Transcutaneous Electrical Nerve Stimulation (TENS) I Physiotherapy: Dr Rohit Bhaskar
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Transcutaneous electrical nerve stimulation (TENS) therapy involves the use of low-voltage electric currents to treat pain. A small device delivers the current at or near nerves. TENS therapy blocks or changes your perception of pain. Strength duration curve
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Ultrasonic therapy uses high-frequency sound waves to treat injuries and conditions. It works by generating ultrasound using piezoelectric crystals that expand and contract in response to an electrical current. This creates alternating compressions and rarefactions that transmit energy into the body. Ultrasound has both thermal and non-thermal physiological effects, such as generating heat in tissues through absorption and cavitation, microstreaming, and mechanical tissue massage. Its heating properties can accelerate healing while its non-thermal effects may increase cell permeability and movement. Ultrasonic therapy is used to reduce pain and swelling and aid in tissue repair by stimulating fibroblasts and collagen production.
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Transcutaneous Electrical Nerve Stimulation (TENS) is a method of electrical stimulation that aims to provide pain relief by exciting sensory nerves and stimulating the pain gate mechanism and/or opioid system. TENS works through several mechanisms including activation of pain-gating mechanisms in the spinal cord and stimulation of the descending pain suppression system and endogenous opioid release. Different TENS waveforms, frequencies, pulse widths and intensities can be used depending on the type of pain and desired effects. Common types of TENS include conventional high frequency TENS and acupuncture-like low frequency TENS. Care must be taken with electrode placement and TENS is generally contraindicated for those with pacemakers or heart conditions.
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TENS
This document discusses T.E.N.S. (Transcutaneous Electrical Nerve Stimulation), a non-invasive pain management technique. It stimulates nerves under the skin to reduce pain signals according to the gate control theory. T.E.N.S. has efficacy rates of 50-80% for controlling chronic and acute pain, such as post-surgical or injury pain. Different T.E.N.S. techniques like high frequency, low frequency, and brief intense stimulation are described along with their parameters and applications. Placement of electrodes and contraindications are also covered.
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Microwave diathermy (MWD) uses electromagnetic radiation in the microwave frequency range to generate heat in tissue. MWD uses a magnetron to produce microwaves with frequencies commonly between 300 MHz to 300 GHz. These short wavelength microwaves generate strong electrical fields that cause heating through ionic movements and molecular distortion within tissues. MWD provides superficial heating that is more localized than shortwave diathermy and penetrates deeper than infrared radiation. Key uses of MWD include reducing pain, swelling and muscle spasm in inflammatory conditions like tendinitis as well as accelerating healing for injuries and infections.
Interferential therapy
This document discusses interferential therapy (IFT), including its history, principles, instrumentation, applications, effects, and precautions. Some key points:
- IFT was developed in the 1950s and involves applying two medium frequency alternating currents slightly out of phase to produce a low frequency effect for therapeutic purposes.
- The interference of the currents produces an amplitude-modulated frequency that can stimulate tissues in a manner similar to low frequency electrotherapy.
- IFT is used for pain relief, muscle stimulation, increasing blood flow, and reducing edema through its physiological effects on tissues from 10-150 Hz.
- Proper electrode placement and current parameters are important to achieve the intended effects while avoiding contraindic
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Short Wave Diathermy (SWD) is a treatment that uses electromagnetic energy to produce deep heating in joints and soft tissues. This form of heat can be applied to deeper structures than other forms of heat treatment.
Ultrasonic therapy
Ultrasonic therapy uses high-frequency sound waves to treat injuries and conditions. It works by generating ultrasound using piezoelectric crystals that expand and contract in response to an electrical current. This creates alternating compressions and rarefactions that transmit energy into the body. Ultrasound has both thermal and non-thermal physiological effects, such as generating heat in tissues through absorption and cavitation, microstreaming, and mechanical tissue massage. Its heating properties can accelerate healing while its non-thermal effects may increase cell permeability and movement. Ultrasonic therapy is used to reduce pain and swelling and aid in tissue repair by stimulating fibroblasts and collagen production.
Transcutaneous Electrical Nerve Stimulation (TENS) SRS
Transcutaneous Electrical Nerve Stimulation (TENS) is a method of electrical stimulation that aims to provide pain relief by exciting sensory nerves and stimulating the pain gate mechanism and/or opioid system. TENS works through several mechanisms including activation of pain-gating mechanisms in the spinal cord and stimulation of the descending pain suppression system and endogenous opioid release. Different TENS waveforms, frequencies, pulse widths and intensities can be used depending on the type of pain and desired effects. Common types of TENS include conventional high frequency TENS and acupuncture-like low frequency TENS. Care must be taken with electrode placement and TENS is generally contraindicated for those with pacemakers or heart conditions.
