Electrotherapy 4th Lecture 24-25 PDF

# Assignment of Electrotherapy ## Modality presentation English / Arabic for Banner. - Banner/Video/brochure. ## Due Date 21st November ## Assignment - Contact Supervision Doctors - Due date: 21st November - Word/Booster/Presentation/Brochures/ all references pdf must be attached to the e-mail...

# Assignment of Electrotherapy ## Modality presentation English / Arabic for Banner. - Banner/Video/brochure. ## Due Date 21st November ## Assignment - Contact Supervision Doctors - Due date: 21st November - Word/Booster/Presentation/Brochures/ all references pdf must be attached to the e-mail. - Topics: Soft e mail [email protected] ## Useful Sites for search - https://researchrabbitapp.com/home - https://www.connectedpapers.com/search - https://elicit.com/ - https://scholar.google.com/scholar - https://www.oalib.com/search - https://www.base-search.net/Search - https://www.researchgate.net/ - https://pubmed.ncbi.nlm.nih.gov/ ## ELECTROTHERAPY BAS 207 Salah Eldin Bassit Ph D, DPT Assistant Professor of Basic Sciences # Diadynamic Current(s)?? ## Diadynamic Therapy ## Bernard Currents ## Agenda - History/Introduction - Slide 12 - Modes/Types - Slide 15 -Physiological effects - Slide 25 - Therapeutic effects - Slide 26 - Indications - Slide 32 - Dangers/Precautions - Slide 37 - Contraindication - Slide 38 - Methods of electrode application/Dosage of Treatment - Slide 40 ## Introduction - Is an electronic modulation of symmetrical biphasic sinusoidal waveform, with frequency of (50-100Hz), which are specifically modulated to produce therapeutic effects. - Pulse duration is extremely long (6-10 msec). - So, it is more painful, most people consider it to be considerably more uncomfortable than other forms of electrical stimulation. - It involves the application of low-frequency, modulated electrical currents to the body to treat pain, inflammation, and muscle issues. ## History of Diadynamic - Was developed in the 1950's and attributed to Bernard (a French Dentist). ## Classic current types: - 1- MF (monophase Fixe) - 2- DF (diphase Fixe) - 3-CP (Courtes Periodes), - 4- LP (Longues Periodes) - 5-RS(Syncopal Ryhthm). ## Diadynamic Modes - Fixed monophase (MF) - Fixed diaphase (DF) - Short period (CP) - Long Period (LP) - Syncopal Rhythem (RS) ## Fixed Monophase (MF) - Half wave rectified alternating sinusoidal current - Frequency = 50Hz - Pulse period = inter-pulse interval = 10ms - Strong vibration sensation. - Used for treatment of pain without muscle spasm. - Connective tissue trauma (Ligament sprains) - Phantom pain - N.B:MF current can cause muscle stimulation at lower intensity than with DF. ## Fixed Diphase (DF) - Full wave rectified alternating sinusoidal current - Continuous series of 10ms impulse - Produce tickling (prickling) sensation - Duplicate the second half of each AC cycle - Direct monophasic current - No inter-pulse interval - Frequency is 100Hz ### Uses: - Improved circulation - Analgesia - Used for initial treatment - N.B: muscle contraction occurs only at high intensities ## 3-CP (Courtes Periodes, short periods) - Rapid alternation between one second of MF current and one second of DF without interval pauses. - In DF, there are tickling - In MF, there are strong vibration ### Uses - Muscle & ligament traumas, acute injuries. - Traumatic and Neurogenic pain ## 4- LP (Longues Periodes, long periods) - The gradual raising and lowering in amplitude is associated with more pleasant sensation than produced by CP. - Neuralgia, myalgia, arthralgia & chronic pain conditions. - LP has a long lasting analgesic effect - LP Slow alternation between DF and MF. ## FYI - CP and LP are used to prevent accommodation. - CP and LP currents have analgesic effects and used in treatment of traumatic and neurogenic pain. ## Syncopal Rhythm (RS) - It is a delivery of fixed duration of MF, followed by equal rest duration (i.e.: 1 second phase of MF followed by 1 second rest phase). ### Uses: - Electrical stimulation of muscles - Motor test of nerve excitability ## Diadynamic Modes Table | Wave | Physiological Effect | Indication | Feeling | |---|---|---|---| | DF | Full wave rectified alternating current | Has strong analgesic effect for short duration | Pain with muscle spasm | Itching or prickling sensation | | MF | Half wave rectified alternating current | Stimulate