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A comprehensive overview of thermal therapy, a common modality used in occupational therapy. It covers the principles of heat transfer, different types of thermal modalities, their applications, and precautions. The document also includes questions and answers related to thermal therapy, making it a valuable resource for students and practitioners.
Typology: Exams
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preparatory
thermal therapy is _____ treatment
3 cm
how deep does thermal therapy travel
hot and cold
top reason for lawsuit
no
is thermal therapy covered by insurance?
104 - 113 degrees F
temperature for thermal therapy
cell death-catabolism
Too high temperature leads to _____
conduction
Direct collision of 2 materials at different temperatures (heating pad, paraffin), #1 type of energy transfer OTs use
convection
Contact between circulating medium and another material at different temperatures (fluidotherapy, whirlpool)- same thing as conduction, but circulating
radiation
Through the traveling of electromagnetic waves, across the air, from the warmer to the cooler substance or body, Deep physical agent modalities
evaporation
Transfer of heat from the body by conversion of a volatile liquid vapor when the liquid is applied to the skin (vapocoolant) NOT EFFICIENT- hot and cool gels- getting rid of heat in the body
conversion
Ultrasound energy from one form to another- with deep physical agent modalities
15 to 20 min
duration of thermal therapy
____ layers of towels- prevent burning, too much heat energy, etc.
no
can you use moist towels with heat
Hydrocollator
Hot Pack Machines
158 to 168 degrees F
temperature for hydrocollator
conduction
Heat transfer via _____ hydrocollator
2.5 hours
how long does it take for hot packs to heat back up in hydrocollator
put in freezer
what to do with hot packs if not using for awhile to kill bacteria
whirlpool
Used in Greece 500 to 300 BC- hot springs, Various shapes and sizes - stainless turbine, Turbine turned toward or away from patient, Patient can do therapeutic exercise in whirlpool, Hard to keep clean and costly to heat
convection and conduction
type of heat transfer in whirlpool
paraffin
Can't bill for, Use since early 1900's, Low specified heat - transfer not good, Will not last a long time- put in zip lock bag to keep the heat in, Add too much oil - heat gets higher- oil keeps it from sticking to the side of bath, Dispose of after use - contaminated- not hot enough to kill bacteria, 160 kills bacteria
conduction
heat transfer in paraffin
hand, elbow, foot
body parts that can use paraffin with
fluidotherapy
Natural cellulose ground up corn cob, Circulates warm air, Can help with edema if arm is above heart, Can do AROM, Cannot Tx proximal joints, Expensive, Tolerance an issue with some
convection and conversion
heat transfer with fluidotherapy
temperature of fluidotherapy
mechanoreceptors and pain receptors
fluidotherapy stimulates ______
fluidotherapy desensitizes _____
no
can fluidotherapy treatment proximal joints
if arm is above the heart
how can fluidotherapy help with edema
VASODILATION, increases blood flow, repairs tissue, removes inflammatory compounds- histamines, More oxygen to tissues, More nutrients to tissues, More "troops" to the tissues (macrophages, neutrophils, fibroblasts), speed up healing process
Hemodynamic (blood effects) of thermal therapy
agonist, antagonist, antagonist
neuromuscular effects of thermal therapy- depends on how long heat applied- short term- more firing of ______ and inhibits ______, long term has opposite effect- more firing of antagonist
increase in temperature, decreases firing rate of type II muscle spindle, excitatory to agonist muscle and inhibitor to antagonist.
