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Superfic heat,cold part 1 f10


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Superfic heat,cold part 1 f10

  1. 1. PTA 200Modalities and Procedures in Physical Therapy<br />Superficial Heat and Cold<br />
  2. 2. Superficial Heat and Cold<br />Primarily increase or decrease temperature of skin, superficial subcutaneous tissues<br />
  3. 3. Therapeutic Application<br />Heating Agents <br />Transfer heat to patient’s body, between various tissue/fluids<br />Cooling Agents <br />Transfer heat away from patient’s body<br />
  4. 4. Therapeutic Application<br />Conduction<br />Convection<br />Conversion<br />Radiation<br />Evaporation<br />
  5. 5. Therapeutic Uses of Cold<br />Control inflammation<br />Decrease pain<br />Decrease edema<br />Decrease spasticity<br />Facilitate movement<br />
  6. 6. Therapeutic Effects of Cold<br />
  7. 7. Hemodynamic Effects<br />
  8. 8. Hemodynamic Effects<br />Immediate vasoconstriction<br />Less than 15 minutes<br />Stimulates smooth muscles of vessels to contract<br />Decreases release of histamine, prostaglandins (vasodilators)<br />Increases blood viscosity (increases resistance to flow)<br />Decreases blood flow to maintain core temperature<br />
  9. 9. Hemodynamic Effects<br />After 15 minutes, vasodilation occurs<br />Mostly distal extremities<br />Temperatures < 10 C (350 F) >15 minutes<br />Cold induced vasodilation (COVD)<br />Amount of vasodilation usually small<br />Skin redness NOT due to vasodilation <br />Due to increase in oxyhemoglobin concentration of blood<br />Cold decreases oxyhemoglobin dissociation <br />Makes less oxygen available to tissues<br />Hunting Response<br />Response to pain associated with extreme cold<br />
  10. 10. Neuromuscular Effects<br />
  11. 11. Decreased Nerve Conduction Velocity<br />Proportional to degree and duration of temperature change<br />Application of cold > 5 minutes<br />Reverses (normal) within 15 minutes<br />After 20 minutes, may take 30 minutes or more to recover.<br />
  12. 12. Decreased Nerve Conduction Velocity<br />Decreased NCV of sensory and motor nerves occurs<br />Greatest effect in myelinated, small fibers <br />pain transmitters<br />Least effect in unmyelinated, large fibers<br />
  13. 13. Increased Pain Threshold<br />Counter-irritation via Gate Theory<br />Secondary to decrease in muscle spasm<br />Secondary to decrease in sensory NCV<br />Secondary to post-injury edema reduction (decreased blood flow)<br />Reduces pressure on nerves due to edema<br />
  14. 14. Decreases Spasticity<br />Decrease in gamma motor neuron activity (stretch reflex)<br />After 10-30 minutes, decrease in afferent spindle, GTO activity.<br />Caused by decrease in muscle temperature<br />Can last for 1- 1.5 hours<br />So… <br />Application of cold up to 30 minutes in patient with increased tone,<br />will decrease tone for up to 1-1.5 hours<br />
  15. 15. Facilitation of Muscle Contraction<br />Brief application (few seconds) facilitates alpha motor neuron activity<br />Produces muscle contraction in flaccid muscle. <br />CVA, SCI<br />Prolonged cold (few minutes) decreases force of contraction<br />
  16. 16. Metabolic Effects<br />
  17. 17. Decreases Metabolic Rate<br />For inflammation<br />For healing <br />not recommended for patient with delayed healing<br />Cartilage-degrading enzymes decreased <br />OA, RA<br />
  18. 18. Inflammation Control<br />Decreases chemical reactions secondary to acute inflammatory response<br />Decreased blood flow secondary to vasoconstriction, increased viscosity <br />Causes secondary decrease in bleeding, edema<br />(normally) Increased function during this stage of healing<br />
  19. 19. Inflammation Control<br />If temperature of tissue remains elevated… <br />Cryotherapy remains indicated (48-72 hrs)<br />After activity there is secondary acute inflammatory response<br />may need to continue cold for some time<br />
