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Therapy Modalities Lecture > Thermal Agents: Heat > Flashcards

Thermal Agents: Heat Flashcards

1
Q

Mechanisms of Heat Transfer: Conduction

A
  • Transfer of heat between 2 objects that
    are in contact with each other
  • Ex: Hot packs/cold packs, movement of heat through tissue layers
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2
Q

Mechanisms of Heat Transfer: Convection

A
  • Transfer of heat by the movement of a
    medium
  • Ex: Whirlpool or Air
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3
Q

Mechanisms of Heat Transfer: Radiation

A
  • Transfer of Energy w/out contact or the
    use of a medium
  • Energy moves through space
  • Ex: Laser or UV Light
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4
Q

Mechanisms of Heat Transfer: Conversion

A
  • One form of energy changed to heat
    energy
  • Ex: Diathermy (electromagnetic energy
    changed to heat energy) or Ultrasound
    (acoustical energy changed to heat)
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5
Q

Mechanisms of Heat Transfer: Evaporation

A
  • Loss of heat by changing a liquid to a gas
    (endothermic reaction)
  • Ex: Vapo-coolant spray
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6
Q

What is Thermotherapy?

A
  • The application of therapeutic heat to the
    body, which increases tissue temperature
    to between 104 - 115 degrees
  • Heat is removed from the modality and
    absorbed by the body
    ~ Requires a heat gradient
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7
Q

What are the Effects of Heat Application?

A
  • Increased Cell Metabolism
  • Increased Circulation
  • Increased Permeability
  • Decreased Tissue Stiffness
  • Decreased Pain
  • Decreased Muscle Tone and Spasm
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8
Q

Effects of Heat Application: Increased Cell Metabolism

A
  • Cell metabolism increases 2-3 times for
    each increase of 18 degrees
  • Results of increased metabolism
    ~ Increased O2 consumption (Bad)
    > Can increase secondary damage/
    hypoxia
    ~ Increased Cellular wastes (Bad)
    ~ Increased tissue temperature (Good)
    ~ Increased tissue activity (Depends)
    > Good during repair and
    maturation phases
    • Speeds up fibroblasts
    > Bad during acute phase
    • Inhibits WBC
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9
Q

Effects of Heat Application: Increased Circulation

A
  • Doubles
  • Due to local vasodilation
  • Results of increased Circulation
    ~ Increased cellular waste removal
    ~ Increased supply of O2, Leukocytes,
    Nutrients, and Enzymes
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10
Q

Effects of Heat Application: Increased Permeability

A
  • Increased Potential for Venous and
    Lymphatic drainage
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11
Q

Effects of Heat Application: Decreased Tissue Stiffness

A
  • Increased Elasticity of Collagen
  • Decreased fluid viscosity
    ~ Ground Substance
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12
Q

Effects of Heat Application: Decreased Pain

A
  • Increased blood flow = Increased O2 =
    Decreased Pain (chemical mediators get
    flushed out)
  • Counter-irritant
  • Removal of pain stimulating chemicals
    ~ Pain - spasm - stasis; removal of one,
    removes all
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13
Q

Effects of Heat Application: Decreased muscle tone and spasm

A
  • Reduction in pain
  • Decreased muscle spindle sensitivity
  • Reduction of cellular metabolites
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14
Q

Heating Factors: Rate of Heating

A
  • Rate of Heating
    ~ Depends on difference between
    temperature of modality and tissues
    treated
    > The greater the difference, the
    more rapid the rate of heat
    transfer
    > If tissue temperature is high, it will
    decrease the magnitude of the
    gradient
  • Adipose can be a limiting factor for
    heating because it insulates
    ~ Can be a benefit in terms of
    decreasing heat loss after treatment
  • Pt. needs to be at a resting state or
    normal temperature to apply heat
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15
Q

Special Considerations for Heat Application

A
  • During the first 5-6 minutes of treatment,
    the body absorbs heat faster than it can
    dissipate it
  • After 7-9 minutes the body is able to
    counteract the heat by moving blood to
    the area to cool it
    ~ Vasodilation
  • After 20 minutes, when the intensity of
    the treatment stays constant superficial
    blood vessels constrict (rebound
    vasoconstriction: the body’s attempt to
    save underlying tissues)
  • If intensity is too strong during
    vasoconstriction, burns will occur
    ~ Mottling
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16
Q

Thermotherapy Indications

A
  • Decreased ROM (usually due to scar
    tissue)
  • Subacute Inflammatory Conditions
    (repair/maturation)
  • Pain (increased blood flow)
  • Hematoma Resolution
  • Edema Removal
    ~ Increased permeability and
    vasodilation = drainage through
    venous and lymphatic systems
    ~ Heat opens the door for osmosis:
    moving water into tissues
17
Q

Thermotherapy Contraindications

A
  • Acute Conditions
    ~ Increases Secondary Damage
    ~ Increases Edema Accumulation
  • Compromised Circulation
    ~ Body unable to cool area
  • Infection/Open Wounds
  • Compromised Sensation
    ~ Body may not sense overheating and
    will be less able to protect area
18
Q

Moist Heat Packs

A
  • 1cm of effective depth
  • Cover pack with a commercial cover and
    at least one layer of towel
    ~ Keeps from burning and clean
  • Pt. should not be lying or sitting on pack.
    This will increase the likelihood of burns
19
Q

