Contraindications for IFT

Question 1

• Active implants eg pacemaker

Answer 1

o global
o current delivered by the IFT machine could interfere with the pacemaker
o literature isn’t v clear on this and some pacemakers can block interference from external electronic devices but think about risk/ benefit of treatment for someone with a pacemaker

Question 2

• Pregnancy

Answer 2

o Local contra
o IFT to abdomen/ lower back/ pelvis risks creating unwanted uterine contractions and stimulating labour in the last trimester or miscarriage in the first trimester
o Direct effects on foetal development aren’t clear but because of potentially devastating consequences best to err on side of caution

Question 3

• Malignancy

Answer 3

o Local contra
o blood flow may help spread cancer. But we could be critical and say cancerous tissues thrive in acidic environments. This machine can increase blood circulation, which could increase nutrients and lower acidity… no consensus in this area
o analgesic effects may mask pain and early signs of metastatic disease
o research evidence is low – studies in animal models are unclear about whether electrical stimulation would promote tumour growth
o in someone with early stage or possible malignancy may want to think about risk/ benefit of treatment
o in people with late stage may help ameliorate pain and improve strength for the use of walking aids

Question 4

• Active epiphysis

Answer 4

o Precaution
o Persons under 21
o Can lead to pain
o Unsure if will affect bone growth

Question 5

• Metal implant

Answer 5

o Precaution – suggested risk of burn
o Buuut persons with joint replacements that include metal components have been treated with E-stim with benefit and without adverse reactions
o Resources generally agree that the conduction of electrical current is not likely to be affected by most metal components, including surgical implants of the type used in joint-replacement surgery

Question 6

• Local circulatory insufficiency

Answer 6

o Local contra
o Increasing cellular activity increases metabolic demand; in cases of severely compromised circulation, the demand may exceed oxygen supply, resulting in increased pain
o Deficiency in circulation is associated with skin deterioration and oedema. Applying electrodes over compromised skin may cause skin breakdown, which is difficult to heal and can potentially lead to chronic wounds

Question 7

• Devitalised tissue

Answer 7

o Local
o You need patient to be able to give you feedback about sensation – they may not be able to do this. Too high currents can lead to burns
o Analgesic effects require intact afferent nerves
o We do sensory feedback test to minimise risk

Question 8

• Anticoagulant medications

Answer 8

o Diminish patient’s ability to create blood clots
o E-stim stimulates regional blood flow and reduces platelet aggregation. These effects could exacerbate bleeding when haemostasis has not been established
o Buuuut some electrical stimulation techniques have been used to decrease pain and improve muscle strength, without increased bleeding, in people with haemophilia

Question 9

• Epilepsy

Answer 9

o was a global contra a few years ago
o Now based on research it’s just local to neck and head area
o Treating it as a global contra could be an abundance of caution if you know that you have a patient with active epileptic fits

Question 10

• Infections

Answer 10

o Local contra
o Don’t want to spread them – seen in labs that bacteria are readily transferred through inadequately cleaned sponges
o However, IFT increases blood flow so could help people with impaired circulation fight infection

Question 11

• Tissue bleeding

Answer 11

o Local
o Stimulates regional blood flow, causes release of inflammatory mediators and reduces platelet plug formation
o these effects could exacerbate bleeding when haemostasis has not been established

Question 12

• Cardiac issues

Answer 12

o Local contra
o Use over the anterior chest area may cause heart arrhythmias or fibrillation
o Stimulation of intercostal muscles may interfere with breathing
o Electrical current should only be applied to the anterior chest area with great caution
o However, lower-extremity E-stim appears to be safe in patients with cardiac failure

Question 13

• Reproductive organs

Answer 13

o Local contra
o Risks for gamete production aren’t known
o Has been used in some specialised circumstances eg on pelvic floor to treat incontinence but this requires special training and otherwise should be avoided

Question 14

• Eyes

Answer 14

o Local contra
o risks of treating eyes are not known
o no known clinical indication that requires eye stimulation

Question 15

• Anterior neck

Answer 15

o Local contra
o Stimulation in this area may reflexively stimulate the vagus or phrenic nerves, which may induce a rapid fall in blood pressure, causing the patient to faint. Stimulation may also cause laryngeal spasm. Resources generally recommend that this body region should be avoided
o However, actual evidence for this is low