J._CONTRAST_BATH_THERAPY[1].pptx

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1. CONT RAST BATH

2. Cont rast bath is an alternating immersion of body segments like hands and legs in warm and cold water so as to produce alternating vasodilation and vasoconstriction in the peripheral blood vessels to provide vascular exercise to the part. Traditionally cont rast bath consists of alternating immersion of the body segment in hot (106°F ) and cold (50°F ) water typically 4 minutes of hot followed by 1 minute of cold. Treatment time generally lasts about a period of 20 to 30 minutes.

3. TECHNIQUE OF APPLICATION The temperature of the hot water should be 40 to 45 degree celsius and cold water around 10 to 18 degree celsius . while instructing the patient for home programme explain for the ease of understanding that the hot water should be as hot as can be tolerated on the immersed part and cold water should feel ice cold to the skin without any discomfort on prolonged immersion.

4. Stationary water immersion, tandem whirlpools, or moist heat packs and ice packs can be used for this The treatment commences with hot water The part to be treated is first immersed in hot water for 6 to 10 minutes at a stretch If the water feels too hot or not warm enough hot water can added or diluted according After soaking in warm water the part is transferred to the cold tub and allowed to soak 1 minute The part is then transferred to warm water and allowed to soak for 4 minutes The cyclic immersion in hot and cold water in the ratio of 4:1 is continued for 30 minutes or for 4 0r 5 cycles . min treatment time is 20 minutes

5. The treatment cycle ratio of 4:1 is variable depending upon the underlying disorder in acute conditions the ratio maybe be changed to 2:1 Alternating between hot and cold water is thought to trigger a vascular pumping action caused by vasodilation ( hot water ) and vasoconstriction (coldwater ) does stimulating local circulation in the treated extremity . In chronic conditions with indurate oedema the contrast bath treatment should commence and end with hot water soak and in acute conditions with significant effusion treatment should be terminated with cold soak .

6. PHYSIOLOGICAL EFFECTS Alternating immersion in hot and cold water causes alternating episodes of vasoconstriction and vasodilation which mimics a pumping effect in the treated part and does increasing the local blood flow. Oedema is decreased Reduction of necrotic cells at the cellular level.

7. LIMITATIONS OF CONTRAST BATH Contrast baths probably cause only a superficial capillary response resulting in inability of the larger deep blood vessels to constrict and dilate in response to superficial heating. lymphatic capillaries contain only epithelial cells and are unable to change sizes, so they are unable to vasodilate or vasoconstrict the solid matter in edema must be removed by the lymphatic system and lymph vessels are not affected by temperature. Only gravity, muscle contractions, or external pressure moves matter through the lymph system.

8. INDIC ATIONS Cont rast bath is indicated for any conditions that needs stimulation of peripheral circulation and a Choice of modality for acute and chronic musculoskeletal injuries like : Sprain Strain post fracture stiffness peripheral vascular disorders like lymph oedema vasculitis , varicose veins. Increasing joint ROM Pain reduction

9. CONTRAIN DICATIONS Loss of thermal sensation Hypersensitivity to cold Arteriosclerosis in advanced stage with chronic insufficiency of blood supply Arteriosclerotic endarteritis Patient with microvascular disease secondary to diabetes Buergers disease ( Pt may not be able to tolerate the rapid change in temperature depending upon the severity of the disease ) Deep vein thrombosis

10. PRECA UTIONS A Neoprene toe cap may be used to decrease the discomfort associated with cold Immersions. The combination of increased circulation and placement of the extremity in a gravity dependent position tends to increase Oedema, so inspecting the treated part post session to assess whether the treatment has not actually increased the amount of oedema.

11. RECENT RESEARCHES EFFECTS OF CONTRAST THERAPY USING INFRARED AND CRYOTHERAPY AS COMPARED WITH CONTRAST BATH THERAPY ON BLOOD FLOW, MUSCLE TONE, AND PAIN THRESHOLD IN YOUNG HEALTHY ADULTS : The aim of this research was to compare the effects of contrast bath therapy (CBT) and contrast therapy (CT) using infrared (IR) and cryotherapy (CR) on blood flow, muscle tone, and pain in the forearm. The variables measured were blood flow, muscle tone, and pain before and after intervention. Both types of CT produced fluctuations in the blood flow ( P <0.05). The pain threshold increased on both therapies; a significant increase was noted with IR and CR ( P <0.05) therapies. Muscle elasticity was induced and stiffness was reduced with all therapies ( P <0.05). IR and CR resulted in significant changes ( P <0.05) in blood flow as compared with the CBT. The results of this study suggest that CT using IR and CR is more effective in improving blood flow than CBT and has the same effect on muscle tone and pain. Nonetheless, using IR and CR is efficient with regard to mobility and maintaining temperature; therefore, it would be convenient to use these in clinical settings. Further studies involving CT should be carried out to determine whether our findings are clinically relevant.

