Oculomotor Nerve (cranial nerve III).pptx

Cranial nerves. Cranial nerve 3.

1. Heat & Cold Therapy Bismah Mudassar (70126686) Rana Sajid (70126500) Usman Saeed (70126182) Ramesha Kanwal (70126509) Alishba Sajid (70129777 ) Isha Mushtaq (70126317 )

2. Contents INTRODUCTION HEAT THERAPY SUPERFICIAL HEAT THERAPY MODALITIES OF SHT DEEP HEAT THERAPY COLD THERAPY EXAMPLES OF COLD THERAPY

3. Introduction to therapeutic heat Classification: S uperficial heat D eep heat. C lassification is done on the basis of depth of penetration of the thermal effect in to the body tissue.

4. Superficial Heat Therapy (SHT) M aximum depth of penetration of 5 mm from the surface of the skin. E ffect is restricted to the skin and superficial subcutaneous tissues.   Cautions and guidelines Duration : 15-20 minutes at a time to avoid burns or skin irritation. Temperature : Use a comfortable, warm temperature Protection : cloth or towel as a barrier between the heat source and your skin.

5. Vasodilation: blood vessels widen more blood flows through them, increasing circulation to the heated area. oxygen and nutrients to the tissues and removes metabolic waste products more efficiently. Muscle Relaxation: increased blood flow brings more oxygen and nutrients to the muscles, aiding in the repair of damaged tissue and reducing muscle soreness. Pain Relief: It blocks pain signals by stimulating sensory receptors in the skin, it promotes the release of endorphins (body's natural painkillers) Increased Tissue Elasticity: Heat makes tissues more pliable and elastic, helpful for stretching exercises or physical therapy. Mechanism of action of SHT Reduction in Stiffness: Heat therapy can reduce joint stiffness, making it easier to move and perform daily activities. This is especially useful for people with conditions like osteoarthritis or rheumatoid arthritis. Relaxation and Stress Reduction: The sensation of warmth and relaxation provided by heat therapy can have a calming effect on the nervous system, reducing stress and promoting a sense of well-being. Local Metabolism: Heat increases the metabolic rate of tissues, which can enhance the healing process by speeding up cellular activities involved in tissue repair.

6. Convection B y movement from a warmer zone of fluid or air to a cooler area by convection current. indirect transmission through physical movement of the molecules over the cooler body part, e.g. whirl pool bath, warm saline bath, hydrotherapy. Conduction from a warmer object to a cooler object by direct physical contact, e.g. salt packs, moist packs, and paraffin wax bath. Radiation from a warmer object to a cooler object by electromagnetic radiation, e.g. infrared radiation Transmission of superficial heat transfer of heat energy from a point of higher concentration to a point of lower concentration

7. Physiological effects of SHT Generalized heating Increased physiological reactions: Raised cardiac output metabolic rate pulse rate respiratory rate and superficial blood circulation Decreased physiological reactions: Lowered blood pressure muscle spasm blood supply to internal organs muscles and stroke volume of the heart Local heat application Increased physiological reactions: local blood flow Increased interstitial fluids turn over and better drainage Increased flexibility of capsules, ligaments and tendons Increased metabolic rate Decreased physiological reactions: joint stiffness muscle torque muscle spasm pain

8. Indications and Contraindications for SHT Indications Joint stiffness and pain Muscle spasm and pain Painful chronic lesions—Posttraumatic, degenerative or inflammatory Rheumatism of the skeletal and soft tissue. Contraindications Acute traumatic and inflammatory lesions of the musculoskeletal system Infections—local or general Circulatory deficiency Diminished thermal sensation Deep vein thrombosis Malignancy Bleeding disorder Severe swelling Impaired cognition or inability to assess the degree of heat being felt. Very young and very old patients.  

