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Magnetic field is brought to tissues with the help of a inductor-disk and inductor-cable. An
inductor-disk (the fig. 10) represents a flat spiral consisting of three coils of a copper wire
made in a plastic skeleton. The inductor-cable is a copper wire in rubber isolation, it is possible
to make a various kind of a spiral of it (fig. 11) - flat, cylindrical or as a loop. Between inductor
and body of the patient leave a backlash in 1 -2 cm which is provided with that on a part of a
body, that undergoes the influence, under inductor we put combined in some layers a towel or
a sheet. The creation of a backlash considerably reduces heating of superficial tissues, which is
connected with the influence of an electrical field.
At use of an inductor-disk, inductor-cable as a flat spiral or loop a magnetic field penetrates in
a tissue on depth 5-8 cm. At use of inductor-cable as a cylindrical loop the magnetic field
influences all the volume of a tissue (of extremity or trunk). Devices: - "IKV" (short-wave
inductothermy).
The device is supplied with inductor-disks (small and large) and inductor-cable. By the
additional order the complete set of gynecological applicators is delivered: vaginal, lumbar
(small, average and large), collar.
The basic biophysical processes. The magnetic field, penetrating the tissues, induces in
them electrical currents named as induction currents, vortical currents or currents Fuko. The
more is the electroconductivity of a tissue, the current of greater force is formed in it. The
occurrence of vortical currents is accompanied by heating of tissues. The more
electroconductive is the tissue, the more intensively it will be heated up. First of all lymph,
blood and parenchymatous organs will be heated up. The skin is heated up unsignificantly, its
hyperemia does not arise. Probably, the formation of heat in a skin mostly depends on action
of an electrical component of an electromagnetic field. Non-thermal (oscillatory) effect in
inductothermia is expressed poorly, but it should be taken into account.
The basic physiological reactions and medical effect are connected first of all with
effects of heat, which defines the indications to application of this method in physiotherapy.
These effects are the following: antispasmodic, sedative, intensifying blood and lymph
circulation and metabolism. Resorbable and regenerative effect of heat (in particular at
inflammatory processes) is connected with the last effect. In connection with available
oscillatory effect it is possible to indicate inductothermy at earlier stages of inflammatory
process, than heat therapy. For the account of oscillatory effect it is possible to relate some
side-effects of inductothermia: deterioration of coronary blood flow at ischemic disease of
heart, deterioration contractility and conductivity of myocardium at diseases of a muscle of
heart, reduction of arterial pressure. On the other hand, with oscillatory effect is connected
activation of glucocorticoid function of adrenal glands, increase of phagocytic function of
neutrophyls, in some researches the increase of a titer of antibodies in blood is shown. The
basic indications to application.
1. Inflammatory processes (without suppuration) in a stage of the
resolution.
2. Degenerative-dystrophic and inflammatory diseases of musculoskeletal system.
3. Disease and trauma of peripheral nervous system.
4. Hypermotor dyskinisia of internal bodies.
Fig. 15 Biodosimeter
We distinguish the following types of dozes: suberythema, that is not causing
erythema of skin, and erythema. Suberythema doze is a part of a biodoze, which is accepted
for designating in simple fraction (from 1/8 up to 7/8 biodozes). Among erythema dozes
allocate small or poorly - erythema (1-2 biodozes), average or erythema (3-4 biodozes), large
or hypererythema (5-8 biodozes).
The general irradiation will be carried out usually suberythema dozes, and local -
erythema. By erythema dozes we irradiate during one procedure a site of skin, area isn't more
than 800 sq cm or some sites of the same total area.
3. Laser radiation.
The lasers are optical quantum generators. The name they have received from a
combination of the first letters of a phrase in English "Light amplification by stimulated
emission of radiation” ("LASER"), that the amplification of light is translated as "as a result of
the compelled radiation".
Atoms, of which the various substances consist, in the elementary kind represent
system consisting of a nucleus and rotating around it electrones. In usual conditions this
rotation occurs on constant, so-called basic (stationary) orbits. Thus the atom has a minimum
quantity of energy. The external influences can give to electrone the additional energy
allowing it to overcome an attraction of a nucleus and to proceed into more removed orbit. The
atom will proceed in the exited condition. But this condition is unstable. Through a very short
interval of time (about 10~b sec) electrone comes back to a former orbit, having allocated the
absorbed energy as quantum of light (photon). Such spontaneous transitions of electrone from
one orbit to another are accidental, are independent from each other, occur in different time.
