Interferential therapy

IFT which stands for Interferential Therapy is one of the types of electrotherapy used for the management of pain. The principle of interferential therapy is to cause two medium frequency currents of slightly different frequencies to interfere with one another. For example, if circuit A carries a current with the frequency of 4000Hz and Circuit B carry a current with a frequency of 3980 Hz, then the low frequency produced will be 20 Hz and this frequency is very useful in pain modulation. A new low-frequency current known as the beat frequency is equal to the difference in frequencies between the two medium frequency currents produced in the tissues at the point where the two currents cross.
It is basically used for the treatment of Chronic, Post Traumatic, and Post-surgical pains. The basic principle involves the utilization of effects of low frequencies (<250pps) without painful or unpleasant side effects. The major advantage of IFT is that it produces effects in the tissue, exactly where required without unnecessary and uncomfortable skin stimulation. This technique is widely used to elicit muscle contraction, promote healing and reduce edema.

Vector effect: The interference field is rotated to an angle of 450 in each direction, the field thus covers a wider area. This is useful in diffuse pathology or if the site of the lesion cannot be accurately localized.

Frequency swing: Some equipment allows a variation in the speed of the frequency swing. A rhythmic mode may be a continuous swing from 0 to 100 Hz in 5-10s and back in similar time or it may hold for 1-6s at one frequency followed by 1-6s at another frequency with a variable time to swing between the two.

Constant frequency: Some treatments may be carried out with the interference fixed at a certain frequency. Rhythmic frequency is useful if several types of tissues are to be treated at once. A variation in the frequency also overcomes the problem of tissue accommodation where the response of a particular tissue decreases with time.
WORKING PRINCIPLE: Interferential current therapy works by sending small amounts of electrical stimulation to damaged tissues in the body. The therapy is meant to boost the body's natural process of responding to pain, by increasing circulation thus produces hormones that promote healing. IFT delivers intermittent pulses to stimulate surface nerves and block the pain signal, by delivering continuous deep stimulation into the affected tissue. IFT relieves pain, increases circulation, decreases edema, and stimulates the muscles. A frequency of 100Hz may stimulate the large diameter A-beta fibers, which have an effect on the pain gate, and inhibit the transmission of small-diameter nociceptive traffic ( C and A-delta fiber), which effectively closes the gait to painful impulses. Interferential current Increases the circulation of blood thus reduces swelling.

1. Hands on Interferential therapy #abcd HSG Shubham Singh

2. Outline #abcd Introduction Principle of production Modes Methods of application Dosages Setting of apparatus Techniques of application Physiological effects Contraindication Indication

3. Introduction Interferential therapy: a form of electrical treatment using medium frequency currents to produce a low frequency current of low frequency effects . also called nemac’s current medium frequency currents = a current with frequency ranging between 1000Hz to 10,000Hz Interference: the combination of two or more electromagnetic waveforms to form a resultant wave in which the displacement is either reinforced or cancelled

4. Greater penetration Higher tolerance Comfort over the low frequency current Effects are produced in the tissues where they are required without unnecessary or uncomfortable skin stimulation. Can be used for pain relief as well as for muscle stimulation. Why Interferential therapy ?

5. The problem associated with application of low frequency current (faradic, sinusoidal current) is very high skin impedance that results in pain thereby discomfort Abbrevations Z = skin impedance in ohms f = frequency of current in hertz c = capacitance of skin in microfarad When low frequency current (frequency=50-60Hz) is applied - skin resistance is 3200 Ω When medium frequency current (frequency=4000Hz) is applied - skin resistance becomes 40 Ω   IFT over low frequency current

6. Abbreviations I = Applied current V = Voltage R = Skin resistance (remains constant) r = Skin resistance developed due to applied current When low frequency current is applied - R(developed skin resistance) is large thus produces pain and discomfort When medium frequency current is applied - R(developed skin resistance) is small thus produces comfort with higher penetration and higher tolerance  

7. Principle of production Interference effect : It uses two medium frequency currents that crosses in patient tissue One of the medium frequency current is kept constant at 4000Hz(at these frequency tissue generates minimum impedance) The other current is varied between 3900 to 4100 Hz The point of interference or the point of intersection of currents produces a low frequency current This point of interference effects a beat frequency (treatment frequency, amplitude modulated frequency), which is equal to the difference between two medium frequency currents.

