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Electrotherapy

Treatment given by Electricity is called Electrotherapy. The following modalities are present in
Physiotherapy block under Electrotherapy. Section.

 Electrical muscle stimulation - ES.


 Trancutaneous nerve stimulation – TNS
 Ultra sound therapy – US.
 Inter ferential therapy – IFT
 Infra Red radiation – IRR
 Short wave diathrepy – SWD.

I -Electrical Stimulation (Es)

Electric Current: - The flow of electrons in the conductor represents an energy transmission. It is
measured in terms of ampere.

 A body possessing surplus of electrons said to bear a Negative electrical charge.


 A body possessing fewer of electrons bear positive charge.
 When two regions have different electrical charge they are said to have a potential
difference which is measure in Volts.
 The flow of electron always from negative to positive.

Lugi Galvoni in 1726 began to stimulate the nerves and muscles of frog with electrical charge and
arrived at the belief that animals developed electricity spontaneously.

Humbolt a German scientist note that contraction of muscle occurred on the “Make and break of
the circuit”

Principle of electrical Stimulation

 Electricity can contract a muscle or a nerve fiber against its will.


 Usually the nerve or muscle fiber is enveloped by a Polarized membrane which bears an
electrical potential of their own.
 Active potential of nerve at resting stage is 60 milli volt.
 Active potential of muscle at resting stage is 90 milli volt.
 If an electric current of sufficient strength is passed through the fiber, partial depolarization
occur at the membrane and that leads to firing of the fibre. So that on the “make of the
circuit” excitation occur at the cathode.

Where as on the “break of the circuit some degree of hyper irritability is present at the anode”.

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Fig showing conduction of nerve impulses:

The active transport of sodium ions from the axoplasm into the interstial of fluid, which is known
as pumping of Sodium ions from the interior axons became strongly electro negative.

Depolarization stage: On applying the stimulus, the membrane of the fiber become depolarized i.e.
the pumping out of sodium stops. Instead the Na++ ions starts to diffuse into the axoplasm through
the membrane starting at a point. Now the interior of nerve fibre become positive while outside is
negative. This is just opposite of the resting nerve fiber.

Depolarization : Once the stimulus stops again resulting electro negative inside the axoplasm.

Myoneural junction :-Since the ends at the muscle through the nerve ending (myoneural junction )
the impulses which possess at high speed in the nerve can reach the muscle.

Fig:

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Picture of Electrical muscle Stimulator:

Electrical Stimulation:- Clinical aspects:

Since it was discovered that electricity stimulate nerve and muscle it has been used clinically for
both Therapeutic and diagnostic purpose.

Therapeutic Electricity : -

 Electrical stimulation is clinically applied to treat the denervated skeletal muscle.


 Innervated skeletal muscle can also be stimulated when the patient can not will not contract
it voluntarily.
 If any spastic paralysis in the muscle, stimulation can reduce this spasticity.
 Sometimes due to ventricular fibrillation cardiac arrest may occur, at that time Electrical
Stimulation promote its activity.
 Electrical stimulation inhibit the fibrosis. Stimulation tends to reduce the inter and intra
fascicular fibrosis.
 Electrical stimulation is helpful in re-educating the muscle (especially in tendon transfer
technique). An extremely weak muscle may be unable to move its tendon. In this event
stimulation may make it easier for the patient to begin voluntary contraction.
 Trans cutaneous nerve stimulation has been found to provide relief of pain in acute neuritic
patient.
 Since stimulation is effective in retarding atrophy there may be some possibility of
reinnervation.

Patient getting Electro Therapy treatment

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Electrical Diagnosis

 Electro encephalography, electro myography have proved useful for detection , registration
, and quantification of various disturbances of functions in the central and peripheral
nervous system.
 Electro myography record the electrical activity from the muscle.
 The nerve conduction velocity is helpful to localize the level of interruption of a peripheral
nerve or motor nerve.
 Since stimulation is effective in retarding atrophy, there may be some possibility of
reinnervation. By doing S.D .curve (Strength and duration curve) one can diagnose
whether a muscle is innervated or deinnervated.

