Ultrasound clinical application review


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Ultrasound clinical application review

  1. 1. Therapeutic Ultrasound Clinical Application Review Casey Christy, MA, ATC, CSCS
  2. 2. Clinical Application Review <ul><li>Beam Nonuniformity Ratio (BNR) The ratio between the highest intensity in an ultrasound beam and the output reported on the meter. </li></ul><ul><ul><li>Peak area of the maximum BNR (PAMBNR) the size of the area that produces the peak intensity </li></ul></ul><ul><li>Effective Radiating Area (ERA) The portion of the sound head’s surface that emits ultrasonic energy. </li></ul>
  3. 3. Clinical Application Review <ul><li>Frequency The number of cycles per second. 1 MHz or 3 MHz frequencies are commonly used in athletic training applications. Each frequency has its own characteristics and its selection depends on the depth of the targeted tissues. </li></ul><ul><ul><li>1 MHz for deep tissue, 3 MHz for superficial tissue </li></ul></ul>
  4. 4. Clinical Application Review <ul><li>Technique Tips </li></ul><ul><ul><li>Overlap by half </li></ul></ul><ul><ul><li>Observe the speed limit (4cm/sec) </li></ul></ul><ul><ul><li>Appropriate treatment size area (2-3x ERA) </li></ul></ul><ul><ul><li>Appropriate frequency and intensity </li></ul></ul><ul><ul><li>Calculate thermal effect </li></ul></ul><ul><ul><ul><li>Know .2 and .6 constants </li></ul></ul></ul>
  5. 5. Clinical Application Review <ul><li>Frequency Characteristics </li></ul>1 MHz 3 MHz Beam profile Relatively divergent Relatively collimating Penetration Depth 5 or more cm 0.8 to 3 cm Maximum heating rate 0.2°C (.36°F) 0.6°C (1.1°F) per min per w/cm 2 per min per w/cm 2 “ Slow heater” “Fast heater” Heat latency Longer Shorter
  6. 6. Clinical Application Review <ul><li>Selecting a Duty Cycle </li></ul><ul><ul><li>Pulsed for non-thermal effects, acute injury </li></ul></ul><ul><ul><li>Continuous for thermal effects, and when heat is not contraindicated </li></ul></ul>
  7. 7. Clinical Application Review <ul><li>Tissue temperature effects </li></ul><ul><ul><ul><li>Mild 1°C (1.8°F) increase: Reduces mild inflammation, accelerates metabolic rate. </li></ul></ul></ul><ul><ul><ul><li>Moderate 2°C (3.6°F) increase: Decreases muscle spasm, decreases pain, increases blood flow, reduces chronic inflammation. </li></ul></ul></ul><ul><ul><ul><li>Vigorous 3-4°C (5.4°F+) increase: Tissue elongation (with load applied), scar tissue reduction. </li></ul></ul></ul>
  8. 8. Clinical Application Review <ul><li>Phonophoresis </li></ul><ul><ul><li>Moving topical anti-inflammatory medication in the tissues </li></ul></ul><ul><ul><li>Examples are cortisol and dexamethasone </li></ul></ul><ul><ul><li>Effectiveness inconclusive </li></ul></ul>
  9. 9. Clinical Application Review <ul><li>Phonophoresis cont… </li></ul><ul><ul><li>Stationary rx done with very low intensity (.25w/cm 2 or pulsed) </li></ul></ul><ul><ul><li>Invisible method: rubbing med into skin then applying traditional US with regular US gel. </li></ul></ul>
  10. 10. Clinical Application Review <ul><li>Alternate application methods </li></ul><ul><ul><li>Immersion </li></ul></ul><ul><ul><ul><li>Small or irregular, bony areas </li></ul></ul></ul><ul><ul><ul><li>Soundhead 1 cm away from treatment area </li></ul></ul></ul><ul><ul><ul><li>Wipe bubbles off soundhead as they accumulate </li></ul></ul></ul><ul><ul><ul><li>May need higher intensity than normal </li></ul></ul></ul>
  11. 11. Clinical Application Review <ul><li>Alternate application methods cont… </li></ul><ul><ul><li>Gel pad </li></ul></ul><ul><ul><ul><li>Irregular areas </li></ul></ul></ul><ul><ul><ul><li>Apply thin layer of US gel on both sides of gel pad </li></ul></ul></ul><ul><ul><li>Combination with electrical stimulation </li></ul></ul><ul><ul><ul><li>Muscle spasm </li></ul></ul></ul>
  12. 12. Clinical Application Review <ul><li>Contraindications </li></ul><ul><ul><li>Never over or near spine, heart, head or genitalia/reproductive organs (includes abdomen) </li></ul></ul><ul><ul><li>Growth plates </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Infection </li></ul></ul>
  13. 13. Clinical Application Review <ul><li>Contraindications cont.. </li></ul><ul><ul><li>Joint replacements </li></ul></ul><ul><ul><li>Cardiac pacemaker </li></ul></ul><ul><ul><li>Persons with vascular probs (ie: thrombophlebitis) </li></ul></ul><ul><ul><li>Areas of decreased sensation </li></ul></ul><ul><ul><li>Metal implants: check with physician </li></ul></ul>
  14. 14. Clinical Application Review <ul><li>State practice acts vary on use of therapeutic ultrasound by certified athletic trainers </li></ul><ul><li>In NJ, standing orders or physician script required </li></ul>
  15. 15. Clinical Application Summary <ul><li>Ask yourself… </li></ul><ul><ul><li>Do you know US terminology? </li></ul></ul><ul><ul><li>Do you know US indications and contraindications? </li></ul></ul><ul><ul><li>Do you know how to select the appropriate treatment parameters? </li></ul></ul><ul><ul><li>Can you calculate the thermal effect of US? </li></ul></ul><ul><ul><li>Can you explain the benefits of US? </li></ul></ul><ul><ul><li>Do you know all of the methods to administer US? </li></ul></ul>If yes to all of these, then you are a well-prepared AT Student!
  16. 16. References <ul><li>Denegar et al. Therapeutic Modalities for Musculoskeletal Injuries. </li></ul><ul><li>Knight and Draper, Therapeutic Modalities; The Art and Science. </li></ul><ul><li>Starkey, Therapeutic Modalities. </li></ul>