Unit 3: Superficial Heat Flashcards
Heat Transmission
-Conduction
-Radiation
-Convection
Conduction (heat transmission)
Exchange of thermal energy between two surfaces in direct physical contact (ex. hot pack, paraffin)
Radiation (heat transmission)
Transfer of energy through electromagnetic waves from the source to the body (ex. laser therapy)
Convection (heat transmission)
The conveyance of heat by movement of heated particles (ex. whirlpool, fluidotherapy)
-Heat and movement together produce greater blood flow than heat alone
Superficial Heating Agents
-Penetrate 1-2cm after 15-30 minutes (deeper structures after 20 minutes)
-Absorbed only in the epidermis and dermis
-Capable of increasing intra-articular temperature at digits
Biophysical Effects of Superficial Heating Agents
-Metabolic effects
-Changes in nerve conduction velocity
-Increased pain
-Altered tissue extensibility
Biophysical responses to Heat
Increases:
-Blood flow
-Rate of cell metabolism
-Oxygen consumption
-Capillary permeability
-Inflammation
-Muscle contraction velocity
Decreases: Biophysical responses to Heat
-Fluid viscosity
-Pain
-Muscle spams (by reducing pain and ischemia)
Metabolic Effects of Superficial Heating Agents
-Increase metabolic rate
-Increase blood flow and oxygen
-Facilitate greater number of antibodies, enzymes, leukocytes, and nutrients
-Benefit all stages of wound healing (except inflammation)
Nerve Conduction Velocity from Superficial Heating Agents
-Increased nerve conduction velocity
-Increases pain threshold= Analgesic effect (Gate Theory)
-Decreased muscle spasm via decreased gamma efferent activity
-Decreasing gamma activity decreases stretch on the muscle spindle; Reducing afferent firing from the muscle spindle hence indirectly decreasing alpha motor neuron firing (interrupts pain-spasm cycle)
Pain Control of Superficial Heating Agents
-Increased activity of cutaneous thermoreceptors (Inhibitory gating effect on the transmission of the sensation of pain)
-Increased vasodilation with increased blood flow can decrease pain created by ischemia
-Psychosocial effects-may influence patient’s perception of pain
-Decreasing muscle spasms, accelerating healing, and altering in nerve conduction can also help reduce pain
Alter Tissue Extensibility (Superficial Heating Agents)
-Increased soft tissue temperature has been shown to increase extensibility
-Collagenous tissue (tendon, ligament, scar tissue, joint capsule)
-If heat is applied to collagenous tissue prior to or with stretching, the tissue can reach a state of Plastic Deformation
-If not heated first will only reach Elastic Deformation
Plastic Deformation (Alter Tissue Extensibility: Superficial Heating Agents)
When the tissue is taken to a length and most of the lengthening is retained after cooling.
Elastic Deformation (Alter Tissue Extensibility: Superficial Heating Agents)
The tissue is lengthened - however, the length does not remain after the force is removed.
Increasing Joint Motion/Reducing Stiffness (Superficial Heating Agents)
-Increased tissue temperature facilitates tissue extensibility
-Maximum increased length with the lowest risk of injury
-Low load- prolonged stretch during or immediately after heat
Superficial Heat Clinical Indications
-Decrease pain
-Decreases muscle spasm
-Decreased viscosity (soften thick/brawny edema)
-Cutaneous vasodilation
-Increased elasticity, extensibility, and flexibility of tissues
-Increased metabolism in tissues
Precautions for Superficial Heating Agents
-Acute injury of inflammation
-Very young or very old
-Topical counter irritants (i.e. biofreeeze)
-Demylinated peripheral nerve
-Pregnancy
-Impaired circulation
-Poor thermal regulation
-Edema
-Cardiac insufficiency
-Metal in the area
-Open wounds
Contraindications for Superficial Heating Agents
-Recent or potential hemorrhage (i.e. bruising)
-Thrombophlebitis (heat can dislodge clot)
-Areas of impaired circulation
-Impaired mentation/communication
-Infrared irritation to eyes
-Area where these is malignancy (Don’t want to increase circulation or metabolic rate in this area)
Clinical Reasoning with Precautions/Contraindications for Superficial Heating Agents
-Acute Injury/Inflammation
-Recent or Potential Hemorrhage
-Thrombophlebitis
Acute Injury/Inflammation (Clinical Reasoning with Precautions/Contraindications for Superficial Heating Agents)
-Increased temperature will cause vasodilation, which can further increase edema level limiting recovery/function
-Determine when injury occurred
-Assess skin temperature, color, and edema location
Recent or Potential Hemorrhage (Clinical Reasoning with Precautions/Contraindications for Superficial Heating Agents)
-Increased temperature will provoke or worsen injury causing increased bleeding into interstitial tissue
-Inspect for ecchymosis/discoloration
-Inquire when injury occurred/mechanism of injury
Thrombophlebitis (Clinical Reasoning with Precautions/Contraindications for Superficial Heating Agents)
Superficial heat can cause a blood clot to dislodge and move to vital organs
Ask patient: (Clinical Reasoning for Superficial Heating Agents)
-Hx of blood clots
-Assess for edema and tenderness/calf
-Ask about and test sensation
-Assess cognitive abilities
-Skin integrity, open wounds, bruising, signs of infection etc.
