Exam 2- Ultraviolet , Thermotherapy , Cryotherapy

What is the use of artificial UV light for therapeutic purposes?

Phototherapy

What is the use of artificial UV light with a chemical photosensitizing agent for therapeutic purposes?

Phtochemcial effect

Physiological and therapeutic effects of UV light?

Induce skin erythema response

Inhibit epidermal hyper proliferation

Enhance apoptosis

Induce local immunosuppression

Decrease cutaneous cell turnover

Increase vitamin B production

Ultraviolet radiation is absorb in the first _______ of skin

1-2mm

The physiological effects of UV radiation are?

Very superficial

-alters cell biochemistry

-cell damage and death

-inflammatory reaction

-increased capillary permeability

How do you determine the does of UV radiation?

Minimal erythma dose

Estimate based on Fitzpatrick`s Skin Phototype

Why is UV light not used much for healing?

It's photogermicidal

-meaning it can kill the bacteria but also kill the tissue it is trying to heal too

What is UV radiation used for?

Clearance of psoriasis

Clearance of atopic dermatitis or eczema

Regimentation vitiligo

What are some photosensitivity agents

Psoriasis- psoralen

Creams and oral meds

Contraindications of UV radiation

Over the eye

Malignant skin

History of melanoma

SLE, Porphyria's, pellagra sarcoidosis, herpes simplex

Active tuberculosis

Kidney, cardiac, and liver disease

Hyperthyroidism

Diabetes mellitus

Acute eczema or dermatitis

Risks of UV radiation

Areas recently exposed to other radiation's

Fever

Large dose

Children's

Pregnant or lactating

Photosensitizing drugs

What method of heat transfer is done through direct contact?

Conduction

Example of therapies that use conduction

Heat (or cold) applied directyl to the skin

Hydrocollator packs

Paraffin bath

What method of heat transfer is air or water particles move across the body part causing heating (or cooling)

Convection

Examples of therapies that use convection

Whirlpool

Fluidotherapy

Method of heat transfer from a warmer surface to a cooler through air or vacuum

Radiation

Example of therapy that uses radiation heat transfer

Infrared lamps

Method of heat transfer when the heat is generated from another energy form?

Conversion

-its not really a true method of heat transfer but converting a form of energy into heat

Examples of therapy that use conversion method of heat transfer

Ultrasound

Diathermy

Physiological effects of thermotherapy

Enhance proliferation phase of soft tissue healing

Increase soft tissue elasticity

Pain relief through a counter irritation effect

Decreased muscle spasm

How does thermotherapy enhance the profiler phase of soft tissue healing?

Increase rate of angiogenesis, formation of granular tissue and collagen synthesis

Significant vasodilation

What are the main therapeutic effects of using thermotherapy?

Enhance tissue healing

Decrease pain

Decrease muscle spasm

Increase joint mobility

What can be beneficial in the treatment of low back pain?

Long duration low level heat

What can be beneficial to reduce myofasical pain?

Shorter duration moist heat

Contraindications to thermotherapy

Areas of impaired heat sensation

Malignancy

Thrombophlebitis

Hemorrhage

Abdomen, pelvis, low back in pregnancy

Acute inflammation/inflammatory conditions

Confused and unreliable patients

Precautions to thermotherapy

Impaired circulation

Over wounds

Severe cardiac insufficiency

Over superficial metal implants

May cause decreased motor skill and reaction time

Can increase fever

Why is impaired circulation a precaution for thermotherapy

Could quickly heat things up cause the blood doesn't spread the heat too hell

Why is severe cardiac insufficiency a precaution for thermotherapy

Heart may not pump well enough to circulate blood fast enough to prevent over heating of a single spot

Different types of thermotherapy

Moist hot packs (hydrocollator)

Warm whirlpool

Paraffin

Fluidotherapy

Heat lamps

Contrast bath

(Topical counterirritants)

Temperature for moist hot packs

158-169 F

How many layers of towels for moist hot packs

6-8 layers

How many layers of towels does 1 terry cover equate to

About 4 layers

How do you do the towers for moist hot packs (hydrocollator packs)

Cross cross pattern

TRUE or FALSE

You should not allow the patient to lay on heat packs

TRUE

Treatment Tim for hydrocollator packs

20 minute

Hydrotherapy is used for?

Cleansing and debridement of wounds

Mechanical effects of hydrotherapy

Therapeutic exercise

Thermal effects of hyrdrotherapy

Hot or cold therapy

Temperature needed for warm whirlpool

86-100 F

Temperature of water MUST be ______ if the size of the body area being treated is bigger

Lower

Treatment time for warm whirlpool

10-45 minute

What is a Sitz bath used for

Soaking the perineal/anal area for pain and itching

Paraffin bath temp

124-129 F

How many layers should you re dip for paraffin bath

6-10 layers

Treatment time of paraffin bath

30 minutes

When using a paraffin brushing technique, how many layers?

