Electrotherapy
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Electrotherapy is the use of electrical energy in the treatment of impairments of health and a conditions of abnormal functioning. <ref> Institute of Electrical and Electronics Engineers, "The IEEE standard dictionary of electrical and electronics terms". 6th ed. New York, N.Y., Institute of Electrical and Electronics Engineers, c1997. IEEE Std 100-1996. ISBN 1-55937-833-6 [ed. Standards Coordinating Committee 10, Terms and Definitions; Jane Radatz, (chair)] </ref> It is basically composed of the use of electric currents, referred to by the IEEE as "Tesla currents" <ref> IEEE, "The IEEE standard dictionary of electrical and electronics terms".</ref>, in therapeutic applications.
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[edit] History
Historically, in its first experiments by researchers, electrical stimulation was used to activate electrically excitable tissues and read muscle and nerves. Other experiments more than a century ago, by such pioneers as Nikola Tesla<ref> Rhees, David J., Electricity - "The greatest of all doctors': An introduction to `high frequency oscillators for electro-therapeutic and other purposes". Proceedings of the IEEE. Vol. 87, no. 7, pp. 1277-1281. 1999 ISSN 0018-9219 </ref> <ref> Tesla, Nikola, "High Frequency Oscillators for Electro-Therapeutic and Other Purposes". 1898-09-13. (ed., available from tesla.hu) </ref>, investigated the health benefits of this field (and what whould become known as medical diathermy). Today electrotherapy has developed into a whole area of diagnosis and treatment in physiotherapy. The various modern applications includes stimulation of tissue with the objective of healing or restoring a lost function.
The exact mechanism of electrical stimulation’s beneficial effect remains controversial. Electrical stimulation may directly block transmission of pain signals along nerves. In addition, electrical stimulation has been shown to promote the release of endorphins, which are natural painkillers produced by the body.
Several different electrical stimulation devices exist, each producing different frequencies, waveforms, and effects. Electrical modalities include
- Transcutaneous Electrical Nerve Stimulation (TENS) (the most commonly used)
- Interferential Current (IFC)
- Galvanic Stimulation (GS)
[edit] Transcutaneous electrical nerve stimulators (TENS)
The patient may use a TENS unit at home for pain relief on a long-term basis. TENS units are about the size of a pack of cigarettes and typically cost $250 - $700. All units allow the user to adjust the intensity of the stimulation; some units also allow the user to select high-frequency stimulation (60 - 200 Hz) or low-frequency stimulation (<10 Hz).
High frequency stimulation, sometimes called "conventional", is tolerable for hours, but the resultant pain relief lasts for a shorter period of time. Low-frequency stimulation, sometimes called "acupuncture-like", is more uncomfortable and tolerable for only 20-30 minutes, but the resultant pain relief lasts longer.
TENS users should experiment with various electrode placements. Electrodes can be placed over the painful area, surrounding the painful area, over the nerve supplying the painful area, or even on the opposite side of the body. TENS users need to try the unit for several days with several electrode placements prior to deciding if it will be useful. A home trial for several days to weeks is preferable.
[edit] Interferential current (IFC)
Interferential current is essentially a deeper form of TENS. In essence, IFC modulates a high frequency (4000 Hz) carrier waveform with the same signal produced by a TENS unit. The high frequency carrier waveform penetrates the skin more deeply than a regular TENS unit, with less user discomfort for a given level of stimulation. Deep in the tissues, the carrier waveform is cancelled out, resulting in a TENS-like signal deep under the skin.
Anecdotal evidence suggests that the IFC units may be useful for patients who have not had relief from TENS. However, IFC devices tend to be more expensive than TENS units.
[edit] Galvanic stimulation (GS)
Galvanic stimulation is most useful in acute injuries associated with major tissue trauma with bleeding or swelling. In contrast to TENS and IFC units, which apply alternating current, galvanic stimulators apply direct current.
Direct current creates an electrical field over the treated area that, theoretically, changes blood flow. The positive pad behaves like ice, causing reduced circulation to the area under the pad and reduction in swelling. The negative pad behaves like heat, causing increased circulation, reportedly speeding healing.
[edit] Applications and fields
Various cells in the body are influenced by electricity, these include fibroblasts, macrophages, neutrophils and erythrocytes, along with bone, cartilage, ligaments and tendons. It is believed that stimulating these cells can promote healing in injured tissue.
Electrotherapy, in the form of transcutaneous electrical nerve stimulation (TENS) is increasingly used in the management of certain types of pain, although there is still much debate regarding its actual effectiveness. Some research has reported TENS to be as much as 65% effective in reducing pain in acute injuries.
Other forms of electrotherapy include Scenar, Ultrasound (US), Pulsed Shortwave Diathermy (PSWD), Interferential Therapy (I/F), TECAR therapy, Laser Therapy and Combination therapy.
Proponents of electrotherapy argue that the different modalities affect different tissues, e.g. ultrasound affects small areas such as ligaments and tendons and has no effect on muscles. Pulsed shortwave, however, can have a therapeutic effect on muscles.
From a treatment perspective, the questions with electrotherapy are related to the type of injury (sprain, haematoma, fracture, etc.) and the stage the injury is at (acute, repair phase, remodeling phase). From that position we must decide what type of cells we want to stimulate and what is the best way to influence them.
[edit] See also
[edit] References and notes
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[edit] External links and articles
- Further readings
- Watkins, Arthur Lancaster, "A manual of electrotherapy.". 2d ed., thoroughly rev. Philadelphia : Lea & Febiger, c1962. 272 p.
- Scott, Bryan O., "The principles and practice of electrotherapy and actinotherapy". Springfield, Ill., C.C. Thomas, c1959. 314 p. LCCN 60004533 /L
- Neuroelectric Conference (1969 : San Francisco, Calif.), " Neuroelectric research; electroneuroprosthesis, electroanesthesia and nonconvulsive electrotherapy". Editor, David V. Reynolds and Anita E. Sjoberg. Springfield, Ill., Thomas, 1971. LCCN 75115389 (ed. Selected papers presented at the 1969 Neuroelectric Conference, the second annual conference of the Neuroelectric Society.)
- Websites
- Electrotherapy on the Web Tim Watson's website on electrotherapy, containing in-depth discussion and dose calculations.
- The Turn of The Century Electrotherapy Museumde:Elektrotherapie
