Physiotherapy Equipment: Paraffin Bath
Physiotherapy Equipment: Paraffin Bath
Physiotherapy Equipment: Paraffin Bath
Paraffin Bath
Underpinning Theory
Heat and Cold have potent effects on
tissues.
Metabolic and enzymatic processes are
temperature dependent.
Increase of 30C increases collagenase
activity several fold.
Underpinning Theory
Temperature differences of a few
degrees alter nerve conduction at 50C
to 70C alter blood flow and collagen
activity.
Underpinning Theory
There are three ways to heat or cool
tissue these are:
Conduction
Convection
Conversion
Underpinning Theory
Way to Heat or Cool Best known example in
Tissue Rehabilitation Medicine
Conduction Hot Pack
Convection Hydrotherapy
Continuous Immersion
Clinical Use
Dipping is the most common of the two
approaches. Consists of:
Patient submerging the treated extremity in the bath 10
times with pauses between dips, to permit a layer of
paraffin to solidify.
The treated area is then covered in plastic sheet and
placed in insulating cover for 20 minutes.
Paraffin is then stripped off and returned to the
container.
Clinical Use
Continuous immersion is an alternative approach
and consists of the following:
Treated extremity is dipped in once or twice in paraffin
and kept immersed for 20 – 30 minutes
Clinical Use
Safety Considerations
Thermometers should always be kept in
the reservior and paraffin temperature
should be always checked before use to
avoid burns.
Operating Principles
Operating Principles
A paraffin bath is a thermostatically
controlled reservior filled with 1:7
mixture of mineral oil and paraffin.
Typically held at 52OC to 54OC which is
high but still can be tolerated by the
human body due to the heat capacity of
paraffin.
Operating Principles
The schematic of a paraffin bath is
similar to a hydrocollator the only
difference is its construction and how
hot water is utilized.
Operating Principles
Hydrocollator
Underpinning Theory
Heat and Cold have potent effects on
tissues.
Metabolic and enzymatic processes are
temperature dependent.
Increase of 30C increases collagenase
activity several fold.
Underpinning Theory
Temperature differences of a few
degrees alter nerve conduction at 50C
to 70C alter blood flow and collagen
activity.
Underpinning Theory
There are three ways to heat or cool
tissue these are:
Conduction
Convection
Conversion
Underpinning Theory
Way to Heat or Cool Best known example in
Tissue Rehabilitation Medicine
Conduction Hot Pack
Convection Hydrotherapy
Battery
2pcs 1.5v AA
Schematic Diagram
Frequency
Generator
Schematic Diagram
Pulse Width
Modulator
Schematic Diagram
Power Amplifier
Schematic Diagram
Current Amp
Schematic Diagram
Voltage Control
Circuit Operation
The oscillator that controls the pulse rate of
the output from a variable one - shot
multivibrator with the output pulses from the
multivibrator being coupled through a power
amplifier to the primary winding of which
transformer is connected through a voltage
clamp and variable I.E. mode circuit to the
output leads from the device.
Circuit Operation
Potentiometer are provided to vary the
pulse rate, duty cycle, and output pulse
amplitude as is necessary or desirable
for a particular patient.
Clinical Use
Target area should be clean thoroughly
thru the use of alcohol and cotton
swabs or tissue.
This is needed to prepare the skin for the probe
and make a good electrical contact.
Clinical Use
Once the skin is clean place ultrasonic
jelly on the target area where the
probes are to be placed on.
Clinical Use
Attach the probes they can be fixed into
position thru the use of straps or tape.
Clinical Use
Once the probes are fixed. Plug the
probes into the unit.
Make sure that the Amplitude is at its lowest
and turn the duty cycle and frequency knobs to
the desired value.
And turn it on. Slowly crank up the amplitude
control and advise the patient that there will be
a tingling sensation and say when it becomes
uncomfortable so that the operator / therapist
can stop cranking up the amplitude control.
Clinical Use
Once the Amplitude is set. Turn on the
timer and start the patient on his
treatment.
