Passive Care Exam 2: Part 2 -- UV, Thermotherapy, & Clinical Decisions

What is electromagnetic radiation between x-rays and visible light?

Ultraviolet Radiation

What therapy 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?

UV Therapy

Dermatosis is treated by what modality?

Ultraviolet

Which type of UVA light is carcinogenic? Which is declining in use?

PUVA = carcinogenic

UVA1 = declining use

Which type of UVB light is declining? Which is less of a cancer risk?

BBUVB = declining

NBUVB = less cancer risk

What is the UVC type of UV light?

Photogermicidal

T/F: UV radiation is absorbed in the lowest layers in the skin and can reach very deeply.

FALSE

Absorbed in the First layers (1-2mm) of skin and very superficial

What are the 4 physiological effects of UV radiation?

1) Alter cell metabolism

2) Cell damage & death

3) Inflammatory reaction

4) Increased capillary permeability

Before UV radiation, the skin should be tested first with a minimal erythema dose, and fait redness for _____ hours after treatment?

24 hours

What are 4 clinical indications for UV radiation treatment?

1) Psoriasis

2) Atopic dermatitis

3) Vitiligo

4) Mycosis Fungoides

What are 9 contraindications of UV radiation?

1) Eye

2) Malignant skin

3) Melanoma

4) Lupus

5) acute TB

6) Kidney/cardiac/liver diseases

7) Hyperthyroidism

8) Diabetes mellitus

9) Acute eczema/dermatitis

What are 6 risks of UV radiation?

1) Areas recently exposed to other radiation

2) Fever

3) Large dose

4) Children

5) Pregnant (areas of pregnancy)

6) Photosensitizing Drugs

What are 7 types of thermotherapy?

1) Hot packs

2) Warm whirlpool

3) Paraffin

4) Fluidotherapy

5) Contrast bast

6) Heat lamps

7) Topical

What mechanism of thermotherapy is direct contact?

Conduction

What mechanism of thermotherapy is air or water moving across the body?

Convection

What mechanism of thermotherapy is from warmer surface to a cooler surface from air or vacuum?

Radiation

What mechanism of thermotherapy is heat generated from another form?

Conversion

What mechanism of thermotherapy does infrared lamps use?

Radiation

What mechanism of thermotherapy does hot packs & paraffin use?

conduction

What mechanism of thermotherapy does US and diathermy use?

Conversion

What mechanism of thermotherapy does whirlpool & fluidotherapy use?

Convection

What is the major difference in heating between thermotherapy and ultrasound/diathermy?

Thermotherapy = superficial heat

Diathermy/US = deep heat

What are the 4 functions of thermotherapy?

1) Pain relief (pain gating, counterirritatino)

2) Calming/Sedating effect

3) Spasms reduction (decrease gamma motor neurons)

4) Increased mobility (decreases joint viscosity & viscoelasticity of muscles/tendons/ligaments)

Long low level thermotherapy is good for what kind of pain? How about short moist thermotherapy?

Low back pain

Myofascial pain

T/F: Thermotherapy may be better than ibuprofen for analgesic

TRUE

What are 4 indications for using thermotherapy?

1) Decrease pain

2) Decrease muscle spasms

3) OA

4) RA

What are 7 contraindications of Thermotherapy?

1) Impaired heat sensation

2) Malignancy

3) Thrombophlebitis

4) Hemorrhage

5) Pregnancy (abdomen, pelvis, LBP)

6) Acute inflammation/inflammatory conditions

7) Confused/unreliable patient

What are 6 precautions for thermotherapy?

1) Impaired circulation

2) Over wounds

3) Severe cardiac insufficiency

4) Over superficial metal implants

5) May cause decreased motor skill and reaction time

6) Can increase fever

At what temperature should the hydrocollator packs be kept? For what time frame?

158-169 F

20 mins

How many layers of towels is needed for Hydrocollator packs?

