ULTRASOUND THERAPY-1.pptx

ULTRASONIC
THERAPY
- DR.PRATIK CHAVAN
(MD)(AYU)
22-01-2024 1

OBJECTIVES OF SESSION
1.Definition
2.Production Of Ultrasonic Waves
3.Properties Of Wave
4.Coupling Media
5.Technique Of Application
6.Parameters Of ULTRASOUND
7.Physiological Effects Of Ultrasound.
8.Therapeutic Uses Of Ultrasound .
9.Contraindications For Applying Ultrasound .
10.Precuations
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ULTRA
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BEYOND
or
EXTREME
PERIODIC MECHANICAL
DISTURBANCE OF AN ELASTIC
MEDIUM SUCH AS AIR.
SOUND

INTRODUCTION
 In the medical community, ultrasound is the modality that is used for a
number of purposes including -
DIAGNOSIS,
DESTRUCTION OF TISSUES
THERAPY
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DIAGNOSIS
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ULTRASONOGRAPHY

ECHOLOCATION
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https://flexbooks.ck12.org/cbook/ck-12-physics-flexbook-2.0/section/12.6/primary/lesson/ultrasound-ms-ps/
SONAR

DESTRUCTION OF TISSUES :
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https://www.agadamedical.it/en-hifu-high-intensity-focused-ultrasound.html

THERAPY:-
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PRICE- 1959 RS PRICE- 3399 RS

THERAPEUTIC ULTRASOUND
THERAPEUTIC ULTRASOUND is most widely used modalities in physiotherapy
department It has been used as a valuable tool in rehabilitation of many different
injuries, to stimulate the repair of soft tissue injuries and to relieve pain.
 It has been traditionally classified as a deep heating modality and used primarily
to elevate tissue temperature.
Ultrasound is not strictly electrotherapy because it is a mechanical vibration,
although produced electrically. It has sometimes been described as micro-
massage.
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DEFINITION
1. Ultrasound refers to mechanical vibrations, which
are essentially the same as sound waves but of a
higher frequency.
2. Such waves are beyond the range of human
hearing and can therefore be called ULTRASONIC.
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 Vibration merges with sound at frequencies around 20 Hz;
vibration below this frequency is often called infrasound or infrasonic.
1. Audible sound – 20 to 20000 Hz
2. Ultrasound – Greater then 20000 Hz
3. Infrasound – Less than 20 Hz
4. Therapeutic ultrasound – 0.5 to 5 MHz
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FREQUENCY OF ULTRASOUND
Several different therapies are employed in range from 0.5 to 5 MHz.
 Majority of ultrasound generators are set at a frequency of 1 MHz & 3
MHz
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 1 MHz is transmitted through the more
superficial tissue and absorbed primarily in
the deeper tissues at depths of 3 to 5 cm.
 3 MHz, the energy is absorbed in the
more superficial tissues with a depth of
penetration between 1 and 2 cm
© textbook of electrotherapy Jagmohan singh

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PROPERTIES OF WAVES
1. Sonic waves are a series of mechanical
compression and rarefactions in the
direction of travel of the wave, hence they
are called longitudinal waves
2. They can occur in solids, liquids and
gases and are due to regular
compression and separation of molecules.
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PRODUCTION OF ULTRASOUND
1. For a 1 MHz machine a vibrating
source with a frequency of one
million cycles per second is
needed.
2. This is achieved using either a
quartz or a barium titanate
crystal, lead zirconate or nickel-
cobalt ferrite crystal
3. These crystals deform when
subjected to varying potential
difference – a piezo-electric effect
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© https://www.slideshare.net/sbishop2/ultrasound-12800533

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PIEZOELECTRICITY
1. Piezoelectricity is a natural
phenomenon found in certain
mineral crystals, but may also be
synthesized commercially.
2. The crystal transforms mechanical
energy into electrical energy and it
reverse, electrical into mechanical
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©-https://www.google.com/science/art/

ATTENUATION OF ULTRASOUND
The loss of energy from the ultrasound beam in
the tissues is called attenuation and depends on -
1. ABSORPTION
2. SCATTERING
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1. Absorption –
Ultrasound is absorbed by
the tissues and converted to
heat at that point.
This contributes the thermal
effect of ultrasound.
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2. Scattering
 This occurs when the normally
cylindrical ultrasonic beam is deflected
from its path by reflection at interfaces,
bubbles or particles in its path.
 The overall effect of these two is such
that the ultrasonic beam is reduced in
intensity the deeper it passes.
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©https://www.researchgate.net/

COUPLING MEDIA
1. Ultrasonic waves are not transmitted by air, thus some couplant which does
transmit them must be interposed between the treatment head
(transducer) and the patient’s skin.
2. Some coupling medias and their efficiency of transmission are:
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COUPLING MEDIAS THEIR EFFICIENCY OF
TRANSMISSION
Aquasonic gel- 72.6%
Glycerol 67%
Distilled water 59%
Liquid paraffin 19%
Petroleum jelly 0%
Air 0%

