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SHORTWAVE الموجات القصيرةالعلاج بالإنفاذ الحراري DIATHERMY. Sekar.L. SWD - INTRODUCTION. Application التطبيق of High-Frequency Electromagnetic Energy عالية التردد الطاقة الكهرومغناطيسية A deep-heating في أعماق التدفئة modality شكل

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shortwave diathermy

SHORTWAVE الموجات القصيرةالعلاج بالإنفاذ الحراريDIATHERMY

Sekar.L

swd introduction
SWD - INTRODUCTION
  • Application التطبيقof High-Frequency Electromagnetic Energy عالية التردد الطاقة الكهرومغناطيسية
  • A deep-heating في أعماق التدفئة modality شكل
  • Does Not stimulate لا حفز MOTOR المحركات& SENSORY NERVES. الأعصاب الحسية.
  • No Danger لا يوجد خطر of CHEMICAL BURNS الحروق الكيميائية
swd introduction1
SWD - INTRODUCTION
  • No Contraction of Muscles is produced لا تقلص العضلات وينتج
  • Frequency تردد (27.12 MHz at wavelength of 11 M)
  • Diaضياء means through من خلال and
  • Thermo الحرارية means temperature درجة الحرارة heat.
  • Short wave diathermy (SWD), or radio frequency (RF), is used to penetrate deep اختراق عميق into the body tissues أنسجة الجسم to stimulate blood flow تدفق الدم .
possible shortwave diathermy unit
Possible Shortwave Diathermy Unit

A=Power Switch

B=Timer

C=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)

shortwave diathermy unit
Shortwave Diathermy Unit
  • Generates Both an Electrical الكهربائية and a Magnetic Field المجال المغنطيسي
    • SWD Units at 13.56 MHz= Stronger Magnetic Field
    • SWD Units at 27.12 MHz = Stronger Electrical Field
generation of high frequency swd
Generation of High Frequency SWD

SWD have two main الرئيسيتينcircuits الدوائر;

The machine circuit الجهاز الدوائر which produce high frequency current coupled with

The patient circuit الدائرة المريض through inductors to transfer the electrical energy to the patient.

principle of production of swd
Principle of Production of SWD
  • This type of high frequency current is obtained by DISCHARGING التفريغa CONDENSER المكثف through an INDUCTANCE ملف محاثة of LOW OHMIC RESISTANCE.انخفاض المقاومة الأومية
biophysical and biochemical effects of swd
Biophysical and biochemical effects of SWD

Effects of an electrostatic field الحقل الكهربائي :

1- Free ions in the tissues give minimal movement (Vibration of Ions اهتزاز الأيونات) due to high frequency leading to friction احتكاك between ions and produce heat. إنتاج الحرارة

+

-

+

-

-

+

-

+

biophysical and biochemical effects of swd1
Biophysical and biochemical effects of SWD

2- The dipolar وثنائي القطب molecules جزيئات(as water – will rotate to & fro - Swinging) charge change rapidly, friction between molecules leads to heat in the tissues.

biophysical and biochemical effects of swd2
Biophysical and biochemical effects of SWD

3- The non-polar وغير القطبية molecules (as fat الدهون– Insulator عازل, undergo distortion تشويه of their electron cloud الإلكترون سحابة leading to back & forth ويعود عليها movement) cause minimal friction and molecular movement producing little heat.

physiologic responses to swd
Physiologic Responses To SWD
  • Tissue Temperature Increase
  • Increased Blood Flow (Vasodilatation)
  • Increased Venous and Lymphatic Flow تدفق الدم الوريدي واللمفاوي
  • Increased Metabolism
  • Changes In Physical Properties الخواص الفيزيائية of Tissues
  • Muscle Relaxation - عضلة الاسترخاء
  • Analgesia - تسكين
types of electrodes in swd
Types of Electrodes in SWD
  • Flexible pads منصات مرنة : consist of metal electrode encased المغطى in rubber and produce an electrostatic field.
types of electrodes in swd1
Types of Electrodes in SWD
  • Space plates لوحات الفضاء : consist of a rigid metal electrode قطب المعادن الصلبة encased in a Perspex cover  electrostatic field.
types of electrodes in swd2
Types of Electrodes in SWD
  • Coil:ملف or cable electrode كابل كهربائي consists of a wire with plugs at either end electromagnetic field.
types of electrodes in swd3
Types of Electrodes in SWD
  • The monode: flat, rigid coil encased in Perspex cover electromagnetic field.
types of electrodes in swd4
Types of Electrodes in SWD
  • The diplode: or drum electrode طبل الكهربائي, consists of a flat coil electrode encased in a Perspex cover with two wings electromagnetic field
swd methods
SWD - Methods

