EPT practical 1

- General procedure
Introduction: explain Rx and obtain consent
Check contraindications
Prepare equipment
Position patient: skin sensation test if necessary
Explain Rx procedure and give warning
Check pre- and post- Rx symptoms

- Documentation
Subjective feelings of patient
O/E result: skin sensation test
Rx particular: position, machine model, Rx area, electrode type, Rx method, dosage

1. PEMF (Magnetopulse, BTL)

Indication  Fracture
 Arthritis
Contraindication  Cardiac pacemaker and brain stimulator
 Hearing aid
 Pregnancy
 Malignancy
 TB
 Deep X-ray therapy
 Head region: may cause drowsiness
Equipment  Machine
 Disc or solenoid applicator
 Magnet
Position Comfortable and well supported
Skin preparation  Check open wound
 No need expose or wash Rx area: body tissue is
transparent to magnetic field
 No skin sensation test needed
Expected sensation No sensation
Machine checking Select appropriate applicator and dosage
Turn on machine and use magnet to feel the magnetic field
 Allow patient to feel the magnetic field
Dosage Acute Chronic
Frequency 5Hz >10Hz
 Inflammation  Vasodilation
 Pain  Healing
Intensity ≤50G ≥50G
Duration 10mins 30mins
2. Microcurrent (Microstim, ITO ES-522)
Indication  Soft tissue healing
 Pain control
Contraindication  Cardiac pacemaker and brain stimulator
 Hearing aid
 Pregnancy
 Malignancy
 Hemorrhage
 Epilepsy: trans-cerebral stimulation
 Cardiac problem: trans-thoracic stimulation
Equipment  Machine
 Probe electrode with Q-tip stick
 Pad electrode with sponge
 Bandage
 Soap and water
Position Comfortable and well supported
Skin preparation  Check open wound
 Wash Rx area: reduce skin resistance
 Sharp and blunt test
Expected sensation Mild pin-prick sensation or no sensation
Machine checking Select appropriate electrode and dosage
Turn on machine and produce a short circuit
Rx method Probe method
 Search and treat
Locate and mark high conductance points in test mode
Maintain pressure on each point for 30s in Rx mode
 Swirl the dragon
Twist the probes around circumference of Rx area
 GTO
Place the probes on origin and insertion of muscle
Apply stretching force when current comes
 ETR
Place the probes on medial and lateral side of muscle
Move the probes along muscle: 1cm interval
Dosage
Pain control Soft tissue healing
Polarity -ve -ve
 Vasodilation  Bone repair
 Scar softening
Frequency 30Hz 1Hz
Intensity 200-600uA 10-100uA
Ramp time Sharp Gentle
Duration Probe: 10mins Pad: 30mins
 30s each point
3. SDC & IDC (Enraf)
Indication Innervate denervated muscle
Contraindication  Cardiac pacemaker and brain stimulator
 Hearing aid
 Metal implant
 Malignancy
 TB
 DVT and thrombophlebitis
 Infection
Equipment  Machine
 Probe electrode
 Pad electrode with sponge
 Bandage
 Soap and water
Position Comfortable and well supported
Skin preparation  Check open wound
 Wash Rx area: reduce skin resistance
 Sharp and blunt test
Expected sensation Tingling sensation
 Inform concentration of current
 Inform unwanted discomfort or pain
 Avoid danger of sustaining skin or tissue damage
Machine checking Select appropriate dosage
Turn on machine and test with our hands
Rx method  Unipolar
1 pad electrode and 1 probe electrode
 Bipolar
2 pad electrodes on muscle
Dosage Frequency: 10Hz
Intensity: until contraction is observed
Pulse duration: chronaxie
Rest period: chronaxie x 5
 5s rest between contraction, 2mins rest between sets
Waveform: trapezoidal
 3 sets of 10 contractions
 1 time/day
4. ES (Respond select, Zynex E-wave, ITO-120Z, ITO-320)
Indication  Shoulder subluxation
 Foot drop
 Bell’s palsy
 Muscle strengthening
 Neuropathic pain
Contraindication  Cardiac pacemaker and brain stimulator
 Hearing aid
 Metal implant
 Malignancy
 TB
 DVT and thrombophlebitis
 Infection
Equipment  Machine
 Probe electrode
 Pad electrode with sponge
 Bandage
 Soap and water
Position Comfortable and well supported
Skin preparation  Check open wound
 Wash Rx area: reduce skin resistance
 Sharp and blunt test
Expected sensation Tingling sensation
 Inform concentration of current
 Inform unwanted discomfort or pain
 Avoid danger of sustaining skin or tissue damage
Machine checking Select appropriate dosage
Turn on machine and test with our hands
Rx method  Shoulder subluxation
Stimulate Supraspinatus + between mid and post Deltoid
No contraction should be observed
 Foot drop
