Unit 12 - Heat and Cold Therapies.docx

**[HEAT AND COLD THERAPIES]** **Learning Outcomes** i. Identify various mode of heat therapy. ii. Describe the physiologic effects of local heat applications (thermotherapy) iii. Identify various modes of cold therapy (cryotherapy) iv. Describe the physiologic effects of local cold applica...

**[HEAT AND COLD THERAPIES]** **Learning Outcomes** i. Identify various mode of heat therapy. ii. Describe the physiologic effects of local heat applications (thermotherapy) iii. Identify various modes of cold therapy (cryotherapy) iv. Describe the physiologic effects of local cold applications (cryotherapy) v. Identify indications and contraindications for various heat and therapies vi. Identify safety precautions to consider when applying heat and cold treatments **INTRODUCTION** **Terminology** - Antipyretic: A drug used to prevent or reduce fever - Compress: A moist gauze dressing applied frequently to an open wound, sometimes as therapeutic techniques - Conduction: The transfer heat from one molecule to another in direct contact - Convection: The dispersion of heat by air currents - Cryotherapy: The use of extreme cold to freeze and remove abnormal tissue - Cyanosis: A bluish tinge of skin color - Erythema: A redness tinge of skin color associated with a variety of skin rahes - Evaporation: When a liquid turn into gas - Fever: The temporary increase in the body's temperature in response to a disease or illness - Hyperemia: Increase blood flow to an area - Hyperthermia: A body temp above the usual range - Hypothermia: A core body temp below the lower limit of normal - Insulator: Materials that do not allow electricity to pass through them; glass, air, wood, plastic and rubber. - Mottling: Blotchy, red-purplish marbling of the skin. - Pallor: Skin paleness - Radiation: The transfer of heat from the surface of one object to surface of another object without contact between the two objects - Shivering: The action of shaking slightly and [uncontrollably](https://www.google.com/search?sca_esv=8ded6165f44582e6&sca_upv=1&rlz=1C1BNSD_enMY996MY996&biw=718&bih=706&sxsrf=ADLYWIJcPemljc1NtL1AgVl_sm1i_5NuMw:1715957542943&q=uncontrollably&si=ACC90nyCA_YIOll8NnE-SsymedG7pUTVpnOHyUwlCs59TukvPn7c3u0xcbqVyP-y8KWM47lKFjMeXNmA1y1MoTKizarZ0RYjkrY3Rt321d0-VRSy2psGatI%3D&expnd=1&sa=X&ved=2ahUKEwiPxK_-95SGAxX3cvUHHXO6B9QQyecJegQITxAR) as a result of being cold, [frightened](https://www.google.com/search?sca_esv=8ded6165f44582e6&sca_upv=1&rlz=1C1BNSD_enMY996MY996&biw=718&bih=706&sxsrf=ADLYWIJcPemljc1NtL1AgVl_sm1i_5NuMw:1715957542943&q=frightened&si=ACC90nyOnVY18Aw7zUtkWPYo5mTn1Z26Ua2av6nlEZ8cERD1S467VqgDnFTAG7ef0gguXZZacZ08p0x3IrnWfaCfkZK62ih1yvi4w206MMlk7utjvNGUU7c%3D&expnd=1&sa=X&ved=2ahUKEwiPxK_-95SGAxX3cvUHHXO6B9QQyecJegQITxAS), or excited. - Suppuration: The formation of pus - Thermotherapy: The use of heat in conventional or alternative medicine, especially for the relief of muscular pain or [stiffness](https://www.google.com/search?sca_esv=8ded6165f44582e6&sca_upv=1&rlz=1C1BNSD_enMY996MY996&sxsrf=ADLYWILgnMjkfDmv2xjycAZnkVO6vLMcOg:1715957760563&q=stiffness&si=ACC90nytWkp8tIhRuqKAL6XWXX-NkXrv3OS0J0PEdMxQQf5XfF9ZVrqMGYNmOV7jdjW-4_XfP3u34L5N2kIv-XHZX5ZDQXlp7aap_WI_7dVtMS2ZHIgOlFI%3D&expnd=1&sa=X&ved=2ahUKEwjNhZLm-JSGAxWKaPUHHdJYBJIQyecJegQIDhAN). - Vasoconstriction: Constricted blood vessels - Vasodilation: Increase diameter of blood vessels **TEMPERATURE REGULATION** - Is regulated & maintained by interrelated feedback system, which can be altered by disease or environmental conditions - Temp regulation is homeostatic function that balances heat production & loss to maintain body temp(36°C -- 37.5°C) - Controlled by -- body's thermostat, the hypothalamus **Process of Heat Transfer** Conduction: the process by which heat is transferred from the hotter end to the colder end of an object Convection: the process of transferring heat through air or liquid currents Radiation:  the emission or transmission of energy in the form of waves or particles