Introduction to electro Introduction to electro therapytherapy

Year 2 Semester 1Year 2 Semester 1

What is electro therapy ?What is electro therapy ? Electrotherapy can be defined as the Electrotherapy can be defined as the

treatment of patients by electrical treatment of patients by electrical means . means .

Electrical forces are applied to the body Electrical forces are applied to the body to bring physiological changes for to bring physiological changes for therapeutic purposes.therapeutic purposes.

MEDIUM FREQUENCY

CURRENTLOW

FREQUENCY CURRENT

HIGH FREQUENCY CURRENTS

PHOTOTHERAPYBIOFEED

BACKELECTRO DIAGNOSIS

ELECTROTHERAPY

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

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

ThermotherapyThermotherapy Short wave diathermyShort wave diathermy Micro wave diathermyMicro wave diathermy Paraffin wax therapyParaffin wax therapy Hydrocollator packsHydrocollator packs

Short wave diathermyShort wave diathermy

Wax bath & hydrocollator pack Wax bath & hydrocollator pack

ELECTROTHERAPYELECTROTHERAPY Faradic current stimulationFaradic current stimulation Alternating current stimulationAlternating current stimulation Pulsed direct current stimulationPulsed direct current stimulation

currentscurrents Alternating Alternating

– Sinusoidal currentSinusoidal current- interferential therapyinterferential therapy- Russian stimulationRussian stimulation- TENSTENS

– Diadynamic currentsDiadynamic currents Faradic type current (0.3 ms pulse)Faradic type current (0.3 ms pulse) Galvanic current is interrupted direct currentGalvanic current is interrupted direct current

Electrical stimulation Electrical stimulation

Interferential therapyInterferential therapy

Sound wavesSound waves Ultra soundUltra sound

CryotherapyCryotherapy Ice bagsIce bags Ice massageIce massage Ice packsIce packs

Cryotherapy & CPM Cryotherapy & CPM

Photo therapyPhoto therapy Laser therapyLaser therapy Ultra violet raysUltra violet rays

Electro magnetic wavesElectro magnetic waves Infra red raysInfra red rays

High frequency current – wound healingHigh frequency current – wound healing

pharmacotherapypharmacotherapy IontophoresisIontophoresis PhonophoresisPhonophoresis

mechanotherapymechanotherapy Spinal tractionSpinal traction Continuous passive motion movement Continuous passive motion movement

devicesdevices Intermittent pneumatic compression Intermittent pneumatic compression

devicesdevices

Lumbar TractionLumbar Traction

Cervical tractionCervical traction

CPM CPM

ElectrotherapyElectrotherapy Physical PrinciplesPhysical Principles

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

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

produce specific physiological effectsproduce specific physiological effects

CURRENT ?CURRENT ? Current Current

- Flow of electrons (electric charge)- Flow of electrons (electric charge)- flow of ions- flow of ions

Frequency Frequency - number of occurrence of any event - number of occurrence of any event

per unit timeper unit time

Current & safetyCurrent & safety

HazardsHazards ELECTRICAL SHOCKELECTRICAL SHOCK Large amount of current is passed Large amount of current is passed

through the bodythrough the body Sudden flow of currentSudden flow of current Caessation or stopping of currentCaessation or stopping of current Variation of the currentVariation of the current

Hazard Hazard

Hazard Hazard

Check if main switch Is offCheck if main switch Is off

Hazard Hazard

CausesCauses Poorly designed machinesPoorly designed machines Improper insulation – equipment, wiresImproper insulation – equipment, wires Badly serviced machinesBadly serviced machines Mishandling of machinesMishandling of machines Improper guidance to patientsImproper guidance to patients Lack of safety measuresLack of safety measures

HazardsHazards Due to main current typeDue to main current type

– (Ohm’s law) Lower resistance greater (Ohm’s law) Lower resistance greater amount current amount current

– Current passes through the low Current passes through the low resistance tissues, wet skin.( Exposed resistance tissues, wet skin.( Exposed part touched with wet hands )part touched with wet hands )

– Damage depends on contact with the Damage depends on contact with the current – finger or head current – finger or head

– Type of current (alternating)Type of current (alternating)

Hazards….. contdHazards….. contd– Voltage of 240 V can cause ventricular Voltage of 240 V can cause ventricular

fibrillation in heart muscle and can fibrillation in heart muscle and can cause deathcause death

– Current -10mA causes discomfortCurrent -10mA causes discomfort– Above 10 – 50mA cause painful Above 10 – 50mA cause painful

muscle contractionmuscle contraction Electric shockElectric shock

Electric shockElectric shock amount of injury to the body is directly amount of injury to the body is directly

proportional to the duration of exposure. proportional to the duration of exposure. tissue breakdown occurs with longer tissue breakdown occurs with longer

exposure, which allows internal current flow. exposure, which allows internal current flow. Heat is produced by current flow through Heat is produced by current flow through

tissues, causing:tissues, causing:– severe burns severe burns – protein coagulation – the proteins in the cells clump protein coagulation – the proteins in the cells clump

together, destroying the function of the cells together, destroying the function of the cells – vascular thrombosis – clotting of blood vascular thrombosis – clotting of blood – Tissue necrosis Tissue necrosis

Effects of the major shockEffects of the major shock Fall in BPFall in BP UnconsciousnessUnconsciousness Breathing stopsBreathing stops Ventricular fibrillationVentricular fibrillation Cardiac arrestCardiac arrest

HazardsHazards Damage due to therapeutic currents Damage due to therapeutic currents

and other modalitiesand other modalities– PainPain– Induce anxiety and fearInduce anxiety and fear– Fainting spellFainting spell– Psychological shock due to poor Psychological shock due to poor

comprehensioncomprehension– burnsburns

Damage ….contd Damage ….contd – ScaldingScalding– Head acheHead ache– Fall in BPFall in BP