6-8 layers of towels

T/F: In the warm whirlpool, the temperature of water must be lower if the size of the body area being treated is smaller

FALSE

Temp of water LOWER if body area BIGGER

How long should an individual be in the warm whirlpool?

10-45 mins

What are 4 contraindications for warm whirlpool thermotherapy?

1) Incontinence

2) Fever

3) MS

4) Pregnancy

What is a plastic or stainless steel bath that is over the normal toilet for soaking the perianal/anal area and for hemorrhoids?

Sitz bath

How many times should you dip the paraffin wax (aka how many layers of wax) before putting the extremity in the plastic bag and adding toweling?

6-10 times dipped

For paraffin wax, what temperature should it be kept at? What is the time frame for use?

124-129 F

30 mins

What treatment is dry cellulose heated to 110-126 F then blown around a chamber by fans? What is the time frame for this treatment?

Fluidotherapy

-- 30 mins

What treatment is a moist towel and lamp and a depth of penetration of a few mm? What is the time frame for this treatment?

Infrared lamp

-- 15-20 mins

What treatment is used in the subacute phase to allow transition from cold modalities to warm modalities?

Contrast bath

T/F: Contrast bath is good for swelling because it helps to pump the capillaries

FALSE

NOT good for swelling because does NOT pump capillaries

T/F: The length of treatment does not allow deep penetration for contrast bath

TRUE

Sharp sensory pain from contrast bath tends to cause a _________ in pain and break the ______________ cycle.

Decrease in pain

Break pain/spasm cycle

What is the timing for Contrast bath?

First modality 1-4 mins, then next modality 1-4 mins

Repeat for 20-30 mins

Topical counterirritants will decrease pain and increase ROM by inhibiting what 2 fibers which inhibits pain?

A delta & C fibers

What are the 4 goals of Topical counterirritants?

1) Decrease skin temperature

2) Theoretical therapeutic effects

3) Colling stimulates cold receptors in skin

4) Cold signals compete for spinal pathways with pain signals

What style of application stimulates large myelinated mechanoreceptors in topical counterirritants?

Rubbing Application

What is the application of cold for therapeutic purposes?

Cryotherapy

What is the combination of cold and exercise?

Cryokinetics

What is an increase in tissue temperature during cold therapy?

CIVD (cold induced vasodilation / hunting)

What form of cryotherapy is ice massage, cold packs, ice bath, and cold water circulation cuffs?

Conduction

What form of cryotherapy is cold whirlpool and is most effective?

Convention

What form of cryotherapy is vapocoloant spray?

Evaporation

What are the 4 goals of cryotherapy?

1) Relieve or decrease pain

2) Decrease blood flow & metabolism

3) Protect injured tissue

4) Decrease Muscle spasm

What are the 8 contraindications of cryotherapy?

1) Impaired cold sensation

2) cold induced urticaria

3) Raynaud's

4) Cryoglobulinemia

5) Paroxysmal cold hemo

6) Open wounds

7) Peripheral vascular disease

8) Confused

What is an allergic reaction to cold response?

Cold utriciaria

What is a disorder that causes decreased blood flow to the fingers with white, blue, and red coloring?

Raynaud

What is abnormal clumping of plasma proteins?

Cryoglobinemia

What is it called when cold temperatures activate antibody RBS causing lysis, so excess hemoglobin is excreted in urine and there is dark urine?

Cold Induced Hemoglobinuria/Paroxysmal

What are the 4 stages of cryotherapy sensation?

1) Cold

2) Burning

3) Aching pain

4) Numbness

T/F: Chemical cold pouches are one time uses

TRUE

-- internal pouch when broken will mix the chemical ONE time

What is the time frame for cold whirlpool?

15-20 mins

What are 2 major advantages of cold whirlpool?

1) Surround entire joint

2) Perform active exercises

What are 2 major disadvantages of cold whirlpool?

1) Cannot elevate

2) Not ideal for acute

What does the constant circulation prevent in the cold whirlpool?

