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Electrotherapy class lecture for students
- 2. TOPIC OUTLINE • Electrotherapy •Ultrasound • Diathermy • Laser
- 3. DEFINITION OF TERMS 1.CHARGE • Obtained by the addition or removal of electrons and occurs when atoms of elements are acted upon by external physical forces • POSITIVE charge • NEGATIVE charge • ION • 4 fundamental properties of electrical charge
- 4. DEFINITION OF TERMS 2.Polarity • Net charge of an object→ being either negative and positive • Electrode with net negativity and positivity 3. Electrical Field • Force created by the separation of charge may be one of attraction or repulsion and represents the electrical field 4. Voltage • Driving force that moves electrons • Electromotive force or electrical potential energy
- 5. 5. Conductors andInsulators • Materials in which ions move freely are conductors • Materials in which ions do not move freely are insulators 6. Current • Movement of ions in a conductor in response to a voltage force • Movement is directly proportional to the magnitude of driving force DEFINITION OF TERMS
- 6. OHM’S LAW Resistance • Oppositionto the flow of current Capacitance • Degree to which electrical charge is stored in a system containing conductors and insulators Impedance • Form of resistance to the flow of current but is frequency-dependent • Resistance to alternating current
- 7. DEFINITION OF TERMS 7.Inverse Square Law • the intensity of electric radiation varies inversely with the square of the distance 8. Cosine Law • max radiation is applied when the source is at a right angle to the part to be treated
- 8. ANODE (+) CATHODE(-) Repels Cation Repels Anion Fewer large bubbles of O2 appears slowly Tiny bubbles of H formed rapidly Acidic reaction Alkalinic reaction Less coloration of skin Marked coloration of skin Solidification of protein Liquefaction of protein Hardening of tissue Softening of tissue Low risk for burn Danger for burn Red Black
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- 11. CONTRAINDICATIONS Demand type pacemaker Unstable Arrhythmias Epilepsy Over carotidsinus Pharyngeal or laryngeal ms Venous or arterial thrombosis or thrombophlebitis Pelvis, abdomen, trunk and low back area during pregnancy
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- 15. SAFETY • All electricaloutlets should have the three prong GFCI outlets • Ensure all line-powered equipment has a testing seal • Never use an extension cord • Unplug all line powered equipment at the end of each day • A sticker should be placed on equipment indicating the last inspection/ maintenance every 6-12 months • Keep an updated log for all equipment in the PT dept
- 16. LOW FREQUENCY CURRENT MEDIUM FREQUENCY CURRENT HIGH FREQUENCY CURRENT Frequency 1-2,000 pps3,000-6,000 pps >500,000 pps Sensory (+) minor (+) MAJOR (-) Motor (+) MAJOR (+) minor (-) Example Faradic Sinusoidal Direct current IFC TENS Russian current SWD MWD Effect Stimulate nerve and muscle Pain inhibition Thermal
- 17. LOW FREQUENCY CURRENT a.Short Duration • <10 ms • indicated for innervated b. Long Duration • > 10 ms • indicated for denervated Duration of current
- 18. • The numberof impulse per unit time • Depends partly on pulse duration & mainly on the interval between them • Aka Pulse Rate Frequency of Impulse • Rectangular • Trapezoidal • Triangular • Saw-tooth Waveform LOW FREQUENCY CURRENT
- 20. LOW FREQUENCY CURRENT •Monophasic/Direct Current •Biphasic/ Alternating Current •Symmetrical •Asymmetrical •Constant/ Continuous •Pulsed Current/ Interrupted Other waveforms
- 21. LFC MODALITIES PULSE WIDTH PULSERATE INDICATION 1. CONSTANT MONOPHASIC CURRENT Galvanic current 10 ms 50 Hz/pps 1. Denervated mm 2. Iontophoresis 3. Wound healing 2. INTERRUPTED DIRECT CURRENT a. Short duration IDC b. Long duration IDC <10 ms >10 ms 50– 70 pps 5-10 pps or less Innervated muscle Denervated muscle
- 22. LFC MODALITIES PULSE WIDTH PULSE RATE INDICATION 3.ASYMMETRIC BIPHASIC/FARADIC CURRENT 1 ms 50 pps 1. Innervated mm 2. FES 3. Adjust frequency of 80-100 for full tetanic contraction 4. SYMMETRIC BIPHASIC/SINUSOIDAL 10 ms Innervated muscle
