cryotherapy introduction

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PTA 200Modalities and Procedures in Physical Therapy : 

PTA 200Modalities and Procedures in Physical Therapy Superficial Heat and Cold

Superficial Heat and Cold : 

Superficial Heat and Cold Primarily increase or decrease temperature of skin, superficial subcutaneous tissues

Therapeutic Application : 

Therapeutic Application Heating Agents Transfer heat to patient’s body, between various tissue/fluids Cooling Agents Transfer heat away from patient’s body

Therapeutic Application : 

Therapeutic Application Conduction Convection Conversion Radiation Evaporation

Therapeutic Uses of Cold : 

Therapeutic Uses of Cold Control inflammation Decrease pain Decrease edema Decrease spasticity Facilitate movement

Therapeutic Effects of Cold : 

Therapeutic Effects of Cold

Hemodynamic Effects : 

Hemodynamic Effects

Hemodynamic Effects : 

Hemodynamic Effects Immediate vasoconstriction Less than 15 minutes Stimulates smooth muscles of vessels to contract Decreases release of histamine, prostaglandins (vasodilators) Increases blood viscosity (increases resistance to flow) Decreases blood flow to maintain core temperature

Hemodynamic Effects : 

Hemodynamic Effects After 15 minutes, vasodilation occurs Mostly distal extremities Temperatures < 10 C (350 F) >15 minutes Cold induced vasodilation (COVD) Amount of vasodilation usually small Skin redness NOT due to vasodilation Due to increase in oxyhemoglobin concentration of blood Cold decreases oxyhemoglobin dissociation Makes less oxygen available to tissues Hunting Response Response to pain associated with extreme cold

Neuromuscular Effects : 

Neuromuscular Effects

Decreased Nerve Conduction Velocity : 

Decreased Nerve Conduction Velocity Proportional to degree and duration of temperature change Application of cold > 5 minutes Reverses (normal) within 15 minutes After 20 minutes, may take 30 minutes or more to recover.

Decreased Nerve Conduction Velocity : 

Decreased Nerve Conduction Velocity Decreased NCV of sensory and motor nerves occurs Greatest effect in myelinated, small fibers pain transmitters Least effect in unmyelinated, large fibers

Increased Pain Threshold : 

Increased Pain Threshold Counter-irritation via Gate Theory Secondary to decrease in muscle spasm Secondary to decrease in sensory NCV Secondary to post-injury edema reduction (decreased blood flow) Reduces pressure on nerves due to edema

Decreases Spasticity : 

Decreases Spasticity Decrease in gamma motor neuron activity (stretch reflex) After 10-30 minutes, decrease in afferent spindle, GTO activity. Caused by decrease in muscle temperature Can last for 1- 1.5 hours So… Application of cold up to 30 minutes in patient with increased tone, will decrease tone for up to 1-1.5 hours

Facilitation of Muscle Contraction : 

Facilitation of Muscle Contraction Brief application (few seconds) facilitates alpha motor neuron activity Produces muscle contraction in flaccid muscle. CVA, SCI Prolonged cold (few minutes) decreases force of contraction

Metabolic Effects : 

Metabolic Effects

Decreases Metabolic Rate : 

Decreases Metabolic Rate For inflammation For healing not recommended for patient with delayed healing Cartilage-degrading enzymes decreased OA, RA

Inflammation Control : 

Inflammation Control Decreases chemical reactions secondary to acute inflammatory response Decreased blood flow secondary to vasoconstriction, increased viscosity Causes secondary decrease in bleeding, edema (normally) Increased function during this stage of healing

Inflammation Control : 

Inflammation Control If temperature of tissue remains elevated… Cryotherapy remains indicated (48-72 hrs) After activity there is secondary acute inflammatory response may need to continue cold for some time

Inflammation Control : 

Inflammation Control Prophylactically after exercise to decrease DOMS Delayed Onset Muscle Soreness Due to muscle connective tissue damage secondary to exercise

Inflammation Control : 

Inflammation Control Duration of treatment typically 15 minutes , except spasticity control In general, applications 1 hour apart Tissue temperature can return to normal

Edema Control : 

Edema Control Decreases intravascular fluid pressure via decreasing blood flow, increased viscosity Most effective if applied immediately, in conjunction with elevation and compression

R-I-C-E : 

R-I-C-E R: Rest I: Ice C: Compression E: Elevation

Edema Control : 

Edema Control Cryotherapy ineffective with edema secondary to immobility and poor circulation.

Pain Control : 

Pain Control 10-15 minute application can control pain for 1 or more hours. Facilitation Rarely used. (Rood)

Cryokinetics : 

Cryokinetics Purpose: To apply cooling agent to point of numbness shortly after injury, to decrease sensation of pain, allow patient to exercise toward regaining ROM ASAP. (Athletics) Cold for 20 minutes (numbness) Exercise for 3-5 minutes Re-cooling Repeat about 5 times

Cryostretch : 

Cryostretch Cooling prior to stretching Decreases spasm, secondary increase in ROM Spray n’ Stretch, Fluoro-methane Spray If patient condition not improving or worsening within 2-3 treatments, Approach should be re-evaluated and changed, or Refer to MD

Contraindications : 

Contraindications

Contraindications for Cold : 

Contraindications for Cold Cold hypersensitivity or intolerance Cryoglobulinemia Uncommon disorder Aggregation of serum proteins in distal circulation when distal extremities cooled Proteins form a “gel” that can impair circulation, Causes local ischemia, gangrene Paroxysmal Cold Hemoglobinuria Release of hemoglobin into urine from lysed red blood cells, In response to local or general exposure to cold

Contraindications for Cold : 

Contraindications for Cold Raynaud’s Disease Paroxysmal digital cyanosis Sudden pallor followed by redness of skin of digits, Precipitated by cold or emotional upset Relieved by warmth Bilateral and symmetric (women) Raynaud’s Phenomenon Generally only in one extremity May be associated with thoracic outlet, carpal tunnel syndrome or trauma

Contraindications for Cold : 

Contraindications for Cold Regenerating Nerves Local vasoconstriction or decreased nerve conduction may delay regeneration Circulatory compromise or peripheral vascular disease Chronic peripheral vascular disease may have edema Cold may increase this edema Indicators for swelling due to Peripheral vascular disease Pallor and coolness

Precautions : 

Precautions

Precautions : 

Precautions Over superficial main branch of a nerve Over an open wound delays healing Hypertension can cause transient increases in systolic or diastolic BP Patients with poor sensation or mentation Very young or very old impaired temperature regulation, ability to communicate

Adverse Effects : 

Adverse Effects

Adverse Effects : 

Adverse Effects Tissue Death Frost Bite Nerve damage Unwanted vasodilation due to prolonged vasoconstriction, ischemia, thromboses in smaller vessels. Freezing of tissues damage at 39 degrees F To avoid, duration limited to under 45 minutes and tissue temperature above 39 degrees F When goal is vasoconstriction, treatment limited to 10-15 minutes

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