Theramal Energies
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| temperature | means of measuring heat using the relative terms heat and cold
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| specific heat | amount of energy required to raise the temp of a given weight of material one degree
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| materials of high specific heat (SH) | hold more energy at the same temp than materials of lower SH
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| the higher the SH | the hotter the substance feels
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| SH of water | 1 which is higher than paraffin and fluidotherapy
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| methods of heat transference | an object heated to a higher temp that its surroundings will give off heat in one of three methods-conduction, convection, radiation
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| conduction | transfer of heat by molecular collision when two bodies are in contact and not the same temp
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| convection | transfer of heat by the movement of a mass, gas or liquid
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| radiation | transfer of heat between two bodies separated by a medium which does not become heated
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| conversion | non-thermal energy(mechanical, electrical, chemical) is changed to thermal energy
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| evaporation | vaporization of a liquid. molecules with energy escape from a liquid surface and change into gas
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| thermoregulation | heat or cold
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| systemic (general) heat dissipation | 70% skin, 27% evaporation, 2% warm inspired, 1% excretion
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| 70% Skin | radiation, convection
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| excessive systemic heating | overheating-heat prostration, heat stroke
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| local heat dissipation | when area is being heated, when heat is removed
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| when area being heated | convection, conduction
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| when heat is removed | radiation, convection
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| TTR | tissue temp rise, heat is applied faster that the body can dissipate
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| heat magnitude of physiological effects depends on | temp differential btw skin and modality, rate at which heat is added, volume of tissue heated, circulation in area, length of application, thermal conductivity of tissue
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| physical effect heat | receptor site, thermal
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| physiological heat | hemodynamic, neuromuscular, metabolic altered tissue properties
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| increased physiological effects from thermal heat energy | vasodialation, shunts blood flow fr other structures, mild inflame reaction, local hyperemia-erythema, dec viscosity of blood,rise in tissue temp superficial + deep,inc NCV-edema-cellular metabolism- and removal of metabolites,inc pain threshold
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| decreased physiological effects from thermal heat energy | dec gamma motor neuron activity, dec in strength and endurance
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| changes in tissue from thermal energy | inc tissue extensibility of connective tissue and muscle
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| analgesia | elevation of pain threshold due to thermal heat
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| physiological effects of thermal heat energy edema | inc hydrostatic, inc permeability
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| systemic effects thermal heat energy | inc HR, inc RR, inc excretion, dec BP, general vasodilation, general relaxation
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| local effects thermal heat energy | promote soft tissue healing, pain reduction, relaxation, and decreased joint stiffness
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| vasodilation | local cutaneous blood vessels (skin blood flow), axon reflex(local), reflex heating mechanism (central)
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| heat application temperature | raise heat in tissues 40-45 degrees C (104-113 degrees F)
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| heat application | superficial vs deep, moist vs dry, constant heat sources, local vs general
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| superficial heat | direct increase in surface temp with slight indirect heating of deeper structures= type of physiological effect is heat
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| types of heating | hot packs, paraffin, fluidotherapy, infrared
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| skin responses | even hyperemia and erythema, skin warm to touch, mottling is a danger sign, blanching is a danger sign
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| deep | direct increase in temp in deep structures without heating of superficial structures=physiological effects are mixed
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| types of deep heating | ultrasound, short wave diathermy
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| hot pack | hydrophilic silica gel in canvas w/property to hold water, tank water temp 158-179 deg, water level should cover packs, new pack req 24 hrs to heat, 20-30' pack to re-heat, rapid loss of heat to atmosphere(HP should be made just prior to application)
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| hot pack protocol | 6-8 layers, 20',comfortable warmth
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| Hot pack factors to consider | age, will pt be laying on pack, towel or hot pack cover, how busy is machine, area treating
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| paraffin | paraffin wax and mineral oil, 126 degree tank temp, feet and hands
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| paraffin feet and hands | feet will feel warmer, harder to dissipate heat
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| paraffin wax and mineral oil | 6-7:1 ratio, lower specific heat than water (SH=.65), mineral oil lowers the specific heat and facilitates easy removal
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| glove paraffin protocol | remove jewelry, bandage any open cuts, glove, wrap c baggie or towel, elevate, 20',
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| two paraffin techniques | glove and immersion
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| immersion paraffin protocol | remove jewelry, bandage any open cuts, 1-2 layers, remain in tank, 5-10', constant heat
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| treatment procedure | wash part, support part, instruct pt to relax part and to avoid moving once treatment starts, explain that first dip is the warmest, make sure first layer covers the treatment area and is the highest layer
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| fluidotherapy | air and cellulose (corn cob), stimulates thermoreceptors and mechanoreceptors, can move during treatment, can wear splints and use exercise equipment, wash part and remove jewelry
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| fluidotherapy protocol | set temp setting, set air speed, instruct in exercise prior to starting treatment if actively exercising, 20'
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| summary of hot pack | conduction, moist heat, inexpensive, covers large area, treat most areas of the body, easy to apply at home, uneven heating of irregular surfaces
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| summary of paraffin | conduction, moist heat, good with irregular surfaces, uniform heating, skin softening, limited to hands and feet, messy, immersion is constant heating, greater risk of mottling especially immersion method
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| fluidotherapy | convection, dry heat, uniform heating, can exercise during treatment, limited to distal limbs, messy removal, constant heating
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| indications heat | subacute and chronic inflammatory conditions, pain, spasm, contractures, spasticity, prelim
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| precautions heat | diminished sensation, elderly, children, scars, RA, pregnancy, poor thermoregulation
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| contraindications heat | acute conditions, edema, fever, skin rashes, lesions,infection,hemorrhage, malignancy, infants, cardiac insufficiency, PVD, thrombophlebitis, impaired mentation
