Modalities (Chapter 7 and 8: Introduction to Thermal Agents + Superficial Cold and Heat)

Which of the following is a mechanism of pain control using thermotherapy?

*Gating the transmission of pain* by activating cutaneous thermoreceptors -The mechanisms of pain control using thermotherapy include positive psychological experience of heat, improved healing from increased blood flow, and *gating of pain transmission* by cutaneous thermoreceptor activation

When employing cryokinetics, which of the following is the full and correct sequence of treatment?

1. Cold is applied for 20 minutes or until the patient reports numbness 2. the patient performs stretching or stretching for 3-5 minutes 3. cold is reapplied until the patient reports numbness -In cryokinetics, cold and exercise are used to numb the pain associated with the injury, To achieve this effect, cold is applied first for up to 20 minutes, or until the patient reports numbing of the area; then the patient performs stretching and stretching exercise for 3-5 minutes until sensation returns. The cooling agent is then reapplied until analgesia is regained. -This sequence of cooling, exercise, and re-cooling is repeated about 5 times

A patient being treated with cryotherapy is most likely to experience which of the following sequences of sensation?

1. Intense cold 2. burning 3. aching 4. analgesia -The first sensation is cold when the thermal receptors are stimulated, with increasing stimulation, the sensation becomes burning. As the pain receptors become activated, aching is felt, followed by analgesia as sensory nerve conduction becomes blocked by the cold

To produce the greatest increase in tissue extensibility within safe ranges, tissue should be elevated to:

104-113 Degrees F -A maximum increase in residual length is achieved when the tissue temperature is maintained between 104 and 113 degrees F (40 and 45 degrees C) for 5-10 minutes

In which of the following cases is superficial thermotherapy least appropriate?

A patient with stiffness in the elbow motion following a fall without associated fracture, 12 hours post injury -The patient with elbow stiffness following a recent fall may have a significant potential for hemorrhage from injuries to the vasculature, Applying heat to an area of potential hemorrhage is contraindicated because it can cause a hemorrhage to worsen

Cryotherapy is most effective in slowing nerve impulses of which fiber type?

A-delta fibers -Cryotherapy has the greatest effect on conduction by myelinated and small fibers and the least effect on conduction by unmeyelinated fibers, demonstrating the greatest decrease in conduction velocity response to cooling

Cryotherapy most effectively controls edema caused by:

Acute Inflammation -Cryotherapy is recommended for control of edema associated with acute inflammation and exerts this effect by promoting vasoconstriction, reduced activity of leukocytes, an d increasing blood viscosity, which can reduce local circulation and accumulation of fluids into the interstitial space

Which of the following increases the risk of burning with superficial thermotherapy?

Both A and B (patient reports that he is not feeling sufficient warmth following the application of hot packs with 8 towel layers, thus 2 are removed by the therapist AND a patient uses an electric heating pad all night to minimize joint stiffness in the morning) -Scenarios associated with decreased sensitivity to heat increase the risk for burns

When applying IR radiation, when using an IR lamp, the therapist should of all of the following EXCEPT

Cover the area to be treated with a towel -The towels are used for patient modesty and to limit the target area by covvering the outlying areas -Covering the treatment area with a towel will decrease the amount of IR radiation reaching the treatement area

All of the following effects can be achieved by applying cold to tissues EXCEPT:

Decreased blood viscosity -Cold tends to increase blood viscosity, adding resistance to flow, slowing the circulatory rate and inflammatory response

Heat has which of the following muscle effects on muscle strength?

Decreases muscle strength directly following the application of heat -Muscle responds to heat by initially decreasing strength directly after application -Gradually afterward, muscle strength recovers and actually increases above the pretreatment level after several hours

During conduction, heat is transferred from the material at the higher temperature to the material at the lower temperature as a result of:

Direct collision between molecules causing acceleration -Heating by conduction is the result of energy exchange by direct collision between the molecules of two material at different temperatures -Heat is conducted from the material at the higher temperature to the material the the lower temperature as the faster-moving molecules in the warmer material collide with the molecules in the cooler material and cause them to accelerate

In which of the following scenarios would the application of a controlled cold compression pump be most appropriate?

