Chapter 10. Application Procedures: Electrotherapy
Use of Electrical Current Stimulation for Pain Relief
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TENS
–Transcutaneous:
–Electrical
–Nerve:
–Stimulation:
•Stimulate sensory nerves with _________________ current via surface electrodes
TENS: Physiological Aspects
•Electrode placement
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•Clinician can change the patient’s perception of __________ and ______________ pain.
•Selective depolarization of ________________ nerves
How Does TENS Work?
•Sensory TENS
•Tx for __________ __________
•Stimulate ____________ _________________ nerves
•
•Frequency: _______ - _______ pps
•Motor TENS
•Tx for __________ __________
•Stimulate ____________ _________________ nerves
•Elicit slight ______________ ______________
•
•Frequency: _______ - _______ pps
•Brief-intense TENS
•Tx for __________ __________
•Stimulate ____________ _________________
•Elicit slight ______________ ______________
•
•Frequency:
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Brief Research Findings on TENS
•Research is difficult.
•TENS has relieved pain associated with
–Osteoarthritis
–Rheumatoid arthritis
–Dysmenorrhea
–Low back pain
•Postoperative TENS
TENS: Application Procedures
Step 1. Foundation:
A. Definition
1. Decreasing pain by stimulating ___________________ nerves
B. Effects
1. Afferent nerve stimulation
2. Pain relief
3. Some motor nerve stimulation at higher amplitudes
C. Advantages
1. Portable
a. Can be used during activity
2. Self-treatment
3. Alternative to cold during cryokinetics
D. Disadvantages
1. Eliminates pain; not_____________ of pain
2. May mask more serious problems
3. We don't know enough about it yet
4. May become a “cure-all”
E. Indications
1.
2.
3.
F. Contraindications
1. Do not use on person with:
a. An implanted pacemaker
b. History of heart disease
2. Do not treat transthoracic area
3. Discontinue use if a skin irritation develops
G. Precautions
1. Treatment over an area with:
a. Impaired sensation
b. Skin lesions (cuts, abrasions, new skin, recent scar tissue)
2. While driving or operating heavy machinery
3. Temporary decrease in pain does not mean cause of pain has gone.
4. Delicate unit, not a cheap radio
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Step 2. Preapplication Tasks: TENS
A. Make sure TENS is the proper modality.
1. Reevaluate injury/problem.
2. If applied previously, review patient response to previous treatment.
3. Is therapy compatible with TENS?
4. Make sure it is not contraindicated
B. Preparing the patient psychologically
1. Explain procedure
a. Describe sensation:
b. Electricity will _________ cause muscle contraction.
c. Only small amount of current will be used.
d. Cannot be electrocuted.
e. Should not be ___________
2. Demonstrate procedure on yourself.
3. Check for and warn about precautions
C. Preparing the patient physically
1. Remove clothing from electrode contact area
a.
2. Place patient in comfortable position.
D. Preparing the equipment
1. Output should be at _______________ setting.
2. Prepare electrodes
a. Attach electrodes to _______ and _______ to TENS.
b. Apply a conducting medium, if non-self-adhering _________________
3. Check equipment and electrodes.
4. Check connecting cords.
5. Electrode placement
a. Directly over the _______
b. Proximal or distal to pain
c. _________________ over pain (two-channel unit)
d. Over ___________ point
e. Dermatome placement
6. Firmly attach electrodes to athlete’s skin
a.
7. Good contact essential; sometimes hard to achieve
a. Tape to skin and/or wrap with an elastic wrap
Step 3. Application Parameters: TENS
A. Begin stimulation
1. Select pulse width and rate as per manufacturer’s recommendation.
2. Turn unit on.
3. Tell the athlete you are beginning.
4. Slowly increase _________ ______________
a. Ask athlete to tell you when he begins to feel pins and needles.
b. Increase current until it feels most comfortable.
c. Should be no muscular contraction. (exception:
3
)
5. Adjust pulse width and rate
a. Go through entire range and select most comfortable settings.
b. Specific settings for specific conditions.
i. Acute pain: ________________ pulse width (75 µsec) and high
pulse rate (____–____ pps)
a) Pain relief is almost immediate
b) Short lasting pain relief (____–____ min)
ii. Chronic pain: _______________ pulse width (200 µsec) and
low pulse rate (____–____ pps)
a) Pain relief may take ½ hr
b) Long lasting pain relief (____–____ hr)
B. Dosage
1. Maximal current that is comfortable
2. May need to increase ever____ min as the body_____________ to the stimulus.
C. Length of application
1. Extremely variable
2. Some treat for ____–____ min, others for __________
D. Frequency of application
1._____ or ____ times a day as needed for pain
E. Duration of therapy
1. Use until TENS is no longer effective.
Step 4. Postapplication Tasks: TENS
A. Remove equipment
1.