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Ultraviolet radiation covers a small part of the electromagnetic spectrum between visible light and X-rays. It is divided into UVA, UVB, and UVC based on wavelength. UV is produced by mercury vapor lamps and fluorescent lamps and can cause both immediate and long term effects on skin like erythema, pigmentation, vitamin D production, and skin cancer. The dosage of UV exposure depends on the lamp output, distance from the skin, exposure time, and individual skin sensitivity. UV therapy is used to treat conditions like psoriasis, acne, and eczema.
TENS
This document discusses T.E.N.S. (Transcutaneous Electrical Nerve Stimulation), a non-invasive pain management technique. It stimulates nerves under the skin to reduce pain signals according to the gate control theory. T.E.N.S. has efficacy rates of 50-80% for controlling chronic and acute pain, such as post-surgical or injury pain. Different T.E.N.S. techniques like high frequency, low frequency, and brief intense stimulation are described along with their parameters and applications. Placement of electrodes and contraindications are also covered.
MWD
Microwave diathermy (MWD) uses electromagnetic radiation in the microwave frequency range to generate heat in tissue. MWD uses a magnetron to produce microwaves with frequencies commonly between 300 MHz to 300 GHz. These short wavelength microwaves generate strong electrical fields that cause heating through ionic movements and molecular distortion within tissues. MWD provides superficial heating that is more localized than shortwave diathermy and penetrates deeper than infrared radiation. Key uses of MWD include reducing pain, swelling and muscle spasm in inflammatory conditions like tendinitis as well as accelerating healing for injuries and infections.
Interferential therapy
This document discusses interferential therapy (IFT), including its history, principles, instrumentation, applications, effects, and precautions. Some key points:
- IFT was developed in the 1950s and involves applying two medium frequency alternating currents slightly out of phase to produce a low frequency effect for therapeutic purposes.
- The interference of the currents produces an amplitude-modulated frequency that can stimulate tissues in a manner similar to low frequency electrotherapy.
- IFT is used for pain relief, muscle stimulation, increasing blood flow, and reducing edema through its physiological effects on tissues from 10-150 Hz.
- Proper electrode placement and current parameters are important to achieve the intended effects while avoiding contraindic
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This document discusses pulsed electromagnetic energy (PEME) therapy. PEME uses non-thermal pulses of electromagnetic energy to stimulate tissues for therapeutic purposes. It can increase ATP production, alter cell membranes, decrease inflammation, and increase healing. PEME is used to treat neurological conditions like radiculopathies and neuropathies, musculoskeletal issues like fractures and strains, psychological disorders, and general wounds and sores. Contraindications include pregnancy, menstruation, metal implants and recent radiation therapy.
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Contrast bath therapy involves soaking an injured area in alternating hot and cold water baths to increase blood flow and decrease stiffness and pain. The physiological mechanism is that it induces vasodilation and vasoconstriction through changes in water temperature, pumping edema from the injured area. The procedure involves soaking in warm water for 10 minutes, cold water for 1 minute, repeating warm water for 4 minutes and cold water for 1 minute, ending in warm water for 4 minutes for a total time of 25 minutes. Contrast baths can treat injuries like sprains, strains and bruises by removing edema through changes in blood flow. Certain precautions should be taken for conditions like open wounds, pregnancy and impaired sensation.
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INTERFERENTIAL THERAPY
Interferential therapy is a form of electrical stimulation that uses two medium frequency currents to produce a low frequency beating effect deeper in the tissues. It can provide analgesic, anti-inflammatory and muscle stimulation effects. IFT is applied using electrode pads or probes placed on the skin over the treatment area. Parameters like frequency, intensity, and application time can be modified based on the condition being treated. Common indications include pain, muscle spasm, edema, and post-surgical issues. Proper application and monitoring of settings is needed to provide benefit safely.
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Russian current is a form of electrical stimulation using alternating current delivered in 2.5kHz bursts with a 50Hz burst frequency and 50% duty cycle. It was developed by Russian scientist Kots who found it improved strength in athletes. As a result, this stimulation pattern became known as Russian current. It is used clinically to contract and strengthen muscles, typically with 10 seconds on, 50 seconds off bursts to avoid fatigue. The main effects are increased muscle force through central nervous system adaptation and physical muscle growth.
