I.

INFRARED LAMPS - Periosteal Pain, decrease intensity, faster

A. NON-LUMINOUS INFRARED LAMP movement
- Requires pre-heating/warm-up: 5-15 minutes b. DULL & ACHING PAIN
- Distance from skin: 29-36 inches - Add soni-gel (ultrasound gel)
- The area to be treated should be c. PRICKLING, TINGLING, STINGING VIBRATING
perpendicular to the IR beam OR SLIGHT BURNING
- Treatment Time - Stop and terminate machine and have the
a. For Sub-Acute conditions: 15 minutes machine to check.
b. For Chronic Conditions: 30 minutes E. PATIENT SENSATION
B. LUMINOUS INFRARED LAMP a. Continuous (>1 W/cm2)
- Does not require pre-heating/warm-up - Patient should only feel slight warm
- Can be applied immediately b. Pulsed/ low intensity:
- Distance from skin: 18-24 inches - Patient should only feel the coldness of the gel
- The area to be treated should be or no sensation at all
perpendicular to the IR beam F. SPEED OF SOUNDHEAD
- Treatment Time - 4cm/s
a. For Sub-Acute Conditions: 15 minutes - 2-3 seconds / revolutions or cycle
b. For Chronic Conditions: 30 minutes a. Longitudinal Stroke
II. ULTRASOUND b. Circular Stroke
A. MODES - Overlapping circles
a. CONTINOUS G. METHODS OF APPLICATION
- No off time (100%) a. DIRECT CONTACT
- Heating/Thermal Effects - US applicator
- Chronic Cases - Gel-absorbing tissue
- Increase tissue temperature, extensibility, b. WATER BAG APPLICATION
muscle spasm and etc. - Irregular shaped, open bony
b. PULSED - Gloves, latex
- Non-thermal cases c. WATER BATH APPLICATION
- Acute - Irregular distal areas
- Short burst or pulses of usually 2m/s - Basin
- Markspace ratio/pulse ratio = on/off x100% H. Treatment Duration
- Duty Cycle = decrease duty cycle lang dapat - 5 minutes (commonly in clinic)
for acute cases - 2X ERA: 5-10 minutes
B. FREQUENCY I. DUTY CYCLES
1MHz 3MHz a. 25% Duty Cycle: Acute Cases / Non-thermal
- 2-5cm 1-2cm Effect
- Deep Superficial b. 50% Duty Cycle: Sub-acute Cases
- Bulky mm c. 100% Duty Cycle: Chronic Case / Thermal
and joints Effects.
- Hips
III. LASER
- Shoulder
A. TYPES OF LASER TECHNIQUES
- Quads
- Lowback a. Spotting
C. INTENSITY (ACCORDING TO HECOX) - Direct with firm pressure
- ACUTE: 0.1-0.5 W/cm2 b. Gridding
- SUBACUTE: 0.5-1.0 W/cm2 - A treatment area is divided into a grid of
- CHRONIC: 1.0-2.0 W/cm2 square centimeters, with each square
centimeter stimulated for specific time
1-1.5 W/cm2: HIGHER THAN THIS IS DANGEROUS IN - Most frequently utilized method of
THE BODY application and should be used whenever
possible.
D. CONSIDERATIONS
a. SHARP & STABBING PAIN
 - Lines and point should not be drawn on the uncovering each subsequent hole at 15-
patients skin because this may absorb some second intervals until all holes are uncovered.
of the light energy. - When 90 seconds have elapsed since the 1st
- If an open area is to be treated, a sterilized hole was uncovered, cover the patient and
clear (opaque) plastic sheet can be placed close the shutters. In this way, the 1st hole will
over the wound to allow surface contact. have received 90 seconds of exposure, the
c. Scanning last hole only 15 seconds.
- There is no contact between the laser tip and - Instruct the patient to check the area every 2
the skin. (spray-like pattern) hours while awake and to record which
- With this technique, the applicator tip should symbols appeared, which ones faded and the
be held less than 1 cm above because beam ones that each one appeared and faded. This
divergence might occur. information is used to determine the patients
d. Wanding minimal erythemal dose (MED) or the
- Area is bathed with the laser in an oscillating amount of infrared exposure required to
fashion with no direct contact in the skin for a show erythema lasting up to 48 hours.
designated time. B. DOSE-RESPONSE ASSESSMENT
- Not recommended because of irregularities of a. Suberythemal dose (SED)
dosage. - No change in skin redness occurs in the 24
B. ENERGY DENSITY (FLUENCY) hours after UV exposure
b. Minimal erythemal dose (MED)
Type of Condition Dosage - The smallest dose producing erythema within
Soft Tissue 4-16 J/cm2
8 hours after exposure that disappears within
Healing/Wound Healing
24 hours after exposure
Fracture Healing 5-16 J/cm2
c. First-degree erythema (E1)
Acute Arthritis 2-4 J/cm2
Chronic Arthritis 4-8 J/cm2 - Definite redness with some mild
Lymphedema 1.5 J/cm2 desquamation appears within 6 hours after
Neuropathy 10-12 J/cm2 exposure and lasts for 1 to 3 days. This dose
Acute Soft Tissue 2-8 J/cm2 is generally about 2.5 times the MED.
