Bath: Benefits and Effects
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Why would you use a Contrast Bath?
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-Impaired venous circulation -Edema -Sinus/Congestive headaches -Transition between acute and subacute inflammatory conditions
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What are the effects of a Paraffin Bath?
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-Increased ROM -Retains perspiration -Softens and moistens skin
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What are the effects of MHP?
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-Decreased sensory nerve sedation -Pain reduction -Increased tissue extensibility -Increased vasodilation and blood flow -Increased perspiration = increased conductivity for estim -Increased local metabolism
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What are the contraindications for cryotherapy?
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-Systemic Lupus -Raynaud's Syndrom -Regeneration of peripheral nerves -Moderate/Total loss of sensation -Open wounds (24-72hr)
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What are the contraindication for hydrotherapy?
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-All general heat contraindications -Venous ulcers -HTN -Respiratory instability -Phobic of water -Pt's unable to transfer or sit safely *Note: be cautious of pt's with seizure disorder
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Thermal Agents: Temp and Duration
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*MHP:* 170 degrees; 15-30 minutes *Paraffin:* 125-127 degrees; 20 minutes *Fluidotherapy:* 110-125 degrees; 20-30 minutes
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Why would you use a MHP?
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-Subacute or Chronic conditions
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What are the contraindications to using a MHP?
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-infection -fever -cancer -active bleeding -PVD -Acute inflammatory conditions -Devitalized tissue -Old/Young pt with thermoregulation issues -Cardiac insufficiency
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Why would you use cryotherapy?
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-acute inflammatory conditions -edema -pain -muscle spasms
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Cryotherapy Agents: Temps and Durations
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*Cold Pack:* 12 degrees; 10-30 minutes *Iced Towels:* 10 minutes (changed every 45s) *Ice Massage:* 10-15 minutes *Cold Immersion:* -cool= 67-80 degrees -cold= 55-67 degrees -very cold= 32-55 degrees -duration= 10-20 minutes *Vapocoolant:* 5 minutes *Contrast Bath:* -warm water= 100-110 degrees -cold water= 55-65 degrees -duration= 20-30 minutes
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What is the purpose and the effects of Thermal Agents?
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Purpose: to increase temperature of target tissue to a temperature to produce local therapeutic effects Effects: -Increased cell permeability/capillary pressure -Increased metabolism -Increased perspiration -Sedation of sensory nerves -Increased tissue extensibility
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What are the effects of cryotherapy?
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-Decreased pain -Vasoconstriction -Decreased local metabolism -Decreased acute edema -Decreased nerve conduction -Decreased strength production -Decreased spasticity
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General guidelines for hydrotherapy temps and durations.
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-Duration: 20 minutes -For rinsing, soaking, irrigating wounds: 1-5 min -For debridement: 10-20 min -Full Body Immersion: never greater than 102 degrees -Chronic pain: 99-110 degrees -Open wounds, Circulatory, Cardiac: 92-99 degrees -Aquatic PT: 80-92 degrees -DOMS: 55-65 degrees
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Why would you use a Paraffin Bath?
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-Subacute or chronic inflammatory conditions -Useful before massage
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What are contraindications for Paraffin bath?
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-All general heat contraindications -Active acute inflammatory phase -Open wounds -Skin infections
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Why would you use an ice massage?
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-Muscle guarding -Trigger points -Acute injury -Decrease pain and edema -Hemorrhage
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What are contraindications to contrast baths?
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-All general heat and cold contraindications *Note: be cautious of pts with fragile skin or loss of sensation
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What are the effects of hydrotherapy?
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-Increased metabolism -Increased vasodilation, blood flow -Increased ROM -Muscle relaxation -Sensory nerve sedation -Hydrostatic pressure increases lymphatic production
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Why would you use a vapocoolant spray?
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-Muscle spasms -Trigger points -Myofascial conditons
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What are the contraindications for Fluidotherapy?
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-All general heat contraindications -Cancerous lesions -Open wounds *Note: be cautious of pt's with allergies to dust/pollen
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Why would you use fluidotherapy?
