sekar.l. application التطبيق of high-frequency electromagnetic energy عالية التردد...

SHORTWAVE الموجاتباإلنفاذ القصيرةالعالج

DIATHERMYالحراري

Sekar.L

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SWD - INTRODUCTIONApplication التطبيق of High-Frequency Electromagnetic Energy

  الكهرومغناطيسية  الطاقة التردد عالية

A deep-heating   التدفئة أعماق فيmodality شكل

Does Not stimulate  حفز MOTOR ال .SENSORY NERVES & المحركات

الحسية  .األعصاب

No Danger خطر يوجد of CHEMICAL الBURNS الكيميائية الحروق

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SWD - INTRODUCTION

No Contraction of Muscles is produced     وينتج  تقلصالعضالت ال

Frequency تردد (27.12 MHz at wavelength of 11 M)

Dia ضياء means through خالل and من

Thermo الحرارية means temperature الحرارة درجةheat.

Short wave diathermy (SWD), or radio frequency (RF), is used to penetrate deep  عميق into the اختراقbody tissues الجسم to stimulate blood flow أنسجة

الدم . تدفق

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Possible Shortwave Diathermy Unit

A=Power SwitchB=TimerC=Milliameter (monitors current from power supply not current entering patient-volume control)D= Intensity(%max power to patient)E=Tuning Control(tunes output from RFO)

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Shortwave Diathermy Unit

•Generates Both an Electrical and a Magnetic Field الكهربائية

المغنطيسي المجال

SWD Units at 13.56 MHz= Stronger Magnetic Field

SWD Units at 27.12 MHz = Stronger Electrical Field

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Generation of High Frequency SWD

SWD have two main ;الدوائر circuits الرئيسيتين1. The machine circuit

الدوائر  which produce الجهازhigh frequency current coupled with

2. The patient circuit المريض  through الدائرة

inductors to transfer the electrical energy to the patient.

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Principle of Production of SWD

•This type of high frequency current is obtained by DISCHARGING التفريغ a CONDENSER المكثف through an INDUCTANCE

of LOW ملفمحاثة OHMIC RESISTANCE.

  األومية  انخفاضالمقاومة

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Biophysical and biochemical effects of SWDEffects of an electrostatic field  الكهربائي : الحقل1- Free ions in the tissues give minimal movement (Vibration of Ions  األيونات due to (اهتزازhigh frequency leading to friction احتكاك between ions and produce heat.

الحرارة  إنتاج

+

+

+

+

--

-

-

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Biophysical and biochemical effects of SWD2- The dipolar وثنائي molecules القطب as water – will)جزيئاتrotate to & fro - Swinging) charge change rapidly, friction between molecules leads to heat in the tissues.

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Biophysical and biochemical effects of SWD3- The non-polar وغير molecules (as fat القطبية ,عازل Insulator –الدهونundergo distortion تشويه of their electron cloud

سحابة  leading to اإللكترونback & forth  عليها ويعودmovement) cause minimal friction and molecular movement producing little heat.

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Physiologic Responses To SWDTissue Temperature Increase

Increased Blood Flow (Vasodilatation)

Increased Venous and Lymphatic Flow واللمفاوي  الوريدي الدم تدفق

Increased Metabolism

Changes In Physical Properties الخواصof Tissues الفيزيائية

Muscle Relaxation -  االسترخاء عضلةAnalgesia - تسكين

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Types of Electrodes in SWDFlexible pads  مرنة consist of : منصاتmetal electrode encased المغطى in rubber and produce an electrostatic field.

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Types of Electrodes in SWDSpace plates  الفضاء : لوحاتconsist of a rigid metal electrode

  الصلبة  المعادن encased in a قطبPerspex cover electrostatic field.

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Types of Electrodes in SWDCoil: ملف or cable

electrode  كهربائي كابلconsists of a wire with plugs at either end electromagnetic field.

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Types of Electrodes in SWDThe monode: flat, rigid coil encased in Perspex cover electromagnetic field.

