Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
59 Cards in this Set
- Front
- Back
|
What are some types of physical agents?
|
Paraffin Baths
Ultrasound Fluidotherapy Moist Hot packs Short wave Diathermy |
|
|
Superficial Heat vs Deep Heat
|
Superficial Heat- Heats up the skin primarily and subcutaneous tissue.
Deep Heat- Increase temperature of deeper tissues. Can reach a depth of approximately 5cm |
|
|
First Law of Thermodynamics
|
Energy cannot be created nor destroyed, only transformed from one form to another.
During transformation, heat is released. (Thermal energy) |
|
|
Specific Heat
|
Amount of energy required to raise the temperature a given number of degrees.
Materials used as thermal aets and the bodies soft tissues have varying specific heats. Thermal agents with a high specific heat are applied at lower temperatures than air-based thermal agents due to heat differences. |
|
|
Heat
vs Cold |
Kinetic energy=molecular motion
Cold=> Decrease molecular motion=less heat Heating agents transfer heat to the body whereas cooling agents transfer heat away from the body. Cold agents take on the heat of the body. |
|
|
Temperature
(conversions) |
-Fahrenheit
-Celcius -Kelvin (used in scientific research) -Rakin (Used in scientific research) F=(9/5 x C) + 32 C=5/9 (F - 32) |
|
|
Superficial Heat Modalities
|
-Penetrate only 1-3cm
-Common forms include: Moist hot pack, paraffin baths, fluidotherapy, warm whirlpool, microwaveable or air-activated hot packs, electric heating pads. |
|
|
Deep heat modalities
|
Penetrate up to 5 cm
Common forms include: Ultrasound & Diathermy |
|
|
Modes of Heat transfer include:
|
Conduction, Convection, Evaporation, & Radiation
|
|
|
Conduction
|
Method of heat transfer as a result of energy exchange between 2 materials at different temperatures.
DIRECT interaction of the molecules in the warmer area with those in the cooler area leading to the speed of molecular movement of both materials becoming equal. Slow process: Fast moving objects--> Collide-->With cold slower moving object. Warm object gives up energy and the slower object absorbs energy. The fast molecules move slower as a results and the initial slow molecules increase speed and temperature. |
|
|
Heats effect on cancer
|
Heat increases metabollic rate.. SO, you may increase the rate that the cancer metabolizes and hence it can progress.
|
|
|
Convection
|
Heat transfer results from DIRECT contact between a circulating medium and another material of a different temperature.
|
|
|
When heating or cooling by convection the thermal agent is in _______, so new parts of the agent at the initial treatment temperature keep coming into contact with the patients body part.
Two examples include: ____ & _____ |
Motion.
Fluidotherapy & Whirlpool |
|
|
Evaporation
Two examples include: _____ & _____ |
A material must absorb energy in order to evaporate and thus change form from a liquid to a gas or vapor.
Energy is absorbed in the form of heat, either from the material itself or from an adjoining material, resulting in a decrease in temperature. Ex/ Sweating & Vapocoolant sprays |
|
|
Radiation
|
Heating by radiation involves the DIRECT transfer of energy from a material with a higher temperature to one with a lower temperature WITHOUT the need for an intervening medium or contact.
|
|
|
Radiant energy can be propagated through space or matter in ______. The rate of temperature increase that is caused by radiation depends on the _____ of the radiation, the _____ of the radiation source and the ______, the distance of the source from _____, and the ____ of the radiation to the tissue.
|
All directions
Intensity relative sizes area being treated the treatment area angle |
|
|
All objects (above absolute zero temp) can give off or take on thermal energy through the process of __________.
|
radiation
|
|
|
Cold Modalities
Can affect the temperature of tissues to a ______depth than a superficial heat modality Temperature gradient between the cold modality and the skin is ______ than heat modalities Cooled tissue takes longer to ____ than heated tissue takes to ________. |
greater
much larger warm up, cool down |
|
|
If apply cold pack to patient, how long does it take for tissues to return to initial temp?
|
Can take 3 hours
|
|
|
Two types of application of modalities
|
Local applications & General applications
|
|
|
Local Reactions
|
-Localized sweating and swelling with heat
-Localized and pile erection (goose bumps) with cold -Includes change in local metabollic rate, blood flow, and skin conditions with both heat and cold. |
|
|
Systemic Reaction
|
-Physiologic changes occurring in the various systems of the body
-Reactions may include generalized sweating or shivering, or cardiovascular changes such as increased or decreased pulse rate and blood pressure. |
|
|
Heat leads to ______ at local area
vs Cold leads to ______ at local area |
Vasodilation
vs Vasoconstriction |
|
|
Mild dosage for heat
|
99-101 degrees F (1-3 degree change)
subtherapeutic Warm |
|
|
Moderate Dosage for heat
|
102-106 degrees F (4-7 degree change)
Beginning to reach therapeutic range Hot |
|
|
Vigorous Dosage of heat
|
107-113 degrees F (7-13 degree change)
End of therapeutic range Above 113 degrees F, tissue damage can occur (necrosis/destruction) |
|
|
What is the overall therapeutic temp range for heat modalities?