2. Return all controls to _____ or minimum setting.
3. Remove and clean electrodes.
4. Place electrodes and TENS unit in proper place.
B. Instructions to athlete
1.
2. Instruct athlete concerning level of activity and/or self-treatment
C. Record treatment and patient response to treatment.
Step 5. Maintenance: TENS
A. Electrodes
1. Must be kept clean.
2. Make sure wire is firmly attached to electrode.
Interferential Current (IFC)
•Interference of two separate medium-frequency sinusoidal currents on one another
•Symmetrical, sinusoidal, medium frequency AC
•Two channels with different frequencies, used simultaneously
•Two currents cause a ____________ _________________ ___________________ modulation
•Basic principle
–Decrease tissue impedance (resistance) so simulation is less painful
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Why Use IFC Therapy?
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What Is IFC Therapy?
•Four electrodes in a crisscross pattern
–Two electrodes from one channel
–Two electrodes from another
–Where two currents cross or interfere is called a vector.
o Static Vector
 Does _________ move
 Used for ________________ pain
 Target tissue located where two channels crisscross
o Dynamic Vector
 ________ throughout the treatment field between the 4 _______________
 Used for ____________________________ pain
 Indicated on units as ___________ or _____________
Is IFC Therapy Effective?
•Differing opinions on effectiveness
•Lack of clinical research
•Those who have had success
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IFC: Clinical Applications
Step 1. Foundation: IFC
A. Effects
1. Pain relief
2. Some motor nerve stimulation at higher amplitudes
3. Muscle spasm reduction
B. Advantages
1. More comfortable than a TENS
a. Medium-frequency currents meet with ______ skin resistance than low
frequency currents.
i. TENS uses low frequency currents
2. Stimulates tissues __________ than a TENS unit
3. _______________ coverage area than TENS
D. Disadvantages
1. Temporarily eliminates pain; doesn't deal with ___________ of the pain
2. May mask more serious problems
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3. Few portable units available
4. Sometimes becomes a “Cure-all”
E. Indications
1.
2.
3.
4.
F. Contraindications
1. Do not use on a person who has:
a. Implanted pacemaker
b. History of heart disease
2. Do not treat transthoracic area
3. Discontinue if skin irritation develops
G. Precautions
1. Be cautious when using IFC over:
a. Impaired sensation
b. Skin lesions (cuts, abrasions, new skin, recent scar tissue, etc.)
2. Use caution when using IFC while driving or operating heavy machinery.
3. A temporary decrease in pain does not mean the cause of the pain has gone.
Step 2. Preapplication Tasks: IFC
A. Preparing the patient physically
1. Remove clothing, tape, etc. from the electrode contact area.
2. Place the patient in a comfortable position, usually sitting or lying.
B. Preparing the equipment
1. Make sure output is at the minimal setting.
2. Prepare electrodes.
a. Attach four electrodes to _______ and _______ to machine.
b. Apply a conducting medium (if necessary
C. Preparing the patient psychologically
1. Explain procedure.
a. Describe sensation:
b. Muscle will _______ contract, just stimulate the sensory nerves.
c. Small amount of current will be used.
d. Cannot cause electrocution.
e. Should not be painful.
2. Demonstrate procedure on yourself.
3. Check for and warn about precautions.
4. Check equipment and electrodes.
a. ___________________ electrodes
b. Check connecting cords.
5. Find out where the patient’s pain is.
a. Make a small mark.
b. Bracket the pain with the electrodes. (Clock analogy)
6. Firmly attach electrodes to athlete’s skin
a.
