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What is Ultrasound?
Located in the Acoustical Spectrum May be used for diagnostic imaging,
therapeutic tissue healing, or tissue destruction Thermal & Non-thermal effects We use it for therapeutic effects Can deliver medicine to subcutaneous tissues (phonophoresis)
Ultrasound
Sinusoidal waveform
Therapeutic ultrasound waves range from 750,000 to 3,000,000 Hz (0.75 to 3 MHz)
Displays properties of
wavelength, frequency, Amplitude
Transducer
A device that converts one form of energy to another Piezoelectric crystal: a crystal that produces (+) and
(-) electrical charges when it contracts or expands
Crystal of quartz, barium titanate, lead zirconate, or titanate housed within transducer
alternating current is passed through a crystal resulting in contraction & expansion of the crystal
Types of Current
Direct Current: the uninterrupted unidirectional
flow of electrons
Frequency
Velocity
The speed of sound wave is directly related to
the density ( velocity = density)
result of a change in the speed of a wave as it enters a medium with a different density
Attenuation
Absorption = Frequency (3 MHz) , and Penetration = Absorption (1 MHz) , so Penetration = Frequency + Absorption (1 MHz) Tissues water content = low absorption rate (fat) Tissues protein content = high absorption rate
(peripheral nerve, bone)
Muscle is in between both
US passing through air = almost all reflected (99%) US through fat = 1% reflected Both reflected/refracted @ m. interface Soft-tissue: bone interfaced = much reflected
impedances, intensity is increased creating a Standing Wave (hot spot)
sound head that produces ultrasonic waves; expressed in square centimeters (cm2)
Represents the portion of the heads surface area that produces US waves Measured 5 mm from face of sound head; represents all areas producing more than 5% of max. power output Always lesser area than actual size of sound head Large diameter heads column beam Small diameter heads more divergent beam Low frequency (1 MHz) diverge more than 3 MHz
BNR
SPI
Duty Cycle
Percentage of time that US is actually being
emitted from the head Ratio between the USs pulse length & pulse interval when US is being delivered in the pulsed mode
Pulse length = amount of time from the initial nonzero charge to the return to a zero charge Pulse interval amount of time between ultrasonic pulses Duty cycle = pulse length/(pulse length + pulse interval) x 100 100% duty cycle indicates a constant US output Low output produces nonthermal effects (20%)
Slower strokes can be easier maintained If patient complains of pain or excessive heat,
then decrease intensity but increase time Apply constant pressure not too much & not too little
Coupling Agents
Optimal agent distilled H20 (.2% reflection) Modern units have a shut down mechanism if
Improperly coupled head causes temp.
sound head becomes too hot (Dynatron beeps; red lights on Chattanoogas)
Types of agents:
Direct H20 immersion Bladder
Direct Coupling
Effectiveness is if body part is hair,
irregular shaped, or unclean Must maintain firm, constant pressure Various gels utilized
Water Immersion
Used for odd shaped parts Place head approx. 1 away from part Operators hand should not be immersed
No metal on part or operators hand Ceramic tub is recommended If nondistilled H20 is used, intensity can be .5 w/cm2 because of air & minerals Dont touch skin except to briefly sweep skin when bubbles form
Bladder
H20 filled balloon or plastic bag coated
with coupling gel Use on irregular shape part Place gel on skin, then place the bladder on the part, and then place gel on bladder Make sure all air pockets are removed from bladder
Indications
Soft tissue healing & repair Joint contractures & scar tissue Muscle spasm Neuroma Trigger areas Warts Sympathetic nervous system disorders Postacute reduction of myositis ossificans Acute inflammatory conditions (pulsed) Has been shown to be ok to use following the stopping of bleeding with an acute injury (pulsed)
Contraindications
Acute conditions (continous output) Ischemic areas or impaired circulation areas Tendency to hemorrhage Around eyes, heart, skull, or genitals Over pelvic or lumbar areas in pregnant or menstruating females Cancerous tumors Spinal cord or large nerve plexus in high doses Anesthetic areas Stress fracture sites or over fracture site before healing is complete (continuous); epiphysis Acute infection
Thermal Effects
blood flow sensory & motor nerve conduction velocity extensibility of structures (collagen); joint
stiffness collagen deposition macrophage activity Mild inflammatory response which may enhance adhesion of leukocytes to damaged endothelial cells muscle spasm pain + all Nonthermal effects
Nonthermal Effects
cell membrane permeability vascular permeability blood flow fibroblastic activity Altered rates of diffusion across cell membrane Secretion of chemotactics Stimulation of phagocytosis Production of granulation tissue Synthesis of protein edema Diffusion of ions Tissue regeneration Formation of stronger CT
Pulsed Ultrasound
Stimulates phagocytosis (assists w/ of chronic
inflammation) & increases # of free radicals ( ionic conductance on cell membrane)
Pulsed Ultrasound
Acoustical Streaming: stable cavitation leads this;
one-directional flow of tissue fluids, & is most marked around cell membranes
Facilitates passage of calcium potassium & other ions, etc. in/out of cells Collagen synthesis, chemotactics secretion, update of calcium in fibroblasts, fibroblastic activity
Flows around the cell membranes & its organelles Flow of bubbles in stream cause change in cell membrane permeability
Clinical Applications
Chronic Inflammation - Pulsed US has
1.0 to 2.0 W/cm2 at 20% duty cycle
Thermal Applications
Phonophoresis
US is used to deliver a medication via a safe,
painless, noninvasive technique Opens pathways to drive molecules into the tissues Not likely to damage or burn skin as with iontophoresis Usually introduces an anti-inflammatory drug Preheating the area may enhance delivery of medication
Encourages vascular absorption & distribution of meds.
Phonophoresis
Factors affecting rate of medication diffusion
Hydration higher water content = skin more penetrable Age better with younger ages Composition better near hair follicles, sebaceous glands & sweat ducts Vasularity higher vascular areas are better Thickness thinner skin is better Corticosteroids hydrocortisone, dexamethasone Salicylates Anesthetics - lidocaine
Types of medications