PHTY208 Lecture Notes - Lecture 2: Hot Water Bottle, Hives, Motor Skill
TOPIC 2: ELECTROPHYSICAL AGENTS, HEAT THERAPY AND CRYOTHERAPY
Electrotherapy: treatment of a patient using an electrophysical agent (EPA) to bring about
physiological changes for therapeutic purposes
1. Types of EPA
-superficial heat e.g. hot packs
-deep heat e.g. ultrasound, shortwave diathermy (SWD)
-cryotherapy e.g. cold packs
-electrical stimulation e.g. interferential, portable TENS
-laser
2. Duty of care
-incorrect use of EPA can result harm to patients e.g. burns and tissue damage
-Physiotherapists are obligated to take all reasonable steps to avoid risk of damage or harm
being caused to their patients
-includes explanations of benefits and potential dangers of treatment so that patients can give
informed consent
Very important to know:
-contraindications and precautions
-working physics of each modality
-Physiological changes that occur in tissues
-correct dosage
3. Contraindications and precautions
-Contraindication (CI): any condition that renders a particular line of treatment improper or
undesirable (Miller and Keane (1983))
-Precaution: action taken in advance to protect against possible injury
-Possible interactive effects of modalities used concurrently or sequentially may increase
dangers usually associated with an individual modality
-e.g. ice prior to another modality such as electrical stimulation will numb skin and patient may
not feel current concentrating and tissue damage
-additional obligation to ensure any risks are avoided
Examples of CIs:
For superficial heat (e.g. hot pack)
-circulatory insufficiency
-risk of dissemination (i.e. spreading a disease for example an infection, tumours, TB,
osteomyelitis)
-exacerbation (i.e worsening) of an existing condition (e.g. inflammation post injury, skin rash)
-to eyes or testes
How do I know if and EPA is CI?
-use information gathered from the:
-Patient interview
-Physical examination
-supplement with additional questions/tests if required
3. Contraindications and precautions
Some EPA modalities have specific CIs, check these e.g.
-wax: CI if the skin is broken
-laser: specialised eye protection required for both therapist and patient
4. Skin tests
-thermal sensitivity
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-reaction to ice
-sharp and blunt discrimination
-erythemal levels (UV light treatment)
-thermal sensitivity
-Tests ability to discriminate hot from cold at the site to be treated
-look for inability to reliability discriminate hot from cold
-ice reaction
-either perform an ice cube massage for 30+ sec
-Or apply an ice pack and examine local response under the pack after 1 min then 5 min
-be aware of possible latent effects
-look for excessive erythema, inflammatory weal, blotchy uneven erythema or a systemic
reaction (e.g. increased BP or HR)
-Sharp/blunt discrimination
-test the area to be treated using the end and side of a new toothpick/paperclip on another
patient
-Dispose of immediately in a bin (or sharps container if have drawn blood?)
-look for: inability to reliably differentiate sharp from blunt
-Testing should always be conducted:
-if indicated in the history e.g. patient indicates they are numb over knee after surgery
-at the first treatment and, subsequently, after any relevant change in a patient’s condition
-Always record tests undertaken and results
5. Warnings
-physiotherapist is responsible for ensuring the patient has the necessary information to give
informed consent for treatment
5. Components of a warning
-what you should feel
-what you should not feel
-what is the danger (risk of treatment)
-what you should do if this happens
-check understanding
-do they have any questions?
-obtain verbal consent to proceed
5. General warning
“when having …. Therapy, what you should feel is…”
“do you understand what I have said?”
“are you happy for me to proceed”
5. Warning signs
If radio-frequency equipment (MW/SWD) could be in use, provide appropriate multilingual signs to
advise all clinic entrants in case any have an indwelling stimulator e.g. a pacemaker
6. EPA practice standards
-indicates the usual sequence when planning to use EPA
-Physiotherapist is required to ensure that the equipment satisfies the relevant Australian
Standards
-need to check the modality specific risks in the table of contraindications and precautions
-Table 3 of the guidelines for use of EPA
6. Sequence of EPA application
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7. Documentation
-date
-pre treatment assessment
-CI/P checked
-skin test
-machine test
-warning
-Consent
-treatment details
-intensity and frequency
-Continuous or pulsed
-duration
-area treated
-location of electrodes
-method
-Equipment details
-result of treatment
-adverse reaction check and any action taken/recommended
-all other treatment details
-sign and print name and designation
8. Infection control
-physiotherapists have a responsibility to apply standard precautions and, when necessary,
additional precautions of infection control
-Routine care
-hand washing
-Disposal of sharps
-levels of care
-non critical: contact with intact skin is considered low risk
-Probes and sponges: wipe or soak in sodium hypochlorite solution (e.g. milton) between
patients: allow to dry completely
-hot/cold packs: use fresh towels
-self adhesive electrodes- refuse only with the same patient or sterilise between patients
with alcohol swabs
-other EPA equipment: if not in contact with patients, wipe routinely with hot water, a neutral
detergent, a disposable cloth and allow to dry
-semi critical: non intact skin or potential for contact with blood, mucous membranes, or body
substances
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Topic 2: electrophysical agents, heat therapy and cryotherapy. Electrotherapy: treatment of a patient using an electrophysical agent (epa) to bring about physiological changes for therapeutic purposes: types of epa. Deep heat e. g. ultrasound, shortwave diathermy (swd) Incorrect use of epa can result harm to patients e. g. burns and tissue damage. Physiotherapists are obligated to take all reasonable steps to avoid risk of damage or harm being caused to their patients. Includes explanations of bene ts and potential dangers of treatment so that patients can give informed consent. Contraindication (ci): any condition that renders a particular line of treatment improper or undesirable (miller and keane (1983)) Precaution: action taken in advance to protect against possible injury. Possible interactive effects of modalities used concurrently or sequentially may increase dangers usually associated with an individual modality. E. g. ice prior to another modality such as electrical stimulation will numb skin and patient may not feel current concentrating and tissue damage.
