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Interferential Current or therapy for Physiotherapy students


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This lecture intends to provide general outline about the uses, parameters, precautions and contraindications of interferential current for undergraduate physiotherapy students at Kathmandu University School of Medical Sciences, Nepal. After the lecture, students will explore the evidences about current practices on the uses of IFT in various musculoskeletal pain conditions, critically appraise them and present the evidences to the class.

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Interferential Current or therapy for Physiotherapy students

  1. 1. Saurab Sharma, MPT Lecturer, KUSMS Interferential therapy/ current (IFT, IFC) Electrotherapy Lecture 5
  2. 2. Objectives of session  At the end of the class, students will be able to:  Understand the background of IFT  Explain the mechanism  Explain the clinical uses of IFT  Understand the use of various treatment parameters  Identify Hazards, Precautions and Contraindications2
  3. 3. Introduction  Developed in 1950’s  Popular in 1970’s  Transcutaneous application of medium frequency alternating currents, whereas amplitude is modulated at the low frequency for therapeutic purpose. 3
  4. 4. Introduction  Reduces the skin resistance, thus reduces discomfort produced by low frequency currents.  Also permits treatment of deeper tissues. 4
  5. 5. Introduction  Available in 77- 98% per PT departments in Western world (UK, Ireland, Australia). (1995- 2000)  90% use it at least once a day. 5
  6. 6. Uses  Pain relief (91%)  Acute pain- 26%  Chronic pain- 50%  NSCLBP- 88% (Foster et al. 1999)  Other conditions- asthma, fracture, incontinence, psoriasis, swelling, enhance tissue healing, improve blood circulation, muscle strengthening6
  7. 7. Theoretical mechanisms of IFC  Neural effects  Blood flow and swelling  Placebo  Muscle stimulation  Bone and tissue healing  Bronchodilatation 7
  8. 8. Uses- EBP  Ischaemic pain  Cold induced pain  Thermal quantitative sensory testing  Mechanical pain  DOMS  Blood flow  Cell activity  Muscle stimulation  IFC versus TENS 8
  9. 9. Clinical indications  For all types of pain syndrome  Various musculoskeletal conditions, Knee OA, Jaw pain, Fracture pain, LBP, shoulder disorders, Palmar Psoriasis, Fibromyalgia, knee surgery, swelling, incontinence, bone healing 9
  10. 10. Physical principles of IFC 10
  11. 11. Physical principles of IFC  Current A- 4,000 Hz  set in the machine (Intrinsic frequency/ carrier frequency)  Current B- 4,000 -4,200 Hz  set by the therapist.  Same amplitude but higher frequency  Resultant waveform (F) = f2-f1  Low frequency Current (0-200 Hz) 11
  12. 12. Physical principles of IFC  Amplitude of F (Current C) is NOT constant  Called as “beat frequency- BF” or “amplitude modulated frequency- AMF”  F ranges from 1 Hz to 200 Hz  The frequency swing is also referred to 12
  13. 13. Physical principles of IFC: Example  When two medium frequency currents are mixed:  Frequency of resultant current will be equal to the mean of the two original currents  This will vary in amplitude at frequency equal to difference between the two currents- AMF/ BF  When two currents of 4000 and 4100 Hz are mixed, results in medium frequency current of 4050 Hz, whereas amplitude13
  14. 14. AMF  Medium frequency current act as carrier  Carrier frequency brings low frequency current to the tissue.  Literature shows that it is medium frequency that causes the effect rather than AMF  But, responses induced by IFC stimulation changes with different AMF14
  15. 15. AMF  Lower AMF causes tapping or beating sensation  Higher AMF causes tingling sensation or tetanic muscle contraction.  Lower AMF (5Hz) are more uncomfortable than 50-100 Hz  50 and 100 Hz produces similar effects 15
  16. 16. AMF- Parameters for conditions  Treatment of pain- 1- 130 Hz (no consensus)  130 Hz for pain (38% therapist use in Scotland)  LBP- 80- 120 Hz 16
  17. 17. Frequency sweep  Sweep may be set between two pre- fixed AMFs  Hypothesized to reduce adaptation, stimulates greater range of excitable tissues for better treatment effects  Eg- between 50 – 100 Hz (can be adjusted in most machines)  Most common- 6^6 (slowly increasing and decreasing over period of 617
  18. 18. Electrode placement  4 electrodes - Quadripolar, 4 pole method  2 Electrodes- Premodulated-Bipolar, 2 pole method  Effects are like normal electrical stimulation  More effects under the electrodes  More sensory stimulation 18
  19. 19. Electrode Placement- Quadripolar 19 • Clover leaf pattern • Leaves are at right angle to the electrode placement • “4 pole” causes deep within tissue effects
  20. 20. Electrode Types  Suction electrode  Carbon electrode  Plate electrode 20
  21. 21. Electrode placement  For muscle stimulation:  large electrode over nerve supplying the muscle, smaller electrode over the motor point  Two electrodes of equal size over proximal and distal end of muscles  For Pain relief: same as TENS21
  22. 22. Electrode placement in LBP  painful area (86.4%)  spinal nerve root (53%)  peripheral nerve (26%)  trigger point (10%)  acupuncture point (5%)  Stimulation of nerve root better improvement in function compared to application at painful area22
  23. 23. Current intensities  Strong but comfortable sensation- as reported by patients  Strong but comfortable sensation for various people may be achieved at different intensities 23
  24. 24. Treatment Duration  Recommended 10- 15 minutes  No longer than 20 minutes on one area 24
  25. 25. Use as a treatment adjunct  In 73% of cases  IFC may not be an effective treatment on its own, but rather as part of comprehensive treatment program 25
  26. 26. Hazards  Burns  Increased pain  General malaise  Nausea  Vomiting  Dizziness/ fainting  Migraine/ headache  Neurological effects  Infection 26
  27. 27. Contraindications  Uncooperative patients  Under anticoagulation therapy or history of pulmonary embolism or deep vein thrombosis should not be treated with the vacuum electrode applications  Fragile or bruised skin 27
  28. 28. Contraindications: Application over  The trunk or pelvis during pregnancy  Active or suspected malignancy  The eyes  The anterior aspect of the neck  The carotid sinuses  Patients with pacemakers  Dermatological conditions e.g. dermatitis, broken skin  Danger of haemorrhage or current tissue bleeding (e.g. recent soft tissue injury)  Avoid active epiphyseal regions in children 28
  29. 29. Precautions: Check for pain sensitivity prior to Rx  Care should be taken to maintain the suction at a level below that which causes damage / discomfort to the patient  If there is abnormal skin sensation, electrodes should be positioned in a site other than this area to ensure effective stimulation  Patients who have (marked) abnormal circulation  For patients who have febrile conditions, the outcome of the first treatment should be monitored  Patients who have epilepsy, advanced cardiovascular conditions or cardiac arrhythmias should be treated at the discretion of the physiotherapist in consultation with the appropriate medical practitioner  Treatment which involves placement of electrodes over the anterior chest wall 29
  30. 30. Ask yourself  What do I hope to achieve?  How can this be done?  What frequency would be most effective?  Should 2 or 4 electrodes be used?  Where exactly are the electrodes to be placed?  How long a treatment should be given? 30
  31. 31. References  Kathleen Sluka. Mechanisms and Management of Pain for the Physical Therapist. 2nd Edition. IASP Press. Wolters and Kluwer. 2016  Tim Watson. Electrotherapy: Evidence Based Practice. 2008. Churchill Livingstone. 12th edition.  John Low, Ann Reed. Electrotherapy Explained. Principles and Practice. Butterworth Heinemann. 3rd Edition. 31