1. Thermal Agents Chapter 6

2. Heat Energy can be transferred to, from, or within the body through different modes of heat transfer.

3. MODES OF HEAT TRANSFER

4. Conduction energy is exchange by direct contact between molecules of two materials at different temperatures

5. PAs transfer thru Conduction Hot pack Cold Pack Paraffin

6. Guidelines for Heat Transfer By Conduction 1.The greater the temp difference between the PA and the body part it is applied to, the faster the rate of heat transfer. 2.Materials with high thermal conductivity transfer heat faster than those with low thermal conductivity.

7. Guidelines for Heat Transfer By Conduction 3.The area of contact 4.The Temperature Rate.

8. Convection Heat Transfer Result of direct contact between circulating medium and another material of different temperature. Examples: whirlpool, fluidotherapy

9. Conversion Heat Transfer A non-thermal form of energy is converted to heat. No Direct contact i.e. US – mechanical energy Diathermy – electromagnetic energy

11. Radiation Heat Transfer Example – infrared lamp

12. Heat Transfer Thru Evaporation A material must absorb energy to evaporate. i.e vapocoolant spray, sweat

13. Physiological Affects of Thermal Agents

14. Heat vs Cold Blood flow – vasodilation Neuromuscular - ↑nerve conduction, ↓pain, strength changes Metabolic - ↑ metabolism ↑tissue extensibility Blood flow – vasconstriction Neuromuscular - ↓ nerve conduction, ↓pain, strength changes, ↓spasticity Metabolic - ↓metabolism ↓ tissue extensibility

15. Use of Cold Controls Pain Inflammation Edema Modification of spasticity

16. Cryokinetics Technique that combines the use of cold and exercise in the treatment of pathology or disease.

17. Cryostretch Application of a cooling agent before stretching.

18. Contraindications For Cryotherapy (p. 140) Cold hypersensitivity Cold intolerance Cryoglobulinemia Paroxysmal cold hemoglobinuria Raynaud’s disease or phenomenon Over regenerating peripheral nerves Over an area with circulatory compromise or peripheral vascular disease

19. Precautions For Cryotherapy (p. 141) Over a superficial main branch of a nerve Over an open wound Hypertension Poor sensation Poor mentation Very young or old

20. Application Techniques Page 143, 144, 145, 149

21. Use of Heat Pain control Increase tissue extensibility Increase healing Examples: HP, Paraffin, and Fluidotherapy

22. Contraindications for Use of Thermotherapy (page 157) Recent or potential hemorrhage Thrombophlebitis Impaired Sensation Impaired Mentation Malignant Tumor IR irradiation of the eyes

23. Precautions for Use of Thermotherapy (page 158) Acute injury or inflammation Pregnancy Impaired circulation Poor thermal regulation Edema Cardiac insufficiency Metal in area Over an open wound Demyelinated nerves

24. Adverse Effects of Thermotherapy (page 160) Burns Fainting Bleeding Skin and eye damage from infrared irradiation

25. Superficial Thermotherapy

26. Hot Packs Commercial HP are made of a hydrophilic silicate gel covered in canvas. Come in various shapes and sizes

27. HP are stored in hot water. They are stored in a thermostatically controlled water cabinet called a hydrocollator.

28. Application Technique - HP Page 162

29. Paraffin

30. Warm, melted wax mixed with mineral oil is used as a superficial thermal agent. 6:1 Ratio Paraffin is heated to 126- 134 degrees.

31. Application of Paraffin (page 164) Two Techniques: Dip-Wrap Method Dip-Immersion Method

32. Fluidotherapy

33. Fluidotherapy is a dry agent that transfers heat by convection. Finely ground corn cob particles are housed in a cabinet. Heated air circulated thru the particles acting to superficially heat the immersed body part.

34. Infrared Lamps

35. What is infrared? IR is the portion of the electromagnetic spectrum that is just beyond red visible light. Heat and electromagnetic rays in IR ranges are emitted due to vibration of electrons. IR is a source of superficial heat that will absorb about 3 mm. Currently being utilized as “Anodyne” to treat diabetic peripheral neuropathy.

37. Application Techniques for IR Page 167

38. Documentation

39. Documentation of Cryotherapy (page 149) The following should be documented: –Area of body being treated –Type of cooling agent used –Treatment duration –Patient positioning –Response to intervention Review Examples – page 149

40. Documentation of Thermotherapy (page 168) The following should be documented: –Area of body being treated –Type of heating agent used –Treatment parameters: Temp or power of agent # and type of insulation layers used Distance of agent from patient Patient’s position or activity –Treatment duration –Patient positioning –Response to intervention