SHORTWAVE الموجات القصيرةالعلاج بالإنفاذ الحراري DIATHERMY

1. SHORTWAVE الموجات القصيرةالعلاج بالإنفاذ الحراريDIATHERMY Sekar.L

2. SWD - INTRODUCTION • Application التطبيقof High-Frequency Electromagnetic Energy عالية التردد الطاقة الكهرومغناطيسية • A deep-heating في أعماق التدفئة modality شكل • Does Not stimulate لا حفز MOTOR المحركات& SENSORY NERVES. الأعصاب الحسية. • No Danger لا يوجد خطر of CHEMICAL BURNS الحروق الكيميائية

3. SWD - INTRODUCTION • No Contraction of Muscles is produced لا تقلص العضلات وينتج • Frequency تردد (27.12 MHz at wavelength of 11 M) • Diaضياء means through من خلال and • Thermo الحرارية means temperature درجة الحرارة heat. • Short wave diathermy (SWD), or radio frequency (RF), is used to penetrate deep اختراق عميق into the body tissues أنسجة الجسم to stimulate blood flow تدفق الدم .

4. Possible Shortwave Diathermy Unit A=Power Switch B=Timer C=Milliameter (monitors current from power supply not current entering patient-volume control) D= Intensity(%max power to patient) E=Tuning Control(tunes output from RFO)

5. Shortwave Diathermy Unit • Generates Both an Electrical الكهربائية and a Magnetic Field المجال المغنطيسي • SWD Units at 13.56 MHz= Stronger Magnetic Field • SWD Units at 27.12 MHz = Stronger Electrical Field

6. Generation of High Frequency SWD SWD have two main الرئيسيتينcircuits الدوائر; The machine circuit الجهاز الدوائر which produce high frequency current coupled with The patient circuit الدائرة المريض through inductors to transfer the electrical energy to the patient.

7. Principle of Production of SWD • This type of high frequency current is obtained by DISCHARGING التفريغa CONDENSER المكثف through an INDUCTANCE ملف محاثة of LOW OHMIC RESISTANCE.انخفاض المقاومة الأومية

8. Biophysical and biochemical effects of SWD Effects of an electrostatic field الحقل الكهربائي : 1- Free ions in the tissues give minimal movement (Vibration of Ions اهتزاز الأيونات) due to high frequency leading to friction احتكاك between ions and produce heat. إنتاج الحرارة + - + - - + - +

9. Biophysical and biochemical effects of SWD 2- The dipolar وثنائي القطب molecules جزيئات(as water – will rotate to & fro - Swinging) charge change rapidly, friction between molecules leads to heat in the tissues.

10. Biophysical and biochemical effects of SWD 3- The non-polar وغير القطبية molecules (as fat الدهون– Insulator عازل, undergo distortion تشويه of their electron cloud الإلكترون سحابة leading to back & forth ويعود عليها movement) cause minimal friction and molecular movement producing little heat.

11. Physiologic Responses To SWD • Tissue Temperature Increase • Increased Blood Flow (Vasodilatation) • Increased Venous and Lymphatic Flow تدفق الدم الوريدي واللمفاوي • Increased Metabolism • Changes In Physical Properties الخواص الفيزيائية of Tissues • Muscle Relaxation - عضلة الاسترخاء • Analgesia - تسكين

12. Types of Electrodes in SWD • Flexible pads منصات مرنة : consist of metal electrode encased المغطى in rubber and produce an electrostatic field.

13. Types of Electrodes in SWD • Space plates لوحات الفضاء : consist of a rigid metal electrode قطب المعادن الصلبة encased in a Perspex cover  electrostatic field.

14. Types of Electrodes in SWD • Coil:ملف or cable electrode كابل كهربائي consists of a wire with plugs at either end electromagnetic field.

15. Types of Electrodes in SWD • The monode: flat, rigid coil encased in Perspex cover electromagnetic field.

16. Types of Electrodes in SWD • The diplode: or drum electrode طبل الكهربائي, consists of a flat coil electrode encased in a Perspex cover with two wings electromagnetic field

17. SWD - Methods Capacitor field Method مكثف مجال الأسلوب Inductive field / Cable Method حثي حقل / كبل الأسلوب Selection of Appropriate methods Can Influence The Treatment

18. Capacitor (Condenser) Electrodes • The electrodes acts as CAPACITOR • The patient tissues & Insulating material acts as DIELECTRIC MEDIUM. عازل المتوسط • Heat production by conversion of ELECTROMAGNETIC ENERGY الطاقة الكهرومغناطيسية MECHANICAL ENERGY(HEAT) الطاقة الميكانيكية (الحرارة)

19. Capacitor (Condenser) Electrodes • If the goal of treatment is to increase tissue extensibilityزيادة الأنسجة التمدد & the limitation is primarily to capsular tightness,المحفظة ضيق then capacitor field method of SWD is the more appropriate choice.

