New Innovations In Pain Control Anne Hartley BPHE, CAT(C), DO (MP) ©Anne Hartley 2011
Capital Sports Therapy Symposium <ul><li>Thank you to KineMedics  </li></ul>copyright Anne Hartley 2011
InterX <ul><li>My experience with the unit </li></ul>copyright Anne Hartley 2011
Interactive Neurostimulation <ul><li>Non-invasive, interactive neurostimulation for the treatment of acute, subacute and c...
Latest Pain Control Device <ul><li>Alternating current, high amplitude </li></ul><ul><li>Pulsed sinusoidal biphasic wavefo...
Skin Impedance <ul><li>Works with the skin impedance  </li></ul><ul><li>Concentric electrodes </li></ul>copyright Anne Har...
Skin Impedance <ul><li>The amplitude, symmetry and damping of each pulse depends on the skin impedance. </li></ul><ul><li>...
Interactive Technology <ul><li>The unit displays the differences in skin impedance when applying the current. </li></ul><u...
copyright Anne Hartley 2011
copyright Anne Hartley 2011
copyright Anne Hartley 2011
copyright Anne Hartley 2011
Treatment copyright Anne Hartley 2011
Treatment Time <ul><li>Usually 15 – 20 minutes depending on the size of the treatment area, degree of pain, type of applic...
APPLICATION METHOD <ul><li>1. Determine aims of treatment </li></ul><ul><li>2. Determine structure injured, stage of heali...
APPLICATION METHOD <ul><li>8.  Set desired parameters </li></ul><ul><li>9. Turn up the intensity gradually inform patient ...
copyright Anne Hartley 2011
Contraindications <ul><li>Electrode over malignant tumors </li></ul><ul><li>Over the Carotid Sinus </li></ul><ul><li>Over ...
CONTRAINDICATIONS <ul><li>Over the eyes or genital area </li></ul><ul><li>If patient is operating machinery </li></ul><ul>...
CONTRAINDICATIONS <ul><li>Cardiac pacemaker </li></ul><ul><li>Pregnant women </li></ul><ul><li>Decreased sensation </li></...
Parameters and Set up <ul><li>Acute injuries (Inflammatory to Proliferation Stage of Healing) = High frequency or cycling ...
InterX Therapy Presets <ul><li>Acute (Inflammatory, Proliferation) </li></ul><ul><ul><li>480, 360, 90-360 </li></ul></ul><...
InterX Application <ul><li>Turn unit on </li></ul><ul><li>Choose Acute, Chronic or Cycling </li></ul><ul><li>Choose freque...
InterX Application <ul><li>Scan  to find acupuncture points (active sites) or ion imbalance in the injured site </li></ul>...
Scan for Active Sites <ul><li>Active sites on the skin are areas of lower impedance than the surrounding areas </li></ul><...
Scan for Active Sites copyright Anne Hartley 2011
Scan for Active Sites <ul><li>Over larger areas, the user can expect to find 3 -7 active sites which then can be treated w...
Activity Reading copyright Anne Hartley 2011
Activity Readings copyright Anne Hartley 2011
TARGET <ul><li>Having identified active sites then </li></ul><ul><li>Point stimulation – hold applicator on active site </...
copyright Anne Hartley 2011
copyright Anne Hartley 2011
Target <ul><li>2. Multidirectional Sliding Technique </li></ul><ul><li>After the point stimulation, slide the device in di...
copyright Anne Hartley 2011
Target <ul><li>Treat the spinal segment that serves the lesion site </li></ul><ul><li>Treat the nerve that serves the lesi...
copyright Anne Hartley 2011
Dynamic <ul><li>The InterX can be used during passive, active, resisted, proprioceptive and sport specific or functional a...
copyright Anne Hartley 2011
Dynamic <ul><li>Place the device on area area of tightness, pain or restriction for 30 sec while exercising. Can continue ...
Research – Post op Hip <ul><li>Non-invasive interactive neurostimulation in the post-op recovery of patients with a trocha...
<ul><li>Http://www.jbjs.org.uk/cgi/content/abstract/89-B/11/1488 </li></ul>copyright Anne Hartley 2011
Research – Post-op Hip <ul><li>Outcome measurements </li></ul><ul><li>Visual analog scale for pain </li></ul><ul><li>Pain ...
Research – Post-op Hip <ul><li>Results – stim group </li></ul><ul><li>Decrease in the mean VAS pain scale  </li></ul><ul><...
