EPT Flashcards
Electrical stimulation CI
Bleeding disorder:
* Haemorrhagic conditions
Chance of aggravating a disease:
* Active deep vein thrombosis or thrombophlebitis
* Local malignancy
* Local infection
* Tuberculosis locally
Chance of disrupting implants:
* electronic device implant
Special body part:
* Anterior neck or carotid sinus
* Head
* NMES: no chest/intercostal
Special body condition:
* Locally recently radiated tissue
* Abdomen or low back during pregnancy (NMES is CI anywhere on the body)
Thermal CI
Bleeding disorder:
* Haemorrhagic conditions
Chance of aggravating a disease:
* Active deep vein thrombosis or thrombophlebitis
* Local malignancy (cold is safe)
* Local infection (cold is safe)
* Tuberculosis locally
Special body condition:
* Locally recently radiated tissue (cold is safe)
* Abdomen or low back during pregnancy (cold is safe)
Sensation/Cognitive:
* Impaired cognition or communication
* Areas where sensation is impaired
Non-thermal CI
*Haemorrhagic conditions
*Local malignancy
*Locally recently radiated tissue (laser is safe)
*Abdomen or low back during pregnancy
*Eyes
Skin Testing
Electrical stimulation:
Sharp & dull
Thermal:
Hot & Cold
Non-thermal:
None
US Precaution
Over metal implant
NMES specific contraindication
- Pregnant women (anywhere)
- Impaired circulation
- Unstable due to recent surgery, bone fracture, or osteoporosis
- Chest/ intercostal muscles of the lower abdomen
TENS Conventional dosage
Acute/Chronic: Acute
Desired outcome: Sensory
Freq.: 80-150 Hz
PD: 60μs
Time: 20 min-3 hrs
Intensity: Strong comfortable tingling
Placement: site of pain/dermatone
Analgesic: Rapid onset & offset
Mechanism: Segmental (pain gate)
TENS Acupuncture-like dosage
Acute/Chronic: Chronic
Desired outcome: Motor
Freq.: 1-10Hz
PD: 200 μs
Time: 30-60 mins
Intensity: Strong & comfortable twitch
Placement: site of pain/motor point
Analgesic: Onset~30min, Offset~4-6 hr
Mechanism: Segmental and extra segmental (opioid release)
NMES for Muscle Strength
Freq.: 35-65Hz
PD: 300us
Time: 12-15 contraction
Intensity:Strong and comfortable muscle contraction
On: off time:
➢ Grade 5 - do not need to use NMES
➢ Grade 4 - 1:2
➢ Grade 3 - 1:3
➢ Grade 2 - 1:4
➢ Grade 1 - 1:5
NMES for Pain/Edema
Pain: Same as TENS setting
Edema: 5-20 Hz-intensity to muscle twitch
NMES for spasticity
Freq.: 35-100Hz
PD: 200-300us
Time: 20 min
Intensity: Strong and comfortable muscle contraction (muscle tetany)
On: off time: 1:1
FES applicable condition:
For UMNL patient/decondition MSK:
stroke, MS, SCI, CP, PD, TBI
Not for LMNL patients/fixed contracture:
peripheral nerve lesions, motor neuron disease, GBS, polio and post-polio syndrome
IFC Dosage for Acute/Chronic pain/Muscle stimulation/Edema
**no PD–>continous biphasic waveform with no on/off time
Acute/Chronic pain: same as TENS
Muscle Stim/Edema: same as NMES
High Voltage Pulsed Current Edema/Wound
Pulsed Monophasic waveform
▪ Frequency: 80-150 Hz
▪ Pulse duration: 200μs fixed by machine
**Long interpulse interval (800μs)–>time for electric charge to dissipate
▪ Time: 30-90 mins
▪ Intensity: strong but comfortable tingle (sub-motor)
Wound:
one electrode in wound and another 10-20 cm away
Edema:
Cathode over edema, anode 10-20cm away
Heat therapy Points to note
Hydrocollator Packs:
- Machine: 70-80 deg to kill microbes
- Check skin after 5 min (max temp at 8 min)
Wax:
- Check-in with Pt after 5 min
Contrast Bath Indication
Indication:
- repetitive strain-type injuries
- muscle recovery from exercise
- arthritis
Do not use with lymphedema/during acute injury/inflammation
Contrast Bath Application
Hot bath: 38-43 deg
Cold bath: 10-20 deg
Hot : Cold = 4:1
- Start with less contrast
- Always start in hot (min: 1 min, average: 3 min)
End with cold bath: mild inflammation
End with hot bath:
- Arthritis
- For muscle relaxation
- FU with massage Rx
Ice pack application
- Check for cold urticaria after 1 & 5 mins
- Protect boy prominences/superficial nerve with towel
Ice massage
Duration: up to patient report numbness/pain reduction
Normal sequence of sensation: cold–>burning–>aching–>numbness
US Parameter
Frequency:
- 1MHz (deep)
- 3 MHz (superficial)
Duty cycle:
- acute= 25%
- subacute= 50%
- chronic= continuous
Time: 5-10 (per Rx area= 2x the size of the transducer head)
Intensity:
- Acute= 0.1-0.5 W/cm2
- Subacute= 0.5-0.8 W/cm2
- Chronic= 1.0-2.5 W/cm2
Laser Therapy
Depth:
- Red-near infrared = 1-5mm
- near-mid infrared = 5-10mm
Intensity:
Acute = 2J/per point or 2J/cm2
Chronic = 4J/per point or 4J/cm2
Frequency:
Acute: <1000Hz (<1kHz)
Chronic: >1000Hz (>1kHz)
Continuous or pulsed (laser lasts longer):
Continuous can deliver more energy (J) vs pulsed in same duration of treatment
Safety
- sign must be on door
- protective eyewear worn by patient and physiotherapist
Ultraviolet
From longest to shortest wavelength:
o UVA – management of dermatoses
o UVB – management of dermatoses
o UVC – management of infected wound
