US

Introduction + ask for consent

Contraindications
Pulsed US Continuous US
Cardiovascular diseases and blood pressure abnormalities
Circulatory problems (deep vein thrombosis and thrombophlebitis)
Hemorrhage
Medication
General health (diabetes mellitus, tuberculosis, fever, surgery)
Psychiatrics
Cardiac pacemaker and brain stimulator
Metal implant (can be used for pulsed US at low dose)
Malignancy
Acute infection
Post-radiotherapy
Pregnancy
Open wound
Heat-sensitive skin diseases (eczema)
Implant containing cement or plastic

Positioning
Back: prone with pillow under abdomen/side-lying with pillow between legs
Neck (Cx or upper Tx): prone/sitting with body leaning forward and pillow under head
Shoulder: supine with pillow under head/sitting with pillow held by both arms
Elbow and hand: sitting with pillow under forearm
Hip: supine/prone/side-lying
Knee: supine/sitting with leg supported
Ankle: supine with whole leg elevated
Prepare equipment
Mackintosh -> thermometer -> needle and wipe -> US gel and paper towel -> bowl
containing water -> tissues -> towel and pillow -> hot and cold test tubes
Skin sensation test
Hot and cold + Sharp and blunt
Apply treatment
What is your pain level now?
The treatment will be for few minutes. In the beginning when I place the soundhead onto
your skin, you will feel cold. During treatment, you may feel a very slight warmth or you may
not feel anything. If you feel pain, please call me immediately to avoid the danger of burn. It
would be safe if you follow my instructions. Please relax, do not move, and do not touch the
machine. If you are in doubt, please call me.
Check machine
How do you feel?
Check patient periodically (subjective feeling and skin)
End of treatment + documentation
Check skin
What is your pain level now?
Normally you will not have abnormal feelings after treatment. Have a little redness on the
skin owing to soundhead compression is normal. Please come back tomorrow.

Parameters
No. of treatment area = ERA/1.5
Treatment time
 Acute = 1-2 mins
 Sub-acute = 1.5-2.5 mins
 Chronic = 2-3 mins
Frequency
 Superficial (3-6 mm) = 3 MHz
 Deep (1-2 cm) = 1 MHz
Intensity
 Acute = 0.5-0.8 W/cm2
 Sub-acute = 0.8-1.0 W/cm2
 Chronic = 1.0-1.5 W/cm2
Mode
 Acute = pulsed 1:4 (20%)
 Sub-acute = pulsed 1:1 (50%)
 Chronic = continuous
 SWD
Introduction + ask for consent
Contraindications
PSWD CSWD
Cardiovascular diseases and blood pressure abnormalities
Circulatory problems (deep vein thrombosis and thrombophlebitis)
Hemorrhage
Medication
General health (diabetes mellitus, tuberculosis, fever, surgery)
Psychiatrics
Cardiac pacemaker and brain stimulator
Metal implant
Malignancy
Acute inflammation
Post-radiotherapy
Pregnancy
Heat-sensitive skin diseases (eczema)
Implant containing cement or plastic
Open wound

