Presentator: Albertus Bouw
Azka hayati
Pembimbing: dr. Julius Aliwarga, [Link]
THERAPEUTIC HEATING MODALITIES
Primary Mode of Modality Depth
Heat Transfer
Conduction Hot Packs Superficial Heat
Paraffin Bath
Convection Fluidotherapy Superficial Heat
Hydrotherapy
Moist Air
Conversion Radiant Heat Deep Heat
Laser
Microwaves
Shortwaves
Ulltrasound
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen‘s Handbook of PM&R,4th ed,1990
Diathermy: the application of high-frequency
electromagnetic energy that is primarily used to
generate heat in body tissues.
Diathermy may also be used to produce
nonthermal effects.
Diathermy:
shortwave diathermy
microwave diathermy
William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
SWD is the therapeutic application of high- frequency
current
▪ the machines have three basic components of the
circuitry :
- POWER SUPPLY
- OSCILLATING CIRCUIT
- THE PATIENT’S CIRCUIT
▪ The frequencies that are allowed for SWD by the
Federal Communication Commision (FCC) :
27,12 MHz (= ג11 m )
13,56 MHz ( =ג22 m)
40,88 MHz ( =ג7,5 m)
William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
Shortwave diathermy:
Continuous shortwave diathermy has
been used in the treatment of a variety of
conditions for some time.
Pulsed shortwave diathermy has received
renewed interest and research
documenting its clinical efficacy.
William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
Formula :
=גV/N
= גwavelength 22 ; 11 ; 7,5 meters
V = velocity of light 11 meters
N = frequency of oscillation 27,33 MHz
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy, Krusen's
Handbook of PM&R,4th ed,1990 6
7
THERMAL EFFECTS
The wavelengths are much too short in duration
not capable of producing depolarization and
contraction of skeletal muscle.
The physiologic effects are primarily
thermal, resulting from high-frequency vibration
of molecules.
William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
rising tissue temperature changes in some enzyme
increased blood flow reactions
dilation of the blood vessels alterations in the physical
properties of fibrous
increased filtration and
diffusion through the a certain degree of
different membranes muscle relaxation
increased tissue metabolic a heightened pain
rate threshold
decreased joint stiffness enhanced recovery from
injury
William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
BIOLOGICAL EFFECT OF SHORTWAVE
DIATHERMY
Late 1940s: the FFC (Federal
Communications Commission) designated
specific operating frequencies for SWD (13.56
MHz, 27.12 MHz & 40.68 MHz) and MWD
(2450MHz & 915 MHz ).
At present, 27.12MHz is utilized most widely
for SWD.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
Biological action of SWD, [Link] et al.(1926):
1. Marked vasodilatation of capillaries and
arterioles
2. Deep penetration of mild heating
3. Germicidal and antitoxic actions
4. Resolution of the inflammation without pus
formation
5. Pain relieving and sedative effect
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
Techniques of application
Condenser techniques
The affected part of the patient to be treated
is placed between two capacitor plates
Four modification are used :
1. Space plates are capacitor plates enclosed
in rigid plastic material a plastic ring
surrounding the condenser plate is
adjustable & provides proper spacing
between body surface & condenser plates
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
[Link] capacitor plates are covered by a glass
envelope.
In order to avoid sweat accumulation &
selective heating of the area the glass
cover should not be in direct contact with
the skin.
The position of the condenser plate within
the glass envelope, and thus the distance
between the body surface & the condenser
plates, is adjustable
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
3. The rubber or plastic materials called
condenser pads
Proper spacing between the skin & the
electrode is provided by a 1- to 2-inch
layer of terry cloth between the skin & the
pads
4. Internal metal electrodes are inserted into
the vagina or rectum after applying a
water soluble lubricant
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
Application to spesific part of the body
1. Shoulder condenser plates may be used
2. Hip the usual method is application with pads
3. Elbows, knees, ankles, arms, feet & hands
condenser plates & pads are commonly used
4. Hands application of condenser plates in the
form of pads or space plates
5. Back condenser plates or pads are used
6. Neck condenser plates or pads are used
7. Pelvic organs application with internal
electrodes
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
The temperature elevation is measured with a
thermometer inside the electrodes
Temperature up to 45°C have been
recommended duration of application: 5-
30”
Start with a lower temperature & shorter
duration observe the tolerance of the
patient
The more acute the process to be treated
the less the tissue temperature elevation
should be & the shorter the duration of the
treatment
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
Capacitor Field
a. Contraplanar: electrodes are placed on opposite
sides of the part, to treat deeply placed structures,
[Link]
a. Using 2 rigid electrodes
b. Using 1 rigid and 1 flexible electrodes
b. Coplanar: electrodes are placed on the same side
of the part to treat more superficial structures, e.g.