S.D.Curve

The degree of response of a nerve or muscle depends on its strength and duration . The curve
drawn relating these two parameters are called strength and duration curve.

 Galvonic current is applied to the muscle under test.


 The amount of current require to bring minimum contraction is measured.
 The duration of muscle is progressively shorten and the intensity of the current required to
bring minimum contraction is measured for each duration.
 With the different values found formed a curve relating strength the current and duration
can be drawn.
 In normally innervated muscle the intensity of current of minimal contractions is same over
a wide range of variation and has increased only very short pulse duration are given.
 In denervated muscle the curve is not horizontal but raised steeply and no responses elicited
at the short pulse duration.
 In partially innervated muscle or during the recovery of denervated muscle a kink
(depression) is appeared on the curve It always appears between 3 and 10 milliseconds or
between 10 and 30 milliseconds or land 3 milliseconds.

So by doing SD curve at frequent interval one can find out whether there is any innervations in the
muscle after doing continuous stimulation.

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Strength of Stimulates

Depends on its adequacy to induce response from the tissue. The strength of stimulate are
classified as

 Sub minimal
 Minimal
 Maximal
 Supra maximal

The minimal duration of an effective stimulates

for nerve is – 0.03 milli seconds.

for muscle is - 1 milli seconds.

Types of Nerve Forms.

 Galvanic
 Faradic
 Exponential
 Sinusoidal etc

Galvanic: Is interrupted or continuous current of long duration. The impulse last for 1/10 of a
second.

Faradic : The duration is very brief. The impulse last for 1/1000 of a second.

Motor points : Positioning of the electrodes are done on the basis of anatomical knowledge rather
than motor point charts.

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Technique of Stimulation :

 Mono polar - One indifferent and one active electrode.


 Bi polar - Two electrodes one of same size placed over the muscle.

Electrodes: For clinical electric stimulation it is safer to use an electrode covered win fabric that
can be kept wet.

Fig.

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II – Trans Cutaneous nerve Stimulation

Pain Modalities:: TNS is one of the pain subside especially for Neurities. Many of the electrical
agent and physical treatment applied by the Physiotherapist are an attempt to reduce the level of
pain perceived by the patient.

It is necessary to have an understanding how pain generated, transmitted and interpreted by the
nervous system.

How Pain Perceived: There is usually a chain where by

 Pheripheral receptors are stimulated by a physical or chemical agent and this stimulus is
carried by.
 Pheripheral nerves to the spinal cord through the brain stem and to the cerebral cortex.
 The pain is appreciated at a conscious level.

How Pain modulated

The inhibition to the impulses on their route to the mechanism thereby pain can be subsided.

 Suppose the pain impulses have a maximum frequency of 15 pulse/sec and 40 pulse/sec.
 If a higher frequency stimulation is applied, a physiological block to the conduction of pain
might occur. So the patient often happy to have the pain level reduced even when the
underlying pathology is unaffected.. Example TENS and IFT.

Tran cutaneus nerve stimulation is the application of a pulsed rectangular nerve current. (via)
surface electrode in the patient’s skin.

Intensity: Can be varied from 0-60 milliampare. A tingling sensation should be felt by the patient.

Positioning of the electrode: Electrodes can be placed.

 Over the area of the treatment intensity of pain


 The appropriate route of the peripheral nerves.

Uses: Method of reducing pain in cutaneous nerve


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(1) Low ulnar, high ulnar

(2) low median

(3) Lateral popleteal

(4) Posterior tibial nerve.

III – Ultra Sound Therapy

Sound: Sound is the periodic disturbances of a medium. The medium may be air, water. Air
relatively poor transmitter of sound, where as water is very good.

Ultrasound : Ultra sound is defined as a form of acoustic vibration with frequency is so high that
cannot be received by human ear. Usually frequency below 17,000 cycles per second are called
sound waves which those above 17,000 cycles per second are defined as Ultra sound.