- 23. INNERVATED = TETANICDENERVATED=TWITCH Type of muscle contraction 1pps= brisk >20 pps= partial tetany >60 pps= full tetany Sluggish Rate of change current strength of contraction Sudden Depends on the numbers of motor units stimulated Gradual Depends on the number of muscle fibers stimulated Duration of Impulse Short duration Long duration Polarity used Cathode Anode •Asymmetric Biphasic Current •Symmetric Biphasic Current •Short Duration IDC •Constant Monophasic Current •Long Duration IDC
- 24. ELECTRODIAGNOSIS ASYMMETRIC BIPHASIC CONSTANT MONOPHASIC Normal (+) strongtetanic (-) Partial Denervation (+) weak tetanic (+) weak twitch Complete Denervation (-) (+) strong twitch
- 25. Muscle strengthening, muscle spasm(pump) or edema, ROM • 10-25 contractions • Duty cycle: interrupted: 1:3 Muscle spasm (fatigue) • Duty cycle: continuous or 1:1 Muscle re-education • Treatment time: 10- 30 mins or to pt’s tolerance
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- 27. IONTOPHORESIS • Application ofa continuous direct current (MONOPHASIC) to transfer medicinal agents through the skin or mucous membrane for therapeutic purposes • Ion transfer depends on: Dosage = time x intensity • Safe Limit for active electrode (Intensity) Anode: Cathode:
- 28. CATHODE ION CHARGE INDICATIONS Salicylate(-) Analgesia, myalgia, plantar warts Sodium chloride (-) Recent scars Acetic acid (-) Calcium deposits Dexamethasone (-) Anti inflammation/ arthritis Potassium Iodide (-) Keloid
- 29. ANODE ION CHARGE INDICATIONS Copper(+) Fungal infections Hyaluronidase (+) Edema reduction Magnesium (+) Muscle relaxant Xylocaine (+) Tendinitis, anti inflammation Hydrocortisone (+) Anti-inflammation
- 30. ANODE ION CHARGE INDICATIONS Glycoparrolate(+) Hyperhydrosis Calcium (+) Hyperhydrosis Lidocaine (+) Analgesia Zinc sulfate (+) Ulcers, slow healing wounds
- 31. CONTRAINDICATIONS (IONTO) Impaired skin sensation Allergy or sensitivityto therapeutic agent or direct current Very recent scars, cuts, bruises or broken skin Metal in or near the treatment area Cardiac pacemaker Over heavy scarring tissues Malignancies Over lower abdomen/ uterus during pregnancy Over Osteomyelitis Anterior Cervical region
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- 33. FUNCTIONAL ELECTRICAL STIMULATION •Can use alternating current (ASYMMETRIC BIPHASIC) (AC 80-100Hz) to stimulate an innervated muscle for general stimulation of innervated muscles • also called NMES
- 34. INDICATIONS Disuse atrophy Impaired ROM Musclespasm Muscle reeducation Spasticity management FES
- 35. INDICATION DUTY CYCLE Weakness1:1 or 1:2 No atrophy 1:1 or 1:2 Minimal atrophy 1:1 or 1:2 Moderate atrophy 1:3 or 1:4 Severe atrophy 1:5 or 1:10 FES
- 36. FES ON SHOULDERSUBLUXATION • Waveform: • Modulation: • Electrode placement: • Amplitude: • Pulse rate: • Duration of tx: • Duty cycle:
- 37. FES ON IDIOPATHICSCOLIOSIS • Waveform: • Modulation: • Electrode placement: • Amplitude: • Pulse rate: • Duty cycle:
- 38. FES AS DFASSIST • Waveform: • Modulation: • Electrode placement: • Amplitude: • Pulse rate:
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- 40. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION •Most common & important form of electro analgesia THEORIES OF PAIN RELIEF 1. Gate Control Theory 2. Release of natural endogenous opiates 3. Counter Irritation 4. Induced Vasodilation
- 42. INDICATIONS (TENS) Post oppain During labor and delivery Bone Fx Chronic pain Trigeminal neuralgia Phantom pain Antiemetic effects Improved blood flow
- 43. CONTRAINDICATIONS (TENS) Demand typepacemakers Over chest area of patients with cardiac problem Over eye, laryngeal or pharyngeal muscles, head and neck of patients after CVA or epilepsy Application to mucosal membrane Over trunk, pelvis, lower back, lower abdomen and uterus during pregnancy
- 44. ELECTRODE PLACEMENT At thepoint of pain At dermatomes with nerve roots Over trigger and acupuncture points Proximal or distal to the pain site At segmental related myotomes TENS
- 45. TYPE OF TENS Conventional/ High Rate Acupuncture-like/ Strong Low Rate Brief intense Burst mode/ Pulse Trains Hyperstimulation/ Point Stimulation Modulation mode
