The document discusses the motor points of various nerves including the axillary, musculocutaneous, radial, median, ulnar, femoral, sciatic, tibial, superior peroneal, deep peroneal and facial nerves. It also discusses principles of electrical stimulation application such as patient positioning, skin preparation, testing the equipment, determining treatment parameters and monitoring the patient during treatment. Precautions, contraindications and procedures for initiating, conducting and terminating the treatment are provided.

1. Electrical Stimulation
Motor points and Application

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Motor Points of Axillary Nerve

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Motor Points of Musculocutaneous nerve

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Motor Points of Radial Nerve

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Motor Points of Median Nerve
LOAF
Lumbricals 1 & 2,
Opponens pollicis,
Abductor pollicis
brevis and
Flexor pollicis brevis.
1 & 2

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Motor Points of Ulnar Nerve
3 & 4

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Motor Points of Femoral Nerve

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Motor Points of Sciatic Nerve

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Motor Points of Tibial Nerve

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Motor Points of Sup. peronei Nerve

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Motor Points of Deep peronei Nerve

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Motor Points of Facial Nerve
Temporal Br.
Frontalis
Orbiclaris Oculi
Corrugator Supercilii
Zygomatic Br.
Orbiclaris Oculi
Buccal Br.
Risorius
Buccinator
Levator Labii Superioris
Levator anguli oris
Nasalis
Orbicularis oris
Mandibular Branch
Mentalis

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Motor Points of Facial Nerve

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Motor Points of the Back

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PRINCIPLES OF APPLICATION
LOW FREQUENCY

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Receiving the patient
Greet the patient & introduce yourself.
Develop a good rapport with the patient.
Provide them a comfortable position to
sit/laydown

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Case sheet reading/History Taking
Name: Identification of the patient
Age: Modulation of treatment (Adult/Old )
Sex: Provide privacy (Male/Female)
Occupation: Correlate the symptoms/signs of the patient for
ergonomic advice if applicable
Chief Complaints: Generation of problem list
Side: Right or Left side of the involvement.
Site: Specific area/region to be treated
(Anterior/Posterior/Medial/Lateral)
Duration of the condition: Acute/Sub-acute/Chronic (Treatment
planning & Setting)
Diagnosis: Condition of the patient

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General contraindications
Hyperpyrexia
Epilepsy
Severe renal and
cardiac problems
Cardiac pacemakers
Severe Hypotension
and hypertension
Infections
Pregnant women
Metal Implants
Mentally retarded
patients
Mentally upset
patients
Malignancy
Eyes
Anterior aspect of
neck & carotid sinus

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Tray Preparation
Skin Resistance Lowering Tray
Pillows
Cotton
Soap
Towel
Mackintosh
Kidney Tray
Petroleum jelly or Vaseline
U – pin (sharp & blunt)
Clips
Bowel of water

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Tray Preparation
Treatment Tray
Pillow
Towel
Bed sheet
Cotton
Adhesive tapes
Straps
Salt
Powder
Scissor
Paper
Graph paper
Pencil
Eraser
Scale
Crepe bandages
Machine & accessories

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Local Contraindications
Open wounds
Scars
Local skin infections
Cuts
Abrasions
Eczema
Localized haemorrhagic spots

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Skin sensitivity testing
With the patient's eyes
closed, alternate
touching the patient
with the needle and the
brush at intervals of
roughly 5 sec
instruct the patient to
tell the therapist if they
notice a difference in
the strength of
sensation on each side
of their body.

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Testing of equipment & Demonstration
This is to gain the self-confidence & cooperation of the patient for
the treatment.
Check for mains output by using the tester, look for any frayed part
of power cords, integrity of cables & electrodes.
Verify that all the knobs/controls in the apparatus are at zero.
Connect the machine power cord to the mains (220/110 Volts) &
switch on the mains..
Switch on the machine by turning on the power knob/switch of the
machine.
Set the timer
Keep your index and middle fingers on active and indifferent
electrodes to check whether the machine is working or not.
Demonstrate a muscle contraction to the patient by placing the
electrodes on therapist’s hand.

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Positioning of the patient
Place patient in a well-supported, comfortable &
relaxed position.
Use adequate pillows, towels & bed sheets.
Expose the body part to be treated, have patient
remove all jewelry from the area.
Drape the untreated part of the patient to
preserve modesty, protect clothing, but allow
easy accesses to the body part.
If possible give the position in which patient can
see the treatment.

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Positioning of the Therapist
Appropriate walk stand position
The therapist should be close to the
machine for operating the machine & also
near to the affected side of the patient.
If possible the therapists should position
herself so as to observe the face of the
patient.

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Preparation of the part to be treated
Skin Resistance Lowering
Uncover the part to be treated
Clean the area with water & soap to
remove any oil/cream/gel/dust
Use mackintosh and then towel for
supporting and wiping off the water.
Wipe the treatment area periodically with
saline water for better current conduction.

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Instructions & Warning to the patient
Instruct the patient,
NOT TO move the treatment part,
NOT TO touch the power cord & the generator,
NOT TO sleep during the treatment.
Inform the patient that he/she should feel a mild prickling
sensation;
if it is too intense should immediately report to the
physiotherapist.
If there is any burning sensation immediately inform the
therapist, as it might lead to burn.
Inform if the position is not comfortable.

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Application of Treatment
Select appropriate method of treatment
Make sure the power cords are not touching the
patient.
Select the current.
Select parameters.
Set treatment time.
Gradually increase the current.
The patient must be observed throughout to
ensure that treatment is progressing
satisfactorily and without adverse effects.

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Termination of Treatment
Reduce the intensity gradually to zero
Switch off the machine and the main supply.
Remove the electrodes and clean the patient.
Inspect the treated part for any adverse
reactions.
If there is any mild Erythema, apply powder.
If it is too severe, summon the physician or
advise the patient to go to the physician.
Set the next appointment.
Do winding up procedure.

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Recording
An accurate record of all parameters of
treatment including
region treated,
technique,
dosage, and
the resultant effect must be made.
This is for both follow up assessment
purposes and for legal requirements.

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References
1. Singh J. Textbook of Electrotherapy. 2 edition. Jaypee. 2012. p 94 – 125
2. Forster A, Palastanga N. Clayton’s Electotherapy, Theory ans Practic. 9th Ed. W B Saunders;
2006. p
3. http://en.wikipedia.org/wiki/Radial_nerve
4. http://en.wikipedia.org/wiki/Median_nerve
5. http://en.wikipedia.org/wiki/Ulnar_nerve
6. http://en.wikipedia.org/wiki/Femoral_nerve
7. http://en.wikipedia.org/wiki/Sciatic_nerve
8. http://en.wikipedia.org/wiki/Tibial_nerve
9. http://en.wikipedia.org/wiki/Superficial_fibular_nerve
10. http://en.wikipedia.org/wiki/Deep_fibular_nerve
11. http://www.microsurgeon.org/facialpalsy
12. http://en.wikipedia.org/wiki/Temporal_branch_of_the_facial_nerve
13. http://en.wikipedia.org/wiki/Zygomatic_branch_of_the_facial_nerve
14. http://en.wikipedia.org/wiki/Buccal_branch_of_the_facial_nerve
15. http://en.wikipedia.org/wiki/Marginal_mandibular_branch_of_the_facial_nerve
16. http://informatics.med.nyu.edu/modules/pub/neurosurgery/sensory.html

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THANK YOU