Thermopulse


Thermopulse Equipamento Ondas Curtas
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The equipment

Thermopulse is an electromedical shortwave diathermy device, which generates radiofrequency energy (high frequency in 27.12MHz) in the form of intentional electromagnetic radiation for the treatment of several pathologies. This type of therapeutic heating became popular, because the high frequency currents can penetrate deeper in the tissues, presenting a greater advantage when compared to other methods which heat the tissue in a more superficial manner.

The equipment must be used only under prescription and supervision of a licensed professional.

 

How it works

Shortwave diathermy generated by Thermopulse is carried out by the application of electromagnetic energy through the body tissues. The device consists of a sine wave generator circuit which produces a current with a frequency of 27.12 MHz and a resonant circuit which can be tuned exactly to the same frequency.

Thermopulse produces electric and magnetic fields, with oscillating high frequency currents, which are alternating fields that produce the electromagnetic filed, generating physiological and therapeutic benefits.

In these frequencies, the electromagnetic energy is converted into thermal energy by the induction of currents circulating in the insulating tissue. The heating effect produced by shortwave diathermy aids the healing process, transmitting deep heat into the tissue and resulting in numerous beneficial effects.

The mode of application may also be pulsed, that is, it allows the electromagnetic energy shots to be emitted at pre-programmed intervals of time, minimizing the thermal effect of pain and edema control and accelerating healing.

 

Accessories:

  • Cable (1.5m);
  • Vulcanized electrode Kit for Thermopulse Solid State 1.25m;
  • Inductive electrode Kit Thermopulse Solid State 1.25m;
  • Digital Operations manual IBRAMED 100511;
  • Fuse card (C-314) with two 5A fuses
  • Band for large inductive electrode.

 

The use of cables, electrodes and other accessories different from those specified above may result in increase of emissions or decrease of the immunity of the equipment. The device and its characteristics may suffer alterations without previous notice.



Treatments


Thermography: report of treatments carried out in the thermographic research

To scientifically prove the efficacy of Thermopulse, a FLIR equipment was used, a thermographic camera which measures the temperature of tissue before and after the application of shortwave diathermy.

The application of infrared or thermographic radiation is the use of an infrared camera to “see” or “measure” the thermal energy which is emitted by every existing object or material in nature. Thermal or infrared energy is non-visible light, since its wavelength is too long to be detected by the human eye. This energy is part of the electromagnetic spectrum and is perceived by the skin as a sensation of heat. Unlike visible light, in the infrared world, all materials with a temperature above absolute zero emit heat. Even very cold objects, like ice cubes, emit infrared light.

The higher the temperature of the objects, the greater will the infrared radiation be. Infrared radiation allows us to see what the eyes cannot see. Infrared Thermography cameras produce visual images of infrared radiation and calculate precise measurements without contact with the objects. In general, almost all mechanical and electrical components become overheated before failing, which makes infrared cameras extremely valuable tools to detect failures before they occur. Besides, they have been widely used in applications, such as the improvement of manufacturing processes, energy saving, quality control of products, workplace safety, medicine and veterinary.

About Diathermy

The electromagnetic radiation used in electromedical equipment is inserted in the RF band use for communications. Thus, it could interfere in signals and, to prevent this interference, the Federal Communication Commision (FCC), which regulates all forms of telecommunications, has designated specific frequencies for medical applications. The bands permitted are centralized in 13.56MHz, 27.12MHz and 40.68MHz.

The frequency of 27.12MHz is the most commonly used, because it presents the widest band.

 

Difference between capacitive shortwave, inductive shortwave and microwave and their tissue heating potential

Diathermy applicators in capacitive plates are made of metal boards covered with by a plastic compartment or carbon rubber electrodes placed in blocks of felt.

A high frequency alternating electric current passes from one plate to the other through the patient, producing an electric field and a current flow in the body tissue which is between the plates. As the current passes through the tissue, it causes the oscillation of the charged particles, resulting in an increase of temperature of the tissue.

In inductive diathermy applicators, the quantity of heat generated in an area of tissue depends on the force and density of current, being greater in tissue with more conductivity, as the muscles. Since the current always passes through the way with the minimum resistance, and for this reason, when a type of capacitive applicator plate is used, the current generally concentrates in the surface of the tissue and does not penetrate the so effectively in deeper tissue if these tissues are little conductive, such as subcutaneous fat. Therefore, capacitive plates generally produce more heat on the skin and less heat in the deeper structures, in contrast to the inductive applicators, which heat deeper structures effectively, because the incidence of the magnetic field can reach a deeper penetration to induce the electric field and the current inside the target tissue.

In this context, microwave diathermy produces high frequency alternating current in an antenna. This alternating current produces an electromagnetic field which is differentiated through the tissue by a curved reflection surrounding the antenna. Diathermy equipment is only useful when small areas of tissue are involved.

Microwaves generate more heat in the tissue with high electrical conductivity (muscles); however, his radiation penetrates less deeply than inductive shortwave diathermy.

