# *Cold Whirlpools* * Indicated in = **?** * Time = **?** ## Footnote *Cryotherapy*

**Cold Whirlpools**: (**-**) Indicated in ***acute*** & ***subacute*** conditions in which exercise of the injured part during cold treatment is desired. (**-**) Choose temperature and time based on treatment * ***10-30*** min. ## Footnote Cleaned and disinfected after every treatment

# *Cold Bath* * Time = **?** * Temp = **?** ## Footnote *Cryotherapy*

**Cold Bath**: (**-**) Time ***15-20*** min. (**-**) Temperature: ***55-64*** deg. ## Footnote **Notes**: * Less time for colder temperatures

# *Cold Bath Temps* * Acute Inflammation of distal extremities = **?** * Exercise = **?** * Wound case, spasticity = **?** * Cardiopulmonary compromise, treatment of burns = **?** * Pain Management = **?** * Chronic RA/OA, increased ROM = **?** ## Footnote *Cryotherapy*

**Water Temperatures**: * Acute Inflammation of distal extremities = ***32-79*** * Exercise = ***79-92*** * Wound case, spasticity = ***92-96*** * Cardiopulmonary compromise, treatment of burns = ***96-98*** * Pain Management = ***99-104*** * Chronic RA/OA, increased ROM = ***104-110***

# *Contrast Baths* Hot & Cold: * Time(s) = **?** * Temp(s) = **?** ## Footnote *Cryotherapy*

**Contrast Baths** (**-**) Hot bath = **104-106** deg F / x 3-4 minutes (**-**) Cold bath = **50-60** deg F / x 1 minute (**-**) Repeat hot & cold x 25-30 minutes **Notes**: Other indications * Arthritis of small joints * MSK sprains/strains * CPRS * Limb desensitization

# *Application Process* * First, evaluate the patient and set the goals of treatment * Then = **?** ## Footnote *Cryotherapy*

**Application Process**: (**a**) Evaluate the patient and set the goals of treatment. * What do you want to do? * Why? (**b**) Determine whether cryotherapy is the most appropriate intervention. * What is your goal for cryotherapy?

# *Application Process* You've asked the appropriate questions, **NO** contraindications or precautions, what next = **?** ## Footnote *Cryotherapy*

**Application Process**: (**-**) You've asked appropriate questions on contraindications and precautions and determined that cryotherapy is **NOT** contraindicated for this patient or condition. (**-**) NEXT = * Inspect the area to be treated * Look for open wounds and rashes (**-**) Assess sensation * Check the patient’s chart for any record of previous adverse responses to cold and for any diseases that would predispose the patient to an adverse response.

# *Application Process* Things to consider when selecting the appropriate cooling agent = **?** ## Footnote *Cryotherapy*

**Application Process**: (**a**) Select the appropriate cooling agent * Appropriate intensity of cold for desired outcomes * Best fit for location and size of area being treated * Contours to skin and able to make good contact * Best application for duration and position * Readily available and affordable (**b**) Options * Cold packs or ice packs * Ice cups for ice massage * Controlled cold compression units * Vapocoolant sprays or brief icing * Frozen towels * Ice water immersion * Cold whirlpool * Contrast bath (**c**) Considerations * With agents that cool by conduction or convection, such as cold packs or a cold whirlpool, good contact must be maintained between the agent and the patient’s body at all times to maximize the rate of cooling. * For brief cooling, the best choice is an agent that is quick to apply and remove. * The patient can readily use ice packs, ice cups, and cold packs at home. * Ice packs and ice massage are the least expensive means of providing cryotherapy * Controlled cold compression units are the most expensive.

# *Application Process* * What should be included when we explain the procedure & reason for applying cryotherapy = **?** * STAGES of sensation in Cryotherapy = **?** ## Footnote *Cryotherapy*

**Application Process**: (**-**) Explain the procedure and the reason for applying cryotherapy * Describe the sensations the patient can expect to feel. * Educate on what sensations they need to notify you for (Too cold/not cold enough). (**-**) ***STAGES*** of sensation in Cryotherapy 1. COLD 2. Burning/tingling 3. Achey/Pain 4. Numb

# *Application Process* After applying the appropriate cooling agent, what should we do = **?** ## Footnote *Cryotherapy*

**Application Process**: (**a**) Apply the appropriate cooling agent. * Place patient in idea position for comfort and agent application * Provide bell or other safety device near patient (**b**) Check on patient response frequently

# *Cryotherapy - Application Process* * Assess the outcome of the intervention = **?** * Documentation = **?** ## Footnote *Cryotherapy*

**Application Process**: (**a**) Assess the outcome of the intervention. * Reassess the patient * - Progress toward the set goals of treatment and for any adverse effects of the intervention. * - Re-measure quantifiable subjective conditions and objective limitatios, and reassess function and activity. * Check skin for response to treatment (**a**) Document * Note patient set up, modality use, and response