Laboratory Manuals

Electrotherapy I (201 PHT)

2011/2012 A.D.

Objectives:
At the end of this lecture the student should be able to:

1. List indications and contra-indications of Shortwave Diathermy (SWD).

2. Apply sensory test on the patient.
3. Describe the best position of the patient during the application of SWD.
4. Prepare the SWD machine.
5. Apply SWD as per guidelines and instructions.
6. Apply contra-planner, co-planner, cross-fire techniques on the patient.
7. List factors affecting the dose of SWD given to the patient.
8. Discuss the effect of every factor affecting dose of SWD and explain how to
manipulate it.
9. List indications and contra-indications of Microwave Diathermy (MWD).
10. Describe the best position of the patient during the application of MWD.
11. Prepare the MWD machine.
12. Apply MWD as per guidelines and instructions.

Shortwave Diathermy –
Microwave Diathermy
 Shortwave Diathermy

Practical application:
1. Preparation of the patient:
a. Check if the patient is indicated for Shortwave Diathermy (SWD);
i. Musculoskeletal disorders: e.g., Osteomyelitis, osteoarthritis, subacute and chronic
arthritis, tendonitis, bursitis, capsular lesion, tenosynovitis, post-traumatic conditions as
fracture, hematoma.
ii. Sport injuries: e.g., strain, sprain and contusions.
iii. Pulmonary disorders: e.g., bronchial asthma, Sub-acute and chronic bronchitis.
iv. Neurological disorders: e.g., neuritis, sciatica.
v. Genitourinary disorders: e.g., endometritis, Dysmenorrhea, Ovaritis, fallopian tube
adhesions.
vi. Oral disorders: e.g., gingivitis, oral cyst.
vii. ENT disorders: e.g., sinusitis, laryngitis.

b. Check the patient for the presence of any contra-indication;

i. Unreliable patients.
ii. Loss of sensation and analgesic drugs.
iii. Patient receiving deep X-ray therapy.
iv. Ischemia and poor circulation.
v. Neoplasm.
vi. Metallic implants and superficial metals.
vii. Pacemakers.
viii. Open wound and burns.
ix. Acute inflammations, infections and injuries.
x. Moderate and excessive edema.
xi. Tendency of hemorrhage; during menstruation, pregnancy, peptic ulcer and varicose veins.
xii. Severe cardiac condition and blood pressure abnormalities.

c. Apply sensory assessment to the patient.

d. Explain the procedure of SWD application to the patient.

e. Monitor patient's vital signs before starting the treatment.

f. Remove all superficial metals and jewelry from the treated area and check that there is no
internal or implanted metal.

g. Check clothes in this area are not tight or wet.

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 h. Put the patient in the most suitable and comfortable position according to the treated part, e.g.,
prone for back and neck regions, supine OR sitting for treating the knee region, supine OR
sitting for the ankle region, sitting for the wrist and hand regions, …….., etc.

2. Preparation of the device:

a. Check that the cable is connected to the electric outlet.
b. Turn on the device.
c. Ensure that all knobs are turned back to zero.
d. Ensure that the machine is emitting shortwave by passing the test tube between the two
capacitive electrodes or within the electromagnetic field of the inductive SWD electrodes.

3. Preparation of the treated part:

a. The treated area must be exposed.
b. Properly clean and dry the treated area.
c. Remove any dust, grease or ointments on the skin.
d. Put a piece of towel between skin surfaces that are in direct contact with each other within the
field of SWD.

4. Technique of application:
a. Adjust the electrodes' position according to the treated area and the selected technique of
application. (will be explained later)

b. Check that all knobs are at zero before turning on the machine.

c. Turn on the machine on and check that there are waves passing within the field of the electrodes
using the fluorescent test tube.

d. Adjust the duration of application: suitable treatment duration is 15 minutes. Press the (+) button
to increase the duration and the (-) button to decrease it.

e. Select the mode of application;

i. Continuous SWD:
ii. Pulsed SWD: it ranges from 15 – 200 Hz.

f. If it is the first session in the day, switch the intensity on and wait for 2-3 minutes as a warming-
up period.

g. Increase the intensity of the waves gradually and slowly till the patient feels mild comfortable
warmth.
i. Instruct the patient not to move or touch the electrodes during the session.
ii. If the patient feels strong warmth the intensity should be reduced immediately.

