儀器治療學
出自KMU Wiki
Using Therapeutic Modalities to effect the Healing Process
How should the athletic trainer incorporate therapeutic modalities into a rehabilitation program for various sports-related injures?
在一般比賽現場的臨時AT，
假如有發生受傷情形，一定都會準備冰塊(製成ice pack)或冷噴做為急性發炎期的緊急處理。
如果是專業的隨隊防護員，可能本身球隊或訓練中心就備有專業治療配備(ex:水療、超音波儀器、短波微波儀器.........)，防護員只需幫助運動員使用治療儀器和指導運動員各種儀器帶來的指導效果，督導運動員持續治療，促進運動員的傷害復原。專業防護員假如要隨隊出國，也有一些儀器可以隨身攜帶(ex:超音波儀器)，使運動員在國外也可進行復健治療。
發炎反應期：可進行冷療(每次冰敷約15~20分鐘，休息20分鐘，反覆2個小時)
纖維修復期：
熱療，深層熱療有止痛效果，或進行電療及後期配合運動
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What specific modalities may be incorporated into treatment during the inflammatory-response phase and fibroblastic-repair phase?
Inflammatory - response phase : We can use cryotherapy , electrical stimulating and low - power laser to modulate pain .
And we also use low intensity ultrasound to facilitate the healing .
Fibroblastic - repair phase : We will chang treatment from coid to heat . Superficial heat can be used ex : hot pack , paraffin , warm whirlpool , infrared , fluidotherapy ...these modalities can reduce pain . And we may use electrical stimulation and low - power laser to modulation pain , as can stimulation of trigger points with low - power laser .
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What are the physiological events associated with the inflammatory-response phase of the healing process? How can you differentiate between acute and chronic inflammation?
The physiological event in healing process :
(1) Immediate vasoconstriction (2)Vasodilation (3)Clot formation (platelet plug)
(4)纖維組織的生長
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Chronic inflammation:
1. Occurs when acute response does not eliminate injuring agent.
2. Leukocytes replaced by macrophages, lymphocytes, and plasma cells.
3. Specific mechanism which causes conversion is unknown.
4. Overuse or overload with cumulative repetitive microtrauma.
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Infrared Modalities
What are the definition and basic therapeutic clinical of an infrared modality and how are these modalities classified within the electromagnetic spectrum?
Definition and basic therapeutic clinical of infrared modality:
Near infrared:
Also called luminous.
Wavelength: 800-1500 nanometers
Far infrared:
Also called nonluminous.
Wavelength: 1500-150,000 nanometers
Definition:
1.Dry hot
2. Infrared ray are a portion of the electromagnetic spectrum and are just beyond the red portion of visible light.
3. Intensity is controlled by varying the wattage and the distance of the lamp from the surface to be heated.
4.Place the lamp parallel with the body part being treated so that the rays hit the body surface as close to a 90° angle as possible for maximum absorption.
5. All jewelry in the area must be removed.
6. If an area near the face is being treated, covering the eyes with cotton ball, gauze or goggles may be advisable.
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What are the physiological effects of both therapeutic heat and cold?
(1)熱對於生理效應的影響可大致分為代謝反應與血管反應,甚至會影響反射與化學物質的釋放等
(2)冷對於生理效應的影響包含血管反應,代謝反應,週邊神經反應,深層組織反應等
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What are the various thermotherapy techniques that can be used by the athletic trainer?
Hydrocollator Packs, Paraffin Bath, Infrared Lamps, Fluidotherapy
Ultrasound, shortwave, microwave,
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Therapeutic Ultrasound
What is therapeutic ultrasound, and what are its two primary physiologic effects?
●治療型超音波主要是一種音波能，
治療型超音波頻率介於0.75-3MHz，故人耳聽不見，
其又分為低頻治療超音波與高頻治療超音波，
低頻的超音波衰退率較慢（穿透力較高），可達較深層的組織，
高頻的超音波主要針對表淺治療。
●治療型超音波的生理效應主要是熱效應和非熱效應
熱效應方面主要是讓組織受熱，增加組織溫度使產生熱反應
（增加膠原組織彈性、增加皮下血流、止痛、紓緩肌肉、增加關節活動度、修復慢性發炎等）
非熱效應方面主要是產生空泡效應使空泡周圍的液體流動可減少水腫疼痛、藉由直接改變細胞活性達治療目的為主。
Thermal effects:
Mild: increase 1℃, increase metabolic rate.
Moderate : increase 2-3℃, reduce muscle spasm, reduce pain, and increase blood flow.
Vigorous: increase 3-4℃, increase soft tissue extensibility.
Nonthermal effects:
Acoustical streaming: refer to the movement of fluids along the boundaries of cell membranes as a result of mechanical pressure wave.
Cavitation: is the vibration effect on gas bubbles by an ultrasound beam.
