BAHAN AJAR ELEKTROFISIKA DAN SUMBER FISIS I. Anggriani Sst.Ft., M.KM

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BAHAN AJAR

ELEKTROFISIKA DAN

SUMBER FISIS I

Anggriani Sst.Ft., M.KM

SEKOLAH TINGGI ILMU KESEHATAN STI HAJAR

2019

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KATA PENGANTAR

Dengan mengucapkan puji dan syukur kehadirat Allah SWT, Tuhan Yang Maha Esa

yang telah memberikan rahmat dan hidayahnya sehingga bahan ajar kuliah Elektrofisika dan

Sumber Fisis 1 ini dapat terselesaikan dengan baik. Bahan ajar hanay ini digunakan

dilingkungan Stikes Siti Hajar khusunya mahasiswa fisioterapi, dengan harapan bahan ajar ini

dimaksudkan dapat membantu mahasiswa dalam proses perkuliahan di kampus. Bahan ajar

ini lengkap sesuai capain pembelajaran yang diharapkan yang terdiri atas topik-topik

berkenaan dengan elektrofisika dan sumber fisis. Selanjutnya saya mengucapkan banyak

terimakasih atas dukungan Stikes Siti Hajar dan rekan-rekan fisioterapi dalam menerbitkan

bahan ajar ini. Mungkin bahan ajar ini masih banyak kekurangan, diharapkan kritik dan

sarannya untuk kedepannya lebih baik lagi.

Semoga dengan adanya bahan ajar ini, capaian pembelajaran yang diharapkan dalam

menunjang pencapaian kompetensi fisioterapi dapat diperoleh sesuai harapan.

Medan, Agustus 2019

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P e n g e s a h a n

J u d u l

: E l e k t r o f i s i k a d a n S u m b e r F i s i s

M a t a K u l i a h

: E l e k t r o f i s i k a d a n S u m b e r F i s i s 1

K o d e M a t a K u l i a h

: F T 1 3 0 3

N a ma P e n u l i s

: A n g g r i a n i S s t . F t . , M . K M

N I D N

: 0 1 2 9 0 6 7 8 0 3

P e r g u r u a n T i n g g i

: S t i k e s S i t i H a j a r

M e d a n , A g u s t u s 2 0 1 9

D i s y a h k a n / D i s e t u j u i o l e h :

K e t u a S t i k e s S i t i H a j a r ,

T r i s n o S u s i l o S s t . F t . , M . K M

N I D N . 9 9 0 1 0 0 1 5 7 0

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1 Elektrofisika & Sumber Fisis 1

ANGGRIANI

Content

1. HEAT AND SKIN

2. CONDUCTIVE AND CONVECTIVE HEATING 3. CONVERSIVE HEATING

4. CRYOTHERAPY

5. ULTRASONIC THERAPY 6. TRACTION

7. DIRECT CURRENT 8. LOW FREQUENCY CURRENT 9. MEDIUM FREQUENCY CURRENT 10. ELECTRODIAGNOSIS

11. PHOTOTHERAPY

CLASSIFICATION OF PHYSICAL AGENTS

EFFECTS TYPE OF AGENT MODALITIES

THERMAL CONDUCTION HEATING HEATING BY RADIATION

HOT PACKS, PARAFFIN WAX, INFRARED THERMAL AND NON

THERMAL

DIATHERMY PRODUCING CONVERSIVE HEATING AND NON THERMAL EFFECTS

SHORT WAVE DIATHERMY, MICROWAVE DIATHERMY, ULTRASONIC ENEREGY STIMULATION OF NERVE OR

MUSCLE

LOW FREQUENCY CURRENT, MEDIUM FREQUENCY CURRENT

FARADIC TYPE CURRENT, SINUSOIDAL CURRENT, DIRECT CURRENT, INTERFERENTIAL CURRENT, TENS STIMULATION CIRCULATORY

MECHANISMS

COMPRESSION UNIT, LOW FREQUENCY CURRENT, MEDIUM FREQUENCY CURRENT INTERMITTENT PRESSURE, SINUSOIDAL CURRENT, INTERFERENTIAL CURRENT, DIADYNAMIC CURRENTS EFFECTS ON SKIN AND

SUPERFICIAL TISSUE FOR INFECTION AND SKIN LESIONS

ULTRAVIOLET RAYS DIATHERMY

MERCURY VAPOR LAMPS, SHORT WAVE DIATHERMY, INFRARED RADIATION

BY:HILARY WADSWORTH

STRUCTURE OF THE SKIN

• Pembungkus Elastis Yang Melindungi Kulit Dari Pengaruh Lingkungan.

