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Thermal Agents Superficial Heat

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  • 1. Thermal Agents: Heat KIN 195
  • 2. Heat modalities: Superficial Heat
    • Skin temperature rises but subQ tissue increase is minimal
    • 1cm penetration
    • depth of penetration is related amount of fat in area
    • Hot Packs
    • Whirlpools
    • Paraffin Baths
    • Infrared Lamp
  • 3. Heat Modalities: Deep Heat
    • Ultrasound and diathermies
    • Transmits well through superficial tissue layers
    • 3-5cm penetration
  • 4. Factors effecting tissue temperature rise:
    • temperature gradient/rate: high or low vs. time
    • volume of tissue: if treatment area is great there may be a decrease in BP from hypothalamus (vasodilatation)
      • Heat Sink: as long as the heat can be dissipated as fast as the modality adds heat, it is considered safe
    • Duration of treatment
    • Modality of treatment used
  • 5. Factors effecting tissue temperature rise:
    • Beyond 113 F protein denaturization and tissue burning may occur
    • Best general tissue temperature and blood flow increase is via exercise
  • 6. Physiological effect of superficial heat
    • Increase circulation 1.5-2x normal
    • Increased metabolism (contraindicated in 2-3 days post injury)
    • Increased inflammation, phagocytosis, & wound healing
    • Decreased pain (analgesia); not as effective as cryotherapy for acute pain (cryokinetics, anyone?)
    • Decreased muscle spasm
    • Decreased tissue stiffness (fluids less viscous and collagen releases easier)
  • 7. Physiological effect of superficial heat: Hemodynamic
    • Depth of effects are not as great as with cold
    • Vascular changes are confined to skin (1cm)
    • So Why use it?
  • 8. Physiological effect of superficial heat: Neuromuscular
    • Increase sensory nerve conduction
    • Temperature is carried on A-delta fiber
    • Analgesic effects both distal and proximal to area treated
    • This is why non-acute back patients use heat instead of ice
  • 9. Physiological effect of superficial heat: Neuromuscular
    • Firing of II fibers results in a decrease in muscle firing, reducing muscle spasm
    • Increased golgi tendon organ firing which inhibits muscle contraction
  • 10. Contraindications for the use of superficial heat
    • Acute inflammation
    • Decrease sensation in area
    • Impaired circulation (unable to dissipate Tissue Temperature Rise, TTR)
    • Malignancies: increased metabolic rate
    • Pregnancies
  • 11. Moist Heat Packs
    • Canvas Pouch with Silica Gel
    • Pack is kept in a water-filled heating unit maintained between 160º F -170 º F
    • Pack maintain temperature for 30-45 minutes
    • Packs transfer heat by conduction
    • Main benefit is superficial heat to 1cm
  • 12. Moist Heat Packs
    • Set-up
      • Cover pack w/ terry cloth or towel covering
      • Place pack on patient in comfortable manner (patient on pack is contraindicated)
      • Check patient within 5 to 6 minutes for comfort
      • Allow 3-4 hr minimum between treatments on the same day
  • 13. Moist Heat Pack
    • Precaution
      • infected areas must be covered with gauze
    • Contraindications
      • Acute conditions
      • Peripheral vascular disease
      • Impaired circulation
      • Poor thermal regulation
    • Indications
      • Subacute or chronic inflammatory conditions
      • Reduction of subacute or chronic pain
      • Subacute or chronic muscle spasm
      • Decreased ROM
      • Hematoma resolution
      • Reduction of joint contractures
      • Infection (discuss)
  • 14. Paraffin Bath
    • A mixture of wax an mineral oil in a ratio of 7 parts wax to 1 part oil
    • Temperature of 118º F to 126 ºF for upper extremity tx.
    • Temperatures of 113 º F to 121 º F for lower extremity (circulation is less efficient)
    • Paraffin can provide approx. 6x the amount of heat as water due to low specific heat.
