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Cryotherapy in Occupational Therapy

Cryotherapy in Occupational Therapy by Dennis M., MS OTR:

A survey taken by AOTA revealed that cryotherapy was the second most used Physical.

Agent Modality used in occupational therapy practice. So not the most exciting topic to discuss, but a useful one to Occupational therapy patients. The most important principle in the use of Physical Agent Modalities in the practice of Occupational therapy practice, is that it is used as an adjunct to facilitate increased independence in occupational performance for the patient.

The ancient Greeks and Romans used ice & snow for a variety of health related problems. Cryotherapy was used in the 1800s following surgery, and is still practiced today for some orthopedic surgeries. So cryotherapy is a very useful tool for the Occupational therapy practioner. Cryotherapy can be used for sub-acute inflammation, muscle spasm, acute muscle ligament strain, bursitis, tendonitis, and spasticity; to name a few conditions. Cryotherapy is normally applied as: cold packs, ice massage, cold water immersion baths, ice towels & vapocoolant sprays. Cryotherapy is the application of any substance to the body effectively lowering the temperature of the tissue to one-to-two centimeters in depth (Bracciano 2008).

Cold has a direct effect on nerves, nerve endings and causes analgesia through counter irritation, so the therapist can involve the patient in activities which may have been limited due to pain. Cold packs can be left on an average time between 10-20 minutes, closely monitoring any boney prominences & skin to prevent tissue damage from too rapid or prolonged cooling.

Ice Massage can be applied to a smaller or localized area and should not exceed 10 minutes in length, as frostbite and tissue damage may occur. Cold/Ice water immersion baths are often used for edema reduction and used in conjunction with wrapping or compression for digital or hand injuries. The patient is advised to continue hand pumping and exercise throughout the treatment which is normally 15-20 minutes. Therapeutic water temp should be between 35 & 75 degrees Fahrenheit. Ice Towels can be used for the ability to circumferentially covering an extremity but will need to be changed every 5-6 minutes. Vapocoolant sprays are used in the treatment of Trigger points as developed by Travell in the Spray & Stretch Techniques. Cooling agents should not be used with patients who have been diagnosed with cold urticaria, cryoglobulinemia, Raynaud’s disease, compromised circulation, peripheral vascular disease, hypertension or a past history of Frostbite. This brief article only gives an introduction to the use of Cryotherapy and further education should be done for more specific applications and protocols.  

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