Physical Agents MT1

Define Nociception

"Nociception" (the transmission of noxious impulses) is the body sensing something dangerous such as intense heat, intense cold, strong mechanical deformation and /or chemical substances

Define Pain

"Pain" is the brain's interpretation of that sensory information as an unpleasant and/or emotional experience. Pain can also be present with or without tissue damage (but still be described in terms of such damage)

Identify the physiological effects of cold on human tissue.- DIRECT EFFECTS:

1)Activation of cold receptors releases norepinephrine Causes vasoconstriction of smooth muscles in blood vessel walls due to depolarization of sympathetic adrenergic nerve fibers of the vessel walls 2)As cooling continues, vasodilator mediators decrease ie histamine and prostaglandins decrease further enhancing vasoconstriction

List methods of energy transfer in hydrotherapy

1)CONDUCTION (direct Contact) and CONVECTION (if jets are on) 2)SUPERFICIAL heating or cooling 3)High Specific Heat 4x>air 4) High Thermal Conductivity 25x greater than air Stores and transfers heat efficiently JETS ON Is the Heating or Cooling Effect More or Less with the jets on? More because of the circulation

Order of sensation changes with ice application

1)Intense Cold 2)Burning/Aching/Stinging 3)Local anaesthesia 4) Numbness

What is fluidotherapy?

A dry heating agent whose mode of energy transfer is convection It is an enclosed cabinet in which there is small cellulose particles made from corn kernals The body part is placed into the cabinet and heated air is circulated The heated circulating air is moves around these soft particles The machine has portals in which the clinician can do manual therapy at the same time. Specific heat lower than water Temperature is between 100-118ºF

Differentiate between acute and chronic pain

Acute Pain: Immediate nearly always associated with injury or damage Physical Agents helpful Chronic/Persistent Pain: Pain that persists beyond the normal tissue healing time- months and years Normal tissue healing time is between 3 and 6 months Physical Agents may provide temporary relief but no long term relief

Advantages of paraffin

Advantage of Paraffin 1. Even application over entire area, especially beneficial for areas with multiple contours or hard to reach areas. 2. Retains heat over a prolonged period of time. 3. May elevate the body part. 4. Leaves the skin soft and oily. Some practitioners like this for STM. 5. Can use at home easily 6. Good for patients with sensitive skin or diminished sensation. 7. Inexpensive. paraffin more for mobility than for strength since strength decreases after heating

Physical Agent for Proliferative phase How long does it last? What happens? What are the Therapeutic goals? What are the agents you would use?

Body's Goal: Formation and proliferation of new and immature repair tissues to replace damaged tissues Lasts for weeks and sometimes months depending on severity What Happens: Fibroplasia formation of fibrous tissues Angiogenesis growing new blood vessels Increased cellular responses Use of Physical Agents in Proliferative Phase Therapeutic Goals: Promote angiogenesis and fibroplasia Minimize pain Optimize wound contraction Agent Selection: Thermotherapy Diathermy Hydrotherapy Ultrasound Other electrotherapeutic agents

Physical Agent for Remodeling/maturation phase What is the Body's Goal What happens? Therapeutic Goals? Agent Selection?

Body's Goal: Formation of most structurally functional tissue at wound site. Lasts: months or >one year up to two years or more depending on the tissue What Happens: Remodeling- fiber alignment Maturation- increased mechanical strength Use of Physical Agents in Remodeling/Maturation Phase Therapeutic Goals: Enhance tissue repair Enhance tissue strength/elasticity Enhance tissue function Agent Selection: Ultrasound Other electrotherapeutic agents

Appropriate Physical Agent for Hemostasis? How long does hemorrhaging last? What happens?