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 iii. If the machine has a patient safety switch instruct the patient to switch the machine off if
he feels excess heat.

h. During the application of SWD, regularly check the skin to avoid its DANGERS;
i. Burn: to avoid it:
 Don't put the electrodes very close to bony prominences.
 Make sure that the machine's leads are not touching each other.

ii. Shock: to avoid it:

 Don't increase intensity unless the leads and electrodes are connected to the
machine.
 Make sure that the machine is earthed.
 Don't touch the machine, cables or electrodes during the application.
 If the patient is wearing a hearing aid switch it off.

i. After treatment time has finished, turn the intensity switch to zero, remove the electrodes and
turn off the machine.

j. Inspect the area after treatment for any signs of hyperemia, or skin irritation and ask the patient
to stay few minutes for rest and to regain normal skin temperature.

5. Techniques of electrodes positioning:

a. Capacitive electrodes;
i. Contra-planner technique: using two electrodes and producing electrostatic field. The
electrodes are placed on opposite sides of the treated part to treat deeply situated
structures. It might be horizontal or longitudinal.
 Horizontal means that the direction of the electromagnetic field propagation is
perpendicular to the direction of the tissue fibers, (Figure: P5.01)
 Longitudinal means that the direction of the electromagnetic field propagation is
parallel to the fibers of the tissue being treated. (Figure: P5.02)
 The electrodes should be kept at 2.5 – 4 cm distance from the skin surface.
 In case of application on an area where two skin surfaces are in direct contact with
each other, a small towel should be placed between the two skin surfaces.

ii. Co-planner technique:

 The electrodes are placed on the same side of the treated part to treat superficial
tissues. (Figure: P5.03 & P5.04)
 The electrodes should be kept at 2.5 – 4 cm distance from the skin surface.

iii. Cross-fire technique: cross-fire technique is a special form of the contra-planner technique,
used for hollow organs, e.g., nasal sinuses, uterus, intestine, …., etc.

 Facial application [nasal sinusitis (Figure: P5.05)]:

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  The electrodes should be kept at 2.5 – 4 cm distance from the skin surface.
 During the first half of the session the electrodes are placed diagonally in a
contra-planner manner, i.e., one on the right forehead and the other on the
left chin.
 Then during the second half of the session they are placed so that the line
between the two electrodes makes a 90º angle to the line between them
during the first part of the session, i.e., one on the left forehead and the other
on the right chin. (Figure: P5.06)
 This technique is used to provide more uniform heating of the deep tissues
especially air-filled cavities (nasal sinuses).
 Care must be taken to avoid direct placement over the eye.
 This technique is also used for the treatment of uterine disorders such as
dysmenorrhoea.

Fig.P5.01: Horizontal contra-planner technique. Fig.P5.02: Longitudinal contra-planner technique.

Fig.P5.03: Co-planner technique, using two Fig.P5.04: Co-planner technique, using two flexible pads.
space plates.

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Fig.P5.05: Nasal Sinuses; Maxillary, Ethmoidal, Frontal Fig.P5.06: Cross-fire technique.
& Sphenoidal.

b. Inductive electrodes: (refers to electrodes providing electromagnetic fields). Only one electrode
is utilized in this case, with less penetration depth than capacitive electrodes.
i. Coil: the coil is applied using three different methods;
 Wrapped around the circumference of the limb: (Figure: P5.07)
 The coil is kept away from the patient's skin by wrapping one or two towels
on the treated part before wrapping the coil to keep a distance of about 2 cm.

 Flat spiral or Helix: (Figure: P5.08 & P5.09)

 The helix should be separated from the skin using one or more towels.
 The turns of the coil are separated using piece of the towel or wooden
spacers.

 Flat double helix.

Fig.P5.07: Application of the coil around the Fig.P5.08: Application of the coil as a flat spiral or
circumference of the leg. helix.