9. Types of superficial heat modalities

10. Paraffin wax bath Aka paraffin wax treatment or wax therapy therapeutic technique primarily focusing on the hands and feet involves immersing the affected body part in a bath of melted paraffin wax. Preparation: The therapy starts with a special paraffin wax unit or bath that heats the paraffin wax to a comfortable and safe temperature, typically between 125°F and 130°F (51°C to 54°C). The wax is melted until it becomes a liquid. Application: The liquid paraffin wax is then applied to the targeted body part, such as the hands, feet, or sometimes even other joints like elbows. Before application, the therapist may check the temperature to ensure it's not too hot. Immersion: The affected body part is gently immersed in the warm paraffin wax bath several times, allowing the wax to coat the area. As the wax cools and solidifies, it forms a wax shell around the body part. Wrap: After several layers of wax are applied and solidified, the therapist may wrap the treated area with a plastic or cloth wrap to retain heat and maintain the wax's warmth. Rest and Relaxation: The individual undergoing the treatment typically rests for about 20-30 minutes while the wax cools and hardens. During this time, the therapeutic benefits occur.

11. Pain Relief Improved Circulation Skin Hydration  Relaxation Enhanced Range of Motion Pain Management Benefits of Paraffin wax therapy

12. Hot/ hydrocollator packs Aka hot packs or moist heat packs commonly used form of physical therapy modality used in physical therapy and rehabilitation settings for various therapeutic purposes Composition: Hydrocollator packs are typically filled with bentonite, a natural clay material. Bentonite has the ability to absorb and retain moisture, making it ideal for creating moist heat therapy packs. How They Work: Heating: Hydrocollator packs are heated in a hydrocollator unit, which is a specialized heating device often found in physical therapy clinics or healthcare facilities. The unit contains a water bath that maintains the packs at a specific temperature, usually between 160°F to 165°F (71°C to 74°C).   Moist Heat: When heated, the moisture within the bentonite-based pack is released as steam. This moist heat penetrates the skin and underlying tissues more effectively than dry heat, providing therapeutic benefits.

13. Pain Relief Inflammation Reduction Joint Mobility Muscle Relaxation Scar Tissue Softening Chronic Conditions Benefits Application Heating: The packs are heated in the hydrocollator unit to the appropriate temperature. Protection: A cloth or towel is placed between the heated pack and the patient's skin to prevent burns or discomfort. Application: The heated pack is then applied to the targeted area for a predetermined amount of time, typically 15-20 minutes. Monitoring: The therapist monitors the patient during the treatment to ensure comfort and safety. Follow-up: After treatment, the area may be assessed for improved range of motion or pain relief, and additional therapies or exercises may be prescribed.

14. Electric heating pads Electric heating pads are portable and electrical devices designed to provide localized heat therapy for pain relief and comfort. They are commonly used to alleviate muscle aches, stiffness, menstrual cramps, and other sources of discomfort Electric heating pads are widely available in various sizes and shapes, including those designed for specific body parts like the neck, shoulders, or lower back.

15. Benefits Pain Relief Muscle Relaxation Arthritis Relief Menstrual Cramp Relief Stress Reduction Application Plug In: Plug the heating pad into an electrical outlet. Adjust Settings: Use the control unit to adjust the temperature to your desired level. Some heating pads offer multiple heat settings. Place on the Affected Area: Lay the heating pad on the area of your body that requires relief. Always ensure there is a cloth or a thin layer of fabric between the pad and your skin to prevent burns or discomfort. Timer: Some heating pads have a timer function that allows you to set a specific time for the treatment. This can be especially helpful if you plan to use the pad while sleeping . Monitor: While using the heating pad, periodically check the temperature and your comfort level. If the pad becomes too hot or uncomfortable, turn it off or adjust the temperature. Safety Precautions: Follow the manufacturer's safety instructions and avoid falling asleep with the heating pad turned on.

16. Whirlpool bath Aka whirlpool tub or jacuzzi bathtub equipped with water jets that create a swirling or "whirlpool" effect when the tub is filled with water. Components of a Whirlpool Bath: Tub: The whirlpool bath itself is a bathtub with a specially designed shape and interior contours to accommodate water jets. It can come in various sizes and shapes, from standard rectangular tubs to more ergonomic and luxury designs. Water Jets: Water jets are strategically positioned in the walls or base of the tub. These jets release pressurized water, creating a swirling motion in the bath. Control Panel: A control panel allows users to adjust the intensity and speed of the water jets. Some whirlpool baths also offer features like adjustable temperature and lighting.