Body's Goal: Prevent hemorrhaging Lasts just a few seconds or up to minutes in severe pathologies What happens: 1.Vasoconstriction and formation of hemostatic plug in damaged blood vessels 2. Coagulation (blood clotting)- reinforcement of initial platelet plug Use of Physical Agents in Hemostasis Therapeutic Goals: Minimize wound bleeding Minimize further cellular damage Agent Selection: Cryotherapy

Physical Agent for Inflammatory phase What is the body's goal during inflammatory phase? What are the 6 clinical signs? What is the purpose of physical agents during inflammatory phase?

Body's Goals: Clean away cellular debris Prepare for deposition of new, repaired tissues Lasts hours, days or weeks depending on severity What happens: 6 clinical signs 1.Erythema 2.Hyperthermia 3.Edema 4.Pain 5.Muscle spasm 6.Dysfunction Use of Physical Agents in Inflammatory Phase Therapeutic Goals: Minimize wound bleeding Minimize secondary tissue damage Minimize edema Minimize pain and muscle spasm Agent Selection: Cryotherapy Other electrotherapeutic agents

List and describe physiological effects of whirlpool (hot or cold) Musculoskeletal

Buoyancy: Unloads- who might this help? NWB/PWB patients, chronic pain patients, pregnant patients Resistance: What can we do with this? Temperature of water Can change strength capacity and tissue extensibility Warm water? Cold water?

List contraindications, and precautions in hydrotherapy and fluidotherapy-FULL BODY IMMERSION

Cautious with cardiac and respiratory instability Inability to adapt to circulatory changes Bowel or Bladder Incontinence Severe Epilepsy Suicidal patients Limited strength, endurance, balance and ROM- Keep close eye on Fear of Water Pregnancy Increase core temp can affect baby

Evaporation What happens during change of liquid to gas? What happens to the surface during evaporation? Examples?

Change of liquid to gas Cools surface from which evaporation takes place HEAT LOSS from human body Examples of energy transfer: Vapocoolant sprays- fluoromethane spray or Ethyl chloride Cooling of body through perspiration

Describe the effects of water on the body

Cleansing Thermal- superficial heating or cooling Mechanical- turn on the jets, debride a wound Cheap Readily available (usually)

List the target therapeutic window for cryotherapy

Cold: Optimal therapeutic temperature window for cryotherapy is between 60 and 50 degrees F Sub optimal but ok is 81-61 degrees F Tissue damage can occur at 59F but frostbite does not occur until skin temp drops below 39 degrees To avoid soft tissue and nerve damage temp should be above 59F and under 45 minutes.

Purpose of Physical Agents: What is complimentary to Physical Therapy?

Complimentary to other therapy: Reducing pain Improve tissue extensibility Change metabolic rate - reduce or increase Change circulation -reduce or increase Relieving muscle spasm Facilitating muscle activity Promote transdermal drug penetration

Composition of a paraffin bath and why: Why is the oil necessary?

Composition of bath: A. Paraffin wax- 6-7 parts B. Oil (paraffin, mineral or petroleum jelly)- 1 part The oil is necessary as it: A. lowers the melting point and specific heat of the paraffin. B. Makes removal of the paraffin easier. C. lubricates and softens the skin.

Methods of Energy Transfer:?

Conduction, Convection, Radiation, Evaporation, Conversion

Identify the contraindications for the use of cryotherapy What is Cold Urticaria? What is reynaud's disease What is reynauds phenomenon

Contraindications Just ask patient if they have any ice contraindications* Cold urticaria ie cold allergy/hypersensitivity can be allergic to cold Reynaud's disease paroxysmal digital cyanosis Has systemic problems associated with it Raynaud's phenomenon vasospasm which increases vasoconstriction hands turn white and numb from the cold , due to less circulation circulation can be damaged - need to be careful Cold intolerance Pain , numbness and color changes in response to cold Due to rheumatic or traumatic conditions Cryoglubulinemia (uncommon) Serum proteins aggregate in distal vessels Can potentially cause ischemia and gangrene Hx of Ra or lupus makes more prone to this condition Paroxymal Cold Hemoglobinuria Release of hemoglobin in urine Lysing of many blood cells Blood in urine after cryotherapy means physician referral

Identify the physiological effects of cold on human tissue Metabolic effects

Decrease in metabolic rate Decrease in amount of nutrients being delivered to the area Decrease in absorption of nutrients Cautious with slow healing tissues RA and OA (osteoarthritis) like HEAT BUT in inflammatory state especially RA (rheumatoid arthritis) Sometimes OA may need ice to control exacerbation by: Decrease collagenase Decrease elastase

Identify the physiological effects of cold on human tissue SPASTICITY what happens during gamma motor neuron activity? thus causing? What does the golgi tendon set? How long do you have to cool for?

