12. HIGH-FREQUENCY SHORT WAVE AND MICROWAVE THERAPY 23-24.pdf

HIGH-FREQUENCY CURRENTS SHORTWAVE DIATHERMY (SWD) AND MICROWAVE (MWD) ELECTROPHYSICAL AGENTS Grade of Physiotherapy San Pablo-CEU University 2023-2024 OUTLINE 1. SHORT-WAVE DIATHERMY 2. MICROWAVE 3. DOSIMETRY IN HIGH FREQUENCY 4. INDICATIONS, PRECAUTIONS AND CONTRAINDICATIONS. 5. DIFFERENCES BETW...

HIGH-FREQUENCY CURRENTS SHORTWAVE DIATHERMY (SWD) AND MICROWAVE (MWD) ELECTROPHYSICAL AGENTS Grade of Physiotherapy San Pablo-CEU University 2023-2024 OUTLINE 1. SHORT-WAVE DIATHERMY 2. MICROWAVE 3. DOSIMETRY IN HIGH FREQUENCY 4. INDICATIONS, PRECAUTIONS AND CONTRAINDICATIONS. 5. DIFFERENCES BETWEEN MICROWAVE AND SHORWAVE DIATHERMY 6. SECURITY AND PROTECTION USING HIGH FREQUENCY DEVICES. 2 HIGH FRECUENCY: CONCEPT • • • • Alternating currents. 0’5-2450 Mhz. No muscle depolarization. Thermal effect. Q=I2Rt Joule’s Law 3 ACTION MECHANISMS • High Frequency heat is produced inside our body due to the electromagnetic radiation absorption. • Electromagnetic energy is better absorbed in tissues with high water content (soft tissues and organs vs fat). • The depth and effects depends on the therapy. 4 SHORTWAVE DIATHERMY (SWD) • HIGH-FREQUENCY. • WAVELENGTH: 11 m. • FRECUENCY: 27 MHz. 5 SWD APPLICATIONS • CAPACITIVE: treatment area between • INDUCTIVE: solenoid electrode over treatment area 6 SWD APPLICATIONS PARAMETER CAPACITIVE INDUCTIVE ELECTRODE TYPE RIGID PLATE RIGID METAL COILS IN PLASTIC CASING FIELD RADIATION STRONG ELECTRICAL, WEAK MAGNETIC STRONG MAGNETIC WEAK ELECTRICAL ENERGY ABSORPTION • LOW ELECTRICAL CONDUCTIBILITY: skin, fat, collagen • HIGH IMPEDANCE • LOW WATER CONTENT • HIGH ELECTRICAL CONDUCTIBILITY:muscle, synovial fluid • LOW IMPEDANCE • HIGH WATER CONTENT HEATING PATTERN SITE OF APPLICATION MORE SUPERFICIAL LOW FAT CONTENT (elbow, wrist, hand, knee, ankle, foot) MORE PENETRATING HIGH WATER CONTENT(neck, shoulder, trunk, hip, thigh) 7 SWD APPLICATIONS CAPACITIVE APPLICATORS • APLICATIONS: – Transversal/contraplanar: SERIE. – Longitudinal:PARALLEL. – Coplanar: SUPERFICIAL. • ELECTRODE SIZE. • DISTANCE ELECTRODE-SKIN. 8 SWD APPLICATIONS • TRANSVERSAL/CONTRAPLANAR: • ELECTRODE PLACED ON EITHER SIZE OF THE LIMB • ELECTRIC FIELD PERPENDICULAR TO TISSUES. • SERIE EFFECT: HIGH IMPEDANCE TISSUES MORE HEATED (SUPERFICIAL). • MICROWAVE. • SHORTWAVE DIATHERMY. • LONGITUDINAL • ELECTRODE PLACED AT EACH END OF THE LIMB: • ELECTRIC FIELD PARALLELL TO TISSUES • PARALLEL EFFECT: LESS IMPEDANCE TISSUES MORE HEATED (LIQUIDS). • SHORTWAVE DIATHERMY 9 SWD APPLICATIONS • COPLANAR: • BOTH ELECTRODES PLACED ON THE SAME SIDE OF THE LIMB. • THE FIELD FOLLOWS THE ROUTE OF LEAST RESISTANCE (through blood vessels:IONS) • ELECTRODES PLACED ONE ELECTRODE AND A HALF DISTANCE BETWEEN THEM. 10 TRANSVERSAL APPLICATION • SAME SIZE AND DISTANCE (1). • SAME SIZE, DIFFERENT DISTANCE (2). 1 2 • DIFFERENT SIZE, SAME DISTANCE (3). 3 • DIFFERENT SIZE, DIFFERENT DISTANCE (4). 4 11 Distance JOIN THE DARKSIDE SWD APPLICATIONS • INDUCTIVE ELECTRODES: – INDUCTIVE COIL APPLICATOR (CIRCUNPLODE): CABLE PRECOILED AND ENCASED IN AN INSULATED DRUM. – STRONG MAGNETIC FIELD. 12 SWD APPLICATION MODE • CONTINUOUS SWD • PULSED SWD • EMR with no interruption • EMR with interruption • THERMAL EFFECT • MECHANICAL EFFECT • Increase in molecular kinetic energy and increase in temperature. • Burst of pulses • Vasodilatation • Decrease in pain • Increased metabolism • Decrease in joint stiffness • Increase in nerve conduction velocity • Decrease swelling • Increase in pain threshold • Increased tissue elasticity. • Increased blood flow • Reduction of oedema • Promotes tissue repair. 