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TENS, or transcutaneous electrical nerve stimulation, is a non-invasive method of pain relief using a device that sends electrical pulses to nerves under the skin via electrodes. There are four parameters that can be adjusted: pulse shape, pulse width, frequency, and intensity. TENS is commonly used to treat both acute and chronic pain conditions like back pain, arthritis, and sports injuries. Electrodes are placed on or near painful areas or trigger points and treatment sessions typically last less than 40 minutes daily. High and low TENS frequencies have different common parameter settings. Precautions are taken to avoid electrolyte reactions or use of TENS on certain body areas or for people with medical contraindications.
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Russian current
Electrical stimulation involves using a medium-frequency current to stimulate nerves and muscles. Specifically, it uses a 2500 Hz sinusoidal alternating current delivered in bursts at 50 Hz intervals of 10 ms on and 10 ms off. This Russian current protocol of 10 seconds on, 50 seconds rest, repeated for 10 cycles over 10 minutes was found to be effective for generating muscle fatigue. The stimulation aims to synchronously depolarize sensory and motor fibers, activate fast motor units, and strengthen muscles through electrically evoked contractions against an external load.
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1. Iontophoresis is the transfer of ions through the skin using direct current. Positively charged ions migrate to the negative electrode and vice versa.
2. Different ions can be used to treat various conditions like salicylate for pain, chlorine for softening scars, and acetic acid for calcium deposits.
3. Proper application involves cleaning the skin, placing moistened electrodes on the treatment area and indifferent site, and applying a mild current for 15 minutes.
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tens.pptx
Transcutaneous electrical nerve stimulation (TENS) is a method of electrical stimulation that aims to provide pain relief by exciting sensory nerves and stimulating the pain gate mechanism and/or opioid system. TENS works through activation of pain-gating mechanisms and removal of pain-causing substances. Parameters like waveform, frequency, pulse width, and amplitude are used. Different types of TENS include conventional high frequency TENS, acupuncture-like low frequency TENS, burst TENS, brief intense TENS, and modulated TENS. Electrodes are placed on or near painful areas and TENS can be used to treat conditions like osteoarthritis, fibromyalgia, and labor pain.
TENS.pptx
The document discusses Transcutaneous Electrical Nerve Stimulation (TENS) and its use for pain management. It provides details on:
- How TENS works according to the Gate Control Theory of pain, using electrical pulses to stimulate nerve fibers and inhibit pain signals.
- The different TENS settings and modes used for different types of pain relief, such as high vs low frequency TENS.
- Contraindications and safe application of TENS, including electrode placement and skin conditions.
- Guidelines for self-administration and maintenance of TENS units.
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A faradic current is a short duration interrupted direct current with a pulse duration of 0.1-1 ms and frequency of 50-100 Hz. It produces a biphasic, asymmetrical and spiked waveform. Faradic currents are used to produce near normal tetanic-like muscle contractions and relaxations. When applied to nerves and muscles, it causes sensory stimulation, muscle contraction, reduced swelling and pain, and increased metabolism. Faradic current is indicated for muscle reeducation, maintaining range of motion, loosening adhesions, and replacing orthosis. It involves placing electrodes on muscles or nerve trunks and gradually increasing and decreasing intensity to cause contraction and relaxation.
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Laser therapy uses low-level lasers that emit coherent light to induce biological effects in tissues. It was first developed in the 1960s and approved by the FDA in 2002 to treat carpal tunnel syndrome. Lasers are classified based on their power output and potential hazards, with classes 1 and 2 being safe for therapeutic use. Common types include helium-neon and gallium arsenide lasers. Physiological effects include reducing pain and inflammation, promoting tissue healing, and recovery from nerve injuries through various cellular mechanisms like increased ATP and growth factor production.
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Interferential therapy is a form of electrical stimulation that uses two medium frequency currents to produce a low frequency beating effect deeper in the tissues. It can provide analgesic, anti-inflammatory and muscle stimulation effects. IFT is applied using electrode pads or probes placed on the skin over the treatment area. Parameters like frequency, intensity, and application time can be modified based on the condition being treated. Common indications include pain, muscle spasm, edema, and post-surgical issues. Proper application and monitoring of settings is needed to provide benefit safely.
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This document summarizes fluidotherapy, a dry heating modality. It transfers heat to the body through convection using a cabinet containing heated air and finely ground cellulose particles. This creates a fluid-like medium allowing limbs to float and exercises to be performed. Key effects include increased blood flow, pain relief and improved range of motion. It is used to treat distal extremities for conditions like pain, swelling and post-operative rehabilitation. Contraindications include fever, anesthesia or severe circulatory issues. Advantages include ease of use and allowing some active exercise in a comfortable, dry environment.