Decrease in spasticity seen with application of cryotherapy decrease in gamma motor neuron activity followed by decrease in afferent spindle and golgi tendon organ Golgi tendon sets the tone of the muscle Cooling for 10-30 minutes Temporary decrease in spasticity and clonus Depression of achilles tendon reflex Decreased muscle temp results in decreased discharge from afferent spindles and golgi tendon organs Effects for 1- 1.5 hours

List the physiological effects of application of heat to the human tissue.

Direct and indirect Hemodynamic effects Hemodynamics Vasodilation Local or systemic Most effect superficially but some effect in muscles Increased blood flow Direct Hemodynamic Effect of Heat Direct reflex relaxation of the smooth muscles in the blood vessels by cutaneous thermoreceptors Theory: transmission from thermoreceptors directly to smooth muscle results in release of bradykinin and nitrous oxide resulting in vasodilation where heats is applied. Nitrous oxide= vasodilation, pain reliever Decreased viscosity of joint fluid (think pasta sauce) Indirect Hemodynamic Effect Thermoreceptors activate spinal cord reflexes. Info sent to dorsal horn and substantia gelatinosa Decrease in sympathetic adrenergic activation Decrease muscle tone Indirectly causes increased vasodilation "Consensual heat vasodilation" Benefits? Don't pull a hot pack on an open wound

disadvantages of paraffin

Disadvantage Cannot observe the part during treatment The paraffin can accumulate dirt and debris from skin. This can be eliminated if you discard the used paraffin. Most effective in distal extremities. Passive treatment, can't perform exercises simultaneously.

Describe the use of commonly used cryoagents and know the range of duration of treatment. Ice Pack: Towel or bag? Commercial or chemical cold pack? Ice towel? Ice massage/cryostick? Cryohydrotherapy Contrast baths - varies Crycompression

Duration of Treatment (dosage) Ice Packs: Towel or bag 10-20 min Rule of thumb 15 mins Commercial or chemical cold pack 10-15 min Ice towel 5-10 min Ice massage/cryostick 4-8 min Some people respond better to just two minutes Can tell skin blanches and get a little red ring Cryohydrotherapy 4-8 min Contrast baths- varies Depends on what you are trying to achieve and the stage of healing Cryocompression 5-15min Prob do for 15 minutes

List important safety issues including recommended temperatures in use of hydrotherapy

ELECTRICAL SAFETY Turbines need to be grounded ie GFCI outlet No Frayed cords TEMPERATURE Use a thermometer Full body immersion: 96-100o One LE: 98o - 104o One UE: 98o - 108o Any circulatory problem, wound healing or cleansing:90-95o ie lower temperatures!

Define Infrared and its use

Emits electromagnetic radiation within frequency range to emit heat Temp increase is proportional to Distance of the source Angle of incidence of the source to the tissue Think: radiator Amount of energy reaching patient from source is related to the distance of the source Not proportional ie distance of source may increase 2x but heat energy may only decrease 1/4th Primarily used for treating psoriasis or wound care Decreased use since emergence of microwavable hotpacks Only superficial

List contraindications, and precautions in hydrotherapy and fluidotherapy

Extremity WP: Maceration around wound Increases maceration Increase wound size Active Bleeding Increase circulation Increase vasodilation Increase blood loss Wound near turbine Agitate wound Can drive bacteria into wound Impaired Sensation Always check temperature of tub Infection in the area Extra precautions on cleaning and sterilizing Impaired Cognition Recent Skin grafts Heat and cold tolerance is very low Agitation can damage

