A QUICK GUIDE FOR THE GRAND 4.

Position the patient with the

PRACTICAL EXAMINATION FOR surface of the area to be treated
ELECTROTHERAPY perpendicular to IR beam.
a. Non-luminous Lamp: 29-36
INFRARED LAMPS inches
INDICATIONS b. Luminous Lamp: 18-24 inches
5. Provide the patient with a means to
a. Pain Relief call for assistance and instruct
b. Reduction of Muscle Spasm patient to call if discomfort occurs.
c. Hasten Edema Absorption 6. Instruct the patient to avoid
d. Accelerates Wound Healing/Repair moving closer to or farther from
e. Used for pre-heating tissue
the lamp and to avoid touching the
PHYSIOLOGIC EFFECTS lamp because movement toward or
away from the lamp will alter
a. Sweating amount of energy reaching the
b. Cutaneous Vasodilation
patient.
c. Sensation
7. Set the lamp treatment time
d. Increase in Metabolism
a. Sub-acute Conditions: 15
ASK CONTRAINDICATION/PRE- minutes
CAUTION b. Chronic Conditions: 30
minutes
1. Do you have any bruising or 8. Monitor the patients response
bleeding? during treatment. It may be
2. Do you have normal feeling in this necessary to move the lamp
area? farther away if the patient
3. Do you have constant pain that becomes too warm
does not change?
4. Do you have any problems in the Documentation
heart?
For Maam Jean
5. Do you have any metal inside this
area? - IR on forearm, 1000nm peak
6. Have you applied any cream or wavelength, 100W at 18 in. x 30
ointment to this area? If so, what mins.
type?
For Maam Danielle
PROCEDURE
- Non-Luminous IR on forearm x
1. Remove clothing and jewelry from 20mins.
the area to be treated and inspect
area. Drape the patient with LASER
modesty, leaving the area to be INDICATION
treated uncovered.
2. Put IR opaque google on the a. Tissue Healing: Soft Tissue and
patient and PT if there is possibility Bone
of IR irradiation of the eyes. b. Arthritis
3. Non-Luminous Lamp: Pre-heat c. Lymphedema
for 5-15 minutes d. Neurological Conditions
Luminous Lamp: Can apply e. Pain Management
directly PHYSIOLOGIC EFFECTS
 - Patient should not feel anything
CONTRAINDICATION/PRE-CAUTION
a. Do you know if you have tumor in
this area? How About Constant
pain?
b. Have you recently had radiation
applied in this area?
c. Do you have any bruising or
bleeding in this area?
d. Are you pregnant?
e. Do you have any normal feeling
sensation in this area?
f. Are you taking any medication that
increases your sensitivity to light or
your risk of sunburn?
g. Do you sunburn easily?
Procedure:
1. Evaluate the patients clinical
findings and set the goals of
treatment.
2. Determine whether laser or light
therapy is the most appropriate
treatment.
3. Determine that laser or light
therapy is not contraindicated for
the patient or the condition. Check
with the patient and check the
patients chart for contraindications
regarding the application of laser or
light therapy.
4. Select an applicator with the
appropriate diode(s), including
type(s) (LED, SLD, or laser diode),
wavelength(s), and power.
5. Select the appropriate energy
density (fluence) (J/cm2)
a. Wound Healing: 4-16 J/cm2
b. Soft Tissue Healing: 5-16 J/cm2
c. Fracture Healing: 5-16 J/cm2
d. Acute Arthritis: 2-4 J/cm2
e. Chronic Arthritis: 4-8 J/cm2
f. Lymphedema: 1.5 J/cm2
g. Neuropathy: 10-12 J/cm2
h. Acute Soft Tissue
Inflammation: 2-8 J/cm2
i. Chronic Soft Tissue
Inflammation: 10-20 J/cm2
6. Before treating any area at risk for
cross-infection, swab the face of
the applicator with 0.5% alcoholic
chlorhexidine or the antimicrobial
approved for this use in the facility
7. If using an applicator that includes
laser diodes, the patient and the
therapist should wear protective
goggles. These goggles should
shield the eyes from light the wave
length of the laser. DO NOT
substitute sunglasses for the
goggles provided with or intended
for your laser device. Sunglasses
do not adequately filter IR light.