 Ultra sound used for therapeutic purpose range between 0.8 to 1 megacycle.
 Intensity used for therapeutic ranged to 4 volts/m2.
 Intensity is expressed in volts/m2.

Principle of Ultrasound Therapy

The production of ultrasound wave is achieved with the help of electrical oscillation in tern
produced it an electrical generator of sufficient power.

The electrical oscillation of one megacycles are then transformed into mechanical vibration in a
transducer unit. The unit consists of properly designed crystal which vibrate with the electrical
field applied to (Piezo electric effect). The transducer unit itself passed against the area to be
treated.

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Technique of application :

 The transducer unit must be held in intimate contact with the body surface even very small
layer of air between transducer and tissue will interrupt effectively the passage of sonic
energy. So it is in practice to fill the space between the transducer of a of body surface by a
coupling fluid which does not interface the transmission of sonic energy. This also avoids
friction.
 Another technique is under water treatment when water is used as medium, the body
section to be treated and the sound transducer are immersed in to the water both.

Dossage : 10 mts.

Indication:

 Muscle spasm seems to decrease by Ultra sound.


 All joint contracture resulting from the development of capsular tightness and scarring.
 Calcific bursitis and tendinitis can be treated.
 Pain persists follow sprain can be relieved.
 Scar tissue is made more pliable by applying will be sound.
 It break down adhesion formed between the adjacent structure.
 If it is applied over thickened nerve an analgesic effect is found. (because it slows down
the nerve conduction velocity).
 Used as treatment of pain occur in post operative neuro fibromas, where they are embedded
in scar tissue.
 Conditions like multiple sclerosis, keloid, dermatitis, periostitis, peptic ulcer Torticollis etc
can do treated with U.S.
 The mechanical effect of U.S.has an effect on chromic oedemo.

Contra Indication:

 Should not applied over eyes because cavitations is most likely to occur in the fluid media
and may lead o irreversible damage.
 Precaution should be taken and corresponding adjustment of the dosage made when an area
of the spinal cord is treated after a laminactomy (i.e after the major cover tissue have been
removed)
 Should be applied with caution over anesthetic area and in patients with haemorhagic
diathesis.
 Should not apply over malignancy. Since tumor growth may accelerate.
 Contra indicated to the individuals with vascular disease where the blood supply would be
unable to follow the increase in metabolic demand and tissue necrosis may result.
 High dosage produce bone necrosis resulting in pathological fracture
 U.S. should not applied to a radiated are for atleast six months after radiation.
 The reflection of an ultrasonic wave from bone may produce double the intensity of U.S. in
periosteal region which may cause over heat and can manifest itself as periosteal pain.

So it is best to avoid posting the ultrasound over subcutaneous bony parts. U.S. must applied with
proper precaution with proper dosage and with proper technique.

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Damage to equipment: When the treatment head hold in air while switched on, reflection of the
beam back into the treatment head may set up a standing wave which could damage the system.

IV- Infra Red Radiation

 Radiation is the process of propagating energy through matter or vacuum.


 Infra red radiation travel through an evacuated space is unchanged, but when they traversed
matter the radiant energy is transformed into other form of energy such as heat.
 Infra red radiation used for therapeutic purpose extends from the limit of the visible zone
and has a wave length span of approximately 7,600 to 1,50,000 Angstrom unit.
 The intensity of infra red radiation is measured in terms of Pyrons. One Pyrons is equal to
0.0697/Walts/cm2.

Source: Infra red radiation are emitted from luminous and non luminous sources.

 Heat of sun the luminous and natural source. Artificial sources like tungsten, carbon
filament bulbs as well as carbon arc and mercury vapour lamps emit high proportion of
Infra red radiation.
 Clinical intra red generator are usually operated at a temperature sufficiently high to emit
some visible radiation. They are glow a dull red. This emission as predominantly non
luminous. (These consists of heated resistance wire wound into approximately shaped coil
of resistance wire covered with copper tubing or other metal covered with corborundam or
some other refractory method).
 Therapy with infra red source is usually done at radiation intensity level of 1 to 7 pyrons.

