Biophysical Agents

Conduction

heat transfer from object to patient, requires direct contact

Example of thermotherapy that uses conduction

heat pack

Convection

heat transfer from circulating medium to another material of different temperature

Example of thermotherapy that uses convection

heat from whirlpool

Conversion

heat transfer by conversion of non-thermal form of energy into heat

Example of thermotherapy that uses conversion

ultrasound

Radiation

heat transfer from material of higher temp to material of lower temp

Hemodynamic effects of thermotherapy

Increased local vasodilation leading to increased local metabolism

Increased local perspiration

With thermotherapy, how far does the heat typically penetrate?

less than 1 cm

Neuromuscular effects of thermotherapy

Muscle relaxation promoted

Increase in nerve conduction velocity

Increased pain threshold

Temporary decrease in muscle strength (WP, SWD)

Metabolic effects of thermotherapy

Increased body temp, HR, respiration

Decrease in BP

Overall increased rate of metabolism

Integumentary effects of thermotherapy

Capillary pressure and cell permeability may increase

Increased collagen extensibility

When is thermotherapy indicated?

Modulation of pain (subacute, chronic)

Alteration of skeletal muscle performance to facilitate movement through inhibition of muscle spasm and increasing tissue extensibility through facilitation of ROM

Facilitate tissue healing

Contraindications for thermotherapy

Acute inflammation

Existing fever

Malignancy

Recent/potential hemorrhage, active bleeding

Cardiac insufficiency

Peripheral vascular disease

Irradiated tissues

Impaired sensation/mentation

Heat allergy

Relative contraindications for thermotherapy

Pregnancy

Skin rashes, open wounds

With topical counter-irritants

Obesity

What temperature are traditional canvas packs stored submerged at?

165-170

What temperature are gel heat packs stored submerged at?

120-140

How many layers of toweling should be placed between a patient and a canvas hot pack?

6-8 layers or commercial cover

How many layers of toweling should be placed between a patient and a soft vinyl hot pack?

1-2 layers or cloth/paper pillowcase

How long does it take for maximum vasodilation to occur in an adult when using a hot pack?

20 minutes

Mottling

visual sign of a pre-burn status of skin; splotchy, discolored, or multicolored skin

What are the contents of paraffin?

mix of wax and mineral oil

Paraffin temperature

127-130

What are the advantages of paraffin treatment?

Bony, distal extremities easy to cover

Improves skin integrity

Adaptable to home use

Disadvantages of paraffin treatment

Messy to treat and clean up

Heat not always tolerated

Heat in wax doesn’t last as long as HP

Ice massage

heat abstraction or cooling-heat is removed or lost from an object

Cold pack and cold whirlpool

Conduction-heat transfer from warmer area (patient) to colder area (cold pack) leaving target tissues colder

Hemodynamic effects of cryotherapy

Initial local vasoconstriction

Later vasodilation

Metabolism decreased initially and increased later

Neuromuscular effects of cryotherapy

Slowed nerve conduction velocity

Muscle spindle activity decreased promoting relaxation

Muscle viscosity increased (slows reactions)

Pain relieved

Temporary decrease in strength

Metabolic effects of cryotherapy

Response to injury reduced

Decreased HR and respiration

Overall decrease in metabolism

Integumentary effects of cryotherapy

Connective tissue becomes less flexible

Decrease in metabolism and blood flow impacts rate of tissue healing

Indications for cryotherapy

Modulation of pain (acute, chronic)

Facilitate movement if pain has caused decreased ROM

Inhibition of muscle spasm to facilitate movement

Facilitation of tissue healing through decrease in inflammation

Contraindications for cryotherapy

Cold urticaria (allergy)

Cryoglobulinemia, multiple myeloma, lupus, RA, chronic liver disease

Intense psychological dislike of cold

CHF, hypertension, respiratory problems

PVD, poor circulation

Peripheral nerve damage

Open wounds after 48 hours

Before ultrasound

Irradiated tissues

Impaired sensation/mentation

Diagnosis of Raynaud’s phenomenon-vasoplastic disorder

Precautions for cryotherapy

Avoid application over superficial branch of nerve

Watch for early frosting of bony prominences

What are the four stages of sensation in cryotherapy?

