BTL – 07p
operating manual & user's guide
page 15
Procedure Prescription
Name, surname, date of birth, insurance company
Name and number of diagnosis and stage of disease
Name of procedure - ultr the form. PPR (if pulse ultrasound is used)
Form of application: Dynamic, Local
Emitter head size (ERA)
Intensity and changes of intensity
during treatment (step); highest tolerable level
Application time and application changes during treatment (step); longest time tolerated
Frequency of procedure and its changes during treatment
Total number of procedures
Date of next appointment
Date of prescription, name and signature of prescribing physician
Facultative features of the prescription
Patient's position, contact medium, additional information for the physiotherapist.
Instructions for a patient
Ultrasound therapy is mostly asymptomatic, but a sensation of moderate heat or warmth may be felt in the treated
area. A burning sensation on the skin during therapy indicates insufficient contact. Pain during application
indicates either an overdose or insufficient movement of the emitter head. In the case of an overdose, stop the
procedure immediately and inform prescribing physician. Therapy can be resumed at a lower intensity, usually
after a one-day break.
After the first treatment, a transient deterioration of the disease may occur. A marked improvement should occur
not later than the third application. If there is no improvement (in acute and subacute states), ultrasound therapy
should not be continued.
If ultrasound therapy is applied to chronic processes (which rarely happens) or to change the mechanical qualities
of tissues (e.g., Dupuytren's contracture or plantar aponeurosis related to calcar calcanei), impressive results
cannot be expected by the third application. If ultrasound therapy is not immediately followed by a manual therapy,
results should not be expected, even after the tenth application.
Procedure
1. Inform the patient about the procedure.
NEVER LET PATIENTS APPLY
THE ULTRASOUND
TO THEMSELVES!
2. It is unnecessary to inform patients about rare contraindications unless such information is specifically
requested. However, be sure to ask if epistaxis is present or if patient is menstruating.
3. Place the patient in the proper position for the therapy.
4. Use a sufficient amount of the appropriate contact medium.
5. Set the prescribed intensity and time, apply the emitter head, and switch on the ultrasound.
6. Move the emitter head continuously in accordance with the prescribed application.
7. Repeatedly ask the patient about his or her sensations. If he or she feels a burning sensation, add more
contact medium. If pain occurs, lower the intensity. If necessary, interrupt the procedure and inform the
prescribing physician.
8. After the prescribed time has elapsed, lower the intensity and switch the instrument off. Most instruments
switch off automatically.
9. Clean the contact medium off the patient and dry the skin.
A therapeutic example
Large edema in outer ankle region; two days after distortion; high palpatory soreness (tenderness), X-ray
negative.
Dg.: Distorsio art. talocruralis l.dx. Hematoma gravis reg. condyl.
fibul. l.dx. S 90.0 sub-acute
Pulse ultrasound, PPR 1:8 (heat generation would exasperate both the condition and the healing process).
Frequency 3 MHz (superficial process).
Subaqual, semistatic application. Emitter head distance: 10 cm (for local soreness, sufficient contact can not be
made. In addition, a close ultrasonic field must not be applied to a bony projection situated just under the skin.)
Emitter head size (ERA):
4 cm
2
Water temperature: 20
ο
C. (Simultaneous negative thermotherapy for subacute states)
Intensity: 2.0 - 3.0 W/cm
2
, step 0.2 W/cm
2
(A subacute process usually calls for a lower intensity. However, in this
case, the use of pulse ultrasound is most important with a distant ultrasonic field where intensity is at least two
times lower).
Application time: 6 minutes. Irradiated area is approximately twice larger than the emitter head ERA. The shortest
time for acute states is twice 3 minutes. Since intensity increases in increments, length of time should not.
Frequency of procedures: At first, three procedures daily, after that every second day. As the condition changes
from subacute to subchronic, pauses between procedures are lengthened in order to give the organism a better
opportunity to heal itself.
Total number of procedures: 5