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ULTRASOUND AND ELECTRICAL STIMULATION COMBINATION

By: Ray Bieri
May Sullivan

Physiological Effects
  1. Edema reduction.
  2. Promotion of tissue healing.
  3. Decrease pain.
  4. Decrease muscle spasm.
Indications
  1. Spasticity.
  2. Relieve pain.
  3. Acute inflammation (pulsed output).
  4. Chronic inflammation (pulsed or continuous output).
  5. To increase local blood circulation.
  6. Trigger areas.
  7. Joint contractures.
  8. Musculoskeletal conditions.
  9. Adhesive scar formation following immobilization or surgical repair.
Contraindications
  1. Over areas with metal implants.
  2. Patients with cardiac pacemakers.
  3. Over the carotid sinus areas.
  4. Over a pregnant uterus.
  5. Near or over cancerous malignancy.
  6. Thrombosis.
  7. Seizures.
  8. Acute strains where muscles are over stretched or torn.
  9. Tendency to hemorrhage.
DO NOT USE ULTRASOUND IN THESE AREAS:
  1. Over the eyes, head, or genitals.
  2. Over the heart or directly over the spinal column.
  3. Over the abdomen or lumbar areas of a menstruating female.
  4. Over skin with sensory deficits.
  5. Over epiphyses of growing children.
Preparation of Athlete
  1. Position the athlete for comfort and your ease in handlingof the applicator.
  2. Explain to the athlete the purpose of the treatment, the sensation tobe expected ("pins and needles" or " muscle twitch") and the benefits fromthem.
  3. Before the application of the electrical stimulation pad placement andultrasound, clean the treatment area with alcohol to remove body oils,dirt, or grime.
  4. Advise the athlete to inform you of any unexpected sensations.
Treatment Set-Up and Initiation
  1. Using a single lead with two output connectors, plug inputlead into designated channel of the electrotherapy device.
  2. Plug one of the output connectors into the ultrasound unit input jackon the side of the device.
  3. Attach the second output connector to a large electrode pad and placethe pad on an area of ht body away from the immediate treatment area. Thelarge pad creates a monopolar set-up (the ultrasound head should not touchthe pad during treatment).
  4. Always make sure each of the therapeutic modalities' intensities areset at zero before starting treatment on the athlete.
  5. Set up the ultrasound equipment appropriately for the treatment criteria -
  6. - High Frequency 1 MHz
    - less absorption
    - deeper penetration
  7. - Low Intensity
    - sensation of a mild vibration

    8. An acute injury needs about a 20% duty cycle during pulsedultrasound to separate collagen, which will increase its extensibility andgenerate a mechanical break up of waste products. For chronic injury, a continuous setting generates constant heat fordeeper penetration and increase tissue temperature which will:

    • increase blood flow
    • increase collagen extensibility
    • decrease pain by level 1 pain control
    • increase metabolic and enzymatic activity
  8. Apply transmission gel to cover the treatment area and the applicatorhead. More gel may be added during treatment if necessary. Placeapplicator on treatment surface ensuring constant contact.
  9. Set up premodulated treatment for the designated channel on theelectrotherapy device for the stimulation targeting motor nerves. A lowintensity level ( 2-5 Hz), should be used when utilizing a premodulatedcurrent. This will stimulate A-delta motor nerves for a rhythmic musclecontraction.
  10. Set timer for the proper treatment time, 3-7 minutes and no more than15 minutes.
  11. Begin treatment first with turning on the ultrasound unit and then theelectrical stimulation.
  12. begin moving the ultrasound applicator head in acircular motion and adjust the intensity knob to the desired levelfor the treatment.
  13. use a slow rhythmic, regular pattern with a firmand gentle pressure on the skin.
  14. Upon completion of treatment - 1) turn devices off and set intensitylevel to zero, 2) clean off applicator head and treated body part.



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