Capacitor field Method مكثف مجال الأسلوب

Inductive field / Cable Method حثي حقل / كبل الأسلوب

Selection of Appropriate methods Can Influence The Treatment

capacitor condenser electrodes
Capacitor (Condenser) Electrodes
  • The electrodes acts as CAPACITOR
  • The patient tissues & Insulating material acts as

DIELECTRIC MEDIUM. عازل المتوسط

  • Heat production by conversion of ELECTROMAGNETIC ENERGY الطاقة الكهرومغناطيسية

MECHANICAL ENERGY(HEAT) الطاقة الميكانيكية (الحرارة)

capacitor condenser electrodes1
Capacitor (Condenser) Electrodes
  • If the goal of treatment is to increase tissue extensibilityزيادة الأنسجة التمدد & the limitation is primarily to capsular tightness,المحفظة ضيق then capacitor field method of SWD is the more appropriate choice.
capacitor condenser electrodes2
Capacitor (Condenser) Electrodes
  • Create Stronger Electrical Field Than Magnetic Field
  • Ions Will Be Attracted Or Repelled Depending on the Charge of the Pole
capacitor condenser electrodes3
Capacitor (Condenser) Electrodes
  • Center Has Higher Current Density Than Periphery
capacitor condenser electrodes4
Capacitor (Condenser) Electrodes
  • Patient Is Between Electrodes and Becomes Part of Circuit
capacitor condenser electrodes5
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
capacitor electrodes air space plates
Capacitor Electrodes (Air Space Plates)
  • Two Metal Plates Surrounded By Plastic Guard
  • Can Be Moved 3cm Within Guard
  • Produce High-Frequency Oscillating Current
capacitor electrodes air space plates1
Capacitor Electrodes (Air Space Plates)
  • Area To Be Treated Is Placed Between Electrodes Becoming Part of Circuit
capacitor electrodes air space plates2
Capacitor Electrodes (Air Space Plates)
  • Sensation Of Heat In Direct Proportion To Distance Of Electrode From Skin
  • Closer Plate Generates More Surface / superficial Heat
capacitor electrodes pad electrodes
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
methods of placement of electrodes capacitor method
METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD
  • COPLANAR METHOD طريقة متحد المستوى

In this electrodes can be placed side by side جنبا الى جنب on the same aspect of the part, provided that there is adequate distance between them. كافية المسافة بينهما

capacitor electrodes pad electrodes1
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
methods of placement of electrodes capacitor method1
METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD
  • CONTRAPLANAR METHOD كونترا طريقة مستو

In this electrodes are placed on opposite sides الأضلاع المتقابلة of the treatment part. Most satisfactory method for deeply placed structures. وضع هياكل عميق E.g. - Joints

methods of placement of electrodes capacitor method2
METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD
  • CROSSFIRE
  • METHOD تبادل لاطلاق 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.
methods of placement of electrodes capacitor method3
METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD
  • MONOPOLAR

METHOD أحادي القطبطريقة

The active electrode أحدث الكهربائي is placed over the site of the lesion اكثر من موقع من الآفة & the indifferent electrode is applied to some distant part of the body.

inductothermy method
Inductothermy تسخين تحريضي Method
  • Creates A Stronger Magnetic Fieldالمجال المغنطيسي Than Electrical Field
  • Using a long tubular flexible conductor موصل أنبوبي طويل مرنة covered in thick rubber called a Cable Or Coil, is Wrapped Circumferentially بشكل محيطي Around An Extremity Or Coiled Within Electrode
  • If the goal is to increase blood flow to aid healing of a muscle injury then Inductothermy can be chosen.
inductothermy method1
Inductothermy Method