Characteristics Of A Coupling Media
1. High transmissivity for
ultrasound
2. Low susceptibility to bubble
formation
3. A chemically inactive nature
6.A hypoallergic character
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PRICE- 140 RS
FOR 250 ML GEL

TECHNIQUES OF APPLICATION
1. DIRECT CONTACT METHOD
- If the surface to be treated is fairly
regular then a coupling medium is applied
to the skin in order to eliminate air
between the skin and the treatment head and
transmit the ultrasonic beam from the
treatment head to the tissues.
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2. WATER BATH METHOD
When direct contact is not possible
because of irregular shape of part or
because of tenderness, a water bath may be
used.
As the part to be treated is immersed in
water this can only reasonably be applied to
the hand, ankle and foot
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WATER BATH METHOD
1. The patient is seated and part is put in water of a comfortable temperature in
such a position that it is suitably supported
2. The treatment head is placed in the water and held 1 cm from the
skin and moved in small concentric circles, keeping the front parallel to the
skin surface to reduce reflection to a minimum.
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3. WATER BAG METHOD
method of applying ultrasound therapy
to irregular surface which cannot
conventionally be placed in a water bath is
treated with a plastic or rubber bag filled
with water forming a water cushion
between the treatment head and the skin.
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PARAMETERS OF ULTRASOUND
1. MODE
2. FREQUENCY
3. INTENSITY
4. DURATION OF TREATMENT.
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1. MODE
1. Continuous mode produces more
heat so it is used for musculoskeletal
conditions such as muscular spasm,
joint stiffness, pain, etc.
2. Pulsed mode produces less heat so it
is used for soft tissue repair, e.g.
tendinitis.
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2. FREQUENCY
Attenuation increases with increase in frequency
effectively lower frequency penetrate further.
1. Ultrasonic 3 MHz—superficial tissue
2. Ultrasonic 0.75 to 1 MHz—penetrate deeply.
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3. INTENSITY
Power is the total energy/sec supplied by the machine and is measured in
Watts.
Intensity applied is according to the nature of the lesion.
1. For acute and immediate post-traumatic: 0.1 to 0.25 W/cm2
2. For chronic and scar tissue: 0.25 to 1 W/cm2.
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4. DURATION OF TREATMENT
1. Amount of energy depends on intensity and duration of treatment.
2. Size of area determine the treatment time1–2 minutes for every cm2
3. Many transducer heads have an area of 5 cm2
Minimum—1–2 minutes
Maximum —8 minutes
Average—5 minutes
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DOSAGE
Three factors which determine ultrasound dosage are as follows:
1. Size Of The Treatment Area
2. Depth Of The Lesion From The Surface
3. Nature Of Lesion.
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INSTRUMENTATION
1. Duty cycle: Adjusts between continuous
and pulsed ultrasound application
2. Frequency: Selects the depth of penetration
3. warmer: Used to preheat the transmission
gel, primarily for patient comfort
4. Intensity: Adjusts the output intensity.
The WATT METER displays the output in
either total watts or watts per square
centimeter.
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5. Maximum head temperature: Prevents overheating in case the head is not
properly coupled.
6. Pause: Interrupts the treatment but retains the remaining amount of treatment
time
7. Power: Turns the unit ON or OFF
8. Start-Stop: Initiates or terminates the production of ultrasound from the
transducer.
9. Timer: Sets the duration of the treatment.
10. Watt meter: Displays the output of ultrasound in total watts or watts per square
centimeter.
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PATIENT PREPARATION
1. Establish that no contraindications are present .
2. Determine the method and mode of ultrasound application to be used.
3. Clean the area to be treated
4. Determine the type of coupling method to be used
5. For direct coupling: spread the gel over the area to be treated
6. Advise the patient to report any adverse, unusual, or painful sensations
during the treatment.
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INITIATION OF THE TREATMENT
Reduce the INTENSITY to zero before turning ON the POWER.
 Select the appropriate mode for the output (CONTINUOUS or PULSED)
Set the WATT METER to displays the appropriate output for the type of
treatment
Set the TIMER to the appropriate treatment duration
Begin slowly moving the sound head over the medium
 Press the START button to begin the treatment session
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Slowly increase the INTENSITY-
Keep the sound head moving
Move the head at a moderate pace (4 cm per second or slower)
If Pain Is Experienced:
Move the sound head at a faster rate
Use a lower the intensity
If the gel begins to wear away or if the sound head begins sticking on the skin, depress the
PAUSE button and apply more gel
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MAINTENANCE
Daily Maintenance
 Clean ultrasound head and transducer face as recommended by the manufacturer
 Monthly Maintenance
Check all electrical cords for twist
Check the sound head cable for twist any cut
Clean the transmitter face as recommended by the manufacturer.
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PHYSIOLOGICAL EFFECTS
ULTRASOUND HAVE FOUR BASIC PHYSIOLOGIC EFFECTS :
1. CHEMICAL REACTIONS
2. BIOLOGICAL RESPONSES
3. MECHANICAL RESPONSES
4. THERMAL EFFECTS
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CHEMICAL REACTION
1. Just as test tube is shaken in the laboratory, to enhance chemical action.
2. Ultrasound vibration stimulate tissue to enhance chemical reactions and
processes therein and ensure circulation of necessary elements and
radicals for recombination
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BIOLOGICAL RESPONSES
1. The permeability of membranes is
increased by ultrasound, which
enhances transfer of fluid and
nutrients to tissues.
2. This quality is of importance in the
process of Phonophoresis, where
molecules are literally pushed
through the skin by the sound wave
front for therapeutic purposes.
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©-https://www.sciencedirect.com/science/article/pii/S0041624X16300063