20. Capacitor (Condenser) Electrodes • Create Stronger Electrical Field Than Magnetic Field • Ions Will Be Attracted Or Repelled Depending on the Charge of the Pole

21. Capacitor (Condenser) Electrodes • Center Has Higher Current Density Than Periphery

22. Capacitor (Condenser) Electrodes • Patient Is Between Electrodes and Becomes Part of Circuit

23. Capacitor (Condenser) Electrodes • Fat Tissue Resists يقاوم Current Flow • Thus Fat Is Heated In An Electrical Field • Precaution: electrical field may overheat area with large fat content

24. Capacitor Electrodes (Air Space Plates) • Two Metal Plates Surrounded By Plastic Guard • Can Be Moved 3cm Within Guard • Produce High-Frequency Oscillating Current

25. Capacitor Electrodes (Air Space Plates) • Area To Be Treated Is Placed Between Electrodes Becoming Part of Circuit

26. Capacitor Electrodes (Air Space Plates) • Sensation Of Heat In Direct Proportion To Distance Of Electrode From Skin • Closer Plate Generates More Surface / superficial Heat

27. Capacitor Electrodes (Pad Electrodes) • Greater Electrical Field • Patient Part of Circuit • Must Have Uniform Contact (toweling) • Spacing Equal To Cross-sectional Diameter of Pads • Part To Be Treated Should Be Centered

28. METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD • COPLANAR METHOD طريقة متحد المستوى In this electrodes can be placed side by side جنبا الى جنب on the same aspect of the part, provided that there is adequate distance between them. كافية المسافة بينهما

29. Capacitor Electrodes (Pad Electrodes) • Increasing The Spacing Will Increase The Depth Of Penetration. But Will Decrease The Current Density • Capacitive Method Good for Treating Superficial Soft Tissues

30. METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD • CONTRAPLANAR METHOD كونترا طريقة مستو In this electrodes are placed on opposite sides الأضلاع المتقابلة of the treatment part. Most satisfactory method for deeply placed structures. وضع هياكل عميق E.g. - Joints

31. METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD • CROSSFIRE • METHOD تبادل لاطلاق النارطريقة • In this first half of the treatment is given with the electrodes in one contra planar position & for the second half the electrodes are repositioned at right angles.

32. METHODS OF PLACEMENT OF ELECTRODES – CAPACITOR METHOD • MONOPOLAR METHOD أحادي القطبطريقة The active electrode أحدث الكهربائي is placed over the site of the lesion اكثر من موقع من الآفة & the indifferent electrode is applied to some distant part of the body.

33. Inductothermy تسخين تحريضي Method • Creates A Stronger Magnetic Fieldالمجال المغنطيسي Than Electrical Field • Using a long tubular flexible conductor موصل أنبوبي طويل مرنة covered in thick rubber called a Cable Or Coil, is Wrapped Circumferentially بشكل محيطي Around An Extremity Or Coiled Within Electrode • If the goal is to increase blood flow to aid healing of a muscle injury then Inductothermy can be chosen.

34. Inductothermy Method Passing Current Through A Coiled Cable Creates A Magnetic Field By Inducing Eddy Currents دوامة التيارات(small circular electrical fields) That Generate Heat

35. Inductothermy Method • Two Arrangements: • Pancake Coils فطيرة لفائف • Wraparound Coils ملفوف لفات • Toweling Is Essential. • Pancake Coil Must Have 6” in Center. Then 5-10cm Spacing Between Turns

36. FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D 1- Spacing: تباعد Spacing provided by: 1- Wrapping غلاف flexible pads in towel. 2-Flat felt spacing pads between pad electrode and skin. 3-Air when using space plates.

37. FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D a- Normal spacing تباعد طبيعية  even field الميدان حتى distribution. b- Increased spacing زيادة التباعد  deep field عمق الميدانconcentration. c- Decreased spacing إنقاص تباعد  superficial سطحيconcentration. a) c) b)

38. FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D • About 4 cm distance will give heating of the deep tissues. • Conversely the minimum skin electrode distance is about • 2 cm, will give superficial heating.

39. FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D 2.Electrode size حجم القطب:If the electrodes are too small than the diameter of treated part line of force will be concentrated superficially. -If the electrodes are markedly larger the line of force will be lost in the air. Electrode size: -Ideally, the electrodes should be slight larger أكبر قليلا than the area treated.

40. FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D 3.Metal المعادن: metal causes the lines of force to concentrate on the metal

41. Heating With Continuous SWD Patient Sensation Provides Basis For Recommendations Of Continuous SWD Dose I (Lowest) - No Sensation هناك إحساس of Heat Dose II (Low) - Mild Heating Sensation معتدل تدفئة الإحساس Dose III (Medium) - Moderate or Pleasant Heating Sensation معتدلة أو بليزانت تدفئة الإحساس Dose IV (Heavy) -Vigorous Heating Within Pain Threshold تدفئة قوية ضمن عتبة الألم

42. Uses Non-thermal Effects الآثار غير الحرارية • Edema reduction • Lymphedema reduction • Superficial wound healing • Treatment of venous stasis ulcers Thermal Effects التأثيرات الحرارية • Deep heat • Increased blood flow • Increased cell metabolism • Increased tissue extensibility • Muscular relaxation • Possible changes in enzyme reactions

43. Indications of SWD - A condition that could benefit from a specific modality. • Disorders of Musculoskeletal System; • ( Sprain, Strain, Muscle & Tendon tear, Capsule lesion, Joint stiffness, Hematomas) • Sub acute & Chronic Inflammatory Conditions; • (Tenosynovitis, Bursitis, Synovitis, Sinusitis, Dysmenorrhoea, Fibrositis, Myositis)

44. Contraindications - A condition that could be adversely affected if a particular modality is used. • Metal implants يزرع معدنية or metal jewelry(be aware of body piercings) – Concentration of the field. • Cardiac pacemakers الناظمات القلبية– Interference with function • Ischemic areas المناطق الدماغية– The inability of the circulation to disperse heat could result in high temperature – Burns.

45. Perspiration عرقand moist dressings رطبة الضمادات :The water collects and concentrates the heat. • Tendency to hemorrhage نزف, including menstruation حيض– Increase vasodilatation, prolong hemorrhage. • Pregnancy الحمل– Miscarriage • Hyperpyrexia فرط السخونة

46. Sensory loss / Impaired thermal sensation ضعف الإحساس الحراري • Cancer السرطان/ Malignant tissuesالأنسجة الخبيثة– Accelerate the rate of growth & Metastasis • Active أحدث  TUBERCULOSIS السل– Increase the rate of development of the infection. • Recent الأخيرةRadiotherapyالعلاج الإشعاعي– Skin sensation & Circulation may be decreased.

47. Dermatological الأمراض الجلدية Conditions – Will exacerbate • Severe Cardiac conditions ظروف قاسية القلب– Greater demand of Cardiac output. • Peripheral vascular disease أمراض الأوعية الدموية المحيطية - DVT

48. Areas of particular sensitivity: • Epiphysis plates مشاشي لوحات in children • The genitals الأعضاء التناسلية • Sites of infection مواقع الإصابة • The abdomen with an implanted intrauterine device جهاز مزروع داخل الرحم(IUD) • The eyes and face • Application through the skull جمجمة

49. Therapeutic Effects of SWD 1- Pain relief:تخفيف الآلام Stimulation of Sensory heat receptors – Pain Gate Mechanism. 2-Muscle spasm تشنج العضلات: Heating Secondary Afferent muscle spindle – Inhibitory influence to motor pool. 3- Inflammation التهاب: Assists in removal of cellular debris and toxins. Nonthermal: Alters diffusion rate across the cell membrane Thermal: Increases intramuscular metabolism

50. Therapeutic Effects of SWD • 4- Accelerate تسريع wound healing التئام الجروح : by increase cutaneous circulation جلدي تداول, Vasodilatation increases: • Blood flow • Capillary filtration • Capillary pressure • Oxygen perfusion • 5- Infection عدوى: increase circulation and increase white blood cells and antibodies – Reinforcing body’s normal defense mechanism. • 6- Fibrosis تليف : increase extensibility التمدد of fibrous tissues such as tendons, joint capsule and scars. Alters collagen properties, allowing it to elongate.