Clinical Use
Once finished with the use of the
machine and the unit is turned off do
the following.
Disconnect the probe to the unit.
Undo the tapes or straps.
Clean the probe surface with tissue or cotton.
Clean the patients’ skin on the treated area.
Functional Test
Materials Needed
Voltmeter
Oscilloscope
400 ohm test load.
Functional Test
Connect the unit as shown below.
4
TENS 0 osc
0
W
Functional Test
Stimulator Voltage or Current
Test Stimulator Voltage using oscilloscope
The result should be within ±10% of the
manufacturer specifications.
Current can be computed thru the equation
V=IR.
Functional Test
Frequency Generator
Using the test setup obtain the waveform
for each of the predetermined frequencies
on the settings knob.
They should be within 10% of the given
frequencies.
Functional Tests
Duty Cycle
Using the test setup set check if the unit
can provide preset duty cycles. Waveforms
can be viewed thru the oscilloscope and
actual duty cycles obtained from there.
Base Level Maintenance
Base Level Maintenance is conducted
every 12 months and is done to ensure
that the equipment is functioning
properly.
Base Level Maintenance
Check the battery terminals for
corrosion and if found clean them up.
Check the probe cord for electrical
continuity. Remember to shake and flex
the cable when doing this so that any
broken segments in the cable will start
acting up.
Base Level Maintenance
Check the casing if there are any signs
of physical abuse or damage. If so
replace the broken part or repair it by
application of glue.
Check that all indicators are functioning.
Conduct a Functional Test.
Physiotherapy Units
Traction Unit
Underpinning Theory
Traction widens the
interverbral spaces, thus
reducing nerve root
compression by interverbral
disks and associated pain and
burning or tingling sensation in
the neck, arms, shoulders
(when cervical spine is
involved) or the back,
buttocks, legs and feet (when
the lumbar spine is involved).
Underpinning Theory
Forces applied to widen interverbral
spaces are not met by using weights
and studies show that better results
occur when it is done intermettent or
cycled in a sufficient effective force that
is comfortable is used.
Underpinning Theory
Pelvic Belt or Lumbar traction applied to the
patient lying on a bed was inefficient since
friction from the lower body against the bed
dissipated all of the linear force before it
could widen the intervertebral spaces.
This caused the design and fabrication of split
type beds that roll back several inches from
the frame.
Underpinning Theory
For cases where limb bone fracture
patients undergo traction.
It is used to keep the area being healed
clear of the jagged edges from the broken
bones.
It is also done to keep the healthy tissue
from suffering pressure from the broken
bones.
Clinical Use
Let the patient lie down on the traction
bed. Strap down his upper body on the
fixed portion of the bed.
Put the belt on his pelvic area. See to it
that the belt is locked in and doesn’t
slip off.
Give the patient the emergency stop
button.
Clinical Use
Clinical Use
Set the machine time interval, applied
pressure and start the machine.
Monitor patient during the first
application of force.
Ask if he is still comfortable with the
applied force on his pelvic area.
If he is not comfortable stop the
procedure and recalibrate the machine to a
lesser degree of force and begin the
procedure again.
Clinical Use
Once settled in, advice the patient that you
are giving him the emergency stop button if
any discomfort beyond his limits is felt he
may press the button to stop the machine.
When the timer finished alarm sounds. Help
the patient by undoing the straps and belts
and for certain instances help him to get out
of the bed.
Clinical Use
Pressure is
monitored
by a Sensor
constantly
comparing
the measured
pressure to the
desired value.
Theory of Operation
Once the
desired
pressure is
achieved the
compressor
should shut off.
Theory of Operation
When the machine wants to lessen the
applied force on the patient it simply
turns on the pressure relief valve 2 and
air from the piston escapes thru it
lessening the applied force on the
patient.
Theory of Operation
Theory of Operation
When the emergency button is pressed
or the end of the session has occurred
both pressure relief valves 1 and 2 are
turned on. This vents all the pressure
inside the piston and the weight of the
patient helps in clearing most of the air
up thus lessening the applied pressure.
