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Course Material – Dr. Sreeraj S R
CRYOTHERAPY APPLICATION PRACTICAL EXAM SCRIPT
F.Y. B.P.Th. Practical Examination (30 Marks) | Subject: Electrotherapy I
Institution: Dr. N.Y. Tasgaonkar
College of PT
Target Subject: Physiotherapy Paper I
Total Marks: 30 Marks Chilling Unit Temp: -12°C to -15°C
Note: Steps marked with (*) are Critical Fail Indicators. Omission of safety checks,
warnings, sensation testing, or mandatory skin audits results in an automatic critical
fail for that section.
Station 1: Communication Skills & Initial Assessment (6 Marks)
Receiving the Patient (1 Mark)
Action: Student receives patient politely, verifies identity, and ensures comfort.
Student: "Good morning! My name is [Student Name], a first-year B.P.Th. student. Let
me verify your full name and date of birth... Great. Please sit down comfortably."
Patient: "Hi, thank you. I twisted my right ankle yesterday while playing, and it is swollen
and aching." (this script is set on this simulation)
History & General Contraindications Check (*) (2 Marks - CRITICAL FAIL STEP)
Action: Student screens thoroughly for all general/systemic contraindications.
Student: "Before we start, I need to screen for a few important general health conditions
for your safety: 1) Do you have any heart conditions, severe high blood pressure, active
cancer, or tuberculosis? 2) Does cold weather cause your skin to break out in hives or
make your fingers turn white, blue, or severely painful (screening for Raynaud's, Cold
Urticaria or PVD)? 3) Do you have any blood clotting issues or blood disorders caused by
low temperatures? (screening for Paroxysmal Cold Hemoglobinuria) 4) "Have you ever
been diagnosed with a blood condition or kidney problem where exposure to cold
temperatures causes abnormal blood protein clumping or pain?" (for Cryoglobulinemia
and Cryoglobulinuria)
Patient: "No, I don't have any of those conditions."
Taking Informed Consent (1 Mark)
Student: "We plan to apply a cold gel pack to your right ankle to reduce swelling and
ease your pain. Do I have your explicit permission to proceed?"
Patient: "Yes, you have my consent."
Patient Instructions & Cold Warnings (*) (2 Marks - CRITICAL FAIL STEP)
Action: Student provides mandatory sensory warning (CBAN) and safety reporting
rules.
Student: "During this treatment, you will feel a mandatory sequence of four sensations
called CBAN: Cold → Burning → Aching → Numbness. This is completely normal.
However, if you feel extreme pain, severe burning, or start feeling dizzy, please tell me
immediately."](https://image.slidesharecdn.com/cryotherapypracticalexamscript-260815151309-d390d897/85/Comprehensive-Cryotherapy-Practical-Exam-Guide-for-Physiotherapy-Students-In-Script-1-320.jpg)
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Course Material – Dr. Sreeraj S R
Station 2: Pre-Treatment Preparation & Safety Checks (6 Marks)
Collecting Materials (1 Mark)
Action: Student selects appropriate cold packs, towels, Macintosh, basin, elastic
wrap, coconut oil, test tubes with holder, and bedsheets and pillows.
Equipment Integrity & Safety (2 Marks)
Action: Student inspects cold pack for tears, leaks, or hardened gel and verifies
freezer/chilling unit temperature (-12°C to -15°C).
Student (to Examiner): "I am inspecting the cold pack to ensure it is intact with no gel
leakage or tears. I have also verified that the chilling unit temperature is within the
standard range of -12°C to -15°C."
Positioning & Patient Preparation (1 Mark)
Action: Student positions the patient comfortably and elevates the limb to manage
acute edema. Expose the part to be treated and cover the other parts if needed.
Student: "I will position your ankle fully supported on pillows, elevating the limb slightly
above heart level to help drain the acute swelling."
[if the method of application is direct contact, the student should prepare a Gutter for the
same)
Local Contraindications & Sensation Testing (*) (2 Marks - CRITICAL FAIL STEP)
Action: Student inspects local area for skin integrity/wounds and performs thermal
sensation testing.
Student: "I am inspecting the ankle skin for open wounds, active bleeding, chronic sores,
skin grafts, or regenerating nerve sites. Everything looks clear."