Russian currents
Russian current is a form of electrical stimulation using alternating current delivered in 2.5kHz bursts with a 50Hz burst frequency and 50% duty cycle. It was developed by Russian scientist Kots who found it improved strength in athletes. As a result, this stimulation pattern became known as Russian current. It is used clinically to contract and strengthen muscles, typically with 10 seconds on, 50 seconds off bursts to avoid fatigue. The main effects are increased muscle force through central nervous system adaptation and physical muscle growth.
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The Rebox device applies specific electric currents transcutaneously to treat pain, immobility, and musculoskeletal and neurological disorders. It works by restoring microcirculation, reducing inflammation, and improving blood and lymph flow. Treatment sessions last 5-10 minutes using different modes and electrode tips. Rebox is used for conditions like back pain, ankle sprains, and knee ligament injuries. Contraindications include open wounds, pregnancy, and use near pacemakers.
UVR
Ultraviolet radiation can be used therapeutically to treat various skin conditions. It has both immediate physiological effects like erythema, tanning, and long term effects like aging and cancer. There are different types of UV generators that produce UVA, UVB or UVC. Dosage is carefully determined based on skin type and response. PUVA treatment uses oral photosensitizing drugs before UVA exposure to treat conditions like psoriasis. Precautions must be taken with UV therapy due to risks of overexposure like burns, aging and skin cancer.
Cyclotherm
Cyclotherm is a device that circulates fluid through an applicator to heat or cool the skin surface and vary the temperature between 1-40°C at a rate of 13°C per minute. It can be programmed to apply preset temperatures for predetermined times for therapies like thermotherapy, cryotherapy, and thermal contrast therapy. Heat is used to increase circulation, metabolism, and inflammation/wound healing while decreasing pain and muscle spasm. Cold causes vasoconstriction, lowers metabolic rate, and provides pain relief. Therapies include using heat before stretching/mobilization and cold for acute injuries, pain relief, and reducing inflammation/spasm. Contraindications include vascular diseases and inability to sense
Tens transcutaneous electrical nerve stimulator
TENS, or transcutaneous electrical nerve stimulation, is a non-invasive method of pain relief using a device that sends electrical pulses to nerves under the skin via electrodes. There are four parameters that can be adjusted: pulse shape, pulse width, frequency, and intensity. TENS is commonly used to treat both acute and chronic pain conditions like back pain, arthritis, and sports injuries. Electrodes are placed on or near painful areas or trigger points and treatment sessions typically last less than 40 minutes daily. High and low TENS frequencies have different common parameter settings. Precautions are taken to avoid electrolyte reactions or use of TENS on certain body areas or for people with medical contraindications.
Ultrasound therapy
The document discusses ultrasound therapy, including its introduction, production, physiological effects, application techniques, methods, indications, and contraindications. Specifically, it explains that ultrasound therapy involves using high-frequency sound waves to treat soft tissue injuries and conditions. It describes how piezoelectric crystals or transducers are used to produce the therapeutic ultrasound and discusses direct contact and indirect immersion and bladder application as methods of delivery. The document also lists common uses of ultrasound therapy such as for soft tissue injuries, sprains, and arthritis, as well as who should avoid it like those with cancer lesions or metal implants.
Russian current
Electrical stimulation involves using a medium-frequency current to stimulate nerves and muscles. Specifically, it uses a 2500 Hz sinusoidal alternating current delivered in bursts at 50 Hz intervals of 10 ms on and 10 ms off. This Russian current protocol of 10 seconds on, 50 seconds rest, repeated for 10 cycles over 10 minutes was found to be effective for generating muscle fatigue. The stimulation aims to synchronously depolarize sensory and motor fibers, activate fast motor units, and strengthen muscles through electrically evoked contractions against an external load.
Iontophoresis
Dr. Shweta Panchbudhe provides a lesson on iontophoresis. The key points are:
1. Iontophoresis is the transfer of ions through the skin using direct current. Positively charged ions migrate to the negative electrode and vice versa.
2. Different ions can be used to treat various conditions like salicylate for pain, chlorine for softening scars, and acetic acid for calcium deposits.
3. Proper application involves cleaning the skin, placing moistened electrodes on the treatment area and indifferent site, and applying a mild current for 15 minutes.
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Transcutaneous electrical nerve stimulation (TENS) is a method of electrical stimulation that aims to provide pain relief by exciting sensory nerves and stimulating the pain gate mechanism and/or opioid system. TENS works through activation of pain-gating mechanisms and removal of pain-causing substances. Parameters like waveform, frequency, pulse width, and amplitude are used. Different types of TENS include conventional high frequency TENS, acupuncture-like low frequency TENS, burst TENS, brief intense TENS, and modulated TENS. Electrodes are placed on or near painful areas and TENS can be used to treat conditions like osteoarthritis, fibromyalgia, and labor pain.