Cold

Burning

Aching

Numbness

Indications for cold water immersion

Acute pain/edema

neurological spasticity (MS, MD)

What is the temperature range for an ice whirlpool or ice bath?

55-65

Frequency for cold water immersion

3-4X/day acute

Contrast baths

alternate heat and cold, vasodilation-vasoconstriction

When can contrast baths be used?

in transition between acute and subacute phases

When are contrast baths indicated?

To increase blood flow to an area without increasing edema

Temperature ranges for contrast baths

Cold 45-55

Warm 98-104

Duration for contrast baths

3:1, hot to cold for 20 minutes

Why do you stay in the warm bath longer with contrast baths?

takes longer to vasodilate then vasoconstrict

At what temperature are frozen-gel packs/commercial cold packs kept at?

0-10

Cold gel pack duration

15 minutes or through 4 stages

What is the slowest form of cryotherapy?

Gel-pack

Crushed-ice pack duration

no more than 30-60 minutes

What must be placed in between a vinyl frozen gel pack and skin?

wet washcloth

What happens to the respiratory rate with prolonged use of cryotherapy?

decreases

Modes of compression

Intermittent Pneumatic Compression (IPC)

Cryocuff

Compression bandaging for edema

Compression garments

Lymphedema bandaging

Indications for compression

Control of minimize edema from injury, post-op, burns, chronic venous insufficiency, lymphedema

Improve venous and systemic circulation

Enhance healing of venous leg ulcers

Reduce orthostatic hypotension

Prevent thrombophlebitis

Contraindications and/or precautions for compression

Acute inflammation or trauma

Acute skin infections, fragile skin

Presence of recent or acute deep vein thrombosis

Edema secondary to cardiac/kidney dysfunction

Acute fractures

Hypertension

Potential complications from compression treatments

Integumentary: swelling in adjacent quadrants, skin breakdown, ischemia

MSK: decrease in ROM of involved joints due to immobility

Cardiopulmonary: SOB from fluid overload

Psychological: sensation of feeling “trapped”

What is the standard inflation and deflation modes for IPC?

3:1 ratio, 45 seconds on and 15 seconds off

S/Sx of restricted circulation and neural transmission for compression pump treatments and compression wrap treatments

Pallor

Erythema

Cyanosis

Tingling or numbness

Pain or hyperesthesia

Swelling or increased swelling

Decreases in extremity temperature

Hydrotherapy

external application of water in solid, liquid, or vapor form for healing purposes

Indications for whirlpool

Graded exercise

Thermotherapy- pain relief, soften scar tissue and adhesions, decrease joint stiffness

Cryotherapy- pain relief, decrease edema, cool down after exercise

Wound management

Relative contraindications for whirlpool

Pre-existing fever

Acute inflammatory conditions

Cardiac and/or respiratory instability

Active bleeding

Confused, combative patients

Skin allergies

Pre-existing edema

Peripheral vascular disease

Pt on vasodilators

Clean, beefy red wounds with granulating tissues

When staff and time are limited

When cost is a factor

What factors are considered when determining type of tank for whirlpool treatment?

Immerse body part

Easiest transfer

Control of patient

Cost

Extremity tank considerations

distal segments, body part dependent

Lo-Boy tank considerations

sit with LE’s fully extended

need triceps or lift

Hi-Boy tank considerations

need full flexion of hip/knee

must climb in

Hubbard tank considerations

total body

prone/supine

hydraulic lift to ¼ ton

What is the largest tank used for whirlpool treatment?

Hubbard tank - 500 gallons

Whirlpool heat treatment temperature

98-104

Whirlpool cold treatment temperature

45-60

Whirlpool wound cleansing temperature

96-100

When is an additive indicated for used in whirlpool?

Open wound-infected

When is the use of the jets to create water agitation indicated?

Relaxation

increased ROM

Decreased pain

Precautions for whirlpool treatment

Fainting

Falls

Drowning

Electrocution

What should be included in all notes for whirlpool treatment documentation?

Tank style or size

Water temp

Frequency and duration

Additives

Patient transfer ability

Use of agitation