  20. 20. Inflammation Control<br />Prophylactically after exercise to decrease DOMS <br />Delayed Onset Muscle Soreness<br />Due to muscle connective tissue damage secondary to exercise<br />
  21. 21. Inflammation Control<br />Duration of treatment typically 15 minutes , except spasticity control<br />In general, applications 1 hour apart <br />Tissue temperature can return to normal<br />
  22. 22. Edema Control<br />Decreases intravascular fluid pressure via decreasing blood flow, increased viscosity<br />Most effective if applied immediately, in conjunction with elevation and compression<br />
  23. 23. R-I-C-E<br />R: Rest<br />I: Ice<br />C: Compression<br />E: Elevation<br />
  24. 24. Edema Control<br />Cryotherapy ineffective with edema secondary to immobility and poor circulation.<br />
  25. 25. Pain Control<br />10-15 minute application can control pain for 1 or more hours.<br />Facilitation<br />Rarely used. (Rood)<br />
  26. 26. Cryokinetics<br />Purpose:<br />To apply cooling agent to point of numbness shortly after injury,<br />to decrease sensation of pain, allow patient to exercise toward regaining ROM ASAP. (Athletics)<br />Cold for 20 minutes (numbness)<br />Exercise for 3-5 minutes<br />Re-cooling<br />Repeat about 5 times<br />
  27. 27. Cryostretch<br />Cooling prior to stretching<br />Decreases spasm, secondary increase in ROM<br />Spray n’ Stretch,<br />Fluoro-methane Spray<br />If patient condition not improving or worsening within 2-3 treatments, <br />Approach should be re-evaluated and changed, or <br />Refer to MD<br />
  28. 28. Contraindications<br />
  29. 29. Contraindications for Cold<br />Coldhypersensitivity or intolerance<br />Cryoglobulinemia<br />Uncommon disorder<br />Aggregation of serum proteins in distal circulation when distal extremities cooled<br />Proteins form a “gel” that can impair circulation, <br />Causes local ischemia, gangrene<br />Paroxysmal Cold Hemoglobinuria<br />Release of hemoglobin into urine from lysed red blood cells,<br />In response to local or general exposure to cold<br />
  30. 30. Contraindications for Cold<br />Raynaud’s Disease<br />Paroxysmal digital cyanosis<br />Sudden pallor followed by redness of skin of digits,<br />Precipitated by cold or emotional upset<br />Relieved by warmth <br />Bilateral and symmetric (women)<br />Raynaud’s Phenomenon<br />Generally only in one extremity <br />May be associated with thoracic outlet, carpal tunnel syndrome or trauma<br />
  31. 31. Contraindications for Cold<br />Regenerating Nerves<br />Local vasoconstriction or decreased nerve conduction may delay regeneration<br />Circulatory compromise or peripheral vascular disease<br />Chronic peripheral vascular disease may have edema <br />Cold may increase this edema <br />Indicators for swelling due to Peripheral vascular disease <br />Pallor and coolness<br />
  32. 32. Precautions<br />
  33. 33. Precautions<br />Over superficial main branch of a nerve<br />Over an open wound <br />delays healing<br />Hypertension <br />can cause transient increases in systolic or diastolic BP<br />Patients with poor sensation or mentation<br />Very young or very old <br />impaired temperature regulation, <br />ability to communicate<br />
  34. 34. Adverse Effects<br />
  35. 35. Adverse Effects<br />Tissue Death<br />Frost Bite<br />Nerve damage<br />Unwanted vasodilation due to prolonged vasoconstriction, ischemia, thromboses in smaller vessels.<br />Freezing of tissues<br />damage at 39 degrees F<br />To avoid, duration limited to under 45 minutes and tissue temperature above 39 degrees F<br />When goal is vasoconstriction, treatment limited to 10-15 minutes<br />
  36. 36. Application, General Rules<br />