|
104-113 degrees
|
|
|
Physiologic Heat Responses
|
Erythema
Sweating Increased blood to the area Collagen extensibility increases Fluid viscosity decreases Metabolism increases Nerve stimulation |
|
|
Physiologic Cold Response
|
Skin blanch or blush (decreased blood to area)
Pilo Erection |
|
|
Thermal Sensory Experience Heat/Cold
Mild Moderate Extreme |
Mild: Analgesia-> General relaxation and/or decreased pain, spasms
Mod: Stimulating/invigorating Extreme: Fight/Flight response; Fear/Pain |
|
|
Heat :
Hemodynamic response Neuromuscular Effects Tissue Effects |
Hemodynamic response: Vasodilation-histamine and prostaglandin release. Smooth muscle relaxation. Increase enzymatic activity.
Neuromuscular Effects: Increase nerve conduction; Increase activity of cutaneous thermoreceptors->Spinal Cord effects Tissue Effects: Increase collagen extensibility |
|
|
Van Hoff's Law
|
If there is a rise in temperature by 10 degrees, there is a two or three fold increase in metabolism.
|
|
|
Paraffin wax is especially useful before joint mbilization on the hands and feet. Why?
How about with electrical stimulation? |
It can raise the temperature in small joint capsules of the hand 13.5° F (7.5°C) at a depth of about 0.5 cm below the skin.
E-stim reduces skin impedance. (warmer skin = lower impedance) |
|
|
Contraindications of Heat Modalities
|
1. Acute inflammatory conditions may be aggravated by the addition of heat
2. Already existing fever may be elevated further by heating the patient. Increasing metabolisms so won’t be good. 3. Malignancies may metastasize due to the increased blood flow produced by heating. Increasing metabolism 4. Active bleeding, such as that which occurs with acute trauma, may be prolonged. Vasodilation caused by heat could worsen. 5. Patients with cardiac insufficiency/PVD may not be able to tolerate the additional stress on the heart, which is produced by generalized heat. 6. Extremely old adults and children less than 4 years old have unreliable thermoregulatory systems and may develop a fever quite easily as a result of generalized heat treatments. Patients with peripheral vascular disease have a diminished capacity to meet the increased metabolic demands of heated tissues. 8. Tissues which are devitalized by x-ray therapy should not be heated. |
|
|
Commercial Hot Pack:
What type of heat delivery? How long can it retain heat? Superficial or deep heat? |
Conductive means of delivering heat.
Retains heat for a 1/2 hour Provides superficial heat |
|
|
Advantages/Disadvantages Commercial Hot pack
|
Advantages:
-Ease of preparation -Variety of shapes and sizes available -Moist, comfortable heat -Relatively inexpensive to purchase and replace Disadvantages -No method of temperature control once applied to patient -Does not readily conform to all body parts -Sometimes awkward to secure in place on patient Do not retain heat for longer than about 20 minutes Are a form of passive intervention, not requiring active patient participation May leak and then must be discarded |
|
|
Advantages and Disadvantages of Paraffin Wax
|
Advantages:
Low specific heat = higher temperature Low thermal conductivity = slower heating and decrease risk of burns Even distribution Oils moisten skin Wax can be used for exercise Disadvantages: Effective for only distal extremities No method for temperature control Heating only lasts 20 minutes |
|
|
Advantages and Disadvantages of Fluidotherapy
|
Advantages:
Convenient and easy to administer Temperature can be controlled Agitation can be controlled Most regions of an extremity can be treated (may require different units) Some active exercise can be carried out during treatment Can be used for desensitization Disadvantages: Expensive unit to purchase Some patients are intolerant (claustrophobia) Some patients are intolerant to the dry materials (cellex) Corn husk material |
|
|
Cryotherapy
Therapeutic uses include: |
Heat abstraction- heat moves from body to cooling agent.