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| dangers heat | burn, fainting, bleeding
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| systemic general heat retention | non-shivering thermogenesis, muscle tensing, shivering, pyeloerection, counter-current exchange
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| problem of excessive cooling | frostbite
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| counter-current exchange | exchange of heat from arteries to veins to prevent blood too cooled from going back to the core, results in cooler blood going to the periphery
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| what does the exchange of heat from arteries to veins to prevent blood too cooled from going back to the core do | prevents dec in body temp
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| what does cooler blood going to the periphery do | dec the differential btw the cold environment and the skin, reduces heat transfer through radiation
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| local heat retention | when area is being cooled, when cold is removed
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| when area is being cooled | conduction
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| when cold is removed | radiation, convection, conduction
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| TTD | tissue temp drop, rate of heat is removed faster than body can rewarm
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| cold magnitude of physiological effects depend on | temp differential btw skin and modality, rate at which heat is removed, volume of tissue cooled, length of application, thermal insulation of tissue
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| physical effect cold | receptor, thermal
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| physiological cold | hemodynamic, neuromuscular, metabolic, altered tissue properties
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| physiological effects cold | vasoconstriction, opening of A-V shunts, shunting of blood from other structures, local erythema, inc viscosity of blood, dec in NCV, elevation of pain threshold,dec cellular metabolism, inc stiffness of tissue, systemic effects
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| local erythema | blanching, cyanosis
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| dec in NCV | small more that large, myelinated more that unmyelinated
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| anesthesia | elevates pain threshold
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| increase stiffness of tissue however | dec stretch reflex, dec gamma, dec 1a and 1b firing, short duration cold inc AMN firing
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| systemic effects of cold | dec HR, dec RR,Inc BP, general vasoconstriction
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| vasoconstriction | dec in skin blood from, reflex local vasoconstriction, CIVD
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| dec in skin blood flow | protection other are at from cooled blood, improves heat retention
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| CIVD | cold induced vasodilation, hunting response
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| A-V Shunts | found in tips of fingers, toes, lips, and ears. protect cutaneous tissue against extremes in temperature. normally closed bu open with low temps.do not function in conditions of prolonged cold
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| secondary hypoxic injury | death of uninjured tissue from lack of oxygen. cold puts tissues into hibernation by decreasing cellular metabolism=decreased cellular metabolism retards the healing process by suppressing the inflammatory response
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| what happens with decreasing cellular metabolism | less need for oxygen, reduces damaged area, less debris, less edema, less hematoma, less to repair
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| superficial skin tissue response to cold | immediate and rapid drop of temp, plateaus several degrees above temp or modality, immediate rewarming when cold removed
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| subcutaneous tissue response to cold | same as superficial but less drop in temp
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| deep structures tissue response to cold | delayed drop in temp, less cooling, TTD cont after removal of cold
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| colds effects is deeper than heat | greater temp difference between modality and skin, less convection methods so stays colder longer, adipose tissue resists re-warming, tissues continue to drop in temp post treatment
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| cold application acute stage | want dec metabolism, apply within 24 hours to prevent secondary hypoxia, negative effects=dec circulation, retardation of healing
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| cold application subacute stage | want dec pain through anesthesia, cryokinetics=cold with movement, negative effects=dec metabolism, dec circulation
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| RICE protocol | acute stage, REST, ICE, COMPRESSION, ELEVATION
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| RICE REST | controversial
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| RICE ICE | 30' every 2 hours
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| RICE Compression | combat and interstitial pressure
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| RICE Elevation | dec capillary hydrostatic pressure, combat effects of gravity
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| cold cycle | cold, burning, aching, numbness=anesthesia, CBAN
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| cold pack | silica gel in vinyl, tank temp 10-15 degrees F, 24 hour cooling with new pack, 30' cooling for pack between uses
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| cold pack protocol | one thin layer, 20', explain cold cycle
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| ice massage protocol | ice applied directly to skin, circular or longitudinal stroke, drape and do not wipe, pressure to tolerance, treat until anesthesia
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| ice immersion protocol | water bath with ice, monitor skin color, 5-6' with musculo-skeletal sprains, 1' to dec spasticity
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| vapocoolant spray protocol | cold in a bottle, spray and stretch, 30 degree angle, 18" from part, move 4"/sec from origin of muscle to area of pain
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| summary cold pack | conduction, treat most areas of body, treat large area, easy to apply, erythema response
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| summary of ice massage | conduction, limited to small areas, messy, greater TTD, blanching may occur during massage, but skin should have an erythema when ice removed
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| summary of ice immersion | conduction, body or limb, greets TTD, greatest danger, strong erythema=can see slight cyanosis in distal digits
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| indications for cold | acute and subacute conditions of the musculo-skeletal system, muscle spasms due to pain, post-surgical pain and edema, spasticity, fevers, emergency burn care, facilitation and inhibition techniques
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| precautions for cold | diminished sensation, very young and very old, long duration application, run-down condition
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| contraindications for cold | raynaud's disease, cold hypersensitivity, Hx of frostbite, cardiac disorders, unstable hypertension, compromised circulation, open wounds, over regenerating peripheral nn, cryoglobulinemia, scleroderma,lupus
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| danger of using cold | urticaria, cyanosis, frostbite,nerve damage
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| 3 factors when to use Heat or Cold | patient preference, stage of condition, goal of treatment
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| when to use heat | 48-72 hour waiting period, subacute and chronic, analgesia,mm lengthening, facilitates better speed of contraction, affects more superficial structures, facilitates healing,general relaxation, may have rebound effect,dec pain/spasm, works on gate theory
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| when to use cold | can use immediately, acute and subacute, anesthesia,better for dec spasticity,facilitates tetanic contraction, affects deeper structures, inhibits healing, no rebound effect, good for dec pain and spasm, works on gate theory
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