PT-122-Topic-3-Superficial-Heating-Modality.pdf

Superficial Heating Modalities Mary Audrey D. Viloria, MSRS, PTRP Instructor III [email protected]  Topic Outline Chapter III. Superficial Heating Modalities 1. Principles 2. Indications 3. Precautions 4. Contraindications 5. Techniqu...

Superficial Heating Modalities Mary Audrey D. Viloria, MSRS, PTRP Instructor III [email protected]  Topic Outline Chapter III. Superficial Heating Modalities 1. Principles 2. Indications 3. Precautions 4. Contraindications 5. Techniques of application  Objectives At the end of the lesson, the student shall be able to: Understood and analyzed the principles behind superficial heating agents, specifically hot moist pack and paraffin wax bath. Identified the different indications, contraindications, precautions and dangers on the use of HMP and PWB. Searched for, critically appraised, and applied research evidence regarding the use of HMP and PWB. Demonstrated beginning competence in planning and implementing appropriate superficial heating modalities in an individual patient case. Applied clinical reasoning skills and professional attitudes to appropriately respond to the human health experience. Rationale for the Use of Heating Agents Pain relief Reduction of muscle spasm Increases blood flow Facilitate tissue healing Prepare stiff joints and tight muscles for exercise Provides tranquility and relaxation Superficial Heating Modality Causes an increase in skin and superficial subcutaneous tissue temperature Superficial Heating Agents They are used to: 1. heat superficial joints that has little soft tissue covering 2. cause a heating effect in deeper structures (ex. muscle – through reflex mechanism) 3. heat collagen tissue in order to increase its extensibility Biophysical Effects of Temperature Elevation Physiologic changes occurs based on: 1. Extent of the temperature rise 2. The rate at which energy is being added to the tissue 3. The volume of tissue exposed Therapeutic level of vigorous heating is set between 40°C and 45 °C (104 °F to 113 °F) At these limits, hyperemia occurs The Rate of Temperature Rise This can influence physiologic responses Increases local blood flow – causes removal of heat produced If temperature rise is slow – effective heating levels may not be obtained Increased rate Tissue of tissue Damage temperature The Rate of Temperature Rise Physiologic alteration can occur at the site of local temperature rise and in areas remote from the area of heat absorption. > tissue volume affected by addition of thermal energy, > changes in other areas and for systemic alterations. Metabolic Reactions For every 10 °C (50 °F) increase in tissue SIMPLY Energy expenditure increases temperature there is two with increasing temperature to threefold rise in the chemical activity in cells and metabolic rate. (+) Effect of increased chemical reaction rate: INCREASE IN OXYGEN UPTAKE Vascular Effects Increased tissue temperature is associated with vasodilation which result to increase blood flow into the area. Vasodilation of heat-exposed skin can be processed to occur through 3 factors: 1. Axon reflex 2. Release of chemical mediators 2° to temperature elevation (histamine, prostaglandins) 3. Local cord reflexes Neuromuscular Effects Heat is used therapeutically to provide analgesia and assist in the resolution of pain and muscle guarding spasms. Elevate pain threshold (through GCT) Alters nerve conduction velocity Change muscle spindle firing rates Elevation of muscle temperature to about 42°C decreases type II afferent firing and increase Ib afferent firing from GTO -> decrease tonic extrafusal fiber activity Superficial heating can only produce decrease in gamma efferent activity (MS) Causes decrease in muscle spindle stretch -> decrease alpha motor neuron firing -> less muscle spasm Connective Tissue Effects This can be altered through combination of temperature elevation and stretch Can alter viscoelastic properties of connective tissues - permits residual elongation of connective tissues after stretch is applied, then released General Rationale Indications Before active exercise Analgesic and sedative effects Before PROMEs or Relaxation and tissue extensibility Stretching Before Joint Mobilization Decrease joint stiffness Before ES application Reduce skin impedance Before Traction Relaxation and decreased muscle tension Before massage Relaxation and increased blood flow Before US application Relaxation and warms tissues Muscle Spasm Relaxation General Contraindications Injury stage of bleeding and edema DVTs Areas of poor circulation Dysesthesia/Altered sensation Age (too young/too old) Skin or lymphatic cancers Conductive Convective Heating Agents Heating Agents Hot Moist Pack or Hot Packs Fluidotherapy Paraffin Wax Contrast Bath Quantity of Heat Gained and Subsequent Physiological Responses are dependent on, but not limited to: 1. THERMAL CONDUCTIVITY 2. VOLUME OF BODY EXPOSED 3. TIME OF EXPOSURE Hot Packs Consist of canvass or nylon cases filled with a hydrophilic silicate or some other hydrophilic substance or sand Stored in a thermostatically controlled cabinet in water at a temperature of Covering for application: between 70˚C and 75˚C (158˚F and Terry toweling or commercial 167˚F) hot pack covers It comes in variety of shapes and 6-8 layers (depends on towel sizes -> should be chosen