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(2) Physical Modalities > S1_L3: Therapeutic Ultrasound and Shockwave Therapy > Flashcards

S1_L3: Therapeutic Ultrasound and Shockwave Therapy Flashcards

1
Q

TRUE OR FALSE: A deep heating modality that has both thermal and mechanical effects on tissues. An ultrasound has both thermal and mechanical effects on tissues

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

Source: Michlovitz

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2
Q

The following statements are true about ultrasounds, EXCEPT:

A. uses a sound that is beyond what human ear can hear
B. uses a mechanical form of energy
C. requires a medium
D. used for improving connective tissue extensibility
E. None of the above

A

E. None of the above

NOTE: US also utilized a form of acoustic, or sound, energy

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3
Q

Match the following zones.

  1. Far Field
  2. Absence of divergence
  3. Length depends on diameter of treatment head and frequency
  4. Distribution of energy is nonuniform
  5. Maxima (compressed) and minima (spread out) are close to each other

A. Fraunhofer Zone
B. Fresnel Zone

A
  1. A
  2. B
  3. B
  4. B
  5. B
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4
Q

Match the following zones.

  1. near part of the far field
  2. Beam is more divergent
  3. Near Field
  4. Practical Application: Underwater technique
  5. Nearly absent interference which gradually decreases with increasing distance to the transducer

A. Fraunhofer Zone
B. Fresnel Zone

A
  1. A
  2. A
  3. B
  4. A
  5. A
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5
Q

TRUE OR FALSE: US is not ideal for muscles

A

True

US must be used on the insertion or tendon, not the belly of the muscle. This is because high collagen content in tendons absorbs the US more than the muscle

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6
Q

US may have both (1)_______ and (2)_______ effects

A
  1. Thermal
  2. Non-thermal (mechanical)
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7
Q

Higher temperatures are achieved in tissues with high (1)_______ and with the application of high (2)_______US

A
  1. collagen content
  2. frequency
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8
Q

TRUE OR FALSE: Based on US parameters, frequency and penetration has a direct relationship

A

False

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9
Q

The following statements are true, EXCEPT:

A. Maximum temperature achieved is higher in 3 MHz
B. Depth of penetration is lower in 3 MHz
C. Temperature and frequency has a direct relationship
D. 1MHZ is able to penetrate up until 2cm deep
E. None of the above

A

D. 1MHZ is able to penetrate up until 2cm deep

It is up to 5cm deep

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10
Q

TRUE OR FALSE: Using 3 MHz ultrasound as compared with 1 MHz ultrasound in tissues with higher collagen content, the depth of ultrasound penetration is less. However, a higher maximum temperature is achieved.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

Source: Cameron

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11
Q

TRUE OR FALSE: sound travels slower through denser connective tissues. sound travels in a sinusoidal pattern.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

D. Only the 2nd statement is true

Source: Michlovitz

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12
Q

This is the distance between two successive peaks in the pressure wave

A

Wavelength

Source: Michlovitz

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13
Q

What is the available human ear sound frequency range?

A

16,000–20,000 Hz

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14
Q

Ultrasound enters the body and is attenuated in the tissue by (1)____, (2)_____ and (3)_____

A
  1. absorption
  2. reflection
  3. refraction
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15
Q

Generation of US waves are by (1)_____ through the application of a high frequency (2)_____ to a piezoelectric crystal

A
  1. reverse piezoelectric effect
  2. alternating current (AC)
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16
Q

Differentiate a direct piezoelectric effect from a reverse piezoelectric effect.

A

Direct: mechanical to electrical
Indirect: electrical to mechanical energy, resulting to production of sound

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17
Q

Match the US parameter.

  1. 100% duty cycle
  2. Increase cell membrane permeability
  3. Increase intracellular calcium ions
  4. Promotes macrophage responsiveness
  5. Increase blood flow

A. Pulsed Mode
B. Continuous Mode

A
  1. B
  2. A
  3. A
  4. A
  5. B
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18
Q

Match the US parameter.

  1. Increase rate of protein synthesis by fibroblasts
  2. Increase soft tissue extensibility
  3. May stimulate local histamine release
  4. Increase metabolic rate
  5. May stimulate changes in vascular tone

A. Pulsed Mode
B. Continuous Mode

A
  1. A
  2. B
  3. A
  4. B
  5. A
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19
Q

Match the US parameter.