Never look into the beam or the
laser aperture. Remember, a laser
beam can damage the eyes even if
the beam cannot be seen.
8. Expose the area to be treated.
Remove overlying clothing, opaque
dressings, and any shiny jewelry
from the area. Non opaque
dressings, such as thin films, do not
need to be removed because it has
been shown that most laser light
can penetrate through these
wound dressings
9. Apply the applicator to the skin
with firm pressure, keeping the
light beam(s) perpendicular to the
skin. If the treatment area does not
have intact skin, is painful to touch,
or does not tolerate contact for any
reason, treatment may be applied
with the applicator slightly above
the tissue, without touching the
skin but with the light beam(s) kept
perpendicular to the tissue surface
a. Spotting:
- Direct with firm pressure
b. Gridding:
- A treatment area is divided into a
grid of square centimeters, with
each square centimeter stimulated
for specific time
 - Most frequently utilized method of
application and should be used
whenever possible.
- Lines and point should not be
drawn on the patients skin
because this may absorb some of
the light energy.
- If an open area are to be treated, a
sterilized clear (opaque) plastic
sheet can be placed over the
wound to allow surface contact.
c. Scanning
- There is no contact between the
laser tip and the skin. (spray-like
pattern)
- With this technique, the applicator
tip should be held less than 1 cm
above because beam divergence
might occur.
d. Wanding
- Area is bathed with the laser in an
oscillating fashion with no direct
contact in the skin for a designated
time.
- Not recommended because of
irregularities of dosage.
10. Start the light output and
keep the applicator in place
throughout the application of each
dose. If the treatment area is larger
than the applicator, repeat the
dose to are as approximately 1 inch
apart throughout the treatment
area. The device will automatically
stop after delivery of the set dose
(J/cm2).
DOCUMENTATION
Blue Laser, 405 nm, 200 mW, to area of
the wound, 4J/cm2 to 4 areas of the
wound in dorsal aspect of forearm
ULTRAVIOLET RADIATION
a. UVA
- 320-400 nm
- Produces Fluorescence
b. UVB
- 320 290 nm
- Produces most erythema on the
skin
c. UVC
- Below 290 nm
- Produces Germicidal Effects.
INDICATION
- Acne
- Psoriasis
- Tetany
- Vitamin D Deficiency
- Chronic Ulcer/Wound
- Osteomalacia/Rickets
- Sinusitis
PHYSIOLOGIC EFFECTS
- Facilitate healing
- Erythema production (UVB)
- Epidermal hyperplasia
- Vitamin D synthesis
- Vitamin D production
- Increased pigmentation
- Tanning
- Thickening of epidermis
- Bactercidal effects
- Exfoliation
ASKED CONTRAINDICATION/PRE-
CAUTION
a. Do you know if you have tumor in
this area? How About Constant
pain?
b. Have you recently had radiation
applied in this area?
c. Do you have any bruising or
bleeding in this area?
d. Are you pregnant?
e. Do you have any normal feeling
sensation in this area?
f. Are you taking any medication that
increases your sensitivity to light or
your risk of sunburn?
g. Do you sunburn easily?
Procedure:
I. GETTING THE MED OF THE
PATIENT
1. Clean and dry the surface to be
tested. Make certain that the skin
of the area selected for the test has
not been previously exposed to UV
radiation.
2. Tape the erythrometer to the flexor
aspect of the forearm or to the
lower abdomen or in the buttocks.
Use only the abdomen if the
forearm is too small or if it is
unavailable for another reason.
3. Cover all the holes in the
erythrometer
4. Drape the patient completely
5. Put on goggles and give a pair to
the patient
6. Position the UV lamp directly over
the area (so it is perpendicular) 36
inches (76cm) away.