參考文獻：Therapeutic Modalities-For Sports Medicine and Athletic training,5th （Prentice）
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How does an ultrasound wave travel through biologic tissues, and what happens to the acoustic energy within those tissues?
●超音波是透過探頭(applicator)發出音波，
而探頭主要的結構是壓電晶體(piezoelectric crystal)
當被交流電刺激時壓電晶體產生的形狀上凹凸的變化，而產生出高頻率（Hz）的音波。
●在軟組織(soft tisue)傳遞是以縱波(longitudinal waves)的方式傳遞，
而傳遞到骨頭時以橫波(transverse waves )的方式傳遞。
在波的能量傳遞過程中，
會因為介質性質的不同或是波傳遞方向和介質之間的夾角而產生被穿透、被吸收、折射和反射。
音波穿透身體會經過皮膚、脂肪組織、肌肉和一些結締組織最後到骨頭，
而每一層都對音波的都有不同的吸收能力。
除此之外在不同的介質之間也會因為傳到速率發生改變而造成能量的被吸收
(ex：骨頭和肌肉之間，因組織(介質)不同，而造成音波的反射，熱點(hot spots)的產生)。
●Attenuation(弱化):energy contained within a sound beam is decreased as it travels through tissue.
Attenuation is due to scattering and absorption.
The attenuation is greater in tendon, cartilage, and bone.
參考文獻：Therapeutic Modalities-For Sports Medicine and Athletic training,5th（Prentice）
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What are the potential thermal effects and nonthermal effects of ultrasound facilitate the healing process?
熱效應可以使組織血液灌流增加，促使細胞釋放Histamine使細胞通透上升，接著Histamine會刺激白血球活性上升清潔組織。
血液的灌流可以使組織得到的養分增加，使組織修復增快。
非熱效應則是形成空泡作用，使周圍組織液體流動減少水腫和使細胞通透性改變，增加組織Healing速度。
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[ Thermal Effects of Ultrasound ]
- 增加 collagen extensibility
- 增加血流
- 減少疼痛
- Reducyion of muscle spasm
- 減少 Joint stiffness
- Reduction of chronic inflammation
肌肉組織一般溫度為36°C-37°C
在Mild Heating中,利用超音波的熱療使溫度增加1°C可使新陳代謝速率加速
在Moderate Heating中,溫度增加2-3°C可減少肌肉spasm,疼痛,chronic inflammation,與血流
在Vigorous Heating中,增加3-4°C可減少viscoelastic properties of collagen
[ Non-Thermal Effects of Ultrasound ]
- 增加纖維母細胞活性
- 增加蛋白質合成
- 組織再生
- 減少腫脹與疼痛
- Bone healing
- Pain modulation
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Shortwave and Microwave Diathermy
What is diathermy, and what are the different types of diathermy? What are the potential physiological effects of using continuous shortwave, pulsed shortwave, or microwave diathermy?
Diathermy is the application of high-frequency electromagnetic energy that is primarily used to generate heat in body tissues. It may also be used to produce nonthermal effects.
Diathermy may be classified as two distinct modalities: shortwave diathermy and microwave diathermy. Shortwave diathermy may be continuous or pulsed.
The physiologic effects of continuous shortwave and microwave diathermy are primarily thermal, resulting from high-frequency vibration of molecules. Pulsed shortwave diathermy has been used for its nonthermal effects in the treatment of soft-tissue injuries and wounds.
Resource: Therapeutic Modalities-For Sports Medicine and Athletic Training, 5th edition, McGraw-Hill.
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What are the various clinical applications、precautions, and indications for using continuous shortwave, pulsed shortwave, and microwave diathermy?
Diathermy治療能夠促進血管擴張，增加血流及代謝速率、下降疼痛閾值、加速神經細胞的修復等功能。Continous shortwave, pulsed shortwave, and microwave diathermy在臨床上常用於治療muscle strain, contusions, osteoarthritis, tendinitis, bursitis, tenosynovitis, ligament sprain, myofascial trigger point, joint contractures等傷害，其中Continous shortwave和microwave diathermy大部分是利用" Thermal effect (熱效應)" 來減少肌肉的疼痛、改善關節的ROM、以及改善受傷部位的循環功能，減少水腫的情形出現。
而在使用diathermy儀器時應特別注意避免任何電子儀器靠近，包含像是配有助聽器及心律調節器的人都不宜使用，另外懷孕的人過於肥胖的人也應避免diathermy的治療。
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Precautions:
1. Instruct the patient not to move after the unit is positioned for treatment, because movement can change the tuning.
2. To avoid possible shock, instruct the patient not to touch any part of the device and object that may be grounded,
3. Instruct the patient to notify you in case of any discomfort or if it gets too hot. If the patient complains of any pain or discomfort during treatment, immediately reduce the output to zero. Make the necessary corrections before treatment is re-initiated.
4. Ordinary prudent practice makes it unlikely that therapists would be exposed to harmful levels of radiation.
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