  • 15. Paraffin Bath
    • Used to deliver heat in uniform amounts to small irregularly shaped areas (hands, fingers, wrist and foot)
    • Wax moistens skin, water tends to dry skin
  • 16. Paraffin Bath Set Up
    • Immersion Bath
      • Clean body part
      • Dip part quickly; allow 10 sec. to dry (turns milky)
      • Dip the extremity 6-12 more times
      • Then cover with cellophane or towel for duration of tx (10-15 min)
      • DO NOT touch sides or bottom of bath (burns)
      • After tx scrape off and replace in bath
    • Pack (Glove) Method Clean extremity
      • Immerse extremity in bath and allow wax to dry - repeat 7-12 more times
      • After final withdrawal from wax, cover extremity with plastic bag, or wax paper. Then wrap in towel
      • If indicated elevate body part
      • Following tx remove wax and return to bath
  • 17. Paraffin Bath
    • Precautions
      • Sensation is different from specific heat and thermal capacity - may cause burns
      • Avoid using with athlete who are required to catch or throw a ball - skin becomes slippery
    • Contraindications
      • Open wounds (options?)
      • Skin infections
      • Sensory loss
      • Peripheral vascular disease
    • Indications
      • Subacute and chronic inflammation
      • limitation on ROM after immobilization
  • 18. Infrared Lamp
    • Radiant energy
    • 2 types luminous (infrared) and nonlumious (far infrared)
    • Luminous produces some visible light (as opposed to nonluminous), nonlumious is less penetrating than luminous
  • 19. Whirlpools
    • Tx temperature is between 105º-112º F for extremities and 100-108º F for whole body (recall TTR)
    • Tx times usually last 10-20 minutes; watch for lethargy with WWP
  • 20. Warm Whirlpool
    • Precautions
      • Must be connected to ground-fault indicator
      • Instruct patient not to turn whirlpool motor on or off while in whirlpool
      • Patient should be continually monitored
      • Do not run while turbine is dry
      • Clean tank pre and post infectious wound tx
      • Patients under the influence of drugs
      • Keep clothing and bandages out of whirlpool
  • 21. Warm Whirlpool
    • Indications
      • Decreased ROM
      • Subacute or chronic inflammatory conditions
      • Stiffness or soreness
      • Irregular shaped areas
    • Contraindications
      • Acute conditions where water turbulence would further irritate injured area
      • Fever above 101 F
      • Tx within 24-48 of acute injury
      • Comprimised circulation
  • 22. Transitions from cold to heat:
    • No signs of increased inflammation; decreased swelling
    • No increase in tissue temperature
    • If decreased range from pain-stay with cold
    • Change to heat when effect from ice applications plateaus
    • If decrease range from stiffness then use heat
  • 23. Contrast Treatments:
    • Used as a transition between cold and heat
    • Allows type of vascular pumping via cold/hot/cold treatment ?
    • May use water or ice packs/hot packs etc..
    • May vary the length of time in cold vs.. heat depending on effects desired
    • Ending of treatment should reflect effect you want to end with
    • Latest research says ineffective (Knight & Draper this summer presented this information; also on p. 232)
  • 24. Contrast Bath Set Up
    • Two tubs placed as close together as possible
    • Fill one tub in the range from 105 F- 110 F and the other 50 F - 60 F
    • Position patient on chair or bench between two tubs
    • Heat Tx given 1st
    • Contrast bath 20 -30 minutes at 3-5 minute intervals or a combination (3 min hot 5 min cold etc.)
  • 25. Contrast Bath
    • Precautions
      • Same as with all whirlpools
    • Indications
      • Ecchymosis removal
      • Edema removal
      • Subacute or Chronic Inflammation
      • Impaired circulation
      • Pain Reduction
    • Contraindications
      • Acute injuries
      • Hypersensitivity to cold
      • Contraindication relative to whirlpool use
      • Contraindications relative to cold application
      • Contraindications relative to heat application
  • 26. Heat Case Study
    • Similar to Cold Case Study, use at least 3 primary sources in this assignment. Appropriateness of source will be reflected in grade.
    • Cite source as (Author name, date) within answer and full source in “Citations” at end of answer.
    • Each question should be answered concisely in 3-4 sentences (short paragraph).