Theory of Operation
Functional Tests
Timer Accuracy
Check the accuracy of the timer with a
stopwatch.
Turn on the unit.
Set the timer to 1 minute. Start the session and
time it with the stopwatch.
Acceptable error should be less than 10%.
Functional Tests
Traction Control Accuracy
Test vertically mounted traction units at 10, 50
and 100 lbs by placing an appropriate set of
weights on a chair under the unit and attaching
them to a coupling device.
Set the machine’s force control to the equivalent
force in each case.
Set its dwell and rest controls for 20 secs each.
The machine should be able to lift each weight off
the chair.
Functional Tests
Traction Control Accuracy
An alternative test can be done by using a
spring scale and tests should be conducted
at 10, 50 and 100 lbs or pressure.
The machine should be able to deliver
forces accurate within 10% of the indicated
value.
Recalibrate the unit if it fails this test
criteria.
Functional Tests
Intermittent Traction
Verify correct operation when intermittent
traction is selected, using the same test
setup as done on the Traction Control
Accuracy Test.
The rope should slacken after 20 seconds and
tighten after 20 more seconds.
Preventive Maintenance
Electrical safety tests should be
performed every 12 months.
A traction unit should be serviced
and tested every 6 to12 months,
depending on its use and age.
Preventative Maintenance
General Routine Tasks
Chassis/Housing
Examine the exterior of the unit for cleanliness and general
physical condition. Be sure that any plastic housings are not
broken, that necessary assembly hardware is present and tight and
that there are no signs of spilled liquids or other serious abuse. If
necessary, clean and lubricate any relevant components at this
time.
Preventative Maintenance
General Routine Tasks
Mounts and Fasteners
Inspect the chassis and all stress-bearing parts. Carefully examine
the basic structure for evidence of:
Undue stress, including metal fatigue.
Fractures.
Integrity of welds.
Size, condition, and tightness of fasteners.
Condition and characteristics of any mounting substructure (i.e., wall,
backing board or plate, chair or treatment table structure).
Corrosion.
Preventative Maintenance
General Routine Tasks
Castors, Wheels and Brakes
If the equipment moves on castor wheels, check their condition.
Remove all lint and dirt from castors and wheels and make sure
that they spin and swivel freely.
Lubricate metal wheels with sewing machine oil.
Check the operation of any brakes and swivel locks.
If the wheels heat up when moved on relatively short distances
this is a sign that the bearings have gone bad and the wheel
should be replaced.
Preventative Maintenance
General Routine Tasks
Mains Power Plug
Examine the mains power plug for damage and corrosion of the
blades. Attempt to wriggle the blades to determine that they are
secure. Shake the plug and listen for rattles that could indicate
loose screws. If any damage is suspected, open the plug and
inspect it. Check the tightness of the wire clamping screws.
For disposable plugs, check the condition of the blades for damage
or corrosion if signs of these are found replace the plug.
Preventative Maintenance
General Routine Tasks
Mains Power Cable
Inspect the mains power cable for signs of damage, cuts or
exposed wires.
If damage is present, we can:
Replace the entire cable.
If the damage is near one end, cut out the defective portion and
reconnect the reusable plugs to the good section. Be sure to wire a
new mains power cable or plug observing correct polarity.
Use stretch tape to cover nicked insulation on a electrically good cable.
But this is to be done if the cable is used in areas not sensitive to
bacteria growth since stretch tape can house bacteria when used over
a period of time to seal nicked insulation.
Preventative Maintenance
General Routine Tasks
Cable Strain Reliefs
Examine the strain relief at both ends of the mains power cable.
Ensure that they grip the cable securely.
Preventative Maintenance
General Routine Tasks
Circuit Breaker and Fuse
If the equipment is protected by a switch-type circuit breaker then
check that it moves freely.
If the equipment is protected by an external fuse then check its
value and type against that marked on the chassis and ensure that
a spare fuse is provided.
Preventative Maintenance
General Routine Tasks
Controls and Switches
Caution:
Before moving any controls and alarm limits, note their positions.
