Thermal Physiology and Modalities Flashcards
Decision making process
asses the pt
look at your toolbox of multiple modalities
determine the most appropriate modality
be sure to check the precautions and contraindications for the modality you are considering
check the parameters
is the modality cost effective?
will the modality allow for safety?
does the pt understand what the goals of the modality are?
indications for thermotherapy
sub-acute/chronic conditions
pain
decreased ROM
resolution of edema (post inflammatory phase)
myofascial trigger points
muscular conditions
could you use heat during the inflammatory phase
NO
most of the time use cold
contraindications of thermotherapy
acute musculoskeletal conditions (if the injury just occurred)
impaired circulation
vascular disease (PVD)
skin anesthesia (they can’t feel the heat)
open wounds or skin conditions
acute DVT
why don’t you want to use heat on an acute DVT
you don’t want to dislodge a clot and move it
physiological effects of local superficial heating on tissues
dilation –> increased circulation (blood flows throughout the body more efficiently)
reduction of sympathetic impulses –> increase blood flow to venous plexuses
increased metabolic rate
consensual heat vasodilation
remote vasodilation in response to heating
is a good response
joint/musculoskeletal tissue loosens, more effective when we use interventions
2 types of penetration
deep
superficial
what would we use to penetrate heat to deeper tissues
diathermy or ultra sound
increase tissue temp w/ increased blood flow
what would we use to penetrate heat to superficial tissues
hot pack
effects of heat
increase local temp
increased local metabolism
vasodilation
increase BF
increased release of leukocytes and phagocytes
increased capillary permeability
increased lymph and venous drainage
increased removal of metabolic waste
analgesia
decrease mm tone
decrease spasm
increased tissue elasticty
methods to apply therapeutic heat
hot pack (conduction)
paraffin bath (conduction)
fluidotherapy (convection)
infared (radiation)
hydrotherapy (convection)
what is conduction
heating up locally
what is convection
moving particles around
hot pack unit temp
166-175 F
how long does the heat pack stay on
15-20 minutes
how many layers of toweling for hot packs
6-12
what do we want to avoid with hot packs
the pt lying on the hot pack directly
what temp should the paraffin unit be at
126 F
how much more heat does paraffin provide than water
6x
what is the equipment used for paraffin
unit
towels
plastic bags
what’re the methods for applying paraffin
dipping
painting
submersion
how many layers do we apply of paraffin
6-10
how long do we use paraffin
20 minutes
how do we prepare the pt for paraffin treatment
ensure the body part is cleansed and dried (could use gel hand sanitizer)
inspect for any cuts, irritation, sensitivity or redness
can we reuse paraffin
yes
cleaner to just throw out and replace
what is the standard formula for infrared lamps
20 in for 20 minutes
equipment for IR
lamp
dry toweling
moist toweling
fluidotherapy machine
through convection
heats up a joint
physiologic effects of cold
decreased local temp
decreased metabolic rate
local vasoconstriction
decreased nerve conduction velocity
depressed excitability of free nerve endings and peripheral nerve fibers
control of pain
control of edema
in what stages of healing can we use cold
all 3 stages
how do we determine the extent of cooling to use
type of cooling method
duration of treatment
thickness of the surface its on
body part
cold physiology
initial response to cold is vasoconstriction
hunting’s response
hypothalamus induces shivering
arterial vasoconstriction result in increased blood pressure and heart rate
hunting’s response to cold
prevents local tissue damage secondary to vasoconstriction
indications to use cold
acute pain
edema
myofascial trigger points
muscle guarding and spasm
acute muscle strain
bursitis
tendinotis
DOMS
spasticity
contraindications of cold
impaired circulation
vascular disease (PVD)
hypersensitivity to cold
skin anesthesia
open wounds or skin conditions
infection
purpose of cutaneous circulation
nutrition
temp regulation
cutaneous blood vessel types
subcutaneous venous plexus
arteriovenous anastomoses
subcutaneous venous plexus
conduct heat to the skin surface
arteriovenous anastomoses
maximal constriction at 59 F
below 59F, dilation caused by local effects of cold of the vessels
this produces paralysis of the contractile mechanism of the vessel wall or blockage of nerve impulses into internal vessels
always check on our pateints
where are col, warm and pain receptors found
subendothelially
what happens to pain receptors at extreme temps
transmit in response to possible tissue damage
how do warm and cold receptors react
they readily adapt
what happens when larger surface areas are treated
vasomotor centers and the hypothalamus are activated
summary of the effects of cold
decreased local temp
decreased metabolism
vasoconstriction
decreased blood flow
decreased nerve conduction velocity
decreased mm extensibility
extreme anesthesia effects
what are contrast baths used for
used for sub-acute swelling and pain
what are contrast baths
having a hot and cold bath
going back and forth
what does a contrast bath do
desensitizes and creates vasodilation/vasoconstriction response
equipment for contrast baths
2 large containers
thermometer
towels
ice chips
what is the hot contrast bath set to
80-104 F
how long do you stay in the hot bath
at first 3-4 minutes, then 2-3 minutes every time, last time should be 5 minutes (end with it)
what is the cold contrast bath set to
55-67F
how long do you stay in the cold bath
2-3 minutes
what do we do upon completion
check girth of skin
has the swelling gone down?