7. Turn on the lamp
a. Arc Lamp: Warm up for 5-10
minutes
b. Fluorescent Lamp: Can be used
within 1 minute being turned on.
8. Open the shutters and expose the
1st hole, keeping the remaining
holes covered. After 15 seconds,
uncover the 2nd hole. Continue
uncovering each subsequent hole
at 15-second intervals until all
holes are uncovered.
9. When 90 seconds have elapsed
since the 1st hole was uncovered,
cover the patient and close the
shutters. In this way, the 1st hole
will have received 90 seconds of
exposure, the last hole only 15
seconds.
10. Instruct the patient to check
the area every 2 hours while awake
and to record which symbols
appeared, which ones faded and
the ones that each one appeared
and faded. This information is used
to determine the patients minimal
erythemal dose (MED) or the
amount of infrared exposure
required to show erythema lasting
up to 48 hours.
II. APPLICATION OF UVR
1. Warm up the lamp if necessary
a. Arc Lamp without glass filter
- 5-10 minutes
b. Arc Lamp with Glass Filter
- 20 minutes
c. Fluorescent Lamp
- Brief warm period about 1 minute
after being switched on
d. Fluorescent Lamp with Glass
Filter
- 20 minutes
2. During Warm-up period, cover the
lamp beam with a UV-opaque card
or direct the lamp away from the
patient or toward a wall or floor.
3. Place UV-opaque goggles on the
patient and the clinician.
4. Remove clothing and jewelry from
the area to be treated
5. Wash and dry the area to be
treated
6. Cover all the areas not needing
treatment that may otherwise be
exposed to radiation with a UV-
opaque material such as a cloth or
paper towel
7. Position the area to be exposed
comfortably. When psoriatic
plaques are treated with UVB, a
nonUVB-absorbing lubricant such
as mineral oil may be applied to
the plaques to decrease
reflectance by the scale on the
plaques. Do not apply agents
containing salicylic acid, which
absorbs UVB light.
8. Adjust the position of the lamp or
the patient so that the distance
between the lamp and the area to
be exposed is the same as it was
when the MED was determined.
Also, place the lamp so that the UV
beam will be as perpendicular to
the treatment area as possible.
Measure and record the distance of
the lamp from the patient.
 9. Stay close to the patient, or give
the patient a call bell and a means
to turn off the lamp. Also, provide
the patient with a means to open
the cabinet if a whole-body
treatment is being given.
10. Direct the beam at the
treatment area, and start the timer.
Select the treatment time
according to the recommendations
for dosimetry that follow.
11. When treatment is complete,
observe the treated area;
document the treatment given and
any observable response to the
treatment.
12. Subsequent treatment should
be conducted in the same manner
but the duration per area usually
can be increase by 5 seconds each
time.
Documentation
UVB to dorsal aspect of the elbow,
lamp no. 2366, 30 in. away from the
patient skin x 3 mins.
2 Hours after psoralen ingestion, pt
placed in UV cabinet, lamp 2345, PUVA to
bilat. Knees and elbow x 6 mins.
ULTRASOUND
Indication
- Pain and muscle spasm
- Adhesions
- Calcific Tendonitis
- Hematoma
- Swelling
- Acute Effusion
- Chronic Synovitis
- Fracture
- Wound Healing
PHYSIOLOGIC EFFECTS
1. THERMAL EFFECTS
Increase local blood flow
Increase Soft Tissue Extensibility
Decrease in Joint Stiffness
Reduce Pain and Muscle Spasm
Promote Healing Process
Increase Motor and Sensory Nerve
Conduction Velocity
2. NON-THERMAL EFFECTS
Stimulation of Tissue Regeneration
Soft Tissue Repair
Blood Flow Chronically Ischemic
Tissues
Protein Synthesis
Bone Repair
ASKED CONTRAINDICATION/PRE-
CAUTION
1. Do you have pain at rest?
2. Are you pregnant?
3. Do you have joint replacement in
this area?