If any of them appear unreasonable, consider the possibility of
inappropriate clinical use or of developing device failure. Discuss this
with clinical users.
Record the settings of those controls that should be returned to their
original positions following the inspection .
Preventative Maintenance
General Routine Tasks
Indicators and Displays
Confirm the operation of all lights, indicators, meters, gauges and
visual displays on the unit.
Ensure that all segments of a digital display function.
Preventative Maintenance
General Routine Tasks
Alarms
Test the activation of alarms, if so equipped.
End of Session
Emergency Stop
Preventative Maintenance
General Routine Tasks
Labeling
Check that all necessary placards, labels, conversion charts and
instruction cards are present and legible.
Preventative Maintenance
Specific Routine Tasks
Accesories
Carefully examine operating levers, chains, cables, ropes and
spreader bars used to transfer the machines linear motion to
the patient harness.
Examine ropes for wear and fraying.
Cables should be clean and free of corosion and without
fishhooks, and kinks
Check S-hooks, chain links, and spreader bars for cracks,
bends and other evidence of weaknes.
Tighten, repair, or replace components as necessary.
Preventive Maintenance
Specific Routine Tasks
User Calibration/Self Test
Verify operation of these features, where applicable.
Preventive Maintenance
Specific Actions
Clean the exterior.
Perform Functional Test on Unit.
Electrical Safety Test
Traction Unit is a Class I Body Protected
device. It requires:
L1 and L2 Insulation Test.
Ground Resistance Test
Current Leakage Test.
Physiotherapy Units
Ultrasound
Underpinning Theory
Therapeutic ultrasound units convert
electromagnetic energy to high
frequency sound waves which penetrate
tissues to produce pain relief through
thermal and non-thermal physiological
reactions.
Underpinning Theory
The conversion of energy occurs in a
transducer.
Parts of a Physiotherapy
Ultrasound Machine
TGS Ultrasound Machine
Generator Head
Parts of a Physiotherapy
Ultrasound
Wattmeter
Power On Switch
Time Indicator
Time Control
Output Enable Switches
Pulse Duration Selector
Amplitude Control
Equipment Operation
There are two components of a
therapeutic ultrasound machine
1. Generator
Creates the electrical energy, whose parameters are
set by the user, to treat the patient.
2. Transducer
Is located inside the head and it converts the
electrical energy into sound waves which are
absorbed by the patient on a particular location on
his body.
Equipment Operation
When the patient is receiving
ultrasound it is better to apply
ultrasonic gel to the particular location
being treated.
This is due to the sound wave’s
tendency to attenuate or reflect when
there is a change in medium. Ultrasonic
gel makes the space between the head
and the body seem very minimal.
Equipment Operation
Modes of Operation for the device can
be:
Constant
Pulsed
60 pulses / sec
50 %
Clinical Use
Physiotherapy Ultrasound are used by
Physiotherapists in the following manner:
Prepare the site of treatment by removing clothing
on that area and applying Ultrasonic gel.
Plug in the physiotherapy ultrasound and select
the desired frequency, mode of operation,
amplitude and duration of session.
Apply the head on the area with the Ultrasonic gel
and move it along this area until the units timer
runs out.
Clinical Use
There are no temperature tissue
indicators employed by a therapeutic
ultrasound so it all depends on patient
feedback if it is too hot for their
comfort.
Clinical Use
Moving the head along the area treated
with ultrasonic gel causes the gel to
move away from the target area due to
mechanics of moving the head around.
So it is advisable to use a tongue
depressor to collect and move back the gel
on the target area during treatment.
Clinical Use
After using the physiotherapy
ultrasound, the physiotherapist must
clean off the ultrasonic gel on the:
Patients skin on the treated area for
hygiene purposes.
Head of the ultrasound device, this is to
prevent corrosion of the device transducer
and other parts.
Assembly / Disassembly
Guidelines
Make sure to take down the position of the control
knobs before opening up a unit.
If adjustments are to be done, take note on how
many times the trimmers are turned and in what
specific direction they where turned.