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This document provides an overview of various physical modalities used in physical medicine and rehabilitation, including electrotherapy, light therapy, and acupuncture. It discusses the physiological basis and protocols for transcutaneous electrical nerve stimulation (TENS), interferential current therapy, neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), ultraviolet light therapy, low-level laser therapy, and acupuncture. Benefits are described for reducing pain and improving muscle function. Precautions and contraindications are also outlined to safely administer each modality.
ZMPCZM022000.12.01 User's manual
This document provides a user manual for the IF8100 interferential therapy device. It includes sections on device controls, electrode placement, skin care, batteries, customer service information, and treatment protocols for pain relief, edema reduction, spasm reduction and other indications. Treatment protocols provide recommendations on electrode placement, intensity levels, treatment times, recommended modes and stimulation parameters.
Zmpczm022000.12.01 User's manual
The IF8100 is an interferential therapy device with multiple treatment modes for pain relief and muscle stimulation. Key information from the document includes:
- Interferential therapy uses two channels of 4000Hz stimulation in a cross-pattern to penetrate the skin more effectively than TENS or NMES devices. The beating frequency can be set from 1-150Hz.
- Treatment modes include Low (1-10Hz), High (80-150Hz), Muscle (6s on/6s off at 50Hz), and Combo (cycles through other modes).
- Electrodes are placed in a cross-pattern around the treatment area. Intensity is set as high as comfortably tolerated. Typical treatment is 20
ZMPCZM022000.12.01 User's manual
This document provides a user manual for the IF8100 interferential therapy device. It includes sections on device controls, electrode placement, treatment protocols, and technical specifications. The manual describes how to use the device for applications such as pain relief, edema reduction, and muscle spasm reduction. It provides guidance on treatment parameters and recommended modes for different therapeutic goals.
ZMPCZM022000.12.01 User's manual
The document provides a user manual for an interferential therapy device called the IF8100. It includes instructions on device controls, recommended electrode placement and protocols for various applications including pain relief, edema reduction, spasm reduction and increasing local blood circulation. Protocols are provided for different treatment modes and include details on frequency settings, intensity levels and treatment duration. The manual also covers device start-up, supplies ordering information, technical specifications and safety information.
Neuromuscular monitoring
This document discusses neuromuscular monitoring techniques used during anesthesia to assess the level of neuromuscular blockade from muscle relaxants. It describes how peripheral nerve stimulation and recording the evoked muscle response can objectively evaluate blockade. Common stimulation patterns like train-of-four and post-tetanic count are outlined. The advantages and disadvantages of different monitoring methods like mechanomyography, electromyography, and acceleromyography are summarized.
Zmpcrm073000.12.01 User's Manual
This document provides instructions for use of the In TENSity 5000 TENS Stimulator. It includes information on parts of the device, general safety warnings, instructions for use including how to turn the device on and off and adjust settings, specifications, cleaning and care instructions, troubleshooting tips, and other use details. The manual describes how the device uses transcutaneous electrical nerve stimulation (TENS) to help reduce various types of pain by sending electrical pulses to nerves under the skin that reduce the body's perception of pain signals.
TENS.pptx
Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique that uses low voltage electrical currents to stimulate nerves for pain relief. TENS works by activating A-beta fibers through the skin which closes the pain gate in the spinal cord and reduces pain signal transmission. There are different TENS modalities for acute or chronic pain including conventional TENS, acupuncture TENS, and brief intense TENS. TENS is used to treat various pain conditions like postoperative pain, arthritis, and labor pain by placing electrodes on the skin over painful areas.
IFT.pdf
Interferential therapy is a form of electrical stimulation that uses two medium frequency currents between 4000-5100 Hz to generate low frequency interference currents between 1-100 Hz at targeted tissue depths. This allows for pain relief, muscle stimulation, increased blood flow and lymphatic drainage without the limitation of skin resistance. Electrodes are placed diagonally over the area of interest and current intensity is gradually increased until felt by the patient. Contraindications include coagulation issues, arterial disease, infections and pacemakers. Typical applications are for pain, swelling, muscle stimulation and tissue healing.