12. ACUTE EFFECTS OF CONTRAST BATH ON SYMPATHETIC SKIN RESPONSE IN PATIENTS WITH POSTSTROKE COMPLEX REGIONAL PAIN SYNDROME Each group consisted of 20 participants. No significant difference was detected in stroke duration, aetiology, and Brunnstrom stages between groups. Elbow spasticity level was significantly higher in CRPS group  (p = .034).  SSR amplitudes of plegic hands were significantly decreased after CB in CRPS and control groups  (p = .0002, p = .013  respectively). Also, CB reduced the SSR amplitude of healty side in CRPS group  (p = .003).  There was no statistically significant change in SSR latency or percentage changes of SSR amplitude and latency after CB in both groups. CB leads to a significant reduction in sympathetic activity of plegic side of stroke patients. Also, CB to the plegic side has an inhibitory effect on sympathetic activity of healty side in poststroke CRPS .

13. VARIATION OF SKIN TEMPERATURE DURING AND AFTER CONTRAST BATH THERAPY : Twenty volunteers were randomly separated into two groups of 10 subjects and submitted either protocol A (PA), beginning therapy with 4 minutes/immersion in warm water and ending with 1 minute in cold water or protocol B (PB), beginning with 1 minute/immersion in cold water and ending with 4 minutes in warm water, each protocol was performed four times 20 minutes of total treatment time. Skin temperature was measured with an infrared thermometer above the anterolateral ankle skin before, during and after CWB. Skin temperature measurements were taken 3, 6, 9 and 12 minutes after CWB to measure the time to return to resting body temperature (RBT) Significant variations in the skin temperature were obtained in both protocols. PA showed a greater delay in returning to the resting local temperature after the contrast bath as compared with PB or control group implying treatment should terminate depending upon factors of blood circulation or muscle repair. Further studies should be conducted to evaluate CWT in specific populations where inflammation or injury has already occurred.

14. RESULTS OF REST, SOFT SOLE SLIPPERS, CONTRAST BATH AND PLANTAR STRETCHES PHYSIOTHERAPY IN CASE OF PLANTAR FASCIITIS : To study the effectiveness of Rest, exercises (Plantar fascia stretching technique), soft sole slippers and contrast bath with in patients with plantar fasciitis in fresh as well as recurrent cases. The Present study concluded that 2-weeks treatment program performed on subjects with plantar fasciitis demonstrated that both contrast bath and plantar fascia stretching exercises combined with rest & soft sole slippers were effective in reducing pain intensity and improving functional activities. There are conflicting results in the short and long term, probably because the exact etiology of plantar fasciitis and the subjective component of the pain do not allow a proper standardization of results; therefore, it is difficult using this type of review to identify which is actually the best treatment during various stages of plantar fasciitis. So long terms follow up is required to support our conclusion. But still this regimen is followed in all primary plantar fasciitis due to reduced costs and the safety of the procedure.

15. THE COMPARISON OF THE EFFECTS OF CONTRAST BATH ON CIRCULATION OF CONTRALATERAL LOWER LIMB IN TYPE 2 DIABETIC AND HEALTHY WOMEN Contrast bath is a thermal agent that is used as alternative heat and cold water on a target limb. Type 2 diabetes mellitus in long term leads to vascular insufficiency. It seems that contrast bath is useful for patients with diabetes mellitus due to the increase in blood flow and vascular pumping. The purpose of this study is to investigate the effect(s) of contrast bath on circulation of contralateral lower limb in women with type 2diabetes mellitus compared to healthy subjects. The contrast bath protocol included the immersion of the right foot in the warm bath (38-440C) for four minutes and then in the cold bath (10-180C) for one minute. These processes were repeated five times as the total duration of the intervention was 24 minutes. The treatment was started and terminated with warm water. The dorsalis pedis pulse was significantly higher at all times of the measurements except between immediately post the contrast bath and after 10 minutes of applying it in the diabetic group .The results of the skin temperature measurement demonstrated incremental changes in the healthy and the diabetic groups. The oral temperature at all times was not significantly different in the normal and the diabetic groups (P > 0.05). The results of this study showed that contrast bath can increase circulation in the contralateral limb. However, its influence on superficial and deep blood flow is uncertain. 

16. REFE RENCES : Physical Agents in Rehabilitation An Evidence-Based Approach to Practice - Michelle Cameron Michlovitz'S Modalities for Therapeutic Intervention Therapeutic Modalities in Rehabilitation -  William E. Prentice  Therapeutic modalities - Chad starkey