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94 Cards in this Set
- Front
- Back
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generic grading rubric
1 |
introduce yourself to patient
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2
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provides pt education
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3
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establish contraindications
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4
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positions pt appropriately
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5
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identifies treatment area appropriately
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6
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selects correct parameters
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7
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initiates modality application
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8
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continues modality application
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9
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discontinues modality application
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10
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includes appropriate follow up procedures
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11
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responds to troubleshooting questions
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12
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confidence
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13
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compromises safety of patient
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indications
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pain control
increase collagen extensibility tissue healing bone healing |
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contraindications
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malignancy
preggers cns tissue joint cement plastic components pacemaker or any implant thrombophlebitis eyes, genitalia, heart hemophilia decreased sensation/circulatory impairment stress fx site |
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indications acronym
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PITB
pain control increase collagen extensibility tissue healing bone healing |
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contraindications acronym
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ppp stem jc hd
pacemaker plastic components preggers stress fx thrombophlebitis eyes, genitalia, heart malignancy joint cement cns tissue hemophilia decreased sensation |
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contraindications/precautions
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over spinal cord
metal implants over epiphyseal plates (thermal) fx site (thermal) breast implants (thermal) acute inflammation (thermal) |
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contra/precautions
thermal |
over epiphyseal plates
fx site breast implants acute inflammation |
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contra/precautions
thermal acronym |
FOBA fat obese allie bear
fx site over epiphyseal paltes breast implants acute inflmmation |
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pt education
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what US is
what it should feel like shouldnt feel like what to do if you feel what you shouldnt purpose of modality why you are using this device |
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properly position pt
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watch machine and pt at the same time
-place pt in stretch and in such a way to potentially increase stretch |
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palpate the treatment site
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have pt contract muscle
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Ultrasound what is it
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it is a deep penetrating modality capable of producing changes in tissue thru both thermal and non-thermal mechanisms
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US how it works
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uses acoustical energy requiring a dense medium to be transmitted thru. It is transmitted by mechanical waves (vibration) that deform the medium. US and its effects are differentiated by frequency and amplitude of the wave
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US production
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it is produced by AC flowing thru a piezoelectric crystal housed in a transducer. P-crystals produce positive and negative electrical charges when they contract or expand
US is produced by a reverse piezoelectric effect causing contraction and expansion of the crystal leading the crystal to vibrate thus producing high-frequency sounds waves |
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why cant US be transmitted in air?
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because it has a high frequency thus requiring a dense transmission medium
-a coupling medium needs to be used for US energy to pass from the transducer to the tissues |
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transmission of US waves
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longitudinal waves
transverse waves |
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longitudinal waves
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US passes through soft tissue as a longitudinal wave
-energy is transmitted parallel to the direction of the wave |
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transverse waves
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occurs when longitudinal waves strike bone, transverse waves cannot pass thru fluids and are found in the body only when US strikes bone
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what does the sound head or transducer contain?
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crystal to convert electrical energy into mechanical acoustical energy
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the effective radiating area is
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smaller than the surface area of the crystal (or the face of the transducer)
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frequency
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depth of penetration is inversely related to the output frequency
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high frequency doesnt penetrate as deep because
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energy is rapidly absorbed and heats 3x faster than 1 mhz
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unstable cavitation
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the violent oscillation and subsequent rupture of bubbles during US application at too high an intensity
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SAI
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total watts/ effective radiating area
spatial average intensity -max output 3.0 W/cm2 |
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SATP
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ave intensity during the "on" time of the pulse. The output meter on an US unit displays the SATP intensity
-spatial average temporal peak intensity |
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if the intensity (w/cm2) is constant and ERA goes up what happens to W
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the total power increases directly proportional to the increase in ERA
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continuous output
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effectively heats tissues located 5 or more cm deep
-measured in SATP because 100 percent of the time -SATP should not exceed 8 W/cm2 (metered output x BNR) |
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pulsed output
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pulsing decreases temporal ave intensity, reducing thermal effects.
it has a duty cycle (not 100%) |
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duty cycle =
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pulse length/(pulse length + pulse interval) x 100
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ultrasound BNR
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the ratio of the highest intensity within the beam
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BNR
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spatial peak intensity/SAI
a perfectly uniform US beam, one that has no 'peaks and valleys' would have a BNR of 1:1 |
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what is an unacceptable BNR?
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anything above 8:1
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why do we keep the sound head moving during treatment?