BATCH 06 - IFT PRESENTATION.pptx
The document discusses interferential therapy (IFT), including its principles, working mechanisms, and applications. IFT involves applying two medium frequency currents simultaneously to generate low frequency interference currents in the body. Key points include:
- IFT uses medium frequencies between 1000-10,000 Hz to generate low frequency currents from 50-150 Hz. This allows for deeper, more comfortable current penetration.
- IFT can be applied using bipolar, static quadripolar, or vector scan quadripolar methods depending on the treatment area and desired effects.
- Physiological effects include pain relief, muscle stimulation, increased blood flow, and edema reduction depending on the frequency used.
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PIVD (Slipped or Herniated Disc): Physiotherapy Treatment
A prolapsed disc is commonly known as ‘slipped disc’, where a disc does not actually slips but the part of the inner softer part of the disc bulges out or herniates through a weakness in the outer part of the disc.
The prolapsed intervertebral disc is also known as herniated disc.
STAGES OF PIVD:
(1) Bulging: At this early stage, the disc is stretched and doesn’t completely return to its normal shape when pressure is relieved. It retains a slight bulge at one side of the disc. Some of the inner disc fibres could be torn and the soft jelly ( nucleus pulposus ) is spiling outwards into the disc fibres but not out of the disc.
(2) Protrusion: At this stage, the bulge is very prominent and the soft jelly centre has spilled out to the inner edge of the outer fibres, barely held in by the remaining disc fibres.
(3) Extrusion: In the case of a herniated spinal disc, the soft jelly has completely spilled out of the disc and now protruding out of the disc fibres.
(4) Sequestration: Here some of the jelly material is breaking off away from the disc into the surrounding area.
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Stroke: Physiotherapy Treatment
A stroke, sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death.
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Polio (Poliomyelitis): Physiotherapy Treatment
Poliomyelitis (polio) is a highly infectious viral disease that largely affects children under 5 years of age. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.
Parkinson Disease: Physiotherapy Treatment
Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.
Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.
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Vestibular System Anatomy Function - Dr Rohit Bhaskar
Vestibular system, apparatus of the inner ear involved in balance. The vestibular system consists of two structures of the bony labyrinth of the inner ear, the vestibule and the semicircular canals, and the structures of the membranous labyrinth contained within them.
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Typhoid Fever - Dr Rohit Bhaskar
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs. Without prompt treatment, it can cause serious complications and can be fatal. It's caused by a bacterium called Salmonella typhi, which is related to the bacteria that cause salmonella food poisoning.
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Thyroid Disorders - Dr Rohit Bhaskar
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Liver and Gall Bladder - Dr Rohit Bhaskar
The document discusses the liver, gallbladder, and hepatic biliary system. It covers the anatomical structure and physiology of the liver including lobules, zones, and blood supply. It describes the formation and circulation of bile as well as the functions of bile salts. The gallbladder's role in regulating bile pressure and concentration is explained. Common liver disorders like jaundice, cirrhosis, and hepatitis are outlined. Finally, liver function tests are summarized.
Limbic system - Dr Rohit Bhaskar
The limbic system is a set of structures in the brain that deal with emotions and memory. It regulates autonomic or endocrine function in response to emotional stimuli and also is involved in reinforcing behavior .
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Levers in Human Body ( Physiotherapy ) - Dr Rohit Bhaskar
Muscles and bones act together to form levers. A lever is a rigid rod (usually a length of bone) that turns about a pivot (usually a joint). Levers can be used so that a small force can move a much bigger force. This is called mechanical advantage.
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Immunity ( Medical ) - Dr Rohit Bhaskar
Immunity can be defined as a complex biological system endowed with the capacity to recognize and tolerate whatever belongs to the self, and to recognize and reject what is foreign (non-self).
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Principal’s Of Lifting & Moving Patient - Dr Rohit Bhaskar
Casualty lifting is the first step of casualty movement, an early aspect of emergency medical care. It is the procedure used to put the casualty (the patient) on a stretcher.
Developed emergency services use lifting devices, such as scoop stretchers, that allow secured lifting with minimal personnel. Other methods (explained below) can be used when such devices are not available.
Since only stabilised casualties are moved (except in unusual circumstances), the lifting is usually never performed in emergency; emergency movements are sometimes performed to respect the Golden Hour. This depends on the organisation of the medical services and on the specific circumstances.
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Jaundice - Dr Rohit Bhaskar
Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment. Jaundice has many causes, including hepatitis, gallstones and tumors. In adults, jaundice usually doesn't need to be treated.
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Hydrotherapy - Dr Rohit Bhaskar
Hydrotherapy is the use of water, both internally and externally and at varying temperatures, for health purposes. Also known as water therapy or "water cures," hydrotherapy includes such therapeutic treatments as saunas, steam baths, foot baths, contrast therapy, sitz baths, and colonic cleansing.