• Organ Terberat Dan Terbesar Dari Tubuh. • Seluruh Kulit Beratnya Sekitar 16 % Berat

Tubuh,

• Pada Orang Dewasa Sekitar 2,7 – 3,6 Kg Dan Luasnya Sekitar 1,5 – 1,9 Meter Persegi.

LAPISAN KULIT

EPIDERMIS IS NON VASCULAR, 0.07-0.12mm THICKNESS MOST OF THE BODY

0.8-1.4mm PALMS AND SOLES PIGMENTATION OF THE SKIN

HYPODERMIS IS A DEEPER 30mm IN ABDOMEN, CONTAINS FAT CELL MANY BLOOD VESSELS AND NERVE ENDING

DERMIS HIGHLY ELASTIC 1-2mm THICKNESS, 3mm PALMS AND SOLES HAIR FOLLICLES, SEBACEOUS, AND SWEAT GLANDS

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CIRCULATIORY SYSTEM OF THE SKIN

HEAT CONDUCTION SYSTEM NUTRITIVE SYSTEM

1. Arteriovenous Anastomoses 2. Blood Flow 3. Lymphatic System Arteries that supply

the skin

FIBER TYPE

SERNSATION NERVE SIGN AND SYMPTOMS

CUTANEOUS SENSATION Pain Temperature

Exteroceptors All sensory Nerve All Sensory Nerve

Decrease HYPOAESTHESIA Complete Loss ANASTHESIA Sensation

Pain HYPOALGESIA Sensation HYPERALGESIA Loss ANALGESIA Complete Loss ATHERMAESTHESIA Decrease HYPO Increase HYPER DEEP SENSATION Proprioceptors Mototr Branches of spinal nerve

Loss of muscle BATHAESTHESIA Joint tendon VISCERAL SENSE Organic Sensation Visceral Pain Visceroceptors autonomic Nerve Hunger, Nausae Referred Pain

Sensory receptors of the skin

Mechanoreceptors

TYPE SITE

TOUCH AND PRASSURE RECEPTORS Free nerve ending

MEISSNER’S tactile PACINIAN HAIR END ORGANS

PROPRIOCEPTORS Tendon Of Muscle PRESSORECEPTORS AND STRETCH

RECEPTORS

Type of Sensory Receptors

• Mechanoreceptor • Chemoreceptors • Thermoreceptor

• Electromagnetic radiation and pain

Thermoreceptors

• Kulit menerima sensasi Dingin dan Panas • Suhu akan mengaktifkan Group IIIA Fiber dan

C Fiber

• Spesific receptor Krause untuk panas, Ruffini untuk dingin

• Temperatur Panas 20-45C, >45C reseptor pain aktif

• Temperatur Dingin 15-29C,

Stimulasi Pain: electrical, mechanical, extremes of heat and cold, and chemical

• Electromagnetic receptors are neuroepithelial cell ex: retina terhadap cahaya

• Pain receptors are nociceptors. • Three kind of pain are sense:

- Deep Pain from: muscle, tendon, joint and fascia

- Superficial or cutaneus pain - Visceral pain

Biophysical Properties of the Skin

• Electrical properties of skin: water with salt dissolved from sweat glands, chemically pure water does not conduct electricity, moist skin conducts electricity ex: palm and soles, • Surface electrical Resistance of skin • Thermoregulatory Sweating • Electrolyte conductivity in skin

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3 Regulation of body temperature

• Thermostatic control of temperature occurs in spinal cord and hypothalamic

• Reflex thermoregulatory include: autonomic, spmatic, endocrine and behavioural pattern • Control cold from the posterior hypothalamus • Control warmth from the anterior hypothalamus • Increase catecholamine from adrenal is an

important endocrine respone to cold • Increase heating would increase reflexly the

blood supply

Physiological Effects of heat and Cold

• Vascular control in skin: hyperaemia (increase blood flowing into dilated makes skin become fiery red

• Vasodilatation with heating release of histamine like substance that dilate the capillaries and axon reflex

Type of mechanism

Vasoconstriction Vasodilatation

Neural Sympathetic nerve Axon reflex Hormonal L-epinephrin

Norepinephrin

Bradikinin Acetylcholine Local Chemical Histamine Radiations UV, IRR

• Vascular control in muscles: relation to muscle oxygen requirements

• Evidence base showing that muscle blood flow is not increased by heat.