through space or a material medium Evaporation: the process that changes liquid water to gaseous water (water vapor). **HEAT AND COLD APPLICATIONS** - Heat and cold are applied to the body for local and systemic effects - Local heat application: thermotherapy - Cold application: cryotherapy **The physiologic effects of heat** - Heat applications beneficial only for subacute & chronic inflammation not during the acute inflammatory phase of musculoskeletal injury. - Heat produces analgesia and sedation by promoting release of endorphins and by stimulating nerve endings to block pain transmission by the gate control theory of pain modulation. **Local Effects of Heat** - Heat has been a long-standing remedy for aches and pain, / with comfort & relief. - Heat causes vasodilation & increases blood flow to the affected area, bringing oxygen, - nutrients, antibodies, and leukocytes. - Application of heat promotes soft tissue healing and increases suppuration. - A possible disadvantage of heat is that it increases capillary permeability, which allows - extracellular fluid & substances such as plasma proteins to pass through the capillary - walls and may result in edema or an increase in pre-existing edema. - Heat is often used for pt.s with musculoskeletal problems such as joint stiffness from arthritis, contractures, and low back pain. **Local Effect of Cold** - The physiological effects of cold lowers the temperature of the skin and underlying tissues and causes vasoconstriction. - Vasoconstriction reduces blood flow to the affected area & reduces the supply of oxygen & metabolites, decreases the removal of wastes, and produces skin pallor & coolness. - Prolonged exposure to cold results in impaired circulation, cell deprivation, and subsequent damage to the tissues from lack of oxygen & nourishment. - The signs of tissue damage due to cold are a bluish purple, mottled appearance of the skin, numbness, & sometimes blisters & pain. - Cold is most often used for sports injuries (eg; sprains, strains, fractures) to limit postinjury swelling & bleeding. **Physiological Effects of Heat & Cold** **HEAT** **COLD** ---------------------------------- ------------------------------------------------ Vasodilation Vasoconstriction Increases capillary permeability Decreases capillary permeability Increases cellular metabolism Decreases cellular metabolism Increases inflammation Slows bacterial growth, decreases inflammation Sedatives effect Local anesthetic effect **Systemic Effect of Heat and Cold** - Heat applied to a localized body area, particularly a large body area, may cause excessive peripheral vasodilation, which produces a drop in blood pressure. - With extensive cold applications & vasoconstriction, a pt.'s Bp can increase because blood is shunted from the cutaneous circulation to the internal blood vessels. - Shivering, a generalized effect of prolonged cold, is a normal response as the body attempts to warm itself. **Thermal Tolerance** Specific conditions necessitate precautions in the use of hot / cold application: i. Neurosensory impairment -- people with sensory impairments ii. Impaired mental status -- people who are confused iii. Impaired circulation -- people with peripheral vascular disease, diabetes iv. Immediately after injury / surgery -- heat increases bleeding & swelling. v. Open wound -- Cold can decrease blood flow to the wound thereby inhibiting healing. **Variable Affecting Physiological Tolerance to Heat and Cold** - Body part -- The back of the hand & foot are not very temperature sensitive. The inner aspect of the wrist & forearm, the neck, & the perineal area are temperature sensitive. - Size of the exposed body part. The larger the area exposed to heat & cold, the lower the tolerance. - Individual tolerance; the very young & old -- lowest tolerance. - Length of exposure. People feel hot & cold applications, after a period of time. - Intactness of skin. Injured skin areas are more sensitive to temperature variations. **Temp for Hot and Cold