- 46. MODE PULSE WIDTH (PULSE DURATION) PULSE RATE (FREQUENCY) INDICATIONDURATION OF TREATMENT CONVENTIONAL 50-100 50-80 Chronic and Acute pain 20-60 mins ACUPUNCTURE 150-300 1-5 Chronic pain 30-40 mins BURST MODE 50-200 1-4 Acute pain, more effective on CHRONIC pain 20-30 mins BRIEF INTENSE 50-250 50-150 Before painful procedure 15 mins HYPERSTIMULATION 150-300 1-5 Chronic pain 15-30 secs
- 47. •A method ofmodulating the above TENS mode for the purpose of preventing of neural adaptation due to constant electrical stimulation •Frequency, pulse duration, Intensity may be altered Modulation mode
- 48. TENS PARAMETER TUNE OFESPECIALLY FOR YOU Conventional 50 to 100 Acupuncture 150 to 300 Burst 50 to 200 Brief Intense 50 – 250 Point Stimulation 150 to 300 milliseconds Accommodation varies in duration 50 to 80 ang freq ng high rate 1to 5 ang low rate Burst mode is 1 to 4 Brief 50-150 1to 5 hyperstim Varies in modulation
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- 51. INTERFERENTIAL CURRENT • Crossingof 2 sinusoidal waves with similar amplitudes, but different carrier frequencies that interfere with one another to generate an amplitude-modulated BEAT frequency • Uses two medium freq currents (MFC) around 4,000 to evoke interference current between 1-100 Hz Physics related to IFC • Constructive interference • Destructive interference • Beat frequency • Constant • Variable
- 52. • Pain • Swelling/Edema • Urinary Incontinence • Osteoarthritic pain INDICATION • Malignancies • All types of electronic implants • During first trimester of pregnancy • Over lower abdomen/ uterus during pregnancy • Over transcervical area CONTRAINDICATIONS IFC
- 53. 1. 1-10 Hzconstant 2. 1-10 Hz rhythmic 3. 1-100 Hz rhythmic 4. 90-100 Hz rhythmic 5. 100 Hz constant • motor • minor swelling • mild muscle pump • motor • severe swelling • vigorous muscle pump • motor and sensory • pain & swelling • sensory • neuralgic pain • sensory • chronic pain due to sympathetic dystrophy IFC
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- 55. RUSSIAN CURRENT • Medium-frequencypolyphasic (AC) waveform • The intensity is produced in a burst mode that has a 50% duty cycle, with a pulse width range of 50 to 200 μs and an inter burst interval of 10 msa • More comfortable and stimulating both deep and superficial tissues • Augment muscle strengthening by stimulating both sensory and motor nerve fibers resulting in tetanic contractions that are painless and stronger than those made voluntarily by the patient
- 57. CONTRAINDICATIONS (RUSSIAN) Over the abdominal and pelvisarea of pregnancy Over area of malignancy Over the anterior cervical area Over electronic implant
- 58. PROTOCOLS 1. Muscle Strengtheningprotocol • Amplitude: • Pulse rate: • Pulse Duration: Current applied to provide stimulation during the ff activities: • Isometric exercise at several points through ROM • Slow isokinetic exercises • Short arc joint movement when ROM is restricted Russian
- 59. PROTOCOLS 2. Muscle spasmprotocol • Amplitude: • Pulse rate: • Pulse duration: • ES applied to provide isometric contraction Russian
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- 61. EMG BIOFEEDBACK • Electronicinstrument used to measure motor unit action potential (MUAP) that are generated by active muscles • The signals are detected, amplified & converted into audio visual signals that are used to reinforce voluntary control • Used to either increase or decrease muscle activity to achieve a functional goal • Measures electrical activity of muscle and not the muscle contraction directly
- 62. • Any conditionwhere mm contraction is detrimental • Skin irritation at electrode site CONTRAINDICATIONS • Good vision, hearing and communication abilities • Good comprehension of simple commands, concentration • Good motor planning skills • No profound sensory or proprioceptive loss Patient selection for Biofeedback training EMG
- 63. USES OF BIOFEEDBACK FACILITATION •Initial setting: High sensitivity, widely spaced • Progression: Lower sensitivity, move closer INHIBITION • Initial setting: Low sensitivity; closely spaced • Progression: Heighten sensitivity; move farther apart