• Heat and exercise will increase blood flow more than exercise alone

• Local heating over 45C increase capillary permeability and dilatation cause redness and oedema, blister formation is due to activity of proteolytic enzymes in skin, and denaturation and death of cells and tissue

Summary of the local physiological effects of heating

Increase in temperature 39-44C Analgesic Efffects on sensory Nerve endings Capillary Dilatation Axon reflex Reduction of pain

And muscle spasm

Increased Capillary filtration Clearing of metabolism Reduction of oedema Arteriole dilatation Increased vasodilatation Increase nutrient Antibodies leucotysosis Cronic inflammation OR Acute inflammation Increase Skin blood Flow INCREASED METABOLISM Biochemical And biopysical Reaction stimulated DECREASED VISCOSITY OF COLLAGEN Increased extensibility Of tendon and capsule Ligament is produced by Stretch and load adhesions

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1 Conductive and Convective Heating

ANGGRIANI

Heat Exchange by Conduction

• Perpindahan energi panas melalui molekul dengan cara adanya energi kinetik yang berbenturan dari molekul

• Conductivity air lebih baik dari lemak. • Sumber conductive heating meliputi: electic

heating pads, thermal water baths, contras baths, hot packs, and paraffin wax

Hemodynamic effect

Vasodilatation

Cellular –

temperature  cell metabolism  O2; cell waste 

excreted

temperature blood hemoglobin releases O2 (106°F =

twice as much O2released)

temperature (104°-113°F) plastic deformation of collagen-rich tissues occurs more easily

Blood & Fluid Dynamics –

b. flow  edema, but b. flow removes wastes, etc.

Triggers release of bradykinin

Hydrocollar Packs

• Merupakan kain berisi silical gel, yang di celupkan ke dalam stanless stell tank air dengan temperatur 76-80C selama 30-40 mnt. • Digunakan untuk relaksasi dam muscle spasm

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2 Biological effect

• Penetrasi Hydrocollar tidak sedalam Infra red, • Infra Red memiliki penetrasi 0.5-1mm • Hyperaemia: increase vasodilatation open

arteriovenous anastomosis

• Increase ini flow of nutrients, antibodies, leucocytes, oxygen to the tissue

• Release histamin and bradikinin producing vasodilatation of capillaries

• Increase vasodilatation of superficial fascia and muscle • Decrease gamma fibre activity of the muscle spindle • Reduce conduction velocity of the C nerve fibres

Indication Hydrocollar Packs

• Pain and Muscle Spasm: Superficial with increase circulation than reduction of nerve conduction velocity of the pain nerve fibre. • Inflammation: Mild Inflamation, increase

phagocytosis

• Oedema: cronic stage with increase permeability of cell membrane bring fluid from the tissue to the venous and lymphatic vessel

Contra indication for hydrocollar packs

• Impaired skin sensation

• Circulatory dysfuntion: vericose veins, deep trombosis

• Infection and open wounds • Cancer or tuberculosis

Advantages and Disadvantages

• Easy to apply, sedative effect

• Not easy applied around shoulder and hips

• Lilin yang di cairkan di tangki pemanas • Wax has slow thermal conductivity • Use has melting point 52-54c • Should be changed every six months.

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3 Physiological Response

• Increase in skin temperature up to 12-13c, in

subcutaneous fascia there is an increase of 5c, in superfisial muscle there is only 2-3c

• Superficial capillaries and arteioles caused local hyperaemia and reflek vasodilatation, Vasodilatation in the muscle are negligible.

• Exercise after wax is essential to increase muscle circulation, and to use the sedative effect of heat to obtain ROM and Muscle Stength.

• Sedative effect on the tissue

• Wax leaves the skin moist, soft and pliable, this is useful for stretching scars and adhesions before applying mobilisation techniques.

Indication

• Pain and Muscle Spasm.