Following a surgical repair of a proximal tibial fracture that is stable -Cold compression units are advantageous for simultaneous application of cold compression and are commonly used after surgical repair of a limb -The main disadvantage is that they cannot be used for the trunk or digits

What type of IR radiation lamps available to clinicians and what type of wavelength does this lamp have?

IR-A lamps with wavelengths between 770 and 1400 nm -IR lamps currently available for clinical use all emit IR-A, generally with mixed wavelengths of approximately 780-1400 nm with a peak intensity at around 1000nm

In which of the following cases is the application of ice or a cold pack least desirable?

Inflammation with carpal tunnel syndrome -In carpal tunnel syndrome, the nerves that supply part of the hand for motor control and sensation are entrapped and compressed -Icing this area may help with inflammation, but could also potentially worsen the nerve conduction block through the effects of cold on nerves

All of the following statements about treatment with IR radiation are true EXCEPT:

Lighter skin will absorb more radiation than darker skin -IR absorption coefficients are primarily affected by color, with darker tissue and skin absorbing more radiation than lighter tissue and skin

For maximum efficiency and safety when using hot packs, do all of the following EXCEPT:

Maintain the hot pack in water temperatures of 113 to 122 degrees F -Store hot packs in water tha is thermostatically controlled to 158-167 degrees F -A hot pack generally takes 30 minutes in hot water to reheat and 2 hours to heat initially -A total of approximately 6 layers of toweling should be used to cover hot pack -A hot pack cover is equivalent to about 3 layers of toweling. -A water temperature of 113-122 degrees F is not warm enough and will not be efficient

Which of the following modes of heat transfer does NOT require and intervening medium?

Radiation -Infrared lamps are an example of heat transfer by radiation, which can be placed at a distance from the skin without an intervening medium and still transfer heat to the skin

Which of the following treatment scenarios will prove most effective for increasing muscle length?

The application of heat before and during stretching -A maximum increase in length, with the lowest risk of injury, is obtained if the tissue temperature is maintained at 35-40 degrees C. -If the tissues are allowed to cool before being stretched, the effects of the prior heating on tissue extensibility will be lost

All of the following statements about evaporation are true except:

The temperature of evaporation for sweat is below that of normal skin temperature -The temperature of evaporation for sweat is a few degrees higher than normal skin temperature. -Therefore, warming the skin as the result of exercise or external heat will promote evaporation of sweat

Which of the following statements about the area of tissue heated by a superficial heat source is true?

The tissue coming into direct contact with the heat source and tissue adjacent to it will be warmed -A superficial heat source will heat not only the tissue that it directly contacts, but also the tissues adjacent to it, as the tissue itself can conduct heat

All of the following are examples of heat transfer by convection EXCEPT:

Ultrasound -Convection is a process of heat transfer resulting from direct contact between a *circulating medium* and another material of a different temperature. Ultrasound does not transfer heat via a circulating medium. -Rather, heat transfer with ultrasound is through conversion of mechanical energy into thermal energy within deeper tissues

During conduction, heat is transferred:

Until both the physical agent and the superficial tissues are of equal temperatures -The rate of heat transfer by conduction between two materials depends on the the temperature difference between the materials, their thermal conductivity and their area of contact -If there is no temperature difference, then heat transfer ceases

Which of the following effects can be achieved by applying heat to tissues?

Vasodilation, increased collagen extensibility, decreased pain -Heat therapy promotes vasodilation , increased collagen extensibility, and decreased pain

Cryotherapy most effectively reduces spasticity if applied for how long?

When applied for 10-30 minutes -Cryotherapy application of 10-30 minutes duration can produce a long lasting effect of decreased spastisity for a few hours

To prevent overheating from a conductive agent during a thermotherapy session, a therapist typically:

Will have the patient remove any jewelry in contact with skin in the treatment area -Because metal has high thermal conductivity, metal jewelry should be removed from any area that will be in contact with a conductive agent to avoid overheating or cooling the skin in contact with the meal. -If metal jewelry is not removed, heat will rapidly transfer to the metal, with the potential to burn the skin that it is in contact with