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Ultrasound is a type of sound, and all forms of sound consist of waves that transmit energy by alternately compressing and rarefying material. Ultrasound is defined as sound with a frequency of greater than 16 kHz, which is not heard by human. The greater strength of energy is the greater amplitude of deviation of material’s particles from previous condition. The wave’s length is a distance, which includes one region of compressing and one region of rarefying. The wave’s length is in converse proportion to the frequency. Ultrasound waves of low frequency spread spherically. Ultrasound waves spread directory when the frequency increases and the wave length is decreased. So, therapeutic ultrasound has a frequency of between 800 and 3000 kHz. These waves spread parallel, they way be concentrate on separate region. Spreading of ultrasound waves has the same properties as the light spreading: attenuation, refraction, reflection from the border of two environments. Attenuation is decreasing ultrasound intensity, when the wave travels through tissue. Attenuation of ultrasound is different tissues is different. For example, coefficient of ultrasound attenuation for bones is higher in 12-15 times than it for muscle. Generally, the higher the frequency is, the greater the attenuation, and the less the depth of penetration. Ultrasound of high frequency is intensively absorbed by air. Small layer of air between source of ultrasound and skin can detain ultrasound. It requires a using of contracting environments without air in physiotherapy (vaselin oil, glycerin, lanolin). In other cases, when the close contact between ultrasound source and skin surface is impossible (wrist, foot region) they use action through water layer (1-2 cm). Ultrasound is generated by using of converse piezoelectrical effect. Piezoelectrical effect is an electrical polarization of crystals, generated by their mechanic deformation: compression, extension, curve, and twistion. A variety of materials are piezoelectric, including quartz, barium titanate and others. On the other hand, in alternating electrical current these crystals are compressed and extended according to electrical field’s direction. Frequency of mechanic waves matches frequency of electrical field. So, the ultrasound apparatus consists of generator of high frequency and ultrasound transducer (vibrator, applicator) with quartz ore barium titanate plate inside. Apparatuses: - UST (ultrasound therapeutical) – is a portable apparatus. Model 1,01F generates ultrasound with frequency 880 kHz; model 3,01G generates ultrasound with frequency 2640 kHz. - “Ultrasound-T5” is a portable apparatus. It generates ultrasound with frequency 880 kHz. Apparatuses have two regimes: uninterrupted and pulsatile with impulses’s frequency 50 Hz and with impulses of different duration. Apparatuses have changeable vibrators with generating surface 1 or 4 cm2. There are for treatment of stomatological, urological, ophtalmological, and othorhinolaryngological diseases and others. The main biophysical processes in the tissues depend on three basic effects of ultrasound: mechanical (mechanico-dynamical) effect, physico-chemical and thermal. Mechanical effect appears on cellular and subcellular levels. Ultrasound of great intensity leads to ruption on tissue with formation of microscopical cavities. This process is called cavitation, and it is absent when ultrasound used therapeutically. Mechanical effect of low intensity ultrasound in physiotherapy leads to vibrative micromassage of tissues. Physico-chemical activity of ultrasound is connected with complex electronic-quantive processes on molecular level. Movement of molecules is accelerated ion’s formation is increased. The amount of free radicals increases in tissues. Formation of bioactive substances and oxidative-reductive reactions are stimulated in tissues, dispersity of cell colloids increases. In therapeutical doses, ultrasound plays the role of catalyzer of biochemical reactions. Electronic-quantive processes increase greatly own chemoluminescention of blood.