Research – Bimalleolar Ankle Surgically Repaired  Fractrures <ul><li>60 patients with operative reduction and internal fix...
Research – Bimalleolar Ankle Surgically Repaired  Fractrures <ul><li>Results: </li></ul><ul><li>VAS scores for the stim gr...
Neurostimulation in MCL of sheep <ul><li>Compared to controls the stimulation reduced the swelling at the surgical site </...
Research – Total Knee Replacement <ul><li>61 subjects – 30 stim and standard rehab, 31 just standard rehab </li></ul><ul><...
TKR copyright Anne Hartley 2011
TKR <ul><li>Medication InterX Control </li></ul><ul><li>PCA (mg) 29.7 32.7 </li></ul><ul><li>Voltarol (100mg) 2.3 3.2 </li...
TKR <ul><li>ROM </li></ul>copyright Anne Hartley 2011
TKR <ul><li>Edema </li></ul><ul><li>No significant difference in the swelling. Slightly less in the stim group </li></ul>c...
Physiological Effects of InterX Scientific Abstract <ul><li>Blood was used from 4 healthy adults before and 20 minutes aft...
Physiological Effects of InterX <ul><li>Lymphocyte metabolism did not change </li></ul><ul><li>Cytokine showed acceleratio...
Accessories copyright Anne Hartley 2011
Small Joints, acupuncture points copyright Anne Hartley 2011
copyright Anne Hartley 2011
copyright Anne Hartley 2011
copyright Anne Hartley 2011
Case Study - Demonstration <ul><li>Lets go through a case study of someone with an injury in the room </li></ul>copyright ...
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New innovations in pain control- Anne Hartley- CSTS- March 2011

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  • I have had the unit for over 2 years. When I first got the unit from KineMedics to try I left it in the box for 3 weeks. Mark called me and asked me how I liked the unit and I hadn’t tried it yet. Next day, used it on an adhesive capsulitis with amazing changes in range of motion that allowed me to work the shoulder more confortably. Had a cervical spine dysfunctional patient and the range improved again quite quickly and I could do more manual techaniques with it. Started to become a believer and actually purchased the unit. I have taught and used modalities for over 40 years. Run workshops all over the US and Canada. This unit is different and very handy.
  • As you know an alternating current is more comfortable than a direct current but because the amplitude runs from microamps (subsensory) to milliamps the patient feels a bit of strong tingling on and off. Biphasic wave forms that are pulsed with tihis amplitude can enter the body with less impedance at the skin barrier
  • You can apply the unit over an injured site the impedance is highest the unit will stick to the lesion site and help diagnose the pathology Eg. Shoulder and unit reads a high impedance over the biceps tendon and supraspinatus tendon. Plus high readings around the acupuncture points around the shoulder
  • The display surface on the unit shows an acute and chronic choice as well as cyling for subacutre or need for cycling frequency. On and off and intensity up and down controls
  • Two electrodes on front plate 2 AA batteries inside
  • Demonstration with the unit
  • New innovations in pain control- Anne Hartley- CSTS- March 2011

    1. 1. New Innovations In Pain Control Anne Hartley BPHE, CAT(C), DO (MP) ©Anne Hartley 2011
    2. 2. Capital Sports Therapy Symposium <ul><li>Thank you to KineMedics </li></ul>copyright Anne Hartley 2011
    3. 3. InterX <ul><li>My experience with the unit </li></ul>copyright Anne Hartley 2011
    4. 4. Interactive Neurostimulation <ul><li>Non-invasive, interactive neurostimulation for the treatment of acute, subacute and chronic pain </li></ul><ul><li>Musculoskeletal, Neural, Bursal, Pre and Post Surgical Pain </li></ul>copyright Anne Hartley 2011
    5. 5. Latest Pain Control Device <ul><li>Alternating current, high amplitude </li></ul><ul><li>Pulsed sinusoidal biphasic waveform </li></ul><ul><li>Microamp and milliamp elements in each phase </li></ul>copyright Anne Hartley 2011
