Cryotherapy

Question 1

what are the uses of cryotherapy?

Answer 1

Control inflammation
Reduce pain
Reduce edema
Reduce spasticity

Question 2

what is the hemodynamic effect of cold?

Answer 2

initial decrease in blood flow

Question 3

what is involved in the initial decrease in blood flow after cold is applied?

Answer 3

• Vasoconstriction → contraction of smooth muscle in vessel walls
• Decreased production of vasodilator mediators → Histamines & Prostaglandin
• Increased sympathetic adrenergic activity
• Vasoconstriction near & distal to cold application
• Increase blood viscosity

Question 4

what is involved in decreased capillary permeability after cold is applied?

Answer 4

Decreased fluid in interstitial space → can reduce any new edema

Question 5

what is rebound vasodilation (Hunting Response)?

Answer 5

• Reduce cold induced injury if cold for prolonged period (injure tissues)
• Highly debated prob false

Question 6

what does applying cryotherapy do nerve conduction ?

Answer 6

decreases it so when the area becomes numb & conduction can’t be brought to spinal cord

Question 7

what effect do cooler temps have on sodium channels?

Answer 7

delayed inactivation of sodium channels & subsequently prolong the time of depolarization

Question 8

what neurovascular within the body experience the greatest effect from applying cryotherapy?

Answer 8

Greatest effect on myelinated small fibers
A-Delta nociceptive fibers

Question 9

what does cold have the smallest effect on within the body?

Answer 9

Smallest effect on large unmyelinated fibers

Question 10

how does applying cryotherapy reduce pain & increase pain threshold?

Answer 10

• Counter irritation via control theory (stopping nerve conduction)
• Sensory nerve conduction slowing
• Cold depresses the excitability of free nerve endings & peripheral nerve fibers → increasing the pain threshold

Question 11

what occurs to muscle strength after cooling for a short period?

Answer 11

• Immediate increase in isometric strength (cooling for 5 min or less)
• Motor nerve excitability
• Increased motivation

Question 12

why is there a decrease in strength after prolong cooling?

Answer 12

• Reduced blood flow to muscles
• Slowing of motor nerve conduction velocity
• Increased muscle viscosity
• Increased joint or muscle stiffness

Question 13

why is there decreased spasticity after applying cryotherapy?

Answer 13

Reduction in Gamma Motor Neuron Activity
Decreased muscle spindles activity & golgi tendon organs
Prolonged effects may last up to 30 min

Question 14

how does cryotherapy decrease metabolic rate?

Answer 14

• Decreased collagenase, elastase, hyaluronidase, protease & histamine w/ reduction in joint temp
• Decreased rate of cellular oxidation (reduce inflammation)

Question 15

how does cryotherapy control acute inflammation?

Answer 15

• Decrease tissue temp slows rate of chemical reaction
• Decrease blood flow via vasoconstriction
• Increase blood viscosity
• Decrease capillary permeability
  Reduces movement of fluid form capillary to interstitial tissues

Question 16

how does cryotherapy control edema?

Answer 16

Reduces histamine (which is a vasodilator) this causes vasoconstriction

Question 17

what is the gate control theory?

Answer 17

Activation of cutaneous thermal receptors which gate keep nociception at spinal cord

Question 18

how can the application of cold affect patients with motor neuron lesions?

Answer 18

• Application of cold for 5 minutes can decrease DTR/MSR
• Application of cold for 15-30 min can decrease resistance to stretch making it easier to participate in functional activities

Question 19

what is cryokinetics?

Answer 19

Application of a cooling agent to reduce pain & allow exercise & ROM ASAP

Question 20

what is cryostretch?

Answer 20

Apply cold to reduce muscle spasm, allowing greater increase in ROM w/ stretching

Question 21

what are the contradictions to cryotherapy?

Answer 21

Cold Hypersensitive (Cold induced ulcers)
Cold Intolerance
Cryoglobulinemia
Paroxysmal Cold Hemoglobinuria
Reynaurd’s Disease/ Phenomena
Regenerating Peripheral Nerver
Area w/ impaired sensation
Area w/ compromised circulation or Peripheral Vascular Disease

Question 22

why is one with cold hypersensitive be a contradiction?

