Background

This section provides two videos about how the occupational therapy (OT) practitioner can use physical agent modalities (PAMs).  Specifically, you will learn about cryotherapy and thermotherapy. Cryotherapy uses cold temperatures for therapy. Thermotherapy uses of hot temperatures for therapy. These PAMs are tools to use within your therapy practice to help your client accomplish their goals. PAMs are thought to alter the body’s physiological function and pain perception, to improve movement, and to increase healing.

When using PAMs, it is important to keep a few things in mind. First, keep your client’s goals and occupations central. The American Occupational Therapy Association collaborated with the organization Choosing Wisely to develop recommendations for best practices. One of the recommendations is “Don’t use physical agent modalities (PAMs) without providing purposeful and occupation-based intervention activities.”  Meaning, use PAMs as a way to open a door to accomplish occupations, exercises, or other therapeutic interventions.

Second, always make certain that you know, understand, and follow precautions and contraindications to ensure that you do not harm your client. Precautions indicate that your client has conditions that may cause them harm from the PAMs, so use extra caution. Contraindications are conditions that indicate that your client will be harmed from the PAMs. DO NOT use PAMs if contraindicated.

Finally, know your state’s PAM regulations. Each state’s licensure laws dictate the professional qualifications required to use PAM. States’ requirements vary.  We recommend that you read your state’s OT Practice Act prior to using any physical agent modalities.

Cryotherapy

This video explains two different ways the OT practitioner may use cryotherapy, or cold therapy. The video discusses when it is appropriate to use cryotherapy, precautions that should be taken, and the contraindications, which indicate that it is not appropriate for you to use cryotherapy.

Video is licensed under CC BY 4.0.

Cryotherapy Video Transcript

Cryotherapy Tips

The purpose of using cryotherapy—cold modalities, is to decrease blood flow, slow metabolism, decrease inflammation, and reduce your client’s pain. This opens a door so that you can work with your client, pain free, to do things that they couldn’t do before, such as exercises.

• Physiological Effects
  • Vasoconstriction.
  • Analgesic effects.
  • Slowed metabolism.
  • Neuromuscular effects, such as reducing spasticity.
• Precautions
  • Diminished circulation.
• Contraindications
  • Peripheral vascular disease or compromised circulation.
  • Cold sensitivity or Raynaud’s phenomenon.
  • Multiple myeloma, leukemia, or systemic lupus—cryoglobulinemia.
  • Cold intolerance—rheumatic diseases or following amputations or crush injuries.

Ice Pack Tips

• • DO NOT ever put icepacks directly on your client’s skin. Make sure to have at least one layer of fabric in between skin and ice.
  • Apply ice packs no longer than 20 minutes.

Ice Massage Tips

• • Hold ice directly against your client’s skin and move in slow circles over the target tissue.
  • Your client will report the following sequence: cold, burning, aching, and numbness.
  • The goal is for your client to reach numbness, which generally takes 10 minutes or more.

Thermotherapy

This video explains how the OT practitioner can use thermotherapy, or heat, as PAMs. We discuss what thermotherapy does, why to use it, precautions and contraindications, and two different ways to administer thermotherapy.

Video is licensed under CC BY 4.0.

Thermotherapy Video Transcript

Thermotherapy Tips

The purpose of using thermotherapy—hot modalities, is to increase heat and vasodilate tissue, which causes more blood flow to come into that tissue area. More blood flow will increase the body’s metabolism, impacting that immune healing function.

• Physiological Effects
  • Vasodilatation.
  • Decreased tissue viscosity.
  • Increased metabolism.
  • Analgesic, pain relieving effects.
• Therapeutic Range
  • Tissue temperature range is 102° F to 113° F.
• Precautions
  • Edema.
  • Diminished circulation.
  • Compromised circulation.
  • Use of anticoagulant medications.
  • Heat sensitivity.
• Contraindications
  • Impaired sensation caused by skin grafts or scarring.
  • Tumors or cancer.
  • Advanced cardiac disease.
  • Acute inflammation or acute edema.
  • Deep vein thrombosis.
  • Pregnancy.
  • Bleeding tendencies.
  • Infection.
  • Primary tendon or ligament repair.
  • Semi-coma or impaired status.
  • Rheumatoid arthritis.
  • Open wounds or skin infections for paraffin baths.

Moist Hot Pack Tips

• Apply moist hot packs for 10-20 minutes.
• Have at least six to eight layers of dry padding between the hot pack and your client.

Paraffin Bath Tips

• Have your client wash their hands with soap and water first.
• Have your client dip their hands into the paraffin bath for one to two seconds.
• Have your client remove their hands and allow the paraffin to harden.
• Ask your client to repeat the above eight to ten times.
• Help your client place their hands in insulated mitts or a towel.
• Wrap your client’s mitted or toweled hands in a plastic bag for 15-20 minutes.

Resources

• Cryotherapy, Physiopedia
• Thermotherapy, Physiopedia
• Therapeutic Modalities by Benjamin J. Seidel, DO, Lawrence Chang, DO, MPH, Aaron Greenberg, DO from PM&RKnowledgeNOW

References

Bracciano, A. G. (2008). Physical agent modalities: Theory and application for the occupational therapist. Slack Incorporated.