Stanbridge - T4 - Modalities - W3

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Questions and Answers

What is the primary benefit of Helium Neon (HeNe) lasers in therapy?

Treatment of deep muscle injuries

Wound healing with effective absorption depth (correct)

Reduction of nerve pain in deeper tissues

Surgical cutting of tissues

Which physiological response is NOT associated with Low Level Laser Therapy (LLLT)?

Improved tissue healing

Increased ATP production

Decreased fibroblast activity (correct)

Increased blood circulation

How does the absorption depth of Gallium Arsenide (GaAs) lasers compare to that of Helium Neon (HeNe) lasers?

Both have the same absorption depth

GaAs has a deeper absorption depth than HeNe (correct)

HeNe lasers absorb to a depth of 5 cm

GaAs has a shallower absorption depth than HeNe

What distinguishes high-intensity lasers from low-power lasers in terms of therapeutic application?

High-intensity lasers have a maximum peak output greater than 500 mW Signup and view all the answers

Which condition is effectively treated with Neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers?

Bursitis and tendinitis Signup and view all the answers

What is true regarding the frequency of sound waves in relation to tissue penetration?

Longer waves correspond to shorter frequencies. Signup and view all the answers

In the context of ultrasound, which statement accurately describes stable cavitation?

It produces small changes in the radius of gas bubbles. Signup and view all the answers

What factor significantly increases the absorption of ultrasound energy in tissues?

The presence of scar tissue. Signup and view all the answers

Which scenario is most likely to cause unstable cavitation during ultrasound treatment?

Employing improper application techniques with 1 MHz frequency. Signup and view all the answers

Which temperature range is typically associated with significant thermal effects from ultrasound?

104°F - 113°F Signup and view all the answers

What is the recommended time frame for stretching after ultrasound treatment to gain thermal benefits?

Within 8-10 minutes. Signup and view all the answers

In which condition is ultrasound absorption generally less effective?

In adipose tissue. Signup and view all the answers

What determines whether to continue ultrasound treatment during a session?

The patient's subjective tolerance Signup and view all the answers

Which action should be taken first if a patient experiences sharp pain during ultrasound treatment?

Pause the machine and decrease intensity Signup and view all the answers

Which of the following is an appropriate method for concluding ultrasound treatment?

Gradually decrease the intensity before turning off power Signup and view all the answers

When performing post-treatment evaluations, what should be inspected primarily?

The skin condition at the treatment site Signup and view all the answers

What is the correct action to take regarding the transducer after treatment?

Sanitize it with alcohol before returning to the cradle Signup and view all the answers

Which statement is true regarding the use of ultrasound for treating knee osteoarthritis?

It is beneficial for reducing pain and improving function Signup and view all the answers

What is the advised speed for keeping the transducer moving during treatment?

4 cm/sec Signup and view all the answers

What frequency range selections are appropriate for ultrasound applications?

1 MHz or 3.3 MHz Signup and view all the answers

For which condition is ultrasound NOT recommended?

Plantar fasciitis Signup and view all the answers

What distinguishes low level laser therapy from high intensity laser therapy?

Low level lasers do not exceed a peak power of 500 mW. Signup and view all the answers

Which characteristic is unique to lasers compared to ordinary light sources?

Lasers produce monochromatic and coherent light. Signup and view all the answers

In laser classification, which class encompasses lasers that are hazardous to the eye upon direct viewing?

Class 3b Signup and view all the answers

What physiological response is primarily stimulated by light absorption in mitochondrial cytochromes?

Increased cellular energy balance. Signup and view all the answers

Which wavelength range is most effectively absorbed in superficial tissue?

400-700 nm Signup and view all the answers

How does laser therapy support nerve repair?

By stimulating the surrounding neural tissues. Signup and view all the answers

What occurs when unstable molecules in the laser medium shed energy?

They emit photons which create the laser beam. Signup and view all the answers

What type of light is associated with class 1 lasers?

Lasers that are safe for any exposure time. Signup and view all the answers

What key factor does NOT contribute to the effectiveness of laser therapy?

Type of energy supplied to the laser. Signup and view all the answers

What effect does increased nitric oxide (NO) have in relation to laser therapy?

It serves as a vasodilator. Signup and view all the answers

What is a common anti-inflammatory medication used in phonophoresis that demonstrates a 12-fold enhancement?

