Equipment required

- Paraffin
- Mineral oil
- Thermostatically controlled container
- Plastics bags or paper
- Towels or mitts

Procedure

Paraffin may be applied by three different methods: dip-wrap , dip-immersion, and paint. The
dip-wrap method is the one most commonly used. The dip-wrap and dip-immersion
metghods can be used only for treating the distal extremities. The paint method can be used
for any area of the body. With all three methods, do the following:

1. Remove all jewelry from the area to be treated and inspect the area
2. Throughly wash and dry the area to be treated to minimize contaminatiion of the
paraffin
For teh dip-wrap method (for the wrist and hand):
3. With fingers apart, dip the hand into the paraffin as fa as possible and remove (Fig.
8.27). advise the patient to avoid touching the sides or the bottom of the tank because
these areas may be hotter than the paraffin.
4. Wait briefly for the layer of paraffin to harden and becomr opaque.
5. Redip the hand, keeping the fingers apart. Repeat steps 3 through 5 six to ten times.
6. Wrap the patient’s hand in plastic bag, wax paper, or treatment-table paper and then in
a towel or towelling mitt. The plastic bag or paper prevents the towel from sticking to
the paraffin, and the towelling acts-as insulation to slow the cooling of the paraffin.
Caution the patient not to move the hand during dipping or during the rest period
because movement may crack the coating of paraffin, allowing to penetrate and the
paraffin to cool more rapidly.
7. Elevate the extremity
8. Leave the paraffin in place for 10 to 15 minutes or until it cools.
9. When the intervention is completes, peel the paraffin oof the hand and discard it (Fug.
8.28).
For the dip-immersion method:

3. with fingers apart, dip the hand into the paraffin and remove.

4. wait 5 to 15 seconds for the layer of paraffin to harden and become opaque.

5. redip the hand, keeping the fingers apart.

6. allow the hand to remain in the paraffin for up to 20 minutes, and then remove it.

The temperature of the paraffin should be at the lower end of the range for this method of
application because the hand cools less during treatment than with the dip-wrap method.
 Yhe heater should be turned off during treatment so that the sides and the bottom of the
tank do not become too hot.

For the paint method:

3. paint a layer of paraffin onto the treatment area with a brush.

4. wait for the layer of paraffin to become opaque.

5. paint on another layer of paraffin no longer than the first layer.

Repeat steps 3 through 5 six to ten times.

6. cover the area with plastic or paper and then with towelling. As with the dip-immersion
method, the plastic or paper is used to prevent the towel from sticking to the paraffin, and
the toweilling acts as insulation to slow down the cooling to the paraffin.

Caution the patient not to move the area during treatment because movement may crack
the coating of the paraffin, allowing air to penetrate and the treatment area to cool more
rapidly.

7. leave the paraffin in place for 20 minutes or until it cools.

8. when the intervention is completed, peel off the paraffin and discard it.

For all methods:

When the intervention is complete, inspect the treatment area for any signs of adverse
effects, and document the intervention.
APPLICATION TECHNIQUE 8.8

In most clinics, the paraffin bath is left plugged in and on at all times. In this circumstance,
it can be used by many patients, one after another, and its goal temperature can be
maintaned. If the unit is unplugged or turned off and the paraffin is allowed to cool, be
sure that the paraffin has returned to between 52C and 57C (126F and 134F) before it is
used again for treatment. Caution should be applied for the first 5 hours after turning a
unit on because some units take up to 5 hours to heat the wax, and during this heating
period, parts of the wax may be hotter than the recommended therapeutic temperature
range. This could result in burning. Always follow the manufacturer’s instructions to
ensure safe use.