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7. Good contact essential; sometimes hard to achieve
a. Tape to skin and/or wrap with an elastic wrap
Step 3. Application Parameters: IFC
A. Procedures (pain relief)
1. Turn unit on.
2. Tell the patient you are beginning.
3. Slowly increase current intensity
•Have the patient tell you when she begins to feel __________ and
___________________
•Increase the current until it feels most comfortable.
•No muscular contraction
4. Adjust pulse rate settings for specific injury
a. For acute pain
i. Use a high pulse rate of ____–____ pps
ii. Pain relief is almost immediate
iii. Lasts only a few minutes to 1 hr
b. For chronic pain
i. Use a low pulse rate of ____–____ pps
ii. Pain relief may take ____ hr
iii. May last ____–____ hr
5. Target or vector
a. Pain that is easily identifiable and pinpointed
i. Use target or vector buttons to move spot where current
intersects to area directly over pain
b. Pain that is hard to pinpoint
i. Use dynamic vector
B. Dosage
1. Maximal current that is comfortable
2. May need to increase every ____ min as body adapts to stimulus
C. Length of application
1. ____–____ min
D. Frequency of application
1. Once or twice daily, as needed for pain
E. Duration of therapy
1. Use until IFC is no longer effective.
Step 4. Postapplication Tasks: IFC
A. Equipment removal
1. Turn off power.
2. Return all controls to ____ or minimum setting.
3. Remove and clean electrodes.
4. Place electrodes and belts in proper place.
B. Instructions to the patient
1. Arrange next treatment.
2. Instruct patient concerning level of activity and/or self-treatment
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C. Record treatment and patient responses
D. Return generator cart to proper place.
Step 5. Maintenance: IFC
A. Electrodes
1. Must be kept clean.
2. Make sure wire is firmly attached to electrode post.
Nueromuscular Electrical Stimulation (NMES)
•Used for
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History of NMES
•Originally used to increase muscle strength in trained athletes
•Introduced in 1977 by Russian physiologist Yakov Kots
–Up to 30% more force than a voluntary maximal contraction
–Lasting strength gains of up to 40% in healthy athletes
–No sensory discomfort
•1980 companies started manufacturing Russian current
•No North American scientist has been able to duplicate Kots’s claims
–Great amount of pain
Why NMES?
•Used on patients who cannot perform a ____________________ muscle contraction
–Peripheral nerve innervation is intact, yet muscle is too __________ to contract from
atrophy, pain, immobilization, etc.
•Promotes early AROM in postsurgical and immobilized limbs
NMES for Muscle Reeducation/Prevention of Disuse Atrophy
•Treatment goals:
•Reeducate muscle toward normal motion
•Facilitate active exercise
***Don’t Replace Strength Training with NMES***
•NMES recruits fibers in the opposite order than that of a voluntary contraction.
–Machine =
–Voluntary =
•Patient needs to move on to more traditional weight training ASAP.
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NMES for Decreasing Muscle Spasm
•Cause and mechanism of muscle spasm are not clearly defined
•Result from trauma, accumulation of chemical irritants, muscle weakness, and pain
•Pain and discomfort lead to more __________ and a protective ____________ _____________
•As the spasm puts pressure on sensitive nerve endings, more ______ is produced.
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•Goals of the treatment should be to break up the pain–spasm–pain cycle
•10 sec on; 10 sec off
•Want to elicit a _________________ ____________________
•Goals
–Increase
–Remove
–Mechanically stimulate
–Induce some muscle spasm
NMES for Decreasing Edema
•Produce cyclic muscle contractions to help pump chronic edema
–5–10 sec on; 5–10 sec off
NMES: Application Procedures
Step 1. Foundation: NMES
A. Definition
1. Use of electrical current for therapeutic purposes
2. Stimulate _____________ nerves
a. Usually aimed at causing muscles to contract
B. Effects
1. Muscle contraction
a. Increase
b. Retard ____________ development
c. Decrease and retard neuromuscular inhibitions
d. Increase muscle relaxation; decrease ____________
2. Decrease pain
a. Possibly by decreasing ___________ ______________
C. Advantages
1. Can be applied to immobilized body part
D. Disadvantages
1. Sometimes becomes a “cure-all”
E. Indications
1. Residual or chronic muscle spasm
2. Any time normal neuromuscular function is not possible
3. Muscle strains
4. During cast immobilization or disuse atrophy
5. Pain owing to muscle spasm
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F. Contraindications
1. Do not use:
a. On a person with a pacemaker
b. Over the heart or brain
c. Over recent or non-union fractures
d. Over potential malignancies
G. Precautions
1. Be cautious over an area with:
a. Impaired sensation
b. Skin lesions (cuts, abrasions, new skin, recent scar tissue)
