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Thermotherapy Flashcards

1
Q

Factors that determine the effects of
heat

A

 Extent of tissue temperature rise (TTR)
 Rate at which energy is being
transferred
 Volume of tissue
 Composition of tissue
 Capacity of tissue to dissipate heat
(e.g., blood supply)

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2
Q

Extent of tissue temperature rise (TTR) =

A

degree to which tissue temperature increases will influence the therapeutic effects of heat

For therapeutic purposes, a moderate increase in temperature (typically 40-45°C or 104-113°F) can enhance circulation and decrease muscle spasms, but excessive heat may cause tissue damage or burns.

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3
Q

Rate at Which Energy is Being Transferred =

A

The speed at which heat is delivered to the tissue plays a role in the physiological response

Rapid heat application can cause an initial thermal shock to the tissues, whereas gradual heating is generally safer and more effective for muscle relaxation and pain relief.

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4
Q

Volume of Tissue =

A

Larger areas of tissue take longer to heat and may require more energy for adequate temperature elevation

Smaller areas, such as localized muscles, can heat up more quickly and respond to heat therapy in a more controlled manner

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5
Q

Composition of Tissue =

A

Different tissues (muscle, fat, skin) respond to heat in different ways

Muscle tissue, with its higher blood flow and metabolic activity, typically absorbs heat more effectively than fat tissue, which acts as an insulator and may require more time to reach therapeutic temperatures

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6
Q

Capacity of Tissue to Dissipate Heat (e.g., Blood Supply):

A

Tissues with better blood circulation, such as muscles, are better able to dissipate excess heat

High blood flow helps remove the heat from the tissue more efficiently, preventing thermal injury

Conversely, areas with poor circulation or larger fat deposits may have a reduced capacity to dissipate heat, increasing the risk of overheating.

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7
Q

Therapeutic Temperature Range:

A

between 40°C to 45°C (104°F to 113°F) = heat can promote beneficial effects like increased blood flow, muscle relaxation, and improved tissue flexibility without causing harm to the tissue

113°F to 122°F (45°C to 50°C), the risk of burning the tissue increases significantly

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8
Q

Biophysical Effects of Temperature Elevation:

A

Metabolic Changes (Increased Metabolic Rate)

Vascular Effects

Neuromuscular Effects

Connective Tissue Effects

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9
Q

Metabolic Changes (Increased Metabolic Rate):

A

Heat application increases the metabolic rate of tissues by stimulating enzyme activity and promoting cellular processes

This increased metabolism enhances tissue healing and can aid in the reduction of pain and inflammation

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10
Q

Vascular Effects:

A

Vasodilation: Heat causes vasodilation, or the expansion of blood vessels, which results in increased blood flow to the area. This is beneficial for promoting oxygen delivery, removing waste products, and facilitating tissue healing.

The degree of vasodilation and blood flow response can vary depending on the tissue being heated. For example, muscle tissue may respond more significantly than fat due to differences in circulation.

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11
Q

Neuromuscular Effects:

A

Pain Reduction and Muscle Relaxation)

Decreased Pain: Heat has a analgesic effect on the nervous system, reducing pain perception and providing comfort to the affected area

Muscle Spasms: Heat helps reduce muscle spasms by relaxing muscles, improving muscle flexibility, and promoting blood flow to the muscle fibers

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12
Q

Connective Tissue Effects:

A

Increased Elasticity and Flexibility - helps increase the elasticity of collagen fibers in tissues like tendons, ligaments, and joint capsules, making them more flexible and less resistant to stretch

Decreased Viscosity and Joint Stiffness: Heat reduces the viscosity of synovial fluid, allowing for smoother joint movement and a reduction in joint stiffness, particularly useful in conditions like arthritis or after long periods of immobilization.

