6_w_-_7_w_electro PDF

Name of Department : Physical Therapy and Rehabilitation Course Code and Name : FTY243E -Electrotherapy I Course Week : 6.Week - 7.Week Course Day and Time : Monday 14:00 – 17:50 Course Credit/ACTS Information : 3/4 Examina...

Name of Department : Physical Therapy and Rehabilitation Course Code and Name : FTY243E -Electrotherapy I Course Week : 6.Week - 7.Week Course Day and Time : Monday 14:00 – 17:50 Course Credit/ACTS Information : 3/4 Examination Type and Gradings : Multiple Choice Instructor’s Name & Surname : Busenur KARAGÖZ E-mail & Phone: : [email protected] Instructor’s Room : - Office Hours : - GBS Link : https://gbs.gelisim.edu.tr/en/lesson-details-17-316-12112-2 ALMS Link : https://lms.gelisim.edu.tr/ AVESIS Link : https://avesis.gelisim.edu.tr/bukaragoz  | 14 WEEKS’S COURSE CONTENTS | 1.Week Introduction to Electrotherapy, 9.Week Electrodiagnostic Tests Electrophysical Principles 10.Week TENS (Transcutaneous Electrical 2.Week Electrical Properties of Cells and Tissues Stimulation) 3.Week Mechanism of Muscle Contraction 11.Week NMES (Neuromuscular Electrical 4.Week Direct Currents and Iontophoresis Stimulation) 5.Week Galvanic Current 12.Week FES (Functional Electrical Stimulation) 13.Week Russian Current 6.Week Faradic Current 7.Week Sinusoidal Current 14.Week Interferential Current MIDTERM EXAM 15.Week Diadynamic Current FINAL EXAM  | WEEKLY LEARNING OUTCOMES | o Knows the properties of low frequency currents o Defines Faradic current o Knows the areas of use of Faradic current  | ABOUT THE PREVIOUS COURSE | o Medical Galvanism: Anodal Galvanism, Cathodal Galvanism, Reciprocal Use of Anode and Cathode, In-water Applications o Surge Galvani and Pulsed Direct Current o Characteristics of denervated muscle o Neuropraxia,Axonotmesis,Neurotmesis  | DAILY FLOW | 09.00-09.50/ Faradic Current 10.00-10.50/ Faradic Current 11.00-11.50/ Faradic Current 12.00-12.50/ Faradic Current  | LOW FREQUENCY CURRENTS | Low frequency currents include various currents. Currents with a frequency below 5000 Hz. Their general physical characteristics are the continuous change of very low voltage between the electrodes applied to the body and a flow rate lower than milliampere.  | LOW FREQUENCY CURRENTS | The main physical effect is the stimulation of the motor and sensory nerves, as a result of sudden ion concentration changes in the affected tissue, resulting in physiological effects. Low frequency currents are often used to stimulate muscle, nerve, or both. The physiological effects of the current include increasing muscle strength, accelerating wound healing, reducing pain and edema.  | FARADIC CURRENTS | Faradic currents are short-term, intermittent alternating currents. They have a transit time of 0.1-1 ms and a frequency of 30-100 Hz. They have two unequal phases. It is an alternating current whose direction and intensity change in a certain order with time.  | FARADIC CURRENTS | Faraday's original faradic current is an alternating current with an irregular low frequency. The current flowing in two different directions from one side to the other is in the form of a triangular wave, the transition time of the first pulse is low and the intensity is high, the intensity of the second pulse is low and the transition time is long.  | FARADIC CURRENTS | In the first used devices, faradic currents with 50 Hz frequency are usually used to stimulate healthy muscles. However, parameter settings can be customized on new devices. In latest applications, the frequency can be selected according to the structural characteristics of the muscles. In slow-contractile muscle, low frequency (10-30 Hz) In fast-contractile muscles, high frequency (50-70 Hz) are preferred.  | FARADIC CURRENTS | The currents used for muscle stimulation via the motor nerve are expressed as faradic type currents with frequencies between 30-100 Hz and a transition time of 0.1-1 msec. Faradic stimulation is a biphasic waveform with a transition time of 0.3 msec. The transition time is often less than 1 ms and the pulse repetition frequency is less than 100 Hz. Faradic current can be used for both diagnostic and therapeutic purposes. In order to stimulate the muscle with the faradic current, it is necessary the muscle to be the innervated.  | FARADIC CURRENTS | Therapeutic Effects of the Faradic Current: 1) Chemical Effects 2) Heat Effects 3) Physiologic Effects  | FARADIC CURRENTS | Chemical Effects: In each phase of the current, the ions move in one direction. The flow direction of the ions changes due to the change in the direction of the current phase. Since the current transition time is short, the risk of chemical change and burns caused by the faradic current in the tissue is low.  | FARADIC CURRENTS | Heat Effects: It is not used to warm tissues because the intensity of the current is very low. Physiological Effects: ⁃ On sensory nerves ⁃ On motor nerves ⁃ On healthy muscle ⁃ On the denervated muscle ⁃ Reducing Pain and Edema ⁃ Electrodiagnostic Evaluation ⁃ Reducing Pain with Opposite Irritation Effect  | FARADIC CURRENTS | On sensory nerves: ✓ A feeling of needling occurs in the place where the current is applied. ✓ This feeling does not cause pain as long as the current intensity is not increased too much. ✓ When the current is cut off, a slight erythema is seen, depending on the surface vasodilatation that occurs in the area of application.  | FARADIC CURRENTS | On motor nerves: ✓ The faradic current stimulates the motor nerves and leads to contraction of the muscle which is innervated by that nerve. ✓ Metabolism increases due to increased muscle activity. ✓ The removal of metabolites increase due to increased metabolism. ✓ Metabolites cause dilatation in arterial capillaries and that increases blood circulation in the muscles.  | FARADIC CURRENTS | On healthy muscle: ✓ If muscle contraction is performed against a resistance, hypertrophy occurs in muscle fibers and muscle strength increases. ✓ Low frequency currents are more effective in increasing muscle strength than medium frequency currents.  | FARADIC CURRENTS | On the denervated muscle: ✓ The transition time of the faradic current is 0.1-1 msec, so it does not stimulate the denervated muscle. Reducing Pain and Edema ✓ As the permeability of the cell membrane changes, fluid flow accelerates, edema decreases and arterial dilation occurs. ✓ In addition, as a result of increased metabolism, waste materials are removed from the tissue.  | FARADIC CURRENTS | Electrodiagnostic Evaluation ✓ The minimum current intensity that causes contraction as a result of stimulation of a normal muscle from the motor point with faradic current is called threshold current. ✓ It is used in the diagnosis of some muscle and nerve diseases. ✓ If there is a decreased response to the threshold current in the muscle, it is referred to as hypoexcitability, if there is an increased response, it is referred to as hyperexcitability. ✓ If there is no response, this condition in which the muscle cannot be stimulated is called inexcitability.  | FARADIC CURRENTS | Reducing Pain with Opposite Irritation Effect ✓ If a high-intensity and non-surged current is applied to the sensory nerve, accommodation occurs and after a while the excitability of the tissue against the current of the same intensity decreases. ✓ Even if the current is cut off, this effect continues for a while. ✓ In this way, the pain is also reduced.  | SINUSOIDAL CURRENTS | It is a type of alternating current in symmetrical sinus wave form. The current increases in the positive direction for a while, then the current decreases in the positive direction. Then, in the negative direction, the current starts increasing and decreases again.  | SINUSOIDAL CURRENTS | They are low frequency currents that alternate equally. The frequency used in the treatment is 50-100 Hz. Each stimulation takes 10 ms. The current can be surged.  | SINUSOIDAL CURRENTS | It is usually surged to cause rhythmic muscle contractions. This condition relieves pain and reduces edema. Because of the strong sensory stimulation, this current is often applied over large areas and is rarely used for local muscle stimulation.  | SINUSOIDAL CURRENTS | Therapeutic Effects of Sinusoidal Current Chemical Effects Heat Effects Physiologic Effects  | SINUSOIDAL CURRENTS | Chemical Effects: (-) pole is more stimulant than (+) pole. Heat Effects: It is not used to warm tissues because of its current intensity is low Physiological Effects: On sensory nerves On motor nerves On the denervated muscle  | SINUSOIDAL CURRENTS | On sensory nerves: ✓ Where the current is applied, a feeling of pins and needles occurs. ✓ Pins and needles feeling is more than faradic current application. ✓ Reflex vasodilatation leads to erythema in the area of application and blood flow in subcutaneous tissues accelerates. (more than faradic current)  | SINUSOIDAL CURRENTS | On motor nerves: ✓ Sinusoidal currents can stimulate motor nerves. ✓ If the current stimulus is more than 20 per second (60 per sec in faradic current), the time between the two stimulus become too short, so the muscle contracts again without time to relax and tetanic contraction occurs.  | SINUSOIDAL CURRENTS | On Denervated Muscle: Generally, contraction in denervated muscle can be obtained using a 10-msec stimulation duration. However, it is not preferable to apply the sinusoidal current to the denervated muscles, because the patient needs more current intensity than he/she can tolerate.  | SINUSOIDAL AND FARADIC CURRENTS | Therapeutic Effects and Use Patterns of Faradic and Sinusoidal Currents ⁍ Muscle re-education ⁍ Teaching its new duty to the muscle ⁍ Treatment of Denervated Muscles ⁍ As Electrodiagnostic Test ⁍ To Increase Muscle Strength ⁍ To increase blood circulation ⁍ To increase venous and lymphatic circulation ⁍ Solving and preventing adhesions ⁍ To Maintain and Increase Joint Range of Motion ⁍ Reduce pain with opposite-irritation effect ⁍ Conversion Disorder  | SINUSOIDAL AND FARADIC CURRENTS | Muscle re-education: Helps to restore muscles with loss of active contraction due to long- term immobilization or improper use. With the application of the Faradic current to the muscle, the patient is given the feeling that the muscle is moving again. During practice, the patient is guided and motivated to ensure active participation. The application is continued until received active muscle contraction from the patient.  | SINUSOIDAL AND FARADIC CURRENTS | Teaching its new duty to the muscle: After the muscle transfer and transplantation, it is used to teach its new job to the functionally modified muscle. While stimulating the muscle with the faradic current, it is asked to the patient to concentrate on the motion and actively participate  | SINUSOIDAL AND FARADIC CURRENTS | Treatment of Denervated Muscles: Nerve lesions that cause paralysis in musles are: o Neurapraxia o Axonotmesis o Neurotmesis Wallerian degeneration: It is defined as the degeneration of axons distal to the cut point. Degeneration occurs in the myelin sheath and axon distal to the injury along the nerve fiber and up to the previous node of Ranvier Classification of peripheral nerve lesions; (Seddon 1947) Neuropraxia Axonotmesis Neurotmesis Neuropraxia: It is a temporary cessation of conduction in the nerve as a result of nerve compression. There is no degeneration in the nerve, the schwann cell and myelin sheath are intact. Nerve conduction is normal. Axonotmesis: There is complete motor, sensory, and autonomic loss due to the disruption of axon integrity. Wallerian degeneration is observed depending on the presence of real pathology. Since the basement membrane and endoneurium are intact, there is solid reinnervation and full functional recovery. Recovery depends on the distance of the motor end plate and sensory end organ to the lesion. Neurotmesis: There is a complete disruption in the nerve trunk integrity. There is scar tissue between the neuroma that occurs proximally and the bulb that forms distally. It has a very limited regeneration and recovery capacity. Even with surgical treatment, there is inadequate functional gain.  | FARADIC CURRENTS | ❖ In neuropraxia there is a response to the faradic current, but no active movement is observed. ❖ There is no response to faradic current in both neurotmesis and axonotmesis, also no active movement is observed.  | FARADIC CURRENTS | ❖ After the degeneration reaction is completed, about 10-21 days, the 1 msec stimulation time of the faradic current is insufficient for stimulation of the nerve and no response can be obtained with faradic current. ❖ In this process, the muscle is stimulated with an intermittent(pulsed) galvanic current with a stimulation duration of 500-1000 msec. Therefore after degeneration, it is appropriate to stimulate the nerve with faradic current in the first 10-21 days and then with an intermittent galvanic current. As Electrodiagnostic Test: In healthy muscles the faradic current given from the motor point of muscle to have minimal contraction is called treshold faradic amount. When a muscle cannot respond to the threshold faradic value and responds to higher current intensities, it is called hypoexitability. If it’s not responds to the threshold faradic at all is called inexitability (Duchenne reaction), and if it responds more, it is called hyperextability. The Duchenne reaction shows complete degeneration. Hyperextability is seen when degeneration begins. To Increase Muscle Strength: If stimulation with faradic current is made against an appropriate weight resistance, an increase in muscle cross-sectional area is achieved. To increase blood circulation: Reflex vasodilatation which is occured by stimulation of sensory nerves and muscle contraction increases blood circulation. Especially used in circulatory disorders, which is seen as the result of immobilization. If sensory stimulation is used to increase circulation, sinusoidal current is preferred.  