Thermo Cryo Modalities Flashcards
The amount of heat energy within a substance depends on what three things
- Speed of particles (kinetic energy)
- Number of particles (mass)
- Capacity of particles to store heat (specific heat capacity)
amount of heat formula
Amount of heat= (mass) x (Temp. final- Temp. initial) x (specific
heat)
optimal temperature for therapeutic tissue heating effect
104-113 degrees F
Temperature of human tissues at baseline
82 to 96 degrees F
Therapeutic window between suboptimal and optimal temperatures
97 ro 103 degrees F to 104-113 degrees F
what human tissue conducts heat the least?
fat
what human tissue conducts heat the most?
muscle
what stores more heat air or water?
water
conduction- method of energy exchange and examples
physical contact (2 solid substances) hot pack
Convection-method of energy exchange and examples
physical contact (gas/fluid against a solid substance) Free: no external perturbation, forced- external perturbation
Paraffin bath, fluidotherapy, hydrotherapy
Radiation-method of energy exchange and examples
air contact between agent and tissue
shortwave diathermy
Evaporation- method of energy exchange and examples
Liquid to gaseous state when contact with tissue
Vapo-collant spray
Moist Heat Paraffin Bath Dipping with continuous immersion
7-10 dips followed by a continuous immersion of 30 minutes
Moist Heat Paraffin Bath Dipping with wrapping
7- 10 dips followed by plastic liner and towel/ cloth mitten over (30 min.)
Moist Heat Paraffin Bath brushing with wrapping
7- 10 layers
Hot packs are kept at which temperature
158-169 degrees F
Paraffin is kept at what temperature
124-129 degrees F
Fluidotherapy is kept at which temperate
Fluidotherapy: After turning on and warm up is complete, temperatures range in 110-126°F
Coupling medium of hot packs
5-8 layers of toweling. Commercial cloth is equivalent to 2-3 layers.
Coupling medium of paraffin
Intact skin (wrap first with sterile gauze if minor cut present- e.g. paper cut)
Coupling medium fluidotherapy
None
Application time for a hot pack
about 20 minutes
Application time for parrafin
about 30 minutes
Application time for fluidotherapy
about 30 minutes
Screening thermal discrimination 5 point scale with test tubes filled with water at each of these 5 temperatures held for 10-15 seconds with 60 seconds between temperature shift
Very cold (freezer 23-32°F)
Cold (refrigerator 50-55°F)
Neutral (room temperature 68-72°F )
Warm (thermal agent water around 91-95°F)
Hot (paraffin filled tube around 124-129°F)
Scoring for thermal discrimination screening
4-5/5=normal/ slightly impaired (no restriction to use)
3/5= moderately impaired (be precautious with patient as per sound clinical judgment)
1-2/5= severely impaired (risk for harm with thermal use)
0/5= Totally impaired (all thermal & electrophysical agents are contraindicated)
Metabolic response to heat (3)
vasodilation
increase blood flow and cell metabolism
enhanced soft tissue healing
Neuromuscular response to heat (3)
decrease gamma motor neuron activity
decrease alpha motor neuron activity
decrease muscle spasms
Musculoskeletal response to heat (3)
increases viscoelastic properties and decrease joint viscosity
improves muscle flexibility and joint mobility respectively
enhances soft tissue mobility
contraindications to heat (6)
Over areas with sensory impairment (unable to sense heat)
Over cancerous areas
Over areas with thrombophlebitis
Pregnancy (over localized areas of pelvis, abdominal, and low back)
Over areas with acute or severe inflammation
Confused patients*
precautions to heat with localized use (6)
Over areas with impaired blood circulation (patients can’t self cool)
In patients with severe cardiac insufficiency (do not want to increase fluid load to the heart)
Over areas with superficial open or closed wounds including grafts and burns
Over superficial metal implants in human tissue
In cases of systemic infectious diseases
Over areas in presence of demyelinated nerves
stages of early tissue repair (4)
Hemostasis (second-minutes)
Inflammatory (hours/days/weeks)
Proliferative (weeks/months)
Remodeling/Maturation (months/year)
Cellular response to cold (5)
reduction of tissue temperature reduction of cell metabolism reduction in tissue oxygen requirement reduces secondary tissue damage decrease free proteins = decrease edema
metabolic response to cold (3)
depolarization of sympathetic adrenergic nerve fibers
norepinephrine causes smooth muscles to contract in blood vessels
vasocontriction
Neurological response to cold (4)
cold stimulus competes with pain stimulus
decrease localized pain substances (histamine and prostaglandin)
decrease nerve conduction velocity of pain nerve fibers
decrease gamma motor neuron= decrease muscle spasm/tone
optimal tissue temperature for cold
60 to 50 degrees F
Tissue temperature normally
82 to 95 degrees F
therapeutic window for cold between suboptimal to optimal
81 to 61 degrees F to 60 to 50 degrees F
Greater adipose tissue leads to a ____ cooling effect
diminished
cryotherapy ranked strong for (2)
- Post-operative knee arthroplasty
2. Mixed post-op musculoskeletal conditions
cryotherapy ranked moderate for (4)
- Ankle sprains
- Spasticity
- Joint/ tendon/ muscle conditions
- Arthritic/ Rheumatoid conditions
Gel pack temperature
23-32 degrees F
cubed ice bag temperature
32-50 degrees F
crushed ice bag temperature
32-50 degrees F
wetted-ice bag temperature
32-50 degrees F
ice cup/icicle temperature
two other cryogents
vapocoolant spray, controlled continuous cold unit with compression
coupling medium for gel cold packs
wet towel layer between cryoagent and skin
treatment duration for gel cold pack
10-20 minutes
treatment duration for ice cup/icicle
5-10 minutes
treatment duration for controlled cold unit with compression (cryocuff)
1-8 hours depending on condition
treatment duration for vapocollant
3-5 Quick sprays for a second to afraction of a second depending on area followed by 1-2 minute stretching of targeted tissue
I-BANA
Intense cold burning aching numbness analgesia
contraindications for cold therapy (7)
Over skin areas where sensation of cold is severely impaired In patients with cold induced urticaria
In patients presenting with Raynaud’s disease/ phenomenon In patients with Cryoglobulinemia (proteins become insoluble at lower temperatures- this can cause protein build up and limit circulation)
Over open dermal wounds
Over peripheral vascular disease areas Patients who are confused*
Precautions for cold therapy (10)
Over areas of impaired circulation
Over thoracic areas in patients with cronopathies
In hypertensive patients
In patients with Cardiovascular and Cardiorespiratory disorders
Over superficial peripheral nerves
Patients with hemiplegia
In very young/ old patients
In Overweight/ Obese patients
The potential for there to be some loss of Joint Position Sense Awareness immediately after use of cryotherapy over stressed joints
The effects of compression with a gel pack on underlying tissue
what is contrast immersion used for
Enhances peripheral blood flow post acute injury. Good for edema control.
What temperatures does contrast immersion alternate between
Alternate between hot (99-100°F) and cold (41-68°F) water.
hot:cold ratio for contrast immersion
4:2 constant or variable
how many cycles is contrast immersion how long does treatment last for
4 cycles
20-30 minutes total