• Oedema and Inflammation. Swelling in hands affected by rheumatoid arthritis or

degenerative joint disease, and early cronic stages of inflammation

• Adhesion and scars. Wax softens the adhesion and scars in the skin thus fascilitates the mobilisation and stretching procedures

Contraindication

• Impaired skin sensation

• Dermatological condition: eczema, athlete’s foot

• Circulatory dysfunction: varicosa veins, deep vein thrombosis and arterial disease • Analgesic drugs: use strong narcotics for pain • Cancer or tuberculosis: heat increasing

metabolic, may increase the rate of growth and spread of the disease

Contrast Bath

• Method of applying heat and cold water to control the normal body temperature regulating mechanism

• Two baths one with hot water 40-45C, and the other cold water at 15C

• The treatment should begin and end with hot water

• Procedure should not take more than 15 minutes • Marked vasodilatation, an increase of deeper

circulation, an marked sedative effect.

Summary

• Conductive heating by means of steam pack, paraffing, and contrast baths is cheap, quick and effective way of providing moist heat to allieviate pain, muscle spasm, • The biological effects of conductive depend tissue,

time radiated, pathophysiology of the tissue, and ability the tissue to dissipate heat.

• Maximum penetration is only dermis level

• Heat is transmitted by movement in mass in a liquid or a gas. The transfer of heat is by conduction from the molecular of fluid to the surface

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Neuromuscular effect

Changes in nerve conduction velocity and firing rate

chemical reactions & cell metabolism nerve conduction

Pain Control –

circulation  congestion in area

Mechanical pain by reducing pressure on nerves (swelling is removed)

Analgesic effect

•  aktivitas enzim pada suhu 39o_-40o_{C }

reaksi biokimia sell, oksigen, & pemulihan (healing)

Metabolic effect

Increased metabolic rate

• Kenaikan suhu akan meningkatkan extensibilitas pada jaringan.

• Ketika jaringan di beri pemanasan sebelum dilakukan stretching, akan terjadi peningkatan yg lebih ketika stretching dan akan mencegah kesobekan jaringan

Altered tissue extensibility effect

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1 Conversive Heating

ANGGRIANI

Topic

• Short Wave Diathermy • Microwave Diathermy • Infrared Radiation

Short Wave Diathermy

• Physic: Radio Wave in the short wave band, ferquencies range 10-MHz to 100MHz. Physiotherapis use the frequencies 27.12MHz, with wavelength 11m

• Two circuits are used: the machine circuit and the patient circuit

• The electrostatic • The electromagnetic

• Physic: Radio Wave in the short wave band, ferquencies range 10-MHz to 100MHz. Physiotherapis use the frequencies 27.12MHz, with wavelength 11m

• Two main circuit are used:

- Circuit Machine (produces HFC & intensitas) - Circuit Patient (mediator yang akan

ditransferkan energi electrical dari electrostatic or electromagnetic

Short Wave Diathermy

Electrostatic Field

• Merupakan inductothermy metode, electrode yg digunakan kabel tebal berberbentuk coiled • Saat arus HFC dialirkan ke kabel akan terpusat

pada dan mengelilingi kabel coiled

Electromagnetic field

a. Electromagnetic b. Electrostatic c. Total field pattern

• Effect electrostatic

- Ions in tissue fluid akan bergerak depan belakang sehingga timbul fibrasi & friction (heat)

- Dipolar in molecule such water molecules akan rotasi (heat)

- Nonpolar molecules such fat melepaskan electron (oscilation) min friction min heat

Biophysical & Biochemical SWD

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• Effects electromagnetic

- heat production akan mempengaruhi jaringan yg banyak mengandung air (darah & otot), lemak & tulang sedikit berpengaruh - perubahan temperatur akan mempengaruhi

cardiovascular, hormonal & nervous control - panas pada kulit akan meningkatkan aliran

darah, panas sedang akan menurunkan tonus otot krn menurunkan muscle spindle.

a. Electromagnetic

• Panas jaringan dalam tubuh terjadi akibat

– Fibrasi ion

• Pd jar. mengandung elektrolit

– Rotasi dipoles • Pd jar. konduktor – Displacement electron • Pd jar. isolator

REAKSI BIOFISIS

+ _ + _ é • Pain • Muscle spasm • Inflammation • Delayed healing • Infection • fibrosis

