general contraindications
pacemaker, anterior neck, eyes, brain, heart, testicles, ovaries, pregnancy, neoplasm, infection, phlebitis/thrombophlebitis, active hemorrhage, menstruation, decreased sensitivity, inability to communicate, recent or heavy scarring, tumors, tuburculosis, osteomyelitis, metal implants
low voltage galvanism (iontophoresis) – indications
introduce therapeutic ions locally in a noninvasive manner, allows for prolonged treatment effects
low voltage galvanism (iontophoresis) – contraindications
general contraindications, damaged or open skin lesions, known sensitivity to therapeutic ions, impaired sensation to heat or pain, recent scarring, metal embedded close to skin in treatment area, electronic implants
low voltage galvanism (iontophoresis) – physiological effects
transmembrane transport of ions, increased cell permeability, upregulate ATP
low voltage galvanism (iontophoresis) – set up
two unequal pads (monopolar technique), small active pad soaked in ionic medicine placed over treatment area, large dispersive pad (at least twice the size) placed over broad, flat area at least 6-8in away. (If a bath is used, use the largest dispersive pad) The polarity of the active pad must match the polarity of the medicine.
low voltage galvanism (iontophoresis) – What is the rule for maximum intensity when applying continuous LVG at the active pad?
Miliamperage rule – to ensure that the reaction isn’t too strong the maximum amount of current is limited to 0.5-1.0 mA/in2
low voltage galvanism (iontophoresis) – What is the initial treatment time? Why? Subsequent time?
Start with 3-4min and check skin for reactions before continuing. Usually 10-20min total.
low voltage galvanism (iontophoresis) – What is the typical mA range for iontophoresis?
40 mA*min – usually 1-5mA for 10-20min
low voltage galvanism (iontophoresis) – How is the dosage calculated?
mA * T
low voltage galvanism (iontophoresis) – How is the polarity of the active electrode decided?
same polarity as the ion beign dispersed
low voltage galvanism (iontophoresis) – what is the polarity of water?
either positive or negative
low voltage galvanism (iontophoresis) – what is the indication for water as a therapeutic substance?
hyperhydrosis
high voltage pulsed current – indications
pain, edema, hypertonicity, spasm, tissue healing, muscle re-education
high voltage pulsed current – contraindications
general contraindications
high voltage pulsed current – physiological effects
increased cell permeability, upregulates ATP, general increase in cell activity
high voltage pulsed current – acute muscle strain set up
Rationale – gate control Frequency – 80-150 pps Intensity – sensory Pad placement – either side of treatment area Continuous mode for 15-20min
high voltage pulsed current – chronic muscle hypertonicity set up
Rationale – muscle fatigue
Frequency – 80-150 pps
Intensity – motor
Pad placement – over muscle to be treated
Continuous mode with wide pulse duration for 15-20min
high voltage pulsed current – acute edema
Rationale – negative pole repels plasma
Frequency – 80-150 pps (100 does the job)
Intensity – sensory
Pad placement – either side of treatment area
Continuous mode for 15-20min
high voltage pulsed current – chronic edema
Rationale – muscle contraction to move large proteins into lymph
Frequency – 1-15pps
Intensity – motor
Pad placement – either side of treatment area
Continuous mode OR surge mode with 10sec on 10 sec off for 15-20min
low voltage alternating current (sine/biphasic) – indications
pain, chronic edema, hypertonicity, spasm, tissue healing, strengthening
low voltage alternating current (sine/biphasic) – contraindications
general contraindications
low voltage alternating current (sine/biphasic) – physiological effects
increased cell permeability, upregulates ATP, general increase in cell activity
low voltage alternating current (sine/biphasic) – delayed onset muscle soreness set up
Pad placement – either side of treatment area
Frequency – 40-50pps
Intensity – motor to patient tolerance
Pulse mode at 5pps OR surge mode at 3-6 surges per minute for 15-20min
low voltage alternating current (sine/biphasic) – chronic muscle hypertonicity set up
Pad placement – either side of treatment area
Frequency – 80-150pps
Intensity – motor to patient tolerance
Tetanize mode for 15-20min
TENS (conventional and low frequency) – indications
pain
TENS (conventional and low frequency) – contraindications
general contraindications
TENS (conventional and low frequency) – physiological effects
increased cell permeability, upregulates ATP, general increase in cell activity
TENS (conventional and low frequency) – acute radicular pain set up
Frequency – 85pps
Pulse width – 75 microseconds
Intensity – sensory
Pad placement – 2 pads on either side to make a cross that meets at target treatment area
Treatment time – 15-20min in office, up to 20hrs at home
TENS (conventional and low frequency) – chronic pain set up
Frequency – 5pps Pulse width – 200 microseconds Intensity – mild motor Pad placement – 2 pads on either side to make a cross that meets at target treatment area or placed at acupuncture points Treatment time – 15-20min
TENS (conventional and low frequency) – What is the purpose of burst mode or modulation mode?