Passing Current Through A Coiled Cable Creates A Magnetic Field By Inducing Eddy Currents دوامة التيارات(small circular electrical fields) That Generate Heat

inductothermy method2
Inductothermy Method
  • Two Arrangements:
    • Pancake Coils فطيرة لفائف
    • Wraparound Coils ملفوف لفات
  • Toweling Is Essential.
  • Pancake Coil Must Have 6” in Center. Then 5-10cm Spacing Between Turns
factors influence field distribution in s w d
FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

1- Spacing: تباعد

Spacing provided by:

1- Wrapping غلاف flexible pads in towel.

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

3-Air when using space plates.

factors influence field distribution in s w d1
FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

a- Normal spacing تباعد طبيعية  even field الميدان حتى distribution.

b- Increased spacing زيادة التباعد  deep field عمق الميدانconcentration.

c- Decreased spacing إنقاص تباعد  superficial سطحيconcentration.

a)

c)

b)

factors influence field distribution in s w d2
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 d3
FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

2.Electrode size حجم القطب:If the electrodes 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 أكبر قليلا than the area treated.

factors influence field distribution in s w d4
FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

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

heating with continuous swd
Heating With Continuous SWD

Patient Sensation Provides Basis For Recommendations Of Continuous SWD

Dose I (Lowest) - No Sensation هناك إحساس of Heat

Dose II (Low) - Mild Heating Sensation معتدل تدفئة الإحساس

Dose III (Medium) - Moderate or Pleasant Heating Sensation معتدلة أو بليزانت تدفئة الإحساس

Dose IV (Heavy) -Vigorous Heating Within Pain Threshold تدفئة قوية ضمن عتبة الألم

slide42
Uses

Non-thermal Effects

الآثار غير الحرارية

  • Edema reduction
  • Lymphedema reduction
  • Superficial wound healing
  • Treatment of venous stasis ulcers

Thermal Effects التأثيرات الحرارية

  • Deep heat
  • Increased blood flow
  • Increased cell metabolism
  • Increased tissue extensibility
  • Muscular relaxation
  • Possible changes in enzyme reactions
indications of swd a condition that could benefit from a specific modality
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)
contraindications a condition that could be adversely affected if a particular modality is used
Contraindications - A condition that could be adversely affected if a particular modality is used.
  • Metal implants يزرع معدنية or metal jewelry(be aware of body piercings) – Concentration of the field.
  • Cardiac pacemakers الناظمات القلبية– Interference with function
  • Ischemic areas المناطق الدماغية– The inability of the circulation to disperse heat could result in high temperature – Burns.
slide45

Perspiration عرقand moist dressings رطبة الضمادات :The water collects and concentrates the heat.

  • Tendency to hemorrhage نزف, including menstruation حيض– Increase vasodilatation, prolong hemorrhage.
  • Pregnancy الحمل– Miscarriage
  • Hyperpyrexia فرط السخونة
slide46

Sensory loss / Impaired thermal sensation ضعف الإحساس الحراري

  • Cancer السرطان/ Malignant tissuesالأنسجة الخبيثة– Accelerate the rate of growth & Metastasis
  • Active أحدث  TUBERCULOSIS السل– Increase the rate of development of the infection.
  • Recent الأخيرةRadiotherapyالعلاج الإشعاعي– Skin sensation & Circulation may be decreased.
slide47

Dermatological الأمراض الجلدية Conditions – Will exacerbate

  • Severe Cardiac conditions ظروف قاسية القلب– Greater demand of Cardiac output.
  • Peripheral vascular disease أمراض الأوعية الدموية المحيطية - DVT
slide48

Areas of particular sensitivity:

    • Epiphysis plates مشاشي لوحات in children
    • The genitals الأعضاء التناسلية
    • Sites of infection مواقع الإصابة
    • The abdomen with an implanted intrauterine device جهاز مزروع داخل الرحم(IUD)
    • The eyes and face
    • Application through the skull جمجمة
therapeutic effects of swd
Therapeutic Effects of SWD

1- Pain relief:تخفيف الآلام

Stimulation of Sensory heat receptors – Pain Gate Mechanism.