In usual conditions the number of the atoms which are taking place in an exited condition, is
insignificant, therefore energy of spontaneous radiation is insignificant. In a fig. 16 the circuit
of the elementary optical quantum generator (laser) is submitted.
Fig. 16 Circuits of the optical quantum generator: 1 - working body (active substance);
2 - system of excitation ; 3 - power supply; 4-system of cooling; a 5-laser ray.
In lasers the main component is the working body, which represents by itself active
environment or active substance: various gases, liquids, firm bodies, semiconductors. The
substances understand activity of environment or their such condition, when the number of
the atoms which are taking place in an exited condition, exceeds number of atoms staying at
the basic power level, that is in a quiet condition. In the exited condition a working body
results more often by influence of optical or electrical energy.
The following stage of process - transition of atom from exited to the basic condition.
This transition can occur not only spontaneously, but also under action of electromagnetic
waves. Artificial influence by electromagnetic irradiation upon working part allows making the
process a controlled one. In this case according to the principle, formulated by Einstein, the
exited atoms irradiate photons with the same frequency, phase and in the same direction as
the electromagnet waves provoking this irradiation. Transitions of electrons under the
influence of external irradiator are called forced ones, and corresponding irradiation is also
forced one. At presence of great amount of quanta of external irradiation and great amount of
exited atoms in the working part their transformation from exited to primary state occurs and
this leads to laser irradiation. In semiOconductor lasers occurs the direct transformation of
electric energy into laser irradiation that allows making the device quite small.
As distinct from other types of light flow laser irradiation is monochromatic, coherent
(it means that phase of waves of light coincide in space and time). High degree of coherence
difines strict direction of laser irradiation, letting to concentrate it at small area.
Lasers are classified according to the following physico-technical parameters:
1) Active substance (working body) - solid-state, gas-state, fluid, semi-conductive.
In physiotherapeutic devices most frequently are used helium-neon lasers and carbon dioxide
lasers;
2) The length of wave of irradiation - UV range, visible range, IR range, multiple-
tuned range;
3) Mode of irradiation - continuous, impact.
Devices:
- “Yagoda", laser physiotherapeutic plant (LPP). Helium-neon laser, mode of irradiation
is continuous with power up to 10mWt, length of wave is 0,63mkm;
• "Raskos", helium-neon laser, mode of irradiation is continuous
with capacity up to 15mWT, length of wave is 0,633mkm;
• "Galamed" is similar to "Raskos", but the capacity is up to 20 mWt;
• "Uzor" is laser therapeutic device (LTD), arsenid-gallic laser, mode of
irradiation is impact (80, 150, 300, 1500, 3000 Hz), capacity of impulse is up to 2 wt, length of
wave is 0,89mkm (IR range). Nowadays there are many types of devices are produced. There
are also universal, which are made for use in physiotherapy and in surgery, for example
"Rasbor" LGM-2. Some devices are
completed by optical fibers for introduction into vein, for example LDBI (Laser device of blood
irradiation). There are devices for combined influence by laser irradiation and other physical
phactors, for example MLTD (Magnet-infrared laser therapeutic device) for treatment by
constant magnet field, non-coherent light flow of IR sphere and laser impact irradiation of IR
range.
Irradiation is brought to tissues distantly or by contact. Different types of irradiators
are grouped by prof. V.I. Korepanov (1994) in the following way:
a) contact
b) contact with compression (compression provides greater depth of
penetration of irradiation)
c) contact-mirror (special reflectors help maximum absorption of
irradiation by tissues, it does not influence the staff)
d) intravascular
e) intraorganic (optical fiber is inside stomach, urinary bladder etc)
f) intracavitary (optical fiber is in pleural or abdominal cavity, cavity
of cyst, abscess etc);
g) extracorporal (distant irradiation of infusion medium, auto- and
donor blood).
The basical biophysical processes.