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Gait Cycle - Phases & Analysis - Dr Rohit Bhaskar
Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems.
The individual gait pattern is influenced by age, personality, mood and sociocultural factors.
The preferred walking speed in older adults is a sensitive marker of general health and survival.
Safe walking requires intact cognition and executive control.
Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life.
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Spina Bifida - Dr Rohit Bhaskar
Spina bifida is a birth defect where the spinal column does not close properly around the spinal cord. It can range in severity from a mild form where there is no impact to neurological function, to more severe forms where parts of the meninges or spinal cord protrude out of the spine. Treatment may include surgery to cover the exposed tissue, physical and occupational therapy, bracing, and management of symptoms like urinary incontinence. Long term follow up is also needed to address issues like muscle imbalances, contractures, and prevention of secondary complications. The exact causes are unknown but likely involve both genetic and environmental factors like low maternal folate levels.
BRACHIAL PLEXUS INJURY - Dr Rohit Bhaskar
A brachial plexus injury (BPI), also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand.
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Female Reproductive System - Dr Rohit Bhaskar
This document provides an overview of the anatomy of the female reproductive system. It describes both the external and internal structures. The external structures include the mons pubis, labia majora and minora, clitoris, hymen, and urethral opening. The internal structures are the vagina, uterus, fallopian tubes, and ovaries. Each structure is defined and its functions are explained, such as how the vagina facilitates childbirth and the ovaries produce eggs and hormones. Blood supply and nerve innervation are also outlined for each organ.
Erythropoiesis - Dr Rohit Bhaskar
Erythropoiesis (from Greek 'erythro' meaning "red" and 'poiesis' meaning "to make") is the process which produces red blood cells (erythrocytes), which is the development from erythropoietic stem cell to mature red blood cell.
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Foot Drop: Causes, Symptoms, and Treatment - Dr Rohit Bhaskar
Foot drop is a condition characterized by the inability to lift the front part of the foot. It can be caused by injury to nerves like the peroneal nerve or from neurological conditions such as stroke or multiple sclerosis. Symptoms include difficulty lifting the foot and dragging of the toes when walking. Treatment depends on the underlying cause but may include bracing, physical therapy, nerve stimulation, or tendon transfer surgery. The goal is to strengthen muscles and restore functional walking patterns.
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
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Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
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Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
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Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Transcutaneous Electrical Nerve Stimulation (TENS) I Physiotherapy: Dr Rohit Bhaskar
- 1. TENS ©2020 ROHIT BHASKAR PT 1 Presented By Rohit Bhaskar PT At Uttar Pradesh University Of Medical Sciences
- 2. ©2020 ROHIT BHASKAR PT ▪ Transcutaneous Electrical Nerve Stimulation (TENS) is a method of electrical stimulation which primarily aims to provide a degree of pain relief (symptomatic) by specifically exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system. 2
- 3. MECHANISM OF ACTION ©2020 ROHIT BHASKAR PT ▪ Possible Pain-Relieving Mechanisms; ▪ Activation of ‘pain-gating’ mechanisms. ▪ Stimulation of the descending pain suppression system and endogenous opiate mechanisms. ▪ The Central Biasing Theory ▪ Removal of the substances which stimulate pain nerve endings from within the damaged area 3
- 4. PARAMETERS USED FOR TENS ©2020 ROHIT BHASKAR PT ▪ Waveforms ▪ Frequency or Rate ▪ Pulse width or Duration ▪ Amplitude or Intensity 4
- 5. FREQUENCY OR RATE ©2020 ROHIT BHASKAR PT ▪ High Frequency (80-120): ▪ Large myelinated fibers respond effective > 100Hz ▪ Immediate relief of pain ▪ Acute pain ▪ Low Frequency (1-20): ▪ Small unmyelinated fibers respond effectively at <100Hz ▪ Increase endorphin production, thus analgesia following stimulation ▪ Chronic pain 5
