Introduction to Physical agents & Electrotherapy_____ DPT-VDr.FOUZIABATOOLPT.PP-DPTLecturer, RCRS

PHYSICAL THERAPYThe treatment of physical dysfunction or injury by the use of therapeutic exercise and the application of modalities, intended to restore or facilitate normal function or development.

Aims of Physical TherapyRelieve PainModalities, Manual Techniques, EducationImprove ROMModalities, Manual Techniques, Ex. InstructionStrengthen muscles Exercise Instruction, Man. Res. ExercisesImprove FunctionAssistive Devices, Correct Impairments

ELECTROTHERAPYElectrotherapy is the branch of physiotherapy characterized by the treatment of various diseases and disorders with the help of electricity or electrical means.Specifically, electrotherapy uses energy waves that are part of the electromagnetic spectrum to produce desired physiological and chemical effects in the body

Electromagnetic Spectrum

Physical AgentsPhysical agents are various forms of energy and materials applied to patients and their means of applicationIt includes heat, cold, water, pressure, sound, electromagnetic radiation and electrical currents

ActinotherapyThe use of Ultraviolet, other parts of the Spectrum of the suns rays, or X-rays to treat various disorders, particularly Skin diseases.Heliotherapy: the therapeutic use of Sunlight

Categories of Physical AgentsTHERMALDeep heating agents e.g. DiathermySuperficial heating agents e.g.. Hot PackCooling agents e.g. Ice Pack

MECHANICALTraction e.g. Mechanical TractionCompression e.g. Elastic Bandage Water e.g. WhirlpoolSound e.g. Ultrasound

ContELECTROMAGNETIC Electromagnetic tools e.g. UltravioletElectric currents e.g. TENS

01.THERMAL AGENTSThese agents increase or decrease the tissue temperatureDifferent thermal agents produce the greatest change in temperature in different types and areas of tissueHot packs produces greatest temperature increase in superficial tissues with high thermal conductivity in the area directly below it

ContUltrasound produces the most heat in tissues with high ultrasound absorption coefficients, such as bone and tendon. It produces the effect up to a depth of 5cm but only in small area

Cont Physiological Effects of thermal agents

Increase the tissue temperatureTo increase the circulationIncrease metabolic rateIncrease soft tissue extensibilityDecrease pain

ContWhen to apply cold agents???????To decrease circulationDecrease metabolic rateDecrease painHuntings Phenomenon

Cold agents are mostly preferred in acute inflammationPRICER phenomenon in Acute Conditions

02. MECHANICAL AGENTSApply mechanical force to increase or decrease pressure in or on the body

Traction decrease the pressure between structures such as nerves or joints or other sensory changes or that become inflamed when compressed

Traction table

ContCompression increases the pressure between structures to counteract fluid pressure and to control edema

HydrotherapyThe application of water is called hydrotherapyWater provides resistance to increase local pressure, and buoyancy decrease pressure on weight bearing structuresArchimedes PrincipleUsed for exercise when an area is immersed and for cleansing or debriding open wound with or without immersion Fibromyalgia Ankylosing Spondylitis

SoundIt is a mechanical form of energy composed of alternating waves of compression and rarefactionFrequency greater than 20,000 cycles per secondThermal and non-thermal effects Continuous and pulsed mode

Ultrasound

03. ELECTROMAGNETIC AGENTSElectromagnetic agents apply electromagnetic energy in the form of electromagnetic radiation or an electrical currentsElectromagnetic toolsUltraviolet radiation, which has a frequency of 7.5*1014 to 1015 cycles per second produce erythema and tanning of the skin but doesn't produce heatInfrared radiation, which has a frequency of 1011 to 1014 cycles per second produces heat in superficial tissues

ContShort wave diathermy , which has a frequency of 10 million to 100 million cycles per second, produces heat in both superficial and deep tissues

SWD

Electric currentsThe effects and clinical application of electrical currents vary according to the waveform, intensity, duration and direction of the current flow and according to the types to which the current is appliedThese currents depolarize nerves, causing sensory or motor responses that may be used to control pain, increase muscle strength , control the formation of edema, promote wound healing etc

Classification of Electrical CurrentsOn the basis of DirectionOn the basis of FrequencyOn the basis of VoltageOn the basis of AmperageOn the basis of Biophysical Effects

Areas of ElectrotherapyLow frequency currentsMedium frequency currentsHigh frequency currentsPhototherapy ElctrodiagnosisBiofeedback

ContLow Frequency Currents:Frequency range 0 to 100 cycles per secondUse in the stimulation of nervee.g.Direct current, IDC, Sinusoidal current, Diadynamic current, High voltage pulsed galvanic current, TENS

CONT.Medium frequency Currents:Frequency in the range of 1000 to 10,000 cycles per secondUse for muscle re-education, retard the rate of muscle atrophy, drainage of edema and for pain reliefRussian Current, Interferential Current, etc.