Advantages

- Maintains good contact with highly contoured areas

- Easy to use
- Inexpensive
- Body part can be elevated if dip-wraps method is used
- Oil lubricates and conditions the skin
- Can be used by the patient at home

Disadvantages

- Messy and time-consuming to apply

- Cannot be used over an open skin lesion because it may contaminate the lession
- Risk of the cross-contamination if the paraffin is reused
- Part in dependent position for dip-immersion method

FLUIDOTHERAPY

Fluidotherapy is a dry heating agents that transfer heat by convection. It consists of a

cabinet containingfinely ground cellulose particles made from corn cobs. Heated air is
circulated through the particles, suspending and moving the so that they act like a liquid.
The patient extends a body part into the cabinet, where it floats as if in water. Portals in
the cabinet allow the therapist to access the patient’s body part while it is being heated.
Fluidotherapy units come in variety of sizes suitable for treating different body parts.
Both the temperature and the amount of particle agitation can be controlled by the
clinician. (Fig.8.30).
 APPLICATION TECHNIQUE 8.9

Equipment required

- Fluidotherapy unit of appropriate size and shape for areas to be treated

Procedure

1. Remove all jewelry and clothing from the area to be treated and inspect the area.
2. Cover any open wounds with a plastic barrier to prevent the cellulose particles from
becoming lodged in the wound.
3. Extend the body part to be treated through the portal of the unit(see fig 8.29).
4. Secure the sleeve to prevent particles from escaping from the cabinet.
5. Set the temperature at 38C to 48C (100F to 118F).
6. Adjust the degree of agitation to achieve aptient comfort.
7. Teh patient may move exercise during the intervention.
8. Treat for 20 minutes.

Advantages

- Patient can move during the intervention work on gaining AROM

- Minimal pressure applid to the area being traeted
- Temperature well controlled and constant throughout intervention
- Easy to administer

Disadvantages

- Expensive equipment
- Limb musr be in dependent position in some units, increasing the risk of edema
formation
- The constant heat source may result in overheating
- If the corn cob particles spill onto a smooth floor, they will make the floor slippery

INFRARED LAMPS

IR lamps emit electromagnetic radioation within the frequency range that gives rise to heat
when absorbed by matter (Fig.8.31). IR radiation has a wavelength of 770 to 10 6 nm, lying
between visible light and microwaves on the electromagnetic spectrum (see Fig.16.6) and is
emitted, along with visible light and UV radiation, by the sun. IR radiation is divided into
three bands with differing wavelength ranges: IR-A, 770 to 1400 nm; IR-B 1400 to 300 nm;
and IR-C, 3000 to 106 nm. IR lamps currently used in rehabilitation emit IR-A generally with
mixed wavelengths of approximately 780 to 1400 nm and with mixed wacelengths of
approximately 1000 nm. Other sources of IR include sunlight, IR light-emitting diodes
(LEDs), supraluminous diodes(SLDs), and low-intensity lasers.
 The increase in tissue temperature produced by IR radiation is proportional to the
amount of radiation is proportional to the amount of radiation that penetratres the tissue,
which is a function of the power an dwavelenght of the radiation, the distance between the
radiation source and the tissue, the angle of incidence of the radioation, and the absorption
coefficient of the tissue.

Most IR lamps deliver radiation with 50 to 1500 watts of power. Most IR radiation
produced by today’s lamps (780 to 1400 nm wavelength) is absorbed within the first few
milli-meters of human tissue, but at least 50% of UR radiation of 1200 nm wavelength
penetrates beyond 0.8 mm and therefore is able to oass through the skin to interact with the
subcutaneous cappilaries and cutaneous nerve endings. Human skin allows maximum
penetration of radiation with a wavelength of 1200 nm, while being virtually opaque to IR
radiation with a wavelength of 2000 nm greater.

The amount of energy reaching the patient from an IR radiation source is also related to the
distance between the source and the tissue. As the distance of the source from the target
increases, the intensity of radiation reaching the target decreases in proportion to the square
of the distance. For example, if the source is moved from a position 5 cm from the target 10
cm from the target-increasing by a factor if 2, the intensity of radiation reaching the target
will fall to ½ 3 or one-fourth (25%) of its prior level.

