RS-PAM 100: Physical Agents and Modalities

THERMAL MODALITY II (DEEP)

Aiah Penelope G. Cayabyab | BSOT 2-1

OUTLINE OF DISCUSSION: • EFFECTS ON CIRCULATION

I. Therapeutic Ultrasound o Vasodilation and increased lymphatic flow
II. Components of Ultrasound Device • EFFECTS OF NERVE
III. Treatment Parameters o 0.5 W/cm2 ↑ motor nerve conduction
IV. Application Techniques o 1-2 W/cm2 ↓ nerve conduction
V. Contraindication of Ultrasound o 3 W/cm2 ↑ nerve conduction
VI. Precautionary Measures of Ultrasound • EFFECTS ON DRUGS
o Phonophoresis
THERAPEUTIC ULTRASOUND ▪ Movement of drugs through the
• Therapeutic ultrasound refers to the medical use of skin into the subcutaneous tissues
ultrasound waves for therapeutic purposes, such under the influence of the ultrasound
as treating injuries and promoting healing
• Ultrasound waves are sound waves with frequencies NON-THERMAL EFFECTS
above range of human hearing, typically between • MICROMASSAGE
0.75 and 3 MHz o Mechanical effect produced by the
• In therapeutic ultrasound, these waves are applied to compression and rarefaction of waves (as
the body in a controlled manner, penetrating deep they pass thru to tissues)
tissue o Can stimulate cellular activities, improve
• Inaudible sound waves blood flow, and promote tissue healing
• High-frequency energy • CAVITATION
• Thermal or non-thermal effects o When US waves create alternating areas of
compression and rarefaction of tissues
MECHANISM OF HEAT PRODUCTION o Formation of tiny gas bubbles in the
tissues as a result of US vibration
Vibration
Molecular
Friction Heat
▪ The collapse of these bubbles can
Movement
produce localized mechanical forces
that may help in tissue remodeling
When you introduce ultrasound to a body part or to a tissue, it and breakdown of scar tissue
vibrates molecules that causes friction thereby producing heat.
• ACOUSTIC STREAMING
o Movement of fluids along the boundaries
ABSORPTION OF US of cell membrane or tissue structures due
• Dependent on the protein content to mechanical pressure waves
o The higher the protein, the higher will the o Can enhance the delivery of nutrients and
ultrasound be absorbed oxygens to the cells and facilitate the removal
• INCREASING PROTEIN CONTENT of metabolic waste products
• STANDING WAVES
Blood Fat Nerve Muscle Skin Tendon Cartilage Bone
o Formed due to reflected waves
superimposed (interfere) on the incident
waves
• Low to High absorption of ultrasound o Can cause stasis of cells in blood vessels
o Can occur in areas with multiple tissue
PHYSIOLOGICAL EFFECTS OF ULTRASONIC ENERGY interfaces or boundaries
o May lead to stagnation of cells within the
THERMAL EFFECTS
blood cells potentially affecting blood flow and
• THERMAL REACTION
tissue perfusion
o Temp. rise in muscle 2-3C°
o Temp. rise in joints 7-8C°
COMPONENTS OF ULTRASOUND DEVICE
o Temp. rise in area around the joint 3-5C°
• The Generator
*Would be most noticeable by the patient depending on the o The electronic component of the machine
duration of the treatment and parameters set in the US responsible for converting electrical energy
from the power source into the high frequency

1
 electrical signals required to drive the US • Intensity
transducer o Power/strength of the US waves
• The Crystal o Higher intensities = deeper tissues or
o When electrical component is applied to the target specific therapeutic goals
crystal, it undergoes mechanical deformation o Lower intensities = superficial tissues for
producing ultrasonic vibrations patients who are sensitive to the treatment
▪ These vibrations generate the US o Rate of energy transfer from the unit to the
waves that are transmitted to the body
patient’s body o 10W/cm2
• The Soundhead o 1W/cm2
o Contains the US transducer
o Placed in direct contact with the patient’s skin • Treatment length
o Houses the crystal o Duration of the session
o Responsible for emitting the US waves into o 5-10 minutes application
the patient's tissues o Heavily depends on the area, intensity and
• The Applicator frequency
o May include controls for adjusting • Treatment size area
parameters, display screen, and ergonomic o Twice as the size of the sound-head
features o Example:
▪ Smaller treatment area –
appropriate for targeting a specific
injury or area of inflammation
▪ Larger treatment area – used for
generalized pain, relief or muscle
relaxation

