DEVICE BASICS

Basic Device Start Up:

Set the “Stimulator Output Control” knob and the “Ultrasound Output Control” knob fully counter-clockwise

1.      Turn on by pressing the "Power Switch".

2.      Set “Output Display Selector” rocker switch to the “Ultrasound “position.

3.      Set the "Treatment Time" selector to the number of minutes for treatment (5 to 8 minutes is recommended).

4.      Set "Power/Intensity Selector” rocker switch to the "Intensity" setting.    

5.      Set "Pulsed/Continuous Selector" rocker switch to “Pulsed” (acute) or “Continuous” (chronic).

6.      Set the "Stimulator Polarity Selector" rocker switch to “Negative” and apply distal ground electrode.

7.      Depress the "Timer On/Off Selector" button to “On” to activate the unit. Apply approximately 1 heaping tablespoon of coupling gel to the face of the Soundhead.

8.      Rotate the "Ultrasound Output Control" knob clockwise until the desired intensity is indicated in the "Output Display" (0.50 W/cm² is recommended).

9.      Switch the “Output Display Selector” rocker switch to the “Stimulator” setting to observe the applied voltage.

10.   Apply the soundhead to the patient and keep it moving then rotate the "Stimulator Output Control" knob clockwise until the patient reports a slight sensation. This will occur somewhere between 25 & 125 Volts as indicated on the “Output Display”. If no sensation is felt by the time 150 Volts is indicated, then discontinue treatment and troubleshoot the setup. During treatment, keep the soundhead firmly coupled and move it in circular manner at about three inches per second. Add more coupling gel as required to maintain constant, full contact between the soundhead and the patient.

Acute – use positive polarity, voltage 30-50 volts or (50-70) % of sensory and ultrasound either .5 w/cm² pulsed or .1 w/cm² continuous.

Chronic - negative polarity, voltage 50 - 100 volts or (80-90) % of sensory stimulation: ultrasound either 1 w/cm² or .5 w/cm² can be continuous or pulsed.

3 Basic Clinical Steps

1.     Clean the skin of any dirt, sweat or applied oils.

2.     Place Ground - Place either Black Electrode or Large dispersive to act as the ground.

·        Black Electrode (active ground - treats local area using opposite polarity) 

·        Large dispersive (inactive ground – minimizes treatment effect of ground; must be at least 5x larger than active at a minimum or greater than 25cm²) which is placed on either the torso, limbs or feet.

Distal ground – setting the ground to get the electrical field through the body by using either, a lateral (for example, elbow to elbow) or a contralateral (for example, elbow to opposite side knee) electrode placement.

Lateral placement - ground the same area on the opposite side, “Use the left side to ground the right and the right side to ground the left” for example, elbow to elbow.

Contralateral placement - "Use the lower body to ground the upper and the upper to ground the lower" and “Use the left side to ground the right and the right side to ground the left” for example,  left elbow to right knee or right wrist to left ankle.

Limb to Limb correspondence – Outside of arm to outside of leg, inside of arm of inside of leg, front of arm to front of leg, back of arm to back of leg.

Body to Limb correspondence - front of body to front of limb: back of body to back of limb and sides of the body to outside of the limb.

Ground Across– the active Red electrode or Soundhead is used right across from the ground: across either sides of knee or across torso from back to front or side to side.

3. Active Electrode – use either the Red Electrode or Soundhead on the area to be treated, for Soundhead use adequate amounts of ultrasound/conductivity gel and make sure it is a brand that can effectively transmit ultrasound

·       Red electrode – used on area to be treated as passive therapy or used in conjunction with Soundhead. When used with the Soundhead place Red Electrode on the same limb either across limb, such as other side of knee being treated or distal on that same limb, such as the ankle of the knee being treated.

 Electrical stimulation (ES) – offers the choice of positive or negative polarity. The voltage should be set to 80% of sensory level; slowly increase the voltage until they feel it and then reduce the voltage by 20%. For the following the polarity should be kept on negative.

1.     Positive is used in the first 6 hours post injury and also in ischemic wounds. This will control bleeding, build tissue, depolarize and sedate.

2.      Negative is then used up to 4 days post injury or in infection, it will hyperpolarize, stimulate repair, soften tissue and enhance blood flow.

3.     Positive alternating with negative is used from 4 days to 3 weeks post injury, positive for tissue repair while negative increases blood flow and nerve growth.

Ultrasound (US) - Ultrasound therapy consists of continuous or pulsed applications.

High intensity continuous - heats tissue (1-1.5 w/cm²) to initiate tissue repair and in chronic (1-.5 w/cm²) for tendon extensibility, initiates repair and lymph. 

Raises tissue temperature to 40-45 degrees C in 4 to 10 minutes.

·       Increase range of motion, extensibility of connective tissue and circulation to area

·       Initiate a healing response by targeted thermal to stimulate repair

·       Up-regulate heat shock protein (Hsp70) with salicylic acid as a topical agent to increase the removal of damaged or aged proteins (see Facial)

·       Muscle spasm

Low intensity continuous - (.1 w/cm²) stimulates tissue repair and bone growth, stimulates protein synthesis and tissue regeneration.

High intensity pulsed - (1-1.5 w/cm²) stimulates blood flow and initiates healing. This is a minimal thermal effect with a strong mechanical effect or continuous at (.2-.5) watts/cm²

·       Reduce calcium deposits (1) w/cm² pulsed

·       Arthritis, encapsulitis and fibrositis (.75) watts/cm² pulsed

·       TMJ, bursitis and tendonitis (.25) watts/cm² continuous then pulsed

Low intensity pulsed - (.5-.1 w/cm²) stimulates tissue repair and bone growth, stimulates protein synthesis and tissue regeneration.

·       Reduce scar tissue (.5) watts/cm² continuous then pulsed

·       Tissue regeneration  (.1) watts/cm² continuous 

The Soundhead – must be kept flat against the skin and constantly moving. Use nice even strokes working towards the heart or slow circular motions. You should treat an area up to 25 cm2 and then move to new treatment area of up to 25 cm2. So work small circular or rectangular sections then move on to a new area.

Treatment times using ultrasound

· 4-8 minutes continuous

· 5-15 minutes pulsed