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the existence of high-intensity areas in the beam, "hot spots" is the reason to keep beam moving
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BNR inconsistencies
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US energy not consistent as it is emitted from the sound head
-areas of high intensity and lower intensity -the meter displays average intensity |
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nonthermal effects
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changes within the tissues resulting from the mechanical effect of US energy (though accompanied by some degree of heating)
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thermal effects
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changes within the tissues as a direct result of US's elevation of the tissue temperature
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treatment area should be no more than ____ ERA
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2-3 x the ERA of the sound head
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the smaller the area treated, the ____ temperature increase
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the greater the temperature increase
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when should you use nonthermal over thermal US
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when acute injuries are being treated or in other cases when increasing tissue temperature is undesirable
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nonthermal can be pulsed or continuous
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pulsed: 20-25 percent cycle, normal treatment intensity
continuous: 100 percent duty cycle, and a low-output intensity (below .3 w/cm2) |
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the amount of cavitation is in direct proportion to ___
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intensity of he sound wave
low-intensity output with continuous output leads to more stable, prolonged cavitation |
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stable cavitation
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bubbbles compress during high-pressure peaks followed by expansion of the bubbles during low-pressure troughs
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unstable cavitation
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compression of the bubbles during hp but followed by total collapse (bursting of bubble) during the trough
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nonthermal effects
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stimulation of phagocytosis
increased cell perm increased vascular perm increased blood blow reduce edema tissue regen increase fibroblastic activity synthesis of protein synthesis of collagen formation of stronger, more deformable connective tissue |
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thermal effects
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increased sensory nerve conduction velocity
-increased motor nerve conduction velocity -increased extensibility of collagen-rich structures -increased collagen deposition -increased blood flow -reduction of muscle spasm -increased macrophage activity - |
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thermal effects treatment area and tissue temp increases
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an area 2x the size of ErA raises temperature a lot more than a 6x ERA surface area
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to achieve a therapeutic effect through US heating, tissue temperatures must be elevated for
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a minimum of 3 to 5 minutes
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acute phase contraindications
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use of continuous ultrasound output because of the increased tissue temperature and associated increased need for oxygen
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what should the conidtions and settings be in acute/subacute
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low duty cycle and low intensity
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nerve conduction and pain control
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thermal effects of US application and may produce counterirritant effects
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muscle spasm
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thermal effects of US can decrease muscle spasm by reducing the mechanical and chemical triggers that perpetuate the pain-spasm-pain cycle
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tissue elasticity
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thermal
to promote tissue elongation, temperature of target tissues must be elevated 7.2 F -effective stretching time is just over 3 minutes |
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when the goal is elongating tissue
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place the tissues on stretch during the treatment
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wound healing
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superficial wounds have responded favorably to US application
1.5 w/cm2 for 5 minutes over a 1 week treatment |
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common misuses or mistakes using US
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wrong output frequency, output intensity is too low when attempting to produce thermal effects, treating too large an area, using inappropriate coupling media, moving sound head too rapidly
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stable cavitation leads to ...
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microcurrents
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unstable cavitation leads to
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implosion, free radicals, increase in temperature, and increase in pressure
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nonthermal
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no temp increase
baseline 37.5 acute injury, edema, healing |
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mild (thermal)
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1 degree
subacute injury, hematoma mild inflammation, accelerating metabolic rate |
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moderate
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2 degrees
dec muscle spasm, decrease pain, increase blood flow, reduce chronic inf, trigger points |
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vigorous
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4 degrees
stretch collagen tissue elongation, scar tissue reduction, inhibition of sympathetic activity |
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someone who has tendonopathy and decreased ROM
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thermal, increase rom, 1 mhz because it lasts longer so you can stretch it longer and increase the stretch
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speed at which you move US head
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3 to 4 cm/sec
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US we use is duration oriented
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determine when the pt. begins to feel warmth then from that pt determine how long the US should continue
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do you press the start button before or after the sound head is on the target treatment?
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press start button after, and then begin moving sound head to check the intensity
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how long should you put time on US?
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20-30 minutes
even though you shouldnt exceed 10 minutes |
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what should you start your intensity at?
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0-.5 w/cm2 and leave there for 10-15 seconds then move up
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stop machine when?
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before you remove the sound head
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US is only effective in increasing tissue temperature when the treatment area is
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2 times but not more than 3x the size of the sound head's ERA
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output parameters
output frequency 1mhz |
1 mhz: for deep structures such as rotator cuff, vastus intermedius, and gastrocnemius
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output frequency 3.3 mhz
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for superficial structures: MCL, patellar tendon, brachialis
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treatment duration
vigorous heating |
1 mhz: 10-12 minutes
3 mhz: 3-4 minutes |
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duty cycle
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20-25 percent for acute, but use continuous with .3 intensity or lower
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output intensity
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for thermal is determined when you first feel warmth and then you keep it there
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output intensity for nonthermal
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using continuous, just keep it at .2-.3
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what you should feel
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thermal: warmth or heat
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what you shouldnt feel
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pain or burning or discomfort
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things you should do when starting treatment
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GFI
make sure BNR 5:1 is located and plugged into proper portal |
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2
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turn on the machine and set correct parameters
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3
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apply the gel onto the treatment site, skin and move US sound head on space
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4
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press the start button before you move the intensity up
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5
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move the intensity up and keep asking them to tell you when they feel warmth, keep eyes on both intensity so as not to go over 1.6 (8/5) and note the time patient says he/she can feel warmth
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