Dexamethasone Signup and view all the answers

What is a key consideration when applying phonophoresis to ensure effectiveness?

Avoiding air bubbles in the couplant Signup and view all the answers

What conclusion was drawn from Martin et al.'s clinical practice guidelines regarding phonophoresis for heel pain plantar fasciitis?

Phonophoresis has no recommendation for use Signup and view all the answers

In assessing the effectiveness of phonophoresis on chronic injuries, what was highlighted by Kim et al.'s systematic review?

No support exists for phonophoresis over ultrasound or iontophoresis Signup and view all the answers

Which type of laser therapy is typically used in rehabilitation?

Cold laser therapy Signup and view all the answers

What aspect of treatment dosage is similar for phonophoresis and ultrasound?

The same dosage parameters are followed Signup and view all the answers

What is indicated by the phrase 'local application with systemic effects' in relation to phonophoresis?

Local treatment can impact the entire body Signup and view all the answers

What should be avoided to ensure proper phonophoresis application?

Couplant and medication being 'whipped' Signup and view all the answers

What aspect of phonophoresis is stated to have very limited supportive research?

Research on efficacy in chronic conditions Signup and view all the answers

Study Notes

Modalities (PTA 1009)

The presentation covers Ultrasound and Laser therapy.
Students will learn about the physical principles of ultrasound, physiological responses, indications, contraindications, precautions, adverse reactions, and general application, dosage and frequency.

Ultrasound

Sound is the vibration of a medium.
Frequency is the rate at which something repeats over a period.
Ultrasound is a frequency of vibration beyond audible sound (above 20,000 cps).
Human ears detect vibrations up to 20,000 cycles per second (cps).
Therapeutic ultrasound typically operates between 1 MHz and 3.3 MHz (millions of cycles per second - or megahertz).
A sound wave creates pressure in a medium, compressing molecules.
Each molecule transfers energy to its neighbour causing a chain reaction throughout the medium.
Sound waves can travel through liquids, gases, and solids.
Ultrasound machines use piezoelectric ceramic crystals to generate sound waves.
Current applied to the crystal causes it to distort and vibrate producing mechanical waves which are sent into the body.
During treatment, waves impart energy to the target tissue molecules.
Ultrasound can generate thermal and non-thermal tissue effects.

Ultrasound: Indications

Deep Heating: Joint contracture, scar tissue, pain, muscle spasm, subacute/chronic tissue disorders requiring increased temperature or blood flow.
Healing Facilitation: Acute injury or inflammation of soft tissues, peripheral nerves, and open wounds.

Ultrasound: Instrumentation

Includes a console, coaxial cable, and transducer (5 cm² or 10 cm²).
The presentation mentions coupling gel (a medium that allows sound waves to travel effectively through tissues, typically water-based).
Using coupling gel prevents air pockets that reflect/absorb the ultrasound waves

Ultrasound: Beam Nonuniformity Ratio (BNR)

BNR is the ratio of peak power to the average power in an ultrasound beam.
It is measured 0.5 cm from the transducer, indicating transducer quality.
Acceptable BNRs in Ultrasound range from 2.1:1 to 8:1; with an average of 5:1 to 6:1.
A "hot spot" in tissue can receive 6 times more energy than intended.

Ultrasound: Effective Radiating Area (ERA)

The effective radiating area (ERA) is the part of the ultrasound beam that delivers clinically effective power.
The treatment area must be smaller than 4x the ERA, to maximize the effectiveness.
This is because treatment time increases if the area to be treated is significantly larger than the size of the treatment head.

Ultrasound: Biophysical Effects

Thermal: Increased metabolism, reduced muscle spasms, decreased joint stiffness, alteration of nerve conduction velocity, increased circulation, and increased soft tissue extensibility.
Thermal effects depend on tissue temperature changes and factors like type of device/ modality used.
Non-thermal (usually with pulsed ultrasound): Increased cell membrane permeability, increased intracellular calcium levels, facilitation of tissue repair, and promotion of normal cell function.

Ultrasound: Effects on Different Tissues

Tissues with high protein content and dense tissues absorb ultrasound waves best, resulting in significant heat production.

Ultrasound: Effects on Fluids/Bone

Fluid elements have low resistance and absorption, minimizing heat effects.
Bone's high impedance and absorption can result in quick heating and if intensity is too high, it can lead to a prickling sensation.

