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APPLICATIONS OF
IOMEDICAL ENGINEERING IN
ORTHOPAEDIC
PHYSICALTHERAPY
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Anyone who stops learning is old,
whether at twenty or eighty. Anyone
who keeps learning stays young.
The greatest thing in life is to keep
your mind young. Henry Ford
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Orthopaedic physical therapy
Orthopaedic physical therapy is a branch ofphysical therapy which mainly deals with boneand joint related problems
The main aims of treatment are to relieve pain,enhance healing, strengthen muscles andimprove mobility
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Modalities
A method of therapy that involves physical orelectrical therapeutic treatment
Physical therapists use a variety of modalitiesto help treat their patients.
There are a variety of treatment modalities that
can help strengthen, relax, heal muscles andreduce pain.
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Classification of modalities
Electromagnetic
Electrical
Sonic Radiation
Mechanical
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How are Modalities Related?
Electromagnetic energy modalities Shortwave and microwave diathermy
Electrotherapy
Faradic and galvanic currents
TENS
IFT
Iontophoresis
Acoustic energy modalities
Ultrasound
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Radiation modalities Infrared therapy
ultraviolet therapy
Laser hterapy
Conduction modalitiesparaffin wax
contract bath
Mechanical modalitiesTraction
CPM
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Shortwave Diathermy
Heats tissue by introducing high frequencyelectrical current
Performs through electrostatic field heating orelectromagnetic/induction field heating
Pulsed diathermy is relatively new Not continuousreduces likelihood of significant
tissue temperature increase
Utilizes drum electrode
Produces both thermal and non-thermal effects
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Equipment
High frequency generator with an oscillatoralong with amplifier for converting ACcurrent to DC
Also has circuit that tunes to patientTreatment applicator is either condenser or
inductive type
With condenser, patient is part of circuitand requires use of flexible electrodes
Inductiveutilizes drum or cable
electrodes
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Electrotherapy
Low frequency
Electrical stimulation
Iontophoresis
Medium frequency
IFT
High frequency SWD
MWD
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Electrotherapy
Physical Principles
Electricity displays magnetic, chemical, mechanical, andthermal effects on tissueVolume of current (ampere)
Rate of flowResistance
Force that current moves along = voltage
Electricity is applied to nerve tissue at certain intensities
and duration to reach tissue excitability thresholdsresulting in membrane depolarizationTarget sensory, motor, and pain nerve fibers in an effort to
produce specific physiological effects
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Electrical Stimulating Units
Three types of unitsTENS - transcutaneous electrical nerve stimulators
NMES/EMS - neuromuscular electrical stimulators orelectrical muscle stimulators
MENS/LIS - microcurrent electrical nerve stimulatorsor low-intensity stimulators
Generate 3 types of current Monophasic
Direct current or galvanic current - flow in one directiononly from (+) to (-) or vice versa
Used to produce muscle contraction, pain modulation, ionmovement (determined by specific parameters)
Biphasic Alternating current where direction of flow reverses during
each cycle
Useful in pain modulation and muscle contractions
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Ionotophoresis Chemical ions are transported through intact skin
using electrical current -- used to treat skininfections or to produce a counterirritant effect Requires use of low voltage direct current on continuous
mode w/ a long pulse duration (allows for migration ofions)
Polarity of pads is set relative to the medication/solutionbeing used
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Low Intensity Stimulators Microcurrent electrical nerve stimulator Operates at low frequencies and intensities (sub-
sensory) Used to stimulate healing of soft tissue and bone
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INTERFERENTIAL THERAPY
The name Interferential therapy stems
from the concept of two currents
interfering with each otherThis becomes readily apparent when one
views the four electrodes (quadripolar) that
are necessary to produce the standardinterferential effect in a patient
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Makes use of 2 separate generators, emitting current
at slightly different frequencies Quad polar pad placement is used creating
interference pattern
Creates a broader area of stimulation
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Transmission of Thermal Energy
Conduction
Heat is transferred from a warmer object to a coolerone
Dependent on temperature and exposure time
Temperatures of 116.6o F will cause tissue damageand temperatures of 113o F should not be in contact
w/ the skin longer than 30 minutes Examples include moist hot packs, paraffin, ice
packs and cold packs
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ConvectionTransfer of heat through movement of fluids or
gases
Temperature, speed of movement, andconductivity of part impact heating
Whirlpools
Radiation Heating is transferred from one object through
space to another object
Shortwave diathermy, infrared heating and
ultraviolet therapy
Conversion Generation of heat from another object (sound,
electricity or chemical agents)
P ffi B h
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Paraffin Bath
Equipment
A paraffin wax and mineral oil combination, heated to
126-130o F
Indications
Useful in treating chronic injuries
Effective for angular areas of body such as hands,wrists, elbows, ankles and feet
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Contrast Bath
Equipment
Requires use of hot and cold tubs
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Ultrasound
Modality which stimulates repair of soft tissueand pain relief
Form of acoustic energy used for deep tissueheating
Operates at inaudible frequency
Sound scatters and is absorbed as it penetrates
tissues -- losing energy = attenuation
Impedance and penetration are determined byproperties of media (densities)
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Equipment
High frequency generator which provides
electrical current through a coaxial cable to atransducer applicatorThrough piezoelectric effect electrical current is
transformed into acoustic energy through contraction
and expansion of piezoelectric crystals Frequency ranges between .75 and 3.0 MHz
1 MHz ultrasound allows for deeper penetration while3 MHz is absorbed more superficially
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Traction
Drawing tension applied to a body segment
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Low Level Laser Therapy
Light Amplification by Stimulated Emission of Radiation
Used for collagen synthesis, control of microorganisms,increased vascularization, and pain/inflammation reduction
Helium-neon and gallium-arsenide lasers are currently beingexplored by the FDA
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Continuous Passive Motion(CPM)
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Purposes
Produce passive joint motion
Moves the limb through ROM by grasping itproximal and distal to the joint
Effects: Enhance nutrition
Increase metabolic activity
Stimulate tissue remodeling and re growth of healing
tissues:Articular cartilage
Tendons
Ligaments
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Safety in Using Therapeutic
Modalities
Equipment must be used and maintained inappropriate manner
Following manufacturer recommendations
Regarding use and maintenance
Failure to follow recommendations = negligence