17. Benefits Hydrotherapy Stress Reduction Improved Circulation Pain Relief Enhanced Skin Health Improved Sleep Whirlpool baths are generally safe for most people, but individuals with certain medical conditions, such as heart problems or open wounds, should consult with a healthcare provider before using them. Additionally, maintaining proper hygiene and cleanliness in the whirlpool bath is crucial to prevent the growth of harmful bacteria.

18. Contrast bath Hydrotherapy treatment Combination of the effects of both hot and cold bath Body parts immersed in both hot and cold water tanks alternatively Hot water range 36-45◦C Cold water range 15-20◦C The hot water causes vasodilation of the blood flow in the limb The cold water causes vasoconstriction, increasing local blood circulation. Reduces nerve conductivity, muscle spasm and spasticity.

19. Helio means sun therapy means treatment The use of natural sunlight for therapeutic purposes is better known as Heliotherapy. Helps in Melanin production Stimulate metabolism Positive effect on general health Vitamin D formation Heliotherapy

20. Sauna bathing is a form of passive heat therapy  Characterized by exposure to high environmental temperature for a brief period.  Beneficial effect on circulatory, cardiovascular, and immune functions. Relief of stress, muscle spasm, pains and aches, reduction in body weight. Sauna Bath

21. Deep heat therapy (DHT )/ Thermography Deep heat is a treatment for injury and pain. The heat relaxes the muscles and blood vessels, which helps treat muscle spasms and brings more blood to the treated area. Heat generated deep inside living tissues by conversion of non-thermal energy like electromagnetic radiations. This conversion is achieved using the interaction between the non-thermal energy fields and the physical properties of the body tissues, namely capacitance, inductance and acoustic impedance. Different modalities using such energy conversion are shortwave—diathermy, microwave diathermy and therapeutic ultrasound.

22. Physiological effects of DHT Vasodilation Increased blood flow to the treated area, improving nutrient and oxygen delivery. Enhanced removal of waste products. Muscle relaxation Relaxes muscles and reduces muscle spasms. Helps alleviate muscle pain and improve range of motion. Pain relief Stimulates sensory receptors, blocking pain signals (pain gate control). May trigger the release of endorphins (natural painkillers). Tissue extensibility Increases tissue flexibility, making it easier to perform stretches and exercises. Reduces the risk of strains and injuries. Metabolism enhancement Increases the metabolic rate in treated cells, potentially accelerating tissue repair Stress reduction Calming effect on the nervous system, reducing stress and muscle tension Joint mobility Alleviates joint stiffness, improving ease of movement, especially in arthritis cases Soft tissue healing Promotes healing of soft tissues like muscles, tendons, and ligaments through improved blood flow and nutrient delivery

23. Indications Muscle Pain and Tension Arthritis Chronic Pain Sports Injuries Menstrual Cramps Muscle Preparation Contraindications  Acute Inflammation Open Wounds Impaired Sensation Certain Skin Conditions Circulatory Disorders Fever Pregnancy Cancer Heart Conditions Types of modalities Ultrasound: Utilizes high-frequency sound waves to generate deep heat in tissues, promoting blood flow and tissue repair. Shortwave Diathermy: Electromagnetic waves produce deep tissue heating, beneficial for joint pain and muscle injuries. Microwave Diathermy: Uses microwaves to generate heat in deeper tissues, often employed for large muscle groups. Infrared Therapy: Infrared lamps or pads emit heat waves to penetrate deep tissues, improving circulation and easing muscle tension