Adverse Effects of Superficial Heating Agents
-Burns: Excessive heat can lead to tissue death
-Fainting: Inadequate cerebral flow due to peripheral dilation
-Bleeding: Aggressive bleeding due to increased blood flow
Choosing the correct modality depends on… (Superficial Heating Agent)
-Objective of modality
-Location and surface of involved structure
-Desired dosage/tissue temperature
-Desired depth of penetration
(If the depth of penetration is greater than1 cm, then another medium will need to be used –i.e. ultrasound)
Additional Considerations: Moist or dry heat; Position of extremity; Active or passive participation
Types of Methods (Superficial Heating Agents)
-Whirlpool/Hydrotherapy
-Fluidotherapy
-Hot Packs
-Contrast Baths
-Warm Water Soaks
-Paraffin Bath
Treatment Time: Whirlpool/Hydrotherapy
10-20 minutes
Temperature: Whirlpool/Hydrotherapy
Don’t exceed 110°F, typically 92-96°F
Advantages: Whirlpool/Hydrotherapy
AROM. control of temp, able to see body part during tx
Pressure: Whirlpool/Hydrotherapy
Maintained between 4-15 PSI
Disadvantages: Whirlpool/Hydrotherapy
Dependent position, possible edema. sterilize/disinfect between each use, time to set up/clean up
Special Concerns: Whirlpool/Hydrotherapy
-Wounds extremely painful (sensory nerves)
-Medications for pain
-Close Monitoring
-Risk of Infection
Contraindications: Whirlpool/Hydrotherapy
-Maceration
-Bleeding
Precautions: Whirlpool/Hydrotherapy
-Impaired sensation
-Infection
-Confusion/Impaired Cognition
-Skin grafts
Infection Control/Safety: Whirlpool/Hydrotherapy
-Infection: Whirlpool cleansing protocol; Universal precautions
-Safety: Tank grounded, Turbine/water in tank
Whirlpool/Cleansing Effects
-Rehydration
-Softening
-Debridement of necrotic tissue
-Removal of wound debris
-Increased circulation
-Promotes a moist rather than dry wound to promote wound healing
Whirlpool Documentation
-Type of agent used
-Patient position or activities
-Temperature
-Duration of treatment
-Outcome of response to treatment
-Fluid pressure
-Water additives
Fluidotherapy
-Fine particles suspended in hot air steam
-Particles made of ground corn husks
-Temperature controlled by thermostat
-Frequency of speed controlled in blowing mechanism
-For distal extremities
-Preheat: 105-118
-Treatment time: 15-20 minutes
-Beneficial for arthritis, desensitization
Prior to Fluidotherapy treatment…
-Remove jewelry, pull up sleeves prior to entering machine
-Secure sleeve tightly before, during, and after treatment
-Treatment time: 15-20 minutes
Advantages of Fluidotherapy
-Patient can before AROM/PROM in heat
-Temperature can be easily adjusted
-Material can be soothing and help with desensitization
-Low risk of burns
Disadvantages of Fluidotherapy
-Expensive
-Dependent Position
Hot Packs
-Provides moderate to vigorous moist heat
-Many sizes, stored in hydrocollator
-158-167° F /Hydrocollator
-104-113° F (hot packs cooler than water in unit they are stored in)
-Hot packs cool as treatment progresses
-Padding with at least 6 layers of toweling (terry cloth covering equivalent to 3 layers)
-Check skin after 5 minutes
-Do not weight bear on hotpacks
-Treatment time: 15-20 minutes
-Good modality for increasing tissue extensibility using coban tape for stretch
Advantages of Hot Packs
Easy to use, can apply passive stretch, inexpensive
Disadvantages of Hot Packs
Body part in static position, can be difficult to conform, risk of burns if not applied correctly
Hot Pack Documentation
-Area of body treated
-Type of heating agent used
-Treatment duration
-Response to treatment
-The number and type of insulation used
-The patient’s position or activity
Materials for Contrast Baths
-Two large containers (4-6” deep)
-Hot and cold water
-Canning or candy thermometer
Procedure for Contrast Baths
-Fill one container with warm water (100-110 degrees F)
-Fill the second container with cold water (59-70 degrees F)
-Test temperatures with thermometer
-Put extremity completely into warm water (3-4 minutes) then cold (1 min); alternate back and forth 4-5 times
-Start and end with warm water
-Treatment up to 30 minutes
Warm Water Soak
-Used for mobilizing digits and increasing ROM
-Treatment temperature: 99-110° F
-Treatment time: 15-20 minutes
Paraffin Bath
-Remove clothing/jewelry from area being treated
-Wash and completed dry extremity being treated
-Provides high degree of heat to smaller joints
-Composed of mineral oil and paraffin
-Temperature: 118-135° F
-Lower specific heat than water
Treatment time: 20 minutes
Advantages of Paraffin Bath
-Even distribution of heat
-Allows for passive stretch in heat
-Contours, moistens, low specific heat
-Can be purchased for home use
Disadvantages of Paraffin Bath
-No mechanism to control temperature
-Practical for only distal extremities
-Cannot be used over wounds
-Body part is static during application
Client Interaction for Superficial Heating Agents
-Introduce Yourself
-Ask about contraindications
-Inspect the area
-Check sensation
-Explain procedure and benefits
-Explain to the patient what they should feel
-Obtain permission
-Reassure patient that you are available if needed