Therapeutic effects & Dosage SWD

Duration: 10-12 menit krn akan terjadi fase steady state

Intensity: rasa hangat

Frequensi: 1 x sehari

SWD TRANDUCER

• Condenser : plate, rubber pad, coil SWD METODE • Coplanar • Diplode • Coil around • Cross fire

JENIS TRANSDUCER & METODE

PANAS

Glb elektromagnetik Dissipasi Timbul panas lokal diatas level

metabolisme Dilatasi – sirkulasi 

Membatasi panas

• Temperatur jar ditentukan oleh:

– Jenis jaringan – Status sirkulasi – Continous/pulse – Intensitas arus

– Durasi (total time) treatment dan steady state

Kuantitas panas dan peningkatan panas

dlm jaringan

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• Reaksi lokal tubuh thd panas • Reaksi umum tubuh thdp panas • Reaksi jaringan tertentu thd panas

– Jar. Ikat – Jar otot – Jar kapsul sendi – Jar bundel saraf

Pengaruh fisis HFC

Efek terapi

Energi elekrostatik dan elektromagnetik

Panas jarinngan lokal

Efek fisiologis Perubahan (pato)fisiologis

Efek terapetik

Tergantung pd:

– Target jaringan spesifik. – Status sirkulasijaringan

– Patologijaringan

– Besarnya dosis intensitasdan waktuterapi

Pengaruh terapetik

• Merupakan gel electromagnetic

• Frequensi 2450MHz, panjang gel 122,5 mm • Magnetron menghasilkan HFC, memiliki

tranducer (antena & reflector)

MICROWAVE DIATHERMY (MWD)

Timing circuit Power supply magnetron tranducer antenna reflector

• Penetration : kedalaman tergantung frequensi, 2450MHz biasanya kedalaman 30mm

• Absorption : nonpolar akan mengubah menjadi electron, dipolar akan rotasi, ion akan vibrasi

• Reflection : reflection udara-kulit, kulit-lemak, lemak-interface otot balik lagi ke udara, 50% akan terjadi reflection

• Heat yg dihasilkan akan mempengaruhi cardiovascular, hormone, nervous control

Biophysical & biochemical MWD

Therapeutic effects & dosage MWD

• Pain • Muscle spasm • Inflammation • Delayed healing • Infection • fibrosis Duration: 10-12 menit krn akan terjadi fase steady state

Intensity: rasa hangat

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• Small applicator

– Medan electromagnetic bentuk ring

• Large applicator

– Medan electromagnetic bentuk oval

Metoda aplikasi MWD

• Rasa capai dan kantuk

– Pd terapi berulang-ulang; rasa capai dan kantuk, kadang susah tidur, pusing, gelisah. Hilang ssd bbrp hari

• Efek pd darah

– Bl terapi pd pancreas kadar gula darah naik

• Efek pd aliran darah dan lymphe

– Wkt terapi 10-30 menit dilatasi maksimal – Aplikasi abdomen: dilatasi ekstremitas bawah,

suhu naik 30_C

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Ultrasound

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Apa Itu Ultrasound?

• Gelombang Akustik

• Sebagai Alat Bantu Diagnosa (USG), Perbaikan kerusakan Jaringan

• Thermal & Non Thermal Effect

• Fisioterapis gunakan US untuk pengobatan

• Dapat membantu memasukan obat melalui kutaneus/kulit

(Ponophoresis)

(17)

Ultrasound

• Gelombang suara

750.000-3.000.000 Hz (0,75-3Mhz)

• Komponen US

Gelombang/panjang gelombang

Frekuensi

Amplitudo

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Tranduser

• Alat untuk merubah Energi Listrik  Gel. US

• Piezoelectric Crystal

: Kristal yg berisi ion (+) & (-), terjadi ketika kristal

Berkontraksi & Melebar

• Crystal of quartz, barium titanate, lead zirconate, or titanate housed

within transducer

• Reverse (indirect) piezoelectric effect

:

terjadi ketika arus

dikeluarkan melalui kristal yg mengakibatkan kontraksi

• US dihasilkan dari efek piezoelectric yg tidak langsung

• Vibration terjadi dlm frekuensi tinggi

• Fresnal zone

(near field) – luas area dari tranducer

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Tipe Gelombang

• Direct Current: arus searah terputus-putus

• Alternating Current: dua arus terputus-putus

– Ultrasound dihasilkan oleh arus yg mengalir melalui kristal

piezoelektrik

• Pulsed Current: aliran arus terputus-putus, akibat

periode pengeluaran arus tidak terbatas

(20)