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Types of Electrodes in SWDThe diplode: or drum electrode

الكهربائي  consists of a flat ,طبلcoil electrode encased in a Perspex cover with two wings electromagnetic field

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SWD - Methods

1. Capacitor field Method   األسلوب  مكثفمجال

2. Inductive field / Cable Method

   /  األسلوب  كبل حقل حثي

Selection of Appropriate methods Can Influence The Treatment

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Capacitor (Condenser) ElectrodesThe electrodes acts as CAPACITOR

The patient tissues & Insulating material acts as

DIELECTRIC MEDIUM.  المتوسط عازل

Heat production by conversion of ELECTROMAGNETIC ENERGY

الكهرومغناطيسية  الطاقة

MECHANICAL ENERGY(HEAT) الطاقة) الحرارة ) الميكانيكية

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Capacitor (Condenser) ElectrodesIf the goal of treatment is to increase tissue extensibility

  التمدد  األنسجة the & زيادةlimitation is primarily to capsular tightness,

ضيق  then capacitor المحفظةfield method of SWD is the more appropriate choice.

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Capacitor (Condenser) ElectrodesCreate Stronger Electrical Field Than Magnetic Field

Ions Will Be Attracted Or Repelled Depending on the Charge of the Pole

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Capacitor (Condenser) Electrodes

Center Has Higher Current Density Than Periphery

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Capacitor (Condenser) Electrodes

Patient Is Between Electrodes and Becomes Part of Circuit

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Capacitor (Condenser) Electrodes

Fat Tissue Resists يقاوم Current Flow

Thus Fat Is Heated In An Electrical Field

Precaution: electrical field may overheat area with large fat content

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Capacitor Electrodes (Air Space Plates)Two Metal Plates Surrounded By Plastic Guard

Can Be Moved 3cm Within Guard

Produce High-Frequency Oscillating Current

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Capacitor Electrodes (Air Space Plates)

Area To Be Treated Is Placed Between Electrodes Becoming Part of Circuit

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Capacitor Electrodes (Air Space Plates)Sensation Of

Heat In Direct Proportion To Distance Of Electrode From Skin

Closer Plate Generates More Surface / superficial Heat

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Capacitor Electrodes (Pad Electrodes)Greater Electrical Field

Patient Part of Circuit

Must Have Uniform Contact (toweling)

Spacing Equal To Cross-sectional Diameter of Pads

Part To Be Treated Should Be Centered

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METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD

1. COPLANAR METHOD

متحد  طريقةالمستوى

In this electrodes can be placed side by side الىجنب جنباon the same aspect of the part, provided that there is adequate distance between them.

  بينهما  المسافة كافية

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Capacitor Electrodes (Pad Electrodes)Increasing The Spacing Will Increase The Depth Of Penetration. But Will Decrease The Current Density

Capacitive Method Good for Treating Superficial Soft Tissues

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METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD

1. CONTRAPLANAR METHOD

  مستو  طريقة كونتراIn this electrodes are placed on opposite sides

المتقابلة of األضالعthe treatment part. Most satisfactory method for deeply placed structures.

  عميق  هياكل .E.g وضع- Joints

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METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD

1. CROSSFIRE METHOD الطالق تبادل

النارطريقة

In this first half of the treatment is given with the electrodes in one contra planar position & for the second half the electrodes are repositioned at right angles.

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METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD

1. MONOPOLAR

METHOD أحاديالقطبطريقة

The active electrode الكهربائي  is أحدث

placed over the site of the lesion من اكثر

  اآلفة  من the & موقعindifferent electrode is applied to some distant part of the body.

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Inductothermy تحريضي Method تسخين

Creates A Stronger Magnetic Field المجالThan Electrical Field المغنطيسي

Using a long tubular flexible conductor     مرنة  أنبوبيطويل covered in thick موصل

rubber called a Cable Or Coil, is Wrapped Circumferentially محيطي Around An بشكلExtremity Or Coiled Within Electrode

If the goal is to increase blood flow to aid healing of a muscle injury then Inductothermy can be chosen.

