Electrotherapy 1st Lecture PDF

BAS 207 Salah Eldin Bassit Ph D, DPT Assistant Professor of Basic Sciences Salaheldin Bassit MUC2024 Salaheldin Bassit MUC2024 Learning Outcomes: Upon Completion of this course, you should be able to : Salaheldin Bassit MUC2024  Elect...

BAS 207 Salah Eldin Bassit Ph D, DPT Assistant Professor of Basic Sciences Salaheldin Bassit MUC2024 Salaheldin Bassit MUC2024 Learning Outcomes: Upon Completion of this course, you should be able to : Salaheldin Bassit MUC2024  Electrotherapy Electrophysical agents Therapeutic Physical Physical agents modalities modalities EPAs Salaheldin Bassit MUC2024  Administer Select modality effective skillfully. treatment. Adapt Evaluate results appropriately accurately. when necessary. Salaheldin Bassit MUC2024 Introduction The use of electrophysical agents (EPAs) is widespread in the field of physical therapy. Their use is also well documented in numerous published surveys conducted in countries. Salaheldin Bassit MUC2024 Useful Sites https://pubmed.ncbi.nlm.nih.gov/ https://www.researchgate.net/ https://www.electrotherapy.org/ Salaheldin Bassit MUC2024 Electrotherapy Is Not as Challenging as It May Seem! Clinical electrotherapy is sometimes considered challenging and difficult to comprehend. This is far from reality if one possesses some basic understanding of the fundamentals of biophysics, anatomy and physiology. Salaheldin Bassit MUC2024  COMPLEMENTARY ROLE CONSERVATIVE APPROACH Noninvasive and characterized by minimal side effects Salaheldin Bassit MUC2024 DEFINITION OF ELECTROPHYSICAL AGENTS The International Society for Electrophysical Agents in Physical Therapy ISEAPT defines the term electrophysical agent as the use of electrophysical and biophysical energies for the purposes of evaluation, treatment and prevention of impairments, activity limitations, and participation restrictions. Salaheldin Bassit MUC2024  CLASSIFICATION OF ELECTROPHYSICAL AGENTS EPAs can be classifies based on the type or form of energy delivered to soft tissues. Thermal, electromagnetic, electrical, and mechanical energies are delivered through various applicators on most body areas. Salaheldin Bassit MUC2024 TODAY’S DELIVERY OF ELECTROPHYSICAL AGENTS The focus has shifted in the field of health care delivery from doing the thing right to doing the right thing. Another key impetus is the growing recognition and application of a new health care paradigm called evidence-based practice (EBP). Salaheldin Bassit MUC2024  Common Uses of Electrotherapy Pain Relief: Effective for acute and chronic pain conditions such as arthritis, back pain, and neuropathy. Muscle Stimulation: Helps in strengthening weak muscles, especially in post-surgical rehabilitation or in people with conditions like stroke or paralysis. Reduction of Inflammation: By improving blood flow and reducing swelling, electrotherapy aids recovery from injuries. Healing and Tissue Repair: Accelerates wound healing, improves circulation, and promotes regeneration of tissues. Transdermal Drug delivery: Iontophoresis- phonophoresis Salaheldin Bassit MUC2024  Mechanism of Action The electrical stimulation helps in several ways: Alters pain perception: Interrupting pain signals sent to the brain. Enhances muscle contraction: By stimulating nerves and muscle fibers. Increases blood circulation: Promoting faster healing and reducing inflammation. Stimulates cellular repair: Enhancing recovery at the tissue level. Facilitate introduction of ions/ molecules Salaheldin Bassit MUC2024  TODAY’S DELIVERY OF ELECTROPHYSICAL AGENTS THERAPEUTIC EFFICIENCY Doing the thing right is to show efficiency. THERAPEUTIC EFFECTIVENESS Doing the right thing for the patient is to show effectiveness. In the field of therapeutic EPAs, the time has come to do more of the right thing for patients while continuing to do the thing right. Salaheldin Bassit MUC2024  Maximizing the Effectiveness of Therapeutic Modalities There is little value in using the wrong modality properly or in using the right modality improperly. KNOBOLOGY!!!!!!!! Salaheldin Bassit MUC2024  CLINICAL DECISION MAKING Clinical decision making is the process of determining how to treat patients. Salaheldin Bassit MUC2024 SELECTION CRITERIA 1. correct diagnosis. 2. concept of the pathological and physiological changes associated with the injury. 3. overall treatment plan which includes long range, medium range, and short-range therapeutic goals. 4. modality’s effects, indications, and contraindications, including the type and strength of evidence supporting this information. 