    6. 6. Skin Impedance <ul><li>Works with the skin impedance </li></ul><ul><li>Concentric electrodes </li></ul>copyright Anne Hartley 2011
    7. 7. Skin Impedance <ul><li>The amplitude, symmetry and damping of each pulse depends on the skin impedance. </li></ul><ul><li>The pulses will change depending on the skin impedance </li></ul>copyright Anne Hartley 2011
    8. 8. Interactive Technology <ul><li>The unit displays the differences in skin impedance when applying the current. </li></ul><ul><li>The areas of low impedance correlate with the acupuncture points and myofascial trigger points </li></ul><ul><li>The low impedance areas also directly co-relate to the structure in disfunction </li></ul>copyright Anne Hartley 2011
    9. 9. copyright Anne Hartley 2011
    10. 10. copyright Anne Hartley 2011
    11. 11. copyright Anne Hartley 2011
    12. 12. copyright Anne Hartley 2011
    13. 13. Treatment copyright Anne Hartley 2011
    14. 14. Treatment Time <ul><li>Usually 15 – 20 minutes depending on the size of the treatment area, degree of pain, type of application (hand unit, pads, acupuncture head) </li></ul>copyright Anne Hartley 2011
    15. 15. APPLICATION METHOD <ul><li>1. Determine aims of treatment </li></ul><ul><li>2. Determine structure injured, stage of healing, pain and ROM </li></ul><ul><li>3. Position patient </li></ul><ul><li>4. Describe your goals and what patient will feel </li></ul><ul><li>5. Go through contraindications </li></ul><ul><li>6. Test sensation in treatment site </li></ul><ul><li>7. Look up segmental supply and acupuncture points </li></ul>copyright Anne Hartley 2011
    16. 16. APPLICATION METHOD <ul><li>8. Set desired parameters </li></ul><ul><li>9. Turn up the intensity gradually inform patient of feelings </li></ul><ul><li>10. Sensations should be felt in painful area </li></ul><ul><li>11.Treat site, local acupuncture points </li></ul><ul><li>12. Treat segmentally or dermatonally </li></ul><ul><li>13. Retest after treatment </li></ul>copyright Anne Hartley 2011
    17. 17. copyright Anne Hartley 2011
    18. 18. Contraindications <ul><li>Electrode over malignant tumors </li></ul><ul><li>Over the Carotid Sinus </li></ul><ul><li>Over mucous membranes </li></ul><ul><li>Patients prone to seizures </li></ul><ul><li>Over pharyngeal or laryngeal muscles </li></ul><ul><li>Patients with demand-type pace makers </li></ul>copyright Anne Hartley 2011
    19. 19. CONTRAINDICATIONS <ul><li>Over the eyes or genital area </li></ul><ul><li>If patient is operating machinery </li></ul><ul><li>Anterior chest wall </li></ul><ul><li>Senility, language barrier, under age </li></ul><ul><li>Without permission </li></ul><ul><li>In the cerebrovascular or transient ischemic patient </li></ul>copyright Anne Hartley 2011
    20. 20. CONTRAINDICATIONS <ul><li>Cardiac pacemaker </li></ul><ul><li>Pregnant women </li></ul><ul><li>Decreased sensation </li></ul><ul><li>Open skin infection, lesion, suture or cut </li></ul>copyright Anne Hartley 2011
    21. 21. Parameters and Set up <ul><li>Acute injuries (Inflammatory to Proliferation Stage of Healing) = High frequency or cycling high frequencies (dynamic) </li></ul><ul><li>Subacute injuries (Healing Stage) = Mid frequencies or cycling mid frequencies (dynamic) </li></ul><ul><li>Chronic injuries (Remodelling Stage of Healing) = Lower frequency or cycling low frequencies (dynamic) </li></ul>copyright Anne Hartley 2011
    22. 22. InterX Therapy Presets <ul><li>Acute (Inflammatory, Proliferation) </li></ul><ul><ul><li>480, 360, 90-360 </li></ul></ul><ul><li>Subacute (Healing) </li></ul><ul><ul><li>180, 240, 30 – 120 </li></ul></ul><ul><li>Chronic (Remodelling) </li></ul><ul><ul><li>15, 60, 15-60 </li></ul></ul>copyright Anne Hartley 2011
    23. 23. InterX Application <ul><li>Turn unit on </li></ul><ul><li>Choose Acute, Chronic or Cycling </li></ul><ul><li>Choose frequency </li></ul><ul><li>Turn up intensity to an amplitude with comfortable tingling for the patient </li></ul><ul><li>The head of the interX must be in full contact with the skin (no gel needed) </li></ul>copyright Anne Hartley 2011