To prevent nerve accommodation
TENS (conventional and low frequency) – What’s the difference between burst mode and modulation mode?
Burst mode – 5-10 pulses in bursts of ¼ sec on and off
Modulation mode – pulse rate and pulse width change by 50%
interferential (quadripolar) – indications
swelling, spasm, pain
interferential (quadripolar) – contraindications
general contraindications, nearby diathermy machine (15-20’)
interferential (quadripolar) – physiological effects
increased cell permeability, upregulates ATP, general increase in cell activity
interferential (quadripolar) – chronic pain set up
Pad placement – four points of a square around the treatment area, the negative and positive pads of each channel placed diagonally from each other
Rationale – opiate release
Frequency – 5bps
Intensity – mild motor
Turn on vector sweep and frequency sweep on, treat for 15-20min
interferential (quadripolar) – acute pain set up
Pad placement – four points of a square around the treatment area, the negative and positive pads of each channel placed diagonally from each other
Rationale – gate control
Frequency – 80-150bps
Intensity – sensory
Turn on vector sweep and frequency sweep on, treat for 15-20min
interferential (bipolar) – how is premodulated different from quadipolar?
There is only one channel (2 pads), premodulated will effect all of the tissue on the way to the target tissue so it’s better for superficial treatment, quadipolar is better for deep treatment
Ultrasound – indications
tissue healing, soft tissue contracture, scar tissue, pain, muscle spasm, neuralgia, bursitis, tendonitis, calcium deposits
Ultrasound – contraindications
general contraindications (except for metal implants), thrombosis, severe arterial disease, over spinal column after leminectomy, bony prominences, epiphyseal growth plates before maturity
Ultrasound – physiological effects
increased cell permeability, upregulates ATP, general increase in cell activity
Ultrasound – set up
Keep sound head moving to prevent hot spots (standing waves), don’t move too fast, sound head parallel to the body surface. Use gel (direct), a water bath (indirect), or a bladder (indirect) to transmit through. 2-3 times the size of soundhead
Ultrasound – direct technique
contact with gel
Acute conditions – less than 0.5 W/cm2 pulsed
Chronic conditions – less than 1.0 W/cm2 continuous
Ultrasound – indirect technique
underwater or through a bladder or cushion
Add 0.5 to direct technique
Acute conditions – less than 1.0 W/cm2 pulsed
Chronic conditions – less than 1.5 W/cm2 continuous
Ultrasound – treatment time
Acute – 3-5min
Chronic – 8-10min
diathermy (inductive) – indications
pain, relieve sinus pressure
diathermy (inductive) – contraindications
metal in treatment area, water, pregnancy, cancer, synthetic materials must be insulated, electrical devices within 15ft, remove hearing aids, moisture, fluid filled cysts, remove contact lenses, peripheral vascular disease, systemic edema, menstruation, testicles, sensory deficits, bony prominences, epiphyseal centers in children, osteoporosis
diathermy (inductive) – physiological effects
increased cell permeability, upregulates ATP, general increase in cell activity
diathermy (inductive) – dosages
I – athermic (non-detectible warmth)
II – barely perceptible warmth
III – pleasant warmth
IV – maximum tolerable warmth
diathermy (inductive) – set up
Place head parallel to treatment area close enough that the 2ft sphere of influence includes the treatment area. Heat will penetrate 5cm. Frequency is 27,000,000pps
diathermy (inductive) – precautions
If someone feels too hot, you may have already caused tissue damage. Make sure you insulate with a towel to prevent moisture from accumulating and causing superficial burns.