Answer 22

Vascular skin reaction to cryotherapy
Smooth elevated patches which are more red or pale than surrounding tissue
Often very itchy
May be local or widespread

Question 23

what is cryoglobulinemia?

Answer 23

• Aggravation or serum proteins in distal circulation when distal extremity is cooled
• Proteins can form gel which can impair circulation & result in ischemia

Question 24

why is paroxysmal cold hemoglobinuria a contradiction to cold?

Answer 24

• Hemoglobin from RBS is released into urine in response to exposure ti cold
• Often seen in patients w/ Autoimmune Hemolytic Anemia

Question 25

why is it dangerous to apply cryotherapy to someone w/ Regenerating peripheral nerves or over area w/ impaired sensation?

Answer 25

May delay nerve regeneration Can not tell you if they are getting too cold

Question 26

what is a precaution to cryotherapy?

Answer 26

Over main branch of nerve Over an open wound Hypertension Poor sensation or mentation Very young or very old patients

Question 27

what are some adverse effects of cryotherapy?

Answer 27

- Cold Induced Urticaria - Tissue death - Nerve damage

Question 28

what should a patient expect during cryotherapy?

Answer 28

Cold → cold sensation (occurs withing 3 min) Burning → burning sensation (occurs b/w 2-7 min) Aching → Aching sensation (occurs b/w 2-7 min) Numb → Local Numbness or analgesia (occurs b/w 5-12 min)

Question 29

what are the parameters for cryotherapy?

Answer 29

10-20 min

Question 30

what are the advantages to ice pack/cold pack?

Answer 30

Easy to use Inexpensive Low Level of skill required Covers moderate to large area Can be applied to elevated limb

Question 31

what are the disadvantage to ice pack/cold pack?

Answer 31

Must be removed from area to inspect skin Can be heavy & pt may not tolerate resting weight May be difficult to contour along small areas

Question 32

what are the advantages to ice cup/ ice massage?

Answer 32

Treatment area can be observed during application Good for small & or irregular areas Short duration Inexpensive Can apply to elevated limb

Question 33

what are the disadvantages to ice cups/ ice massage?

Answer 33

Time consuming for large area Active participation required (time consuming)

Question 34

what is a cold compression unit commonly used for?

Answer 34

control edema & inflammation

Question 35

when is cold immersion indicated?

Answer 35

acute & subacute conditions when you want to exercise during treatment

Question 36

what is the general procedure for cryotherapy?

Answer 36

Determine which cryotherapy to use Intro Explain procedure & reason (relate to function) Expectations: CBAN Decrease in pain/inflammation/spasticity Possible adverse reactions Screen for contraindications Much will come from records May have to do sensation testing Inspect area to be treated Have pt remove jewelry & clothes from area Check sensation (hot/cold)

Question 37

what is the procedure for cold pack/ Ice pack?

Answer 37

Wrap cold pack or ice pack in a towel (can use pillowcase over cold pack) Position patient comfortably & elevate area if edema is present Apply cold pack to area to be treated → be sure to secure w/ wrap or bandage to make sure it is in good contact Provide pt w/ call bell & timer Check skin after 5 min to ensure no adverse event If apply for 30 min, check every 10 min after initial 5 min check Check again at end to note any adverse reactions Interventions

Question 38

what is the procedure for ice massage?

Answer 38

Place towel around treatment area to absorb any dripping water Continue ice massage for 5-10 min or until numb Check treatment area for any adverse reactions Intervention

Question 39

what is the procedure for cold compression?

Answer 39

Cover limb w/ stocking or towel Wrap sleeve around an area to be treated Elevate treatment area above heart

Question 40

what is the procedure for cold whirlpool?

Answer 40

- Turn on turbine, adjust aeration, agitation & direction of the water being pumped - Instruct pt to keep away from all parts - Pad edge of tank w/ toweling, warn patient that water is cold, then put body part in water - Check patient’s response verbally & visually about every 2 min. Remind them to tell you if area starts hurting or if sensation is lost

Question 41

what is the documentation for cryotherapy?

Answer 41

Area Type of cryotherapy Treatment duration Patient positioning Response Intervention / parameters