c. Decreased range of motion
d. Extensive torn tissue
Step 2. Preapplication Tasks: NMES
A. Make sure NMES is correct modality.
1. Reevaluate injury/problem.
2. If applied previously, review patient response to treatment.
3. Are objectives of therapy compatible with NMES?
4. Select or review current characteristics of machine.
5. Make sure NMES is not contraindicated in this situation.
B. Preparing the patient psychologically
1. Explain procedure
a. Describe sensation:
b. Electricity will cause muscle to ____________
c. Small amount of current will be used.
d. Cannot cause electrocution
e.
C. Preparing the patient physically
1. Remove clothing, tape, etc. from electrode contact area.
a. Do not need to remove from the area between the two contact points.
2. Place patient in comfortable position.
3. Demonstrate procedure on yourself
4. Check for/warn about precautions.
•Inspect skin for cuts, abrasions, new skin
•Make sure it is clean and free from oils.
•Shave excess hair
•Is skin sensation or joint ROM impaired?
D. Preparing the equipment
1. Turn unit on
a. Make sure output is ____ or at minimal setting.
b. Pulse rate (at least _______ Hz) must be displayed in output window.
2. Prepare electrodes
•Attach electrodes to cords and cords to generator
3. Check equipment and electrode operation.
a. Check connecting cords.
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4. Place electrodes on patient’s skin.
a. Electrodes must be firmly attached to body part.
b. Ideal: one on ____________ _____________ and other on
_______________ ________________
c. Good contact is essential.
Step 3. Application Parameters: NMES
A. Procedures: begin stimulation
1. Set pulse rate
a. <____ pps for twitch contraction
i.
ii.
b. >____ pps for tetanic contraction
i.
ii.
2. Set duty cycle.
3. Set timer.
4. Adjust the surge (ramp) controls as necessary.
5. Inform patient that you are beginning treatment.
6. Slowly increase current intensity
a. Have patient tell you when it is _____________
b. Decrease intensity slightly.
c. Intensity must be sufficient to cause __________ _________________
7. Skin resistance will decrease after ____–____ sec; then intensity may be
_________________
8. For treating a motor point, move electrode to find motor point.
a. Look for area that causes _______________ ___________________
b. Pause ____–____ sec in each area so that skin resistance will be
overcome.
9. If patient complains of discomfort:
a. Probably owing to too much_____________
b. Minor small denuded area (scratches, cuts, abrasions)
c. Hypersensitivity of patient
10. As patient’s strength increases, _____________________ can be applied
during the contraction.
B. Dosage
1. Maximal current within patient’s tolerance
2. Note the most the patient can endure.
C. Length of application
1. ____–____ min
2. See individual manufacturer’s instructions.
D. Frequency of Application
1. As often as ___________ per day if separated by ____–____ hr
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Step 4. Postapplication Tasks: NMES
A. Remove equipment.
1. Timer will stop current.
2. Return all controls to ____ or minimum setting.
3. Remove electrodes.
4. Place electrodes and belts in proper place.
B. Return generator cart to proper place and clean up area.
C. Instructions to patient
1. Arrange next treatment
2. Instruct patient concerning level of activity and/or self-treatment before next
formal treatment.
D. Record treatment.
Step 5. Maintenance: NMES
A. Electrodes
1. Must be kept clean.
1. Make sure wire is firmly attached to electrode post.
2. Check current flow vs. a new electrode.
Iontophoresis
 Iontophoresis is an active ______________________ drug delivery system
 Delivers drug ions through the skin using an electric current.
Iontophoresis: Basic Principle
 Like charges repel like charges,
 Drug ions are repelled or pushed into the underlying tissue.
 Two electrodes
–One drug delivery placed over the _______________ area
–One larger dispersive electrode placed over _______________ or __________________
How Does Iontophoresis Work?