List advantages and disadvantages of fluidotherapy

Fluidotherapy: Advantages Constant heat Minimal pressure on area Patient can be active Easy for clinician Fluidotherapy: Disadvantages Leaves residue of corn cob Caution: slipperiness Limb is somewhat dependent May not be best for swelling Too much constant heat Patient can get burnt- need to be careful Very expensive: $2000 used $4,500-6,300 new Fluidotherapy: Contraindications/Precautions Same as for Thermotherapy Cover wounds Remove jewelry due to thermal conductivity

Be familiar with evidence for and against use of heat eg heat on hamstring plus stretch- does it work? What about for gastrocs?

Heat and cold "A hot pack sure feels good on an aching back or knee. Same for the heat from an ultrasound machine, which can warm tissue deep in your body. And a cold pack on a swollen joint can also feel nice. But none of it will help you recover faster. "It's a lot like the free coffee in the waiting room," Anthony Delitto, Ph.D., chairman of the APTA group that identified the questionable practices, said. "It makes patients feel good, but it's not very helpful." In one study, for example, some patients were treated with exercise and either ultrasound or sham ultrasound. There were no differences in the recovery time between the groups. What to do instead: Reserve the ice and heat for home. Ice can ease pain and reduce swelling in an injured joint, and heat can ease sore muscles. But neither will speed your recovery, so don't waste precious time in the physical therapist's office on them."

List the target therapeutic window for thermotherapy

Heat: Optimal heating target tissue to 104 to 113 degrees F This temp is reached in 8-10 minutes >113 degrees results in tissue damage Sub optimal 97 to 103 degrees F Heat results in physiological changes by body After 30 minutes body reaches equilibrium and heating not beneficial

Temperature of Parrafin bath:

Heats via CONDUCTION Temperature of the Paraffin bath is 125º- 136º (ideal is 127º-128º)

List and describe physiological effects of whirlpool (hot or cold) Respiratory

Hydrostatic pressure on chest Decreased lung expansion Increased total work if immersed up to neck 60% increase in total work due to decreased vitial capacity Caution with patients with respiratory and cardiac problems Exercise induced asthma Actually improves with hydrotherapy Humidity Decreased pollen on water Hydrostatic pressure actually helps

List and describe physiological effects of whirlpool (hot or cold) Cardiovascular

Hydrostatic pressure: Enhanced venous return Initial increase in BP BP changes: Heat = vasodilation= decrease BP Cold = vasoconstricton= BP increase Immersion: To neck increase central blood volume 60% To neck increases Stroke volume of heart 30% HR decreases Decreased systolic BP compared to same MET as on dry land

Two types of water therapy:

Immersion Non Immersion

Neuromuscular effects of Hemodynamics

Increase in nerve conduction velocity: Heat decreases the conduction latency in both sensory and motor nerves Easier to stimulate the nerve 2m/s for every 1.8 degrees F increase in tissue temperature 2. Decrease Muscle Spasm Decrease in alpha motor neuron firing rate Decrease stretch on muscle spindles results in decreasing firing rate of type II muscle spindle efferents Decrease in gamma neuron activity of type Ib fibers from Golgi tendon organs Input into SG will close gate to pain which in turn decreases muscle spasm 3. Altered tissue extensibility There is an increase in collagen tissue extensibility when tissue heated prior to stretching Longer lasting effect when you exercise, some people cant so use a form of a heat pack to stretch collagen tissue Heat to 103 degrees to 113 degrees for 5-10 minutes results in stretch with less force Tissue maintains stretch better with heating depending on muscle Hams little effect but shoulder and calf have some effect Excercising the hamstrings is more effective than using a heat pad, no really much effect with heat pad 4. Muscle Strength Changes 1st 30 minutes post heat ( deep or superficial) there is decreased ability to contract Strength returns over next 2 hours Make sure they do heat two hours before therapy Then slight increase after 2 hours Due to decrease alpha motor neuron firing rate Improved pain threshold is reason for slight increase later.