  1. Increase nerve conduction velocity
  2. Reduction of pain & spasm
  3. Good for stretching and vasodilating
  4. Important in tissue and wound healing
  5. Stable cavitation & acoustic streaming

A. Pulsed Mode
B. Continuous Mode

A
  1. B
  2. B
  3. B
  4. A
  5. A
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20
Q

TRUE OR FALSE: Wavelength is inversely related to frequency

A

True

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21
Q

TRUE OR FALSE: Ultrasound cannot effectively travel through air because all of the energy is reflected back toward the transducer

A

True

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22
Q

US head should be applied (1)_____ and in contract with the (2)_____ of the pt

A
  1. perpendicular
  2. body surface area
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23
Q

measure of the decrease in sound energy as the sound wave travels, either by absorption, reflection, or refraction

A

Attenuation

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24
Q

_______ refers to a material’s ability to transmit sound and is related to the molecular density and structure of the material.

A

Acoustic impedance

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25
Q

Select the letters that has a structure or condition contraindicated when using an either one mode of an ultrasound.

A. Pregnancy
B. Acute Inflammation
C. Pacemaker
D. Fractures
E. Eyes

A

A,C,E,

NOTE: Those NOT considered as contraindication in the question above is only a precaution. In addition, pulse mode is allowable for inflammation.

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26
Q

Select the letters that has a structure or condition contraindicated when using an ultrasound.

A. Sensory Deficit
B. Thrombophlebitis
C. CNS tissue
D. Breast implants
E. Reproductive organs

A

A,B,C,E

NOTE: Those NOT considered as contraindication in the question above is only a precaution.

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27
Q

Select the letters that has a structure or condition contraindicated when using an ultrasound.

A. Epiphyseal plates of long bones
B. Malignant tumor
C. Laminectomy (2-4 inches away)
D. Surgical Skin Incision
E. Joint cement or plastic components of arthroplasty

A

B, E

NOTE: Those NOT considered as contraindication in the question above is only a precaution. US may be indicated on well-stitched surgical skin incisions.

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28
Q

TRUE OR FALSE: Ultrasound may be used over areas with metal implants such as screws, plates, or allmetal joint replacements because metal is not rapidly heated by ultrasound, and ultrasound has been shown not to loosen screws or plate

A

True

Source: Cameron

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29
Q

TRUE OR FALSE: Both high frequency and low-frequency ultrasound can promote healing of surgical skin incisions and can relieve pain from scars even when applied months or years after surgery

A

True

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30
Q

Determine the missing or wrong components and edit the documentation.

Cont. US using big head X 1 MHz X 1.5 W/cm2 X 2 mins on the shoulder using direct method to inc tissue extensibility.

A

WRONG: 2 mins
MISSING: pt position, part and laterality of shoulder / description of SH position

CORRECT FORMAT:
Cont. US using big head X 1 MHz X 1.5 W/cm2 X 5 mins on the anteroinferior aspect of (L) shoulder (abducted 90º and externally rotated) in supine using direct method to inc tissue extensibility.

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31
Q

TRUE OR FALSE: US may be applied before using a HMP or cold compress

A

True

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32
Q

Enumerate the methods of application available for ultrasounds

A
  1. direct method
  2. glove/ balloon/ bladder technique
  3. underwater treatment
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33
Q

Match the mode indicated for using an ultrasound.

  1. Transdermal drug delivery
  2. used before stretching shortened (tight) soft tissues/contractures
  3. Reduction of pain via modulation of inflammation or neuronal pain signaling
  4. Reduction of pain via gate control theory, relaxation, and vasodilation

A. Non-thermal / Pulsed US
B. Thermal / Continuous US

A
  1. A
  2. B
  3. A
  4. B
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34
Q

Match the mode indicated for using an ultrasound.

  1. Used for acute conditions
  2. Used for sub-acute or chronic conditions
  3. To accelerate tissue healing

A. Non-thermal / Pulsed US
B. Thermal / Continuous US

A
  1. A
  2. B
  3. A
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35
Q

_______ is sound with a frequency greater than 20,000 cycles per second (Hz) that, when applied to the body, has thermal and non-thermal effects

A

ultrasound

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36
Q

Absorption accounts for about ____ of attenuation

A

one-half

source: Cameron

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37
Q

This is a a measure of the actual cross-sectional area of the ultrasound beam as it exits the metal end plate and is expressed in square centimeters (cm2). This is determined by the size and vibrational properties of the piezoelectric crystal and is always smaller than the cross-sectional area of the metal end plate