Warmer water layer around anatomy (thermopane)

What is the time frame for an ice bath?

8-20 mins

What is the time frame for ice massages? What condition is ice massage useful for treating?

5-10 mins

Plantar fascitis

What does the controlled continuous cold unit with compression do?

Compress & Cool

What is a superficial rapid cooling through evaporation with NO temperature change below the epidermis and the temperature numbs?

Capocoolant spray

What are 3 indications to use Capocoolant spray?

1) Trigger points

2) Muscle spasm

3) Decreased ROM

What are 4 precautions for Capocoolant spra?

1) Frostbite

2) Flammable

3) Local anesthetic

4) Tradition

What are 4 contraindications for Capocoolant spray?

1) Allergy

2) Open wounds

3) Surgery

4) Eyes

What is the process of cooling and rewarming skin?

Rapid skin cooling initially follwoed by a slower cooling rate

Re-warming is initial rapid rise in temperature then slower for 1.5 hours, quicker w/ physical activity

What is the process for cooling and rewarming deep tissue?

Cooling more slowly but continues to cool several minutes after ice removed

Re-warming takes 2.5 hours at rest, rapid when moving

What are 4 indications to do cryotherapy?

1) Pain

2) Spasm

3) Acute injury

4) Chronic & Inflammatory arthritis

What physiological response of cryotherapy is decreased nerve conduction velocity?

Pain

What physiological response of cryotherapy affects spindle and golgi?

Spasms

What physiological response of cryotherapy is vasoconstriction so reduced blood flow?

Edema

(reduces edema)

What physiological response of cryotherapy is when cold decreases metabolism?

Metabolic rate

What physiological response of cryotherapy is a vertical jumping decreased, needing to rewarm before returning to sport?

Performance

What are the 3 possible modalities that can be used for acute pain?

1) Electrical current (IF & Sensory TENS)

2) Low Level Laser

3) Cryotherapy

What is the Hz for IF & Sensory Level TENS for acute pain?

80-150 Hz

What level of dose is used of low level laser therapy for acute pain?

High dose to inhibit pain

What are the 4 possible modalities that can be used for Chronic pain?

1) Electrical current (IF & Motor TENS)

2) Low Level Laser

3) Cryotherapy

4) Thermotherapy

What is the Hz for IF & Motor TENS for chronic pain?

1 - 15 Hz

What level of dose is used of low level laser therapy for chronic pain?

High dose to inhibit pain

What are 3 possible modalities that can be used for muscle spasm?

1) NMES (Russian & Biphasic)

2) Thermotherapy

3) Cryotherapy

What is the on:off ratio for Russian Current & Biphasic Pulsed current in muscle spasms?

10 : 10

What are the 3 modalities that can be used for Edema?

1) Cryotherapy

2) Cold laser

3) HiVolt

What level of cold laser is used for edema?

High dose to inhibit

What polarity of HiVolt is used for Edema? What cells does this attract?

Negative polarity

-- attracts fibroblasts, dermal cells, keratinocytes

What on:off ratio of Russian & Biphasic is used for muscle strenghtening?

10 : 50

What are 3 modalities that can be used for acute healing?

1) Cold laser

2) HiVolt & Microcurrent

3) Ultrasound

What level of cold laser dose is used for acute healing?

Decreased (less) dose to STIMULATE healing

What polarity is used by HiVolt & Microcurrent for acute healing? What cells does this attract?

Positive Polarity

Attracts macrophages & neutrophils

What frequency of ultrasound is used for acute healing?

Pulsed (50%)

What are the 3 modalities that can be used for chronic healing?

1) Cold laser

2) HiVolt & Microcurrent

3) Thermotherapy

What dose is used by cold laser for chronic healing?

Decreased (less) dose to STIMULATE healing

What type of ultrasound is used for chronic healing?

Continuous (100%)

What polarity is used by HiVolt & Microcurrent in chronic healing? What cells does this attract?

Negative polarity

Attracts fibroblasts, dermal cells, keratinocytes