General

procedures

1) Consent + positioning (+ pain scale)

2) Observe
- open wound, skin lesion, infection, rashes

3) Contraindications
- cardiovascular diseases
- metabolic diseases
- acute skin conditions
- metal implants/cardiac pacemaker/(deep brain stimulator)
- cancer/deep X-ray therapy 6/12
- active TB/DVT/osteomyelitis
- (Pregnancy)

4) Collect materials

5) Skin sensation test

6) Check machines

7) Warnings
- don’t move, don’t fall asleep, don’t touch the machine
- (expected feelings)
- do you understand, any questions?
- any discomfort, let me know

8) Set parameters

9) Start treatment

10) Termination
- any discomfort (?)
- observe skin condition – no excess erythema

11) Documentation

(1) SDC

1) Consent + positioning

2) Observe

3) Contraindications

4) Collect materials
- Machine
- Pad & probe electrode + wrapping strip
- Water bowl w water + sponges + soap + mackintosh
- Sharp/blunt

5) Skin sensation test
- Sharp/blunt

6) Check machines

7) Warnings
- Expected feeling: tingling -> pin-prick -> mm contraction (mild) -> not too painful

8) Set parameters
- Rectangular pulse
- PD: 300 ms -> 200 -> 100 -> 10 -> 1 -> 0.1 -> 0.01
- IPI: 700 ms
** Cathode-anode setting: black (inactive, +ve) -> pad
- Intensity: minimal observable contraction

9) Start treatment
- Clean the skin w soap
- Apply pad electrode (earth, +ve)
- Apply probe electrode (motor point, -ve)
- ¯ PD & ­ intensity to look for minimal contraction
- Record the intensity with respect to PD

10) Termination

11) Documentation
** Chronaxie (PD > 10 ms; i.e. abnormal)

(2) IDC

1) Consent + positioning

2) Observe

3) Contraindications

4) Collect materials
- Machine
- 2 pad electrodes + wrapping strip (probe electrode for unipolar)
- Water bowl w water + sponges + soap + mackintosh
- Sharp/blunt

5) Skin sensation test
- Sharp/blunt

6) Check machines

7) Warnings
- Expected feeling: tingling -> pin-prick -> mm contraction -> not too painful

8) Set parameters
- PD: chronaxie
- IPI: at least 4x chronaxie
- Rx time: 30 contractions x 3 sets (2 mins rest btw sets) / day x 2/52
- Intensity: moderate to strong contraction
(gradually reduce as mm recover -> stop Rx when voluntary contraction can be performed)

9) Start treatment
- Clean the skin w soap
- Apply both pad electrodes on mm
- ­ intensity until moderate contraction

10) Termination

11) Documentation

(3) Microcurrent

1) Consent + positioning + pain scale

2) Observe
- Hearing aids

3) Contraindications
- Metal implant is NOT a contraindication (but electronic demand-type cardiac pacemaker is)
- Epilepsy (transcerebral stimulation)
- Cardiac problems (transthoracic stimulation)
- Areas with tendency to haemorrhage

4) Collect materials
- Machine
- Probe electrode + Q-tip stick / Plate electrode + sponges
- Soap + water

5) Skin sensation test (NO)

6) Check machines
- Put probe electrodes together -> short-circuit -> meter will be on

7) Warnings
- Expected feeling: no sensation

8) Set parameters
- Wash the Rx area w soap and water
- Break the Q-tip stick into 2 halves + wet them
- Insert them into probes

Pain Healing
Intensity 200-600 μA 10-100 μA
Frequency > 30 Hz 0.3-10 Hz
Ramp time Sharp Gentle (lower)
Treatment Probe (each point: 10-60 s)
time Pad: like TENS (30-60 mins)


9) Start treatment
Probe method (point stimulation)
1. Search and treat (high conductance points, acupuncture points, trigger points, ah-shi points,
or inflammatory area)
- Press ‘start’ and on the ‘testing mode’
- Inactive probe: muscle
- Active probe: find the points w low skin resistance (2 electrodes close) (if inflammation =
high skin resistance)
- Mark the point for later use
- Then 10-60 s for one point

2. GTO technique (whole mm with scar)
- 2 electrodes on center
- 1 electrode to origin, 1 electrode to insertion
- Go to other lines until finish

3. Swirl the dragon (localized scar)
- Locate the painful area
- Move the 2 probes around the circumference of the area slowly

4. Enhancement of tissue repair (ETR) technique ‘Sandwich and squeeze’ (pain on entire mm)
- Probes on medial and lateral sides of the muscle / tendon
- After finish, move 1 inch until whole length of mm

Rubber electrode method (like TENS but lower current density & longer time)
- Place the pad electrodes into sponges
- Place on the painful area

Sterile electrode pack method (lower current density & longer time)
- Wash hands and wear sterile gloves
- Treat open wound with sterile disposable electrodes

10) Termination
- Re-ask pain scale

11) Documentation

(4) PEMF

1) Consent + positioning + pain scale

2) Observe
- Hearing aids

3) Contraindications

4) Collect materials
- Machine
- Applicator (blanket, rigid & semi-rigid, solenoid, linear, and disc applicators)
- Magnet