the spinal musculature
a. Longitudinal
b. Transversal
John Low, Ann Read. Electrotherapy Explained
Principle and Practice. 2nd ed. Butterworth
Heinemann.
c. Cross – fire: half the treatment is given with
the electrodes in one contraplanar position
and for the second half the electrodes are
repositioned at right angles.
This technique is used for deeply placed
organs in the pelvis and for air-fillled cavities
such as the frontal and maxillary sinuses
a. Anteroposterior field: sacrum - symphisis pubis
b. Superior-inferior field: lumbar - pelvic outlet
John Low, Ann Read. Electrotherapy Explained
Principle and Practice. 2nd ed. Butterworth
Heinemann.
Inductive (magnetic) field technique through
a conductor (usually a coil) produces an
energy of magnetic field heats the treating
tissue placed near the conductor.
The effect of magnetic field technique is
restricted to superficial tissues.
The therapeutic effect of inductive field
technique is similar to that of MWD.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
Three types of applicators:
Cable
Drum (minode or monode)
Contour (diplode)
It is easy and convenient to use the drum-
shaped coil-conductor.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
Induction coil application
The induction coil may be applied “drum”
The coil is enclosed in a plastic container that is
flexible at the hinges & can be molded to fot the
body provides proper spacing between the
skin and loops of the cable
Another applicator is “monode“ which operates
on the same basic principle but is not flexible
Precautions: avoid direct contact between the
plastic housing & the skin, since it interferes with
the heat exchange
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
Application to specific parts of the body
1. Shoulder the drum or monode
2. Elbows & knees wrap-around coils or
the monode
3. Hands & feet monode or drum
4. Back the pancake coil or the drum
5. Neck the drum or monode
6. Hip the drum or pancake oil
7. Knees & ankles wrap-around coil
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
Inductothermy
a. Coil: wound round the
circumference of a limb
a. Using ends of cable
b. Using middle of cable
b. Helix: for a flat surface, e.g. the
lumbar spine or incorporated in a
monode
John Low, Ann Read. Electrotherapy Explained
Principle and Practice. 2nd ed. Butterworth
Heinemann.
Capacitive Coupling
The higher the water content, the better the
conductivity
Guy and co-workers : Capacitor (condenser)
applicators have the fundamental characteristic
of inducing greater power absorption in
subcutaneous fat than in deep muscle tissue
Inductive Coupling
Inductive coil applicators, produce higher
power absorption in the deeper high water
content tissues than in the subcutaneous fat
Circular electrical fields or eddy currents are
induced in the tissues by the applied magnetic
fields
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
Mechanism of heat production in the
condenser field:
When the electrolytes such as tissues
containing some fluids (blood, blood vessels
and muscles) lie in the electric field
vibration of ions and rotation of dipoles
Fat which has poor conductivity produces
molecular distortion
Subcutaneous fatty tissues with poor
conductivity are heated up more intensely
than muscles
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
In the magnetic field poor conductive tissues
(skin or fat) will have more reduced
temperature increase.
In the inductive field eddy currents are
induced in the body converted into heat.
The heat distribution of coil field is very
similar to a microwave field.
Condenser field shortwave therapy carries
out simultaneously same effects on two
symmetrical body sections e.g. both eyes,
ears and tonsils etc.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
Lately non-thermal therapy with pulsed
mode, on which high-output short wave
energy is delivered in repeated pulses.
This provides deep penetration of heat
avoiding heat sensation of the skin and
protecting possible burns.