Collect all the screws into one container as to
minimize the possibility of getting one piece lost.
When re-assembling the unit back, do not over
tighten the screws as this may cause them to lose
their threads or break the plastic housing of the unit.
Assembly/Dissassembly
Guidelines
Consult the service manual for specific
instructions on how to take off and place
back boards and screws on the unit.
If there are multiple boards and connectors
on the device label or draw where each one
of the cable goes to before disconnecting it.
Ensure that no cables or boards are caught
on or squeezed by the casing when re-
assembling the unit together.
Assembly / Disassembly
Assembly / Disassembly
Amplitude
Control
- Transducer
Tank Circuit - Power Supply
- Pulse Width
Control
-Frequency
Generator
Wattmeter
- Timer Circuit Assembly
Functional Tests
Equipment Needed:
Stopwatch
Ultrasound power balance or meter (1 to 30
watts.) Can be a homemade one.
50 to 500 ml of degassed water / reverse
osmosis water.
Functional Tests
Ultrasound Power
Connect the physiotherapy ultrasound to
the wall socket and connect its head.
Take out the power meter and place it on a
lever work area. This is ensured by the
level indicator on the back of the machine
or if none is present on the device it can be
from a inclinometer or carpenters level.
Functional Tests
Ultrasound Power (continued)
Connect the power meter to the mains connection.
Calibrate the power meter using weight or the
other specified calibration devices that comes with
it.
Functional Tests
Ultrasound Power (continued)
Once the unit is set to zero. Place the
remaining parts inside the meter and fill it
with degassed water.
Functional Tests
Ultrasound Power (continued)
Turn on the unit and set it into the highest
setting and place the head into the power
meter via the port hole on top of the
meter.
Functional Tests
Ultrasound Power (continued)
A clamp assembly may be used to maintain
the head stable and so as not to disturb
the water when obtaining the values.
Functional Tests
Ultrasound Power (Alternative Tool)
If a power meter is unavailable then we
can use a home made meter out of some
plastic, paper, and steel wires.
Functional Tests
Ultrasound Power (Alternate Tool)
Same procedure applies.
Instrument must be in level working area.
Use degassed water to do the measurement.
Place the head to the port and watch as the
pointer moves. This is more or less the value of
watts per square centimeter of the head output.
This test is not accurate but will let us see
the output of the head if there is any or a
larger amount.
Functional Tests
Functional Tests
Ultrasound Power
The acceptable error in the measured and
set value should be within +/- 20% of the
watts the unit was set to.
Functional Tests
Ultrasound Power
If the error is too high then it can be
adjusted by rotating potentiometers inside
the system that control the output
amplitude of the signal.
Trimmers control
the low and high
output power of
ultrasound.
Functional Tests
Ultrasound Power Recalibration
In case that the power output is good
enough but the display module is deemed
as too high or too low it can also be
recalibrated thru the us of trimmers.
End of Session
Preventative Maintenance
General Routine Tasks
Labeling
Check that all necessary placards, labels, conversion charts and
instruction cards are present and legible.
Preventative Maintenance
Specific Routine Tasks
Head Cable, Head, and Connectors
Inspect the cable connecting the head and generator for breaks,
signs of stress, exposed parts, and twisted portions.
Verify that all the pins on the connector are not bend or broken.
Examine the Head Assembly. Ensure that there are no breaks in the
handle. And air gaps on the transducer section.
If it is suspected to be fractured or has any dents or air gaps on the
transducer assembly then open up the unit and inspect eh internal
parts of the Head for contamination and corrosion.
If contaminated or corroded then either replace the assembly or re-
solder the connections.
Preventive Maintenance
Specific Routine Tasks
User Calibration/Self Test
Verify operation of these features, where applicable.
Preventive Maintenance
Specific Actions
Clean the exterior.
Perform Functional Test on Unit.
Electrical Safety Test
Physiotherapy Ultrasound is a Class II
Body Protected device. It requires only
a L1 and L2 Insulation Test.