8. Channel / Circuit A = 4000 Hz Channel / Circuit B = 3900 Hz Beat frequency = Frequency of (channel A – channel B) Also called as amplitude modulated frequency or frequency of treatment Produced at the point of intersection Can be varied by varying the frequency of second circuit

9. Concept of beat frequency At the point of intersection When two peaks of amplitude are in the same direction coincides the resultant amplitude will be at maximum, called summation of frequency When two peaks of amplitude are in the opposite direction thus the resultant amplitude will be the difference of two, called cancellation of frequency same phase opposite phase

10. Beat frequency

11. Mode - Can be pre selected on the machine constant mode rhythmic - both the currents are kept constant - a constant beat frequency is produced Ex. 10, 20, 50, 100 Hz -one current is kept constant while other is variable - a variable beat frequency is produced Ex. 20Hz to 80Hz for 6 sec

12. Rhythmic = beat frequency is variable = frequency surge(from lower to higher value and back) Prevents accommodation The pattern and timing of this modulation is usually adjustable in some time called the spectrum Allows the beat frequency to change automatically regularly between some present pair of frequency over a specified time period called frequency modulation / frequency swing / frequency sweep . Ex. 20Hz to 80Hz for 6 sec Importance of rhythmic beat frequency Lower frequency Higher frequency Swinging time

13. Methods of application Depending upon - area to be treated - extent of effect required whether deep or superficial method bipolar quadripolar vector scan static - static interference - area in which IFT s set up remains stationary - clover leaf appearance - lies at 45˚ from each electrode dynamic interference

14. Electrode placement Electrode positioning should ensure adequate coverage of the area for stimulation. Correct and proper positioning of electrodes is important for effective and purposeful delivery, and it depends upon- 1. Size of electrodes: size is directly proportional to area 2. Distance of placement of electrodes: distance is inversely proportional to intensity 3. Types of electrode placement: bipolar or quadripolar

15. Electrode placement methods

16. Importance of electrode placement depth of modulation and amplitude is determined by positioning of electrodes using larger electrodes will minimize patient discomfort closely spaced electrodes increase the risk of superficial tissue irritation and possible damage and skin burn

17. Types of electrodes commonly used Suction electrode Pad electrode Pad electrode with sponge cover Self adhesive pad electrode - Used especially for larger body areas like the shoulder girdle, trunk, hip, knee - Believed to be its effect in blood flow and circulation

18. Quadripolar method Four electrodes are used in two pairs which colour coded Placement: placed diagonally, opposite to one another Produces deep effect i.e. modulation is 100 % and amplitude is greatest

19. VECTOR SWEEP SCANNING : also called ROTATING VECTOR SYSTEM or DYNAMIC INTERFERANCE FIELD SYSTEM by varying the current amplitude of circuit with respect to other, leads to movement of clover leaf pattern of maximum modulation to inflow through 45˚ in the region of intersection

20. Vector Scan When two equal forces intersect, maximum result is halfway between the two forces(45˚) Clover leaf appearance: maximum current modulation as due to the submission of two currents by varying the current amplitude of circuit with respect to other, leads to movement of clover leaf pattern: VECTOR SWEEP SCANNING

21. Quadripolar placement at back Quadripolar placement at Shoulder

22. Bipolar method Two electrodes are used one of each pair Placement: placed diagonally, opposite to one another so that treatment are lies in between In this case currents are superimposed such that single current is produced Interference occurs throughout the reason between two electrode Useful for small areas Produces superficial effect i.e. more sensory stimulation than four pole technique.