Nontherapeutical, high intensive ultrasound can decolorate organic dyes, can oxidate, kalium iodinate (KI), which is also conform physico-chemical effect. Thermal effect includes transformation of mechanical energy in thermal. Firstly, ultrasound heats tissues with high ultrasound absorbtion: nervous tissue, bones. Ultrasound hearts whole tissue (volume heat), heart appears also in the border between two environments with different acoustic density (structive heart). Prominent increasing of tissue temperature is absent during procedure because of low intensive ultrasound using in physiotherapy. Thermal effect in this case plays the second role. The main physiological reactions & main medical action. According to dose we can observe the following actions of ultrasound: damage, inhibition, stimulation. Doses, leading to stimulative effect, not causing destructive effect in tissues are using in physiotherapy. It should be mentioned, that doses, causing stimulative effect are very close by doses, causing inhibition of function. So, treatment procedure may be overdosed easily. Ultrasound of frequency 800-1000 kHz can penetrate in tissues on 5-6 cm deep, which is three times more than ultrasound of frequency 2400 kHz. The best ultrasound penetration is in fat tissue, ultrasound is detained by muscles & nervous tissue. Great amount of ultrasound is absorbed on the border between tissues with different acoustic density. Bones reflect about 60% of ultrasound energy. In small doses ultrasound can penetrate up to 20 cm deep, which is conformed by finding about reflected waves visualization. This fact is used in ultrasound diagnostics. Physiological responsive reactions on main biophysical effects are in close interaction. In therapeutical doses ultrasound shows stimulative activity on cell function. In the beginning of it’s activity mitochondrium swelling and structive changes in matrix are observed, structure of cell shapebecomes illegible. Cell irritation leads to metabolism activation, enlargement of breath mitochondrial activity. This effect of biological stimulation is kept during several hours after single action. High doses leads great changes in cellular microstructures, inhibit cellular activity, cause damage of cell. Ultrasound rejuvenates cellular and fibrous structures of connective tissue. Cells with excessive protoplasma appearsamount of elastic fibers increases in basic substance, collagenogenesis is inhibited. The ultrasound action on excessive connective tissue with changed structure leads scan to became more elastic. Low intensive ultrasound accelerates damaged nervous fiber regeneration, decreases receptors sensitivity (pain reduction). Ultrasound doesn’t cause prominent subjective sensations in skin receptors. The most sensitive to its action is face skin and abdomen skin. Action on skin reflexogenic regions leads to general responsive reactions, which are realized through the main vegetative centers, hypothalamo-hypophysal system. According to this mechanism ultrasound therapy increases lability of nervous centers and adaptive-trophical functions of whole body. This general effect of ultrasound is used in some treatment procedures. The main indications: 1. Adhesive processes and scars (burn trauma, perivisceral complications of gastric and duodenal ulcer, inflammative diseases of female genital system). 2. Degenerative-dystrophic diseases of extremities jonts and vertebral column. 3. Inflammative diseases and traumatical damages of musculo-sceletal system, damage of periarticular tissues. 4. Inflammative diseases of the ear, nose and throat, female and male genital systems. 5. Peripheral nervous system diseases, including damages of facial and trigeminal nerves. 6. Gastrial and duodenal ulcers, bronchial asthma (action on appropriate reflexogenic zones).
The main contraindications: 1. Significant functional disorders of central nervous system. 2. Thrombophlebitis (in zone of action). 3. Arrhythmia. 4. Action on the large jonts regions, brain, prominent bone surfaces. Dosage: 1. According to intensivity of action (from 0,05 to 1,2 Vt/cm2) 2. According to regime of action (uninterrupted or pulsatile) 3. According to duration of procedure (from 2 to 6 minute on one field, up to 15 minute – summarized time on the several fields) 4. According to square of action (one field is not more than 250 cm2, not more than two field in first day and up to 5 field next days) 5. According to frequency of procedures (every day or day about) 6. According to amount of procedures on the course of treatment (from 6 to 14). Ultraphonophoresis (phonophoresis) is the application of ultrasound and drug. Ultrasound increases absorbtion ability of skin, and particles of drug become to penetrate through cells and intercellular spaces in amounts, which can show medical effects. Depth of penetration depends on skin, where the drug is cumulated. The amount of penetrated drug is about 1-5% during phonophoresis. Phonophoresis technique is the same as ultrasound therapy technique, but contact substance has drug. The direction of drug effect must coincide with direction of ultrasound action. Drug must not lose its pharmacological activity during phomophoresis. Phonophoresis of glucocorticosteroids (usually hydrocortisone) and nonsteroid anti-inflammative drugs during jonts and periarticular tissues diseases is mostly widespread.
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