24. Cold therapy/ cryotherapy Localized cooling of the body surface to extract body heat from the underlying tissues, by evaporation or conduction, in order to lower local tissue temperature thermoregulatory reaction is known as cold therapy or cryotherapy. Techniques Ice massage ( ice is placed in a polythene bag and applied over the body tissue) Ice towels ( fill a bucket or bowl with two parts of flaked or crushed ice to one part water in which two terry towels are immersed) Immersion in cold or cold whirlpool ( part of the body is immersed in cold water or a whirlpool in which temperature of water is lowered up to 0-10C) Ice packs or cold packs ( contain special material which retains the cold like the silicate gel) Evaporative cooling or vapocoolant sprays ( used very commonly in sporting activities or athletic injuries) Excitatory cold ( The marked sensory stimulus of ice on the skin can be used to facilitate contraction of inhibited muscle. The ice is stroked quickly three times over the dermatome and skin is then dried).

25. Positive Increased joint stiffness Increased pain threshold Increased blood viscosity Increased strength of muscle contraction Negative Reduced blood flow Reduced capillary permeability Reduced metabolic rate Reduced muscle spasm Reduced strength of muscle contraction Reduced spasticity Physiological effects Adverse Physiological effects: Hypersensitivity to cold is mostly related to release of histamine leading to Cold Urticaria- red wheals on the skin associated with sever itching. Flushed face. Puffy eyelids. Respiratory distress. Anaphylactic shock and syncope

26. Mechanism of action Vasoconstriction: When cold is applied to the skin, it causes blood vessels to constrict or narrow. This reduces blood flow to the area, which can help decrease inflammation and swelling. Pain Reduction: Cold therapy can temporarily numb the nerve endings in the treated area, leading to a reduction in pain perception. It also slows down the transmission of pain signals to the brain. Metabolic Rate Reduction: Cold temperatures can slow down metabolic processes, which can be beneficial in reducing tissue damage and minimizing the body's oxygen and nutrient requirements. Anti-Inflammatory Effect: Cold therapy helps reduce the production of inflammatory molecules, which can be helpful in managing acute injuries and inflammatory conditions.  Muscle Relaxation: Cold therapy can help relax muscle fibers and reduce muscle spasms, making it useful for treating muscle injuries and tension. Edema Control: By limiting blood flow and reducing inflammation, cold therapy can help prevent or minimize the accumulation of excess fluid (edema) in the affected area.

27. Indications Acute soft tissue injuries (e.g., ankle sprain, muscular strain, ligament sprain) Muscle spasm Tendinitis Tenosynovitis Acute swelling Bursitis Post orthopedic surgery Reducing temperature Contraindications Hypersensitivity to cold Open wounds Nerve damage Cold urticaria High blood pressure Recent surgery Peripheral vascular disease

28. Grades of Sprain Grade 1 : Minimal pain and disability: weight bearing not impaired Grade 2 : Moderate pain and disability: weight bearing difficult Grade3 : Severe swelling, no pain, discoloration, no weight bearing possible, significant functional loss. One of the most frequent injured structures in sports, particularly in basketball and football. Lateral ligament sprain accounts for 85% of all ankle sprains. Investigation: X-ray: AP, Lateral (to see any associated fracture) Gradual exercises are started after 72 hours of the injury. Once swelling and pain subsides, partial weight bearing can be started. When partial weight bearing is pain-free, full weightbearing is allowed and early return to activities is suggested. Treatment: P : R : I : C : E : S : Prevention Rest Icing Compression Support. Example: Ankle sprain 28

29. Clinical Features Pain swelling decreased ROM ecchymosis. Very common in contact sports. of injury is direct blow or hit by a blunt object or by a ball. Hematoma occurs when a large sized vessel is damaged and blood starts accumulating in the area. Investigations X-rays are usually normal, but beneficial to exclude any fracture. Treatment Initial application of ice is very beneficial. Cold pack is used for subsidizing swelling and to reduce pain. Ice is applied for a period of at least 20 minutes and response is seen. If there is reduction in swelling and hematoma, it can be continued for another 20 minutes after a interval of 10 minutes. Example: Muscle contusion/ Hematoma

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