13 PULSED HIGH FREQUENCY • • CHARACTERISTICS: • GENERALLY ATHERMAL(MAGNETIC FIELD). • PEAK POWER 250 W. • PD  0’1 ms. • FRECUENCY  1000 Hz. • BIG ELECTRODES. DISADVANTAGES: • LONG TREATMENT TIME. • LESS CLEAR RESULTS VERSUS THERMAL APPLICATIONS. • PROBLEMS WITH THE DOSAGE. 14 CLINICAL INDICATIONS FOR PSWD • CONTROL OF PAIN AND EDEMA • PAIN CONTROL • WOUND HEALING • NERVE HEALING • BONE HEALING 15 MICROWAVE DIATHERMY (MWD) • HIGH-FREQUENCY CURRENT • ANTENNA ELECTRODE. • WAVELENGTH: 12’5 cm. • SHORT WAVELENGTH: • Focused diathermy. • Small, defined areas. • 5-10 cm FRECUENCY: 2450 MHz. • Reflection and refraction. 16 MW ELECTRODES CAPACITIVE ELECTRODES: • CIRCULA FIELD ELECTRODE: 10 cm • LARGE FIELD ELECTRODE CAMPO LARGO: 5 cm • HIGH FIELD ELECTRODE: Trunk CONTACT ELECTRODES: Special applications. 17 HIGH FREQUENCY DOSIFICATION • DEPENDS ON: • INTENSITY • APPLICATION TIME • PULSED SHORTWAVE FREQUENCY • BE GUIDED BY THE HEAT SENSATION PERCEIVED BY THE PATIENT: NEVER HEAT ABOVE THE TOLERANCE LEVEL!!!!!!! • LOWER DOSE IN ACUTE WITH SHORT DURATION, MORE IN CHRONIC WITH LONG DURATION 18 DOSIMETRY • INTENSITY: W/cm2. • DOSE DEPENDS ON: – AREA. – INTENSITY. – ELECTRODES SIZE. – ELECTRODES DISTANCE – TISSUE CONDUCTIVITY 19 DOSIMETRY PATIENT’S PERCEPTION OF HEAT DURING TREATMENT • DOSE I: ACUTE. NO PERCEPTION OF HEAT: ATHERMAL. 10 MINUTES • DOSE II: SUBACUTE.MILD PERCEPTION OF HEAT: THERMAL. 10-15 MINUTES • DOSE III: CHRONIC. COMFORTABLE PERCEPTION OF HEAT: THERMAL. 15-20 MINUTES • DOSE IV: CHRONIC. MAXIMUM TOLERABLE PERCEPTION OF HEAT: THERMAL. 20 HIGH FREQUENCY INDICATIONS • • • • • CIRCULATORY DISORDERS INFLAMMATORY PROCESSES due to increased phagocytosis and defensive mechanisms. • SCAPULOHUMERAL PERIARTHRITIS • TENNIS ELBOW • BURSITIS • PERIOSTITIS • SINUSITIS METABOLIC PROCESSES • Wound healing, ulcers PAIN: Arthropathies, neuralgia, neuritis, hypertonia. LUMBAR PAIN! MUSCULAR HYPERTONIA: Arthrosis, neuralgias 21 PULSED HIGH FREQUENCY INDICATIONS • POST-TRAUMATIC DISORDERS: sprains, contusions, fractures, haematomas. • POSTOPERATIVE DISORDERS. • INFLAMMATORY PROCESSES: Bursitis with calcification, sinusitis or lumbago. • PERIPHERAL CIRCULATORY DISORDERS: diabetic ulcers. 22 PRECAUTIONS • SKIN HEAT BURNS: – METALS, HUMIDITY, ELECTRODE PLACEMENT, ELECTRODE CONTACT. – CONTACT TO THE SKIN. – SKIN HYPERSENSITIVITY (RADIOTHERAPY/OINTMENTS). – LESS BLOOD FLOW. – EXCESSIVE DOSES. – FAT LAYERS (LESS VASCULARIZED) 23 PRECAUTIONS • AREAS OF IMPAIRED CIRCULATION AND HYPOTENSION • INFECTED TISSUES • HEAT SENSITIVE SKIN DISEASES: ECZEMA • NEAR THE EYES • REGENERATING NERVES • METAL IMPLANTS • INFLAMMATION IN CHRONIC PROCESSES • CHRONIC WOUNDS, ULCERS AND DAMAGED SKIN • INTERFERENCE WITH ELECTRONIC DEVICES • ELECTRONIC DEVICES INTERFERENCES. • OBESITY • ALTERED SENSITIVITY • REPRODUCTIVE ORGANS AND IN THE CASE OF INTRAUTERINE DEVICES • CERAMIC, PLASTIC OR CEMENT IMPLANTS. • HAEMOPHILIA AND ANTICOAGULANT TREATMENT 24 RELATIVE CONTRAINDICATIONS • HEAT SENSITIVITY DISORDERS • ARTERIAL AND VENOUS DISORDERS: Atherosclerosis, Thrombosis • CARDIAC DISORDERS • INFECTIOUS DISEASES AND ACUTE INFLAMMATION 26 ABSOLUTE CONTRAINDICATIONS • MALIGNANT TUMOURS • PACEMAKERS • PREGNANCY • TUBERCULOSIS • FEVER • CHRONIC RHEUMATOID ARTHRITIS IN ACUTE PHASE. 