5) Skin sensation test (NO)

6) Check machines
- Magnet -> let Px feel the vibration

7) Warnings
- Expected feeling: no sensation

8) Set parameters
Acute Chronic
Frequency < 10 Hz ≥ 10 Hz
Intensity < 50 G ≥ 50 G
Time 10-15 mins 20-30 mins

9) Start treatment
- Support the Rx part w pillow
- if shoulder: using 3 towels
- if back: do like in SWD
- Place Rx part inside the applicator

10) Termination
- Re-ask pain scale

11) Documentation

(5) EMG biofeedback (muscle re-education)

1) Consent + positioning

2) Observe

3) Contraindications
- Epilepsy

4) Collect materials
- Machine
- Gel + micropore
- Alcohol swabs
- Sand paper
- (mirror for facial mm)

5) Skin sensation test (NO)

6) Check machines

7) Warnings
- Expected feeling: no sensation
- Contract mm until ‘beep’ sound is heard and hold for 5 s, then rest for 5 s

8) Set parameters
- Volume of sound
- Work time: 5 s
- Off time: 5 s
- Number of trials: 20
- Feedback: above (re-education); below (spasticity)
- Filter noise

9) Start treatment
- Clean the skin w alcohol swab and rub w sand paper
- Clean the electrodes w alcohol swab
- Add gel on electrodes
- Ground electrode: bony prominence
- Active electrode: parallel to mm
- [set] Voluntary mm contraction for 3 s -> for threshold

10) Termination

11) Documentation
(6) NMES (Bell’s palsy)

1) Consent + positioning

2) Observe

3) Contraindications
- Epilepsy
- Metal implant: metal denture / false teeth

4) Collect materials
- Machine
- Gel + micropore
- Alcohol swabs
- Mirror
- Sharp/blunt

5) Skin sensation test
- Sharp/blunt

6) Check machines

7) Warnings
- Expected feeling: tingling -> mm contraction (mild) -> not too painful

8) Set parameters
- Waveform: monophasic (DC)
- PD: 86 μs
- Frequency: 1.4 Hz
- On/off time: 6s/6s
- Intensity: sub-motor (tetanic contraction)
- Rx time: 30 mins/day for 2/52

9) Start treatment
- Clean the face and electrodes w alcohol swab
- Add gel on electrodes
- Inactive electrode: stylomastoid foramen
- Active electrode: 1 out of 3 braches of facial nerve
- ­ intensity until little/mild mm contraction

10) Termination

11) Documentation
(7) FES (shoulder subluxation)

1) Consent + positioning

2) Observe

3) Contraindications
- Epilepsy

4) Collect materials
- Machine
- Gel + micropore
- Alcohol swabs
- Sharp/blunt

5) Skin sensation test
- Sharp/blunt

6) Check machines

7) Warnings
- Expected feeling: tingling -> mm contraction (strong) -> not too painful

8) Set parameters
- Waveform: AC
- PD: 100 μs
- Frequency: 20 Hz
- On/off time: 1:3 (5s/15s)
- Intensity: Strong contraction for shoulder joint re-alignment
- Rx time: 30 mins (up to 8 hr) /day for 6/52

9) Start treatment
- Clean the Rx part and electrodes w alcohol swab
- Add gel on electrodes
- Active electrodes: posterior deltoid & supraspinatus
- ­ intensity until strong mm contraction

10) Termination

11) Documentation

(8) FES (spasticity) – apply on agonist / antagonist / both mm

1) Consent + positioning

2) Observe

3) Contraindications
- Epilepsy

4) Collect materials
- Machine
- Gel + micropore
- Alcohol swabs
- Sharp/blunt

5) Skin sensation test
- Sharp/blunt

6) Check machines

7) Warnings
- Expected feeling: tingling -> mm contraction (strong) -> not too painful

8) Set parameters
- Waveform: AC
- PD: 0.5 ms
- Frequency: 20 Hz
- On/off time: 1:1 (3s/3s)
- Intensity: Strong contraction
- Rx time: 20 mins for 5 days/week for 5/52

** If reciprocal: intensity -> minimal contraction only

9) Start treatment
- Clean the Rx part and electrodes w alcohol swab
- Add gel on electrodes
- Active electrodes: agonist / antagonist mm
- ­ intensity until strong mm contraction

10) Termination

11) Documentation

(9) FES (foot drop)

1) Consent + positioning

2) Observe

3) Contraindications
- Epilepsy

4) Collect materials
- Machine w electrodes
- Alcohol swabs
- Sharp/blunt

5) Skin sensation test
- Sharp/blunt

6) Check machines

7) Warnings
- Expected feeling: tingling -> mm contraction (strong) -> not too painful

8) Set parameters
- Waveform: AC
- PD: 0.3 ms
- Frequency: < 50 Hz
- On/off time: 1:2
- Intensity: Low
- Rx time: 30 mins for 2/52
- Ground electrode: heel (H/T -> H)
- Delay: D1 (activation), D2 (stop): 5%