4. Was cement used to hold it in
place?
5. Does it have plastic component?
6. Do you have a pacemaker?
7. Do you have a blood clot in this
area?
8. Do you have hemophilia?
Procedure:
1. Confirm that ultrasound is not
contraindicated for the patient or
the condition. Check with the
patient and check the patients
chart for contraindications or
precautions regarding the
application of ultrasound
2. Apply an ultrasound transmission
medium to the area to be treated.
Apply enough medium to eliminate
any air between the sound head
and the treatment area. Select a
medium that transmits ultrasound
well, does not stain, is not
allergenic, is not rapidly absorbed
by the skin, and is inexpensive.
Gels or lotions meeting these
criteria have been specifically
formulated for use with ultrasound.
Or, for the application of ultrasound
under water, place the area to be
treated in a container of water
- Methods of application for c. 100% Duty Cycle: Chronic Case /
Ultrasound Thermal Effects.
a. DIRECT CONTACT D. Duration of the Treatment
- US applicator - 5 minutes
- Gel-absorbing tissue - 2X ERA: 5-10 minutes
b. WATER BAG APPLICATION E. Modes of the Ultrasound
- Irregular shaped, open bony a. Continuous Mode
- Gloves, latex - No off time (100%)
c. WATER BATH APPLICATION - Heating/Thermal Effects
- Irregular distal areas - Chronic Cases
- Basin - Increase tissue temperature,
extensibility, muscle spasm and
3. Select a sound head with an ERA etc.
approximately half the size of the - Patient should feel slight warm
treatment area. b. Pulsed Mode
4. Select the optimal treatment - Non-thermal cases
parameters, including ultrasound - Acute
frequency, intensity, duty cycle, - Short burst or pulses of usually
and duration; the appropriate size 2m/s
of the treatment area; and the - Markspace ratio/pulse ratio =
appropriate number and frequency on/off x100%
of treatments. Parameters are - Duty Cycle = decrease duty cycle
generally determined by whether lang dapat for acute cases
the intended effect is thermal or - Patient should feel the coldness of
nonthermal. the US
A. Ultrasound Frequency 5. Before treatment of any area with a
a. 1MHz risk of cross-infection, swab the
- 2-5cm sound head with 0.5% alcoholic
- Deep Muscle chlorhexidine, or use the
- Bulky Muscle antimicrobial approved for this use
- Hips in the facility
- Shoulder 6. Placed the soundhead on the
- Quads treatment area
- Low Back 7. Turn on the Ultrasound Machine
b. 3MHz 8. Move the sound head within the
- 1-2cm treatment area. The sound head is
- Superficial moved to optimize the uniformity
B. Ultrasound Intensity according of ultrasound intensity delivered to
to Hecox the tissues and to minimize the risk
a. Acute (<2 weeks) of standing wave formation
- 0.1 0.5 W/cm2 A. SPEED OF SOUNDHEAD
b. Sub-acute (4 weeks) - 4cm/s
- 0.5 1.0 W/cm2 - 2-3 seconds / revolutions or cycle
c. Chronic (Months or years) B. MOVING TECHNIQUES
- 1.0-2.0 W/cm2 a. Longitudinal Stroke
C. Duty Cycle b. Circular Stroke
a. 25% Duty Cycle: Acute Cases / - Overlapping Circles
Non-thermal Effect 9. When the intervention is
b. 50% Duty Cycle: Sub-acute Cases completed, remove the conduction
medium from the sound head and
 the patient, and reassess for any
changes in status.