Minor electric shockMinor electric shock Reasons Reasons

– Concentration of currentConcentration of current– Accommodation of current Accommodation of current – Over doseOver dose– Damage to equipmentDamage to equipment

Safety FeaturesSafety Features1.1. Take responsibility Take responsibility 2.2. Maintenance of equipments Maintenance of equipments 3.3. Maintenance contracts and Planned Maintenance contracts and Planned

replacementreplacement4.4. Environment Environment 5.5. Safe applicationSafe application

1. Take responsibility1. Take responsibility

Physiotherapist has a duty of care to the Physiotherapist has a duty of care to the patients and our own self and should patients and our own self and should confine to scope of practiceconfine to scope of practice

Update knowledgeUpdate knowledge Put up signagesPut up signages Provide relevant information to patients Provide relevant information to patients

when using or giving equipments on loanwhen using or giving equipments on loan Protect your self from exposureProtect your self from exposure

Take responsibility…2Take responsibility…2 Documentation is essentialDocumentation is essential All interactions are documented and signedAll interactions are documented and signed

– Assessment Assessment – IndicationIndication– Results of skin sensation testsResults of skin sensation tests– Modality and machine usedModality and machine used– Time settingTime setting– Treatment parametersTreatment parameters– Outcomes - Effects beneficial and adverseOutcomes - Effects beneficial and adverse

Take responsibility..3Take responsibility..3 Documentation is essentialDocumentation is essential

– drugs taken by patientsdrugs taken by patients– comprehension by patientscomprehension by patients– proper information to patientsproper information to patients– Reaction after therapy sessionReaction after therapy session

2. Maintenance of equipments2. Maintenance of equipments Decide on our purchaseDecide on our purchase Check credentials of the supplierCheck credentials of the supplier Read instruction manuals carefullyRead instruction manuals carefully Ask for performance and safety checkAsk for performance and safety check New machines come with a warrantyNew machines come with a warranty Servicing of machines is very importantServicing of machines is very important Service contracts are available (stickers)Service contracts are available (stickers) Check if the machine needs a licenseCheck if the machine needs a license Check if machine requires calibration Check if machine requires calibration All machines come with a life spanAll machines come with a life span

3. Environment…13. Environment…1 Report faults immediatelyReport faults immediately Near objects that can concentrate currentsNear objects that can concentrate currents Post signage or people with pace makers and Post signage or people with pace makers and

hearing aidshearing aids Using hand phonesUsing hand phones Stacking of equipmentsStacking of equipments Repair by unqualified personnelRepair by unqualified personnel Know the hazards your selfKnow the hazards your self Use tester to check for leakageUse tester to check for leakage

Environment…2Environment…2 Do not allow patients to touch machines Do not allow patients to touch machines

when treatment is onwhen treatment is on When using bath or under water When using bath or under water

treatment extra care should be taken to treatment extra care should be taken to check earthingcheck earthing

Insulation over the cablesInsulation over the cables Store machines not near water or Store machines not near water or

radiator pipesradiator pipes Antenna of micro wave machine should Antenna of micro wave machine should

face the wall face the wall

Environment…3Environment…3 Place Interferential therapy and ultra Place Interferential therapy and ultra

sound machines 3 metres away from sound machines 3 metres away from short wave diathermy machinesshort wave diathermy machines

Treatment couches and chairs for SWD Treatment couches and chairs for SWD and Micro wave diathermy treatment be and Micro wave diathermy treatment be made of wood or plasticmade of wood or plastic

No metal within the line of high No metal within the line of high frequency currentsfrequency currents

4. Safe application…14. Safe application…1 Precautions to be taken when using electrical Precautions to be taken when using electrical

equipmentsequipments a visual check before starting treatmenta visual check before starting treatment

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

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

Safe application…2Safe application…2– Never pull the plug by pulling n the wireNever pull the plug by pulling n the wire– Do not drag machines with the armsDo not drag machines with the arms– Be careful when handling ultra sound Be careful when handling ultra sound

machines wiremachines wire– Worn out cords, broken plugs, faulty Worn out cords, broken plugs, faulty

socketssockets– Check if any leakage of currentCheck if any leakage of current– Checks at intervals for loose Checks at intervals for loose

connectionsconnections

Safe application…3Safe application…3– all machines should be unplugged at end of all machines should be unplugged at end of

the daythe day– check power controls and other monitoring check power controls and other monitoring

devices before using patient for a patientdevices before using patient for a patient– if there is water leaking into the machine it if there is water leaking into the machine it

should be serviced before usingshould be serviced before using

Equipments on loanEquipments on loan Ensure equipments are in working Ensure equipments are in working

conditioncondition Correct written instructions must be Correct written instructions must be

givengiven Contact person and number in case Contact person and number in case

problem is encountered problem is encountered Records must be keptRecords must be kept

What can you do ?What can you do ? arrangement of machinesarrangement of machines flooring with linoniumflooring with linonium InsulationInsulation Ensure patient does not touch machinesEnsure patient does not touch machines Metal casing of machines is earthedMetal casing of machines is earthed Dry floorDry floor Water at a distanceWater at a distance

What can you do for patient ?What can you do for patient ? Switch off machineSwitch off machine Disconnect from source of supply (How ?)Disconnect from source of supply (How ?) Reassurance and restReassurance and rest Water – cold (no hot drinks)Water – cold (no hot drinks) Loosen clothing and allow fresh airLoosen clothing and allow fresh air Artificial respirationArtificial respiration CPRCPR Oxygen therapyOxygen therapy CALL FOR CODE BLUECALL FOR CODE BLUE

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

importantimportant