- 6. PULSE WIDTH OR DURATION ©2020 ROHIT BHASKAR PT Pulse width Indications 50μs Large myelinated fibers (sensory touch) 100 - 150μs Normal neuromuscular system 200 μs Small myelinated fibers 200 – 300 μs Patients with neurological damage 6
- 7. AMPLITUDE OR INTENSITY ©2020 ROHIT BHASKAR PT ▪ TENS units intensity ranges form 1 mA to 100 mA ▪ TENS is only effective when the patient actually feels the stimulus ▪ Patients need to increase the intensity when the body accommodates to the stimulus (when they don’t feel the stimulation anymore) ▪ Dying batteries can cause fading intensities 7
- 8. TYPES OF TENS ©2020 ROHIT BHASKAR PT ▪ Conventional TENS or High Frequency TENS ▪ Acupuncture-like TENS (AL-TENS) or Low Frequency TENS ▪ Brief TENS or Intense TENS ▪ Burst TENS ▪ Modulated TENS or Modified TENS 8
- 9. CONVENTIONAL OR HIGH TENS ©2020 ROHIT BHASKAR PT ▪ Frequency – 50 Hz to 100 Hz ▪ Pulse Width – 20 μs to 60 μs ▪ Intensity – (0 mA to 30 mA). ▪ The intensity until a prickling or tingling sensation is felt. ▪ Principle –Presynaptic inhibition by pain gate mechanism by stimulating Aα and Aβ fibres. ▪ Duration – 30 to 60 minutes once or twice daily. 9
- 10. ©2020 ROHIT BHASKAR PT ▪ Frequency – 1 Hz to 4 Hz ▪ Pulse Width – 150 μs to 250 μs ▪ Intensity – 30 mA to 60 mA. ▪ applied to acupuncture points or motor points of muscle in the segmentally related myotome. ▪ Principle –This stimulates the high threshold Aδ and C fibres, which lead to release of endogenous opioids and provides further sensory input from muscle spindle afferents (chemical theory). ▪ Duration – 20 to 30 minutes once a day. 10 Acupuncture or Low TENS
- 11. BURST TENS ©2020 ROHIT BHASKAR PT ▪ Burst TENS is a series of pulses (i.e. a train), repeated 1- 5 times a second, commonly twice. ▪ Each train or burst consists of a number of individual pulses at the usual conventional TENS frequencies of 50 Hz to 100 Hz but at higher intensity. ▪ It combines both the conventional and acupuncture-like TENS and ▪ therefore provides pain relief by both routes. 11
- 12. BRIEF OR INTENSE TENS ©2020 ROHIT BHASKAR PT ▪ Frequency – More than 100 Hz ▪ Pulse Width – 150 μs to 250 μs ▪ Intensity – Highest level tolerated by the patient. ▪ Principle –Activity in cutaneous Aδ afferents induced by intense TENS produce peripheral blockade of nociceptive afferent activity (Central biasing mechanism). ▪ Duration – 30 to 60 minutes once or twice daily. 12
- 13. MODULATED OR MODIFIED TENS ©2020 ROHIT BHASKAR PT ▪ In modulated TENS the pulse length, frequency, and amplitudes can be constantly and automatically varied. ▪ This cyclical variation is believed to prevent adaptation of the nerves to the current (no accommodation) ▪ is particularly appropriate as a variant of conventional TENS used over long periods. 13
- 14. CONTRAINDICATION ©2020 ROHIT BHASKAR PT ▪ Someone with a pacemaker ▪ Someone with undiagnosed pain. ▪ Someone with a heart condition ▪ On head or neck of someone with epilepsy ▪ Someone with venous or arterial thrombosis or thrombophlebitis ▪ Someone with indwelling phrenic nerve or urinary bladder stimulators ▪ Near operating diathermy device 14
- 15. CONTRAINDICATION ©2020 ROHIT BHASKAR PT ▪ Around the head ▪ On the eyes ▪ Over mucosal surfaces ▪ Using electrodes on infected skin ▪ Electrodes across the chest of a patient with cardiac disease ▪ Electrodes should not be placed near carotid artery in the anterolateral region of the neck. There is a potential risk that stimulation at this site might cause heart block by exciting the vagus nerve. 15
- 16. PRECAUTIONS ©2020 ROHIT BHASKAR PT ▪ Areas of skin irritation, damage or lesions ▪ Areas with impaired sensation ▪ Over abdominal, lumbosacral or pelvic regions during pregnancy other than for labor/delivery ▪ Tissues vulnerable to hemorrhage or hematoma ▪ Athletes should not be permitted to participate in sports while under the influence of TENS analgesia ▪ Extreme caution is needed with patients taking narcotic medication or who are known to have hyposensitive areas. 16
- 17. PRECAUTIONS ©2020 ROHIT BHASKAR PT ▪ Incompetent patients may not be able to manage the device and it must be kept out of reach of children. ▪ For patients with diagnosed malignancies that have been diagnosed as terminal, TENS can be used for pain control with informed consent of the patient. ▪ Otherwise, TENS should not be used when malignancies are present. 17
- 18. THANKYOU ©2020 ROHIT BHASKAR PT 18