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-Desensitization of hypersensitive tissue -Decreased pain -Do therapy during treatment -Increased ROM
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What are the general precautions and contraindications to thermal agents?
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Precautions: -Edema -Loss of sensation -Confusion -Mottling -Dilated arterioles Contraindications: -Fever -Cancer -Active bleeding -PVD -Acute inflammatory conditions -Young/Old -Devitalized tissue -Cardiac insufficiency
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Why would you use hydrotherapy?
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-Subacute and chronic inflammatory conditions -Early PVD -Peripheral nerve injuries (m. weakness)
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What are the effects of Infrared?
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Long waves: *1-2mm depth, penetrates the epidermis Short waves: *up to 10mm depth, penetrates epidermis and dermis
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What is the method of transference of infrared?
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Radiant heat -increases the heat of objects without affecting the medium (object absorbs the waves)
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What are the contraindications to infrared?
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-All heat contraindications -Sunburns -Over scar tissue
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What are the effects of shortwave diathermy?
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-same as general heat modalities -Increased CT extensibility -Increased metabolism -Increased vasodilation = blood flow -Increased perspiration -Muscle relaxation = Decreased muscle spasm -Decreased sensory nerve conduction = Decreased pain
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Short Wave Diathermy: Induction Field
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-Pt is not part of electromagnetic circuit -Heats muscle and good conductors of heat Two Types: 1. Hinged Drum *more common, pre-coiled cable housed in a drum = strong the current 2. Cable *PT manually coils cable around pt's tissue, must be evenly spaced out, amount of cable must be equal, time consuming -Delivered pulsed/continuous: pulsed allows for increased treatment intensities and longer durations
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Short Wave Diathermy: Capacitance Field
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-Pt is part of the circuit -Not commonly seen -Body part is placed between 2 pads -Heat is produced by vibration/distortion of molecules -Heats adipose and bone which are poor conductors of heat -Uses air spaced plates: must be evenly spaced from pt tissue, have even contact, same distance from tissue, hot spots can occur if not aligned properly
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What is reflection?
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Throwing back of a ray of radiant energy from a surface -ability to "bounce off" different surfaces -degree of reflection is reduced as treatment angle approaches 90* -the incident source needs to be at 90* for penetration to occur in a predictable area
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What is absorption?
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Ability to take in light or radiant energy -inversely related to penetration -if an energy source is absorbed by whatever its passing through, then it will not penetrate deeply
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What is the treatment method for both Hot/Cold UV lamp?
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-Establish the MED -Once MED is est. the source must be kept at same distance as when MED was est. so dose is consistent -When treating tissue, different erythemic dosages have certain effects: *SED: suberythemal dose; no erythemia, vit D produced, appropriate for full body treatment *E1: 2.5xMED, erythemia 1-3 days, clear reddening, some scaling *E2: 5xMED, intense erythemia with edema, peeling, pigmentation *E3: 10x MED, erythemia with severe blistering, peeling, and exudation
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Why would you used infrared?
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-Seeping wounds -Area is always visible -Less chance of infection -No weight of equipment or compression
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What are the disadvantages of infrared?
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-Glare can irritate eyes -Pt can't move -Difficult to position, area must be exposed -Need to keep site dry -Difficult to treat a small area due to spreading of waves
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What is the method for infrared?
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-Position lamps so a majority of waves are perpendicular to treatment area -Instruct pt not to touch lamp -Protect pt's eyes
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What method is UV transferred by?
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Radiation -radiant energy from a warmer source to a cooler source -all UV rays are produced from sun
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What are 3 types of generators of UV?
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-Hot UV Lamp (Hot Quartz) -Cold UV Lamp (Cold Quartz) -Dermatologist Office type
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What is the method for Hot Quartz UV?
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-Most commonly used -Made of quartz tube that transmits UV waves -Air cooled, high pressure mercury vapor lamp -Can produce all 3 UV bands -Should not be closer than 15 in from target tissue -Requires 5 min warm up time for machine prior to treatment
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What is Cold Quartz UV?