Paraffin

A
  • For use of small irregularly shaped areas:
    fingers and toes
  • The body part needs to be cleaned first
    in order to limit the spread of infection
  • Post-treatment, the wax will leave the
    skin slippery
  • Immersion Bath
    ~ Dip the body part up to 12 times, then
    immerse
  • Pack/Wrap Method
    ~ Dip body part 6-12 times, then wrap
    in plastic wrap and a towel
    > The first layer should be the
    highest to avoid leakage and burns
20
Q

Warm Water Immersion/Whirlpool

A
  • 100 - 108 degrees for whole body
  • 105 - 112 degrees for extremities
    ~ The extremities are able to keep cool
    more than the body because cool
    blood can reach them
  • Containers should be clean and sanitized
    ~ Iodine can should added to the water
    if an open wound is present
  • This modality is gravity dependent (body
    part lower than the heart) which can
    cause swelling to go down
21
Q

Fluidotherapy

A
  • Unit contains fine cellulose particles in
    which warm air is circulated
  • The particles will mimic water and form
    to the body part simultaneously applying
    heat, pressure, and massage
22
Q

Diathermy

A
  • Used mostly to heat tissues, but there’s
    some non-thermal effects:
    ~ Microwave Diathermy
    > 300 MHz - 300 GHz
    > Not used very much
    ~ Shortwave Diathermy
    > 1.8 - 30 MHz
    > Mostly used
    ~ Main difference between the two is
    frequency of electricity
23
Q

Downside of Microwave Diathermy (MWD)

A
  • Main downside is that it’s much more
    likely to cause tissue burns
    ~ Metal can reflect MWD back towards
    tissues
    ~ Does not penetrate deeply so more
    energy is absorbed superficially
    ~ Increased reflection at tissue
    interfaces
24
Q

Production of Diathermy

A
  • When electricity flows through a
    conductor, a magnetic field is formed
    perpendicular to the flow of electricity
  • SWD generator coverts alternating
    current from outlet to SWD frequency
    ~ Electrical current enters the coil
    contained in the drum of the unit and
    a magnetic field is produced in the
    tissues
25
Q

Thermal Effects of Diathermy

A
  • The magnetic field in the tissues causes
    charged ions and molecules within the
    tissues to oscillate and move
    ~ The motion causes friction resulting
    in heat and increased tissue
    temperature
    ~ Tissues w/ the highest amounts of
    water means they have a higher
    concentration of electrolytes and
    therefore heat the most
    > Hamstrings
    > Quads
26
Q

Thermal Ultrasound vs. SWD

A
  • Ultrasound
    ~ Can heat tissues 3-5 cm deep
    ~ Heats small areas
    ~ Short stretch/thermal window
    ~ Can sometimes cause pain if area
    gets heated too much due to lack of
    movement of probe
  • SWD
    ~ Can heat tissues 3-5 cm deep
    ~ Heats large areas
    ~ Long stretch/thermal window
    ~ Stays warmer longer
27
Q

Thermal Effects of SWD

A
  • Can increase muscle temperature to 104
    degrees in 15 minutes
  • Decay rate is 2-3 times slower than
    Ultrasound
28
Q

Non-Thermal Effects of SWD

A
  • Not well understood, no sound theories
  • Most theories stem from the relationship
    between magnetic and electrical fields
    ~ Thought is that the magnetic field
    affects the electricity driven functions
    of the cells
    > Possibly allows membranes to
    repolarize so cell function is
    restored
    > Fibroblasts, osteoblasts, WBC
29
Q

Advantages of SWD

A
  • Stationary Drum: no hot spots and even
    heating
  • No mess
  • Can be applied over clothing
  • Doesn’t require clinician to be present
    the whole time
30
Q

SWD Indications

A
  • Pain
  • Spasm
  • Decreased ROM
  • Subacute Inflammation
  • Edema
31
Q

Continuous vs. Pulsed SWD

A
  • Continuous SWD
    ~ Not used very much due to the fact
    that it tends to heat tissues too fast
    causing discomfort and possible
    burning
  • Pulsed SWD
    ~ Mostly used
    ~ Alternates between on and off
32
Q

Pulsed SWD Parameters

A
  • Pulse width (duration)
    ~ On time
    ~ Measured in milliseconds
  • Pulse Rate
    ~ Number of pulses per second
  • Power/Intensity
    ~ Measured in Watts
    ~ Function of both pulse width and
    pulse rate
    > Higher pulse widths and rates
    produce more power/intensity =
    more healing
33
Q

SWD Contraindications

A
  • Not over the eyes, genitals, and
    epiphyseal plates in children
  • Pace maker: effects electrical current
  • Pregnancy
  • Cancer
  • Infection
  • Metal implants for MWD
  • Diminished sensation
  • Circulatory Impairment: won’t be able to
    cool down area post-treatment
34
Q

Considering the inflammatory response, when would heat application be most appropriate?

A
  • During the repair and maturation phases
    because it will speed up the process =
    speed up healing
  • Least appropriate acutely because it will
    increase swelling, bleeding, and
    secondary damage which will increase
    WBC and Hypoxia

Therapy Modalities Lecture (9 decks)

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