Stimulate TA with foot switch under heel
 Bell’s palsy
Stimulate facial N trunk under ear + middle branch
Dosage Shoulder Foot drop Neuropathic
subluxation pain
Frequency 50Hz 30Hz 4Hz
Intensity Low Low Strong
PD 100us 300us 200us
On:off 1:1 (5s:5s) 1:4 /
Duration 6hrs/day 30mins/day 30mins/day
2 weeks 2 weeks 10 days
5. EMG Biofeedback (MyoTrac EMG, NeuroTrac Simplex and Myoplus 2, MR-20)
Indication  Muscle strengthening
Equipment  Machine
 Pad and earth electrode with gel and micropore
 Soap and water
Position Comfortable and well supported
Skin preparation  Check open wound
 Wash Rx area: reduce skin resistance
 No skin sensation test needed
Expected sensation No sensation
Rx method 2 electrodes on muscle, 1 electrode on bony prominence
Ask patient to contract against resistance: identify max V
Adjust threshold: half of max V
Hold “set” to adjust parameters
 Work 8s and rest 8s
 10 reps
 Wide band width: larger sound
 Above threshold: encourage stronger contraction
6. LLLT (THOR-DD, THOR LX-2, Omega Xp, Chattanooga)
Indication  Would healing
 Soft tissue healing
 Pain control
Contraindication  Pregnancy
 Malignancy
 Hemorrhage
 Deep X-ray therapy
 Steroid injection therapy
 Eye Rx
Equipment  Machine
 Laser probe with alcohol pad
 Black goggle
 Timer
 Wound dressing set
Position Comfortable and well supported
Precaution  Turn on laser sign
 Wear black goggle
 Do not look directly at the laser beam
 Clean the probe with alcohol pad before and after Rx
Skin preparation  Check open wound and perform wound dressing
 No skin sensation test needed
Expected sensation No sensation
Machine checking Select appropriate dosage
Turn on machine and perform laser beam test
Rx method  Spotting: wound margin (4J/cm2)
1cm from the edge of wound
2cm between each spot
 Gridding: wound bed (1.5J/cm2)
Irradiate each grid at predetermined time
 Scanning: wound bed (1.5J/cm2)
Move the probe continuously
Distance between the probe and wound<1cm
Dosage
Acute wound Chronic wound
Frequency 5Hz 1000Hz
Intensity 1.5J/cm2 5J/cm2
Average power = Power x frequency x PD
Power density = Average P/spot size
Rx time = Energy density/power density
Rx interval Daily 2 times per week
7. UVR (Kernel UVA and UVB, Dermalight UVB, Dermawand UVC)
Indication  Would healing
Contraindication  Pregnancy
 Malignancy
 TB
 Hemorrhage
 Deep X-ray therapy
 Acute skin condition: eczema and dermatitis
 Systemic lupus erythematosus
 Recent skin graft
 Photoallergy to UVR
 Eye Rx
Equipment  Machine (UVA: promote growth/UVC: anti-bacterial)
 Transparent goggle
 Vaseline with cotton bud
 Screening material (paper towel, blanket, paper card)
 Micropore
 Spatula
 Tape measure
 Wound dressing set
Position Comfortable and well supported
Precaution  Wear transparent google
 Do not look directly at the UVR beam
Skin preparation  Check open wound and perform wound dressing
 No skin sensation test needed
Expected sensation No sensation
Machine checking Select appropriate dosage
Turn on machine and observe UVR
Rx method Cover non-treatment area with blanket
Keep 4cm from skin
 Determine E1
Cut 3 different shapes with exposure time 10s, 20s, 30s
Cover the holes with black card and test on inner thigh
Appear last and disappear first
 Peri-wound (E1)
Duration: E1, everyday
 Granulation tissue (E1/E2)
Apply vaseline to wound edge
Cut a hole on paper towel and put it on wound
Duration: E1 x 2.5, twice per week
 Slough (E3)
Cover granulation tissue with paper towel: expose slough
Duration: E1 x 5, once per week
 Eschar (E4)
Cover slough with paper towel: expose eschar
Duration: E1 x 10, once per 2 weeks
8. Shockwave (PiezoWave)
Indication  Fasciitis
 Epicondylitis
 Tendinitis
Contraindication  Cardiac pacemaker and brain stimulator
 Hearing aid
 Pregnancy
 Malignancy
 Angina and CHF
 Coagulation therapy: avoid hemorrhage
 Gas-filled tissue (intestine or lung): avoid hemorrhage
 Epiphyseal plate: affect bone growth
Equipment  Machine
 Shockwave applicator and gel
Position Comfortable and well supported
Skin preparation  Check open wound
 Sharp and blunt test
Expected sensation A little bit painful
After-effect  Swelling and hematoma
 Petechie
 Itching
 Ice-pack 15mins after Rx
Machine checking Select appropriate dosage
Turn on machine and test with our hands
Dosage Heel pain Epicondylitis Tendinitis
Frequency 10Hz 2Hz 4Hz
Energy level 0.23mj/ 0.09mj/mm2 0.17mj/mm2
mm2
Pulse 2000 2000 2000