Increases firing rate of type Ib from Golgi tendon organs - inhibitory to agonist and excitatory to antagonist, Reduces alpha motor neurons, reduction in muscle spasm, reducing muscle spasm should reduce pain
neuromuscular effects of thermal therapy
velocity and firing rate
thermo therapy effects changes nerve conduction _________
pain threshold
thermo therapy increased _______- can tolerate more
articular cartilage injury
injury or damage to the tough cartilage that covers the ends of bone, composed of collagen, which is present on a bone's articulating surface
Decreases muscle spasms (decreasing ischemia), Increasing blood flow removes waste products/inflammatory compounds that activate nociceptors, Psychological aspects, Increases ROM and decreases joint stiffness, Tissue healing
thermal therapy for pain control
no
is thermal therapy recommended during the acute inflammatory stage
Check for contraindications/precautions, Visually inspect tissue before and after application, Test skin for sensory heat discrimination, Educate patient on goals of thermotherapy, expected sensation (i.e. mild warmth) and to ask for assistance if too hot (bell), Therapist wear timer, Check patient periodically (5- 10 min), < 20 min duration depending on patient (dx, history, tolerance...), Stop treating if patient reports excessive heat or burning
steps for application of thermal therapy
vasodilation, increase thermoreceptor activity, decrease joint viscosity
effects of heat
increase cell metabolism, increase blood flow, promotes soft tissue healing
effects of heat on vasodilation
Counter irritation effect- flushes out irritants, Decreases pain/promotes relaxation
effects of heat on thermoreceptor activity
Warming of intra-articular fluid- relaxes the joints, reduces joint stiffness
effects of heat on joint viscosity
contrast bath
Repeated immersion into hot, then cold water
3 - 4 minutes hot, 30 seconds to 1 minute cold
Shocking bath
Counterirritant, "pumping" action form blood vessel dilation and constriction, Activation of descending pain modulation
effects of contrast bath
consensual healing
Heat applied to regions of the spine will cause some reflex vasodilation at the myotomal level, Safer for people who cannot tolerate direct heat- if cant put heat directly on their limbs
cryotherapy
cold, Removing heat from body
adipose tissue
difficult to cool - poor conduction
bone and muscle
good conduction of cold
wet
Use ____ towel between ice and person - towel insulates and protects skin.
reduces edema
main effect of cryotherapy
Commercial cold packs
Ice massage
Cold baths
Vapocoolant Sprays
Controlled cold-compression units
types of cryotherapy
ice massage
Water frozen in paper cup, Apply to small area with overlapping strokes, Use over muscle belly, tendon, bursa, trigger points before friction massage
CBAN: Cold, Burning, Ache, Numbness
4 stages patient will experience with ice massage
RICE- rest, ice, compression, elevation
old school cold therapy compression
MICE - Motion Controlled, Ice, Compression, Elevation- GAME READY
new school cold therapy compression unit
convection and conduction
heat transfer in cold therapy compression unit
increase
short cold application may _________ muscle strength, Facilitates alpha motor neuron activity (Clendenin)
A Icing
quick application of cold, gets muscle to fire
alpha motor neuron activity
A Icing facilitates _______
decrease, increased
Longer cold applications ( i.e. immersion of limb in cold water X 30 min) may ______ muscle strength
for up to one hour then ______ in muscle strength for 1-3 hours.- Reduced blood flow, Increase in viscous properties of muscle
Decreases nerve conduction velocity of A-delta and C fibers, May act as counter-irritant, Decreases edema, less mechanical activation of nociceptors
cryotherapy effects on pain control
Decreases spasticity, Decreases gamma motor neuron activity, Cooling afferent spindles and GTO (golgi tendon organs) discharges are decreased which can persist up to 90 mim., Decreased amplitude of deep tendon reflexes, Decreased frequency and duration of clonus, Improved ability to participate in exercise program, May be able to stretch more
cryotherapy effects on spasticity
clonus
rapid alternating muscular contraction and relaxation
peripheral
cryotherapy alters ______ nerve activity
conduction velocity
cryotherapy decreases sensory and motor _____
superficial nerve
Be careful when applying ice over a _____ (elbow)- May cause nerve death
decreases metabolic rate, reduces the potential for further cell death form secondary hypoxia (cell death), May help reduce destructive joint disease in arthritic conditions, Decreases inflammatory process
metabolic effects of cryotherapy
poor oxygen supply
method of application
Patient tolerance
Condition
Tissue Type
Treatment Purpose
how long treatment in cryotherapy should be depends on:
if they have ever had sensitivity to cold, Cold urticaria, Cryoglobulinemia, May be idiopathic
contraindications for cryotherapy
Cold urticaria
cold allergy - massive release of HA-wheels (white spots with red middle, face flushes, low blood pressure, high heart rate, syncope (loss of consciousness)
syncope
loss of consciousness
Cryoglobulinemia
abnormal blood protein forms precipitate - ischemia/gangrene, Seen in RA, leukemia, lupus
Hypertensive patients
Poor sensation
Poor cognition
Very young or old
Healing wounds
Superficial nerves
Cooling large areas
Using wet medium- extended use, could cause hypothermia
Long duration
precautions for cryotherapy
safety, motor control, function
why sensory testing?
Burn injury, Spinal cord injury, CVA, Brain injury, Peripheral nerve injury, Diabetic Neuropathy
whom to test for sensory issues?
Diabetic Neuropathy
#1 reason for amputation
Postural instability, Balance problems, Challenges with gait, Safety is compromised