23. Bipolar method

24. Shoulder Lower cervical: upper trapezius Knee Elbow Bipolar method

25. Depends upon 1. Intensity 2. Duration 3. Area to be treated i.e. for larger areas a current of higher intensity is required or vice versa to produce effective therapeutic effect When applying on rhythmic mode Intensity is gradually increased till patient feels comfortable   Dosages

26. Duration: A. For acute cases : low intensity with shorter time - once or twice a week B. For subacute and chronic cases : high intensity with longer - three to four times

27. Frequency setting: constant or variable Intensity Time: short or long Mode: static or rhythmic Setting up the apparatus

28. Inspection of skin: cleaning the skin Insulation of wounds over area of application: applying petroleum jelly Positioning of electrodes: positioned so that the crossing points of two currents is over or within the lesion Selection of parameters Educating the patient Techniques of application

29. Physiological effect of IFT Clinical application of IFT therapy is based on peripheral nerve stimulation Depends upon - Magnitude of current: a current with minimum intensity to overcome the threshold of nerve fibre is necessary for stimulation. - Mode: whether rhythmic or constant - Frequency range: EX. a frequency of 100 Hz stimulates large diameter nerve fibers while that of 15 Hz small diameter fibres get stimulated - Electrode positioning: distance between electrodes, accuracy of electrodes

30. Pain relief : activation of pain gait control mechanism Shorter duration pulse at frequency of 100 Hz stimulates large diameter nerve fibres ( higher frequencies(90-130Hz) stimulates the pain gate mechanism) At frequency of 15 Hz small diameter fibres get stimulated ( lower frequencies (2-5Hz) activates the opioid mechanism, thus providing a degree of relief) Increased circulation is also thought to decrease pain Increased blood flow: stimulation of autonomic nervous system leads to muscle contraction or by local pumping effect to achieve a greater effect stimulation was applied via suction electrodes a frequency sweep of 10-30 Hz is observed to be most effective

31. Motor stimulation : innervated muscles will contract at frequency between 1 to 100 Hz at frequency 5 to 20Hz: twitch / partial tetany is produced at frequency 30 to 100Hz: tetanic contraction is produced in rhythmic mode a complete range of muscle contraction is produced most effective motor nerve stimulation appears to lie between 10 and 25 Hz Absorption of exudates : a rhythmic frequency of 1-10 Hz produces a rhythmic pumping action. Also believed its role in stimulating healing and repair

32. IFT over TENS for pain reduction Produced low frequency interference of IFT is characterized with benefits over TENS as subsiding unpleasant effects like pain, discomfort and skin irritation greater penetration treatment area is large for the same setup NOTE: Every device has it’s own therauptic value, above comparisons are made on common parameter for same therauptic effect.

33. Contraindication Arterial disease : stimulatory effect may produce emboli DVT: can dislodge thrombus Acute Infection: can exaggerate acute infection Patient with pacemaker: may alter the function Malignant tumor: can metastasize Large open wound: charge accumulation Over insensitive areas: may leads to burns Over uterus of a pregnant women Very young or very old patients

34. Indication Widely used for relief of pain, for example Low back pain Periarthritis shoulder Osteoarthritis knee Chronic ligamentous lesion Fibrositis Neuralgia Sprain and strain Chronic edema Hematoma: during first 24 Hrs. together with ice packs it is useful for resolution of hematoma Stress incontinence and urinary incontinence

35. IFT over Faradic current(faradism under pressure) for edema reduction Why IFT ? Stronger contraction Easier setup ( bandaging is not needed but in cases area becomes problem while placing electrodes in quadripolar method) NOTE: Every device has it’s own therauptic value, above comparisons are made on common parameter for same therauptic effect.

36. Incontinence Urinary Incontinence Stress incontinence Involuntary loss of urine due to loss of sphincter control Most common in women, secondary to child birth Treatment parameters A sweep of 10-100 Hz is used Frequency of 10-15 Hz stimulates the pelvic floor muscles Frequency of 5-80 Hz stimulates the autonomic nerves system Treatment is given 2-3 times weekly

37. Electrode placement One electrode from each channel is placed on the lower abdomen above the outer half of inguinal ligament The other two electrodes are placed on the upper part of the inner aspect of the thighs, near the origin of adductors Patient position Stride sitting or stride lying May vary from condition to condition

38. Shubham Singh #abcd Thank you for your ’active participation’ & ‘kind collaboration’