•When an electrical ________________ current is applied
–Positively charged electrode delivers _________________ charged drug ions into skin
and surrounding tissues
–Negatively charged electrode delivers __________________ charged drug ions into
skin and surrounding tissues
Why Use Iontophoresis?
•Delivering medicine such as anti-inflammatories and pain relievers directly without the
negative effects of
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•Mild _______________ or ____________ sensation during treatment
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Iontophoresis: Components of System
 Power source = dose controller
 Drug and dispersive electrodes
 Medication
 Unbroken skin at the treatment site
Medication
 Must be water soluble
 Must be ionized (charged)
Common Drug Ions Used in Sports Medicine
•Dexamethasone
–Negative ion
–Reduces _______________________
•Acetate
–Negative ion
–Assists in dissolving calcium deposits and scar tissue in soft tissues
•Hydrocortisone
–Positive ion
–Reduces _______________________
•Lidocaine
–Positive ion
–Assists in decreasing local pain by blocking nerve impulse transmission
Is Iontophoresis Effective?
•Effective in reducing pain and inflammation associated with
•Plantar fasciitis
•Temporomandibular disorders
•Epicondylitis
Drug Dose Calculation
Dosage (mA/min) = Current (mA) × Treatment time (min)
• Examples:
•40 mA/min = 4.0 mA (current) × 10 min (time)
•40 mA/min = 2.0 mA (current) × 20 min (time)
Sensation of Iontophoresis
 Some patients feel little or no sensation
 Others describe it as a ______________ or __________ sensation.
 The intensity of sensation varies among patients and depends on the site being treated.
 These sensations usually decrease or disappear after a few minutes.
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Tips for Increasing Comfort
 Place dispersive electrode over adipose/muscle.
 Avoid sensitive areas of skin.
 Ensure good contact.
 Ensure thorough hydration of electrode.
 Increase current slowly.
 Avoid additional modalities before iontophoresis.
 Do not shave area; clip hair with scissors.
 Do not tape, bind, or compress electrodes.
Typical Skin Reactions
 DC causes capillary dilatation
o Causes _________________ (reddening) of the skin under one or both electrodes.
 Less frequent: appearance of small fluid-filled bumps
o Caused by the release of histamine from dermal mast cells
Note: These skin
reactions disappear over the course of a few minutes but may last longer in
patients with particularly sensitive skin. Also, some patients with sensitive skin may react to the
adhesive on the electrode.

To help reduce the risk of skin irritation
–
–After treatment, apply a lotion containing __________ __________
–Increase the size of the anode or cathode to decrease current density.
–Increase the spacing between electrodes to decrease current intensity.
Factors Affecting Skin Reactions
 Skin type: Fair- or sensitive-skinned patients will usually exhibit more skin irritation or
sensation than others.
 Sensitivity to DC current: DC current can cause increased redness and the release of
histamine in the skin. This can lead to the appearance of an allergic reaction (small white
bumps or hives) even though the patient is not allergic to the drugs used.
 Skin pigmentation: In darker-skinned patients, the normal reddening is usually less visible
than in lighter-skinned patients.
Ionophoresis: Application Procedures (Read Directions for Use)
Step 1. Foundation: Ionophoresis
A. Definition
1. Active transdermal drug delivery system
2. Delivers drug ions through the skin using DC
B. Effects
1. Depends on the drug ion being delivered
2. Pain relief
a. Anesthesia
b. Decreased inflammation
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C. Advantages
1. Prevent pain and
2. Avoid risk that needle injection carries
3. Localized drug delivery; doesn’t travel through entire system
4. Avoid the gastrointestinal side effects of NSAIDs and COX-2 inhibitors
5.
D. Disadvantages
1. Eliminates pain or inflammation
a. Doesn't deal with the cause of the pain/inflammation.
