1. BY
UDENNAKA IKECHUKWU .E.
OBSTETRICS & GYANECOLOGY UNIT
PHYSIOTHERAPY DEPARTMENT
UNIVERSITY OF CALABAR TEACHING
HOSPITAL

2.  INTRODUCTION
 MECHANISM
 PHYSIOLOGICAL EFFECTS OF
ULTRASOUND
 THERAPUEATIC USES OF ULTRASOUND
 TEST & TREATMENT METHODS
 DOSAGE OF ULTRASOUND
 CONTRAINDICATION
 PRECAUTION & DANGERS OF
ULTRASOUND

3.  Sound is defined as the periodic mechanical
disturbance of an elastic medium such as air.
 Sound requires a medium for its transmission
and cannot cross a vacuum.
 The human ear can hear up to a frequency of
20hz - 20khz
 Ultrasound refers to mechanical vibrations, which
are essentially the same as sound waves but of a
higher frequency above 20khz. Such waves are
beyond human hearing and can therefore be
called ultrasonic.
 Therapeutic frequencies range from 1MHz-
3MHz.

4.  Therapeutic ultrasound is produced when
high frequency current is imposed on
materials with piezoelectric qualities to
cause the piezoelectric effects.
 Ultrasound(US) is a deep heating modality

5.  COMPONENNTS
 TREATMENT PARAMETERS
 TRANSMISSION/COUPLING MEDIUM
 PROPERTIES OF US

6.  Therapeutic US is produced when high frequency
current is imposed on materials with
piezoelectric qualities to cause the piezoelectric
effect.
 When electrical energy is applied on piezoelectric
crystals they produce vibration and mechanical
deformity of their molecular structure. This
phenomenon is called piezoelectric effect. This
principle is used for generation of ultrasound
waves
 Piezoelectric crystals (e.g. Germanium, quartz,
barium titanate, Lead- Zirconium-Tartarate etc.)
convert mechanical energy into electrical energy.

7.  The ultrasound machine consists of a
electricity source, coaxial cable, main body
(includes the knobs and buttons), user
graphic interphase, treatment
head/applicator/transducer/sound head.

9. These are determined with the following in
mind:
a) Type of condition and
b) Depth and position of the lesion.
The treatment parameters include:
 Mode
 Intensity
 Time
 Frequency

12.  US waves are not transmitted by air.
 Coupling medium is used between the patients skin
and the transducer.
 Couplants should also serve as lubricant to allow
treatment head move smoothly over skin.
Here are some coupling media and their transmission
rate:
 Aqua sonic Gel 72.6%
 Glycerol Gel 67%
 Distilled Water 59%
 Liquid Paraffin 19%
 Petroleum Jelly 0%
 Air 0%

13.  Reflection & Refraction: if the US beam
encounters an interface between two media while
being transmitted it may be reflected i.e.
Deflected from its original path
 Care is taken not to leave air between the
transducer head and patients skin.
 If US waves are reflected there are tendencies of
damaging the piezoelectric crystals.
 There may also be refraction of the longitudinal
waves at the bone interface. Which is
accompanied by a change in speed and
wavelength of the waves.

15.  Attenuation: this is the gradual reduction of
the intensity of the US beam after it has left
the treatment head.
Two main factors contribute to this:
 Absorption
 Scatter
 Absorption and scatter reduces the intensity
and brings about half-life.

16.  Thermal effect
 Mechanical effect
 Biological effect
 Chemical effect

17. US can be used in treatment of:
 Acute soft tissue injuries
 Scar tissues, keloid and contractures
 Chronic indurated oedema
 Pain relief
 Bone injuries
 Chronic strains/sprains
 Wound healing
 Inflammation of joint capsules, tendons,
ligaments and bursa often associated with
degenerative conditions like osteoarthritis,
rheumatoid arthritis and repetitive stress injuries

18.  Improves protein synthesis thus, increasing
the rate of repair of damaged tissues.
 US helps to reduce pain, break unwanted
calcification of soft tissues and restore
function as well as increased extensibility of
collagen fibers increasing range of motion.

19.  Physiotherapist(PT) should test the ultrasound
machine to ensure proper production of the
US before treatment
 A water bath is used to reflect ultrasound
beam up to the surface of the water
 The ultrasound Machine is turned on while
the treatment head blows the water and
ripples indicate production of US waves.

20.  Direct contact or surface method
 Water bath or Under water method
 Water bag method

22.  Phonophoresis: is the movement of drugs
through the skin into the subcutaneous
tissues under the influence of US
 The thermal and biological effects of
ultrasound increases tissue permeability and
these aid at driving the medication into the
tissues.
 The type of ointment used depends on the
physiological needs of the patient e.g
salycilate. zinc. iodine. hydrocortisone etc

23.  US can be used to treat both Acute and Chronic lesions.
 Acute lesions: a low dose intensity of 0.25-0.5w/cm2
can be used for 2-5mins at initial stages and if
condition doesn’t improve time can be increased or an
intensity of 0.8w/cm2 for 5mins.
 Chronic lesions: can be treated with a pulsed or
continuous mode. The maximum intensity of US which
should be used is that which produces mildly
perceptible warmth. Which usually occurs at 2w/cm2.
 A dose of 2w/cm2 for 8mins is usually considered.
 If treatment doesn’t improve even at a gradually
increased dose and time then US treatment should be
discontinued.

24.  Growing epiphysis
 Poor blood supply
 Pregnancy
 Cardiac disease
 Tumors
 Radiotherapy
 Acute sepsis and other infections
 Bony prominences
 Vascular conditions
 Metallic implants
 Anesthetic area or area with defective nervous
sensation.

25.  Burns
 Damage of equipment
 Unstable cavitation may occur
 Overdose may lead to exacerbation of symptoms
 Treatment area should be clean and dry before
applying coupling gel
 Treatment time should be between 5-10mins
never treat over 15mins regardless of the
treatment area.
 Ultrasound should be discontinued if there is no
improvement after a maximum of 8 sessions

26.  Ultrasound intensity should be adjusted to
patients tolerance
 After treatment the treatment head should be
wiped off and placed in its bracket. Then
clean the coupling medium off the patient.
 the intensity level turned down to zero so the
intensity is not on when next the machine is
turned on.