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Inductothermy Method

Passing Current Through A Coiled Cable Creates A Magnetic Field By Inducing Eddy Currents

التيارات  small circular)دوامةelectrical fields) That Generate Heat

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Inductothermy MethodTwo Arrangements: Pancake Coils

لفائف  فطيرةWraparound Coils

لفات  ملفوف•Toweling Is Essential.•Pancake Coil Must Have 6” in Center. Then 5-10cm Spacing Between Turns

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FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

1- SPACING: تباعدSpacing provided by:

1- Wrapping غالف flexible pads in towel.

2-Flat felt spacing pads between pad electrode and skin.

3-Air when using space plates.

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FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

a- Normal spacing  طبيعية even field تباعدحتى  .distribution الميدان

b- Increased spacing  التباعد deep زيادةfield  الميدان .concentration عمقc- Decreased spacing إنقاصتباعد superficial سطحي concentration.

a)

c)

b)

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FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

•About 4 cm distance will give heating of the deep tissues.

•Conversely the minimum skin electrode distance is about 2 cm, will give superficial heating.

FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

2.ELECTRODE SIZE  القطب If the :حجمelectrodes are too small than the diameter of treated part line of force will be concentrated superficially.

-If the electrodes are markedly larger the line of force will be lost in the air.

ELECTRODE SIZE: -Ideally, the electrodes should be slight

larger  قليال .than the area treated أكبر 39

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FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

3.METAL المعادن: metal causes the lines of force to concentrate on the metal

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Heating With Continuous SWDPatient Sensation Provides Basis For Recommendations Of Continuous SWD

Dose I (Lowest) - No Sensation هناكof Heat إحساسDose II (Low) - Mild Heating Sensation

  اإلحساس  تدفئة معتدلDose III (Medium) - Moderate or Pleasant Heating Sensation

      اإلحساس  تدفئة بليزانت أو معتدلةDose IV (Heavy) -Vigorous Heating Within Pain Threshold

      األلم  عتبة ضمن قوية تدفئة

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UsesThermal Effects

الحرارية  التأثيراتDeep heat

Increased blood flow

Increased cell metabolism

Increased tissue extensibility

Muscular relaxation

Possible changes in enzyme reactions

Non-thermal Effects

  الحرارية  غير اآلثار•Edema reduction•Lymphedema reduction

•Superficial wound healing

•Treatment of venous stasis ulcers

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Indications of SWD - A condition that could benefit from a specific modality. Disorders of Musculoskeletal System;

( Sprain, Strain, Muscle & Tendon tear, Capsule lesion, Joint stiffness, Hematomas)

Sub acute & Chronic Inflammatory Conditions;

(Tenosynovitis, Bursitis, Synovitis, Sinusitis, Dysmenorrhoea, Fibrositis, Myositis)

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Contraindications - A condition that could be adversely affected if a particular modality is used.Metal implants  معدنية or metal يزرع

jewelry (be aware of body piercings) – Concentration of the field.

CARDIAC PACEMAKERS القلبية – الناظماتInterference with function

Ischemic areas  الدماغية The – المناطقinability of the circulation to disperse heat could result in high temperature – Burns.

Perspiration عرق and moist dressings  الضمادات The : رطبةwater collects and concentrates the heat.

Tendency to hemorrhage نزف, including menstruation حيض – Increase vasodilatation, prolong hemorrhage.

PREGNANCY الحمل – Miscarriage

Hyperpyrexia السخونة فرط

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Sensory loss / Impaired thermal sensation   ضعفاإلحساسالحراري 

Cancer السرطان / Malignant tissues الخبيثة  Accelerate the rate of –األنسجة

growth & Metastasis

Active أحدث  TUBERCULOSIS السل– Increase the rate of development of the infection.

Recent األخيرة Radiotherapy لعالج ا & Skin sensation –اإلشعاعيCirculation may be decreased.

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Dermatological األمراض Conditions – Will الجلديةexacerbate

Severe Cardiac conditions   القلب  – ظروفقاسية

Greater demand of Cardiac output.

