Celleration, Inc.

Sound: sound is periodic pressure waves propagating within a gas, fluid, or a solid generated by a vibrating object.

Ultrasound: Ultrasound is sound with a frequency above the normal upper limit of human hearing, typically considered over 20,000 cycles / second or Hertz.

Acoustic Microstreaming: the movement of fluids along cell membranes which occurs as a result of the ultrasound energy creating mechanical pressure changes within the tissue.

Cavitation: is the formation and collapse of gas and vapor filled bubbles or cavities in a fluid. The process ("cavitation") results from the creation and collapse of microbubbles in the liquid. The effect of stable cavitation can result in diffusional changes along cell membranes and thereby alter cell function.

Hz: the symbol for "hertz", the internationally accepted unit for measuring cycles. 1 Hz = 1 cycle per second. KHz is the symbol for kilohertz (1 KHz = 1,000 Hz) and MHz is the symbol for megahertz (1 MHz = 1,000,000 Hz.).

Intensity: the amount of energy transferred to the tissues measured in watts (W) divided by the area of the sound beam measured in square centimeters. Therapeutic applications generally operate in ranges of intensity from 0.1 to 2.2 W/cm² with the maximum intensity for therapeutic applications established by the World Health Organization (WHO) to be 3.0 W/cm². Intensities over 3.0 W/cm² are not considered therapeutic and are typically used in such surgical applications as ultrasonic scalpels and in tissue emulsification.

Diagnostic Ultrasound or ultrasonography: a technique that uses high frequency ultrasound and the echoes to generate an image of the body and/or internal organs. The technique is similar to the echolocation used by bats, whales and dolphins, as well as SONAR used by submarines. The machine sends out high-frequency sound waves, which are reflected off the various body structures. A computer receives these reflected waves and uses them to create an image. Unlike an X-ray, there is no ionizing radiation exposure with this test.

Therapeutic Ultrasound: Therapeutic ultrasound is typically associated with Megahertz (MHz) levels in the range of 1 to 3 MHz and has been used to treat soft tissue for over 40 years.

High Frequency Ultrasound: Ultrasound in the range of 1-3.0 MHz provides clinicians an opportunity to select different ultrasound frequencies based on tissue type and the depth of penetration needed for various applications. Ultrasound diathermy uses ultrasonic energy to produce a warming effect. Historically, the safety of high frequency ultrasound for therapy purposes has been shown through numerous published articles and clinical usage. ^8-9,14,24-27

Ultrasound may be used for its thermal effects in order to relieve pain and muscle spasm to increase tissue extensibility, which may be of use in combination with stretching exercises to achieve optimal tissue length. Lengthening with thermal doses of ultrasound has been demonstrated in the ligament of normal knees and in scar tissue. Once the tissue has been heated to an adequate level (considered to be 40–45°C), the opportunity to stretch the tissues lasts for up to 10 minutes before the tissue cools.

Low Frequency Ultrasound: Low frequency, 20-100 KHz ultrasound devices have been investigated during the past three decades for multiple clinical areas ranging from fracture repair, surgical cutting applications, cauterizing soft tissue, melting fatty tissue and cleaning instruments. It is well recognized that ultrasound of a lower frequency has a longer wavelength, and consequently has much deeper tissue penetration. Long Wavelength Ultrasound has been widely used with the most benefit in acute conditions; however, in chronic conditions, regular therapy can result in the complete relief of some symptoms as well. Multiple studies using KHz US in wound management have demonstrated numerous effects of ultrasound in the treatment of wounds. ^21-24

Ultrasound Mechanisms of Action: The specific manner in which ultrasound works has not been proven clinically, however the general theoretical principles behind ultrasound give a clue as to how MIST Therapy may work in wound healing. The acoustic pressure wave that transfers ultrasonic energy to the wound bed utilizes the atomized mist to promote surface cavitation or "ultrasonic effervescence". This can visibly been seen in the form of a bubbling or frothing action at the tissue surface. This visible non-thermal mechanical cleansing action results in the creation and dissipation of bubbles that in turn release energy to the tissue or creates surface tension at the cellular level. This type of cellular stimulation is often referred to as microstreaming. Microstreaming may alter cell membrane structure, function and permeability, which has been suggested to stimulate tissue repair. Theoretically, these potential mechanisms of action increase cell wall diffusion capabilities, and create a gentle "shaking" of the cells, which in turn release necessary cellular components, stimulating the natural cascade of wound healing.