Thermal effect of laser irradiation is studied well enough. It has a lot in common with
thermal effects of other sources of light of visible and IR range, but thermal effect of laser
irradiation has a number of specific peculiarities. Different biological objects absorp irradiation
of different length of wave. Laser irradiation is monochromatic, its absorption is selective. IR
irradiation of remote zone is absorbed first of all by water. Irradiation of visible sphere of long
wave about 7mlm is absorbed by pigmental formations, molecules of hemoglobin quite well.
Irradiation of the nearest IR zone warms up the membranes of the cells strongly. As a result of
local warming of membranes there appeares gradient of temperature in paramembrane areas
that evokes thermodiffusion outflow of sodium and potassium ions. As a result of it the canals
of cellular membranes open up, the transport of ions and active molecules increases. Changed
electro-chemical ionic balance increases the energy of cell. At influence with impact laser
irradiation the formed warmth has no time to spread upon the neighbouring tissues and fluids.
At great capacity of impulse the momentary warming evokes a kind of explosion of elements
of tissue.
Photochemical reactions are stimulated by visible and UV irradiation. Molecules turn
into excited state as a result of inner transformation of position of atoms. There is observed
the change of membranous potential of cell, charge of its electric field. Free radicals are
formed in tissues intensively. Laser irradiation as distinct from usual light provides selectivity
of stimulation of biochemical compounds, having narrow stripes of absorption.
Mechanical action is peculiar to laser irradiation of high capacity in impact mode. As a
result of direct influence of impulse there appears blast wave in tissues. Its consequence is
formation of sites of compression and depression, spreading deep into tissues. There are
different theoretical possible reasons of mechanical strain in tissues may be considered: a)
light pressure, the value of which is maximum, if the whole irradiation is absorbed at the
surface of tissue; b) pressure of feedback - emission of substance from a surface of irradiated
object towards to a laser ray and occurrence of a pulse of feedback working on a direction of a
ray; c) electrosticking - redistribution of a charge in dielectric, that conducts to occurrence of
the mechanical rotating moment; d) sudden overheating of the irradiated site of a tissue
accompanied by its fast volumetric expansion, that results in occurrence of elastic fluctuations
of a ultrasonic range in boundary areas.
The basic physiological reactions and medical action.
The depth of penetration of laser radiation into tissues depends mainly on two factors;
the spectral characteristic of radiation and structure of tissues absorbing it. The same laws
here are observed, as well as at influence of a usual light flow of IR, seen and UV areas. In the
whole penetrating ability of laser rays is estimated in 2-3 mm, but the rays of nearest IR range
with length of a wave from 0,8 up to 1,2 microns allow to influence depth 5-6 cm. The share of
the reflected radiation can make from 5 up to 40 %. In physiotherapy the radiation of nearest
IR and red part of visible range is used mainly.
The large capacities of laser radiation destroy tissues due to heating and mechanical
action. They are used in surgery: "laser scalpel ", designed in 1964. In physiotherapy the
radiation of low power, so-called low intensity laser radiation is used. Its influence on tisssue
and organism as a whole in many respects reminds action of usual light of appropriate length
of a wave. But the special physical characteristics of laser radiation define a number of other
laws of its action, its higher activity. The basic reactions are observed in skin and superficial
tissues. As a whole low intensity laser radiation is stimulator of cellular activity nonspecific
biostimulator of reparative and metabolism processes in tissues. In cells enzymatic system is
activated, the accumulation of DNA and glycogene is accelerated, the respiratory activity of
mitochondrion raises. The consumption of oxygen by tissues is increased. The stimulating
action is especially precisely shown in tissues which are taking place in a condition of
reparative regeneration. At local application can be observed antiinflammatory action of laser
radiation. The formation of cellular shaft around of the center of an inflammation due to
stimulation of activity of neutrophils and macrophages, acceleration of prolypheration of
fibroblast is made active. Edema of tissues decreases and the broken microcirculation is
normalized. The certain meaning has bacteriostatic effect. The laser radiation influences on
nervous receptors, changing their excitability and rendering anesthetic effect. The effect of
stimulation of regeneration of a nervous tissue is clearly shown. Alongside with local changes
of tissues the laser radiation stimulates non-specific protective systems of organism and
adaptive response by neuroreflex and humoral to mechanisms. Such stimulation is expressed
at more extensive influences, rather than local, punctated. The irritation of receptors of skin in
area of reflexogenic zones changes character of impulses into cerebral cortex and subcortical
structures. In reply to it is formed regulating reaction from the side of the central nervous
system. At the same time hypothalamohypophysial suprarenal system and other endocrine
glands are active. Compensatory and adaptive reactions are directed to restoration of broken
homeostasis. These effects depend on an initial condition of this or that system that explains
apparent universality of therapeutic action of laser radiation at various diseases. The activation
of system of immunity, desensibilizing effect, increase phagocytic activity of neutrophils and
macrophages is observed also. All taken together raises protective adaptive reaction of
organism. Thus, the influence of laser radiation at all levels of organization of living matter is
established: subcellular, cellular, tissue, organ, system and organism. This complex and
multivariate action is investigated not completely.