Comparison of heat distribution in body tissues with an inductive shortwave diathermy applicator, of capacitive plate diathermy, and microwave diathermy.

 

Types of waves

Continuous and Pulsed Shortwave Diathermy

Diathermy is the term used when there is detectable heating in the deep tissues; therefore, shortwave diathermy refers to the heating produced by electric and magnetic fields alternated by high frequencies (short radio waves).

The shortwave diathermy device produces electric and magnetic fields with oscillating high frequency currents, and these alternating fields produce the beneficial physiologic and therapeutic results obtained with the treatment.

Pulsed shortwave diathermy uses a time circuit to electronically interrupt the 27.12MHz waves, resulting in pulse trains containing a series of high frequency oscillations emitted in a sine wave by the pulsed shortwave diathermy applicator.

Each pulse train has a pre-defined duration (on time), separated by successive pulse trains of off time, which is determined by the frequency of repetition. Depending on the device, the frequency of pulse may vary from 1 to 7000 pulses per second. Pulsed shortwaves are released to the patient with a very low intensity, not heating the tissues.

 

Treatment methods

Capacitive mode: a pair of plates is connected to the equipment and the region in the patient’s body to be treated is positioned between the plates

Indications


  • Osteoarthritis: Chronic and acute joint disorders (knee, hip, shoulder, elbow, hand, foot and temporomandibular joints).
  • Chronic Polyarthritis of the Hip and Shoulder Joints: Inflammation of more than one joint;
  • Tendinitis/Tendinosis: Chronic and acute inflammation of the tendons;
  • Tibial pains: painful condition of the lower limbs common in athletes – medial tibial stress syndrome;
  • Bursitis: inflammation of the Bursa (Bursal synovitis);
  • Torsions, Dislocations, and Contusions: articular torsion, articular overload, distortions and traumas;
  • Epicondylitis: Tennis elbow, inflammation of tendon attachments on cubital or radial part of elbow joint (humerus).
  • Fractures: consolidation of bone fractures;
  • Intercostal Neuralgia: acute pain stemming from the thoracic spine vertebrae;
  • Ischialgia and ischial neuralgia: intense pain in the ischium aggravated when sitting or lying down;
  • Contractures: loss of articular movement due to shortening of soft tissue;
  • Lumbago: set of painful manifestations in the lumbar region;
  • Myalgia: síndrome miofascial syndrome that causes muscle pain;
  • Neuralgia and neuritis: pain and inflammation that cause dysfunction of the peripheral nerves;
  • Frozen Shoulder Syndrome: Shoulder pain accompanied by limitation of movement –adhesive capsulitis;
  • Periostitis: inflammation of the periosteum;
  • Fibromyalgia: diffuse chronic pain;
  • Fibrositis: inflammatory process of the structures that compose the muscle sheath;
  • Spondylosis / Osteochondrosis: Arthrosis of the vertebral column or degeneration of the intervertebral discs;
  • Carpal Tunnel Syndrome: neuropathy resulting from the compression of the median nerve in the carpal tunnel;
  • Tenosynovitis: Inflammation of tendon and tendon sheath;
  • Cervical syndromes: chronic painful conditions with myofascial origin in the cervical region;
  • Piriformis Syndrome: Neuromuscular syndrome which involves irritation, lock up or compression of the sciatic nerve;
  • Morton’s Neuroma: Benign neuroma of the interdigital plantar nerve that causes metatarsalgia;
  • Plantar Fasciitis: lesion by effort that causes inflammation in the plantar fascia;
  • Rotator Cuff Tear: painful condition that involves one or more muscles of the rotator cuff;
  • Torticollis: condition of the neck characterized by the stiffness of the muscles in this region;
  • Synovial plica syndrome(SPS): occurs when the synovial plica is irritated or inflamed;
  • Patellofemoral pain syndrome: anterior or retropatellar pain in the absence of other pathologies in the knee.

 

Precautions of use

Diathermy must be used with particular care in obese patients, because it may heat fatty tissue excessively.

Intrauterine contraceptive devices (IUCD) which contain copper. Aparelhos contraceptivos intrauterinos que contenham cobre. Intrauterine contraceptive devices (IUCD) which contain copper present a small amount of metal and do not constitute risk to women during shortwave treatment.

 

Application Modes

SWD – Shortwave Diathermy;

PSWT – Pulsed Shortwave Diathermy;

APSW – Automatic Pulsed Shortwave Diathermy.

 

Power:

  • Output power: 27.12MHz ± 0.6%;
  • Capacitive Mode output power: 10 to 150W (50ohms);
  • Inductive Mode output power: 10 to 80W (50ohms);
  • Power Increments: 10W;
  • Pulse Duration: 100 to 400μs;
  • Pulse Frequency: 50 to 800Hz;
  • Treatment time: 1-60 minutes (increments of 1 minute);
  • Capacitive electrode area: 270cm² each electrode;
  • Inductive electrode area: 85cm².

