01 Intro.ppt

Made By: Zahoor Ahmad (DPT,OMPT)
Riphah International University

Introduction to Physical agents & Electrotherapy
Zahoor Ahmad
DPT, OMPT, PCT,KTP
Assistant Professor NCS
University

PHYSICAL
THERAPY… The treatment of physical
dysfunction or injury by the use
of therapeutic exercise and the
application of modalities,
intended to restore or facilitate
normal function or development.

Aims of Physical Therapy
• Modalities, Manual Techniques, Education
Relieve Pain
• Modalities, Manual Techniques, Ex. Instruction
Improve ROM
• Exercise Instruction, Man. Res. Exercises
Strengthen muscles
• Assistive Devices, Correct Impairments
Improve Function

• ELECTROTHERAPY……
• Electrotherapy is the branch of physiotherapy characterized by the
treatment of various diseases and disorders with the help of electricity
or electrical means.
• Specifically, electrotherapy uses energy waves that are part of the
electromagnetic spectrum to produce desired physiological and chemical
effects in the body

PHYSICAL
AGENTS
Physical agents are
various forms of
energy and
materials applied to
patients and their
means of
application
It includes heat,
cold, water,
pressure, sound,
electromagnetic
radiation and
electrical currents

The use of Ultraviolet,
other parts of the
Spectrum of the sun’s
rays, or X-rays to treat
various disorders,
particularly Skin
diseases.
Heliotherapy:
the
therapeutic
use of
Sunlight
ACTINO
THERAPY

Categories of Physical Agents
THERMAL
Deep heating agents e.g. Diathermy
Superficial heating agents e.g.. Hot Pack
Cooling agents e.g. Ice Pack
MECHANICAL
Traction e.g. Mechanical Traction
Compression e.g. Elastic Bandage
Water e.g. Whirlpool
Sound e.g. Ultrasound

Cont…
ELECTROMAGNETIC
Electromagnetic tools e.g. Ultraviolet
Electric currents e.g. TENS

01.THERMAL AGENTS
These agents increase or decrease the tissue
temperature
Different thermal agents produce the greatest
change in temperature in different types and areas of
tissue
Hot packs produces greatest
temperature increase in superficial
tissues with high thermal conductivity
in the area directly below it

Cont…
Ultrasound produces the most heat in
tissues with high ultrasound absorption
coefficients, such as bone and tendon.
It produces the effect up to a depth of
5cm but only in small area

Cont…
Physiological Effects of thermal agents
Increase the tissue temperature
To increase the circulation
Increase metabolic rate
Increase soft tissue extensibility
Decrease pain

Cont…..
When to apply cold agents???????
o To decrease circulation
o Decrease metabolic rate
o Decrease pain
Cold agents are mostly preferred in acute
inflammation
PRICE phenomenon in Acute Conditions

02. MECHANICAL AGENTS
Apply mechanical force
to increase or decrease
pressure in or on the
body
Traction decrease the
pressure between
structures such as
nerves or joints or other
sensory changes or that
become inflamed when
compressed

Cont…
Compression
increases the
pressure between
structures to
counteract fluid
pressure and to
control edema

Hydrotherapy
 The application of water is called hydrotherapy
 Water provides resistance to increase local pressure,
and buoyancy decrease pressure on weight bearing
structures
 Archimedes Principle
 Used for exercise when an area is immersed and for
cleansing or debriding open wound with or without
immersion

Sound….
It is a mechanical form of energy composed of
alternating waves of compression and rarefaction
Frequency greater than 20,000 cycles per second
Thermal and non-thermal effects
 Continuous and pulsed mode

Ultrasound……….

03. ELECTROMAGNETICAGENTS
Electromagnetic agents apply electromagnetic energy
in the form of electromagnetic radiation or an
electrical currents
Electromagnetic tools
Ultraviolet radiation, which has a frequency of
7.5*1014 to 1015 cycles per second produce erythema
and tanning of the skin but doesn't produce heat
Infrared radiation, which has a frequency of 1011 to
1014 cycles per second produces heat in superficial
tissues

Cont…..
Short wave diathermy , which has a
frequency of 10 million to 100 million cycles per
second, produces heat in both superficial and
deep tissues

SWD

Electric currents….
The effects and clinical application of electrical
currents vary according to the waveform, intensity,
duration and direction of the current flow and
according to the types to which the current is applied
 These currents depolarize nerves, causing sensory
or motor responses that may be used to control
pain, increase muscle strength , control the
formation of edema, promote wound healing etc…

Classification of Electrical Currents
• On the basis of Direction
• On the basis of Frequency
• On the basis of Voltage
• On the basis of Amperage
• On the basis of Biophysical
Effects

Areas of Electrotherapy
• Low frequency currents
• Medium frequency currents
• High frequency currents
• Phototherapy
• Electro diagnosis
• Biofeedback

Cont…
Low Frequency Currents:
o Frequency range 0 to 100 cycles per second
o Use in the stimulation of nerve
e.g.
Direct current, IDC, Sinusoidal current,
Diadynamic current, High voltage pulsed
galvanic current, TENS

CONT….
Medium frequency Currents:
o Frequency in the range of 1000 to 10,000 cycles per
second
o Use for muscle re-education, retard the rate of
muscle atrophy, drainage of edema and for pain relief
Russian Current, Interferential Current,
etc.