Inflammation d. Second-degree erythema (E2)
Chronic Soft Tissue 10-20 J/cm2 - Intense erythema with edema, peeling, and
Inflammation pigmentation appears within 2 hours after
IV. ULTRAVIOLET RADIATION treatment and is like a severe sunburn. This
A. GETTING THE MED dose is generally about 5 times the MED.
- Make an erythrometer (cardboard with holes e. Third-degree erythema (E3)
of different shapes) - Erythema with severe blistering, peeling, and
- Placement of Erythrometer: Flexor aspect of exudation. This dose is generally about 10
the forearm, lower abdomen or in the times the MED.
buttocks. Use the abdomen only if the C. APPLICATION OF UVR
forearm is too small or if it is unavailable for a. Warm up the lamp if necessary
another reason 1. Arc Lamp without glass filter
- Distance of UV lamp: - 5-10 minutes
a. 36 inches away (Hecox) 2. Arc Lamp with Glass Filter
b. 76 cm away (Cameron) - 20 minutes
- Turn on the lamp 3. Fluorescent Lamp
a. Arc Lamp: Warm up for 5-10 minutes - Brief warm period about 1 minute after being
b. Fluorescent Lamp: Can be used within 1 switched on
minute being turned on. 4. Fluorescent Lamp with Glass Filter
- Open the shutters and expose the 1st hole, - 20 minutes
keeping the remaining holes covered. After b. UVR Distance: 36 inches (76cm) away
15 seconds, uncover the 2nd hole. Continue c. Treatment Time: Depends on the MED
 d. Treatment is generally applied to the whole TENS
body and usually is started at 40% to 70% of
A. CONVENTIONAL TENS
the MED and is increased by 10% to 40%
a. Amplitude: Comfortable tingling sensation,
each week to maintain the response.
paresthesia. No muscle response
NMES/FES EMS/ES b. Pulse Rate: 50-80 pps
On & Off Time On & Off Time: c. Pulse Width: 50-100 s
Ratio: 1:5 1:5 d. Duration of Treatment: 20-60 minutes
On Time: 5-10 On Time: 5-10 e. Duration of Pain Relief: Temporary
seconds seconds B. ACUPUNCTURE-LIKE (STRONG LOW RATE
Off Time: 25-45 Off Time: 25-45 TENS)
seconds seconds a. Amplitude: Strong but comfortable rhythmic
Ramp Time: 1-4 Ramp: 1-4 muscle twitches
seconds seconds b. Pulse Rate: 1-5 pps
*If opposite a Pulse Width: c. Pulse Width: 150-300 s
spastic muscle: 200s (small
d. Duration of Treatment: 30-40 minutes
4-8 seconds muscle) 300s
Pulse Width: (large muscle) e. Duration of Pain Relief Long Lasting
200s (small Pulse Rate: <10 C. BRIEF INTENSE TENS
muscle)300 s Hz a. Amplitude: Patient Tolerance
(large muscle) Duration: 10 b. Pulse Rate: 80-150 pps
Pulse Rate: 30- minutes (90 c. Pulse Width: 50-250 s
50 Hz (40 Hz) contractions) d. Duration of Treatment: 15 minutes
Duration: 10-20 e. Duration of Pain Relief: Temporary (30 mins
minutes (10-20 to hour)
contractions) D. BURST MODE (PULSE TRAINS) TENS
FARADISM UNDER FACIAL ES a. Amplitude: Comfortable & Intermittent
PRESSURE On Time: 5 paresthesia
On Time: 5 seconds b. Pulse Rate: 50-100 pps delivered in packets
seconds Off Time: 1 or burst of 1-4 pps
Off Time: 1 second c. Pulse Width: 50-200s
second Ramp Time: 1 d. Duration of Treatment: 20-30 minutes
Ramp Time: 1 second
e. Duration of Pain Relief: Long Lasting (Hours)
second Pulse Width:
E. HYPERSTIMULATION TENS (POINT
Pulse Width: 100s (small
100s (small muscle) STIMULATION
muscle)200 s Pulse Rate: 10Hz a. Amplitude: Strong to patient tolerance
(large muscle) Duration: 30 b. Pulse Rate: 1-5 pps
Pulse Rate: 10Hz contractions per c. Pulse Width: 150-300 s
Intensity motor points x 3 d. Duration of Treatment: 15-30 seconds
d/t Injury: Pts sets increment
comfort Corrugator e. Duration of Pain Relief: Long Lasting
d/t Supercilli
immobilization: Frontalis
Visible Orbicularis Oculi
contractions Main Trunk of
Duration: 20-30 Facial Nerve
minutes Nasalis
Orbicularis Oris
Mandibular
Branch of Facial
Nerve
*ELECTRODES SHOULD BE 2 inches away from each
other