Inflammation Control Decrease Edema formation Decrease pain Decrease spasticity |
|
|
Cryotherapy:
Conduction examples Convection examples Evaporation examples |
Conduction: Ice packs, Ice massage, Ice baths
Convection: Ice whirlpool, Controlled-Cold Compression Units Evaporation: Vapocoolant sprays, Misters, Sweat |
|
|
Hemodynamic effects of cold
|
Immediate vasoconstriction (Inhibition of histamine and prostaglandins)
-Stimulate cutaneous thermoreceptors— Arterioles & venules constrict: smooth muscle contraction Reduced blood flow If core cooling, systemic vasoconstriction Shivering/piloerection Increase in blood pressure Persists as long as cooled <15-20minutes Increase blood viscosity -Lower temps cause blood to become thicker -Moves slower Increase blood pressure -Constriction of blood vessels Smooth muscle contraction Decreases enzymatic activity |
|
|
Cold Induced Vasodilation (CIVD)
|
Prolonged exposure: >15min or <10C (50 F)
Hunting response—cyclical vasoconstriction/vasodilation Occurs primarily in the distal extremities and apical areas Circulatory anastomoses |
|
|
NM effects of Cold
|
Peripheral Nerve Effects
Decreases nerve conduction speed (5 min. or longer) Longer duration, slower conduction Motor and sensory 5 minutes= recovery of 15 minutes 20 minutes = recovery of 30 minutes or longer Raises pain threshold Counter irritant to pain signals Decreases spasm Decreases edema Can cause neuropraxia (temporary disturbance in nerve) Generally prolonged exposure over superficial nerves Muscle Strength Effects Short exposure increase muscle strength Moderate to long exposure Decreases isometric muscle strength initially Muscle strength increases during recovery Test strength BEFORE cryotherapy Decrease spasticity Temporary reduction in: Spasticity, Clonus (Use to decrease spasticity before activity) Metabolism Decreases all metabolic activity Decreases production of cartilage degrading enzymes Decrease vasodilator release (histamine/prostaglandins) Decrease activity cutaneous thermoreceptors |
|
|
Uses in Therapy
|
Control inflammation and Edema (Cold treatment of choice first 24-48 hrs)
-Decreases fluid infiltration due to vasoconstriction, decrease inflammation, decrease pain, decrease metabollic rate, apply up to 20 min at least 1 hr apart) Control Pain (Immediate effect, 10-15 min Tx= relief for 1-2 hrs) Delayed Onset Muscle Soreness (In conjunction with stretch) Decrease Spasticity (Apply for up to 1 hr for ~ 1 hr decrease |
|
|
Crykinetics
|
Cool to numbness to allow ROM without pain
Usually with elite athletes Must know exact cause of injury |
|
|
Cryostretch
|
Quick application before stretch
Usually vasocoolant spray |
|
|
Precautions
|
Hypertensive patients (monitor and discontinue if elevates)
Impaired circulation Thermoregulatory problems- very young or old Over an open wound Oversuperficial nerves People with aversion to cold Poor sensation or cognition If not improving after 2-3 treatments, try something else |
|
|
Contraindications
|
Cold induced URTICARIA (hypersensitivity to cold, Wheals)
Raynauds phenomenon (vasospastic disorder, attacks precipitated by cold) Cryoglobulinemia (Abnormal blood protein, Accumulate when cold, mutiple myeloma, infections chronic liver disease, lupus) Paroxysmal cold hemoglobinuria (hemoglobin released from blood, found in urine) Over an area with Compromised circulation Cold intolerance Over regenerating peripheral nerves |
|
|
Adverse Effects of Cryotherapy
|
Tissue damage
If tissue reaches 15C (59F) Tissue death/Frostbite If tissue reaches -10C (>39F) Place wet towel between source & skin Nerve blocks |
|
|
How long should cold packs be used? How long between Tx?
|
Apply 10-20min, 30 min for spasticity
30 minutes between use of same pack again.. let them sit in freezer to cool again. |
|
|
Home program Icing
|
Bag-O-Peas
Freeze 4:1 mix of water/rubbing alcohol Ice Packs: Crushed Ice (More aggressive: Ice has higher specific heat) |
|
|
Advantages to Cryotherapy
|
Easy to use
Inexpensive Not time consuming for therapist Low level of skill required to apply Cover moderate/large areas Can elevate extremity : RICE |
|
|
Disadvantages to cryotherapy
|
Can’t see area being treated
Weight of pack may not be tolerated Contour may not be possible for small/contoured areas Long tx time compared to ice massage |
|
|
Stages of Treatment with Ice massage
|
Cold
Burning Aching Numbness |
|
|
Advantages/Disadvantages Ice massage
|
Advantages
Treatment area can be observed Beneficial for small/irregular area Duration is short Inexpensive Can elevate extremity: RICE Disadvantages Doesn’t work well with large areas Active participation: client or patient |
|
|
Controlled Cold Compression Unit
|
Alternate pumping air and cold water
Intermittent inflation of the sleeve Combines cold and compression Used postoperatively- units sent home with patients |
|
|
Tissue effects of cryotherapy
|
Decreases collagenous tissue extensibility
|
|
|
HEAT- Increase/decrease
Blood flow ___ Blood viscosity ___ Inflammation ____ Pain____ Metabolism ____ Tissue extensibility ____ Muscle spasm____ Spasticity & Clonus ____ Muscle power____ Blood pressure ____ Nerve conduction velocity ___ |
Blood flow increases
Blood viscosity decreases Inflammation increases Pain decreases Metabolism increases Tissue extensibility increases Muscle spasm decreases Spasticity & Clonus decreases Muscle power decreases Blood pressure decreases Nerve conduction velocity increases sensory |
|
|
COLD- Increase/decrease
Blood flow ___ Blood viscosity ___ Inflammation ____ Pain____ Metabolism ____ Tissue extensibility ____ Muscle spasm____ Spasticity & Clonus ____ Muscle power____ Blood pressure ____ Nerve conduction velocity ___ |
Blood flow decreases
Blood viscosity increases Inflammation decreases Pain decreases Metabolism decreases Tissue extensibility decreases Muscle spasm decreases Spasticity & Clonus decreases Muscle power increases or decreases Blood pressure increases Nerve conduction velocity decrease sensory and motor |
