Electrothermal Agents

Question 1

How to explain to a patient what Ultrasound does?

Answer 1

Ultrasound helps to improve healing, by sending sound waves through the tissues and this causes a small vibration

Question 2

How should ultrasound feel?

Answer 2

Jelly will probably feel. cold - shouldn’t be uncomfortable - may feel a slight pressure as I move the treatment head over the area.

Some people feel a mild heating effect - this is normal

Question 3

Risk of ultrasound?

Answer 3

React to the Gel

Question 4

What are the contraindications to non-thermal (pulsed) ultrasound? (7)

Answer 4

• Pregnancy
• Malignancy
• Active implants (e.g. pacemaker, deep brain stimulator)
• Active epiphysis
• Local circulatory insufficiency - diabetes
• Actively bleeding tissues
• Devitalised tissues

Question 5

What are the contraindications to thermal (continuous) ultrasound? (8)

Answer 5

• Pregnancy
• Maliganancy
• Active implants (e.g. pacemaker, deep brain stimulator)
• Active epiphysis
• Metal implants
• Local circulatory insufficiency – emboli, DVT
• Actively bleeding tissues
• Devitalised tissues

Question 6

What are the ultrasound treatment parameters - depth of lesion?

Answer 6

o	Superficial (>2cm) = 3MHz
o	Deep (2-5cm) = 1 MHz

Question 7

What are the ultrasound treatment parameters - pulse ratio?

Answer 7

o	Acute (up to 2 weeks post injury) = 1:9 or 10% duty cycle
o	Sub-acute (2 to 6 weeks post injury) = 1:4 or 20% duty cycle
o	Chronic (over 6 weeks post injury) = 1:1 or 50% duty cycle

Question 8

What are the ultrasound treatment parameters - intensity?

Answer 8

o	Acute (up to 2 weeks post injury) = 0.1 to 0.3 W/cm3
o	Sub-acute (2 to 6 weeks post injury) = 0.2 to 0.5 W/cm3
o	Chronic (over 6 weeks post injury) = 0.5 to 1 W/cm3

Question 9

How to calculate the dose for ultrasound?

Answer 9

Time = pulse ratio x number of treatment heads (e.g. for 1:9 ratio and 1 treatment head = (1+9)x1 = 10 minutes)

Question 10

How to explain TENS to a patient?

Answer 10

This will involve using this small machine – we will apply these sticky pads around the affected area, and when I turn it on it will send very small electrical signals to the tissues. This should provide you with some pain relief to allow us to progress your treatment program.

Question 11

How does TENS feel?

Answer 11

• for acute pain - Patient should definitely feel tingling but not painful
• for chronic pain – patient should feel a strong tingling sensation
• • ask if it is a strong or mild sensation **

Question 12

Risk of TENS?

Answer 12

Allergic reaction to the pads

Question 13

What are the contraindications for TENS? (8)

Answer 13

• Pregnancy
• Malignancy
• Implanted medical devices (e.g. pacemakers, deep brain stimulators)
• Active epiphysis
• Local circulatory insufficiency
• Epilepsy (CI for neck)
• Actively bleeding tissues
• Devitalised tissues

Question 14

What NOT to do with the TENS at home?

Answer 14

• Get it wet
• Don’t sleep in it – because if you do roll over and knock the dial you will get a sudden surge of TENS – not dangerous but very uncomfortable
• Don’t drive with it (for the same reason as above)
• Only use it over the area we are treating today – not anywhere else”

Question 15

What are the TENS treatment parameters for acute pain?

Answer 15

30 mins

90-130Hz & 100ms in constant mode

Question 16

What are the TENS treatment parameters for chronic pain?

Answer 16

2-5Hz & 200-250ms in burst mode

Question 17

Risk of ice?

Answer 17

Normal for underlying skin to go red - usually resolves soon after

Risk of burns - reduced by using towels to provide a barrier, and reduced by checks during treatment

Question 18

What are the contraindications for ice? (5)

Answer 18

• Malignancy
• Local circulatory insufficiency
• Devitalised tissues
• Bleeding tissues – infection risk
• Pregnancy

Question 19

How to layer ice?

Answer 19

• Wrap the ice pack in a wet towel
• Place ice pack in the wet towel over the affected area
• Apply the plastic layer over the top of the wet towel (acts as an insultating medium)
• Use the dry towel as a wrapper to keep the cold pack in place

Question 20

What are you looking for on 5 minute check for ice?

Answer 20

white skin (add another towel layer),
blue skin (remove ice!!),
abnormal sensation,
excessive pain

Question 21

Effect of ICE to tell the patient?

Answer 21

This should provide you with some pain relief and reduce swelling to allow us to progress your treatment program.

Question 22

Effect of heat to tell the patient?

Answer 22

This should provide you with some pain relief and stiffness, it can also speed up the healing process to allow us to progress your treatment program.

Question 23

Risks of heat?

Answer 23

Normal for underlying skin to go red - usually resolves soon after

Risk of burns - reduced by using towels to provide a barrier, and reduced by checks during treatment

Question 24

What are the contraindications for ICE? (6)

Answer 24

• Malignancy
• Active epiphysis
• Metal implants
• Local circulatory insufficiency
• Actively bleeding tissues – infection risk
• Devitalised tissues

Question 25

How to apply heat?

Answer 25

• Wrap the hot pack in a towel – ensure that there is two layers of towel between the pack and the skin
• Apply hot pack over affected area (if treating hands – ensure hot pack is on both sides)
• Use the second towel as a wrapper to keep the heat pack in place

Question 26

What are you looking for on 5 minute check for heat?

Answer 26

o Erythema – add an additional layer of towelling

o Skin does not feel hot – remove a layer of towel