Heat-internal vibration of Heat-internal vibration of molecules within the bodymolecules within the body

• Conduction-heat lost or gained by direct contact

• Convection-movement through air or H2O tranfers heat to our body

• Radiation-transfer of heat from warmer source to cooler one

• Evaporation-transfer from liquid to gas state• Superficial heat-HP,W/P paraffin• Deep heat-diathermy, ultra sound

• Thermotherapy-heat modalities, used when goal is to increase temperature

• Cryotherapy-cold modalities• Hydrotherapy-H2O is used as medium to increase or

decrease tissue temp.• Heat:

– produces analgesic affect– promotes ms. Relaxation– increases elasticity– decreases viscocity of C.T.– Increases local metabolism of A’s and caps– inc. blood flow to body part treated, inc. edema– inc. Leukocytes and phagocytosis

• Examples of superficial heat<1cm.• Hot packs

– moist heat-stored in hydrocollator units -165 F– 6-8 layers for insulation– towel for perspiration– consider body part treated, position of pt., weight of HP– Cervical, lumbar, small and large– describe to pt. what to expect

• Paraffin– 1 cm. Mineral oil and wax (5# wax/1 part oil) temp. 125

F,retains perspiration and softens skin

• Good for distal parts of extremities• Methods

– Glove-dip 8-10 times, bag, towel, elevate, treatment time 20 min. return wax to unit

– Immersion-dip once to coat, then immerse remainder of time, temp. Increase is greater than glove-edema may result

– Advantages• Conforms to body part treated

– Disadvantages • can’t use with open wound

– Fluidotherapy• dry, warm air is circulated • can use with splints,other things to enhance tx.

• Contraindications for heat– acute inflammation,fever, malignancies,

acute hemorrhage, PVD, overradiated pt, cardiac insufficiency, unexplained pain, acute infection coma, int bleed; precautions-impaired circulation, pregnancy, older adults and children<4 yo

– Precautions: previous existing edema, sensory loss, confused patients

• Cryotherapy-use of cold-goal it to decrease tiss temp, it dec metabolism, causes vasocon, dec bl flow, nerve ms excitability, ms spindle activity, edema and promotes analgesia

• Ice-silica gel in frig, cold W/P, ice w/p, massage, cold spray, contrast baths, normal cold progression-cold, stinging, burning, numbness

Indications-spasticity, acute inf, ms spasm, edema

ContraindicationsContraindications• Raynaud’s disease, cardiac

dysfunction open wounds after 48-72 hours, arterial insufficiency, cold urticaria

Contrast BathsContrast Baths

-two containers with warm/cool water-warm 80-104 degrees F-cool 55-67-Immerse in warm 3-4 min, then cool 1 min.-Repeat 5-6 times-Always finish with warm-used for chronic edema, infl. conditions,

hypersensitization

• Hydrotherapy-Archimedes principle-an immersed object exerts an upward thrust = wt. Of H2O displaced (buoyancy)

• viscocity-resistance to flow• W/P source of moist heat• hydrostatic pressure-exerted agst skin• Pascal’s law- fluid exerts = pressure on all

surfaces of a body at rest which increases in proportion to depth

WhirlpoolWhirlpool

• Conduction and convection• Get inc rate of lymph flow, local met inc.,

perspiration inc, debridement, vasodiation, ms relax, inc cell perm and assist or resis with ROM

• Increases hydrostatic pressure which may increase lymph circulation

• Graded exercise (with or against turbulence• Debrides necrotic tissue therefore

decreasing bacterial load

IndicationsIndicationsStage III and IV woundsSubacute and chronic inflammatory

conditionsEarly PVDPeripheral nerve injuriedMuscle weakness

ContraindicationsContraindications• Same as those for heat• Venous ulcers

TemperaturesTemperatures• Very hot-104-110

• Hot-99-104• Mild Warm-96-98• Neutral-92-96

• Tepid-79-92• Cold-32-79

• Soft tissue extens, chronic

• Pain• Burn patients• Open wounds, circ,

sensory, cardiac disorder, decrease tone

• Exercise, acute inflam (if not able to tol cold)

• Acute inflammation

Aquatic therapyAquatic therapy• Same principles apply• Water temp-79-97 degrees F

– 93-97 for light exercise by elderly deconditoned– 79-83 for more intense exercise and recreational

pools– Should not go below 65 F (may impair ms. contract)

