1. Application of IRR Before application (preparation for patient of IRR treatment) Equipments required :- Preparation of equipment (IRR) Application of IRR treatment:- Duration and frequency of treatment:- Follow up:-

2. Preparation of patient for IRR treatment A.Be sure of intact sensation B.Check the circulation: color of skin {pale, cyanosed}. C.Explain to patient the modality and the aim of the treatment (type of thermal treatment is to improve circulation of superficial circulation). D.Explain the sensation the patient would feel. You will feel warm sensation like sunlight).

3. Preparation of patient for IRR treatment E. Warn the patient:- Not to look to device to avoid eye problems. Not to move to avoid change in angle or distance of treatment. Not to touch the reflector and lamp to avoid burn. Not to sleep or read during treatment

4. Preparation of patient for IRR treatment F.Check for any contraindications and skin problems G.Wash of the area of the body that needs treatment and dry it and avoid any creams. H.The patient should be comfortable and fully supported pain free, relaxed.

5. Preparation of patient for IRR treatment I- Clothing is removed from the affected part, area adequately exposed. J- The patient is warned that he should experience comfortable warmth. K- Remove all metal objects from area of application.

6. Equipments required IR generator: choice of modality. Test tubes. Pillows, sheet, towels. Timer (clock).

8. Application of IRR treatment After having the patient relaxed in his position, and taking of his clothes …. And all of the above preparations apply IRR to area needs treatment and remember the following

9. Application of IRR treatment At the start of exposure, the intensity of radiation is low, but after 5-10 min it will be higher for sure. (About the luminous the lamp becomes red). Test the device on your self, to be sure of its output and calming the patient.

10. Application of IRR treatment No blankets under to avoid fire. The patient face should not be exposed to IRR, if isn't possible to avoid irradiation to the face the eyes must be shielded by e.g. moistened gauze pads.

11. Application of IRR treatment Check the patient every 5 min or less, if heat increased, increase the distance or change the angle [last choice]. If irradiation is extensive, it is desirable that sweating should occur to counteract any unduein temperature sweating is encouraged, so patient should be provided with water to drink so avoiding dehydration

12. Application of IRR treatment Watch for relax position of patient a.Patient with cervical and neck problemstoop sitting {pillows under forehead and leaning of the trunk, with covering back of the head to avoid headache}. Note: wet towel should be used to cover the head + occipit + ear to absorb heat andthe heat. Patient with facial palsy, warming up toskin electrical stimulation and apply IRR parallel (zero angle) to the face, and wet cotton on eyes to avoid absorption on eyes

13. Application of IRR treatment Watch for relax position of patient Patient with back painprone lying but instruct the patient not to move up suddenly to avoid burn, or we can use side lying so the patient will not touch the lamp after the alarm

15. Application of IRR treatment Watch for relax position of patient Patient with knee region problemhalf lying with slight flexion, pillow under knee. And may be from supine

16. Application of IRR treatment At the end of exposure, the skin appears pink (erythema or hyperemia). Following excessive irradiation the patient should not rise suddenly from the recumbent position, or go out into cold immediately

17. Duration and frequency of treatment Sub-acute cases: 15 minutes up to 20 according to the area of treatment Chronic cases: 20 minutes up to 30 min. Treatment may be give every day or on alternate days

18. Follow up Record of changes noted and unexpected changes. Record the dosage for every patient