 

Application techniques – Capacitive method

Contraplanar: the plates are placed in opposite directions of the area to be treated to reach regions located deeply, such as articulations.

Contraplanar out of alignment: similar to the Contraplanar, but the plates are not placed in parallel.

Coplanar: the plates are placed on the same side of the region to be treated to treat more superficial structures, such as paravertebral muscles.

Longitudinal: application mode in which the plates are positioned opposite each other, so that the magnetic field is closed in a longitudinal manner. Example: one plate on the knee and another on the foot.

 

Application techniques – Inductive method

The applicator must be over the area to be treatment and well attached to be patient.

Contraindications


  • Implanted electronic devices (ex.: cardiac pacemaker, deep brain stimulation device etc.);
  • Presence of metal on the surface of the tissues which cannot be removed, such as forms of external skeleton fixation forms or dental braces;
  • Compromised thermal sensitivity;
  • Patients incapable of controlling their own movement or when it not possible to count on their cooperation;
  • Growth epiphyses;
  • Conditions where there is hemorrhage;
  • Conditions in which the edema or hemorrhage are under the tension area, for example, acute bursitis, lymphedema, hematoma or hemarthrosis;
  • Ischemic tissues, whose blood flow cannot be increased to dissipate the extra heat and supply the metabolic demand of increased metabolic activity;
  • Malignant tumors, because the increased metabolic rate leads to an increase in the growth rate of metastases;
  • Active tuberculosis lesions;
  • Recent venous Thrombosis areas, because heating may break loose the blood clot, resulting in pulmonary embolism;
  • Patients in feverish conditions or over areas of acute inflammation.

 

Physiological effects

Shortwave diathermy was originally adopted by therapists as an efficient method to produce deep heating. The greatest current flow is produced in the tissues with the greatest number of ions (the most aqueous) and these are, preferably, the heated tissues.

Therefore, if there is no interference of other factors, when a part of the body is treated with short waves, the Expected result is that the muscle tissue (which presents a high content of water and ions) is heated to a larger extent than fatty tissue (which presents a low amount of water and a low number of ions).

 

Thermal effects

Ion vibration: the tissues contain a large number of ions, which transport charges that move, producing a current flow. If a magnetic field is applied first in a direction and then in another, the ions will be accelerated first in a manner and then in an opposite manner, colliding with adjacent molecules, and releasing some energy to them, thus increasing total random movement, which is heat.

Dipole rotation: the tissues are basically constituted by water. The water molecules behave a little differently, because despite being electrically neutral as total molecules, they are polar, that is, the extremities of the molecules carry small opposite charges.

When applied in polar molecules (charges that revert rapidly), they rotate from one side to the other. This rotational energy disturbs the movement of adjacent molecules, causing more total random movement and more heat.

Molecular distortion: the atoms and the molecules which do not present charge can also be affected by an electric field rapidly oscillating, since the route of their electrons which are in orbit, are altered. When the electric field changes direction, one side becomes more positive and the other more negative, so that the medium position of the “cloud” of electrons is altered, being attracted by the positive side and repelled by the negative side. This does not cause the movement of the molecules, but the interaction with the neighboring molecules causes more random movement and more heat.

 

Clinical effects

Tissue healing: subtle or sub-noticeable levels of heating are used to promote healing soon after the immediate risk of additional bleeding decreases.

Relief of pain: the main aspects of pain relief are reflexes when subcutaneous structures are involved. Therefore, stimulation of heat sensory receptors can activate the mechanisms of gate control of pain. The pain stemming from muscle spasms can be reduced by the application of heat.

Reduction of muscle spasms: heat reduces muscle spasms by decreasing the levels of ischemia associated with prolonged contractions in the affected muscles.

Sedative effect: a quite unspecific sedative effect has been observed.  It was observed that during and after treatments with heat, patients fall asleep more readily. Although it can be only a simple consequence of pain relief, it was observed that skin temperatures increase a little before the start of sleeping, so this sedative effect of superficial heat could be a reflex phenomenon.

Increase of amplitude of articular movement: heat is frequently used in conjunction with exercise, to treat musculoskeletal disorders, such as knee osteoarthritis.

Comparative


Equipamento Thermopulse Ondas CurtasEquipamento Thermopulse Compact Ondas Curtas
ThermopulseThermopulse COMPACT
diatermia por ondas curtas transistorizado
(27,12mhz)
diatermia por ondas curtas
(27,12mhz)
CONTÍNUO E PULSADO (50 a 800Hz)
PULSADO AUTOMÁTICO (50Hz a 160Hz e de 160Hz até 50Hz)
contínuo (Potência máxima 100W)
SINTONIA AUTOMÁTICAsete níveis de potência
ELETRODO CAPACITIVO (10 a 150W)
ELETRODO indutivo (10 a 80W)
eletrodos capacitivos vulcanizados
rebilitaçãorebilitação

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