muscle contraction | Pain without muscle spasm | Strong vibration sensation | | CP | Equal phase of DF and MF are alternating without interval pauses | Stimulate circulation and reduce pain | Traumatic pain | Rapid altemating feeling between DF and MF | | LP | 6 sec MF followed by 6 sec DF in which intensity and frequency rise then fall | long lasting analgesic effect | Myalgia, Neuralgia | Strong vibration to little pricking | ## Diadynamic Modes Summary - **DF:** It is used for the initial treatment and before application of other currents. The patient feels a prickling sensation, which subsides after a short time. - **MF:** The patient feels a strong vibration for longer time than the sensation of DF. It is used for treatment of pain without muscle spasm. - **CP:** In DF phase, there are fine tremors in MF phase (strong and constant vibration). There are rhythmic contractions, being used for treatment of traumatic pain. - **LP:** It has a long-lasting analgesic effect. It is used with combination of CP in treatment of neuralgia. - **RS:** It can be used for electrical stimulation of the muscle and as a test for motor nerve excitability. ## Physiological Effects - Masking of pain. - Stimulation of sensory nerve led to decrease excitability (inhibitory effect) which led to increase pain threshold and pain reduction. - Vasomotor effects. - Stimulate release of histamine & histamine like substance that causes vasodilatation & Hyperemia. - Muscle stimulation. - Via depolarization of motor nerve fibers, thus lead to increase blood flow and reduce edema. ## Physiological Effects Summary - Sensory stimulation – Prickling sensation, Vibration sensation - Motor stimulation - Muscle contraction - Chemical changes due to the unidirectional nature of the current ## Therapeutic effects - Pain relief - Decrease of inflammation - Muscle reeducation and strengthening - Increase of local circulation - Facilitation of tissue healing ## Pain Relief - Stimulation of sensory nerves – Pain gate mechanism - Removal of the noxious metabolism from the area by increase blood flow which is enhanced by muscle contraction. ## Decrease of inflammation - Decreased inflammation and swelling due to the increased muscle pumping action and increased local circulation. - Changes in cell membrane permeability. ## Muscle re-education and strengthening - Muscle contraction which can be used for movement re-education and strengthening. ## Increase of local circulation - Reduced sympathetic tone leading to Vasodilation and the release of histamine-like substances because of the unidirectional effects. ## Raynaud syndrome (Raynaud's phenomenon) - Image of a blood vessel with a description of the phenomenon. - High rate of firing results in vasoconstriction - Low rate of firing results in Vasodilation - Cyanosis, Ischemia, and Rubor are shown in the image. ## Facilitation of tissue healing - Due to the local circulatory changes and the polar effects leading to increased cell activity. ## Indications - Soft tissue injury as sprains, contusions and epicondylitis. - Sudeck's atrophy (Reflex Sympathetic Dystrophy Syndrome (RSDS) Complex regional pain syndrome/ Shoulder hand syndrome. (CRPS) - Image showing the mechanism of RSDS and how it causes pain. ## Early CRPS diagnosis & treatment - **S**welling that comes and goes along with pain, usually one-sided - **T**emperature of the affected hand or foot feels hot to the touch - **A**gony & out of proportion pain not improving as expected - **R**edness or purple discoloration of the affected hand or foot - **T**remors in the affected hand or foot, sometimes with weakness - **START Now** - **N**erve meds like Gabapentin, Pregabalin, & Duloxetine are important to start early. - **O**pioid meds are helpful to support work-outs. ## Indications (Cont.) - Peripheral nerve disorders as neuralgia - Radiculopathy and - Herpes zoster ## Indications (Cont) - Shingles, also known as herpes zoster or just zoster, occurs when a virus in nerve cells becomes active again later in life and causes a skin rash. - Image showing shingles with red patches, fluid-filled blisters, pain and fever, and blisters in various phases of healing. ### Potential complications of shingles include: - Post-herpetic neuralgia — about 10% of adults who get shingles experience long-term pain in the area of skin where blisters