Quality improvement in physiotherapeutic treatment in the United States is a requirement in getting evidence-based clinical results. One of the current modalities used in physiotherapeutic treatment in the US is therapeutic ultrasound. In physical therapy, ultrasound is used in healing bone fractures, stimulate growth of bones, trauma, arthritis, and chronic inflammation. Additionally, ultrasound therapy is used in tendon injuries that are superficial as well as in the treatment processes of scrapes, cuts, burns, sunburn, and fat removal with the intention of rejuvenating the skin. The effectiveness in the treatment process depends on the increase in the local temperature aiding the process of vasodilation and washout of poisonous substances. The painful shoulder is one of the problems that prolonged the rehabilitation program for individuals with hemiplegia. However, the application of various techniques in the treatment process did not yield effective results, which left the patients unsatisfied. The adoption of the therapeutic ultrasound by the physical therapists made the patients hopeful, with the understanding of the various benefits of the therapy modality. These benefits are stimulating bones growth, healing bone fractures and arthritis.
Explanation and Background
Physical therapists apply therapeutic ultrasound in the treatment of tendonitis or bursitis of the shoulder. According to Izadifar et al. (2017), therapeutic ultrasound involves an unfocused beam that is used together with the coupling gel in warming muscle tendons and other tissues in the treatment process. Therapeutic ultrasound uses sound waves in the treatment of inflammation, pain, and muscle spasm. The goals of the treatment include improving blood flow, stimulating the tissues beneath the surface of the skin and accelerating the healing. Ultrasound is also applied in phonophoresis, which is aiding the transportation process of a compound in an individual’s skin. Izadifar et al. (2017) assert that there is a modest level of efficacy in ultrasound therapy, which is a low-risk process thus allowing patients to highly benefit. The waves of the ultrasound are applied to an individual's tissue using a round-headed transducer in the stimulation of ligaments, joints, tendons, and muscles. The gel applied to the individual's skin acts as a conductor of the ultrasound waves and decreases friction.
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Ultrasound in Practice
The ultrasound passes through the skin, which, th rough cavitation and vibration, heats the body tissues, soothes inflammation, and relieves pain. The heating of the tissues results in tissue relaxation, increased one's blood flow while decreasing chronic inflammation and local swelling (Izadifar et al., 2017). Additionally, the increase in the blood flow also helps in delivering nutrients and oxygen to the tissues, eradicates cell waste, thus aiding the process of healing. Ultrasound is also capable of decreasing pain and sensitivity, which is related to the muscular trigger points (Izadifar et al., 2017). The ultrasound waves in physical therapy increase the applied drug delivery by improving the absorption of anti-inflammatory agents into the body t issues.
Ultrasound treatment is carried out at low-frequency ranges in physical therapy, in which it also varies depending on the depth of the body part being treated. Izadifar et al. (2017) explains that a low frequency leads to a large wavelength as well as a deep penetration in the body. According to Izadifar et al. (2017), the absorption of substances in which sound waves travel, power and frequency affect the amount of energy released in the areas being treated. Ultrasound as a therapeutic modality involves the deposition of energy in the tissues to induce a variety of biological impacts.
Risks and Benefits
The application of typically low-frequency ultrasound, which is external, tends to be promising , a lthough there are potential deleterious side effects. For instance, the technique in thrombotic diseases is associated with an increased brain hemorrhage in cases when 3 00kHz u ltrasound and tissue plasminogen activator are used (Izadifar et al., 2017). Other undesirable bioeffects in the ultrasound treatment occur in thermal-based therapies in which individuals suffer from burns (Izadifar et al., 2017). More so, hemorrhages are an undesirable bioeffect originating from lithotripsy, a form of mechanical-based therapy (Izadifar et al., 2017). Therefore, risk minimization should be considered as a way of ensuring that there are optimal benefits to the risk ratio to the patients in the various therapeutic applications.
One of the potential benefits of applying therapeutic ultrasound is that it has well-defined risks and benefits, thus presenting a tractable safety problem to the clinicians. According to Izadifar et al. (2017), the main problem affecting risk minimization in therapeutic ultrasound is that safety information is not well delivered such that it leads to confusion. For instance, the information is not well-delivered if it prevents commercial organizations from gaining profits from the treatment approach. Therefore, in managing the risks authoritative groups, such as the AIUM can be involved in communicating the risks to the medical ultrasound community.
