1、Chapter 9 Cold and Heat Therapy Section Introduction Section Cold and Heat applications Section Introduction Concept of Cold and Heat Therapy Bodily Responses to Cold and Heat Therapy Factors Influencing the Effect of Cold and Heat Therapy Concept of Cold and Heat Therapy The Cold and Heat Therapy i
2、s a therapy method that utilizes substances, the temperature of which are lower or higher than the skin surface temperature, acting on the skin, to attain local and systemic treating effects. cold receptors （ Krause小 体 ): - 真皮上 层 （ 乳头状层 ） ,接受冷的 迅 息 . Heat receptors （ Ruffinis小 体 ): - 真皮下 层 （ 网状层 ),接
3、受 热 的 迅 息 . 25-30万个 3万个 Heat and cold receptors adapt rapidly to temperature changes in the bodys environment. 表皮 真皮 冷刺激 真皮上 层 Krause小 体 热刺激 真皮 下层 Ruffinis小 体 传入 神经纤维 大脑皮质感觉中枢 传出 神经纤维 机体产生相应运动 反射性地引起皮肤和内脏器官血管收缩或扩张 改变机体各系统的体液循环和代谢活动 Bodily Responses to Cold and Heat Therapy Initial, or Primary Respon
4、ses Physiological Responses Thermal Receptors Adaptation Secondary Responses Physiological Responses Table 9-1 physiological responses to heat and cold Heat Cold Vasodilation Vasoconstriction Increases blood flow to the affected area; increases supply of nutrients, oxygen, and wastes removal Reduces
5、 blood flow to the affected area; reduces supply of nutrients, oxygen, and wastes removal Increases capillary permeability Decreases capillary permeability Increases cellular metabolism Decreases cellular metabolism Increases amount and motility of leukocytes Decreases amount and motility of leukocy
6、tes Increases inflammation and suppuration Slows bacterial growth, decreases inflammation Increases lymph flow Reduces lymph flow Raises body temperature Lowers body temperature Decreases the viscosity of the blood Increases the viscosity of the blood Decreasesmuscle tonus and relaxes muscles Increa
7、ses nerve impulse conduction Decreases nerve impulse conduction Decreases viscosity of synovial fluids When the heat and cold receptors are subjected to an abrupt change in temperature, the receptors are strongly stimulated initially. This strong stimulation declines rapidly during the first few sec
8、onds and then more slowly during the next half hour or more as the receptors adapt to the new temperature. This phenomenon is called thermal receptors adaptation. Thermal Receptors Adaptation 16 42 Secondary Responses 继发性效应 When the maximum therapeutic effect of the heat or cold application is achie
9、ved, the opposite effect begins. We call these phenomenon secondary responses. For example heat produces maximum vasodilation in 20 to 30 minutes; continuation of the application beyond 30 to 45 minutes brings tissue congestion, and the blood vessels then constricted. Similarly, cold applications ca
10、n cause blood vessel constriction, but continuation of application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes. Factors Influencing the Effects of Cold and Heat Therapy Treatment method Size of the exposed body part Duration of application Prior skin temperature Environmental te
11、mperature Body part Individual tolerance Treatment method moist heat or cold dry heat or cold the therapeutic effects of moist application are better than that of dry application. Environmental temperature When the environmental temperature is greater than or equal to the body temperature, conductiv