Positioning
Back: prone, coplanar, 2 disc electrodes
Neck: supine, coplanar, 2 pad electrodes
Shoulder: sitting, contraplanar, 2 disc electrodes
Wrist: sitting, contraplanar, pad electrode under wrist with disc electrode on top
Hip: supine, contraplanar, pad electrode under SI joint with disc electrode on top
Knee: sitting, contraplanar, 2 disc electrodes
 MCL: smaller electrode with a shorter skin-electrode distance
Achilles tendon: sitting, longitudinal, pad electrode under foot with disc electrode over knee
 Achilles tendon: plug connection at posterior end
 Shin splints: plug connection at anterior end
Prepare equipment
Electrodes and neon tube -> thermometer -> wooden furniture -> towel and pillow -> hot
and cold test tubes
Skin sensation test
Hot and cold
Apply treatment
Ensure no metals in patient’s pockets and hearing aid is turned off
What is your pain level now?
The treatment will be for few minutes. During treatment, you will feel comfortable warmth.
If you feel pain or excessively hot, please call me immediately to avoid the danger of burn. It
would be safe if you follow my instructions. Please relax, do not move, and do not touch the
machine or you may get an electric shock. If you are in doubt, please call me.
Check machine
How do you feel? Is the heat mild, moderate, or severe?
Where do you feel the heat?
Is the heat evenly distributed?
Check patient periodically (subjective feeling and erythema)
Use towel to absorb moisture on skin
End of treatment + documentation
Check skin
What is your pain level now?
Normally you will have a little erythema after treatment for a while. If there is still erythema
after few hours, please come back to find me. Please come back tomorrow.
Parameters
PSWD (mainly for acute) CSWD
Treatment time = 15-20 mins Treatment time = 15-20 mins
Intensity Intensity = comfortable warmth
 20-40 Hz = maximum 10 (acute) Flexiplode intensity dial no more than 7
 40-110 Hz = 4-8 Circuplode intensity dial no more than 6
 150-200 Hz = 1-2
Circuplode intensity dial no more than 8
 NMES
Introduction + ask for consent
Contraindications
Cardiovascular diseases and blood pressure abnormalities
Circulatory problems (deep vein thrombosis and thrombophlebitis)
Hemorrhage
Medication
General health (diabetes mellitus, tuberculosis, fever, surgery)
Psychiatrics
Cardiac pacemaker and brain stimulator
Malignancy
Acute inflammation
Post-radiotherapy
Pregnancy
Open wound

Positioning
Quads: bipolar with electrodes arranged diagonally, 1/2 lying, knee supported on pillow
TA: bipolar, 1/2 lying, knee supported on pillow
UL: bipolar, sitting, back and forearm supported on pillow
 Unipolar with rubber electrode on lateral aspect of upper arm
Prepare equipment
Rubber electrodes and sponge (or lint electrode) -> rubber bandage -> mackintosh -> needle
and wipe -> vaseline -> bowl containing water and soap -> tissues -> towel and pillow
Skin sensation test
Sharp and blunt
Apply treatment
Wash the treatment area with soap and water
Apply vaseline to protect lesion (if necessary)
The treatment will be for few minutes. During treatment, you may have tingling sensation
and muscle contraction. You can try to contract voluntarily when the current comes, and
relax when the current goes. If you feel concentration of current, unwanted discomfort, or
pain, please call me immediately to avoid sustaining skin or tissue damage. It would be safe
if you follow my instructions. Please relax, do not move, and do not touch the machine or
you may get an electric shock. If you are in doubt, please call me.
Check machine
Gradually increase intensity and ask if the patient feel muscle tingling
How do you feel? Is the tingling tolerable?
Do you feel any concentration of current?
End of treatment + documentation
Check skin
Normally you will have some redness on skin after treatment for a while. Please come back
tomorrow.
Parameters
Waveform = monophasic rectangular
PD = 1 ms
IPI = 20 ms
Train = 4/min
Mild weakness Moderate weakness Severe weakness
Frequency = 3-10 Hz Frequency = 10-30 Hz Frequency = 30-50 Hz
On-off time = 2:25 On-off time = 5:20 On-off time = 10:10
Treatment time = 5 mins Treatment time = 15 mins Treatment time = 15 mins
At most 10 reps at maximal tolerable intensity
 TENS
Introduction + ask for consent
Contraindications
Cardiovascular diseases and blood pressure abnormalities
Circulatory problems (deep vein thrombosis and thrombophlebitis)
Hemorrhage
Medication
General health (diabetes mellitus, tuberculosis, fever, surgery)
Psychiatrics
Cardiac pacemaker and brain stimulator
Malignancy
Acute inflammation
Post-radiotherapy
Epilepsy
Pregnancy
Open wound