APPLICATION TECHNIQUES

DIRECT INDIRECT
METHODS Parallel, Underwater,
longitudinal, rubber bags
circular FO8
TREATMENT PARAMETERS Couplant Gel/cream Degassed H2O
• Mode Distant to skin 8mm 50mm/10-20mm
o Setting of the machine Surface Smooth & flat Irregular
Intensity Same ↑ by 5w/cm2
o Continuous Ultrasound
Advantage Greater coverage Best for irreg.
▪ US waves are emitted continuously surfaces
throughout the session Disadvantage Messy Consuming
o Pulsed Ultrasound
▪ Emitted in pulses 1. Direct Contact Application
o The choice of mode depends on the 2. The Immersion Technique
therapeutic goals and condition being treated 3. The Gel Pad Technique
• Frequency
o Number of US waves emitted per second CLINICAL APPLICATION OF THERAPEUTIC ULTRASOUND
o Depends on factors: depth of the target
• Aiding the Inflammatory Response to Injury
tissue and desired therapeutic effects
o Can help modulate the inflammatory
response following tissue injury
o Promote the removal of inflammatory
mediators such as cytokines and enhance the
recruitment of immune cells to the injured site,
facilitating the healing process
• Connective Tissue healing
o Can stimulate collagen synthesis and improve
the organization of collagen fibers in
connective tissue
o Promote healing in tendons, ligaments, and
connective tissue following surgery or injury
• Superficial Wound Healing

2
 o By promoting blood flow, reducing PRECAUTIONARY MEASURES IN USING ULTRASOUND
inflammation and stimulating tissue repair • Always use lowest intensity that will produce a
process therapeutic response
o Chronic wounds o Do not above what is recommended
• Bone Healing • Ensure that the applicator is moved all throughout
o By promoting osteogenesis and increasing the treatment
the deposition of calcium in the fracture site o To decrease risk of burn
• Bone Growth Stimulator • Ensure that the patient is aware of the nature of the
o In case of delayed unions fractures treatment and its expected outcome
o Promotes proliferation and differentiation of
• If a thermal dose is intended, ensure that any
osteoblasts and enhances the mineralization
contraindications that apply have been considered
of newly formed bone tissues
• Caution is advised in the vicinity of a cardiac
• Pitting Edema
pacemaker or other implanted electronic device
o Promoting lymphatic drainage and improving
• Continuous ultrasound is considered unwise over
tissue fluid dynamic
metal implants
o Increases the permeability of capillary walls
• Reducing Muscle Spasm
DANGERS
o Increasing blood flow, promoting muscle
relaxation • BURNS
o Facilitate the release of endorphins – natural o Overdose
pain reliving chemicals o Too slow movement of transducer head
• Reducing Pain o Not maintained right angle of transducer
o Has analgesic effects by modulating pain head
transmission, pathways and stimulating the o Insufficient couplant
release of endogenous opioids o Irregular bony surface
o Can alleviate acute and chronic conditions: o Entrapped air in couplant
▪ Musculoskeletal pain o Air bubbles
▪ Neuropathic pain • SHOCK
▪ Inflammatory pain • INNACURATE AND REDUCED POWER OUTPUT
• Restoring ROM lost from Scar tissue and/or Joint FROM GENERATORS
Contracture
o Promotes collagen remodeling and increased
extensibility
• Treating Chronic Inflammation
o Tendonitis
o Bursitis
o Arthritis

CONTRAINDICATION OF ULTRASOUND
• Over the uterus during pregnancy
• Over the gonads
• Over malignancies and precancerous lesions
• On patients with vascular abnormalities, i.e. deep vein
thrombosis, emboli, severe atherosclerosis
• Over the eye
• Over the stellate ganglion
• For hemophiliacs not covered by factor replacement
• Over the spinal cord after laminectomy
• Directly over metal implants
• Over an electronic device
• Over tissues previously treated with deep X- ray or
radiation
• Tuberculosis (local)
• Over damaged or at-risk skin, i.e. skin rash, eczema
• Over anesthetic areas
• Over excitable tissue, i.e. heart, exposed nerve, carotid
sinus