- 64. ELECTRODE APPLICATION Electrode selection •Small (0.2 cm) • Large (1 cm) Electrode placement • Bipolar technique • 15 cm apart & parallel to muscle fiber • Active electrodes are placed close together = minimize cross talk, yield small signals, more precise signals • Active electrodes placed farther apart = yields large signal, detection from more than 1 muscle EMG
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- 66. CONTRAINDICATIONS • Demand type pacemakeror unstable arrhythmias • Over the carotid sinus • Venous or arterial thrombosis or thrombophlebitis • Pelvis, abdomen, trunk, and low back during pregnancy PRECAUTIONS • Cardiac disease • Impaired mentation or sensation • Malignant tumors • Skin irritation or open wounds ES:
- 67. RECOMMENDED PARAMETERS • Waveform •Polarity • Pulse Frequency • Pulse Duration • Amplitude • Treatment time Tissue Healing: Inflammatory phase/infected • Waveform • Polarity • Pulse Frequency • Pulse Duration • Amplitude • Treatment time Tissue Healing: Proliferation phase/clean
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- 70. EDEMA CONTROL • Waveform •Polarity • Pulse Frequency • Pulse Duration • Amplitude • Treatment time For Edema associated with Inflammation • Waveform • Polarity • Pulse Frequency • Pulse Duration • Amplitude • Treatment time For Edema associated with lack of motion
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- 73. ULTRASOUND • Mechanical energyproduced by sound waves at frequencies between 85 Hz and 3 Mhz and delivered at intensities between 1 and 3 w/cm2 is absorbed by body tissues and changed to thermal energy • Heats tissues with a high collagen content
- 74. PHYSICAL PHENOMENON • Redirectionof an incident beam away from a surface at an angle equal and opposite to the angle of incidence. • Great at interface between soft tissue and bone • Great at interface between soft tissue and metallic implant • Minimal at interface of soft tissue layers • No interface at transducer head and medium REFLECTION
- 75. • Redirection ofa wave at an interface • US enters a tissue at one angle and continues through the tissue at a different angle REFRACTION • Decrease in US intensity as US travels through tissue depends on: • Absorption • Frequency • Protein: major absorber of UTZ ATTENUATION PHYSICAL PHENOMENON
- 76. 1 MHz 3MHz Beam divergence Parallel beam Lower frequency Faster frequency Greater depth of penetration (5- 8 cm) Less depth of penetration (1-2 cm) Less absorption of sound Greater absorption of sound Focus on US beam in the deeper tissue Increase in motor and sensory conduction and velocities Can be used for phonophoresis Increase in all membrane permeability Increase in human skin fibroblast
- 77. • Measure ofthe variability of the ultrasound wave intensity produced by the machine. • Ratio between the peak intensity and the average intensity • The lower the ratio, the more uniform the treatment. BEAM NON-UNIFORMITY RATIO (BNR) • the portion of the sound head that produces the sound wave • should be close to the size of the sound head or transducer • area covered should not be greater than two to three times the size of the (ERA) for 5 minutes of treatment. EFFECTIVE RADIATING AREA (ERA) PHYSICAL PHENOMENON
- 79. GOALS AND INDICATIONS Modulatepain Increase connective tissue extensibility Reduce or eliminate soft tissue inflammation Wound healing Reduce ms spasm US
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- 81. CONTRAINDICATIONS Malignant tumor Pregnancy: over uterus CNS tissueJoint cement Plastic components Pacemaker Thrombophle bitis Eyes Reproductive organ Radiums and Radiosotopes US
- 82. PHYSIOLOGIC EFFECTS Thermal • 100%duty cycle • Chronic conditions Non-Thermal • Cavitation: alternating compression and expansion of small gas bubbles in tissue fluids caused by mechanical pressure waves • Acoustic streaming: movement of fluids along the boundaries of cell membranes resulting from mechanical pressure waves • <100% duty cycle
- 83. DOSAGE INTENSITY: • Never exceed4 w/cm2 • 0.1 to 0.3 w/cm2 for acute • 0.4 to 1.5 w/cm2 for chronic INTENSITY PURPOSE 0.3-1.0 Wound healing 0.5-1.0 Pain and spasm relief 0.5-1.5 Hematoma resorption 1.0-1.5 plasticity of scar and connective tissue US
- 84. • Acute conditions:1-2x/day for 6-8 days • Chronic conditions: alternating days Frequency of Treatment • limitation of UTZ- up to 14 treatment sessions • Reduction of RBC & WBC NOTE US