In practice, the sinusoidal current is not surged and the current intensity is given so low that it does not cause contraction. This method is mainly used to increase circulation in cases where other heat applications are not used safely due to sensory loss. To increase venous and lymphatic circulation: Increased venous and lymphatic circulation occurs due to pump effect of successive muscle contractions and relaxation on the venous and lymphatic system (Faradism under pressure).  In practice, the extremity to be treated is elevated 45°-60° to allow gravity to assist venous and lymphatic return. If elastic bandages are wrapped around the electrodes, treatment is more effective. The bandage contracts when the muscle contracts, giving more pressure to the vessels and increase the pumping effect further when the muscle relaxes. Solving and preventing adhesions: In situations where active exercise is not possible, electrical stimulation is used to reduce adhesions. Muscle contractions are used to reduce adhesions in scar tissue, tendons and muscles (faradism under tension). Where faradic current applications are preferred in resolving local adhesions, in- water applications and sinusoidal currents are used in large areas. To Maintain and Increase Joint Range of Motion: Movement becomes limited due to the shortened tissues for different reasons. In cases of joint limitation caused by unilateral shortening of the soft tissues around the joint, the contracture is stretched as a result of stimulation of the muscles around the joint with faradic current. In scoliosis deformity, the lateral trunk muscles in the direction of the convexity are stimulated by electrical stimulation. Electrodes are placed on the patient's back and contraction is obtained in these muscles to reduce convexity. Reduce pain with opposite-irritation effect: If a high intensity not surged current is applied on the sensory nerve, the nerve adapts to this stimulation and the conductivity decreases. Even if the treatment is terminated, the decrease in nerve excitability continues for a while and that allows the pain to decrease. Conversion Disorder: Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. In the event of paralysis due to this disorder, the patient can be evaluated with the tetanic current response.  | APPLICATION TECHNIQUE | Preparation of Patient 1. The area to be treated is opened and appropriately supported 2. The patient should be in a comfortable position 3. The patient is informed about the application to be performed 4. Sensory tests are done 5. Since the Faradic current goes through from skin faster with its increased temperature, the heat of the treatment area can be increased by manual methods such as massage.  | APPLICATION TECHNIQUE | Application Technique of Electrodes 1. To reduce the skin resistance against faradic current, it is necessary to wet the skin. 2. Electrodes are fixed to the body by bandage, rubber band or body weight. 3. The passive electrode should be placed near the origin. 4. The active electrode is placed on the motor point. Pen or pad electrodes are used as the active electrode.  | APPLICATION TECHNIQUE | Application of Current 1. The intensity of the current is increased gradually until a good contraction is obtained. 2. The current should be surged so that there are successive contractions and loosenings. 3. The duration of treatment should be set to 20-30 minutes in group applications and good contraction should be achieved.  | TREATMENT APPLICATIONS | Motor point stimulation: Each motor point is stimulated separately.  | TREATMENT APPLICATIONS | Group stimulation: Group stimulation can be used on the muscles that their origins are at the same region. Passive electrode is placed at the origin of muscles, the active electrode is placed at the site where the nerve is superficial.  | TREATMENT APPLICATIONS | Labil Technique: In this technique, the active electrode is approached to the motor point and distanced from it in a rhythmic way. This technique is used if the application device is not able to surge current.  | TREATMENT APPLICATIONS | Nerve stimulation: If the muscle to be stimulated is closed due to plaster, nerve stimulation can be performed. In such cases, application to the muscle can be performed by opening a window on the plaster. However, it is not possible to apply this method to the muscles those nerve is not superficial.  | TREATMENT APPLICATIONS | In-water applications: It is more used for the treatment of forearms and hands, legs from under the knee and feet, due to the fact that skin’s resistance is low in water and large areas are treatable.  | TREATMENT APPLICATIONS | Faradism under pressure: It is applied in increasing venous and lymphatic circulation.  | TREATMENT APPLICATIONS | Faradism under tension: It is preferred in opening and preventing adhesions.  | TREATMENT APPLICATIONS | Faradic current is often used in the form of Functional Electric Stimulation (FES). This technique combines the active participation of the applied region with electrical stimulation. Especially it is used; In cases where voluntary muscle contraction can not be obtained in postoperative or posttraumatic conditions, In the early stages of reinnervation, In the case of atrophy, which occurs after a long period of immobilization, In muscle paralysis / paresthesia  | TREATMENT APPLICATIONS | Faradic current is often used in the form of Functional Electric Stimulation (FES). This technique combines the active participation of the applied region with electrical stimulation. Especially it is used; In cases where voluntary muscle contraction can not be obtained in postoperative or posttraumatic conditions, In the early stages of reinnervation, In the case of atrophy, which occurs after a long period of immobilization, In muscle paralysis / paresthesia  | APPLICATION FEATURES | The current intensity is increased to a value that does not bother the patient and where a good contraction can be observed. Treatment duration may vary between 20-30 minutes. Before the application, the patient should be informed and a sensory test should be done. Since the transition of the faradic current from the skin with increased temperature or wetting is faster, providing a slight increase in the temperature of the skin before the application can increase the effectiveness of the treatment.  | APPLICATION FEATURES | Disposable sticky electrodes and carbon rubber electrodes may be preferred for applications to muscle groups or large muscles, and pen electrodes may be preferred for applications to small muscle groups and motor points. Electrodes should be fixed to the body with a bandage, rubber band or body weight to ensure full contact. The active electrode should be placed at the motor point of the muscle.  | CONTRAINDICATIONS OF FARADIC AND SINUSOIDAL | 1. Skin lesions (Current localize at painful point) 6. Cancer 2. Dermatological conditions (such as Psoriasis, 7. Pacemaker use Eczema) 8. Use of superficial metal implants 3. In cases of acute inflammation or infection 9. On hemorrhagic areas 4. Thrombosis 10. Pregnancy 5. Loss of sensation  | WHAT TO TAKE HOME? | Properties of faradic and sinusoidal currents Application areas Therapeutic effects Contraindications  | QUESTIONS AND SUGGESTIONS | Which of the following are true? I. In neuropraxia there is a response to the faradic current II.In the first 10-21 days of degeneration stimulated with intermittent galvanic current III. Neuropraxia there is no degeneration in the nerve A. All of them B. Only III C. II,III D. I,III E. I,II  | QUESTIONS AND SUGGESTIONS | Which of the following is incorrect? A. The risk of burns caused by the faradic current in the tissue is low. B. Faradic current is used to warm tissues. C. In the faradic current; metabolites cause dilatation in arterial capillaries and that increases blood circulation in the muscles. D. Low frequency currents are more effective in increasing muscle strength than medium frequency currents. E. Faradic current does not stimulate the denervated muscle.  | QUESTIONS AND SUGGESTIONS | Which of the following are true? I.Faradism under pressure is applied in increasing venous and lymphatic circulation. II.If the current stimulus is more than 20 per second in faradic, 60 per second for sinusoidal current; tetanic contraction occurs. III.In sinusoidal currents (-) pole is more stimulant than (+) pole. IV. Sinusoidal current is often applied over small areas A. All of them B. III,IV C. I,III D. II,III,IV E. Only III  | RECOMMENDED WEEKLY STUDIES | o 2 days a week 1 hour each will be enough  | REFERENCES | Elektroterapide Temel Prensipler ve Klinik Uygulamalar, Nihal Şimşek Nuray Kırdı, 2016  | ABOUT THE NEXT WEEK | o Electrodiagnostic Tests  ………….. – ………………………… Since course presentations are private, using the texts and images contained herein on social media or else without permission from the course instructor is against the regulations Law No. 6698. “Everything we see in the world is the creative work of women.”