9) Start treatment
- Clean the Rx part and electrodes w alcohol swab
- Add gel on electrodes
- Ground electrode: on heel
- Indifferent electrode: fibular head (+ve red)
- Active electrode: tibialis anterior (-ve black)
- ­ intensity until strong mm contraction

10) Termination

11) Documentation
(10) Shockwave

1) Consent + positioning + pain scale

2) Observe

3) Contraindications
- Epilepsy
- Blood coagulation therapy
- metal implant is NOT a contraindication

4) Collect materials
- Machine
- Gel pad & gel
- Sharp/blunt
- Tissue

5) Skin sensation test
- Sharp/blunt

6) Check machines (turn on -> have sounds ‘tat tat tat’)

7) Warnings
- Will feel some pain -> should be maximally tolerable -> if can’t tolerate, let me know

8) Set parameters
- Frequency: 1-4 Hz (higher for pain)
- Number of shocks: 2000 shocks
- Intensity: cell repair & regeneration: 0.08; pain: up to 0.28; bone healing: > 0.6 mJ/mm2

9) Start treatment
- Place firm on the Rx area and start

10) Termination
- Re-ask pain scale
- If pain: ice pack for 15-20 mins
- Advice: do for 3-5 times/week

11) Documentation

(11) Laser

1) Consent + positioning + (pain scale)

2) Observe
- infected tissues & open wounds, any haemorrhage

3) Contraindications
- Post-steroid injection area
- Immunosuppressive drugs (for eczema, psoriasis)

4) Collect materials
- Machine + single/cluster probe
- 2 goggles
- Stop watch
- Alcohol swabs
- Warning signs
- (Sterile dressings / dressing set)
- (Semi-transparent for gridding method)

5) Skin sensation test (NO)

6) Check machines (laser beam test)

7) Warnings
- Expected feeling: no sensation
- Don’t look at the laser beam

8) Set parameters
- Probe: single / cluster
- Techniques: spotting / gridding / scanning
- Wavelength: short (superficial) / long (deep)
- Pulse frequency: low (acute + wound) / high – continuous (chronic / infected wound)

9) Start treatment
- Treating a wound:
1st phase -> wound margin (4 J/cm2), spotting 1 cm from edge & 2 cm btw each spot
2nd phase -> wound bed (1.5 J/cm2), scanning
- TMJ pain: spotting (8 J/cm2)
- Pain relief: Achilles tendinitis, LBP: spotting (16 J/cm2)
- Calculate the time: E/P = t
-> Clean the probe w alcohol swab -> set the timer -> start the machine

10) Termination
- Turn off the machine first and then remove the probe
- Observe the wound
- (Re-ask pain scale)
- Clean the probe w alcohol swab

11) Documentation

(12) UV (skin test)

1) Consent + positioning

2) Observe
- infected tissues & open wounds, any haemorrhage

3) Contraindications
- Photo-sensitive drugs / photoallergy
- (Recent skin graft)

4) Collect materials
- Machine + ruler
- 2 googles
- Scissors & 2 black paper + micropores
- Towel

5) Skin sensation test (NO)

6) Check machines (turn on -> purple colour light)

7) Warnings
- Expected feeling: no sensation
- Don’t look into the machine and irradiation area

8) Set parameters
- Scissors: cut the black paper (triangle: 10 s; circle; 20 s; rhombus: 30 s)
- Cover other parts w towels
- Expose one hole (black paper) first, then 2 holes, 3 holes, every 10 s)

9) Start treatment
- Use ruler to measure the distance (4 cm)
- Set 30 s and start until all holes are irradiated

10) Termination
- Ask Px to check if any redness every hour -> record the skin colour changes

11) Documentation
- UV skin test on [Rx area] using Kernel UVB lamp at 4cm
- Suggested E1 = (?)s
- E1 for Px is (?)s (will be assessed in the 2nd session)

(13) UV (treatment)

1) Consent + positioning

2) Observe
- infected tissues & open wounds, any haemorrhage

3) Contraindications
- Photo-sensitive drugs / photoallergy
- (Recent skin graft)

4) Collect materials
- Machine + ruler
- 2 googles
- Scissors & 2 black paper + micropores
- Towel
- Vaseline & spatula

5) Skin sensation test (NO)

6) Check machines (turn on -> purple colour light)

7) Warnings
- Expected feeling: no sensation
- Don’t look into the machine and irradiation area

8) Set parameters

9) Start treatment
- Cover other parts w towels and expose the wound
- Put the machine over the wound by 4 cm (measured by ruler)
- Irradiate the whole wound & peri-wound areas (E1)
- Apply vaseline to wound edge ONLY
- Cut a hole on a paper towel matching the wound shape -> put it onto the wound
- Apply UVR to granulation tissues (E2)
- Cut another paper towel covering the granulation tissues
- Apply UVR to the slough tissues (E3)
- Cut another paper towel covering the slough tissues
- Apply UVR to eschar (E4)

10) Termination

11) Documentation