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precautions for heat
- acute injury or inflammation
- impaired circulation
- poor thermal regulation
- cardiac insufficiency
- metal in the area
- over an open wound
- over topical counterirritants
- demyelinated nerves
contraindications for heat
- recent potential hemorrage
- impared sensation
- impared mentation
- infrared irradiation of the eyes
what are the temps for heat?
- mhp: 158-167
- paraffin: 113-126
- fluidotherapy: 111-125
contraindications for ultrasound
- CNS tissue
- jt. cement
- plastic componets
- reproductive organs
precautions for ultrasound
- acute inflammation
- epiphyseal plates
- breast implants
what are some uses for heat?
- pain control
- increased rom
- decreased joint stiffness
- accelerated healing
what is conduction?
heat transferred by direct and stationary contact. Heat is conducted from material with higher temperature to a material with a lower temp.
what is convection?
heat transfer that occurs as result of direct contact between a circulating medium and another material of a different temperature. The thermal agent is in motion so new parts of the agent come in contact with body part; whirlpool, fluidotherapy.
what is conversion?
transfer of heat when nonthermal energy is absorbed into tissue and transformed into heat. Mechanical, electrical, or chemical; diathermy, ultrasound
what is radiation?
direct transfer of heat from radiation source of higher temerture ot one with lower temperature without need for medium or contact; infrared lamp
what are some of the effects of heat?
- hemodynamic- vasodilation
- neuromusclular- change in nerve conduction velocity rate
- metabolic-increased metabolic rate and oxygen uptake
- altered tissue extensibilty- increased collagen extensibility
when would you know to use heat?
- subacute or chronic inflammation
- subacute or chronic pain
- subacute or chronic muscle spasm
- decreased ROM
- hematoma resoltion
- reduction of joint contractures
What are C-fibers?
small, unmyelinated fibers that transmit slow (1.0-4.0m/sec). They transmit sensations described as dull.
what areas of the body would you treat with a 3 MHz?
What intensity would that be?
thin, superfical areas that are less than 2cm deep.
what are areas of the body you would treat with a 1 MHz?
What intensity would that be?
thicker areas, 2cm+
how are the affects of thermal and non-thermal ultrasound different?
Thermal is prior to stretching and to reduce pain and it is done in a contineous cycle. Non-thermal is more to promote healing by sending pulsed sound waves into the deep tissue.
physical agents can include:
- electromagnetic radiation
- electrical currents
what are the general precautions and contraindications?
- pacemaker or other implanted electrical device
- impaired sensation or mentation
what is the main role of agents used in rehab?
that they are used in conjunction or in preparation of ther ex functional training and manual mobilizations.
How does heat affect pain?
- modify pain transmission or perception or by changing underlying process causing pain.
- acute: control pain and inflammation
- chronic: promotion of function and improvement of coping skills
what are the three stages of healing?
- acute inflammation: 1-6 days
- proliferative: day 3- 20- wound contracture
- maturation: day 9- 12-18mths (depends on tissue)
what is a keloid scar?
an abnormal scar where collagen production exceeds lysis and extends beyond boundaries and damages healthy tissue.
what are some factors that can affect healing?
- vascular supply
- external forces
what are the 2 most common reasons to use cold therapy?
to control pain and inflammation
what is the hemodynamic effect of cold?
hunting response; cyclic vasoconstriction and vasodilation
what are the neuromuscular effects of cold?
decreases nerve conduction velocity and increases pain threshold.
what are some of the uses for cryotherapy?
- inflammation control
- edema control
- pain control
- modulation of spasticity
- symptom management of MS
- facilitation-not commonly used though
what are some of the different types of cryotherapy?
- cold packs
- ice packs
- ice massage
- brief icing
- cold whirlpool
what are the contrandications for cold?
- cold hypersensitivity
- cold intelorance
- over regenrating peripheral nerves
- circulatory compromise or PVD
what are the precautions for cold?
- over superficial main branch of nerve
- over open wound
- poor sensation/mentation
- very young/old
what are the different sensations they will feel while you apply the cold therapy?
- intense cold for first 3 minutes
- aching/buring sensation for 4-7 minutes
- anesthesia for 8-15 minutes
- numbness form 15-30 minutes
you have a patient that you have to monitor for ulcers. what are some questions you would ask them?
- ares with lack of sensation
- areas of pain
- location of current or previous ulcer
- fragile skin, easy bruising
- medications or conditions putting them at higher risk for skin breakdown.
what are the 4 stages of acute inflammation?
what is the rule of nines chart?
anatomical and graphical tool that divides the TBSA into segements that are multiples of 9% or 18% Both arms would have to be burned for it to be considered 9%. if only one arm was burned it would be 4.5%.
what are the three different degrees of burns?
- 1st degree- superficial
- 2nd degree- partial thickness
- 3rd degree- full thickness
what is wound exudate?
draining; fluid passes throught the wals of vessels into adjacent tisses or spaces to help deposit fibrin and leukocytes.
what are the different types of exudate?
- serous- normal in healthy wounds
- sanguineous-may indicate new vessel growth or damage to vessel.
- serosangineous-can be normal
- seropurulent- warns of impending infection
- purulent- may smell and indicate infection
what is the red-yellow-black system?
- red- protect the wound, maintain moist environment.
- yellow- debride necrotic tissue, absorb drainage
- black- debride necrotic tissue
what are the different ways of debridement?
- sharp- with scaple, scissors, and tweezers
- enzymatic-sprinkle packet of enzymes
- autolytic- cover it and the wound will eat its self
- wet-to-dry- apply new wet bandage everyday and allow to dry overnight.
- irrigation- "flushing"
- hydrotherapy- whirlpool