1. Cryotherapy
   1. Definition
      1. "cold therapy;" moves heat out of the body
   2. Biophysiological effects
      1. Analgesic effect influences pain symptoms
      2. Vasoconstriction when applied less than 15 minutes; vasodilation when applied for longer than 15 min
      3. Cold slows down tissue repair but helps control inflammation and edema
      4. Can reduce spasticity
   3. Superficial agents (depths up to 2cm)
      1. Cold packs
         1. Inexpensive, commercially available, variety of shapes and sizes, can make at home
         2. Tx time 20 min
      2. Ice massage
         1. Involves holding ice directly against skin and moving in circles
         2. Tx time is no longer than 10 min
         3. Pt can expect to experience sensation of cold, burning, aching, and finally numbness
         4. Easy to do, inexpensive
         5. Not tolerated well by people and can be messy
2. Heat Transfer Mechanisms
   1. Conduction
      1. heat transfers from a stationary heat source that has direct contact with body tissue
   2. Convection
      1. heated particles/molecules move continuously across body tissue causing heat transfer
   3. Radiation
      1. transfer of radiant energy through air from a warmer source to a colder source
3. Documentation
   1. Physical agent applied
   2. Site of application
   3. Duration of treatment
   4. Physiological response
   5. Subjective response from patient
   6. Reason for using PAM
4. Thermotherapy
   1. Definition
      1. Any modality applied to the body that increases tissue temperature
   2. Superficial agents
      1. Depths up to 1cm
      2. Examples
         1. Warm whirlpool baths
            1. 99-104°F
            2. Tx time 20 min
            3. PROM and AAROM
            4. contraindications
            5. edema
            6. open wounds
         2. Fluidotherapy
            1. 105-118°F
            2. similar to a dry whirlpool bath
            3. Tx time 20 min
            4. PROM and AAROM
            5. contraindications
            6. open wounds
         3. Hot packs
            1. 104-113°F
            2. Wrapped in 6-8 layers
            3. Tx time 20 min
            4. Simple to use and widely available
            5. hot packs can be heavy and uncomfortable for clients; area treated needs to be immobile
         4. Paraffin
            1. A heating unit filled with paraffin wax and mineral oil
            2. 120-130°F
            3. PT immerses hand 1-2 seconds, withdrawals, and then repeat 8-10x
            4. Tx time 20 min
            5. area needs to remain immobilized during tx.
            6. contraindications
            7. open wounds
   3. Deep-heating agents
      1. Depths up to 5cm
      2. Examples
         1. Therapeutic ultrasound
   4. Biophysiological effects
      1. Analgesic effect reduces pain
      2. Vascular effects aid in pain relief and decreasing muscle spasm and spasticity
      3. metabolic effects influence tissuse repair
      4. Tissues are easier to stretch after heat