Student: "Now I will perform a thermal sensation test. Please close your eyes and tell me
if you feel hot or cold when I touch your skin." [Performs thermal hot/cold discrimination
test on target area]
SOP for Hot and Cold Discrimination Test:
It tests the individual’s ability to perceive the difference between hot and cold stimuli.
Expected findings: The individual will be able to discriminate between the hot and cold
stimuli with 100% accuracy.
Equipment: Two test tubes filled with hot (40 - 45°C) and cold (20°C and 25 °C) water.
Testing procedure:
1. Explain the procedure to the patient with his/her eyes open. For example, “I am going
to touch various parts of your arms (or other body part) with these test tubes filled
with hot and cold water, and when you feel the tube, tell me if it feels hot or cold.”
2. Demonstrate the procedure with the patient’s eyes open until the patient understands
the procedure to be performed.
3. The patient closes his/her eyes, or vision is otherwise occluded.
4. Place the hot or cold test tube against the patient’s skin, making certain not to vary
the surface area of contact between the test tube and skin or the pressure of contact.
5. Have the patient identify each stimulus as hot or cold. Make certain the appropriate
temperatures of the stimulus objects are maintained throughout testing.
6. Vary the time and order between stimuli to avoid developing a rhythmic pattern.](https://image.slidesharecdn.com/cryotherapypracticalexamscript-260815151309-d390d897/85/Comprehensive-Cryotherapy-Practical-Exam-Guide-for-Physiotherapy-Students-In-Script-2-320.jpg)
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Course Material – Dr. Sreeraj S R
7. Repeat throughout suspected areas.
8. Document findings.
Student: “As I have found no general contraindication and no local contraindications, I will
proceed with my treatment.” (Mention to the examiner.)
Station 3: Application & Monitoring (8 Marks)
Pack Preparation & Insulation (2 Marks)
For indirect application (Gel Cold Pack)
Action: Student wraps cold pack in a single layer of damp towel to enable rapid
cooling while preventing tissue freezing.
Student (to Examiner): "I am wrapping the gel pack in a single layer of a damp towel to
ensure uniform cold conduction while protecting the skin from direct contact and tissue
freezing."
For Direct Application (Ice Massage / Ice Cube Application / Gel Cold Pack)
Action: Student places the cold pack directly onto the exposed target area without any
towel insulation layer, ensuring close contact over the treatment site, and sets up a
drainage/towel barrier to manage potential condensation or melting.
Student (to Examiner): "I am preparing a gutter for the water to drip down and collect at
the pit to drain off to the basin below. I will also apply coconut oil to make water flow more
effectively. This ensures smooth movement and prevents water trapping on the skin,
avoiding localized supercooling."
Pack Placement & Securing (*) (2 Marks - CRITICAL FAIL STEP)
Action: Student molds the pack closely to the joint and secures it snugly without
causing circulatory constriction. If it is an ice message with a cube or lollypop, it is
rubbing over the area.
Student: "Molding the pack closely around the right ankle joint and securing it snugly with
an elastic wrap. I am checking to make sure the wrap is comfortable and not constricting
your blood flow."
Dosage & Duration Selection (2 Marks)
Student: "Selecting a treatment duration of 15 minutes (within the standard 10–15 minute
range). I am setting the timer now."
Intra-Treatment Safety Monitoring (*) (2 Marks - CRITICAL FAIL STEP)
Action: Student inspects the skin at the 3–5-minute mark and checks for
emergency stop criteria.
Student: "I am lifting the edge of the towel at the 3-minute mark to perform an intra-
treatment skin audit." [Lifts pack corner]
Student (to Examiner): "I am checking for emergency stop triggers: 1) Abnormally rapid
numbness (<2 mins), 2) Persistent severe aching without progressing to numbness, or 3)
Adverse skin signs like hives (urticaria), extreme blanching, or blue/purple mottling. The
skin shows normal mild pinkness, so treatment continues safely."](https://image.slidesharecdn.com/cryotherapypracticalexamscript-260815151309-d390d897/85/Comprehensive-Cryotherapy-Practical-Exam-Guide-for-Physiotherapy-Students-In-Script-3-320.jpg)
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Uploaded bySreeraj S R
Comprehensive Cryotherapy Practical Exam Guide for Physiotherapy Students: In Script
Detailed practical exam script covering cryotherapy application, safety checks, patient communication, treatment procedures, and documentation for physiotherapy students.