occurred, even after the rash has healed completely. - This condition may last for months or, very rarely, years. Severe pain is most common in older patients and often is accompanied by extreme sensitivity to heat and cold in the affected area of skin. ## Phantom pain - Image of person sitting on a couch experiencing phantom pain in their foot and the head. ## Dangers and Precautions - Skin breakdown and burn : monophasic!!!!!! - Nature of diadynamic current may lead over time to skin damage and burn. - This can be over come by short period of application ## When not to use diadynamic current (Contraindication) - Open skin as the current tend to concentrate - Bony areas - Loss of sensation - Infection - Unreliable patients - Thrombosis. - Cardiac pacemakers. - Various dermatological lesions. - Metal implantation. - Image showing a table listing various contraindications for diadynamic current which includes acute inflammation, diseases which cause cachexia, over osteomyleities , active bone, joint and other organ, tuberculosis , malignancy illness, over extreme edema, over hemorrhagic area, over anterior cervical, over transcranial areas, over electronic implants, over superficial metal and pregnancy. ## Methods of electrode application - The choice of application of electrodes should be based on the clinical problems presented. - Image showing different methods of electrode application including pain spot application, paravertebral application, nerve trunk application, vaso­trophic applications, myo­energetic application, and transregional application. ## Dosage of Treatment - **Intensity:** - The intensity of the currents should be increased, gradually and the following phenomena take place; - The patient should feel the current as (vibration or prickling, tingling). - Increased intensity, the motor nerves are activated and the muscles begin to contract. - Further increased of intensity, the patient begins to experience slight pain & or burning sensation.(should be avoided ) ## Dosage of Treatment (Cont.) - **Duration of treatment** - Total application time 10-12 minutes. - Single application time 3 minutes. - **Frequency of treatment** - 6-9 treatments either daily or day per day ## Stimulation Points - **Motor Points** - Superficial location of motor nerve - Predictably located - Motor nerve charts - **Trigger Points** - Localized, hypersensitive muscle spasm - Trigger referred pain - Arise secondary to pathology - Image showing a hand with motor nerve and motor points highlighted and an electrode. ## Stimulation Points (Cont.) - **Acupuncture Points** - Areas of skin having decreased electrical resistance - May result in pain reduction. - **Traumatized Areas** - Decreased electrical resistance (increased current flow). - Image illustrating with the body 's most important analgesic points with other points helping treat nausea, upset stomach, and digestive disorders. ## Motor Points Diagram - Image illustrating motor points in the arm and hand. ## Motor Points Diagram - Image illustrating motor points in the arm and hand. ## Motor Points Diagram - Image illustrating motor points in the leg and foot. ## Motor Points Diagram - Image illustrating motor points in the leg and foot. ## Motor Points Diagram - Image illustrating motor points in the head. ## Motor Points Diagram - Image illustrating motor points in the back. ## Advantages of Diadynamic Therapy - Non-invasive: It provides a pain-relieving and muscle-stimulating effect without requiring surgery or invasive procedures. - Quick results: Customizable: Many patients report a reduction in pain after just a few sessions. - The different types of currents can be tailored to suit the needs of various conditions, whether the goal is pain relief, inflammation reduction, or muscle strengthening. ## Limitations of Diadynamic Therapy - Superficial stimulation: Some patients may not experience deep tissue effects, as diadynamic currents primarily affect superficial tissues. - Skin irritation: Prolonged exposure to the electrical currents may cause mild skin irritation or redness at the electrode sites. ## Thank you - For any questions feel free to contact me: [email protected] - B2-04 - Assistant Prof. Salah Eldin Bassit - Assistant Professor of Basic Sciences - Image showing a laptop with a thank you message and an image of some flowers.