- 85. PULSED UTZ ISUSED WHEN: • When heat exacerbates pain • When reduction of NCV is required in nerve fibers, nerve roots or ganglia • For regeneration of tissue • Aid in resolution of acute non-infective inflammation
- 86. METHOD OF APPLICATION •1.5 “/sec • 0.3 – 1.5 w/cm2 (do not exceed 4 W/cm2) • 3-10 mins • Circular: 2-3sec/revolution • Linear: 1-2 inches/ sec Moving Technique
- 87. METHOD OF APPLICATION •not generally used due to hotspot • 0.2 – 1 w/cm2 (do not exceed 1 W/cm2) • 3-5 mins Stationary Technique • For irregularly shaped parts • plastic container • stationary or moving • 0.5-1cm or 2 inches distance from skin to transducer head Water Immersion
- 88. • Local analgesia& anti- inflammatory drugs Mode: • Pulsed 20% duty cycle • 1-3 w/cm • 5-10 mins • Low intensities & longer time PHONOPHORESIS METHOD OF APPLICATION
- 89. Transducer Head considerations: •Mostcommonly used: •Superficial/divergent: •Deep/convergent:
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- 92. DIATHERMY • “through heating” •application of shortwave or microwave electromagnetic energy to produce heat and other physiological changes within tissues • heats deeper than hot packs and heats a larger area than ultrasound
- 93. TYPES OF DIATHERMYAPPLICATORS • Inductive Coils • heating by the magnetic field method • Can heat both deep and superficial tissues, but they produce the most heat in tissues closest to the applicator and in tissues with the highest electrical conductivity • Capacitive Plates • heating by the electrical field method • produce the most heat in skin and less heat in deeper structures • Magnetron
- 95. INDICATIONS THERMAL • Pain control •Accelerated tissue healing • Decreased joint stiffness • Increased joint range of motion if in conjunction with stretching NON-THERMAL PULSED SWD • Control pain and edema • Promote wound, nerve, and fracture healing
- 96. CONTRAINDICATIONS All forms of Diathermy •Implanted or transcutaneous neural stimulators, including cardiac pacemakers • Pregnancy Thermal level Diathermy • Metal implants • Malignancy • Eyes • Testes • Growing epiphyses Non Thermal Pulsed SWD • Deep tissues such as internal organs • Substitute for conventional therapy for edema and pain • Pacemakers, electronic devices, or metal implants
- 97. PRECAUTIONS All forms of Diathermy •Near electronic or magnetic equipment • Obesity • Copper- bearing intrauterine contraceptive devices Non Thermal Pulsed SWD • Pregnancy • Skeletal immaturity For the Therapist • 1 to 2 m away from all continuous diathermy • 30 to 50 cm away from all PSWD • out of the direct beam of any MWD device
- 98. APPLICATION • Treatment time •Patient positioning
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- 101. LASER • Light Amplificationby Stimulated Emission of Radiation Properties of LASER: 1. Coherence 2. Monochromaticity 3. Collimation
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- 104. CONTRAINDICATIONS Direct irradiation to the eyes Malignancy Within4-6 months after radiotherapy Over hemorrhagic conditions Over thyroid or other endocrine glands Laser
- 105. PRECAUTIONS Low back or abdomenduring pregnancy Epiphyseal plates in children Impaired sensation Impaired mentation Photophobia or abnormally high sensitivity to light Laser
- 106. CONDITION TREATMENT DOSE (J/cm2) Softtissue healing 5-16 Fracture healing 5-16 Acute arthritis 2-4 Chronic arthritis 4-8 Lymphedema 1.5 Neuropathy 10-12 Acute soft tissue inflammation 2-8 Chronic soft tissue inflammation 10-20 Laser
- 107. CLINICAL APPLICATION FORTISSUE HEALING Gridding the wound • 1- 1.5 cm2 open squares • HeNe- 20 seconds • GaAs- 10 seconds • Clean area first prior to application Surrounding the wound • If there is a presence of eschar in the wound that is unusually large • HeNe- every 2 cm2 for 30 seconds • GaAs- every 2 cm2 for 20 seconds Laser
- 108. CLINICAL APPLICATION FORPAIN MANAGEMENT • HeNe- 30 seconds • GaAs- 20 seconds • Direct stimulation over the site of dysfunction or stimulation of associated acupuncture, trigger or motor points • If pain reduction has occurred after 4 or 5 sessions, the use of laser is discontinued • No more than 8-12 treatments