DOCUMENTATION
US (Waterbath) on (B) hands x 0.5W/cm2
x 3MHz x 5mins, each pulsed mode
(50%)
US on lower back areas x 1.5W/cm2 x
1MHz x 5mins per side, continuous mode
DIATHERMY
1. Indication
a. INDICATIONS AT THERMAL LEVEL
- Pain control
- Accelerated tissue healing
- Decreased joint stiffness
- If applied in conjunction with
stretching, increased joint rom
b. INDICATIONS AT NON-THERMAL
LEVEL
- Control of Pain and Edema
- Pain Control
- Soft Tissue Healing
- Nerve Healing
- Bone Healing
- Osteoarthritis Symptoms
- Other Applications (various forms of
neuropathy, ischemic skin flaps,
cerebral disease, and myocardial
disease, head injury)
2. Physiologic Effects
a. THERMAL LEVEL
- Vasodilation
- Increased rate of nerve conduction
- Elevation of pain threshold
- Alteration of muscle strength
- Acceleration of enzymatic activity
b. NON-THERMAL EFFECTS
- Increase microvascular perfusion
- Altered cell membrane function and
cellular activity
- Although diathermy is used primarily
for its deep heating effects, it can also
produce some heat in the skin and
superficial tissues,
3. ASKED CONTRAINDICATION/PRE-
CAUTION
CONTRAINDICATION AT THERMAL LEVEL
- Low back, abdomen, pelvis, of a
pregnant
woman
- Internal and external metal objects
- Eyes
- Malignant areas
- Intrauterine device
- Acute inflammation
- Cardiac pacemaker
- Pain and temperature sensory deficits
- Moist wound dressing
- Over hemorrhaging region
- Testes
- Ischemic tissue
CONTRAINDICATIONS FOR THE USE OF
NON-THERMAL PULSED SHORTWAVE
DIATHERMY
a. DEEP TISSUES SUCH AS INTERNAL
ORGANS
- Although contraindicated for the
treatment of internal organs,
nonthermal PSWD can be used to
treat soft tissue overlying an organ
b. SUBSTITUTE FOR CONVENTIONAL
THERAPY FOR EDEMA AND PAIN:
- PSWD should not be used as a
substitute for conventional therapy for
edema and pain. It is
intended to be used as an adjunctive
modality in conjunction with
conventional methods,
including compression, immobilization,
and medications
- Pacemakers, electronic devices, or
metal implants (warning)
PRE-CAUTION (ALL FORMS)
- Near electronic or magnetic
equipment
- Be at least 3 m and preferably 5 m
from other electrical equipment
- Obesity
- Heat fat excessively
- Copper-bearing intrauterine
contraceptive devices
PRECAUTIONS FOR THE USE OF
NONTHERMAL
PULSED SHORTWAVE DIATHERMY
- Skeletal Immaturity
- Pregnancy
Procedure:
I. APPLICATION FOR CAPACITIVE
METHOD
1. Place two plates over both sides of the - The magnetron microwave applicator
treatment areas ensuring equal should be placed a few inches from
distance from the plates to the skin the area to be treated and directed
(approx. 2-10 cm/ 1 to 3 inches toward the area, with the beam
from skin surface) perpendicular to the patients skin.
a. Coplanar Application
- Muscle
b. Contraplanar Application
- Fatty Tissue
2. Patient must remain in the same
position throughout the treatment for
complete and consistent heating
3. Provide a call bell for patient
4. Pt must be checked the first few
minutes of treatment
5. Tx time: 15-30 minutes (based on Dx
and desired effects)
II. INDUCTIVE METHOD
a. Bundled Cables: wrap coil around
extremity that has been covered by
towel
b. Drum Applicator: place the drum
directly over the treatment area
c. Coiled Sleeve
- Contact should be avoided when
DOCUMENTATION
infection control is an issue
- Cable should be wrapped around the a. SWD
towel-covered limb to be treated, with - 27.12 MHz continuous SWD, power
turns of the cable spaced: at least 3 level 3 to low back area, drum
cm apart, six to eight layers of applicator, placed directly to patient
towels skin, patient prone x 20 mins.
b. MWD
- 2450 continuous MWD to post.
III. APPLICATION FOR MAGNETRON Knee, 3in. away from patient skin
surface, power level 4 x 15 mins.