4. Unit operation
PHG 300A / 301A User Manual Page 16 of 40
• Properly attach the electrodes with viscose pads to the patient’s body, e.g. by Velcro belts, elastic
bandage or sand bags.
• In the place of the arrangement of the electrodes it is necessary to estimate the continuity of the skin
and exteroceptive sensation.
• In order to decrease the resistance of skin you can clean it with alcohol or water with soap, after wiping
leave the skin moist. Small skin damages should be secured with medical or cosmetic petroleum jelly.
• During the first therapy it is necessary to use rather lower doses of current than the recommended ones.
Intensity (sensory threshold level or motor threshold) depending on the goal of therapy, it is necessary
to increase in accordance with the patient’s sensations and maintaining comfort during treatment.
• In case of reporting burning it is necessary to stop the treatment and examine the skin.
• The electrodes should be used in accordance with the indications of the manufacturer and should be
replaced periodically, depending on the degree of wear. Loss of electrical properties by the electrodes
causes the risk of burning the patient.
4.1.3 Ultrasound therapy
• Before the treatment it is necessary to check the efficiency of functioning of the equipment and to control
the cables and ultrasound head.
• It is necessary to explain to the patient the method of treatment and sensations during the treatment
(always painless).
• It is necessary to clean the skin (or soap or alcohol 70%) in the place of application. If skin is very hairy in
the place of treatment, it is necessary to shave it gently, cover the remaining parts of the body in order
to avoid undercooling.
• The position of the therapist should facilitate free access to the equipment in such a way that the
ultrasound head should remain for the whole time of treatment in contact with the skin of the patient.
Proper pressure is necessary in order to ensure firm contact between the skin and the head which enables
maximized transmission of ultrasound energy.
• It is necessary to use the medium conducting the ultrasounds, preferably gel.
• Coupling medium should be applied on the surface of skin, make continuous movements in the form of
overlapping or longitudinal circles, the head shall not be removed from skin, in case of pain or burning it
is necessary to stop therapy and change parameters.
• It is necessary to localize the tissue affected by the disease, determine its type, depth, which determines
the choice of frequency of ultrasounds (up to 6 cm frequency 1 MHz, up to 1 cm frequency 3,5 MHz),
surrounding tissues, tissues repair phase (acute conditions – only mechanical operation of ultrasounds,
in chronic conditions mainly thermal effect), chose the method of application (direct, indirect), determine
proper exit position: without pain, relaxation position, treated tissues should be moved as close to the
surface of skin as possible.
• In direct therapy the head is moved in a continuous way, by exercising pressure, parallel to the skin, by
applying steady, rhythmical motion patterns at average speed of 4cm/sec. Too fast motions cause too
low accumulation of ultrasound energy, too slow motions cause overheating of tissues in case of using
higher intensities of ultrasounds.
• Choice of the method of moving the head depends on the shape of treated surface. In case of treating
surfaces with irregular shape, motion pattern may appear as overlapping circles. This method requires
from the therapist to make circular motions of small diameter, the size of ultrasound head should be such
that the subsequent circular sliding motion overlaps the half of the previous motion.
• In case of treating larger, flat surfaces it is necessary to carry out longitudinal movements. This method
requires from the therapist carrying out sliding movement with the adequate rhythm and carrying out
side movements of length equal to half of the ultrasound head’s diameter. As far as possible it is
recommended to slightly press the head to the skin surface as this increases the penetration of
ultrasounds deep into the tissues.
• Even during treatment of relatively small areas, such as trigger points, elements of scars or tendons it is
necessary to make even very small but continuous movements with the head (often determined as semi-
stationary techniques).
• Ultrasounds in water bath are used if part of the body subjected to therapy is of irregular shape or there
is a spot sensitivity enabling direct contact with ultrasound head. Most often it is used in therapy of
palms, forearms, feet and ankles. Part of the body subjected to therapy should be immersed in degassed
water with temperature pleasant for the patient. Waterproof head must be placed at the distance of 1-2
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