Thermal Agents Superficial Heat


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Thermal Agents Superficial Heat

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