Peripheral vascular disease أمراضاألوعية

المحيطية  DVT - الدموية

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Areas of particular sensitivity:

Epiphysis plates  لوحات مشاشيin children

The genitals التناسلية األعضاءSites of infection  اإلصابة مواقعThe abdomen with an implanted intrauterine device جهاز

الرحم  داخل (IUD)مزروعThe eyes and faceApplication through the skull جمجمة

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Therapeutic Effects of SWD1- Pain relief: اآلالم تخفيف

Stimulation of Sensory heat receptors – Pain Gate Mechanism.2-Muscle spasm  العضالت :تشنج

Heating Secondary Afferent muscle spindle – Inhibitory influence to motor pool.3- Inflammation التهاب : Assists in removal of cellular debris and toxins.Nonthermal: Alters diffusion rate across the cell membraneThermal: Increases intramuscular metabolism

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Therapeutic Effects of SWD

4- Accelerate تسريع wound healing التئام by increase cutaneous circulation : الجروح

تداول  :Vasodilatation increases ,جلديBlood flowCapillary filtrationCapillary pressureOxygen perfusion

5- Infection عدوى : increase circulation and increase white blood cells and antibodies – Reinforcing body’s normal defense mechanism.6- Fibrosis تليف : increase extensibility ,of fibrous tissues such as tendons التمددjoint capsule and scars. Alters collagen properties, allowing it to elongate.

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Dangers and Precautions in SWD1- Burn - can be avoided by:

-Checking all contra-indications and area to be treated.

-Test of thermal skin sensation.

-Taking care during application over a bony prominence.

-Never apply SHORT WAVE DIATHERMY over clothing.

-Making sure that the skin is dry.

-If you apply over two skin surfaces in contact, they must be separated by absorbent material towel.

-Making sure that the leads from the machine are not touching or within 25 mm electromagnetic field around the lead.

-Making sure that there is adequate spacing between the electrodes and the skin.

-Allowing 2 or 3 minutes on each intensity setting maximum heat.

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Dangers and Precautions in SWD2- shock - can be avoided by:

-Not increasing intensity unless the leads and electrodes are connected to machine.

-Making sure that the machine is earthed.

اختبأ  اآللة

-Not touching the machine.

-Making sure that there is no metal within the range of 300mm.

-If the patient is wearing a hearing aid

المعونة  . switch it off جلسة

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Dangers and Precautions in SWD

3.Synthetic Material االصطناعية  المواد

These do not absorb moisture as readily as normal materials

They ignite more easily

The material may absorb energy or concentrating the field.

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Dangers and Precautions in SWD4. Obese Patients

المرضى  السمنة

Fat layers more readily heated

Absorbing 8 times that absorbed in muscle.

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Modes of ApplicationContinuous المستمر short wave

diathermyIncreases tissue temperature

Increased risk of burns

Pulsed نابض short wave diathermy

May or may not increase temperature

Pulses allow for increased treatment intensity and duration

Not the same as “non-thermal”

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Pulsed SWD (PSWD)

It is also known as

Pulsed electromagnetic energy (PEME)

Pulsed electromagnetic field (PEMF)

The production of HFC for PSWD is exactly same as for CSWD.

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Pulsed SWDBy incorporating إدماج a timing circuit

الدوائر  the output can be turned on ,توقيت& off allowing bursts of Oscillations.

Off-Time Longer Than On-Time

Low Mean Power Output

Uses Drum Electrode

Some machines give fixed – length pulses (65 or 400µsec)

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Pulsed SWD-Is short wave at the frequency of 27.12

MHz, which is pulsed at a rate, selected by the therapist.

-The pulse frequency range is from 15 to 200 Hz.

-The maximum intensity is 1000 watts.-The pulse duration is constant at 0.4 ms

in square pulse.-The advantage of pulsed S.W.D. is that a

very high  جدا of كثافة intensity عالية

power السلطة can be administered with minimal effect.

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Pulsed SWD

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PSWD - Physiological Effects1-Increases the number & activity of cells in

the injured region

2-Reabsorption استيعابof hematoma ورم.دموي

3-Reduces swelling & Inflammation4-Increases rate of fibrin deposition

ترسب  orientation & الليفين

5-Increases collagen deposition & organization

6-Increase nerve growth األعصاب & نموrepair.

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PSWD - Indications1- Acute Sprains.

2- Contusions. كدمات

3- Acute Haematoma.