7-10

Fluidotherapy uses what method of heat transfer

Convection

-dry cellulose heated up then blown around chamber by fans

Temperature of Fluidotherapy

110-126

Treatment time for infrared lamp

15-20 minutes

Amount of heat from infrared lamp depends on?

Length of time exposed

Distance from blurb

Angel from perpendicular

Output of the bulb

Contrast bath is used in what phase of healing?

Subacute phase

-or anytime father acute phase for pain relief

Contrast bath (IS or IS NOT) a good treatment of swelling

IS NOT

When does the contrast bath cause pumping of capillaries?

Only during active exercise

How does contrast bath help with pain relief?

Sharp sensory change tends to cause a decrease in pain and break the pain spasm cycle

-going hot tub to ice bath

Whirlpool temp for contrast bath cold part

50-68 F

Whirlpool temp for contrast bath hot part

104-113 F

Generally with contrast bath you should end with _______ when needing vasoconstriction

End with cold

Gernally with contrast bath you should end with ______ when needing vasodilation

Heat

With contrast bath you should end with ______ when worried about swelling

Cold

In the repair phase of healing you should end with _______ for the contrast bath

Warm

What is the main thing contrast bath is used for?

Pain relief

Topical counterirritants are good for?

Pain relief

-biofreeze, icy hot, Ben Gay

Topical counterirritants are thought to take advantage of the fact that?

A-delta and c-afferent fibers inhibit pain

Mechanisms of heat transfer that cryotherapy uses

Conduction

Convection

Evaporation

What is conduction

Direct contact

Examples of cryotherapies that use conduction

Ice massage, cold packs, ice bath, cold water circulation, cuffs

What is convection

Air or water particles move across the body part causing cooling

Example cryotherapy of convection

Cold whirlpool

Evaporation example

Vapocoolant spray

What is an application of cold for therapeutic purposes

Cryotherapy

What is a source of cold applied to the skin surface for the purpose of removing heat from the soft tissue

Cryoagen

What is a combination of cold and exercise

Cryokinetics

What is it called when the body part turns red when it is cold?

Cold induced Vasodilation (CIVD)

Aka = hunting response (hunting-Lewis response)

Cold induced vasodilation is what type of effect?

Delayed secondary effect

Cold induced vasodilation causes what?

Increase in tissue temp during cold therapy

-causing protective response and prevents frostbite

When would you see cold induced vasodilation?

Prolonged cold application temps below 50F

Why does stuff deeper in the skin get colder for a bit after the ice is taken off?

The skin becomes like an ice pack itself and when it is heating up it pulls heat from the deeper tissue

Why is frostbite a risk for obese people?

Insulating layer of fat below the skin doesn't let the heat transfer from subcutaneous tissue to skin occur

Cooling deep tissue occurs?

More slowly but continues for several minutes after ice is removed

What makes a big impact on the depth of the ice effect

Subcutaneous adipose

You should have a re-warming period that is?

2X longer then the cooling period

Re-warming is much more rapid when?

Patient engages in activities

Indications to use cryotherapy

Pain

Muscle spasms

Acute injury

How does cryotherapy help with pain

Decreased nerve conduction velocity

Counterirritation

How does cryotherapy help with muscle spasm

Decrease active of gamma motor neuron system

Decrease pain-spasm cycle

How does cryotherapy help with acute injury

Prevent secondary issue damage

Control acute inflammation, edema and hemorrhage

Vasoconstriction, decreased blood flow and metabolism

Physiological responses of cryotherapy

Decreased physical performance, strength and dexterity

What is good advice for using cryotherapy before activity

Re-warm tissue before returning to sport participation or propioception training

Contraindications of cryotherapy

Impaired cold sensation

Cold-induced urticaria (cold allergy)

Rayunauds disease

Cryoglobulinemia

Paroxysmal cold hemoglobinuira

Open wounds

Peripheral vascular disease

Confused and unreliable patients

What is an allergic reaction to cold?

Cold urticaria

Cold urticaria is what type of reaction?

Anaphylactic reaction

-hives

-itching

Cold urticaria can result in if not careful

Systemic reaction

-difficulty breathing

-loss of consciousness

What is a constriction of arteries and arterioles usually in the distal extremity in response to cold

Raynaud's disease

How does Raynaud's disease work? What colors are associated with it?

Restricts blood flow and results in color change

1. White 2. Blue 3. Red

Raynauds is more common in who?

Women

What is an abnormal clumping of plasma proteins stimulated by cold application

Cryoglobinemia

Cryoglobinemia leads to?

Skin discoloration and dyspnea

What is another name for Cold Induced Hemoglobinuria

Paroxysmal cold hemoglobinuria

What is it when cold temperature activates antibody to RBC causing lysis?

Cold induced hemoglobinuria

Signs of cold induced hemoglobinuria

Excess hemoglobin in urine

Darkened urine and back pain