Positioning
Large back area: quadripolar, cross fire arrangement
2 back areas: bipolar, 2 channels perpendicular to spine
2 sides of spine: bipolar, 2 channels parallel to spine
Prepare equipment
Rubber electrodes and gel -> tape -> mackintosh -> needle and wipe -> bowl containing
water and soap -> tissues -> towel and pillow
Skin sensation test
Sharp and blunt
Apply treatment
Wash the treatment area with soap and water
What is your pain level now?
The treatment will be for few minutes. During treatment, you may have tingling sensation. If
you feel concentration of current, unwanted discomfort, or pain, please call me immediately
to avoid sustaining skin or tissue damage. It would be safe if you follow my instructions.
Please relax, do not move, and do not touch the machine or you may get an electric shock. If
you are in doubt, please call me.
Check machine
Gradually increase intensity and ask if the patient has tingling sensation
How do you feel? Is the tingling tolerable?
Do you feel any concentration of current?
End of treatment + documentation
Check skin
What is your pain level now?
Normally you will have some redness on skin after treatment for a while. Please come back
tomorrow.
Parameters
Conventional mode (acute pain)
 Frequency = 80-120 Hz
 Pulse duration = 30-75 μs
 Treatment time = 30 mins
Acupuncture mode (chronic pain)
 Frequency = 1-10 Hz
 Pulse duration = 150-250 μs
 Treatment time = 45 mins
Brief intense mode (quick analgesia)
 Frequency = 100-150 Hz
 Pulse duration = 150-250 μs
 Treatment time = 10 mins
Burst mode (chronic pain)
 Frequency = 1-2 Hz
 Pulse duration = 100-200 μs
 Treatment time = 15 mins
Surge mode (muscle stimulation)
 Frequency = 50 Hz
 Pulse duration = 100-200 μs
 On-off time = 2:10
 Treatment time = 15 mins
 IFT
Introduction + ask for consent
Contraindications
Cardiovascular diseases and blood pressure abnormalities
Circulatory problems (deep vein thrombosis and thrombophlebitis)
Hemorrhage
Medication
General health (diabetes mellitus, tuberculosis, fever, surgery)
Psychiatrics
Cardiac pacemaker and brain stimulator
Malignancy
Acute inflammation
Post-radiotherapy
Epilepsy
Anti-coagulant therapy
Pregnancy
Open wound

Positioning
Suction (sensory): quadripolar, cross fire arrangement
Rubber electrode (motor): pre-modulated bipolar
 Can be contraplanar and coplanar
Prepare equipment
Rubber electrodes and sponge (or suction cups) -> rubber bandage -> mackintosh -> needle
and wipe -> bowl containing water and soap -> tissues -> towel and pillow
Skin sensation test
Sharp and blunt
Apply treatment
Wash the treatment area with soap and water
What is your pain level now?
The treatment will be for few minutes. During treatment, you may have tingling sensation
and muscle contraction. (You can try to contract voluntarily when the current comes, and
relax when the current goes.) If you feel concentration of current, unwanted discomfort, or
pain, please call me immediately to avoid sustaining skin or tissue damage. It would be safe
if you follow my instructions. Please relax, do not move, and do not touch the machine or
you may get an electric shock. If you are in doubt, please call me.
Check machine
Gradually increase intensity and ask if the patient has tingling sensation
How do you feel? Is the tingling tolerable?
Is that the suction pressure? Can you feel some current flowing?
Do you feel any concentration of current?
End of treatment + documentation
Check skin
What is your pain level now?
Normally you will have some redness on skin after treatment for a while. Please come back
tomorrow.
Parameters
Carrier frequency = 4000 Hz
Sensory
Beat frequency
 Acute = 100 Hz
 Sub-acute and chronic = 25 Hz
Intensity
 Acute = no contraction
 Sub-acute and chronic = mild
contraction
Treatment time = 15 mins
Modulation
 Modulation frequency = 5 Hz
 Sweep time = 6/6 s
Mid-frequency current (motor)
Carrier frequency = 4000 Hz
Beat frequency
 Small muscle = 10 Hz
 Large muscle = 50 Hz
Treatment time = 15 mins
On-off time = 2:10
Motor
Beat frequency
 Small muscle = 10 Hz
 Large muscle = 50 Hz
On-off time
 Severe = 2:25
 Moderate = 5:20
 Mild = 10:10
Treatment time = 15 mins
Russian current (motor)
Carrier frequency = 2500 Hz
Beat frequency
 Small muscle = 10 Hz
 Large muscle = 50 Hz
Treatment time = 10 mins
Duty factor = 1:1
On-off time = 10:50