The amount of energy reaching the target is also related to the angle of incidence of
the radiation; the angle of incidence is the angle between an incidence ray and the normal to
be surface. As the angle of incidence of the radiation changes, the intensity of the energy
reaching the target decrease in proportion to the cosine of the angle of incidence. For
example, if the angle of incidence changes from 0 degrees (i.e.,perpendiculae to the surface
of the skin), with a cosine of 1, to 45 degrees, with cosine of 1/akar 2, the intensity of
radiation will fall by a factor of 1-0,707= 0,23 or by about 23%. Thus the intensity of
radiation reaching the skin is greater when the source is close to the patient’s skin and the
radiation beam is perpendicular to the skin surface.

IR radiation is absorbed the most by darker tissues having hugh IR absorption

coefficients. With the same radiation and lamp positioning, dark skin will absorb more IR and
therefore will increase in temperature more than light skin will.

A number of authors have provided formulae for calculating the exact amount of heat
being deliveres to a patient by IR radiation or for measuring the increase in tissue
temperature;hiwever, as with other thermal agnets, in clinical practice, the patient’s sensory
report is the best gauge of skin temperature. The amount of heat transfer is adjusted by
changing the power output of the lamp and/or the distance of the lamp from the patient so
that patient feels a comfortable level of warmth.

IR lamps for heating superficial tissues were popular during the 1940s and 1950s.
Although IR produces expected effects of heat including reducing pain in patients with
chronic low back pain and increasing joint flexibility and thus the increase in ROM produces
by stretching in joints with contractures, the use of IR has waned in recent years. The decline
in popularity appears to be the result of changes in practice style and concern about
overheating patients if they are placed or move too close to the lamp, rather than excessive
adverse effects or lack of therapeutic efficacy. Most curents uses and literature regarding IR
in therapy relate to low-intensity IR lasers with nonthermal effects, as discussed in detailin
Chapter 16,

AOOLICATION TECHNIQUE 8.10 INFRARED LAMPS

Equipment required

- IR lamp
- IR opaque googles
- Tape measure to measure distance of the treatment area from IR souce
- Towels

Procedure

1. Remove clothing and jewelry from the area to be treated and inspect the area. Drape
the patient for modestly, leaving the area to be treated uncovered.
2. Put IR opaque googles on the patient and the therapist if there is a possibility of IR
irradiation of the eyes.
3. Allow the IR lamp to warm up to 5 to 10 minutes so it will reach a stable level of
output.
4. Position on the patient with the surface of the area to be treated perpendicular to the
IR beam and approximately 45 to 60 cm away from source. Remember that the
intensity of the IR radiation reaching the skin decreases, with an inc=verse squar
relationship, as the distance from the source increases and in proportion to the cosine
of the angle of incidence of the beam. Adjust the distance from the source and wattage
of the lamp output so that the patient feels a comfortable level of warmth. Measure
and record the distance of the lamp from the target tissue.
5. Provide the patient with a means to call for assistance if discomfort occurs.
6. Intruct the patient to avoid movung closer to or farther from the lamp and to avoid
touching the lamp because movement toward or away from the lamp will alter amount
of energy reaching the patient.
7. Set the lamp to trear for 15 to 30 minutes. Generally, treatment times of about 15
minutes are used for subacute conditions, and the treatment times of up to 30 minutes
are used fro chronic conditions. Most lamps have a timer that automatically shuts off
the lamp when the traetment times has elapsed.
8. Monitor the patients’s response during treatment. It may be necessary to move the
lamp farther away if the atient becomes too warm. Be cautious in moving the lamp
closer if the patient report npot feeling warm enough because the patiene may
accommodated to the sensation and may not judge the heat level accurately once
warm.
9. When teh intervention is completed, turn off the lamp and dry any perspiration from
the treated area.
ADVANTAGES

- Does not require contact of the medium with the patient, which reduces the risk of
infection and the possible discomfort of the weight of hot pack and avoids the
problem of poor contact when highly contoured areas are treated
- The area being treated can be observed throughout the intervention

DISADVANTAGES

- IR radiation is not easily localized to a spesific treatment area

- It is difficult to ensure consistent heating in all treatment areas because the amount of
heat transfer is affected by the distance of the skin from the radiation source and the
angle of the beam with the skin, both of which vary with tissue contours and may be
inconsistent between treatment sessions