MECHANICAL RESPONSES
1. Cavitation is a common condition in which a bubble gas is
produced in the tissues as a result of insonation.
2. Stable cavitation is not dangerous to the tissues, as the bubbles
remain intact and oscillate harmlessly in the ultrasonic field.
3. Transient cavitation is dangerous to the tissues, as the bubble
grows and collapse rapidly in the ultrasonic beam and this is
thought to cause very great increase in the temperature
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MECHANICAL RESPONSES
1. The MICRO MASSAGE EFFECT of ultrasound occurs at a cellular level where
the cells are alternately compressed and then pulled further apart. This effect
on intracellular fluids and thus to reduce oedema.
2. TENDON EXTENSIBILITY
- ultrasound increases the extensibility of tendons, crucial to those that
have been shortened by inflammation, strain, or disease, and providing the
clinician with an excellent formula for management of spasm
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CLINICAL APPLICATION OF US
1. Soft tissue shortening
2. Pain control
3. Surgical skin incisions
4. Tendon injuries
5. Bone fractures
6. Carpal tunnel syndrome
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SOFT TISSUE SHORTENING
1. Soft tissue shortening can be the result of immobilization,
inactivity or scarring, and can cause joint Range-of-motion
(ROM) restrictions, pain, and functional limitations.
2. Because ultrasound can penetrate to the depth of most joint
capsules, tendons, and ligaments, since these tissues have high
ultrasound absorption
3. The deep heating produced by 1 MHz continues ultrasound at
1.0 to 2.5W cm² has been shown to be more effective at
increasing joint ROM than the superficial heating produced by
infrared
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PAIN CONTROL
1. Ultrasound may control pain by altering its transmission or perception or by
modifying the underlying condition causing the pain.
2. These effects may be the result of stimulation of the cutaneous thermal
receptors or increased soft tissue extensibility due to increased tissue
temperature,
3. the result of changes in nerve conduction due to increased tissue
temperature
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SURGICAL SKIN INCISIONS
1. The effect of ultrasound on
the healing of surgical skin
incisions has been studied in
both animal and human
subjects.
2. Ultrasound has been shown
to accelerate the evolution
of angiogenesis a vital
component of early wound
healing.
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©- https://www.joharidigital.com/ultrasound-therapy-for-wound-healing/

TENDON INJURIES
1. Ultrasound has been reported to assist in the healing of tendons
after surgical incision and repair
2. It is recommended that ultrasound be applied in a Pulsed mode at
a low intensity during the acute phase of tendon inflammation in
order to minimize the risk of aggravating the condition and to
accelerate recovery
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BONE FRACTURES
 low-dose ultrasound can reduce the fracture healing time in
animals and humans, the use of low-dose ultrasound to accelerate
fracture healing is now recommended.
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CARPAL TUNNEL SYNDROME
1. Carpal tunnel syndrome, also called
median nerve compression, is
a condition that causes numbness,
tingling, or weakness in your hand.
2. Continuous ultrasound has generally
not been recommended for the
treatment of carpal tunnel syndrome
because of the risk of adversely
impacting nerve conduction velocity by
overheating.
3. resent study found that pulsed
ultrasound produced significantly
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CONTRAINDICATIONS
VASCULAR DISEASES
TUMOURS
PREGNANCY
CARDIAC DISEASE
METAL IMPLANT
ANAESTHETIC AREA
SPINAL CORD IN THE AREA OF A LAMINECTOMY , OVER THE EYES , SKULL OR TESTES
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ULTRASOUND IN COSMETICS
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REFERENCES
1. Textbook of electrotherapy – JAGMOHAN SINGH
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Ask your Questions
and make your
contribution
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22-01-2024
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ULTRASOUND THERAPY-1.pptx

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