do we always start with a larger degree change
no
it should be gradual
ice massage
apply continuously until numb
watch for dripping water
position carefully
how do we apply ice massage
in a circular pattern
each stroke should cover 50% of the previous stroke
physiologic response to ice massage
cold
stinging
pain
numbness
cold hydrocollator pack freezer temp
10-25 degrees
how should we position the pt while using a cold hydrocollator pack
w/ protective toweling
body part in elevated position in the acute and subacute phase
how long should treatment with a cold hydrocollator pack be
20 minutes
the pt has to be still
what happens if a cold hydrocollator pack is left on for prolonged periods
decrease mm tone
ice packs use
used for acute injuries to prevent additional swelling following exercise
wouldn’t be put directly on pts skin
treatment with an ice pack
position pt
secure pack
cover w/ towel to prevent heat loss
up to 20 min
what is hydrotherapy
“Water healing”
application of water for physical or psychological dysfunction
types of hydrotherapy
whirlpool
hubbard tank
contrast baths
pool
non immersion irrigation devices
indications for hydrotherapy
wound treatment
enhanced environments for therex
pain control/reduction
edema
health maitenance
properties of water
high specific heat
thermal conductivity
buoyancy
resistance
hydrostatic pressure
specific heat of water
4x that of air
water hold 4x as much thermal energy
things will heat up quicker in water
thermal conductivity
25x greater than air
modes of heat transfer
conduction
convection
radiation
buoyancy
upward thrust on the body opposite to the force of gravity
Archimedes principle
a body immersed or partially immersed in a fluid at rest experienced an upward thrust = to the weight of the fluid it displaces
different bodily tissue shave different specific gravity values
resistance
increases in water
occurs against the direction of motion in proportion to the speed of the body’s motion and frontal area of the body in contact w/ the water
variable
hydrostatic pressure
pressure exerted by a fluid on a body immersed in fluid
pascal’s law
pascal’s law
fluid exerts equal pressure on all body surfaces at rest at a given depth and this pressure increased in proportion to the depth of immersion
as you get deeper in water, pressure increases
equal pressure on the body on all surfaces at rest
uses of hydrotherapy
superficial heating/cooling
wound care
pain control
edema control
contraindications for hydrotherapy
superficial heat and cold anesthesia
maceration around wound
bleeding
precautions for hydrotherapy
impaired thermal sensation
infection in area to be immersed
impaired cognition/confusion
areas of recent skin grafts
full body immersion precautions
confusion/disorientation
alcohol ingestion
medications
urinary incontinence
fear
respiratory problems (COPD, asthma)
what happens to those with respiratory problems w/ full body immersion
extra pressure will be put onto the chest wall in water
full body immersion contraindications
cardiac instability
possible spread of infection
bowel incontinence
severe epilepsy
suicidal
whirlpool equipment
tank
agitator
stainless steal
many body part sizes
how does cold whirlpool transfer hear
convection
how will you know to use cold whirlpool
it will be indicated when exercise during icing is desired
how long does one immerge in a cold whirlpool
5-15 minutes
what is the temp of the cold whirlpool
65-80 degrees
what should we be cautious about with cold whirlpool
gravity dependent positions can increase swelling
a wet compressive wrap should be put on the part prior to treatment
cover toes for comfort
stay with patient
what is the most intense application of cold
cold whirlpool
whirlpool temp ranges
cold whirlpool
tepid
neutral warmth
mild warmth
hot
very hot
cold whirlpool
32-79F
acute condition
won’t usually go below 65F
tepid
79-92
cannot tolerate colder
neutral warmth
92-96F
open wound
mild warmth
96-98F
burns
relax pt
hot
99-104F
pain
increases extensibility
very hot
104-110F
chronic condition
double check pt can tolerate
documentation
type of modality used
pt position
temp of water
of dips, towels, distance, etc.
duration
outcome of response to treatment
BE SPECIFIC
ADD ANY CAHNGES DURING TREATMENT