Cont…
High frequency currents:
o Frequency more than 10,000 cycles per second
o Produce deep heat inside the tissues
e.g.
 SWD
 Therapeutic Ultrasound
 Microwave diathermy

Cont…
Phototherapy:
o Treatments of various disease and disorders with the
help of light
o Pain relief by heat, acceleration of healing through
elevation of temperature, counter irritation and
photochemical effects
e.g. Infrared rays, ultraviolet
rays and LASER
Heliotherapy

Cont…
Electrodiagnosis:
o It means the detection of the disease
and disorders by the use of
electrotherapeutic currents or
electromyography
TESTS:
 Rheobase, Chronaxie, Strength duration curve, Pulse
ratio, Galvanic tetanic ratio, Nerve conduction test
etc…

Cont…
Electromyography:
o It is the study of electrical activity of muscle by
means of surface electrodes placed over the skin or
needle electrodes inserted in muscle itself
e.g. Motor unit potential, Motor nerve conduction,
Sensory nerve conduction etc…

Biofeedback:
o It is the process of furnishing the information to an
individual about the body function so as to get some
voluntary control over it
o Biofeedback is a treatment technique in which people are
trained to improve their health by using signals from their own
bodies. Physical therapists for example, use Biofeedback to
help stroke victims regain movement in paralyzed muscles.
Psychologists use it to help tense and anxious clients learn to
relax.

Cont…

HISTORY OF ELECTROTHERAPY
o In 1646, Sir Thomas Browne, physician used the word
Electricity for the first time
o Aetius, a Greek physician had prescribed the
shocks of Torpedo, an electric fish for the
treatment of gout, headache
o There are also reports from the 17th century of
charged gold leaf being used to prevent scarring from
smallpox lesions

Cont…
o 1780, Luigi Galvani a professor of the anatomy at the
faculty of Bologna, first observed the quick twitching
of the muscle produced by the electricity in a nerve
muscle preparation of the frog’s leg
o French physicist Abbe Nollet administered the shock from
Leyden jar to 180 royal guards simultaneously in the presence
of the King
o Johann Gottlob Kruger, professor of Medicine at Halle,
gave a series of lecture to medical students in 1743
entitled thoughts about the electricity. These were
published in 1744 enlarged by notes and reprinted the
following year. It was the first book on medical electricity.

Cont…
o His pupil Christian Gottlieb Kratzenstein_ book____
published in 1745 was the first to use medical
electricity in its title
o RichardLovett in England treatedmany persons withstatic shocks and
published a treatise in 1756 describing the numerous conditions for
whichelectrotherapy was to be recommended

Cont…
o John Wesley in 1759 published his own experiences
in the book titled Desideratum
o Bertholon described his techniques with its
role in the cure of eight paralysis
o Guys Hospital in London is recognized as the first
hospital physical therapy department
o Renowned Physician S. Weir Mitchell. endorsed
exercises of muscles by faradic stimulation

History of Use of Physical Agents in Medicine
and Rehabilitation
o Physical agents have been a component of medical
and rehabilitation treatment for many centuries
 The remains of bath houses with steam rooms and
pools of hot and cold water that can still be seen in
many cities of the ancient Romans and Greeks
provide evidence that these cultures used heat and
water to maintain health and to treat various
musculoskeletal and respiratory problems

Cont…
o Before the widespread availability of antibiotics and
effective analgesic and anti-inflammatory drugs,
physical agents were commonly used to treat
infection, pain, and inflammation
 Use of sunlight for the treatment of tuberculosis,
bone and joint disease, and the use of warm
Epsom salt baths for the treatment of sore or
swollen limbs

Cont…
Use of physical agent for
biological process
o TENS is use to control pain was
developed based on the gate control
theory of pain modulation as proposed
by Melzack and Wall

Physical agents fallen out of favor
o Infrared lamps_______ were used to treat open
wounds because they provide superficial heat that
can dry out the wound bed; however these lamps no
longer use for this application because it is now
known that wounds heal more rapidly when kept
moist
o Sunlight___ was used to treat T.B.
infection etc. not used now since the
advent of Antibiotics

Cont…
• SWD_____ was popular 20 to 30 years ago,
but because of some side effects (burn) is
rarely used in United States at this time

The Role of Rehabilitation in Patient Care
Rehabilitation is a goal-oriented treatment process
designed to maximize independence in individuals
who have compromised function due to underlying
pathological processes and secondary impairments
Medical treatment addressees at the underlying
pathology or disease, rehabilitation focuses on
sequelae of pathology

General Contra-indications for Electrotherapy
 Nature of restriction, the nature and distribution of the physiological
effects of the physical agent, and the distribution of energy produced
by the physical agent
• Pregnancy
• Malignancy
• Pacemaker
• Impaired sensation
• Impaired mentation

References
• Physical agents in Rehabilitation by Michelle H.
Camron
• Clayton’s Electrotherapy
• Electrotherapy by Subhash Khatri

…….
…THE
END…

01 Intro.ppt

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