Introduction to electro therapy

Year 2 Semester 1

What is electro therapy ?

Electrotherapy can be defined as the treatment of patients by electrical means . Electrical forces are applied to the body to bring physiological changes for therapeutic purposes.

LOW FREQUENCY CURRENT

MEDIUM FREQUENCY CURRENT

HIGH FREQUENCY CURRENTS

ELECTROTHERAPY

PHOTOTHERAPY

ELECTRO DIAGNOSIS

BIOFEED BACK

Low frequency currents( TENS NMES) Medium frequency currents (IFT) High frequency currents (SWD) Infra Red Radiation therapy (IRR) Laser therapy Superficial heating modalities Ultra sound therapy Cryotherapy Ultra Violet Radiation (UVR) Biofeedback (EMG)

Diagnostic electrotherapy
Strength duration curve (SD Curve) Rheobase and chronaxie Nerve conduction test (NCV) Electromyography (EMG)

Thermotherapy
Short wave diathermy Micro wave diathermy Paraffin wax therapy Hydrocollator packs

Short wave diathermy

Wax bath & hydrocollator pack

ELECTROTHERAPY
Faradic current stimulation Alternating current stimulation Pulsed direct current stimulation

currents
Alternating Sinusoidal current - interferential therapy - Russian stimulation - TENS Diadynamic currents Faradic type current (0.3 ms pulse) Galvanic current is interrupted direct current

Electrical stimulation

Interferential therapy

Sound waves

Ultra sound

Cryotherapy
Ice bags Ice massage Ice packs

Cryotherapy & CPM

Photo therapy
Laser therapy Ultra violet rays

Electro magnetic waves

Infra red rays

High frequency current wound healing

pharmacotherapy
Iontophoresis Phonophoresis

mechanotherapy
Spinal traction Continuous passive motion movement devices Intermittent pneumatic compression devices

Lumbar Traction

Cervical traction

CPM

Electrotherapy

Physical Principles
Electricity displays magnetic, chemical, mechanical, and thermal effects on tissue
Volume of current (ampere) Rate of flow of 1 amp = 1 coulomb Resistance = ohms Force that current moves along = voltage

Electricity is applied to nerve tissue at certain intensities and duration to reach tissue excitability thresholds resulting in membrane depolarization
Target sensory, motor, and pain nerve fibers in an effort to produce specific physiological effects

CURRENT ?
Current - Flow of electrons (electric charge) - flow of ions Frequency - number of occurrence of any event per unit time

Current & safety

Hazards
ELECTRICAL SHOCK Large amount of current is passed through the body Sudden flow of current Caessation or stopping of current Variation of the current

Hazard

Hazard

Check if main switch Is off

Hazard

Causes
Poorly designed machines Improper insulation equipment, wires Badly serviced machines Mishandling of machines Improper guidance to patients Lack of safety measures

Hazards
Due

to main current type

(Ohms law) Lower resistance greater amount current Current passes through the low resistance tissues, wet skin.( Exposed part touched with wet hands ) Damage depends on contact with the current finger or head Type of current (alternating)

Hazards.. contd
Voltage of 240 V can cause ventricular fibrillation in heart muscle and can cause death Current -10mA causes discomfort Above 10 50mA cause painful muscle contraction Electric shock

Electric shock
amount of injury to the body is directly proportional to the duration of exposure. tissue breakdown occurs with longer exposure, which allows internal current flow. Heat is produced by current flow through tissues, causing:

severe burns protein coagulation the proteins in the cells clump together, destroying the function of the cells vascular thrombosis clotting of blood Tissue necrosis

Effects of the major shock

Fall in BP Unconsciousness Breathing stops Ventricular fibrillation Cardiac arrest

Hazards
Damage

due to therapeutic currents and other modalities

Pain Induce anxiety and fear Fainting spell Psychological shock due to poor comprehension burns

Damage .contd
Scalding Head ache Fall in BP

Minor electric shock

Reasons
Concentration of current Accommodation of current Over dose Damage to equipment

Safety Features
1.

2.
3. 4. 5.

Take responsibility Maintenance of equipments Maintenance contracts and Planned replacement Environment Safe application

1. Take responsibility
Physiotherapist has a duty of care to the patients and our own self and should confine to scope of practice Update knowledge Put up signages Provide relevant information to patients when using or giving equipments on loan Protect your self from exposure

Take responsibility2
Documentation is essential All interactions are documented and signed

Assessment Indication Results of skin sensation tests Modality and machine used Time setting Treatment parameters Outcomes - Effects beneficial and adverse

Take responsibility..3
Documentation is essential drugs taken by patients comprehension by patients proper information to patients Reaction after therapy session

2. Maintenance of equipments

Decide on our purchase Check credentials of the supplier Read instruction manuals carefully Ask for performance and safety check New machines come with a warranty Servicing of machines is very important Service contracts are available (stickers) Check if the machine needs a license Check if machine requires calibration All machines come with a life span

3. Environment1

Report faults immediately Near objects that can concentrate currents Post signage or people with pace makers and hearing aids Using hand phones Stacking of equipments Repair by unqualified personnel Know the hazards your self Use tester to check for leakage

Environment2
Do not allow patients to touch machines when treatment is on When using bath or under water treatment extra care should be taken to check earthing Insulation over the cables Store machines not near water or radiator pipes Antenna of micro wave machine should face the wall

Environment3
Place Interferential therapy and ultra sound machines 3 metres away from short wave diathermy machines Treatment couches and chairs for SWD and Micro wave diathermy treatment be made of wood or plastic No metal within the line of high frequency currents

4. Safe application1
Precautions to be taken when using electrical equipments a visual check before starting treatment

Plugs, cables, leads, electrodes, controls, dials, indicator light and output

A three pin supply plug One plug point for 1 machine No using of adaptors Long wire to reach the plug. Avoid usage of extension cords Voltage stabilizer if required

Safe application2
Never pull the plug by pulling n the wire Do not drag machines with the arms Be careful when handling ultra sound machines wire Worn out cords, broken plugs, faulty sockets Check if any leakage of current Checks at intervals for loose connections

Safe application3
all machines should be unplugged at end of the day check power controls and other monitoring devices before using patient for a patient if there is water leaking into the machine it should be serviced before using

Equipments on loan
Ensure equipments are in working condition Correct written instructions must be given Contact person and number in case problem is encountered Records must be kept

What can you do ?

arrangement of machines flooring with linonium Insulation Ensure patient does not touch machines Metal casing of machines is earthed Dry floor Water at a distance

What can you do for patient ?

Switch off machine Disconnect from source of supply (How ?) Reassurance and rest Water cold (no hot drinks) Loosen clothing and allow fresh air Artificial respiration CPR Oxygen therapy CALL FOR CODE BLUE

This knowledge will be of use to you when you are a professional even though now it may feel not important