Gelombang longitudinal vs tranversal

• Longitudinal waves

– perpindahan molekul

searah dgn arah gel. Bergerak

– Compression

– pada area yg densitasnya tinggi

(molecules in high pressure areas compress)

– Rarefraction

– pada area yg densitasnya rendah

(molecules in low pressure areas expand)

• Transverse waves

– perpindahan molekul dgn

(21)

• Longitudinal waves

– melalui zat padat & cairan

• Soft tissue – lebih seperti cairan

• US terutama bergerak sbg gel. longitudinal

(22)

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Frequency

• Frequency:

terjadi beberapa kali dlm 1 detik; dinyatakan dlm Hertz or

pulses per second

• Hertz:

cycles per second

• Megahertz:

1,000,000 cycles per second

• In the U.S., menggunakan 1, 2 and 3 MHz

• 1 = low frequency; 3 = high frequency

• 

frequency =



kedalaman penetrasi

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Velocity/kecepatan

• Kecepatan gel.suara secara langsung berkaitan dgn

kepadatan jaringan (



density =



velocity)

• Jaringan padat memiliki kecepatan transmisi yg lebih

tinggi

• gel. 1 MHz pada jar. Lunak 1540 m/detik, pada jar.

Tulang 4000 m/detik

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Pengaruh pada transmisi energi

• Refleksi/terpantul

– terjadi ketika gel. Tidak dapat melalui kepadatan

• Refraksi/bias

– perubahan kecepatan gel.US ketika melalui media dgn

kepadatan yg berbeda

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Attenuation

• Penurunan intensitas Gel.US terjadi krn penyerapan, refleksi, &

refraksi

• 

sbg frekuensi US



krn gesekan/friction molekul dlm gel.us harus di

turunkan untuk melewati jaringan

• US menembus melalui jaringan yg tinggi kadar air & diserap

dlm jaringan padat tinggi protein

• 

penyerapan =



Frekuensi(3 MHz) , dan

• 

Penetrasi =



penyerapan (1 MHz) , jadi

• 

Penetrasi =



Frekuensi +



penyerapan (1 MHz)

• Jaringan



kadar air= tingkat penyerapan rendah (lemak)

• Jaringan



kadar protein = tingkat penyerapan tinggi

(peripheral nerve, bone)

(27)

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Attenuation: Acoustic Impedance

• Menentukan Jumlah energi US yg di refleksikan tergantung dari

permukaan jaringan

• Jika impedansi akustik dari 2 bahan permukaan yg sama , maka semua

gelombang akan tertransmisikan

• Semakin besar perbedaannya, semakin banyak energi yg di refleksikan &

sedikit energi yg masuk pada media ke2

• US melalui udara = semua terefleksikan (99%)

• US melalui lemak = 1% terefleksikan

• keduanya reflected/refracted @ permukaan

• Soft-tissue: bone interfaced = much reflected

• Gel. US @ permukaan dgn impedansi yg berbeda, intensitas akan

meningkatkan Standing Wave (hot spot)

(29)

• Effective Radiating Area (ERA):

are tranducer untuk

mengeluarkan gel.suara dinyatakan dlm square

centimeters (cm

2 ₎

Pd permukaan transducer terjadi emisi glb ultra

sound.

Luas permukaan transducer yg mengeluarkan

gelombang US dikenal sbg ERA (effective radiating

area)

Dalm fisioterapi digunaka transducer ERA 1cm

2 _dan

5cm

2 _.