2. Slight risk of electrode burns
3. Some believe transdermal drug delivery is not possible.
E. Indications
1. Delivery of soluble drug ions into the body for medical purposes
2. Alternative to needle injection or taking a pill
F. Contraindications
1. Do not use with a person who has:
a. An implanted pacemaker
b. Damaged or denuded skin on the treatment area
c.
d. Recent laceration of treatment area
2. Do not treat transcranial area.
3. Do not treat orbital region.
G. Precautions
1. Be cautious when using iontophoresis over an area with:
a. Impaired sensation
b. Recent scar tissue
c. Exposed metal
2. Be cautious when using iontophoresis on persons who:
a. Have diabeties
b. Are pregnant
3. Safe to use over implanted surgical metal
Step 2. Preapplication Tasks: Ionophoresis
A. Make sure Iontophoresis is the proper modality for this situation.
1. Reevaluate injury/problem.
2. Make sure you know what you are dealing with.
3. Review patient response to previous treatment.
4. Are objectives compatible?
5. Make sure you have a physician’s prescription to deliver the medication.
B. Preparing the patient physically
1. Position the patient in comfortable position.
2. Use an alcohol prep to clean treatment area.
C. Preparing the patient psychologically
1. Describe sensation:
2. Electricity will not cause muscle to contract.
3. Only small amount of current will be used.
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4. Cannot cause electrocution.
5. Should not be painful.
6. Demonstrate procedure on yourself.
7. Do a dry run; do not use any medication or open any electrode packages.
8. Check for/warn about precautions.
D. Preparing the equipment
1. Make sure drug delivery electrode and dispersive electrode are working.
2. Prepare the medication.
a. Fill a syringe/eyedropper with the appropriate amount of medication.
3. Prepare the drug delivery electrode.
a. Place it on a table and saturate the sponge side of the electrode with the
medication.
b. Do not overfill; medication should not seep onto the adhesive backing.
4. Apply the electrodes.
a. Attach dispersive electrode to a large muscle belly at least ____ in.
away from the drug delivery electrode site.
b. Apply the saturated electrode to the injury site.
5. Attach the electrodes to the appropriate cords or lead clips.
a. Make sure the leads are connected properly for the polarity of the drug
Step 3. Application Parameters: Ionophoresis
A. Procedures
1. Turn the unit on.
B. Dosage
1. Set the unit to deliver recommended dose of medication.
2. Tell the patient you are beginning.
3. Some units have an automatic ramp.
a. If so, current amplitude will slowly increase to patient’s comfort
b. If not, you can maximize the patient’s comfort by
i. Slowly increasing current intensity
ii. Having the patient tell you when he begins to feel mild tingling
or warm under the medicated electrode
4. Adjust the intensity according to the patient’s tolerance and the dosage.
a. Many electrodes are operational up to a maximum total delivered dose
of 80 mA/min when ________________ polarity is used and 40 mA/min
when ___________________ polarity is used.
C. Length of application
1. Dose specific
D. Frequency of application
1.
E. Duration of application
1. Up to ____ weeks
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Step 4. Postapplication Tasks: Ionophoresis
A. Equipment removal
1. Turn off power.
2. Return all controls to ____ or minimum setting.
3. Remove and dispose of electrodes
4. Place unit in proper place; usually locked up.
B. Recharge or check batteries
C. Instructions to patient
1. Arrange next treatment.
2. Instruct patient concerning level of activity and/or self-treatment
D. Record treatment and any unique patient responses to the treatment.
1. Typical skin reactions that occur from DC are
a. Erythema (redness) under one or both electrodes
b. Small bumps
Step 5. Maintenance: Ionophoresis
A. Electrodes
1. Keep specific iontophoresis electrode pouches on hand.
2. Make sure wire is firmly attached to electrode post.
HVPC Stimulation for Wound Healing
•Electrical stimulation for the purpose of repairing tissues
•Includes management of ___________ ______________ and ______________
_______________
High Volt Pulsed Current (HVPC)
•Production of a twin-peak, monophasic, pulsed current driven by its characteristically high
electromotive force or voltage
•Positive or negative polarity
•Versatile and can perform several functions:
–
–
–
–
Characteristics of High-Volt Stimulator
•Electric stimulators that generate <____ V are termed low volt.
•Electric stimulators that generate >____ V are termed high volt
–HVPC uses between ____ and ____ V.
•Low average current
•Twin peak monophasic waveform
•Short pulse widths in the microsecond range (100–200 µsec)
•Pulse rates of ____–____ Hz
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HVPC: Edema Management
•Two purposes:
–
–
 HVPC
–Decreases the ___________________
–Decreases the leaking of vessels, reducing the number of plasma proteins and amount of
fluid that leave the vessels to enter the interstitial spaces
•Research
–Effective in curbing posttraumatic edema for 4 hr
–Resolution of edema only effective while HVPC is being applied
HVPC: Pain Modulation
•Ineffective in reducing the pain of delayed-onset muscle soreness
•Yet has been shown to help relieve pain caused by muscle spasm
HVPC: Wound Management
•Effective for treating pressure ulcers
•How does HVPC stimulate wound repair?
