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BY
ODUENYI CHRISTIAN
PHYSIOTHERAPY DEPARTMENT
BENUE STATE UNIVERSITY TEACHING
HOSPITAL(BSUTH), MAKURDI.
9/15/2015
1
Therapeutic Ultrasound in
Physiotherapy
Introduction
9/15/2015
2
Ultrasound is used in medicine for:
Diagnosis
Destruction of tissue
Therapy
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
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
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.
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)
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
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)
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 %
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
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
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
Treatment Protocols
9/15/2015
13
Preparation of the Machine
Preparation of the Patient
Set up the treatment
Termination of treatment
Documentation
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
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`
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
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
Physiological effects
9/15/2015
18
Chemical Reactions
Biological Responses
Mechanical Responses
Thermal Effects
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.
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)
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
Contraindications
9/15/2015
22
Vascular conditions
Radiotherapy
Tumours
Pregnancy
Cardiac disease
Implant
Anaesthetic area
Acute sepsis
9/15/2015
23
Time to Demonstrate
9/15/2015
24
Ask your Questions and make your
contributions
9/15/2015
25
A Big Thank You

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Therapeutic ultra sound in physiotherapy

  • 1. BY ODUENYI CHRISTIAN PHYSIOTHERAPY DEPARTMENT BENUE STATE UNIVERSITY TEACHING HOSPITAL(BSUTH), MAKURDI. 9/15/2015 1 Therapeutic Ultrasound in Physiotherapy
  • 2. Introduction 9/15/2015 2 Ultrasound is used in medicine for: Diagnosis Destruction of tissue Therapy
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Treatment Protocols 9/15/2015 13 Preparation of the Machine Preparation of the Patient Set up the treatment Termination of treatment Documentation
  • 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. 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. 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. 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. Physiological effects 9/15/2015 18 Chemical Reactions Biological Responses Mechanical Responses Thermal Effects
  • 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. 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. 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
  • 24. 9/15/2015 24 Ask your Questions and make your contributions

Notas del editor

  1. The amount of molecular agitation is what is measured as heat. Kinetic energy is converted to heat
  2. pass more rapidly through material in which the molecules are close together
  3. Scatter refers to reflection and refraction at the interface
  4. Parameters= measurable quantities, continuous mode: heat effect, good for Msk conditions eg mzl spasm, joint stiffness, pain. Pulse: less heating effect,good for tissue repair e.g Tendinitise