    24. 24. InterX Application <ul><li>Scan to find acupuncture points (active sites) or ion imbalance in the injured site </li></ul><ul><li>Target specific acupuncture points or lesion site </li></ul><ul><li>Dynamic is applying the interX during active exercise (Pads usually) </li></ul>copyright Anne Hartley 2011
    25. 25. Scan for Active Sites <ul><li>Active sites on the skin are areas of lower impedance than the surrounding areas </li></ul><ul><li>On areas of lower impedance, the device will drag or stick on the skin, the stimulation is stronger and the device gets louder </li></ul><ul><li>The device displays an active reading on the screen – the higher the number the lower the impedance </li></ul>copyright Anne Hartley 2011
    26. 26. Scan for Active Sites copyright Anne Hartley 2011
    27. 27. Scan for Active Sites <ul><li>Over larger areas, the user can expect to find 3 -7 active sites which then can be treated with the Target step of the protocol </li></ul><ul><li>Activity Reading (AR) is an objective measurement of the effect that skin impedance has on the waveform </li></ul><ul><li>Higher AR (lower impedance) indicates where treatment should be applied </li></ul>copyright Anne Hartley 2011
    28. 28. Activity Reading copyright Anne Hartley 2011
    29. 29. Activity Readings copyright Anne Hartley 2011
    30. 30. TARGET <ul><li>Having identified active sites then </li></ul><ul><li>Point stimulation – hold applicator on active site </li></ul><ul><li>- A constant changing waveform is delivered to the for 6 sec – 60 sec </li></ul><ul><ul><li>When the stim is complete a yellow value will appear on the screen </li></ul></ul>copyright Anne Hartley 2011
    31. 31. copyright Anne Hartley 2011
    32. 32. copyright Anne Hartley 2011
    33. 33. Target <ul><li>2. Multidirectional Sliding Technique </li></ul><ul><li>After the point stimulation, slide the device in different directions over the active site until the InterX will slide more smoothly </li></ul><ul><li>The point that delivered the highest point stim value is the most active site. Repeat the target step on the most active spot with the multidirectional sliding </li></ul>copyright Anne Hartley 2011
    34. 34. copyright Anne Hartley 2011
    35. 35. Target <ul><li>Treat the spinal segment that serves the lesion site </li></ul><ul><li>Treat the nerve that serves the lesion site </li></ul><ul><li>Treat the dermatome that serves the lesion site </li></ul><ul><li>Treat neighbouring acupuncture points </li></ul>copyright Anne Hartley 2011
    36. 36. copyright Anne Hartley 2011
    37. 37. Dynamic <ul><li>The InterX can be used during passive, active, resisted, proprioceptive and sport specific or functional activity </li></ul><ul><li>Use the Flexible Array of pads – Dynamic presets – 5-20 min </li></ul><ul><ul><li>Acute 90-360 </li></ul></ul><ul><ul><li>Healing 90-360 </li></ul></ul><ul><ul><li>Chronic 30-120 </li></ul></ul><ul><ul><li>Hypersensitive 15 - 60 </li></ul></ul>copyright Anne Hartley 2011
    38. 38. copyright Anne Hartley 2011
    39. 39. Dynamic <ul><li>Place the device on area area of tightness, pain or restriction for 30 sec while exercising. Can continue for 5 minutes on several points </li></ul>copyright Anne Hartley 2011
    40. 40. Research – Post op Hip <ul><li>Non-invasive interactive neurostimulation in the post-op recovery of patients with a trochanteric fracture of the femur </li></ul><ul><li>Journal Bone and Joint Surgery Vol 89-B, No.11, Nov 2007 (Gorodetskyi et al.) </li></ul><ul><li>60 patients divided in 2 groups – one sham and one interX, all other rehab the same </li></ul><ul><li>Treatment was for 10 days post surgery </li></ul>copyright Anne Hartley 2011
    41. 41. <ul><li>Http://www.jbjs.org.uk/cgi/content/abstract/89-B/11/1488 </li></ul>copyright Anne Hartley 2011
    42. 42. Research – Post-op Hip <ul><li>Outcome measurements </li></ul><ul><li>Visual analog scale for pain </li></ul><ul><li>Pain inventory </li></ul><ul><li>Ketorolac for post-op pain </li></ul><ul><li>Overall assessment by surgeon </li></ul>copyright Anne Hartley 2011