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 Fig.P5.09: Application of the coil as a single helix.

ii. Monode & Minode: (Figure: P5.10)

 Using one electrode to produce electromagnetic field and treating only one side of
the tissue. It is effective in treating superficial tissues or structures.
 The electrode should be kept at 2.5 – 4 cm distance from the skin surface.

iii. Diplode OR Drum electrode: (Figure: P5.11)

 Using the drum electrode to produce electromagnetic field and treating only one
side of the tissue. It is effective in treating large area of superficial tissues or
structures.
 The electrode should be kept at 2.5 – 4 cm distance from the skin surface.

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 b)
a)

c)
Fig.P5.10: Application of the Minode OR Monode on a) the posterior aspect of shoulder joint, b) calf muscles and c)
patellofemoral joint.

Fig.P5.11: Application of the Diplode on thoracic spine.

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6. SWD dose adjustment:
Many factors may affect the dose and heating pattern of SWD application, e.g., distance
between the skin and the electrodes, size of the electrodes, air cavities and presence of metal
(superficial or deep).

a. Spacing:
i. Spacing refers to the distance of the metal electrode from the skin (not the plastic cover).

ii. The most appropriate spacing is 2.5 – 4 cm between the metal plate and the skin surface
(contra-planner technique).

iii. Proper spacing provides uniform distribution of heat in the tissue:

 If the electrodes are placed at a distance less than 2.5 cm from the skin, the heat will
be concentrated in central area of the treated part as well as the skin opposite to the
electrodes. (Figure: P5.12a).
 If the electrodes are placed at a distance more than 4 cm from the skin, the heat will
be dispersed over larger area of the treated part and skin, which may reduce the
therapeutic effect of the SWD. (Figure: P5.12b).
 In the co-planner technique using flexible pads, the distance between the two
electrodes should be at least equal to the cross-section diameter of the pads, i.e., if
the pads' diameter is 15 cm, the minimum distance between the electrodes should be
15 cm. (Figure: P5.13)
 In co-planner technique using space plates, the distance between both electrodes (X)
should be greater than the summation of the distance between the skin and the
electrodes (A+B), i.e., X > A+B. If < A+B, the line of force will pass directly
between electrodes and will not pass through the tissue. (Figure: P5.14)

Fig.P5.12: a) Close spacing concentrates heat in deep tissues and b) Wide spacing disperses heat in deep tissues.

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 iv. Spacing is provided by:
 Adjusting the space plates, monode, minode and/or diplode at the proper distance
from the skin.
 Wrapping towel around the flexible pads to separate it from the skin.
 Wrapping a layer or two of towels around the treated part to separate it from the coil
and/or helix.

Fig.P5.13: Co-planner electrodes' spacing.

Fig.P5.14: Co-planner electrodes' spacing.

b. Electrode size:
i. Ideally, the electrodes should be slightly larger than the treated area. (Figure: P5.15a)
ii. If the electrodes are too small as compared to the diameter of the treated part, the SWD
waves will be concentrated superficially. (Figure: P5.15b)
iii. If the electrodes are markedly larger than the treated area, the SWD waves will be lost in
the air.
iv. If one of the electrodes is smaller than the other, the waves of SWD will be concentrated
on the skin surface facing the smaller electrode. (Figure: P5.15c)

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 Fig.P5.15: a) Proper electrodes' size, b) Smaller electrodes, and c) One small and one big electrodes.

c. Positioning of the electrodes:

i. The space plates should be positioned parallel to the skin surface, with the distance
between the two electrodes bigger than the summation of distances between the skin
surface and the two electrodes. (Figure: P5.16a)
ii. If the one of the electrodes is not parallel to the skin surface, the waves will be
concentrated between the skin and the closest point of the electrodes. (Figure: P5.16b)
iii. If the inter-electrode distance is less than the summation of distances between the two
electrodes and the skin, the waves will pass through the air without passing through the
tissue and will not produce the desired physiological effect. (Figure: P5.16c)

Fig.P5.16: a) Proper electrodes' placement, b) One electrode is closer at one point, and c) Space between the
electrodes is less than the summation of distances between the skin and electrodes .

d. Metal:
i. Presence of metal (superficial or deep) causes the lines of force to be concentrated on this
metal, which increases its temperature and might cause burn. (Figure: P5.17)

e. Air cavities:
i. As in nasal sinuses or uterus, the lines of SWD field will deviate to avoid passage through
air as it offers high resistance.
ii. The heating pattern will be concentrated on the walls of air-filled cavities. (Figure: P5.18)

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 iii. With air-filled cavities, the cross-fire technique is the most appropriate technique of
application to provide a uniform distribution of heat on the walls of the cavity. (Figure:
P5.19)

Fig.P5.17: Effect of presence of metal within the field of SWD; a) Superficial metal, and b) Deep metal.