12、e loss is inhibited. Body part The foot and palm of hand have thicker skin and are therefore less temperature-sensitive. certain areas where the skin is thinner, such as the inner aspect of the wrist and forearm, eyelids, the neck, and the perineal area(会阴部 ) are less tolerant to temperature variati
13、ons. Individual tolerance very old person-the sensitivity to heat or cold is decreased and therefore response to the heat and cold stimuli is retarded. Infants-have limited abilities to adapt to heat and cold because of their immature neurological functioning. clients who have neurosensory impairmen
14、ts Section Cold and Heat applications Cold application Heat application Cold application Therapy Effects of Cold Contradictions to cold applications methods Therapy Effects of Cold Relief of congestion or hemorrhage to the affected area (减轻局部充血和出血 ) Relief of pain Controlling inflammation Reducing f
15、ever, and so on. 细胞代谢细胞代谢 增加增加 减少减少需氧量需氧量 增加增加 减少减少血管血管 扩张扩张 收缩收缩毛细血管通透性毛细血管通透性 增加增加 减少减少血液黏稠度血液黏稠度 降低降低 增加增加血液流动血液流动 增快增快 减慢减慢淋巴流动淋巴流动 增快增快 减慢减慢结缔组织伸展性结缔组织伸展性 增强增强 减弱减弱神经传导速度神经传导速度 增快增快 减慢减慢体温体温 上升上升 下降下降生理效应生理效应 用用 热热 用用 冷冷细胞代谢细胞代谢需氧量需氧量毛细血管通透性毛细血管通透性血液黏稠度血液黏稠度血液流动血液流动淋巴流动淋巴流动结缔组织伸展性结缔组织伸展性神经传导速度神
16、经传导速度生理效应生理效应 用用 热热 用用 冷冷细胞代谢细胞代谢 增加增加 减少减少需氧量需氧量 增加增加 减少减少血管血管 扩张扩张 收缩收缩毛细血管通透性毛细血管通透性 增加增加 减少减少血液黏稠度血液黏稠度 降低降低 增加增加血液流动血液流动 增快增快 减慢减慢淋巴流动淋巴流动 增快增快 减慢减慢结缔组织伸展性结缔组织伸展性 增强增强 减弱减弱神经传导速度神经传导速度 增快增快 减慢减慢体温体温 上升上升 下降下降生理效应生理效应 用用 热热 用用 冷冷细胞代谢细胞代谢需氧量需氧量毛细血管通透性毛细血管通透性血液黏稠度血液黏稠度血液流动血液流动淋巴流动淋巴流动结缔组织伸展性结缔组织伸展
17、性神经传导速度神经传导速度生理效应生理效应 用用 热热 用用 冷冷减轻局部充血和出血 使局部血管收缩 ,血流减少 毛细 血管的通透性降低 使血流减慢 血液粘稠度增加 适用于 : 扁桃体摘除术后 ; 鼻衄 ; 局部软组织损伤的初期 ,等 . 减轻局部充血 促进血液凝固而控制出血 减轻疼痛 抑制细胞的活动 减慢神经冲动的传导 血 管收缩 毛细 血管的通透性降低 , 渗出减少 适用于 : 急性损伤的初期 ; 烫伤 ; 牙痛 ,等 . 使神经末稍的敏感性降低而减轻疼痛 . 减轻由于组织肿胀压迫神经末梢而引起的疼痛 . 控制炎症扩散 可使局部血管收缩，血流量减少 血流速度减慢 细胞代谢率 和细菌的活力降
18、低 适用于 : 体表部位炎症早期 .如鼻部软组织发炎 早期，可采用鼻部冰敷以控制炎症扩散 . 降低体温 冷直接与皮肤接触，通过 传导 与 蒸发 的物理 作用，降低体温 ; 头部用冷 : 可降低脑细胞的代谢， 减少脑细胞需氧量 ,提高脑细胞对缺氧的耐受性 ,减少脑细胞的损害 ,有利于脑细胞功能的恢复。 适用于 :高热、中中暑患者降温 ; 脑外伤、脑缺氧等患者 . Contradictions to cold applications Impaired Local Circulation Chronic Inflammation and Deep Suppuration Clients with
19、Cold Hypersensitivity, Heart Diseases and very Weak Clients Contradicted Body Parts 血液循环障碍 大面积组织受损 休克 微循环障碍 周围血管病变 动脉硬化 糖尿病 水肿 ,等 进一步使血管收缩 减少局部组织的血供 导致组织变性坏死 冷 疗 血管收缩，血流减少，影响细胞间液的吸收 . 慢性炎症或深部化脓病灶 关节炎 慢性背部疼痛 痔疮 肛周脓肿等 可使局部血流减少 阻碍炎症的吸收 冷 疗 Contradicted Body Parts posterior occipital, external ear and s
20、crotum (枕后、耳廓、阴囊 ); precordial region(心前区 )-may result in reflexible decreased heart rate and arrhythmia; Abdomen(腹部 )-abdominal pain and diarrhea; sole of foot(足底 )- can cause reflexible coronary artery constriction. Methods ice bag, ice cap or ice collar chemical cold pack moist cold cold compress
21、 cold soaks cooling sponge bath dry cold alcohol sponge bath tepid sponge bath local preparation Assessment the clients physical condition Equipment The clients level of sensation Explanation The client understands the purpose of the therapy and precautions taken during treatment. Use of Ice Bags Purpose to reduce body temperature. to reduce hemorrhage, swelling and pain after sprains, head injuries and dental surgeries