2-Muscle spasm تشنج العضلات:

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 membrane

Thermal: Increases intramuscular metabolism

therapeutic effects of swd1
Therapeutic Effects of SWD
  • 4- Accelerate تسريع wound healing التئام الجروح : by increase cutaneous circulation جلدي تداول, Vasodilatation increases:
    • Blood flow
    • Capillary filtration
    • Capillary pressure
    • Oxygen perfusion
  • 5- Infection عدوى: increase circulation and increase white blood cells and antibodies – Reinforcing body’s normal defense mechanism.
  • 6- Fibrosis تليف : increase extensibility التمدد of fibrous tissues such as tendons, joint capsule and scars. Alters collagen properties, allowing it to elongate.
dangers and precautions in swd
Dangers and Precautions in SWD

1- 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.
dangers and precautions in swd1
Dangers and Precautions in SWD

2- shock - can be avoided by:

  • -Not increasing intensity unless the leads and electrodes are connected to machine.
  • -Making sure that the machine is earthed. الآلة اختبأ
  • -Not touching the machine.
  • -Making sure that there is no metal within the range of 300mm.
  • -If the patient is wearing a hearing aid جلسة المعونة  switch it off.
dangers and precautions in swd2
Dangers and Precautions in SWD

3.Synthetic Material المواد الاصطناعية

  • These do not absorb moisture as readily as normal materials
  • They ignite more easily
  • The material may absorb energy or concentrating the field.
dangers and precautions in swd3
Dangers and Precautions in SWD

4. Obese Patients السمنة المرضى

  • Fat layers more readily heated
  • Absorbing 8 times that absorbed in muscle.
modes of application
Modes of Application

Continuous المستمرshort wave diathermy

  • Increases 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”
pulsed swd pswd
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.
pulsed swd
Pulsed SWD
  • By incorporating إدماج a timing circuit توقيت الدوائر, the output can be turned on & 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)
pulsed swd1
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 عالية جدا intensity كثافة of power السلطة can be administered with minimal effect.
pswd physiological effects
PSWD - Physiological Effects

1-Increases the number & activity of cells in the injured region

2-Reabsorption استيعابof hematoma ورم دموي.

3-Reduces swelling & Inflammation

4-Increases rate of fibrin deposition الليفين ترسب & orientation

5-Increases collagen deposition & organization

6-Increase nerve growth نمو الأعصاب & repair.

pswd indications
PSWD - Indications

1- Acute Sprains.

2- Contusions. كدمات

3- Acute Haematoma.

4- Bursitis. التهاب كيسي

5- Sinusitis. إلتهاب الجيب

6-Synovitis الزليل

7-Sports Injuries

8-Superficial Ulcers قرحة سطحية

9- Neurogenic Pain (Phantom Pain فانتوم الألم, Causalgia حراق)

pswd contraindications
PSWD - Contraindications

1- Cardiac Pacemakers.

2- High fever.

3- Tumour.

4- Metal in the area , including implants.

5-Pregnant Women

6-Impaired sensation

7-Uncooperative غير متعاون/ Unconscious patients فاقد الوعي المرضى

pswd precautions
PSWD - precautions

1- Synthetic materials

2- Obese patients

pswd therapeutic effects
PSWD - Therapeutic Effects

1-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

pswd advantages
PSWD - Advantages

1-Effective in treatment of post traumatic & Infective conditions

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

technique of application
Technique of Application

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

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.

technique of application1
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.

technique of application2
Technique of Application

10- 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.

technique of application3
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.

technique of application4
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).

technique of application5
Technique of Application

C- 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.

technique of application6
Technique of Application

D- Application using a coil electrode:

1- The coil wound evenly firmly heat superficial tissue.

2- Pancake application heat superficial tissues.

technique of application7
Technique of Application
  • E- Application using diplode:
  • Adjust wings of diplode parallel to the skin of the treated area, electromagnetic field will produce.
technique of application8
Technique of Application

F- 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.

technique of application9
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.
treatment time
Treatment Time
  • Most Typically SWD Treatments Last For 20-30 Minutes
  • Remember As Skin Temperature Rises Resistance Falls
when should diathermy be used
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
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