(30)

Intensity Output & Power

• Power:

dinyatakan dlm watts (W);

• Jumlah energi yg dihasilkan oleh transducer

• Intensity:

kekuatan gel.suara @ lokasi tertentu dlm

jaringan yg diobati

• Spatial Average Intensity (SAI):

jumlah energi suara melewati

tranducer ERA;

• Dinyatakan dlm watts per square centimeter (W/cm

2 ₎

(power/ERA)

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Intensity Output & Power

• Spatial Average Temporal Peak Intensity (SATP):

intensitas rata-rata selama waktu “on”

• Output meter displays the SATP intensity

• Spatial Peak Intensity (SPI):

max. output (power) yg di

produksi dalam berkas US (Ultrasound beam)

• Spatial Average Temporal Average Intensity (SATA) or

Temporal (time) Average Intensity:

• Kekuatan energi US dibawa ke Jaringan Tubuh selama periode tertentu

• Hanya berarti pada Pulsed US

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Beam Nonuniformity Ratio (BNR)

• Rasio antara intensitas puncak spasial (spatial peak

intensity (SPI))

• Pd permukaan transducer terjadi interferensi

(superposisi) glb

• Terjadi variasi bentuk amplitudo glb US



variasi

intensitas.

• Oleh karena adanya intensitas tinggi dalam daerah berkas (beam), perlu

untuk menggerakkan tranducer US

(33)

BNR

(34)

Duty Cycle

• Persentase waktu US sebenarnya dipancarkan dari

kepala tranducer

• Rasio antara panjang pulsa & interval pulsa

dihantarkan dalam modus denyutan(kontraksi)

• Pulse length

= jumlah waktu dari muatan nol awal untuk

kembali ke muatan nol kembali

• Pulse interval

– jumlah waktu antara pulsa US

• Duty cycle

= pulse length/(pulse length + pulse interval) x

100 • 100% duty cycle menunjukan output US

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Movement of the Transducer

• 4 cm

2 _/sec

• Bergerak terlalu cepat akan menurunkan jumlah total

energi yg diserap per satuan luas

• Gerakan yg lambat lebih mudah dan tepat pada target

jaringan

• Jika pasien mengeluh rasa sakit atau panas yg

berlebihan,

turunkan intensitas

dan tingkatkan waktu

(36)

Coupling Agents

media jelly

• Optimal agent – distilled H

₂

0 (.2% reflection)

• Types of agents:

• Direct

• H

₂

0 perendaman (under water)

• Bladder / kantung air

(37)

Direct Coupling

• Efektifitas akan menurun jika ada bulu/rambut, permukaan tidak rata

atau tidak bersih

• Tekanan miniman dan konstan

• Berbagai jel dpt digunakan

(38)

Water Immersion

• Digunakan pada permukaan yg tidak rata

• Letakkan kepala tranducer 2,5 cm dari area terapi

• Tangan operator harus bebas dari logam

• Bak yg terbuat dari keramik dangat dianjurkan

• Jgn menyentuh kulit

(39)

Bladder

• Kantung air yg dilapisi dgn jel

• Gunakan pada area yg tidak teratur

• Letakkan jel diatas kulit, kemudian letakkan kantung air diatasnya dan

letakkan jel pada kantung tersebut

(40)

Indications

• Soft tissue healing & repair

• Joint contractures & scar tissue

• Muscle spasm

• Neuroma

• Trigger areas

• Warts

• Sympathetic nervous system disorders

• Postacute reduction of myositis ossificans

• Acute inflammatory conditions (pulsed)

• Has been shown to be ok to use following the stopping

of bleeding with an acute injury (pulsed)

(41)

Contraindications

• Acute conditions (continous output)

• Ischemic areas or impaired circulation areas

• Tendency to hemorrhage

• Around eyes, heart, skull, or genitals

• Over pelvic or lumbar areas in pregnant or

menstruating females

• Cancerous tumors

• Spinal cord or large nerve plexus in high doses

• Anesthetic areas

• Stress fracture sites or over fracture site before

healing is complete (continuous); epiphysis

(42)

Thermal Effects

• 

blood flow

• 

sensory & motor nerve conduction velocity

• 

extensibility of structures (collagen);



joint stiffness

• 

collagen deposition

• 

macrophage activity

• Mild inflammatory response which may enhance

adhesion of leukocytes to damaged endothelial cells

• 

muscle spasm

• 

pain

(43)

(44)

(45)

Nonthermal Effects

• 

cell membrane permeability

• 

vascular permeability

• 

blood flow

• 

fibroblastic activity

• Altered rates of diffusion across cell membrane

• Secretion of chemotactics

• Stimulation of phagocytosis

• Production of granulation tissue

• Synthesis of protein

• 

edema

• Diffusion of ions

• Tissue regeneration

(46)

(47)