Fig.P5.18: SWD field distribution with air-filled cavities.

Fig.P5.19: Illustration of the cross-fire technique.

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 7. Examples of SWD application:

a. Application using two flexible pads or space plates:

i. The electrodes should be slightly larger than the area treated and spaced from the skin by
approximately 2.5 - 4 cm. (Figure: P5.20 & P5.21)
ii. To concentrate heat on one side of the treated area;
 Place the smaller electrode facing the area where heat concentration is required.
 Use equal sized electrodes but with unequal spacing, e.g., 2.5 cm over the area
where concentration is required and more than 3 cm on other electrode side.

Fig.P5.20: Contra-planner application of two space plates; a) on shoulder joint, b)on knee joint, and c) on both knees.

Fig.P5.21: Co-planner application on the back region; a) Using two space plates, and b) Using two flexible pads.

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b. Application using a combination of flexible pad and space plate:
i. With the patient in sitting position, use a space plate
over the top of the leg and a flexible pad under the
foot so that the waves pass across the whole leg, i.e.,
contra-planner, longitudinal application. (Figure:
P5.22)

Fig.P5.22: Contra-planner
application using one space plate
and one flexible pad.

c. Application using a coil electrode:

i. The coil could be wound in a spiral shape around the limb to treat cylindrical areas or as a
helix to treat flat areas.
ii. The coil should be separated from the skin using one or more layers of towels.
iii. Stiff wooden spacers are used to ensure consistent spacing of the circles of the coil or helix
of about 3 cm.
iv. The rounds of the coil should not touch each other or excessive heat will concentrated
between them and may cause skin burn.

d. Application using a flexible pad and coil:

i. This combination is useful in treating hip and shoulder joints.
ii. To localize heat on the joint;
 The proximal end of the cable and one flexible pad are attached to the machine.
 Electrostatic field is produced between the pad and the proximal loop of coil,
electromagnetic field is produced around other loops of the coil. (Figure: P5.23a)
iii. To treat hip joint with referred pain down the thigh;
 The distal end of the coil is attached to the machine and the proximal end of coil is
insulated.
 Electrostatic field is produced between the pad and the proximal loop and
electromagnetic field is produced around all loops of the coil. (Figure: P5.23b)

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a)
b)
Fig. P5.23: Combination of coil and flexible pads.

e. Application using diplode:

i. Adjust wings of the diplode to be parallel to the skin of the treated area which will produce
electromagnetic field in the treated area. (Figure: P5.24)

Fig. P5.24: Application Using Diplode; a) on back, b) on shoulder joint.

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 Microwave Diathermy

Practical application:
1. Preparation of the patient:
a. Check if the patient is indicated for Microwave Diathermy (MSWD);
i. Musculoskeletal disorders: e.g., Osteomyelitis, osteoarthritis, subacute and chronic
arthritis, tendonitis, bursitis, capsular lesion, tenosynovitis, post-traumatic conditions as
fracture, hematoma.
ii. Sport injuries: e.g., strain, sprain and contusions.
iii. Pulmonary disorders: e.g., bronchial asthma, Sub-acute and chronic bronchitis.
iv. Neurological disorders: e.g., neuritis, sciatica.
v. Genitourinary disorders: e.g., endometritis, Dysmenorrhea, Ovaritis, fallopian tube
adhesions.
vi. Oral disorders: e.g., gingivitis, oral cyst.
vii. ENT disorders: e.g., sinusitis, laryngitis.

b. Check the patient for the presence of any contra-indication;

i. Unreliable patients.
ii. Loss of sensation and analgesic drugs.
iii. Patient receiving deep X-ray therapy.
iv. Ischemia and poor circulation.
v. Neoplasm.
vi. Metallic implants and superficial metals.
vii. Pacemakers.
viii. Open wound and burns.
ix. Acute inflammations, infections and injuries.
x. Moderate and excessive edema.
xi. Tendency of hemorrhage; during menstruation, pregnancy, peptic ulcer and varicose veins.
xii. Severe cardiac condition and blood pressure abnormalities.
xiii. Over wet dressings and adhesive tapes.

c. Apply sensory assessment to the patient.

d. Explain the procedure of MWD application to the patient.

e. Monitor patient's vital signs before starting the treatment.

f. Remove all superficial metals and jewelry from the treated area and check that there is no
internal or implanted metal.

g. Check clothes in this area are not tight or wet and there is no wet dressing or Adhesive tapes.

