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Therapeutic ultra sound in physiotherapy

Therapeutic Ultrasound is a deep heating modality used in physiotherapy to provide relief from pain and facilitate healing process

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Therapeutic ultra sound in physiotherapy

  1. 1. BY ODUENYI CHRISTIAN PHYSIOTHERAPY DEPARTMENT BENUE STATE UNIVERSITY TEACHING HOSPITAL(BSUTH), MAKURDI. 9/15/2015 1 Therapeutic Ultrasound in Physiotherapy
  2. 2. Introduction 9/15/2015 2 Ultrasound is used in medicine for: Diagnosis Destruction of tissue Therapy
  3. 3. Definition 9/15/2015 3 Ultrasound is a mechanical vibration at any frequency above the audible sound range Ultrasound therapy (UST) is the application of ultra frequency sound waves (1 – 3MHZ) to tissues in order to promote healing and reduce pain and swelling. Therapeutic Us used in physiotherapy ranges from 0.5 to 5MHZ but most us machine are set at 1MHZ and/or 3MHZ Classified as a deep heating modality
  4. 4. Production of ultrasound 9/15/2015 4 The inverse piezoelectric effect is used in production of ultrasonic sound waves. Examples of piezoelectic materials are quartz,barium titanate and lead zirconate titanate (PZT). Application of high frequency alternating current to the PZT crystal of the transducer transforms the electrical energy into vibratory sound wave (ultrasound)s
  5. 5. Transmission of US wave 9/15/2015 5 Through solid, liquid and gases in form of compression and separation of molecule Normally cylindrical and longitudinal in fashion Velocity higher in materials of high density Air 340 m/s, water 1410m/s, muscle 1540m/s, Bone 3500m/s.
  6. 6. Properties of ultrasound beam 9/15/2015 6 Reflection Refraction Attenuation Absorption  Passing through the tissue US energy is dissipated = attenuation  Half Value Distance = 4cm for 1MHZ and 2cm for 3MHZ  Acoustic Impedance(Z)
  7. 7. Depth of penetration 9/15/2015 7  1MHZ= deeper tissues at depth 3 to 5cm  3MHZ= superficial Tissues at depth 1 to 2cm  Depth of Penetration is inversely proportional to frequency Near and Far Field  Wave fonts from different parts travel different distances causing interference between adjacent fonts
  8. 8. Near and far field 9/15/2015 8  The near field also known as the Fransel zone is the convergent region  The far field known as the fraunhofer zone is the divergent region  Length of Fresnel zone = r2 / λ where r=radius of transducer.  Therapeutic us utilizes the near field  Frequency of US and radius of transducer need to be considered for tissue depth above 6.5cm(shortest)
  9. 9. Coupling media 9/15/2015 9  Ultrasound waves are not transmitted by air, thus some couplant which does transmit them must be interposed  Unfortunately no couplant affords perfect transmission & only a percentage of the original intensity is transmitted to the patient. Aquasonic gel 72.6% Glycerol 67 % Distilled water 59 % Petroleum jelly 0 % Air 0 %
  10. 10. Characteristics of a coupling media 9/15/2015 10 1. Acoustic impedance similar to tissue 2. High transmissivity for US 3. Low suceptibility to bubble formation 4. Chemically inactive in nature 5. A hypoallergic character 6. High viscosity 7. Cheap 8. Relative sterility
  11. 11. US beam parameters 9/15/2015 11  Mode type : continuous and pulsed. Pulsed Mark Space(M:S) ratio: 1:1, 1:2, 1:4 etc.  Power: amount of acoustic energy per unit time (watts)  Intensity: power per unit area of the ultrasound head (watts/cm2). Space average intensity and time averaged/space average intensity(pulsed).  Frequency: number of compression-rarefaction cycles per unit of time, usually expressed in cycles per second (Hertz)  Effective radiating area (ERA): The area of the transducer from which the US energy radiates  Duty cycle: The proportion of total treatment the ultrasound was on
  12. 12. Depth of penetration 9/15/2015 12 Majority of the ultrasound generators used in physiotherapy are set at a frequency of 1MHZ and/or 3MHZ. The depth of penetration of ultrasound beam is inversely proportional to the frequency 1MHZ ultrasound beam has a depth of penetration of 3-5cm and absorbed in deeper tissues 3MHZ ultrasound beam with a depth of penetration of 1-2cm and is absorbed in the superficial tissues
