The Use of Thermal Physical Agent Modalities

The Use of Thermal Physical Agent Modalities

Modality HOT PACKS FLUIDOTHERAPY PARAFFIN BATH ULTRASOUND
Topic
Principles of physics Transfer of heat from a hot Transfer of heat from warm, Transfer of heat from hot wax Transfer of heat to deep tissue
related to modality pack to a body part via air blown particulate in a to the underlying body part via sound waves produced
conduction heating unit to the body via conduction by an electric voltage
part via forced convection across a crystal.
Physiologic changes Increased metabolic rate. Increased metabolic rate.
associated with Vasodilation and increased Increased metabolic rate. Vasodilation and increased Increased metabolic rate.
application of modality Vasodilation and increased Vasodilation and increased
local blood flow. local blood flow.
Analgesia – increased pain local blood flow. Analgesia – increased pain local blood flow.
Analgesia – increased pain Analgesia – increased pain
threshold. threshold.
Reduction of muscle spasm. threshold. Reduction of muscle spasm. threshold.
Reduction of muscle spasm. Improves pliability of skin Reduction of muscle spasm.
Elevates tissue temp. to
Normal and abnormal Increase surface tissue Increase surface tissue Increase surface tissue
tissue responses to the temperature. temperature. temperature. depth of 5 cm or more.
modality Increased enzymatic activity
Mild inflammatory reaction. Mild inflammatory reaction. Mild inflammatory reaction. Changes in nerve conduction
Indications and Increased viscoelasticity of Increased viscoelasticity of Increased viscoelasticity of
contraindications velocity.
related to selection and connective tissue. connective tissue. connective tissue. Increase temperature of
application of the Possible increase in rate of Possible increase in rate of Possible increase in rate of
modality deeper tissues and
growth of cancer cells. growth of cancer cells. growth of cancer cells. structures.
Indications Increased collagen tissue
Indications Indications Pain, decreased flexibility, extensibility.
Acute and subacute strains, Pain, decreased flexibility, Changes in contractile
arthritis, activity of skeletal muscle.
neuritis, neuralgia, muscle spasms, facilitate Contraindications
myalgia, pain and muscle wound healing, arthritis. Impaired circulation and/or Indications
spasms. Contraindications Scar tissue that limits ROM,
Contraindications Impaired circulation and or lack of sensation, open
Malignancies, impaired nerve function, severe wounds, skin rashes, or reduction of pain and
circulation and/or nerve edema an large, open lesions, severe edema, muscle spasm, tendonitis,
function and severe edema. seeping wounds that recent burns. bursitis, calcium deposits,
Do not lay on hot packs cannot be covered tissue healing,
adequately phonophoresis
Contraindications
Do not use over eyes, head,
spinal cord, testes,
pregnant uterus, cancerous
tissue or metal appliances.

Modality HOT PACKS FLUIDOTHERAPY PARAFFIN BATH ULTRASOUND
Topic
Guidelines for Various sizes and types of hit Extremity is placed in unit, Extremity is dipped in Deep heat is applied to the
treatment using the packs are available. avoiding dependent paraffin bath 8-10 times, affected area using US of
modality in position if possible. then covered with a plastic varying intensities and
occupational therapy Layers of towels are placed Temperature can be bag and wrapped with a wave lengths via a specific
between the hot pack and adjusted to patient’s towel. Or extremity may transducer head size and
the body surface (6-8 with tolerance or desired be dipped several times application medium (US
hydroculator packs). Skin therapeutic effect. then reimmersed for the gel, water, medicated
integrity is checked after 5 duration of the treatment. cream).
minutes; treatment for up Treatment time between 10-
to 30 minutes followed by 30 minutes. Treatment time is 20-30 Treatment time will vary
stretching exercise and minutes depending on depending on the affected
purposeful activity Patient may do technique used and area and desired outcome
program ROM/stretching exercise outcome sought; followed followed by stretch and
while in the unit or after by massage, stretching activity.
Guidelines for patient Patient is educated as to the treatment followed by and/or purposeful activity.
education about the need for treatment, how purposeful activity. Patient should be given a
modality (process, the treatment will be Patient is educated as to the basic explanation (in
outcomes, risks and applied, times of treatment Prior to treatment, patient is heating and other layman’s terms) about the
benefits) and number of treatments told what fluidotherapy is, properties of paraffin properties of US.
needed. what it does and what its treatment.
purpose is. Purpose of treatment, time
Expected outcomes and risks Prior to treatment, risks, and number of sessions,
and benefits should be Patient is educated regarding benefits and outcomes are risks and benefits should
discussed prior to treatment time, number of discussed. be discussed prior to
treatment to include treatments needed, and treatment.
alternative treatments. exercise or activity Instructions (with
program to follow. precautions) for home use Patient should perform
Home applications and home may be given along with a stretching and/or activities
activity programs should Instruction in edema stretching and purposeful following treatment in the
be discussed as well. reduction techniques activity program. clinic
should be provided to be
carried out in the clinic or
at home.

Modality HOT PACKS FLUIDOTHERAPY PARAFFIN BATH ULTRASOUND
Topic
Safety rules and Size of hot pack should cover Remove jewelry as digits Remove jewelry and wash Keep head moving and in
precautions related to the intended area. tend to swell. hands prior to use. Throw contact with body surface.
the modality away wax after use.
Patient should not lay on a Avoid high heat and Avoid areas of impaired
Methods of hot pack. dependent positioning as Do not apply over new skin circulation or sensibility.
documenting much as possible. grafts, burns, open
effectiveness of Limit duration of treatment to wounds, skin lesions, or Position patient carefully,
modality 20-30 minutes. Cover open wounds well. acute edema. Do not apply over eyes,
Monitor patient’s
Characteristics of Avoid overuse. Provide adequate instructions pregnant uterus, testes,
equipment including Check skin after 5 minutes exercise/stretching while in for home use if areas of thrombophlebitis,
safe operation fluidotherapy unit, if appropriate. epiphyseal plate or cancer.
for mottled erythema indicated,
and/or blotching. Apply Securely close unused ports. Avoid overuse. Documentation should
more towels if this occurs. Documentation should Documentation should include body area treated,
Documentation should include extremity treated, duration of treatment,
include body area treated, duration and temperature include extremity treated, intensity and wave type,
patient position, duration of the treatment session, duration of treatment and coupling agent used and
of application, patient patient position and any position of the extremity size of transducer head.
response to treatment activity performed while in (ie, closed of open hand)
(including changes in pain the fluidotherapy unit. Document pre and post Patient response to treatment,
and function) immediately Document pre and post A/PROM, pain and edema activity program and pre-
after treatment and on treatment A/PROM, measurements as indicated. /post treatment
follow-up visits. edema, pain and strength Keep a copy of home measurements should be
Document any home measurements as needed. program, if applicable. documents as appropriate.
programs Have regular maintenance
Do not use or store a pack checks. Have regular maintenance Have regular maintenance
that is leaking its contents. Be aware that static checks. checks (at least annually).
Store at ~160oF. electricity can build in unit
Use 6-8 layers of towels. (may need to use dome Accurately monitor the Always have a coupling agent
For commercial hot packs, type of static guard). temperature of paraffin; in contract with the
follow instructions Temperature should be should be between 118oF transducer/skin interface
carefully, provide patient regulated between 102oF – and 125oF. when in use (be aware of
with detailed home 118oF. BNR).
program Agitation can be controlled Use caution with dip-and-
based on patient tolerance. reimmerse techniques as it Insure intensity is low when
produces a more vigorous unit is turned on (depends
heating response. on unit).