List general physiological changes to heat

Increased sweating Increased cardiac output Increased thirst Increased pulmonary minute ventilation Decreased blood pressure

Identify the indications for the use of cryotherapy.

Indications -Inflammation/edema -Exercise the muscles around the effusion is more effective -Pain Control -Facilitation of a muscle -Muscle spasm reduction -Assist collagen to maintain new ROM -Acute problems

Identify indications, contraindications, and precautions with paraffin.

Indications/Clinical Uses: 1. Chronic orthopedic conditions, especially in the distal extremities. 2. Osteo/Rheumatoid Arthritis. *Remember, these conditions can be exacerbated if application of heat applied while in an exacerbated stage. 3. Distal over use conditions- CTS, Tarsal tunnel syndrome, tendonitis of wrist/finger/feet/toes. 4. Post surgical hand and foot problems. 5. Prior to scar tissue or incisional scar mobilization. Contradictions 1) Same as those for MHP. 2) Area with an open wound. (except small ones)- may get burned by the heat. 3) Area with an infection or contagious wart. (Athletes feet). If possible, one can cover the part then dip. The new Nexus bandaids work well.

Immediate management of an ice burn? Describe Ice burn on skin? How do you manage ice burn?

Initially, area looks gray flat sheen Later becomes red Initially, hard skin Skin ultra fragile Immediate management: Warm up area slowly can put hand lightly on the area Use hand lightly on area Do not RUB Don't rub or skin will peel Document and inform physician

Metabolic effects of hemodynamics

Metabolic rate increases: Enzymatic increases observed 102 to 109 degrees 13% increase with 1 degree temp increase Arthritis active flare up. Heat? Increase chemical reactions: increased oxygen uptake increased nutrients available Hemoglobin gives up 2x more oxygen at 106 degrees F compared to 97 degrees F >113 degrees results in enzymatic denaturing ie cooking!

Temperature at which hydrocollator unit is kept

Metal tank Water kept at 160 to 170 degrees Standard machines hold 4-12 hotpacks some hold 24 Packs are made of bentonite- hydrophyllic silicate gel covered with canvas Bentonite can hold a large volume of water for efficient delivery of heat Various size packs 12x12, 12x24, 24x24, cervical 6x18 Pack cover worth 4 towels (aging thins more towels needed)

Identify the physiological effects of cold on human tissue Neuromuscular effects

Nerve Conduction Velocity: Decreases after 5 min of cold Longer the ice application, stronger the effect and longer to return to normal Decrease occurs in both sensory and motor nerves PAIN CONTROL: Counter irritant - uses Gate theory Decreased edema decreases pressure on nociceptors and therefore decrease pain Decrease in nerve transmission slows nociceptive impulses to higher centers Generation of a muscle contraction: Ice Massage less than 5 minutes has been shown to increase strength immediately post treatment Increased motor n. excitability Psych motivation to perform Ice for >30 minutes: Increase strength for 5 mins decreases strength for about an hour then increases again then subsequent increase strength for next 3 hours Decreased blood flow to muscles Slowed motor n conduciton Increased muscle viscosity Increased joint stiffness

Contraindications of heat

Over areas of acute inflammation Check for temperature, if area warm do not apply heat If you feel the arm it is probably still warm 2) Membranes and tissues that micro and macro tears- vasodilation can create more edema and effusion by allowing fluids to seep into surrounding tissues Do not apply for first 23-72hrs 3)New ecchymosis: Check color of bruise- red, purple or blue ecchymosis present then avoid heat Pulse ultrasound is great for treating bruising 4) Compromised circulation (do NOT apply heat) 5) Impaired sensation- susceptible to a burn 6) Impaired mentation- at risk for burn 7)Recent or potential hemorrhage 8)Thrombophlebitis- dislodge a clot 9)Malignant tissue 10)Infection 11) Past hx of intolerance

Identify the physiological effects of the application of paraffin.