Pain and blistering can be induced in 4 to 7 pyrons intensity level.

Technique of application :

 The IRR source is placed over the part to be treated. The distance is 18-24 inches from the
part to be treated.
 The patient should be placed in a relaxed and comfortable position. The patient should
always be warned to report any discomfort from the heat.
 Exposure time is 20-30 minutes and can be given 2 to 3 sittings daily, if indicated.
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Indication :

 It is a pain relieving effort.


 It relief the muscle spasm and an increase of local blood supply.
 It is a psychotherapeutic effort for the patients who sees and feels something definite being
done for him and comforting.
 IRR heating is helpful in the treatment of sub acute and chronic treatment of inflammation
such sprains, fibrositis, tenosynovits.
 Exposure of IRR produce superficial hyperemia , sweating and relaxation of muscle.

Contra indication:

 Over dosage cause blistering burns and even heat strokes.


 It is not advisable as far as eyes are concerned.
 After a great many exposure to a high intensity thermogenic radiation, the skin may
develop a type of erythema called erythema abigene.
 Standardization of dosage and needed.

V – Short Wave Diathermy :

Principle:

 Of a low intensity continuous current is applied to the skin – a tingling sensation may
result.
 In a greater intensity, if interrupted it will cause contraction of the underlying muscle.
 If the current is interrupted or alternated with increasing frequency, it will elicited a tetanic
contraction of the underlying muscle, but at one stage the muscle contraction is no longer
elicited.
 If the frequency exceeds above 10,000 cycles/sec, the patient will experience a sensation of
warmth.
 Thus by using high frequency current it is possible to introduce ‘deep pleasant heat’ which
will reduce joint level pain especially for arthritis .

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Heat intensity:

Heat should not exceed a comfortable warmth. The duration of treatment should not exceed 15
days continuously.

Clinical application :

 All synthetic clothing and metallic materials which cover the body around the area to be
treated must be removed.
 The patient should be settled in a comfortable position and should be questioned about the
loss of sensation.
 Careful placing of electrode is essential. The cable or leads between the apparatus and the
electrode should not cross one another and should not touch the body of the patient. A
spacing pad should be placed between the cable and the skin.
 The intensity of the output should be increased slowly. Once the accurate tuning has been
optional no object within the field should be moved.

Duration: 10 minutes

Indication: For all deep seated joint pains.

Contra indication: Should not apply over pregnant uterus or any malignant tumor.

VI – Inter Ferential Therapy

 Interferential therapy is a form of electrical treatment in which two medium frequency


currents are used, to produce a low frequency effect.
 Direct application of faradic or sinusoidal current to patient is a very high skin impedance
encountered by such a low frequency currents. (50 – 100hz)
 Medium frequency currents of around 4000HZ will able to stimulate motor and sensory
nerves encounter a much low skin impedance.

Principle: The Principle upon which interferential therapy is based that, when two medium
frequency currents cross the patients tissue, they produces the interference effect. One of the
current is kept at a constant frequency of 4000HZ and the other can be varied between 3900H2 and

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4000HZ. An interference effect at a beat frequency between the two current is produced in the
tissues at the point where the two currents cross.

By varying frequency of the second circuit relative to the constant frequency of the first it is
possible to produce a range of beat frequencies. For eq. If circuit ‘A’ carries a current with a
frequency of 4000 HZ and circuit ‘B’ of 3980 HZ then the frequency will be 20 HZ.

Timing : 10-20 minutes

Placing of Electrodes : Four electrodes are used in two pairs, each pair being indicated by the
colouring of the wire from the machine. The electrodes of each pair are placed diagonally opposite
to one another in such a way that the interference effects or beat frequency is produced on the
tissues where it is required.

One of the major advantages claimed for interferential therapy is that the effect are produced in
the tissue where they are required without unnecessary and discomfortable skin simulation.

Indication : Relief of muscular pain.

E.Vijayakumari M.Sc., M.Phil.,

Technical Assistant (Surgical),

CLTRI.

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