The basic indications to application.
1. Lingering non- healing wounds, trophic ulcer.
2. Purulent - inflammatiry processes in soft tissues (at presence of a drainage):
furuncules, phlegmones, abscess.
3. Skin diseases: eczema, neurodermatitis, psoriasis, herpetic infection.
4. Infammatory, traumatic, metabolic-dystrophic diseases of musculoskeletal system,
including fractures of bones (for acceleration of consolidation), defeat of periarticular tissues
and sinews.
5. Inflammatory diseases of mucous environments of a cavity of a nose,
gullet, mouth, including tonsillitis.
6. Diseases of peripheral nervous system, including the ones accompanied by pain.
7. Diseases of internal organs: stomach and duodenal ulcers, inflammatory defeats of
bronchus lungs system, essential hypertension (influence from the appropriate skin zones).
The basic contra-indications to application.
Specific contra-indications to application of cold laser radiation are not revealed. Look
section "General contra-indications to physiotherapy". Dosage according to:
1) density of a flow of capacity of radiation in mWt on 1 sq cm of the area (from 0,3 up
to 10 mWt/sq cm);
2) duration of procedure (influence on one field about 5 minutes, on
some fields - total time of influence about 30 minutes);
3) On repetition of realization of procedures (daily);
4) By quantity of procedures on a rate of treatment (from 3 up to 15).
The note: at intravenous irradiation of blood capacity at an end face of light-carrying fiber up
to 5 mWt, time of an irradiation is about 30 minutes. The procedures daily or with breaks of
some days are possible. Take into account that the restoration of structure of endothelium
after a 30-minute irradiation occurs in 6 hours.
Ultrasound therapy.
Ultrasound is a version of mechanical energy and represents mechanical fluctuations
of elastic environment by frequency more than 16 khz, which are not perceived by human ear.
These fluctuations are transferred as longitudinal waves, which cause alternate compression
and rarefaction of environment or substance (fig. 17). The more is capacity of transmitted
energy, the bigger is the amplitude of deviations of particles of environment from an initial
condition. Distance including one area of compression and one area of rarefaction, makes
length of a wave, which will be back proportional to frequency of fluctuations.
The ultrasonic waves of low frequencies are distributed spherically. In process of
increase of frequency of fluctuations and, according to this, reduction of length of a wave, the
beam of ultrasound waves becomes more rectilinear. The straightforwardness of distribution of
ultrasonic waves of high frequency (800 - 3000 khz) causes their application in physiotherapy.
These waves are distributed in parallel to each other, they can be concentrated on the limited
site. The law of distribution of high-frequency ultrasonic waves comes nearer to law of
distribution of light: absorption, refraction, reflection from border of two environments.
Absorption of ultrasonic waves in different tissues is various. For example, factor of
absorption of ultrasound for bone tissue is 12-15 times higher in comparison with muscular
tissue. As a whole the higher is frequency of fluctuations, the more intensive is absorption, the
less is the depth of penetration. Ultrasound of high frequencies is intensively absorbed by air.
Its slightest layers between radiator and surface of a skin detain ultrasonic waves. In this
connection at medical influence use vacuum contact environments: liquid paraffin, glycerin,
lanolin (fig. 18). When the dense contact between oscillator of ultrasound and surface of a skin
(area of hand, feet) is impossible, will carry out remote influence through water with a
backlash 1-2 cm.