A

Effective Radiating Area (ERA)

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38
Q

TRUE OR FALSE: Attenuation is tissue and frequency specific. It increases with the collagen content of tissues and with the frequency of the ultrasound

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

Source: Cameron

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39
Q

The following statements are true of SWT, EXCEPT:

A. uses high-energy sound waves
B. uses single impulse acoustic sound waves
C. induces a rapid rise in pressure
D. pulse duration is extremely short
E. pulse duration is generated at high frequencies

A

E. pulse duration is generated at high frequencies

pulse duration of the shock wave is extremely short (3 to 5 μs) and is generated at low frequencies

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40
Q

TRUE OR FALSE: No thermal effect is generated in using SWT

A

True

41
Q

TRUE OR FALSE: Tissues with high absorption coefficients generally have higher collagen content. Tissues with low absorption coefficients generally have lower collagen content but higher water content.

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

Source: Cameron

42
Q

TRUE OR FALSE: SWT is noninvasive but has a deep penetration. It is able to penetrate more compared in a US.

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

43
Q

TRUE OR FALSE: Ultrasound most effectively heats deep tissue with a high collagen content but does not overheat the fat.

A

True

44
Q

TRUE OR FALSE: If acoustic impedance is high, transmission is high and the material absorbs little sound. If acoustic impedance is low, the material absorbs more of the energy and less is available for transmission

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

A. both statements are wrong

high impedance = more absorption = less transmission

45
Q

TRUE OR FALSE: Ultrasound heats tissues with a high ultrasound absorption coefficient less than tissues with low absorption coefficients. The rate of tissue heating by ultrasound is proportional to the absorption coefficient of the tissue at the applied ultrasound frequency.

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

D. only the 2nd statement is correct

Ultrasound heats tissues with a high ultrasound absorption coefficient more than tissues with low absorption coefficients.

46
Q

TRUE OR FALSE:

Area 20 cm2, ERA of 10 cm2 = 5-10 mins
Area 40 cm2, ERA of 10 cm2 = 10-20 mins

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

47
Q

TRUE OR FALSE: Pulsed ultrasound, with a duty cycle of 20%, is most commonly used to produce the nonthermal benefits of ultrasound. As the patient progresses, increase the duty cycle by small increments until reaching 100%

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

48
Q

The following statements are true of US application, EXCEPT:

A. Stretching is recommended to be applied during heating and maintained for 5-10 mins
B. Stretch is not done before US application
C. Highest temperature is generally produced at soft tissue–bone interfaces where reflection is greatest
D. All
E. None

A

E. None

49
Q

TRUE OR FALSE: Muscle has a relatively low absorption coefficient

A

True

50
Q

TRUE OR FALSE: Thinner crystals are used to generate higher frequencies of ultrasound.

A

True

51
Q

TRUE OR FALSE: US is used for managing scar tissue, promoting pain relief, and enhancing tissue healing and remodeling in the care of tendinopathies

A

True

Source: Michlovitz

52
Q

TRUE OR FALSE: Attenuation
occurs the greatest in tissues with high collagen and low protein content and with the use of high US frequencies

A

FALSE

high collagen, high protein, high frequency

53
Q

TRUE OR FALSE: A piezoelectric material expands and contracts continuously in response to AC. When the crystal expands, it compresses the material in front of it; when it contracts, it rarefies the material.

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

54
Q

TRUE OR FALSE: Pregnant women are contraindicated for use of SWT. Children are contraindicated for use of SWT

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

55
Q

Match the attenuation of a 1MHz US beam.

  1. 59 %/cm
  2. 3 %/cm

A. Blood
B. Fat
C. Muscle
D. Blood Vessel
E. Skin
F. Tendon
G. Cartilage
H. Bone

A
  1. F
  2. A
56
Q

Match the attenuation of a 1MHz US beam.

  1. 24 %/cm
  2. 96 %/cm
  3. 13 %/cm

A. Blood
B. Fat
C. Muscle
D. Blood Vessel
E. Skin
F. Tendon
G. Cartilage
H. Bone

A
  1. C
  2. H
  3. B
57
Q

Match the attenuation of a 1MHz US beam.