The shortwave therapy unit with pulsed
operation mode is prevalent now.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
THERAPEUTIC APPLICATIONS
Specific characteristic of SWD: immediate
depth effect to penetrate the body with heat.
Other effects: direct weakening of virulence
or destruction of the germs activation of the
body's own resistance power good effect
on the infectious inflammatory process .
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
SWD have to be used in combination
with the adequate drug therapy.
Acute stage inflammation applying of
weak dose i.e. "creeping" dose is
recommended.
No difference between coil field SWD
and MWD, both are indicated to the
treatment of body areas located close to
the surface.
Condenser field therapy can be applied
in all cases to treat all inner organs.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
THE APPARATUS FOR SHORTWAVE
THERAPY
Commonly prevalent specifications:
MODEL SW-180
Operating Frequency 27.12MHz
RF Peak Output 80W on Pulsed Mode, 40W on
Continuous Mode
Pulse Frequency 25 ~ 900Hz, Pulse Width 0.65 ~15.2ms
Size &Weight 835 (H)x380(W)x320(D)mm, 23Kg
Note: Generally shortwave therapy unit made in Europe
adopts an output of 200W. An output of ca.400W may be
necessary for hyperthermy of the entire body.
Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.
THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
APPLICATION TECHNIQUE
Patient’s electrical impedance becomes
part of the impedance of the patient’s
circuit
It is necessary for any given therapeutic
application to retune the patient’s circuit to
resonance after the patient has been
inserted into the circuit
Thus the frequency of the patient’s circuit
is made equal to the frequency of the
oscillating circuit of the machine
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
Tuning is often accomplished by adjusting
a variable capacitor
The power meter on the panel of the
machine will indicate maximal flow of
current when the resonance of frequency
is obtained in the patient’s circuit
The need for tuning has been eliminated
in some machines by using an automatic
device
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
After the machine has been tuned, the
current flow through the patient’s circuit
can be regulated. One way of doing this is
to change the inductive coupling of the
patient’s and the high-frequency
oscillating circuits
The effectiveness of the equipment for
deep-heating purposes largely depends
on the quality of the mode application
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
The value of the deep-heating capability is
best expressed by the ratio of the specific
absorption rate (SAR) in muscle to SAR in fat
Better deep-heating is indicated by :
A larger ratio
electrostatic shielding of the applicator seems to
produce better deep heating
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
DOSIMETRY
Diathermy treatment doses are not precisely
controlled, and the amount of heating the patient
receives cannot be accurately prescribed or
directly measured
Heating occurs in proportion to the square of the
current density and in direct proportion to the
resistance of the tissue
Heating = current density2 x resistance
William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
DOSIMETRY
Depends largely on biological factors-the
therapist is guided by the feeling of warmth
on the part of the patient
High dose : the patient’s feeling of warmth
goes up to tolerance
Medium dose : the patient feels comfortably
warm
Minimal dose : the patient just barely feels
warmth
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
Temperature distribution as modified by
technique of
Application
• H = spesific absorption
rate
H = I² / • I = induced electrical
current
G • G = electrical
conductivity of the
tissues
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
STANDARDS FOR EQUIPMENT
The standard should :
1. Assure the user that the equipment is
powerful enough to produce vigorous
heating effects
2. The user has adequate information as to
where the highest temperature is produced
in the tissues when the various available
applicators are used
3. The equipment has been built to assure
safety both to the patient treated and to the
personnel administering the treatment
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
PRECAUTIONS
All metallic objects, such as watches or jewelry,
should be removed
The patient should be positioned on a wooden
plinth or chair
The accumulation of sweat beads should be
prevented by using terry cloth
Tuning of the patient circuit should always be
done at the low output level to prevent excessive
heating from an uncontrolled surge of current
through the patient
The output of the machine should be adjusted to
the desired level
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
Metallic implants, including surgical
implants, cardiac pacemakers and
electrophysiological braces should not be
exposed to short wave diathermy
Finally, contact lenses should be removed,
since they may cause hot spots
It should be noted :
Applied to the lower back has been observed
to increase menstrual flow
Pregnant women should not be treated with
pelvic diathermy using internal electrodes
because of possible damage to the fetus
There is also some controversy about
treatment of children around the bone growth
zones
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990