25 SHORTWAVE DIATHERMY(SWD)MICROWAVE DIATHERMY(MWD): DIFFERENCES • TECHNICAL DIFFERENCES: • PRODUCTION MECHANISM. • WAVELENGTH AND FRECUENCY: E=h MWD MORE ENERGY (MORE FREQUENCY) • MWD: REFLECTION-REFRACTION DUE TO CLOSENESS TO LIGHT SPECTRUM. 27 SHORTWAVE DIATHERMY(SWD)MICROWAVE DIATHERMY(MWD): DIFFERENCES • CLINICAL: – SWD DEEPEN MORE THAN MWD. – SWD MORE APPLICATION POSSIBILITIES. – SWD ALLOWS PULSED APPLICATION. 28 SECURITY WORKING WITH NONIONIZING RADIATIONS • High-frequency devices maintenance: manual and time delay device • Information and education about risks and guidelines to minimize exposition. • Devices placement: • Separate rooms, minimum distance of 2 meters. • Control console near the room entrance. • Emission electrode in opposite position regarding other rooms/patients. ELECTROTHERAPY DEVICE PLACEMENT • ELECTROTHERAPY AREA: isolated or next to Physiotherapy area. • Do no put the device in the middle of the room. • Do not leave the device working without a patient. • Do not include more than one high-frequency device per room. ELECTROTHERAPY DEVICE PLACEMENT • Do not apply manual therapy treatments next to to highfrequency devices. • Console control next to the room entrance with the patient inside the room. • Shortwave electrode must not be directed to the microwave electrode. ELECTROTHERAPY DEVICE PLACEMENT • Increase the distance between the electrode and the patient to avoid radiations to other patients and workers. • Wooden material furniture recommended. • Work surface separated from electrotherapy devices (high frequency) EDUCATION • ABOUT RISKS OF EXPOSITION TO RADIOMAGNETIC FIELDS. • ABOUT SAFE PRACTICAL ACTIONS. MATERNITY PROTECTION – Avoid innecesary expositions. – High-frequency applications done by other workers. – Pregnant women far from high-frequency devices. PRECAUTION FOR THE THERAPIST APPLYING ELECTROMAGNETIC RADIATION – Therapist stay at least: • 1 to 2 m away from all continuous shortwave (SWD) applicators. • 30-50 cm away from all pulse shortwave (PSWD) applicators. • Out of the direct beam of any microwave device during patient treatment. PRECAUTION FOR THE THERAPIST APPLYING ELECTROMAGNETIC RADIATION – Therapist stay at least: • 2 m away from the unit, electrodes and cables of all SW devices operating with capacitor-type electrodes. • 1 m away from the unit, electrodes and cables of all SW devices operating with inductive-type electrodes. CONCLUSIONS • High Frequency characterizes due to its DEEP THERMAL EFFECT produced inside the human body. • Indications and contraindications are the same for Thermotherapy considering its electromagnetic origin and depth. • Normal applications are SWD and MWD. • Pulsed application produces effects without the tissue’s temperature increase. • SWD has more clinical applications but it is more difficult to handle correctly. • Safety measurements should be taken with SWD and MW 37 REFERENCES • • • • • Manual de Seguridad y Salud frente al Riesgo de Exposición Laboral a los Campos Electromagnéticos en los puestos de Fisioterapeuta y Auxiliar. Maphre, 2011. Belanger A-Y. Evidence-Based Guide to Therapeutic Physical Agents. Elsevier Churchill Livingstone 2.002. Belanger A-Y. Evidence Behind Practice. Lippincot Williams and Wilkins, 2015. Kitchen S. Electrotherapy: Evidence – Based Practice. Elsevier Churchill Livingstone 2.002. Albornoz M, Maya J, Toledo JV. Electroterapia Práctica. Avances en Investigación clínica. Madrid: Elsevier.2023 38