Ultrasound exposure leads to the vaporization of tissues, coagulative necrosis and mild heating. However, the risks can be minimized through the application of various techniques. For instance, in ultrasound-induced heating, in which temperature elevations, can cause undesirable effects, the principle of (ALARA) can be employed, which ensures there are generally short duration exposure and limited temporal average intensities (Marry t al., 2018). Therefore, in treating the highly absorbing tissues such as tendons, the unfocused heating can be minimized as a way of preventing injuries. More so, one can reduce the risks through the application of focused beams in concentrating the heat until the tissue is coagulated to allow the tissue ablation.
Nursing Scope of Practice
An effective medical practice requires the nursing practitioners to consider all the benefits and risks involved in a particular diagnostic examination, thus take all the precautionary measures to ensure the patients maximally benefits with low risks. The registered nurses should encourage diagnostic ultrasound if it clinically benefits the patients and discourage the cases that highly risks the life of the patients as well as theirs. However, the equipment used ultrasound therapy has portrayed an enviable safety record (Marry et al., 2018). In most countries there are no regulations on the application of ultrasound therapy equipment. Additionally, comparing the equipment used in ultrasound therapy to other imaging equipment, they are cheaper. Therefore, lack of regulations and low costs of equipment used in ultrasound can often mean that the personnel involved in the diagnostic approach lack adequate training.
The application of ultrasound equipment by nurses who are not properly trained can lead to problems in performing tests as well as interpreting the obtained results. Therefore, registered nurses involved in the ultrasound therapy need proper training and education on ultrasonography. Getting maximum clinical benefits from ultrasound therapy, while ensuring an efficient application of healthcare resources a registered nurse needs proper skills for both performing the examinations and interpreting the results (Marry et al., 2018). Therefore, the effective use and safety in ultrasound therapy depends greatly on the nurse, who majorly impacts the overall benefit from the examination.
Patient Education
Ultrasound therapy is used in the treatment of various conditions; hence, patients can try the therapy and assess whether the approach is improving their functionality and pain before deciding on continuing the treatment. According to Marry et al. (2018), only licensed therapists are approved to apply therapeutic ultrasound to minimize misdiagnosis and unnecessary examinations. However, the model of treatment has the potential to cause harm if the heat remains in the same locality for a long period. Therefore, patients need to understand the effects of the heat on their bodies, thus making informed decisions from all the information presented to them by the registered nurses after reviewing their diagnosis. Another potential risk that the patients are exposed to with therapeutic ultrasound are the rapid pressure changes, which could result in damage to one's cellular activities.
Therapeutic ultrasound is considered a generally safe mode of treatment for various conditions. However, therapeutic ultrasound is risky in the treatment of certain conditions such as near a pacemaker, over open wounds as well in expectant women (Marry et al., 2018). Therefore, with the application of energy in such circumstances having the potential to cause damage, the patient needs to be well aware of the risks they are exposed to. For instance, the nurses can use simplified language to discuss the risks of the mode of treatment to the patient depending on their condition. A cultural consideration in the treatment process, is asking the patient about importance of family ties in their treatment process. For instance, a troubled patient, such as a wife who is torn between receiving an ultrasound treatment and is in a risky condition such as pregnancy, can be encouraged to discuss the issue with the marriage partner to make a good decision. The nurse can assess the success of the talk with the patient if she is able to make a decision after the discussion with the partner.
Conclusion
Therapeutically ultrasound can be used in treating various conditions. For instance it is used in treating bone fractures, stimulating growth of bones, trauma, arthritis, and chronic inflammation. More so, it is used in treating tendon injuries that are superficial as well as in the treatment processes of scrapes, cuts, burns, sunburn, and fat removal with the intention of rejuvenating the skin. A registered nurse who is informed of the patient-centered type of care involves the patients in the process by informing them of the potential benefits of the mode of treatment as well as the risks, such as burns and the development of hemorrhages. Additionally, the nurses need to understand their roles and have the knowledge and skills in ultrasonography for effective results in ultrasound therapy.
References
Izadifar, Z., Babyn, P. & Chapman, D. (2017). Applications and safety of therapeutic ultrasound: current trends and future potential. Clinical Research Open Access, 3(1), 1-8.
Lioce, E. (2017). Therapeutic Ultrasound: Physical Basis and Clinical Assessment . [Ebook] Retrieved 31 March 2021, from https://www.intechopen.com/books/clinical-physical-therapy/therapeutic-ultrasounds-physical-basis-and-clinical-assessment
Marry, Z., Afzal, M., Sehar, S. & Gilani, S. (2018). Improving nurses knowledge and attitude regarding early mobilization or post-operative patients. Journal of Health, Medicine and Nursing, 51(1), 88-100.
