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Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
Thermal Agents  Superficial Heat
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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).