4- Bursitis. كيسي التهاب

5- Sinusitis. الجيب إلتهاب

6-Synovitis الزليل

7-Sports Injuries

8-Superficial Ulcers  سطحية قرحة

9- Neurogenic Pain (Phantom Pain  األلم ( حراق Causalgia ,فانتوم

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PSWD - Contraindications1- Cardiac Pacemakers.

2- High fever.

3- Tumour.

4- Metal in the area , including implants.

5-Pregnant Women

6-Impaired sensation

7-Uncooperative متعاون Unconscious /غير

patients   المرضى الوعي فاقد

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PSWD - precautions1- Synthetic materials

2- Obese patients

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PSWD - Therapeutic Effects1-Decrease of pain & Swelling – Tissue trauma.

2-Acceleration of Inflammatory & Healing Process

3-Relaxation of Muscle Spasm

4-Decreases the rate of hematoma formation

5-Superficial ulcers are treated successfully – Bed sores

6-Acceleration of bone growth

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PSWD - Advantages

1-Effective in treatment of post traumatic & Infective conditions

2-Often used in conditions where continuous SWD is contraindicated.

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Technique of Application

1- Shortwave machine with chosen electrodes and its test tube أنبوب to ensure the machine is إختبارworking.

2- Test tubes for skin test.

3- Cotton towels or felt pads for spacing.

4- Ensure that there are no contraindications for SW application.

5- Put the patient in a comfortable position and well support, allow the area to be treated to be completely uncovered.

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Technique of Application

6- Inspect the area to be treated.

7- Ensure there is no metal (jewellery or hairpin) within 300mm of treatment area.

8- Explain the procedure and feeling to the patient.

9- If using flexible pad electrodes, wrap them in several layers of towelling or place them between felt pads to ensure the required amount of spacing.

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Technique of Application10- If using space electrodes adjust the distance according to the concentration needed.

11-Instruct the patient not to move during treatment and warn her/him from uncomfortable heat feeling.

12- If the machine has a patient safety switch instruct the patient to switch the machine off if he feel more heat.

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Technique of Application 13- Check the machine controls at the zero

position, then switch the power on.

14- Switch the intensity on and wait 2-3 minutes on the minimum intensity and ask the patient about her/his feeling, then adjust the timer to the required treatment time.

15- After treatment time has finished, turn the intensity switch to zero and remove the electrodes.

16-Inspect the area after treatment and ask the patient to stay few minutes for rest and to regain to normal temperature.

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Technique of Application

1-Application using two flexible pads or space plates:

A- The electrodes should be slightly larger than the area treated and spaced from the skin by approximately 25 mm.

B- To concentrate heat on one aspect of the part the electrode should be unequal in size (smaller one placed over the area where concentration of heat is required).

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Technique of ApplicationC- Coplanar application to treat structures

on one aspect of the body.

The distance between adjacent ends (x) must be greater than the sum of skin electrode distance (A+B) otherwise the line of force will pass directly between electrodes rather than tissues.

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Technique of Application

D- Application using a coil electrode:1- The coil wound evenly firmly heat

superficial tissue.2- Pancake application heat superficial

tissues.

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Technique of Application

E- Application using diplode:Adjust wings of diplode parallel to the

skin of the treated area, electromagnetic field will produce.

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Technique of ApplicationF- Applications to two limbs: Two flexible pads, two space plates or

flexible pad with a space plate are used. It is essential to put a cotton towel between the two limbs to absorb any perspiration.

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Technique of Application

G- Cross-fire application:For the treatment of sinuses, space plates

positioned diagonally, after half of treatment time the positions are alternate. This ensures that all aspects of the sinus membrane are heated. Care must be taken to avoid direct placement over the eye.

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Treatment TimeMost Typically SWD Treatments Last For

20-30 Minutes

Remember As Skin Temperature Rises Resistance Falls

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When Should Diathermy Be Used? If The Skin Or Some Underlying Soft Tissue Is Tender

And Will Not Tolerate Pressure In Areas Where Subcutaneous Fat Is Thick And Deep

Heating Is Required

Induction method When The Treatment Goal Is To Increase Tissue

Temperatures Over A Large Area