on the basis thickness) of the size and contour of the body Commercial hot packs need part/s to be treated. only 1-2 layer of towels for adequate insulation Hot (Moist) Packs Sensation to be felt by the patient Mild to moderate sensation of heat Parameter for application 20-30 minutes Note: If the pack feels too hot to the patient there would be a Check every 5 minutes distinct color change -> add towels/ remove the hot pack  No lying on the pack as it may cause water to be squeezed and may cause faster heat transfer  Local circulation could be reduced d/t compression of vessels (decrease circulatory convective cooling)  Hot (Moist) Packs Advantages Ease of preparation and application Variety of shapes and sizes available Moist, comfortable hear Skin color to be expected Fair skinned – bright pink/red Relatively inexpensive to purchase or blotchy red and white and replace Dark skinned – darker and Disadvantages lighter color No method of temperature control once applied to patient Do not readily conform to all body parts Sometimes awkward to secure in place on a patient Do not retain heat for longer than about 20 minutes It is a passive treatment, not requiring active patient participation Leaking hydrophilic or gel packs must be discarded Paraffin Wax Characteristics: It has a low melting point (54°C/129 °F) It has a low specific heat It conducts heat more slowly than water at the same temperature Paraffin Wax Most commonly used for the distal extremities Fingers, hand, wrist, toes, foot and ankle Mixture: 6-7 parts of wax: 1 part of oil Melted and stored in thermostatically controlled stainless-steel Three principal techniques of application: 1. Dip and wrap/ glove For both method, extremity to be treated should be washed and dried 2. Dip and immerse and all jewelries should be removed from the part 3. Brush Paraffin Wax Methods of Application Dip and Wrap Dip for 6-10 times until solid wax glove has formed the fingers, hand and wrist then must be placed in a plastic bag and wrap with a towel to retain heat Duration: 15-20 mins Dip and Immerse Do the dipping technique, the area that was dipped should be immersed again for 10-20 minutes Where temperature elevation and blood flow changes occur Not good for patients who are predisposed to edema/ cannot sit comfortably in the position required for treatment Brush Angular or difficult to reach part as the elbow is painted with multiple layers of paraffin, wrapped and covered with towels for 20 mins Paraffin Wax Advantages Low specific heat allows for application at a higher temperature than water without the risk of burn Low thermal conductivity allows for heating of tissues to occur more slowly thus reducing the risk of overheating the tissues Molten state allows for even distribution of heat to areas like fingers and toes Frist dip traps air and moisture to create more even heat distribution Oil used in the wax ad moisture to the skin Wax remains malleable after removal, allowing for use as an exercise tool Paraffin provides a comfortable, moist heat Replacing the wax is relatively inexpensive (assuming bath is already owned) Paraffin Wax Disadvantages Paraffin wax is effective only for distal extremities in terms of ease of application The most effective method of application is the bath, which limits accessibility for other body parts to be treated effectively There is no method of temperature control once applied The heating lasts for about 20 minutes It is passive intervention; patient exercise cannot be performed simultaneously Contrast Bath Equipment: whirlpool tanks (alternative: pails/tubs/basin); towels Dosage: Cold bath: 15-20°C Hot bath: 40.6-43.3 °C Duration/Variations: 3-4 mins hot, 30-60 sec cold Treatment Procedure: Begin with hot and continue alternately with cold for approximately 30 mins, end in cold Contrast Bath Indications Athletic injuries (most common), sprains/strains, edema, ulcers, pain relief, desensitize Contraindications Cardiovascular problems, PVDs, hemorrhage, loss of sensation, pregnancy, hypersensitivity Precaution Autonomic fight/flight reactions Intensity depends on patient tolerance Monitoring of pulse Addition of either hot/cold water Fluidotherapy A dry heat agent that transfers heat energy by forced convection Good for joints and distal body parts It uses air-fluidized solids as the heat transfer medium Warm air is uniformly circulated through the bottom of the bed of finely divided cellulose particles. Temperature: 38.8°C to 47.8 °C Agitation: Can be controlled for patient comfort (may vary for patients in desensitization program/ in areas which are hypersensitive) Advantages Convenient, easy to administer Temperature of application can be controlled Agitation of dry particles can be controlled for comfort Variety of sizes of units allows for most body areas to be treated Allows for some active exercise to be carried out during treatment Dry, comfortable heat Can be used for desensitization of hypersensitive hand/finger(s) or foot/toe(s) Disadvantage Relatively expensive modality to purchase Intolerance of some patients to enclosed container Intolerance of some patients to dry materials used  References/Bibliography Hecox. B. Mehretcab. T.A.. and Weisherg. J. (2005) Integrating Physical Agents: in Rehabilitation (2nd ed.) Norwalk. 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