Physiological Effects 1. Vasodilation 2. Increased extensibility of skin and connective tissue. 3. Muscle relaxation. 4. Increased pain threshold.

Analyze patient problems and choose the most appropriate cryotherapy treatment

Precautions Superficial nerves: Ulnar nerve and Fibular head Application over heart /chest area Gout: Actually keeps the gout uric crystals there Patients with Hypertension Deep open Wound

Precautions of heat

Pregnancy- do not apply over abdomen or in whirlpool Heat over low back is not recommended but can be used 2) Open wound ( protect area) 3) Cardiac Insufficiency Local and general vasodilation may increase cardiac demand Monitor closely 4) Metal in the area- remove jewelry 5)Topical ointments icyhot cream not good 6) Fainting post HP 7) Mottled area? Document- use extra layers next treatment. 8) Patients with Low blood pressure Can you take away towels after several minutes? NO! Why? Greater chance of becoming burnt, sensation to heat has been reduced so they wont be able to feel if it is burning them Area may not have ability to vasodilate anymore- burn Anything else?

List tools for pain assessment

Primarily used in Acute pain VAS- 10cm line: Numeric: 1-10 or 1-100 Simple rule of thumb: 1-3= no meds or minimal 4-6= over the counter meds or moderate 7-10= prescription meds or severe Picture: frown to smiley face Word: no pain to worst pain Semantic: McGill Questionnaire Throbbing pulsating Flash/prickle/electric Dull/ache/sore Pain Disability Index: Function Drawing: Sharp xxx Dull ooo Burning /// Stabbing Ache Throbbing

Identify the physiological effects of cold on human tissue INDIRECT EFFECTS

Reflex activation of sympathetic adrenergic neurons results in vasoconstriction in distant areas as well Increase viscosity of blood

What does whirlpool agitation( use of jets) achieve?

Relax Muscle Spasm Relieve Joint pain via gate mechanism Assist mechanical debridement Encourage movement pre exercise

Describe how to clean and sterilize a hydrotherapy tank

Safety cleaning Clean after each patient Clean with a disinfectant Rinse thoroughly Culture tanks periodically to check for growth Safety: Patient care Never leave patient alone Drowsiness from pain meds Secure them with a belt Keep room warm Prevents chill Beware drowsiness Adequate ventilation Decreases humidity Walls and floors should remain dry

Describe simply, pain modulation in human body

T-cells located in the dorsal horn are synaptic and can either stimulate local spinal reflexes, or project to higher centers. T-cells also receive inhibitory input from interneurons arising in the substantia gelatinosa. These interneurons are excited by input from large diameter, low threshold mechanosensative afferents (A-beta). They are inhibited by the noxious A-delta and c fibers. L=large fibers;SG=substantia gelatinosa;T= nociception transmitting cells; S= small fibers; DEOS= descending endogenous opiate system; PAG periaqueductal gray matter; NRM nucleus Raphe Magnus 1= excitatory synapse 2= inhibitory synapse Arrow 1and 2 negative feedback loop and arrow 3 is pathway to brain

Describe one common technique used in paraffin wax treatment

Techniques Temperature of bath 125 to 127 degrees F Wash and Dry part to be treated Water will heat up and burn them Immerse and AVOID movement Don't touch sides of tank Immersion Patient holds hand in bath for full length of treatment Dip- Immersion Dip once or twice and remove once or twice allowin gparrafin to harden then immerse as above Dip Wrap Dip, remove, allow paraffin to harden. Repeat 6-12 times. Then wrap in wax paper or platic bag then wrap in towels. Duration of heating is 20 minutes

List Physical Agents used in Physical Therapy- Thermal: Mechanical: Electromagnetic:

Thermal: Cold pack Ice massage Spray and stretch Hotpack Paraffin Contrast baths Hydrotherapy Fluidotherapy Mechanical: Ultrasound Soft Tissue Mobilization (manual therapy) Electromagnetic: Shortwave Diathermy

Convection

Transfer of energy via a circulating medium (air or fluid) of a certain temperature contacting another material of a different temperature. Air or moving medium moves past surface= heat exchange Convection currents carry the heat either too or from the source Temperature exchange more constant= rapid, consistent temperature increase More heat transferred in same period of time than by conduction Amount of temperature change dependent on: Area exposed Length of exposure Velocity of fluid movement Density of fluid Specific heat of source Thermal conductivity of source Examples of convection Whirlpool with agitation Fluidotherapy Cooling or warming by blood flow through the area

Conduction: How does heat transfer? What needs to happen between two different temperature? What does it depend on? Physical Agents used in Conduction?

Transfer of heat from a warmer object to cooler Collision of molecules Must have contact and be two different temperatures METAL>WATER>BONE>MUSCLE>FAT>AIR Depends on: Duration of exposure Generation of heat within the source Hotpack, Electric heating element Specific Heat of Source Higher specific heat ≈ faster conduction Thermal conductivity of source (Metal>air) Temperature Difference Really hot to really cold = faster energy transfer Conduction in physical agents If heat transferred from one area to another by conduction Clinical benefit: Other tissues? Heat lost or gained? Examples of Physical Agents which use Conduction: Hot Packs Cold packs Paraffin Whirlpool

Radiation: What happens during

Transmission and absorption of electromagnetic waves HEAT Gain or Loss from tissues Examples: Microwave diathermy Infrared lamp Radiation of heat from the body when the body is warmer than the surrounding air

State the specific nerve fibers for the transmission of Nociception

Transmission of Nociception 2. A-Delta-Group III afferents a. transmits sharp, prickly pain b. response is of short duration c. fast component of pain d. nerves are: myelinated e. velocity 4-30 m/sec f. makes up 20% of nociceptive fibers Pain transmitting nerve fibers 3. C-afferents- Group IV afferents. a. sensations felt are: dull, throb, achy, diffuse, burning b. longer lasting pain c. velocity .5-4 m/sec d. 80% of pain fibers e. nerves are: unmyelinated f. slow component of pain

List types of superficial heat used in PT

Types of Superficial Heat Moist Hot Packs Paraffin Fluidotherapy 105-125 degrees F Infrared

List the clinical uses of heat

Use of Heat in PT Pain control Reduce Muscle spasm Increase soft tissue extensibility Increase circulation Causes the reduction of pain , muscle spasm,.... Accelerate Healing????? Enhance Healing

Conversion

Where a non thermal energy (mechanical, electrical or chemical energy is changed to heat Energy in one form transmitted to body- thermal energy Not affected by temerpature of thermal agent but by power of energy source Examples: Ultrasound: Mechanical energy becomes heat by molecular friction Shortwave Diathermy Electromagnetic energy becomes heat by molecular friction

List and describe physiological effects of whirlpool (hot or cold) - Cleansing type

Whirlpool mechanically debrides wound Tissue softening Pressure on area Assists in removing necrotic tissue Increase blood flow Increase nutrients Additives decrease microbes on wound Surfactants (soaps) reduce adhesion of debris on tissue Increased risk of infection/cross contamination=used less clinically now * find that there are good microbes that get washed out with the whirlpool

List clinical uses of hydrotherapy

Wound Care Water Exercise Pain Control Edema Control

List and describe physiological effects of whirlpool (hot or cold) Wound care

Wound care Non immersion devices Deliver fluid at 4-15 PSI High enough to clean Not high enough to increase damage Wound care Painful - care is often coordinated with a wound care team including nursing staff and physicians-medication maybe needed

List and describe physiological effects of whirlpool (hot or cold) Renal

increased urine production Loss of sodium and potassium Decreased antidiuretic hormone and aldosterone Redistribution of blood volume Central hypervolemia May assist in edema reduction