Applications** **Description** **Temp** **Application** ----------------- ------------------------------- ------------------------------------- Very Cold Below 15°C (59°F) Ice bags Cold 15°C -- 18°C (59°F -- 65°F) Cold Packs Cool 18°C -- 27°C (65°F -- 80°F) Cold Compression Tepid 27°C -- 37°C (80°F -- 98°F) Alcohol sponge bath Warm 37°C -- 40°C (98°F -- 104°F) Warm bath, aquathermia pads Hot 40°C -- 46°C (104°F -- 115°F) Hot soak, irrigations, hot compress Very hot Above 46°C (above 115°F) Hot water bags for adults **Applying Heat and Cold** Heat can be applied to the body in both and dry and moist forms **Type of heat and cold therapy** i. Dry heat is applied locally by means of a hot water bottle, aquanthermia pad, disposable heat pack, or electric pad. ii. Moist heat can be provided by compress, hot pack, soak, or sitz bath. iii. Dry cold -- generally applied locally by means of a cold pack, ice bag, ice glove, or ice collar. iv. Continuous cold therapy (cryotherapy) following joint surgery or injury can be delivered. **Guidelines for local applications of heat or cold** i. Determine the pt.'s ability to tolerate the therapy. ii. Identify conditions that might contraindicate treatment (eg; bleeding, circulatory impairment) iii. Explain the application to the pt. iv. Assess the skin area to which the heat / cold will be applied. v. Ask the pt. to report any discomfort. vi. Return to the pt. 15 minutes after starting the heat / cold therapy, and observe the local skin area for any untoward signs (eg; redness). Stop the application if any problems occur. vii. Remove the equipment at the designated time, and dispose of it appropriately. viii. Examine the area to which the heat or cold was applied, and record the pt.'s response. **Contraindication to the Use of Heat and Cold** i. Neurosensory impairment -- sensory impairment ii. Impaired mental status -- confused / an altered level of consciousness iii. Impaired circulation -- peripheral vascular disease iv. Open wounds **Contraindicated the use of Heat:** i. The first 24 hours after traumatic injury : heat increases bleeding & swelling. ii. Active hemorrhage :heat -- causes vasodilation & increases bleeding. iii. Noninflammatory edema: Heat increases capillary permeability & edema iv. Skin disorder -- causes redness / blisters -- can burn / further damage. **Contraindicating the use of Cold** i. Open wounds: increase tissue damage by decreasing blood flow ii. Impaired circulation: impair nourishment of the tissues & cause tissue damage. iii. Allergy / hypersensitivity to cold **Selected Indications of Heat and Cold** **Indication** **Effect of Heat** **Effect of Cold** ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- Muscle spasm Relaxes muscles and increases their contractility Relaxes muscles and decreases muscle contractility Inflammation Increases blood flow, softens exudates Vasoconstriction decreases capillary permeability, decreases blood flow, slows cellular metabolism Pain Relieves pain, possibly by promoting muscle relaxation, increasing circulation, and promoting psychological relaxation and a feeling of comfort; act as a counterirritant Decreases pain by slowing nerve conduction rate and blocking nerve impulses; produces numbness, act as a counterirritant, increases pain threshold Contracture Reduces contracture and increases joint range of motion by allowing greater distention of muscles and connective tissue \- Joint stiffness Reduces joint stiffness by decreasing viscosity of synovial fluid and increasing tissue distensibility \- Traumatic injury \- Decreases bleeding by constricting blood vessels; decreases edema by reducing capillary permeability **Tepid sponging** **Assessment** - Assess body temp **Equipment** - Basin, 6 small towel, bath blanket, thermometer **Preparation** i. Ensure pt.' body temperature ii. Gather equipment and bring to pt.'s room. iii. Check pt.'s identification band. iv. Provide privacy & explain procedure v. Perform hand hygiene. **Procedure (Refer notes)**