–Body possesses bioelectric currents in the vascular and interstitial tissues.
–Blood vessel walls, insulating tissue matrix, interstitial fluid, and intravascular plasma
are capable of conducting bioelectricity.
–When tissues are damaged, an electrical potential is created between ______________
and _______________ tissues.
•Injury potential typically becomes positive 24–48 hr after injury and becomes negative 8–9
days after injury.
•As the wound heals, the difference slowly returns to baseline.
–HVPCcan be used to enhance the natural process of tissue recovery and healing
•DC may stimulate cellular activity when injured.
•Stimulating débridement of injured tissues
•Tissue regeneration and remodeling
•May speed up healing by promoting the natural healing process
•May develop a difference in potential between the wound area and the surrounding healthy
tissue
HVPC: Electrode Polarity
•Cells migrate toward electrodes.
•Direction and speed of migration are influenced by strength and polarity of electrodes
•Negative polarity
–Increases
•
•Stimulation
of __________________ growth
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•
•Epidermal
cell migration
–Inhibits bacterial growth
•Positive polarity
–Increases
–Promotes epithelial growth
•Most treatments begin with the negative polarity
–Encourages blood clots to dissolve and increases the inflammatory by products
•Positive polarity encourages clot formation around the wound and granulation tissue.
HVPC: Benefits
•Less resistance to the current by the skin
•Short phase duration allows for moderately high-intensity muscle contraction with little
discomfort
HVPC: Electrical Muscle Stimulation
•Monophasic current
–Twin-peak, pulsed unidirectional current
•Each peak is 65 µsec wide.
•Modified square wave, M wave, or sawtooth
•Pulse rate
•1–120 pps
•Surge rate or ramp control
HVPC: Technique
•Monopolar or bipolar technique
–Monopolar used when treatment is directed over a large area
–Bipolar used for muscle contraction or chronic pain
•Electrodes
–Black lead is conductive
–Gray or red lead nonconductive (insulator)
–Must use wet absorbent material between conductive face and skin
•Treatment time
–15 min if pulsed or if athlete is going to practice
–15–30 min if surge mode or if athlete is not practicing
HVPC: Application Procedures
Step 1. Foundation: HPVC
A. Definition
1. Production of a twin-peak monophasic pulsed current driven by a large
electromotive force
B. Effects
1. Wound healing
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2. Edema control (negative polarity)
3. Muscle contraction
a. Disuse atrophy
b. Spasm reduction
c. Edema reduction
4. Decrease pain
a. Sensory level (acute pain)
b. Motor level (chronic pain)
