ModalitiesThis is a featured page


Occupational therapists use a variety of modalities to help with treatment.
A modality is the employment of therapeutic agents such as
whirlpools, hot packs, cold packs, paraffin, and fluidotherapy. The
modalities either produce heat or cold and are used for a variety of
Heat modalities are generally used as a preliminary to a prescribed
exercise or activity. Heat helps to increase circulation to the affected
area, decrease pain, improve elasticity of soft tissue prior to stretching
or exercise, and improve joint mobility.
Cold modalities assist in reducing swelling, inflammation, and pain.
Generally, cold modalities are utilized after a treatment session, activity,
or exercise.

Hot Packs
Hot packs are kept in a machine called a hydrocollator, which is filled
with water that’s kept at approximately 170° F, although the hot
packs themselves aren’t that hot.
When placing hot packs on an individual, it’s imperative to put sufficient
toweling and padding in place to prevent burning. Hot packs
are placed in thick, terry cloth pads prior to being placed on the skin.
Four layers of toweling should be in place at all times. The hot packs
are applied for approximately 15 minutes, during which time the patient
should be checked to ensure that the treatment is comfortable
and not causing excess redness.

Fluidotherapy is often compared to a dry whirlpool. A fluidotherapy
machine is filled with a dry, graded media such as ground-up
corncob. The graded media in the unit is blown through the system
similar to the way water is made turbulent in a whirlpool. The
amount of airflow can be regulated to be gentle or more forceful. The
temperature can also be altered, making it cool or warm depending
on the therapist’s goal. Fluidotherapy is most often used as a heat
modality, with the temperature kept between 108–110 degrees. The
graded media in this unit can also be replaced. This unit isn’t indicated
for individuals with open sores or wounds. A patient typically
receives a 10–15 minute treatment and is encouraged to move the extremity
being heated. The turbulence of the graded media can also
serve as a form of desensitization, which was discussed previously in
the section on sensory deficit treatments.

Whirlpools are a familiar modality to many people. Whirlpools consist
of a large or small tank filled with water. The water temperature
is generally set between 100°–104° F; however, if a patient is
heat-sensitive, a burn victim, or a child, the temperature is usually
lessened to 96°–98° F. The motor on the whirlpool provides air bubbles
causing water turbulence. The turbulence can be graded from
limited to full turbulence.

Often whirlpool therapy is used for patients
with some type of wound that needs to be cleaned and debrided.
Whirlpool therapy is also used to allow active motion while in the
warm water prior to an activity or exercise.

Paraffin treatments consist of a mixture of warm paraffin wax and mineral
oil most often used for hand therapy. Patients who derive the
most benefit from paraffin treatments are individuals with arthritis
and patients with a specific joint involvement of the fingers such as a
The temperature of the wax in a paraffin treatment shouldn’t exceed
130° F. A treatment consists of a patient dipping her hand in the
warm liquefied wax for approximately 3–5 seconds, then removing it,
allowing the wax to dry and coat the hand. This is usually continued
for 8 to 10 coats. The hand is then wrapped in plastic followed by a
terry cloth wrap to ensure insulation for approximately 10 minutes.
When the wax is removed, it peels off like a glove and is discarded.

Cold Packs
Cold packs are generally kept in a freezer or some type of cooling device
to maintain the packs at or below freezing. Another form of cold
treatment is referred to as a cryocuff. This device consists of a small
cooling unit attached to an inflatable cuff. The cuff is applied to a specific
body part such as an ankle, wrist, or shoulder. Cold water runs
from the cooling unit through the cuff and back to the unit through
rubber tubing. The patient’s skin should be checked during and following
a cold treatment to ensure that the patient’s skin is having no
adverse reaction to the cold nor sustaining a cold burn.

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