45
 h. Put the patient in the most suitable and comfortable position according to the treated part, e.g.,
prone for back and neck regions, supine OR sitting for treating the knee region, supine OR
sitting for the ankle region, sitting for the wrist and hand regions, …….., etc.

2. Preparation of the device:

a. Check that the cable is connected to the electric outlet.
b. Turn on the device.
c. Ensure that all knobs are turned back to zero.
d. Ensure that the machine is emitting microwave by passing the test tube within the
electromagnetic field of the director.

3. Preparation of the treated part:

a. The treated area must be exposed.
b. Properly clean and dry the treated area.
c. Remove any dust, grease or ointments on the skin.
d. Put a piece of towel between skin surfaces that are in direct contact with each other within the
field of MWD.

4. Technique of application:
a. Adjust the director's position according to be parallel to the treated area and at a distance of 2.5
– 4 cm from the skin.

b. Check that all knobs are at zero before turning on the machine.

c. Turn on the machine on and check that there are waves passing within the field of the electrodes
using the fluorescent test tube.

d. Adjust the duration of application: suitable treatment duration is 15 minutes. Turn the duration
knob till it is directed to the suitable selected duration.

e. Select the mode of application;

i. Continuous MWD.
ii. Pulsed MWD.

f. If it is the first session in the day, switch the intensity on and wait for 2-3 minutes as a warming-
up period.

g. Increase the intensity of the waves gradually and slowly till the patient feels mild comfortable
warmth.
i. Instruct the patient not to move or touch the electrodes during the session.
ii. If the patient feels strong warmth the intensity should be reduced immediately.

46
 iii. If the machine has a patient safety switch instruct the patient to switch the machine off if
he feels excess heat.

h. During the application of SWD, regularly check the skin to avoid its DANGERS;
i. Burn: to avoid it:
 Don't put the director very close to bony prominences.
 Make sure that the machine's leads are not the patient.

ii. Shock: to avoid it:

 Don't increase intensity unless the leads and electrodes are connected to the
machine.
 Make sure that the machine is earthed.
 Don't touch the machine, cables or director during the application.
 If the patient is wearing a hearing aid switch it off.

i. After treatment time has finished, turn the intensity switch to zero, remove the director and turn
off the machine.

j. Inspect the area after treatment for any signs of hyperemia, or skin irritation and ask the patient
to stay few minutes for rest and to regain normal skin temperature.

5. Students assessment in exam:

Students will be assessed based on the attached checklist.

No. Task required Student's performance

Done properlyDone, but not properly Not done

1. General appearance. Full grade ½ the grade Zero

2. Check indication and contra-indications. Full grade ½ the grade Zero

3. Apply sensory test. Full grade ½ the grade Zero

4. Explain the procedure to the patient. Full grade ½ the grade Zero

5. Preparation of the instrument. Full grade ½ the grade Zero

6. Preparation of the treated area. Full grade ½ the grade Zero

7. Application of the modality. Full grade ½ the grade Zero

8. Termination of treatment. Full grade ½ the grade Zero

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References:
1. Cameron MH.: Physical Agent in Rehabilitation from Research to Practice, 2nd Ed.
Saunders, 1999; Pp: 388-403.
2. Prentice WE, Quillen WS, Underwood F.: Therapeutic Modalities for Physical
Therapists, 2nd Ed. New York, The McGraw-Hill Companies, 2002; Pp: 171-192.
3. Robertson V, Ward A, Low J and Reed A.: Electrotherapy Explained, 4th Ed.
Edinburgh, Butterworth-Heinmann Companies, 2006; Pp: 385-424, 441-457.

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