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13
Q

Heat: causing local rise in temperature

A

increase collagen extensibility
decrease fluid viscosity
increase metabolism

dilation of arterioles, capillaries, and venules

nerve stimulation

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14
Q

increase collagen extensibility ->

A

softens scars
stretch collaged
decrease joint stiffness

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15
Q

decrease fluid viscosity ->

A

increase blood flow
hyperemia

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16
Q

increase metabolism ->

A

increase cellular activity
increase phagocytosis
increase products of metabolism
CO2, lactate increase
decrease blood pH

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17
Q

dilation of arterioles, capillaries, and venules ->

A

increase blood flow
hyperemia

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18
Q

nerve stimulation ->

A

axon reflex
proprioceptors
cutaneous heat receptors
hypothalamus

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19
Q

axon reflex ->

A

dilation of arterioles, capillaries, and venules -> increase blood flow and hyperemia

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20
Q

proprioceptors ->

A

decrease muscle spasm

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21
Q

cutaneous heat receptors ->

A

analgesic effect
sedative effect
to cortex-aware of heat

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22
Q

hypothalamus ->

A

general regulation of body heat

vasomotor
sweating
cardiac effects

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23
Q

Physical Principles of Heat:

A

Conduction
Convection
Radiation

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24
Q

Conduction:

A

(direct contact)

direct transfer of heat through the kinetic motion of atoms or molecules, where heat energy is passed from one object to another by direct contact

When a hot pack is applied to the skin, heat is transferred from the pack (hot object) to the skin (cooler object) through direct contact

