Thermotherapy

Question 1

Thermotherapy basics

Answer 1

• heat dilates blood vessels, increases circulation, increase blood flow (hypermia) - local superficial heating is indicated for subacute conditions - produces lower temperature at the site of the pathology relative to the higher temperatures in the superficial tissues which results in analgesia - HP, paraffin, fluidotherapy, whirlpool - deeper heating effect is desired in later stages of healing - diathermy or ultrasound

Question 2

General physiological effects of heat application

Answer 2

1. Increased: cardiac output, metabolic rate, pulse rate, respiratory rate, vasodilation 2. Decreased: BP, mm activity, blood to internal organs, blood flow to resting mm, stroke volume

Question 3

Local physiological effects of heat applicaiton

Answer 3

Increased: dilation of arteries, capillary pressure and permeability, extensibility of collagen tissue, cellular oxidation (2-3x for every 10 degree increase), vasodilation

Question 4

Answer 4

Question 5

Indications (9)

Answer 5

• pain - DOMS - sprains / strains - articular problems - mm pain and spasms - jt stiffness - decreased ROM - myofascial TP - mm guarding

Question 6

Goals of Tx

Answer 6

1. Produce relaxation: reduce mm guarding 2. ROM/flexibility: increase elasticity of connective tissue 3. Reduce pain: presynaptic inhibition of Adelta and C fibers via activation of Abeta (gate-theory) and disruption of pain-spasm cycle 4. Accelerate healing: 5. Preparation for others interventions

Question 7

Precautions (7)

Answer 7

• cardiac insufficiency - edema - impaired circulation - impaired thermal regulation (MS) - topic creams and lotions (demyelinated nerves) - open wounds - pregnancy

Question 8

Contraindications

Answer 8

• acute or early subacute traumatic an dinflammatory conditions - decreased susnsation - DVT - PVD - impaired cognitive function (can be precaution) - decreased circulation - malignant tumors - tendency towards hemorrage or edema - very old/very young pts (can be precaution)

Question 9

Conduction

Answer 9

Heat transfer from warmer object to cooler object by means of a direct molecular interaction from physical contact - hot packs - paraffin

Question 10

Convection

Answer 10

Heat transfer by movement of air to fluid from a warmer area to a cooler area by moving past the cooler area - whirlpool - fluidotherapy

Question 11

Radiation

Answer 11

Transfer of heat from a warmer object to a cooler object by means of electromagnetic energy without the heating of a medium (infrared waves are absorbed by the body) - infrared lamp

Question 12

Tx guidelines

Answer 12

1. Performed by qualified PT, PTA, SPTA 2. Position patient comfortable, expose and drape, remove jewelry 3. Inspect and asses tissue and sensation 4. Call bell or alert instructions given to patients 5. Check patient frequently 6. Dry and inspect skin at conclusion of tax 7. Document specific procedure used (pt position, to time, to area, tissue and sensation integrity, how pt tolerated it, etc.)

Question 13

Rule out

Answer 13

1. When did your injury occur? 2. Did you have any bruising or bleeding? 3. Do you have a history of blood clots? 4. Do you have normal feeling in this area 5. Do you have a history of cancer? 6. Are you pregnant or trying to get pregnant? 7. Do you have any heart or circulation problems? 8. Do you have any metal in this area? 9. Have ou applied creams to this area today? 10. Do you have any nerve issues (CT, MS)?

Question 14

Hot pack application

Answer 14

• use 6-8 layers between patient and hot pack - use 8-10 layers if patient is laying on the hot pack - secure hot pack - check pt within 5 minutes, and periodically after - reaches peak heat at 5 minutes (most burns occur within 6-8 min) - total treatment time: 15-20 minutes “You should feel a moderate to strong, comfortable warmth, but NO BURNING”

Question 15

Skin responses to HP application (normal vs abnormal)

Answer 15

Normal - pinkness or redness in treatment area - wetness or sweating in area Abnormal - excessive redness - blistering - rash or burns

Question 16

Paraffin

Answer 16

Warm, melted (125-127?) wax containing mineral oil (6:1 or 7:1) - applied to small irregularly shaped area (hand, wrist, foot) - oil lubricates and conditions skin; can soften scars

Question 17

Paraffin application

Answer 17

1. Have pt wash area to be treated 2. Dip body part into paraffin as far as posssible and hold it there (avoid touching sides or bottom and avoid movement) 3. Remove area from bath (wait 5-10 seconds for it to harden and looks dull) 4. Repeat dipping 6-10 times 5. LID ON BATH 6. Wrap pt’s hand in plastic, then towel 7. Check on pt in 5 minutes 8. Total treatment time is 10-15 min or until it cools 9. Awkwardly pull it off

Question 18

Contrast baths

Answer 18

Two containers: 98-11 and 50-65 degrees F - immerse area to be treated in warm water for 3-4 minutes; then immerse in cold water for 1 minute - repeat 5-6 times, ending with warm (20-30 min total) depending on pts condition, may want to end in cold (edema) - dry area thoroughly

Question 19

Contrast baths clinical indications

Answer 19

• chronic edema - hypersensitivity disorders - any condition requiring stimulation of peripheral circulation in limbs - PVD - sprains / strains - DOMS - trauma (after acute condition)