Ultrasound: Frequency

Higher frequency (3.3 MHz): absorbed more effectively in superficial tissues (with penetration of 1-3 cm), and accelerates temperature rise.
Lower frequency (1 MHz): penetrates deeper into tissues (up to 3-5 cm in tissue)

Ultrasound: Mode

Continuous: produces primarily thermal effects.
Pulsed: produces both thermal and nonthermal effects. This means the output of the Ultrasound is not constantly applied but rather in short bursts.

Ultrasound: Dosage & Duty Cycles

Duty cycle = (On time/ total treatment time) x 100.
Common duty cycles use 1:1 (50%) or 1:4 ratios (20%) to deliver pulsed ultrasound.
Intensity (the amount of energy per unit area), is typically between 0.5-3.0W/cm2
Duration in minutes (5-10 per point) is dependent on the frequency and the intended target area's size.
More intense treatment at chronic conditions.

Ultrasound: Contraindications/Precautions

Contraindications: Anesthetic areas, impaired arterial circulation, over epiphyseal plates of growing bones, active bleeding, over eyes, testes, spinal cord after laminectomy (may cause cavitation).
Pregnancy, malignancy/infection, over carotid sinus, heart, stellate, cervical ganglia, pacemaker, over regions of thrombophlebitis or DVT, abscesses.
Precautions: Maintain consistent energy transfer, keep transducer moving, avoid bony prominences, use low doses for acute inflammatory pathologies, and avoid epiphyses of growing bones.

Ultrasound: General Instructions for Application

Inspect/check equipment (calibration)
Instruct the patient about the procedure, sensation and expected outcomes.
Position and drape the patient.
Identify the area, palpate the skin, consider depth.
Adjust patient position as needed, if necessary.
Select an appropriate frequency (1 MHz or 3.3 MHz).

Ultrasound: Application Technique

Apply gel to the transducer head, and maintain skin parallel contact.
Apply dosage, and keep transducer moving (approximately ~4 cm/sec).

Ultrasound: Response to Intervention & Documentation

Document patient responses.
Monitor for warmth (normal response).
If sharp pain, decrease the intensity and pause the treatment before changing frequencies.

Laser Therapy

Focuses on biostimulation (cellular-level tissue growth) instead of heat.
Types of lasers: different wavelengths have varying tissue depth.
Wavelengths: 400-700 nm - effective on superficial tissues; 700-1200 nm - effective on deeper tissues.
Classification: Class 1 is safe for any potential exposure; class 2 - safe to blink reflex (visible light); class 3a and 3b increase in power and potential hazard to eyes; and class 4 poses a risk of burns and permanent eye damage.

Laser Therapy: Purpose & Effects

Light is absorbed into mitochondria, triggering biochemical reactions and physiological responses within the cells.

Laser Therapy: Physiological Responses

LLLT & HILT lead to increased ATP production, resulting in increased cellular energy with increased fibroblast activity.
Increased cell proliferation, aiding tissue healing (fibroblasts, endothelial cells, keratinocytes, macrophages, mast cells).
Increased local blood circulation and muscle relaxation, with an anti-inflammatory response and pain reduction.

Laser Therapy: Precautions

Dark pigmented skin (less depth of beam penetration)
Impaired sensation
Photophobia, check for skin rashes
Diabetes, check sensation
Over tattoos.

Laser Therapy : Applications and Technique

Direct contact approach: (LLLT)
Indirect contact approach: (LLLT & HILT)
Sweeping technique: (LLLT & HILT).

Laser Therapy Dosage and Frequency

The frequency is typically determined by the specific laser and manufacturer.
A common way to represent dosage is in joules per cm2.

Laser Therapy: Frequency

Acute conditions benefit from high frequency at lower doses.
Sub-acute conditions may benefit from every other day treatment
Chronic conditions usually benefit from lower frequency but higher doses.
If there is no response after two weeks, re-evaluation is necessary.

Laser Therapy: Documentation

Record the location, surface area, dosage in joules/cm², laser power in watts, frequency and type of laser, mode, and the patient response to therapy.

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Description

Test your knowledge on the applications and effects of laser and ultrasound therapies. This quiz covers the principles of Low Level Laser Therapy (LLLT), the differences among various laser types, and the characteristics of ultrasound treatment. Dive into the specific conditions treated and the physiological responses associated with these modalities.

Stanbridge - T4 - Modalities - W3 - Laser & Ultrasound

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