    43. 43. Research – Post-op Hip <ul><li>Results – stim group </li></ul><ul><li>Decrease in the mean VAS pain scale </li></ul><ul><li>ROM – hip flexion of 88.7 degrees versus sham who had 63 degrees </li></ul><ul><li>Use of Ketorolac was much less </li></ul><ul><li>Pain during walking was less </li></ul><ul><li>At the end of the study, the stim group reported pain of 1 out of 10 while the sham group had a mean score of 5.3 out of ten </li></ul>copyright Anne Hartley 2011
    44. 44. Research – Bimalleolar Ankle Surgically Repaired Fractrures <ul><li>60 patients with operative reduction and internal fixation of the biomalleolar fractures </li></ul><ul><li>2 groups –one non-invasive interactive neurostimulation device group, sham </li></ul><ul><li>Measured the level of pain, ROM, edema and Ketorolac </li></ul>copyright Anne Hartley 2011
    45. 45. Research – Bimalleolar Ankle Surgically Repaired Fractrures <ul><li>Results: </li></ul><ul><li>VAS scores for the stim group were 0 out of 10 by the end of 10 days, sham was 2.1 </li></ul><ul><li>Medication use – stim 112mg mean total, sham was 209mg </li></ul><ul><li>Edema – stim 16.3mm, sham 27.3mm </li></ul><ul><li>Mobility - sum of plantar and dorsiflexion </li></ul><ul><ul><li>Stim – 46 degrees, sham – 28 degrees </li></ul></ul>copyright Anne Hartley 2011
    46. 46. Neurostimulation in MCL of sheep <ul><li>Compared to controls the stimulation reduced the swelling at the surgical site </li></ul><ul><li>The mechanical properties did not improve or decrease from sham (load to failure) </li></ul><ul><li>Histological results show stim group had increase tissue organization over sham </li></ul>copyright Anne Hartley 2011
    47. 47. Research – Total Knee Replacement <ul><li>61 subjects – 30 stim and standard rehab, 31 just standard rehab </li></ul><ul><li>Stimulation using the flexible array electrodes </li></ul><ul><li>VAS for pain </li></ul><ul><li>Medication </li></ul><ul><li>Range of Motion </li></ul><ul><li>Edema </li></ul>copyright Anne Hartley 2011
    48. 48. TKR copyright Anne Hartley 2011
    49. 49. TKR <ul><li>Medication InterX Control </li></ul><ul><li>PCA (mg) 29.7 32.7 </li></ul><ul><li>Voltarol (100mg) 2.3 3.2 </li></ul><ul><li>Paracetamol (500mg) 7.1 7.2 </li></ul><ul><li>Cocodam 30/500 4 4.5 </li></ul>copyright Anne Hartley 2011
    50. 50. TKR <ul><li>ROM </li></ul>copyright Anne Hartley 2011
    51. 51. TKR <ul><li>Edema </li></ul><ul><li>No significant difference in the swelling. Slightly less in the stim group </li></ul>copyright Anne Hartley 2011
    52. 52. Physiological Effects of InterX Scientific Abstract <ul><li>Blood was used from 4 healthy adults before and 20 minutes after treatment with InterX </li></ul><ul><li>Treatment was 480 pulse/sec on lateral elbow </li></ul><ul><li>Measured lymphocyte metabolism, gene expression, cytokine production </li></ul>copyright Anne Hartley 2011
    53. 53. Physiological Effects of InterX <ul><li>Lymphocyte metabolism did not change </li></ul><ul><li>Cytokine showed acceleration of wound and connective tissue healing and inflammation reduction </li></ul><ul><li>Gene expression activity changed </li></ul><ul><ul><li>Mitochondrial stimulation </li></ul></ul><ul><ul><li>Neuron specific genes activated </li></ul></ul><ul><ul><li>LOX4 activated which is related to cartilage regeneration and repair </li></ul></ul><ul><ul><li>LOXL4 activated which is the catalyst for the formation of collagen and elastin </li></ul></ul>copyright Anne Hartley 2011
    54. 54. Accessories copyright Anne Hartley 2011
    55. 55. Small Joints, acupuncture points copyright Anne Hartley 2011
    56. 56. copyright Anne Hartley 2011
    57. 57. copyright Anne Hartley 2011
    58. 58. copyright Anne Hartley 2011
    59. 59. Case Study - Demonstration <ul><li>Lets go through a case study of someone with an injury in the room </li></ul>copyright Anne Hartley 2011

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