ContHigh frequency currents:Frequency more than 10,000 cycles per secondProduce deep heat inside the tissuese.g.SWDTherapeutic Ultrasound Microwave diathermy

ContPhototherapy:Treatments of various disease and disorders with the help of lightPain relief by heat, acceleration of healing through elevation of temperature, counter irritation and photochemical effectse.g. Infrared rays, ultraviolet rays and LASER Heliotherapy

ContElectrodiagnosis:It means the detection of the disease and disorders by the use of electrotherapeutic currents or electromyography

TESTS:Rheobase, Chronaxie, Strength duration curve, Pulse ratio, Galvanic tetanic ratio, Nerve conduction test etc

ContElectromyography:It is the study of electrical activity of muscle by means of surface electrodes placed over the skin or needle electrodes inserted in muscle itself

e.g. Motor unit potential, Motor nerve conduction, Sensory nerve conduction etc

Biofeedback:

It is the process of furnishing the information to an individual about the body function so as to get some voluntary control over itBiofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies. Physical therapists for example, use Biofeedback to help stroke victims regain movement in paralyzed muscles. Psychologists use it to help tense and anxious clients learn to relax. EMG biofeedback

Cont

HISTORY OF ELECTROTHERAPYIn 1646, Sir Thomas Browne, physician used the word Electricity for the first timeAetius, a Greek physician had prescribed the shocks of Torpedo, an electric fish for the treatment of gout, headacheThere are also reports from the 17th century of charged gold leaf being used to prevent scarring from smallpox lesions

Cont1780, Luigi Galvani a professor of the anatomy at the faculty of Bologna, first observed the quick twitching of the muscle produced by the electricity in a nerve muscle preparation of the frogs leg French physicist Abbe Nollet administered the shock from Leyden jar to 180 royal guards simultaneously in the presence of the KingJohann Gottlob Kruger, professor of Medicine at Halle, gave a series of lecture to medical students in 1743 entitled thoughts about the electricity. These were published in 1744 enlarged by notes and reprinted the following year. It was the first book on medical electricity.

ContHis pupil Christian Gottlieb Kratzenstein_ book____ published in 1745 was the first to use medical electricity in its titleRichard Lovett in England treated many persons with static shocks and published a treatise in 1756 describing the numerous conditions for which electrotherapy was to be recommended

ContJohn Wesley in 1759 published his own experiences in the book titled DesideratumBertholon described his techniques with its role in the cure of eight paralysisGuys Hospital in London is recognized as the first hospital physical therapy departmentRenowned Physician S. Weir Mitchell. endorsed exercises of muscles by faradic stimulation

History of Use of Physical Agents in Medicine and RehabilitationPhysical agents have been a component of medical and rehabilitation treatment for many centuriesThe remains of bath houses with steam rooms and pools of hot and cold water that can still be seen in many cities of the ancient Romans and Greeks provide evidence that these cultures used heat and water to maintain health and to treat various musculoskeletal and respiratory problems

ContBefore the widespread availability of antibiotics and effective analgesic and anti-inflammatory drugs, physical agents were commonly used to treat infection, pain, and inflammation Use of sunlight for the treatment of tuberculosis, bone and joint disease, and the use of warm Epsom salt baths for the treatment of sore or swollen limbs

ContUse of physical agent for biological processTENS is use to control pain was developed based on the gate control theory of pain modulation as proposed by Melzack and Wall

Physical agents fallen out of favorInfrared lamps_______ were used to treat open wounds because they provide superficial heat that can dry out the wound bed; however these lamps no longer use for this application because it is now known that wounds heal more rapidly when kept moistSunlight___ was used to treat T.B. infection etc. not used now since the advent of Antibiotics

ContSWD_____ was popular 20 to 30 years ago, but because of some side effects (burn) is rarely used in United States at this time

The Role of Rehabilitation in Patient CareRehabilitation is a goal-oriented treatment process designed to maximize independence in individuals who have compromised function due to underlying pathological processes and secondary impairmentsMedical treatment addressees at the underlying pathology or disease, rehabilitation focuses on sequelae of pathology

The Role of physical agents in Rehabilitation APTA position statement concerning the use of physical agents, published in 1995, states that without documentation which justifies the necessity of the exclusive use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy

ContPhysical agents primarily effects level of impairmentPromote improvements at the levels of disability and handicap

ReferencesPhysical agents in Rehabilitation by Michelle H. CamronClaytons ElectrotherapyElectrotherapy by Subhash Khatri

General Contra-indications for ElectrotherapyNature of restriction, the nature and distribution of the physiological effects of the physical agent, and the distribution of energy produced by the physical agentPregnancyMalignancyPacemakerImpaired sensationImpaired mentation

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