C. Advantages
1. Can be applied to immobilized body part
2. Less resistance to current by skin, thus lower amperage used for stimulation.
3. Highly versatile in functions
D. Disadvantages
1. Cannot provide as strong of a contraction as __________
2. Many aren’t portable.
3. Trial-and-error needed to determine electrode polarity for wound healing.
4. Effects (muscle contraction) are as strong as low-volt units.
E. Indications
1. Wound lesions (pressure sores, scarring from incisions)
2. Edema control and reduction
3. Residual or chronic muscle spasm (when low-volt unit unavailable)
4. Pain
F. Contraindications
1. Do not use on patient with pacemaker
2. Do not use over
a. Heart or brain
b. Lumbar and abdominal area of pregnant women
c. Potential malignancies
d. Anterior cervical area
G. Precautions
1. Be cautious when using HVPC over an area with:
a. Impaired sensation
b. Extensive torn tissue
c. Hemorrhagic area
2. Patients with epilepsy should be monitored during treatment.
Step 2. Preapplication Tasks: HVPC
A. Make sure HVPC is the proper therapy.
1. Reevaluate the injury/problem.
2. Review patient response to previous treatment (if any).
3. Are objectives of therapy compatible with HVPC?
4. Make sure it is not contraindicated in this situation.
B. Preparing the patient physically
1. Remove clothing, tape, etc. from electrode contact area.
2. Remove everything in the area between the two contact points
3. Position the patient in a comfortable position.
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C. Preparing the patient psychologically
1. Explain the procedure or if the treatment is being changed.
2. Describe the sensation.
a. Wound repair or acute edema reduction
i. Moderate prickling pins and needles over smaller electrode
ii. Little sensation over large dispersive electrode
b. Sensory level pain (acute pain reduction)
i. Moderate prickling pins and needles
c. Conditions requiring muscle contraction
i. Moderate, prickling pins and needles progressing to strong
contraction
ii. Electricity will cause muscle to contract or assist normal healing
of body
d. Only small amount of current will be used.
e. Cannot cause electrocution.
f. Should not be painful.
3. Demonstrate procedure on yourself.
4. Check for/warn about precautions.
5. Inspect skin for cuts, abrasions, new skin.
a. Make sure it is clean and free from oils.
b. Shave to ensure electrode conductivity.
c. Is skin sensation or joint range of motion impaired?
D. Preparing the equipment
1. Turn unit on.
a. Make sure output is ____ or at minimal setting.
b. Set the pulse rate.
2. Prepare the electrodes
a. Attach the electrodes to the _______ and the _______ to generator.
3. Check the equipment and electrode operation.
4. Place the electrodes firmly on the patient’s skin.
a. Monopolar: over motor points or muscle belly
b. Bipolar: proximal and distal to muscle
Step 3. Application Parameters: HVPC
A. Procedures
1. Are procedures for conditions requiring muscle contraction?
2. Begin stimulation.
3. Set pulse rate.
a. <____ pps for individual or twitch contractions
b. >____ pps for moderate to tetanic contractions
4. Set polarity.
a. _________________ over motor point (monopolar)
5. Set duty cycle.
6. Set timer.
7. Inform the patient that you are beginning the treatment.
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8. Slowly increase current intensity.
a. Have the patient tell you when it is uncomfortable.
b. Decrease intensity slightly.
c. Intensity must be sufficient to cause _______________
___________________
9. Skin resistance will decrease after 5–10 sec; then intensity may be increased.
10.If treating a motor point, move electrode around to find motor point.
a. Look for area that causes ______________ contraction.
b. Pause ____–____ sec in each area to overcome skin resistance.
11. If the patient complains of discomfort:
a. Probably owing to too much current
b. Minor small denuded area (scratches, cuts, abrasions)
c. Hypersensitivity
B. Dosage
1. Maximal current within patient’s tolerance
a. Not the most that the patient can endure
b. Maximum current that is comfortable
C. Length of application
1. ____ min if pulsed or patient is going to practice.
2. ____–____ min if surge mode or patient not practicing.
3. See manufacturer’s instructions.
D. Frequency of application
1. As often as __________ per day if separated by ____–____ hr
Step 4. Postapplication Tasks: HVPC
A. Equipment removal
1. Timer will stop current.
2. Return all controls to ____ or minimum setting.
3. Remove electrodes.
4. Place electrodes and belts in proper place, not on top of unit.
5. Return generator cart and clean up area.
B. Instructions to the patient
1. Arrange next the treatment
2. Instruct the patient concerning level of activity and/or self-treatment before
next treatment.
C. Record treatment.
Step 5. Maintenance: HPVC
A. Electrodes
1. Must be kept clean.
2. Make sure the wire is firmly attached to the electrode post.
3. Check current flow versus a new electrode.
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Microcurrent Electrical Nerve Stimulation (MENS)
•Therapeutic use of constant (DC) and pulsed (interrupted) currents where the stimulus
amplitude is in the microamperage range
•Proposed uses of microcurrent are
–
–
–
–
•Other than MENS, these devices have been referred to as:
–Low-voltage pulsed microamp stimulation
–Biostimulation
–Bioelectric therapy
–Low-intensity direct current
–Low-intensity electrical stimulation
MNES: Theory
•Brief research
–No clear-cut research supporting the use of microcurrent therapy
–Positive effect in treating
 Pressure ulcers
 Diabetic ulcers
 TMJ disorders
–No effect in treating
 DOMS
 Pressure ulcers
 Coracoacromial arch pain
 Surgically induced wounds
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