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-Similar to hot quartz lamp but lower temp -UVC band only produced *effective in killing bacteria in wounds -Portable, can be used at short distances -Source should be at least 1 in from target tissue -Machine requires 1-3 min warm up prior to treatment
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What is MED
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Minimal Erythemal Dose -smallest dose that produces erythemia that appears in 1-6 hours and disappears within 24 hours
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What is the method for Hot Quartz UV lamp?
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-Position 30 in away from highest point of pt's exposed body -First the therapist must determine MED
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What is the method for Cold Quartz UV lamp?
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-Position 1 inch away from pt's skin -MED is typically not needed to be established first -Generally, MED = 12-15s
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What is referred pain?
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Pain arising from deep body structures but felt at a distant site -must treat the source of the pain -important to explain this rationale to the pt
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What is the inverse square law?
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The intensity of the waves from a source varies inversely with the square distance from the source -further the source from the tissue = weaker energy (due to more scattering)
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What are the physical properties of light?
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-Reflection -Refraction -Absorption
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What are the disadvantages of shortwave diathermy?
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-Scatters radiant energy 2ft from source -Clinicians need to maintain a 3ft distance to avoid overexposure to radiation -Not common in clinic -Treatment site not visible -More contraindications to shortwave diathermy
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What is the method for shortwave diathermy?
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Treatment time = 20-30 minutes *sub acute: 15-20 minutes Frequency = 1-2x/day (subacute), less often for more chronic conditions -Remove all jewelry from area -Pt will feel warmth -Pt should not move during treatment
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What are contraindications for shortwave diathermy?
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-Hemorrhage -Metal in treatment site (on pt or PTA) -Cardiac disease/pacemaker -Pregnancy (pt or PTA) -Epiphysis of a growing bone -Adipose -Application over the skull -All general heat contraindications
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What are the advantages of shortwave diathermy?
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-Penetrates deeper than other thermal agents -Retain heat for longer periods than US so it prolongs time available for stretching
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Why would you use shortwave diathermy?
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-Subacute/Chronic inflammatory conditions -Promotes healing of deeper open wounds (due to increased fibroblast activity)
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What is refraction?
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Bending of energy that is related to energy source -"incident angle" -when angle is less than 90*, part of the energy may be bent or refracted so that the energy enters the tissue in an unpredictable manner
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How do you determine the MED?
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For Hot Quartz: -cut 6 shapes into a 6x10in paper -each shape is exposed to a set amount of UV light by gradually uncovering more of the shapes in a prescribed time frame -source is positioned 30 in away from tissue 1. 30s/120s 2. 30s/90s 3. 15s/60s 4. 15s/30s 5. 15s/15s -check skin every 2hrs -record appearance/fade times -do not repeat until effects of first treatment have disappeared
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What are the precautions for UV?
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-meds that increase photosensitivity -food allergies -disease states -increased estrogen levels
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What are the contraindications for UV?
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-TB -Hyperthyroidism -DM -Acute eczema/dermatitis -Fever -Cancer -Sunburn
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What are the advantages of UV?
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-Mostly for wound healing -Acne -Pressure sores -Slow healing sores -Psoriasis
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Describe the nonluminous (carborumdum core) infrared lamp.
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-Can't see light -Long waves = 1-2 mm depth of penetration -Metal core covered with a mesh screen -Red glow produced -Warm up time = 5-10 min -36 in away from body
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What is shortwave diathermy?
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"Heat through" -Uses electromagnetic energy to produce heat within body's tissue -Shortwave Diathermy = uses magnetic energy -Transferred: conversion (electromagnetic- mechanical) -Depth: 3-5cm -Affects a large surface area -Heat is retained 3x longer than US -Delivered continuously or pulsed -2 Types: Induction Field and Capacitance Field
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Describe the luminous (tungsten filament) infrared lamp.
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-can see light -short waves = 10mm -bulb is mounted in a metal reflector (like a light bulb) -no warm up time is necessary -less intense -30 in away from body