  1. 32 %/cm
  2. 39 %/cm
  3. 68 %/cm

A. Blood
B. Fat
C. Muscle
D. Blood Vessel
E. Skin
F. Tendon
G. Cartilage
H. Bone

A
  1. D
  2. E
  3. G
58
Q

steady, circular flow of cellular fluids induced by US

A. Microsteaming/ Acoustic Streaming
B. Micromassage
C. Cavitation

A

A. Microsteaming/ Acoustic Streaming

59
Q

formation, growth, and pulsation of gas-filled bubbles by US

A. Microsteaming/ Acoustic Streaming
B. Micromassage
C. Cavitation

A

C. Cavitation

60
Q

microscopic movement of oscillation of body fluids and tissues induced by US

A. Microsteaming/ Acoustic Streaming
B. Micromassage
C. Cavitation

A

B. Micromassage

61
Q

The following statements are indications of SWT, EXCEPT:

A. Tension headache
B. Calcium tendonitis of the rotator cuff
C. Lateral epicondylitis
D. Achilles tendinopathy
E. Chronic plantar fasciitis

A

A. Tension headache

62
Q

The following statements are physiological effects of SWT, EXCEPT:

A. Disintegrating calcium deposits
B. Hyperstimulation analgesia
C. Neovascularization
D. Changes in cell permeability
E. None

A

E. None

63
Q

Match the following conditions

  1. Hematoma
  2. Hemorrhage
  3. Petechiae
  4. Pacemakers
  5. Acute injuries

A. side effects of SWT
B. contraindicated for SWT

A
  1. A
  2. B
  3. A
  4. B
  5. B
64
Q

This is a phenomenon in which the crystal generates an electric voltage when mechanically compressed

A

Piezoelectricity

65
Q

TRUE OR FALSE: Higher frequency should be partnered with low intensity.

A

True

66
Q

TRUE OR FALSE: Generation of US is by reverse piezoelectric effect. The most common materials used are quartz

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

C. only the 1st statement is correct

PZT – most commonly used, cheap, efficient

67
Q

TRUE OR FALSE: Increasing the temperature of soft tissue temporarily increases its extensibility. But this increases the risk of tissue damage.

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

C. only the 1st statement is correct

68
Q

TRUE OR FALSE: Absorption coefficients increase with increased collagen content and in proportion to the ultrasound frequency.
Changing the absorption coefficient alters the heat distribution but does not change the total amount of energy being delivered

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

B. both statements are correct

69
Q

What should be the ratio of Beam Non-uniformity Ratio (BNR)?

A

less that or equal to 6:1

70
Q

If the spatial average intensity of a US is 1.5 W/cm2, what should be the spatial peak intensity?

A

9 W/cm2

71
Q

refers to the spatial average intensity of the ultrasound beam between interruptions during pulsed ultrasound.

A. Spatial Average Intensity (SAI)
B. Spatial Peak Intensity (SPI)
C. Spatial Average Temporal Peak Intensity (ISATP)

A

C. Spatial Average Temporal Peak Intensity (ISATP)

72
Q

acoustic power of the ultrasound beam at its highest point which typically occurs somewhere within the central third of the ERA

A. Spatial Average Intensity (SAI)
B. Spatial Peak Intensity (SPI)
C. Spatial Average Temporal Peak Intensity (ISATP)

A

B. Spatial Peak Intensity (SPI)

73
Q

a measure of the average acoustic power across the ERA and is expressed in watts per square centimeter (W/cm2)

A. Spatial Average Intensity (SAI)
B. Spatial Peak Intensity (SPI)
C. Spatial Average Temporal Peak Intensity (ISATP)

A

A. Spatial Average Intensity (SAI)

74
Q

What is the most common adverse effect in the use of US?

A

burn

75
Q

TRUE OR FALSE:

The following documentation of parameters may be used for CTS using US.

Pulsed US using underwater technique x 0.5 W/cm2 x 1 MHz x 15 mins in sitting to decrease pain

A

True

Range of Parameter: 0.5 - 1.0 W/cm2, 1 MHz (underwater or gloved, 3 MHz for direct application), pulsed 1:4 for 5 – 15 mins

76
Q

TRUE OR FALSE:

The following documentation of parameters may be used for bone fractures using US.

Pulsed US x 0.15 W/cm2 x 3 MHz x 20% duty cycle x 15 mins in <position> to decrease pain</position>

A

False

Frequency must be 1.5 MHz only. Remember that only very LOW dosage is allowed

77
Q

TRUE OR FALSE:

The following documentation of parameters may be used for wound healing using US.