  37. 37. Application of Cold <br />Assess patient and establish goals of treatment<br />Determine if cryotherapy most appropriate treatment<br />No Contraindications<br />Select appropriate mode of application based on body part and desired response<br />Explain procedure, reasons for treatment, and expected sensations<br />
  38. 38. Sensory Response to Cryotherapy<br />Due to stimulation of thermal receptors and pain receptors<br />followed by blocking of nerve conduction<br />In this order:<br />Intense cold<br />Burning<br />Aching<br />Analgesia, numbness<br />
  39. 39. Cold Packs and Ice Bags<br />
  40. 40. Cold Packs/ Ice Packs<br />Commercial<br />Silica or mix of saline/gel<br />Stored in freezer at 23 C<br />Moldable to patient’s body<br />Should be cooled at least 30 minutes between treatments or 2 hrs. prior to initial use.<br />
  41. 41. Application of Cold <br />Ice Bags<br />Crushed ice best <br />conforms better<br />Get all/most air out of bag.<br />Colder than ice packs <br />specific heat of ice higher than gels<br />Either decrease time or provide slight insulation.<br />
  42. 42. Application of Cold Packs<br />Home Treatment<br />Ice bags, or frozen peas/vegetables<br />Remove frost from outside of bag or insulate with towel.<br />Homemade cold packs<br />4:1 mix of water, rubbing alcohol<br />
  43. 43. Application of Cold Pack/ Ice Bags<br />Use warm damp towel with cold pack, dry towel with ice bag (?)<br />Secure pack with strap or ace wrap<br />Elevate extremity if indicated<br />Position patient comfortably<br />Check skin periodically <br />Give bell/ set timer<br />
  44. 44. Advantages and Disadvantages<br />
  45. 45. Advantages of Ice Packs/Cold Packs <br />Easy to use<br />Inexpensive<br />Short use of clinician’s time<br />Low skill level required<br />Covers moderate to large areas<br />Can elevate limb simultaneously<br />
  46. 46. Disadvantages<br />Must remove pack to inspect skin<br />Patient may not tolerate weight <br />Difficult to mold to contoured areas<br />Longer treatment time (than ice cup)<br />
  47. 47. Ice Massage or Ice Cup<br />
  48. 48. Ice Massage<br />Ice cups or frozen water “Popsicles”<br />Styrofoam nice, but often bust as ice expands<br />
  49. 49. Application of Ice Massage<br />Use towels in surrounding areas to catch drips.<br />Use small, overlapping circles<br />Keep ice moving rapidly<br />Continue for 5-10 minutes or until analgesia achieved<br />“Quick Icing” used as quick strokes with ice cup to facilitate motor response<br />
  50. 50. Advantages of Ice Massage<br />Treatment area can be observed during treatment<br />Excellent for small, irregular areas<br />Short-duration of treatment <br />Increases compliance<br />Can elevate limb if desired<br />
  51. 51. Disadvantages of Ice Massage<br />Requires clinician throughout treatment, unless patient independent<br />
  52. 52. Intermittent Cold Compression and Cryocuff<br />
  53. 53. Controlled Cold Compression<br />Intermittent Compression/ Cold Pump<br />Usually used in post-op patients<br />Allows for intermittent cold and compression <br />proven more effective than ice alone<br />
  54. 54. Cryocuff<br />Relatively inexpensive<br />Effective compression with cold<br />Patients often need assistance in applying device<br />
  55. 55. Vapocoolant Sprays<br />Ethyl chloride<br />Fluorimethane sprays<br />Work by rapid cooling<br />Desired treatment of trigger points<br />Applied in parallel strokes along skin of muscle immediately prior to stretching<br />
  56. 56. Vapocoolant Sprays<br />Often done after injection<br />Purpose is to provide counter-stimulus<br />Causes reflex decrease in motor neuron activity <br />Secondary decrease in resistance to stretch<br />
  57. 57. Documentation of Cryotherapy<br />Area of body treated<br />Type of cryotherapy used<br />Treatment duration<br />Patient position<br />Response to treatment<br />