Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Therapeutic ultra sound in physiotherapy

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

  • Login to see the comments

Therapeutic ultra sound 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