Maham Yousuf

Assignment: ELECTROTHERAPY

Submitted to: Sir Jam Feroze

Ultrasound

Introduction

Ultrasound (US) is a form of MECHANICAL energy, not electrical energy and therefore

strictly speaking, not really electrotherapy at all but does fall into the Electro Physical Agents

grouping. Mechanical vibration at increasing frequencies is known as sound energy. The

normal human sound range is from 16Hz to something approaching 15-20,000 Hz (in

children and young adults). Beyond this upper limit, the mechanical vibration is known as

ULTRASOUND. The frequencies used in therapy are typically between 1.0 and 3.0 MHz

(1MHz = 1 million cycles per second).

Treatment Area

US heats a limited area

About the size of a catsup packet

Treatment area should be 2 to 3 times the size of the ERA

For larger areas, divide the treatment area into smaller zones

Coupling MethodsDIRECT COUPLINGIMMERSION METHODPAD/BLADDER METHOD

Application

Coupling Methods

Ultrasonic energy cannot pass through the air

A coupling medium is required

Medium should be water-based

Coupling method should confirm to the body area

The body area should be clean and relatively hair-free

Direct Coupling

Gel or Creams

Only use approved coupling

agents

Apply liberally to area

Remove air bubbles by passing

sound head over area (before

power is increased)

Direct Coupling

Move the sound head s-l-o-w-l-y

4 cm/sec

Moving the head faster decreases heating

If the patient describes discomfort, decrease the output intensity

Coupling Ability of Various Media

Substance Transmission

Saran Wrap 98

Lidex ge, fluocinonide (.05%) 97

Thera-Gesic 97

Mineral oil 97

US Transmission gel 96

US Transmission lotion 90

Chempad-L 68

Hydrocortisone powder (1%) 29

Hydrocortisone powder (10%) 7

Eucerin cream 0

Myoflex 0

White petrolatum gel 0

Immersion Technique

Used to treat irregularly shaped areas

The limb is immersed in a tub of degassed water

If tap water is used, increase the output intensity by 0.5 w/cm2

Transducer is held appx. 1” from the body part

Avoid the formation of air bubbles

Pad (Bladder) Method

A mass of conductive gel

Commercial pads

Self-made bladders

Conforms to the treatment

area

Commercial pads help limit

the size of the treatment

area

Electrode Placement

•Electrodes may be placed:

–On or around the painful area

–Over specific dermatomes, myotomes, or

sclerotomes that correspond to the painful area

–Close to spinal cord segment that innervates an

area that is painful

–Over sites where peripheral nerves that

innervate the painful area becomes superficial

and can be easily stimulated

–Over superficial vascular structures

–Over trigger point locations

–Over acupuncture points

–In a crisscrossed pattern around

the point to be stimulated so the

area to be treated is central to

the location of the electrodes

–Bipolar application resulting in

similar physiologic effects

beneath each electrode

–Monopolar setup both an

active and dispersive pad set up

causing higher current density at

the active electrode

–Quadripolar technique

Physiologic Response To

Electrical Current

•Electricity can have an effect on each

cell and tissue it passes through

–Type and extent is dependent on the type of

tissue, its response characteristics, and the

nature of current applied

•Reactions can be:

–Thermal

–Chemical

–Physiologic

•Can be used to:

–Creating muscle contraction through

nerve or muscle stimulation

–Stimulating sensory nerves to help in

treating pain

–Creating an electrical field in biologic

tissues to stimulate or alter the healing

process

–Creating an electrical field on the skin

surface to drive ions beneficial to the

healing process into or through the skin

Therapeutic Uses of

Electrically Induced Muscle

Contraction – High-volt

Currents

•Muscle re-education

•Muscle pump contractions

•Retardation of atrophy

•Muscle strengthening

•Increasing range of motion

•Reducing Edema

Muscle Re-Education

•Muscular inhibition after surgery or injury is

primary indication

•A muscle contraction usually can be forced

by electrically stimulating the muscle

•Provides artificial use of inactive synapses

•Restore normal balance to system as

ascending sensory info is reintegrated into

movement patterns

•Patient feels the muscle contract, sees the

muscle contract, and can attempt to

duplicate this muscular response

Muscle Pump Contractions

•Used to duplicate the regular muscle

contractions that help stimulate

circulation by pumping fluid and blood

through venous and lymphatic

channels back to the heart

•Can help in reestablishing proper

circulatory pattern while keeping

injured part protected

•Sensory level stimulation has been

shown to decrease edema in sprain

and contusion injuries

Retardation of Atrophy

•Electrical stimulation reproduces

physical and chemical events

associated with normal voluntary

muscle contraction and helps to

maintain normal muscle function

•No specific protocol exists

clinician should try to duplicate

muscle contraction associated with

normal exercise routine

Increasing Range of

Motion

•Electrically stimulating a muscle

contraction pulls joint through

limited range

•Continued contraction of muscle

group over extended time appears

to make contracted joint and

muscle tissue modify and lengthen

The Effect of Non-contractile

Stimulation on Edema

•Sensory level direct current used as a driving

force to make charged plasma protein ions in

interstitial spaces move in the direction of

oppositely charged electrode

•Cook et al. hypothesized that

1) the electrical field facilitated movement

of charged proteins into lymphatic channels

2) Electrical field caused indirect stimulation

of autonomic nervous system, stimulating

release of adrenergic substances, increasing

smooth muscle activity and lymph

circulation

Therapeutic Uses of

Electrical Stimulation of

Sensory Nerves –

Asymmetric Biphasic

Currents (TENS)

•Gate Control Theory

•Descending Pain Control

•Opiate Pain Control

THANKS