Electrotherapeutics Modalities and their uses

Uses of different modalities in physicaltherapy

1. ELECTROTHERAPEUTIC
MODALITIES
BY:QURAT UL AIN
LARAIB

2. BIOFEEDBACK
BIOFEEDBACKisaninstrumentationandtechnique
whichisusedtoaccuratelymeasure,processand
feedbacksomereinforcinginformationviaauditoryor
visualsignalsbyelectronicorelectromechanical
deviceespeciallyfortherapeuticpurposes.
Alsodefinedastheprocessoffurnishinganindividual
informationofhisbodyfunction,soastogetsome
controloverit.

3. BIOFEEDBACK INSTRUMENTATION
BIOFEEDBACK instruments are designed to monitor some
physiologic event, objectively quantify these monitoring
and then interpret the measurements as meaningful
information.
The most commonly used instruments include these that
record:
PERIPHERAL SKIN TEMPERATURES : Indicating extent
of vasoconstriction or vasodilation.
FINGER PHOTO TRANSMISSION UNIT : measure
vasoconstriction and vasodilation.

4. •SKIN CONDUCTANCE ACTIVITY : Indicating sweat
gland activity.
•ELECTROMYOGRAM BIOFEEDBACK
:Indicatingamount of electrical activityduring muscle
contraction.

5. USES OF BIOFEEDBACK
•PERIPHERAL NERVE INJURIES
•SPINAL CORD INJURY
•HEMIPEGIA
•DYSTONIC CONDITIONS
•TREATING SPASTICITY
•POSTURAL CONTROL
•MUSCLE STRENTHENING
•FUNCTIONAL RE-EDUCATION

6. LIMITATIONS OF BIOFEEDBACK
•RELEVANCY
•ACCURACY
•RAPID INFORMATION

7. IONTOPHORESIS
•IONTOPHORESIS is a therapeutic technique, which
involves the introduction of ions into the body tissue
through the patient
skin.

8. •PRINCIPLE : The basic principle is to place the ion
under the electrode with the same
charge.I.eNegative ion is placed under cathode and
Postiveion is placed under anode. This is also called as
Technique of ion transfer into the body tissues.
•CURRENT INTENSITY: 5mA to 12mA.
•DURATION OF TREATMENT: 15to 20 mins.

9. •COMMONLY USED ION AND THEIR INDICATIONS:
•POSTIVE IONS:
•HYDROCORTISONE:Anti inflammatoryeffects such as
in RA , Tendonitis.
•CALCIUM CHLORIDE: Effective in stiff joints and post
traumatic pain.
•ZINCE OXIDE :property of healing as inulcers, open
lesions.
•MAGNESIUM OXIDE:muscle relaxant ,good
vasodilator , mild analgesic.

10. •NEGATIVE IONS
•IODINE :effective sclerolyticagents. Use for adherence
scar and adhesive capsulitis.
•CHLORINE: use for scar tissue , keloids and burns.
•SALICYCLIC ACID: general decongeseant, sclerolytic
agent, anti inflammatoryagent.
•SODUIM OR POTASSIUM CITRATE: use forRA.

11. ELECTRICAL STIMULATION
•Application of suitably modified electric current to
stimulate excitable tissues like nerve and muscles to
produce therapeutic
benefits.

12. •ELECTRODE :
•PURPOSE:
•Complete circuit
•Interface between electrode and ion flow
•Resistance to current
•MATERIAL:
•Metallic
•carbon rubber
•Self adhesive

13. • ELECTRODE PLACEMENT
•Electrodes space far apart penetrate more
deeply with less current density.
•Larger the electrodes , less the density.
•Multitude of placement techniques
may be used to create desirable clinical
andphysiological effects.

14. •STIMULATION POINTS
•Motor points
•Trigger points
•Acupuncture points
•Traumatized areas

15. •TYPES OF ELECTRICAL STIMULATION
•Neuromuscular electrical stimulation(NMES)
•Functional electrical stimulation(FES)
•Transcutaneous electrical nerve stimulation(TENS)

16. NMES
•NMES applies electrical impulses to the nervous system
to stimulate sensory and motor neurons.
•COMMON USES:
•Relaxation of muscle spasm
•Preventionor retardation of disuse atrophy
•Improvement of local bloodcirculation
•Re-education of muscle

17. FES
•Technique that use electrical currents to activate
nerves innervating extremities effected by paralysis
and neurological disabilities to restore normal
function.
•MECHANISM: Stimulate muscles in aprogrammed
synergistic sequencethat allowpatient to accomplish a
specificfunctional movements patterns.
•Multichannel microprocessorsare pre-programmed to
executevariety of specific movement.

18. USES OF FES
•Prevent or correct diffuse atrophy
•Improve ROM in stiff joints and spasticity
•Re-education of new muscle action in muscle and tendon
transfer
•Supplementation or substitution of orthosis

19. PARAMETERS OF FES CURRENT
•Frequency (12 –100Hz)
•Intensity of current (90 –200mA)
•Pulse duration(20-300msec)

20. TENS
•Electrical stimulation which primarily aims to provide
a degree of symptomatic pain relief by exciting
sensory nerves.

21. MECHANISM OF TENS
•Gate Control Theory( Malzackand Wall)
•Activation of peripheral sensoryA-beta fibers stimulate
inhibitory interneuron in substansiagelatinosain dorsal
horns of spinal cord.
•Activatedinterneurons produces inhibitionof pain
carryingA-deltaand C fibers and closes spinal pain
gateto preventpainfulimpulse to reachat sensory
cortex.

22. DESCENDING PAIN CONTROL
•Stimulation of smaller peripheral A-delta and C fibers
through the CNS causes a release of enkephalins
blocking pain at spinal cord.
•ENDOGENOUS OPIATE PAIN CONTROL
•Noxious stimulus causesrelease of beta-endorphins and
dynorphinresultingin analgesia.

23. TYPES OF TENS
•HIGH TENS( SENSORY LEVEL)
•Duration (100-500 micro sec)
•Frequency (100-150Hz)
•Sensory level output
•Activates spinal gate

24. TYPES OF TENS
•LOW TENS
•Duration(100-150 micro sec)
•Low pulse frequency(1-5Hz)
•Motor level output
•Modulation through release of beta-endorphin

25. ELECTRODEPLACEMENT
•NEGATIVE ELECTRODE
•Spinal nerve roots
•Painful sites
•Dermatomes
•Myotomes
•Trigger points
•Acupuncture points
•POSTIVE ELECTRODE
•Placed close to spinal
segments

26. CLINICALAPPLICATIONS
•Acute and chronic pain
•Phantom limb pain
•Reflex sympathetic dystrophy
•Postoperative pain
•Obstetric pain
•Neuropathies