• % of WB with depth immersion:– C7-8%– Xiphoid-28%– ASIS-47%

AdvantagesAdvantages• Ease of movement, weightlessness• Progressive WB• Can facilitate, support or resist mvmt• Ease of pt handling• Total body mvmt• Easy to progress program• Can perform many types of exercise

Laws for dosage of EM Laws for dosage of EM radiationradiation

• Cosine law-absorption of ray is optimal when it strikes the surface at the perpendicular

• Inverse square law-Intensity of radiation at any distance is inversely proportional to the square of the distance b/w the sure face and the source of radiation

• Arndt-Schultz law-a certain minimum stimulus is needed to initiate a biological process

DiathermyDiathermy• To heat through (3-5 cm.)• Converts hi fx electromag E to heat in

tissues• Frequency 27.12 MHz • Contraindications

– General for heat– Pacemakers– Metal implants– Epiphyses– Eyes, testes, malignancy, pregnancy

DisadvantagesDisadvantages• Pool cost/ maintenance and upkeep• Time in commuting/changing• Limited carryover • Additional risk

PrecautionsPrecautions• Bowel/bladder incontinence• Open wounds• Infectious disease• Seizures• Tracheotomy tubes• Severe cardiovascular disease• Orthopedic instability

– Induction field-places pt in the EM field produced by the equipment ; current is induced in conductive tissues-heats superficial ms., heat is produced in deeper ms. from overlying ms. (drums or induction coil)

– Condensor field (capacitance)- pt. is placed b/w 2 e’s in the electrical circuit (air spaced plates)

Radiant HeatRadiant Heat• Infrared and ultraviolet• Infrared-form of radiant heat which emits

infrared waves (outside visible spectrum)• 2 types-• Luminous-emits short infrared waves• Non-luminous-emits long infrared waves• Indications-seeping wounds,chronic

conditions• Contra-same for heat

UltravioletUltraviolet• Causes a chemical change in tissues

• Both UV and infrared possess these characteristics

• Direction of travel is in straight line that can be reflected, refracted, absorbed or passed through depending on the medium they strike

• Light is characterized by:

• Wavelength-measured in nanometers• Visible-b/w 400-800 nm• UV light-180-400• Infrared-800-1500

• Frequency-# of oscillations or vibrations in 1 second-expressed in hertz

• The higher the frequency, the shorter the wavelength

• UVA-320-400 nm.-penetrates furthest (into dermis)

• UVB-290-320-psoriasis

• UVC-<290, cold quartz-operates at low temps. Used to promote bacteriocidal effects, wound debridement, tissue regeneration

• UV is used to promote erythemal response w/in 12 hours of exposure-causes chemical reaction that impacts on the immune system

• Indications• -pressure sores, acne, wound care,

psoriasis, to decrease bacteria in pressure sores (especially after pulsed lavage)

• Contraindications• -photosensitivity, cancer, systemic lupus

errythmatosis, cardiac, kidney or liver disease active TB, fever, acute diabetes, drugs, direct eye contact

PrecautionsPrecautions• Photosensitivity as a result of drugs• Drugs such as gold salts, psoralens,

tetracyclines• Syphilis• Alcohol• Elevated levels of estrogen• Foods such as shellfish, strawberries

• Must establish MED-exposure time necessary to produce mild erythemal dose-lasts to 48 hours

• SED-no erythema

• MED-smallest dose producing erythema

• Appears 1-6 hrs, fades in 24

TechniqueTechnique• Goggles• Place body part perpedicular• Protect skin not treated• Use same lamp• Cover genitals, nipples• Place lamp 24-36 inches away• Use test strip to test-uncover each hole so

1st hole will have greatest exposure

ProcedureProcedure• Cut six holes with different shapes• Use skin not exposed to uv light• Remove clothing, jewelry, wash area• Attach MED strip and cover with

towel• Position lamp perpend to treated

surface• 30 sec hole 1,2. 15 sec. 3-6

• Instruct pt. to check arm in bright area every 2 hrs. and document which symbols appear and fade

• Dosage time should be increased by 25% next treatment as long as effects of previous dose have disappeared

LasersLasers• EM E within visible spectrum • Low level laser therapy• Used for tissue healing and pain

management• Contraindicated for pregnant women,

unclosed fontanelles of children, cancerous lesions, cornea, endocrine glands and hemorrhaging lesions