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Minerva Zaniebeth A. Gomez, PTRPDepartment of Physical TherapyCollege of Allied Medical ProfessionsUniversity of the Philippines-ManilaAll rights reserved. Copyright by MZAG, 2009. Use exclusively for PT 158: Physical Agents iII. Approval and consent from Minerva Zaniebeth A. Gomez and University of the Philippines-Manila required before use for other purposes. ([email protected])
1. Describe Alternating Currents (AC) according to:
• Physical properties• Classification
– Uneven (Faradic currents)– Even (Sinusoidal currents)
Learning Objectives:Learning Objectives:
2. Identify the physiological effects and therapeutic effects of:a. Uneven ACb. Even AC
3. Differentiate the precautions/ contraindications of:a. Uneven ACb. Even AC
4. Select appropriate treatment parameters for indicated cases/ conditions.a. Uneven ACb. Even AC
5. Describe Functional Electrical Stimulation and its therapeutic uses.
6. Select appropriate treatment parameters when using FES for different cases/ conditions.
7. Appreciate evidence on the use of FES
ALTERNATING CURRENT ALTERNATING CURRENT
FARADIC Uneven AC
SINUSOIDAL Even AC
Cont. Interrupted
Freq:50 HzPD: 1 ms
Freq: 50 HzPD: 10 ms
Cont. Interrupted
Alternating Current• Periodic changes of the direction
of electron flow in a rhythmic manner NO NET ion transfer
• Frequency used medically is 50 Hz
Alternating Current• Not possible to cause burns,
unless in high intensities• Surged or unsurged
Uneven AC/ Faradic• Two phases• PD: 1 ms• No polarity
needed• Surged• Mild prickling
sensation
• NO chemical effects• Similar to physiological effects of
faradic type currents• Indication and contraindication is
the same with faradic-type currents/ SIDC
Uneven AC/ Faradic
Even AC/ Sinusoidal• Sine curve• PD: 10 ms• Surged or unsurged• No polarity needed
• Indication: Swelling and pain EXCEPT referred & psychosomatic type
• Contraindication: Skin lesion, Infection, Impaired sensation
Indications and Contraindications
• Sensory nerves: Marked prickling sensation longer duration
• Motor nerves: Tetanizes, with a sequence of contraction followed by relaxation
• NO chemical effects
Physiological Effects
• Swelling: Absorption of exudate• Circulation: Superficial
vasodilation via axon reflex (capillary vasodilation) hyperaemia
Physiological Effects
• Facilitate muscle contraction• Re-educate muscle action• Train new muscle action• Exercise for paralyzed muscles• Hypertrophy• Increase strength• Improve circulation • Prevent and loosen adhesions
Therapeutic Effects of Even and Uneven AC
Functional Electrical Stimulation• Functional NMES• Used for: -disuse atrophy
- impaired ROM - ms spasm - ms reeducation - spasticity - supplement to orthotic devices
FES for Shoulder Subluxation
• Waveform: Asymmetrical biphasic square
• Modulation: Interrupted
FES for DF Assist in Gait Training• Waveform:Assymetrical biphasic square
• PD: 20-250 µsec• Modulation:
interrupted by foot switch
FES for Scoliosis Management
• Selection Criteria:– Curves measuring 20-45 deg. (Cobb)– At least 1 year of spinal growth
remaining– An idiopathic and progressive nature
of the curve– Cooperative and psychologically
stable– Compliant and tolerant to stimulation
Evidence in Practice
Pomeroy V. M., King, L., Pollock, A., Baily-Hallam, A., and Langhorne, P. (2006). Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003241. DOI:10.1002/14651858.CD003241.pub2.
Can FES help improve UE motor recovery of a patient at acute-subacute phase post-stroke?Minerva Zaniebeth A. Gomez, PTRP, PT 158 faculty AY 2008-2009(
[email protected]), Ma. Liezel Bumanglag, Justine Charlotte Garcia, Marinelle Rabang, Michiko Alla Uy
FES of hand extensors
Evidence in Practice
• There is significant change in upper extremity function with the use of electrical stimulation compared to no treatment.
• Low internal validity (single studies) low power
Evidence in Practice
• Wide confidence interval crosses zero point
• Heterogenous settings of parameters used “FES” loosely used term among PTs.
References:References:Gersh, M. R. (1992). Electrotherapy in
Rehabilitation. USA: F.A. Davis Company.Hecox, B., Mehreteab, T. A., & Weisberg, J.
(1994). Physical Agents: A Comprehensive Text for Physical Therapist. Appleton & Lange.
Wadsworth, H., & Chanmugam, A. (1988). Electrophysical Agents in Physiotherapy. Singapore: Science Press.
Revised ACDC lecture of Ms. Jazel Ann Atienza, PTRP