ContUS using underwater technique x 1 W/cm2 x 3 MHz x 20% duty cycle x 5 mins in <position> to decrease pain</position>

A

False

Pulsed US must be used

78
Q

TRUE OR FALSE:

The following documentation of parameters may be used for pain relief using US.

Cont US using underwater technique x 0.5 W/cm2 x 3 MHz x 5 mins in <position> to decrease pain</position>

A

True

79
Q

TRUE OR FALSE:

The following documentation of parameters may be used for chronic Tendon Repair using US.

Pulsed US using underwater technique x 0.5 W/cm2 x 3 MHz x 20% duty cycle x 15 mins in <position> to decrease pain</position>

A

False

When chronic, a clinical must use high intensity to increase tissue temperature, therefore, continuous mode must be set.

80
Q

Soft tissue temperature increases by approximately _____°C per minute in vivo in healthy humans when ultrasound is delivered at 1 W/cm2 at 1 MHz

A

0.2

81
Q

TRUE OR FALSE:

The following documentation of parameters may be used for phonophoresis using US.

Pulsed US using underwater technique x 0.5 W/cm2 x 3 MHz x 20% duty cycle x 5 mins in <position> to maximize use of topical drug</position>

A

True

82
Q

This is the percentage or ratio of the pulse duration to the pulse period

A

Duty cycle

83
Q

What is the formula for Duty cycle?

A

Duty cycle = duration of pulse (on time) / pulse period (on + off time)

84
Q

The following are indications to increase US duration, EXCEPT:

A. lower intensities are used
B. higher frequencies are used
C. areas larger than twice ERA
D. heating effects are desired
E. NONE

A

B. higher frequencies are used

It is increased in lower frequencies

85
Q

TRUE OR FALSE: Tissue temperature elevation of 1°C (1.8°F) increases metabolic rate.

A

True

86
Q

How much must US strokes overlap?

A

by half of ERA

87
Q

What should be the rate of movement using an US when using a direct method of application?

A

4cm/sec

NOTE: Cameron recommends speed of moving the US head between 2 and 8 cm/sec only

88
Q

The following statements are true of SWT, EXCEPT:

A. it is electrohydraulic
B. it is electromagnetic
C. it is generated through reverse piezoelectric
D. often done 1x/wk
E. NONE

A

E. NONE

89
Q

TRUE OR FALSE: Elevations in the range of 2°C to 3°C reduce muscle spasm and pain and increase blood flow. Temperature increases of 4°C or greater are necessary to boost collagen extensibility and inhibit parasympathetic activity

A. both statements are wrong
B. both statements are correct
C. only the 1st statement is correct
D. only the 2nd statement is correct

A

C. only the 1st statement is correct

It inhibits SYMPATHETIC activity

Source: Michlovitz

90
Q

TRUE OR FALSE: Local soft tissue swelling and transient pain may be possible side effects of SWT application

A

True

91
Q

TRUE OR FALSE: The alternating compression-rarefaction generated from piezoelectric material is the ultrasound wave

A

True

92
Q

Point of maximum acoustical intensity is found where?

A

between near and far fields

93
Q

This is a phase where molecules adjacent to the energy source are compressed together (condensations)

A

positive pressure phase

Source: Michlovitz

94
Q

Match the following conditions to the amount of heat indicated upon US application.

  1. hematoma
  2. healing
  3. Subacute injury

A. Non-thermal
B. Mid Thermal
C. Moderate Thermal
D. Vigorous

A
  1. B
  2. A
  3. B
95
Q

Match the following conditions to the amount of heat indicated upon US application.

  1. Acute injury
  2. Chronic inflammation
  3. Edema

A. Non-thermal
B. Mid Thermal
C. Moderate Thermal
D. Vigorous

A
  1. A
  2. C
  3. A
96
Q

This is a phase where molecules in the same region disperse (rarefactions)

A

negative pressure phase

Source: Michlovitz

97
Q

Match the following conditions to the amount of heat indicated upon US application.

  1. stretch collagen
  2. pain
  3. trigger points

A. Non-thermal
B. Mid Thermal
C. Moderate Thermal
D. Vigorous

A
  1. D
  2. C
  3. C
98
Q

What is the range of a low, moderate and high intensity SWT? Answer using mJ/mm2

A

Low - < 0.1 mJ/mm2
Moderate - 0.1 - 0.2 mJ/mm2
High - > 0.2 mJ/mm2

(2) Physical Modalities (12 decks)

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