Week 7

Question 1

Name 4 EPAs

Answer 1

Thermal
Non-thermal
Electrical stimulation
Othes

Question 2

Thermal EPAs (7)

Answer 2

Hydrocollator (Hot) packs
Cryotherapy (Ice/cold/immersion)
Continuous Therapeutic Ultrasound
Shortwave Diathermy
Microwave Diathermy
Infrared 
Wax Bath

Question 3

Non thermal EPAs (8)

Answer 3

Pulsed ultrasound
Low intensity pulsed ultrasound (LIPUS))
Pulsed laser therapy
Pulsed shortwave therapy
Pulsed electromagnetic fields
Magnetic therapies
Mircrocurrent therapies
shock wave therapy

Question 4

Electrical Stimulation EPAs (6)

Answer 4

Interferential therapy (IFT)
Transcutaneous Electrical Nerve stimulation (NMES)
Functional Electrical Stimulation (FES)
Microcurrent Therapy (MCT)
Transcranial Direct-Current Stimulation (tDCS)

Question 5

Other EPAs (4)

Answer 5

Biofeedback (no stimulation)
Electromyograph - Biofeedback
Ultrasound Imaging
Ultraviolet light

Question 6

pages to review

Answer 6

10,11.12, 25,26,33

Question 7

Generation of US

Answer 7

An ultrasound wave is generated when an electric field is applied to an array of piezoelectric crystals located on the transducer surface. Electrical stimulation causes mechanical distortion of the crystals resulting in vibration and production of sound waves (i.e. mechanical energy)

Question 8

Generation of US Part 2

Answer 8

The conversion of electrical to mechanical (sound) energy is called converse piezoelectric effect (Gabriel Lippman 1881)

Frequency dependant on crystalline disc and current applied

Question 9

Characteristics of Traditional US (3)

Answer 9

High frequency modality (1- 3MHz)
Thermal and non thermal effects
European, Antipodean North American approaches

Question 10

Characteristics of Long Wave US (4)

Answer 10

Newer modality
45 kHz
Longer wavelength - penetrates more deeply (several metres)
promoted for same uses as traditional high frequency US

Question 11

What is a transducer

Answer 11

A device that produces sound waves that bounce off body tissues and make echoes. The transducer also receives the echoes and sends them to a computer that uses them to create a picture called a sonogram

Question 12

What is ERA

Answer 12

Effective radiating arm

Question 13

What is the power of US measured in

Answer 13

Watts

Question 14

What is the intensity of US measured in

Answer 14

Wcm^-2

p20

Question 15

What is the Beam Non-uniformity Ratio (BNR)

Answer 15

Describes the consistency (or uniformity) of the US output ratio

Question 16

What does the BNR range from

Answer 16

10:1-2:1

Lower = better

Question 17

What is the Duty Cycle (Pulsed Ratio)

Answer 17

describes the proportion of time the current is actually flowing
e.g. 5s on 10s off - duty cycle is 33% (1:2)
typically 1;1 or 1;4
each pulse lasts about 2ms

Question 18

What does frequency refer to

Answer 18

number of waves per second

Question 19

What is frequency measured in

Answer 19

Hertz (Hz)

Question 20

Do lower or higher frequencies penetrate further into the tissue?

Answer 20

Lower

Question 21

What are higher frequencies used for

Answer 21

Superficial tissue (3MHz)

Question 22

What are lower frequencies used for

Answer 22

Deeper tissue (1MHz)

Question 23

What is Attenuation

Answer 23

Reduction in energy as the ultrasonic wave passes through a medium
includes absorption, reflection, refraction and scattering

Question 24

Transducer/air percent reflection

Answer 24

99.9

Question 25

Soft tissue/air percent reflection

Answer 25

99.9

Question 26

Water / soft tissue percent reflection

Answer 26

0.2

Question 27

Soft tissue /fat percent reflection

Answer 27

1.0

Question 28

Soft tissue/bone percent reflection

Answer 28

15-40

Question 29

What is half depth

Answer 29

The depth in the tissues at which half the surface energy is available

Question 30

Half - value depth of penetration for muscle fat and tendon (1 and 3 MHz)

Answer 30

``` Muscle 1(9.0mm) 3(3.0 Fat 1(50mm) 3(16.5mm) Tendon 1(6.2) 3(2.0) ``` ``` 3MHz = 2.0cm 1MHz = 4.0cm ```

Question 31

Therapeutic effects of thermal US

Answer 31

Increasing temperature (40-45 degrees ) hyperaemia, resolution of chronic inflammatory states

Question 32

The effects of thermal US are dependant on what (4)

Answer 32

MODE of US continuous or pulsed The vascularity of the tissue Protein : fat content o the tissue (protein absorbs more than fat) Frequency /intensity applied

Question 33

Tissues preferentially heated (7)

Answer 33

``` Periosteum Superficial cortical bone Joint menisci fibrotic muscle Tendon sheath Major nerve roots intermuscular interfaces ```

Question 34

Affects of therapeutic US on the inflammatory stage

Answer 34

Affects membrane potential stimulates mast cells, platelets, white cells with phagocytic roles and the macrophages Mast cell degranulation Pro inflammatory not anti inflammatory

Question 35

Therapeutic US proliferative

Answer 35

Stimulation of fibroblasts, endothelial cells and myofibroblasts Increased rate of angiogenesis Increased protein and collagen synthesis Proliferative - enhancing and maximising efficiency

Question 36

Therapeutic US during the Remodelling stage (3)

Answer 36

Enhancing normal deposition & organisation of collagen fibres Enhancing tensile strength and scar tissue mobility Effects are dependant on time of initial treatment

Question 37

Machine settings for US dose calculation

Answer 37

Machine frequency Pulse ratio intensity time

Question 38

Other factors for US dose calculations

Answer 38

size of lesion tissue state (stage of healing) depth of lesion half depth values

Question 39

US dose pages

Answer 39

38-40

Question 40

Contraindications of all EPAs (5)

Answer 40

Those who are unable to comprehend instructions, or who are unable to co-operate. The application of EPAs over the abdomen, lower back or pelvis is normally contraindicated during the first 35-weeks of pregnancy. In the area of a tumour where there is active or suspected malignancy, except for palliative care Areas of recent bleeding tissue or haemorrhage Active tuberculosis in treatment area

Question 41

Precautions for all EPAs (4)

Answer 41

Treatment should not normally be carried out: Over the anterior aspect of the neck When there is significant impairment in the circulation/sensory loss of the area to be treated Where there is devitalised tissue e.g. recent radiotherapy Where there is local acute skin conditions e.g eczema, dermatitis

Question 42

Contraindications for US

Answer 42

Avoid exposure to the developing foetus (i.e. do not treat over uterus during pregnancy) Malignancies and precancerous lesions Vascular abnormalities including DVT, severe arterio/atherosclerosis, emboli Acute infections Haemophiliacs not covered by factor replacement Application over: Eye • Testes • Stellate ganglion • Cardiac area in advanced heart disease/pacemakers • Spinal cord after laminectomy • Cranium • Active epiphyseal regions in children • Tissues previously treated by deep X-ray or other radiation

Question 43

Precautions for US (6)

Answer 43

- Anaesthetic areas should be treated with caution if a thermal dose is being applied - Subcutaneous major nerves and bony prominences - Always use the lowest intensity which produces a therapeutic response - Ensure the applicator is moved throughout treatment - Ensure the patient is aware of the nature of the treatment and the expected effects - If pain, discomfort or unexpected sensations are experienced by the patient, the treatment intensity should be reduced. If the symptoms persist, the treatment should be terminated.