  13. 13. Treatment Protocols 9/15/2015 13 Preparation of the Machine Preparation of the Patient Set up the treatment Termination of treatment Documentation
  14. 14. Protocols 9/15/2015 14  Preparation of the machine  Position  Inspect  Be assured of functionality  Bring all accessories closer: • Aquasonic gel • Cotton wool • Methylated spirit • Water in a bowl  Preparation of the patient  Inform your patient  Remove metals  Expose the Rx part  Remove hair if necessary  Wash or swab  Inspect the Rx part  Check for intact sensation  Demand co-operation  Set-up up the Rx  Secure pt.'s comfort and stability of Rx part  Plug dead, supply and power on  Select Rx programme  Apply coupling media  Ensure the transducer is in contact with the coupling media on the skin  Start now  Keeping asking how the pt.'s feels
  15. 15. protocols 9/15/2015 15  Termination  Return intensity to zero  Remove transducer  Cut the mains supply  Clean the skin and the transducer  Inspect  Documentation  Date  Machine  Intensity  Frequency  Mode  duration  Coupulant  Region  Response of Rx`
  16. 16. Application 9/15/2015 16 Principles  Rx surface parallel to the skin  Even pressure maintained to exclude air and balance irregularities in sonic field  Transducer moved continuously over the skin surface  Rate of movement must be slow enough to allow tissue to deform and fast enough to avoid hot spots  Pattern of movement- series of overlapping parallel strokes, circles or figure 8 Techniques of Application 1. Direct contact 2. Water bath: degased water of comfortable temperature, transducer held 1cm parallel to the skin inside the water keeping 3. Water bag
  17. 17. Dosage 9/15/2015 17  Factors to consider  Receny of injury  Depth of tissue  Nature of the lesion  Size of the area  Attenuation  Area of transducer  Acute conditions  Intensity: 0.25 or 0.5 watts/cm2  Time: 2-3minutes  Failure to improve progress to 0.8watts/cm2 or increase time to 4 0r 5minutes  Chronic conditions  Start dose: 0.8watts/cm2 for 4minutes  Failure to improve progress to 1watts/cm2 for 4minutes, 1watts /cm2 for 6minutes, to 1.5watts/cm2 for 6minutes, 1.5watts/cm2 for 8minutes, 2watts/cm2 for 8minutes  Note: A dose of 2watts/cm2 for 8minutes is maximum permitted
  18. 18. Physiological effects 9/15/2015 18 Chemical Reactions Biological Responses Mechanical Responses Thermal Effects
  19. 19. Physiological effects 9/15/2015 19  Chemical reaction Ultrasound vibration stimulate tissue to enhance chemical reactions and processes and ensure circulation of necessary elements and radicals for recombination.  Biological responses  Increase membrane permeability which enhances transfer of fluid and nutrients to tissues  Acoustic Streaming: is unidirectional flow of tissue components which occurs particularly at the cell membrane. Streaming produce changes in the rate of protein synthesis and could thus have a role in the stimulation of repair.
  20. 20. Physiological effects 9/15/2015 20  Mechanical responses  micro massage: cells are alternately compressed and then pulled further apart. This increase mobility of intracellular fluids and thus helps to reduce oedema.  Tendon extensibility: ultrasound apparently increases the extensibility of tendons, muscles and scar tissues.  Thermal effects: as ultrasonic waves are absorbed they are converted to thermal energy (heat)
  21. 21. Clinical application of US 9/15/2015 21  Soft tissue injuries  Oedema  Varicose ulcers  Pain control  Chronic rheumatoid and arthritic conitions  Tendon injuries  Resorption of calcium deposits  Bone fractures  Carpal tunnel syndrome  phonophoresis
  22. 22. Contraindications 9/15/2015 22 Vascular conditions Radiotherapy Tumours Pregnancy Cardiac disease Implant Anaesthetic area Acute sepsis
  23. 23. 9/15/2015 23 Time to Demonstrate
  24. 24. 9/15/2015 24 Ask your Questions and make your contributions
  25. 25. 9/15/2015 25 A Big Thank You

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