BTL – 07p
operating manual & user's guide
page 12
Increases in local temperature and micromassage have several physiological effects:
1. Improvement in local circulation resulting in metabolic improvement. Vasodilatation increase follows the
increasing temperature (more
evident in continuous ultrasound).
2. Increased permeability of capillaries resulting in quick extravasation
humour absorption.
3. Improvement in local circulation and decreased orthosympathic activity, leading to marked muscle relaxation.
4. Local ischemia pain improvement.
5. Transformation from gel to sol occurs as a result of fibrinogen to fibrin transformation, and haematoma and
edema transform to gel. Ultrasound dissolves this gel and hastens reabsorption. Since fibrinogen to fibrin
transformation is a fundamental feature of the healing process (scar formation), we do not recommend the
application of ultrasound during the peracute post-traumatic period.
6. Tissue regeneration improves as a result of the above-mentioned effects.
Ultrasound can also have several negative effects:
1. Tissue lesion - a mechanic and/or thermic tissue lesion can occur when intensity is too strong. Particularly
sensitive is the nervous system (peripheral nerve), which is situated just on the bone (interference) and just
below the surface (close field). If intensity is too strong, flow speed can decelerate in the corresponding nerve,
followed by a total (reversible) impulse flow block and irreversible disintegration of the neuron (myelin coats
are preserved). Bone projections just under the skin (ankles, epicondyles, spondyle spines, etc.) are also
sensitive.
2. Leukocyte mobility impairment is minimized by sufficiently moving of the emitter head.
3. Other negative effects, largely caused by overdoses, are possible: glycemia decline, increased fatigue,
nervousness, changes in appetite, constipation, increased tendency to catch colds (common and severe).
Methods of application
A) Application site and movement of the emitter head
1.
Static application:
A special holder fixes the emitter head at the application site and emitter head is not
moved. This is the least suitable method because of the possibility of the above-mentioned adverse effects.
2.
Semistatic application:
Employed when the application site corresponds with the ERA of the emitter head.
The therapist moves the emitter head continuously in a circular pattern.
3.
Dynamic application:
Employed when the application site is larger than the ERA of the emitter head. The
therapist moves the emitter head in a circular pattern. The application time is prolonged proportionally to the
ERA and the size of the application site.
B) Application site
1.
Local application:
The
ultrasound is applied to the affected site. This is the most common type of application,
and is particularly suitable for the management of muscle spasm, chronic post-traumatic edemas, etc.
2.
Segmental application:
The ultrasound is applied to the nerve radix outflow of the affected site (e.g., Sudeck
syndrome, morbus Raynaud). This method of application is paravertebral and homolateral, making it suitable
for the management of limb diseases
(arms C5 - Th1, legs L3 - S1).
3.
Neural application:
Based on the effect of flow speed decrease in the peripheral nerve to which ultrasound
has been applied. The boundary between the lowering of conductivity and irreversible nerve damage
(asymptomatic) is very narrow. Neural application is considered risky and indicated infrequently as phantom
pain.
4.
Radicular application:
Ultrasound is applied to the corresponding spinal cord radix and then to the
manifested Head zone.
C) Contact between emitter head and body surface
1.
Direct contact:
Provided by a contact medium (a special gel for ultrasound therapy). This method is
considered customary, and it is therefore not necessary to mention it in an ultrasound therapy prescription.
However, because paraffin oil does not conduct electricity, it is useful to use a "conductive gel" for an
ultrasound therapy when giving combined therapy (ultr electrotherapy).
2.
Subaqual emission
:
Advantages
: Subaqual emission employs most of the distant ultrasonic field so that risk of interference is
almost eliminated. In addition, there is no need to apply emitter head pressure against the skin in order to
maintain sufficient contact (the pressure is unpleasant or even painful for a post-trauma patient). Ultrasound
can be applied to interphalangeal joints as well with this method, because treatment is not limited by uneven
surfaces.
Disadvantages
: Cumbersome and difficult handling of the special porcelain tanks. Ultrasound application is
limited to acral the body parts. The therapist also risks lesions to the hands if precautions against dipping them
into the water tank during therapy are not followed (due to reflection and interference of the ultrasonic waves).
Some emitter heads (newer ones included) are advertised as water resistant, but neither feature a holder nor
provide a safe subaqual ultrasound treatment. Ultrasound application through a thin-walled rubber bag
(surgical gloves, condom) full of previously boiled water may be a solution. However, this method makes it