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25
Convection:
(movement of fluids or gases) transfer of heat through the bulk movement of liquid or gas molecules In this process, heated molecules move away from the heat source, and cooler molecules take their place, which results in heat transfer throughout the medium Hot air blowing over the skin from a warm air device or fluidotherapy is an example of convection.
26
Radiation:
(electromagnetic waves) transfer of heat in the form of electromagnetic waves, without the need for a medium (such as air or water) Heat energy is transferred through space by the emission of infrared radiation use of infrared lamps in therapeutic settings is an example of radiation
27
Depth of heating
depth of penetration for heating pads is approximately 1 cm results in changes in cutaneous blood vessels and cutaneous nerve receptors (the skin and superficial tissues)
28
Cutaneous Blood Vessels:
Heat causes vasodilation (expansion of blood vessels), which increases blood flow to the superficial tissue, promoting healing and reducing pain.
29
Cutaneous Nerve Receptors:
The heat also stimulates cutaneous nerve receptors, which can have analgesic effects, reducing pain perception in the treated area.
30
To increase tissue temperature within 1-3cm depth:
moist heat packs (hot packs) paraffin wax bath fluidothearpy warm whirlpool microwavable gel packs air-activated heat wraps electric heating pads
31
To increase tissue temperature within 1-5cm depth:
continuous ultrasound continuous shortwave diathermy
32
Conduction Heat Modalities:
Moist Heat Packs: Paraffin Wax: Electric Heating Pads: Air-Activated, Wearable Heat Wraps:
33
Moist Heat Packs:
typically heated to 70°C to 75°C (158°F to 167°F) 6 to 8 layers of towel are used to insulate the heat pack Moist heat is more effective at increasing skin blood flow compared to dry heat - beneficial for reducing muscle spasms and promoting healing
34
Paraffin Wax:
Lower risk of burns compared to other methods The wax retains heat more consistently, and the temperature can be controlled more easily Dip the affected body part 8 to 10 times into the melted paraffin wax to create a thick layer oil in the wax provides additional benefits for skin moisture and is often used in scar management or to treat dry skin
35
Electric Heating Pads:
These are common home-based modalities that provide consistent heat They can be applied to targeted areas of the body.
36
Air-Activated, Wearable Heat Wraps:
These wearable heat wraps are air-activated and can be worn for up to 8 hours, providing continuous mild heat over a prolonged period
37
Key Point: To achieve a therapeutic effect, tissue temperature should be elevated to:
104°F to 113°F (40°C to 45°C) These temperatures are optimal for promoting circulation, muscle relaxation, and pain relief without causing damage to tissues.
38
Moist Heat Pack Care and Precautions:
Monitor the Patient: Skin Color and Sensation: Towel Layers: Avoid Full Body Weight on the Pack: Additional Towels for Commercial Covers:
39
Monitor the Patient:
Always monitor the patient during the hot pack application to ensure safety and comfort.
40
Skin Color and Sensation:
After approximately 5 minutes, check the skin color under the hot pack and ask the patient about their perception of heat Ensure the temperature is not too intense for the patient, and adjust if necessary.
41
Towel Layers:
Six to eight layers of towels should be used to cover the heat pack This acts as a buffer to prevent direct contact with the hot pack, reducing the risk of burns
42
Avoid Full Body Weight on the Pack:
Never have the patient lie with their full body weight on the hot pack, as this could cause uneven heat distribution or lead to injury.
43
Additional Towels for Commercial Covers:
Commercial hot pack covers may require additional layers of toweling to ensure adequate insulation and prevent the heat from causing discomfort or burns.
44
Convection Heating: Fluidotherapy
uses air-fluidized solids (typically a mix of finely ground corn husks or similar materials) that circulate warm air through them, creating a dynamic and soothing environment for heating
45
Fluidotherapy Target Areas:
primarily used for distal extremities, such as hands, wrists, or feet, as it can provide uniform heat distribution around these areas
46
Fluidotherapy Variable Temperature and Agitation:
can be adjusted based on the patient’s comfort level agitation of the solids helps to improve heat transfer and provides a gentle massaging effect
47
One of the key benefits of fluidotherapy is that patients can perform =
active range of motion (AROM) exercises while heating the tissue, which helps to combine heat therapy with functional exercises
48
Heat Therapy Principles and Indications:
Decrease Pain and Stiffness Alleviate Muscle Spasm Increase Range of Motion (ROM) and Tissue Extensibility Enhance Tissue Healing by Increasing Blood Flow Duration of Application
49
Decrease Pain and Stiffness:
Heat therapy helps to reduce pain and muscle stiffness by promoting vasodilation and relaxing tight muscles, which eases discomfort.
50
Alleviate Muscle Spasm:
Heat can effectively reduce muscle spasms by improving blood circulation, which helps relieve the involuntary muscle contractions.
51
Increase Range of Motion (ROM) and Tissue Extensibility:
By increasing the temperature of tissues, heat therapy improves flexibility and range of motion (ROM), making it easier to stretch muscles and joints
52
Enhance Tissue Healing by Increasing Blood Flow:
Heat therapy promotes vasodilation, increasing blood flow to the treated area This improved circulation helps to deliver oxygen and nutrients to tissues, aiding in the healing process
53
Duration of Application:
For optimal therapeutic effects, heat should be applied for 15 to 30 minutes This allows sufficient time for tissue heating while minimizing the risk of burns or discomfort
54
Contraindications and Precautions to Thermotherapy:
Lack of Thermal Sensation Vascular Insufficiency/Disease Areas of Recent/Potential Hemorrhage Areas of Malignancy Areas of Acute Inflammation or Infection Certain Medical Conditions (e.g., Multiple Sclerosis) Recently Applied Liniments or Heat Rubs Unreliable Situations (e.g., Language Barriers, Cognitive Impairment) Older Adults
55
Lack of Thermal Sensation:
Thermotherapy should be avoided in areas where the patient has diminished or absent thermal sensation, as they may not perceive excessive heat and could risk burns or injury.
56
Vascular Insufficiency/Disease:
Thermotherapy should be used cautiously or avoided in individuals with vascular insufficiency or vascular disease because the heat can worsen circulation problems, leading to complications like skin damage or increased risk of ulcers.
57
Areas of Recent/Potential Hemorrhage:
Avoid applying heat to areas that have recent hemorrhage or potential for bleeding, as heat can increase blood flow and promote further bleeding.
58
Areas of Malignancy:
Thermotherapy should not be used over areas of malignancy (cancer) as the increased circulation can potentially increase the growth rate of tumor cells or cause metastasis
59
Areas of Acute Inflammation or Infection:
Heat should be avoided in areas with acute inflammation or active infections as it can exacerbate inflammation, promote the growth of bacteria, and delay healing
60
Certain Medical Conditions (e.g., Multiple Sclerosis):
In multiple sclerosis and other conditions that affect heat sensitivity, heat can worsen symptoms, leading to fatigue, exacerbation of spasticity, or decreased function
61
Recently Applied Liniments or Heat Rubs:
Avoid applying thermotherapy to areas where liniments or heat rubs have recently been applied, as this can increase the risk of skin irritation or burns due to the combined heat effects.
62
Unreliable Situations (e.g., Language Barriers, Cognitive Impairment):
In situations where the patient is unable to communicate properly (e.g., language barriers or cognitive impairment), it may be difficult to monitor their response to heat, increasing the risk of injury.
63
Older Adults:
Older adults have reduced ability to dissipate heat and may have thinner skin or impaired circulation, which makes them more prone to burns or overheating. Monitoring is essential to avoid adverse effects.
64
Clinical Decision-Making for Thermal Modality Use:
1. Diagnosis and Medical Status: 2. Stage of Injury/Disease: 3. Area of the Body: 4. Patient Preference: 5. Indications/Contraindications: 6. Superficial vs. Deep Heat:
65
1. Diagnosis and Medical Status:
The underlying condition (e.g., musculoskeletal injury, neurological disorder) will dictate whether heat or cold is more appropriate. Comorbidities and the patient’s medical status (e.g., vascular issues, cancer, acute vs. chronic conditions) should be taken into account to avoid exacerbating symptoms.
66
2. Stage of Injury/Disease:
Acute Stage (0-72 hours): Typically, cold therapy is preferred to reduce inflammation, swelling, and pain. Subacute to Chronic Stage (after 72 hours): Heat therapy can be more appropriate to reduce stiffness, increase blood flow, and facilitate tissue extensibility. Consider cold for acute inflammation and heat for chronic stiffness or muscle spasms.
67
3. Area of the Body:
Superficial Areas (e.g., skin, superficial muscles) may benefit from moist heat packs or paraffin wax. Deeper tissues (e.g., joints, muscles) might require ultrasound or diathermy for more effective penetration.
68
4. Patient Preference:
Consider the patient’s comfort and preference between heat and cold. Some patients may have a preference based on previous experience, and respecting this can improve patient compliance.
69
5. Indications/Contraindications:
Cold contraindications might include cold intolerance or vascular issues. Heat contraindications might include areas of acute inflammation or vascular insufficiency.
70
6. Superficial vs. Deep Heat:
Superficial Heat: Best for conditions affecting the skin and muscles near the surface. These modalities typically provide shorter-term benefits. > Moist heat packs and paraffin wax work well here. Deep Heat: For conditions requiring deeper tissue penetration (e.g., joint or deeper muscle issues). > Ultrasound or diathermy can provide more penetrative heat to target deeper structures effectively.
71
Thermotherapy - therapeutic effects
increase temperature increased blood flow to the treated area decreased nerve conduction latency temporarily decreased muscle strength increased pain threshold increased edema vasodilation increased nerve conduction velocity, metabolic rate, muscle elasticity, collagen extensibility decreased muscle tone
72
Thermotherapy - indications
pain control chronic inflammatory conditions trigger point tissue healing muscle spasm decreased ROM desensitization
73
Thermotherapy - contraindications
circulatory impairment areas of malignancy acute msk trauma bleeding or hemorrhage sensory impairment thrombophlebitis arterial disease

Rehab Tech (8 decks)

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