5. Match your therapeutic goal with a modality that will help you achieve that goal. Salaheldin Bassit MUC2024  EMERGING THERAPIES No single year can pass without hearing on medias that at a new therapy has been discovered that shows the beneficial effects for a wide array of soft-tissue pathologies. Evidence-based practice (EBP) Salaheldin Bassit MUC2024  Electrotherapy: yesterday, today and tomorrow There needs to be extensive research on each of these electrotherapy devices to determine the proper use of each device!!!!!!!!!!! Salaheldin Bassit MUC2024 TELEREHABILITATION Salaheldin Bassit MUC2024  Electrical stimulation uses dates back to Ancient Egyptians when electric eels were used to treat painful spines and limbs. Salaheldin Bassit MUC2024 ELECTRICAL STIMULATION Application of electrical stimulation to elicit or facilitate some desired therapeutic response. ELECTRICAL STIMULATION = the stimulation of tissue for therapeutic purposes. These tissues may be excitable or non excitable tissues!!!!!!!!!!. Salaheldin Bassit MUC2024 Current Classification Three Major There are three basic used in commercial therapeutic electrical stimulation units: Direct Current, Alternating Current, and Pulsed Current. Salaheldin Bassit MUC2024  Direct Current( DC) Description: One-directional flow of electrons Constant positive and negative poles Use: Iontophoresis/ Healing of soft tissues Salaheldin Bassit MUC2024  Alternating Current(AC) Description: Bidirectional flow of electrons Use: majority of PT modality Salaheldin Bassit MUC2024  Phase Duration 1 1 2 Monophasic Pulse Biphasic Pulse A phase is the period when electrical current flows in one direction. The phase duration is how long a phase lasts and is usually measured in microseconds (10−6 seconds). For monophasic currents, pulse duration and phase duration are synonymous (only 1 phase). Biphasic pulses have two phase durations Salaheldin Bassit MUC2024 The phase duration determines which nerve type is affected!!!!.  Pulse Duration Monophasic Pulse Biphasic Pulse A pulse is the period when electrical current flows in any direction. A pulse may be made up of one or more phases. The Pulse Duration(PD) is how long each pulse lasts and is the time from the beginning of the first phase of the pulse to the end of the last phase of the pulse. The pulse duration is sometimes called the Pulse Width(PW). Pulse duration is usually measured in microseconds (10-6 seconds) Salaheldin Bassit MUC2024  Interpulse Interval Two Monophasic Pulses Two Biphasic Pulses The interpulse interval is the amount of time between pulses ; The time between the end of one pulse and the start of the next pulse Increasing the pulse frequency decreases the interpulse interval and vice- versa Salaheldin Bassit MUC2024  Intrapulse Interval Biphasic Pulse Intrapulse intervals are brief interruptions of current flow. Are always shorter than the interpulse interval. They decrease the chance to adaptation and the total charge delivered by the pulse. Salaheldin Bassit MUC2024  Pulse Frequency/ Pulse Rate The number of times a pulse occurs per second With alternating currents this measure is described as cycles per second N.B.: “rate” and “frequency” are used interchangeably to describe the number of pulses of electrical current that occur in a second. Salaheldin Bassit MUC2024  Amplitude/ Intensity is the magnitude of the current flow and is often also called the strength or intensity. Amplitude can be measured in amperes or volts. N.B.: Electrical stimulation should be adjusted according to the patient’s response, not an absolute number. Salaheldin Bassit MUC2024  FYI - Biphasic pulsed currents are the most used waveform in electrotherapy. This type of current can be used to produce muscle contractions or to control pain. - Pulse duration is how long a pulse lasts. - Frequency is the number of pulses/second. - Amplitude is the magnitude of the current flow. Salaheldin Bassit MUC2024 Salaheldin Bassit MUC2024 Types of Electrical Stimulation according to the therapeutic use Salaheldin Bassit MUC2024  1. Neuromuscular Electrical Stimulation (NMES) To elicit contraction caused by the electrical depolarization of intramuscular nerve branches. Using surface electrodes that are positioned over muscle bellies. To preserve and recover muscle function in patients and to improve muscle strength in healthy individuals. Salaheldin Bassit MUC2024 2. Functional Electrical Stimulation (FES) The application of NMES for enhancing the control of movement and posture. Enhancement of impaired motor functions, such as hand grasping, and locomotion, using complex transcutaneous and percutaneous electrical muscle stimulation systems. To enable motor function by replacing, or assisting, a patient’s voluntary ability to execute or control the impaired functions. Salaheldin Bassit MUC2024 2. Functional Electrical Stimulation (FES) Salaheldin Bassit MUC2024 Functional Electrical Stimulation(FES) Electrical stimulation of muscle contractions to perform functional activities is known as functional electrical stimulation (FES). Salaheldin Bassit MUC2024  Functional Electrical Stimulation(FES) (cont.) FES may be delivered with transcutaneous electrodes, similar to NMES. For patients with stroke and footdrop, FES can initiate ankle dorsiflexion during the swing phase of gait to assist with walking, substituting for an ankle-foot orthosis (AFO) Salaheldin Bassit MUC2024  FES (Cont.) For FES to be effective, it must produce a contraction of sufficient force to carry out the desired activity, it must not be painful, and it must be controlled and repeatable. To do this, at a minimum, the lower motor neuron, the neuromuscular junction, and the muscle must be intact, and the delivery method must be acceptable to the user. Salaheldin Bassit MUC2024 Salaheldin Bassit MUC2024  For any questions feel free to contact me [email protected] B2-04 Assistant Prof. Salah Eldin Bassit Assistant Professor of Basic Sciences Salaheldin Bassit MUC2024