Electrical Stimulation

Motor points and Application

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Motor Points of Axillary Nerve

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Motor Points of Musculocutaneous nerve

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Motor Points of Radial Nerve

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Motor Points of Median Nerve

LOAF

� Lumbricals 1 & 2,

� Opponens pollicis,

� Abductor pollicis

brevis and

� Flexor pollicis brevis.

1 & 2

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Motor Points of Ulnar Nerve

3 & 4

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Motor Points of Femoral Nerve

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Motor Points of Sciatic Nerve

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Motor Points of Tibial Nerve

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Motor Points of Sup. peronei Nerve

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Motor Points of Deep peronei Nerve

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Motor Points of Facial NerveTemporal Br.

� Frontalis

� Orbiclaris Oculi

� Corrugator Supercilii

Zygomatic Br.

� Orbiclaris Oculi

Buccal Br.

� Risorius

� Buccinator

� Levator Labii Superioris

� Levator anguli oris

� Nasalis

� Orbicularis oris

Mandibular Branch

� Mentalis

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Motor Points of Facial Nerve

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Motor Points of the Back

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PRINCIPLES OF APPLICATION

LOW FREQUENCY

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Receiving the patient

� Greet the patient & introduce yourself.

� Develop a good rapport with the patient.

� Provide them a comfortable position to

sit/laydown

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Case sheet reading/History Taking

� Name: Identification of the patient

� Age: Modulation of treatment (Adult/Old )

� Sex: Provide privacy (Male/Female)

� Occupation: Correlate the symptoms/signs of the patient for

ergonomic advice if applicable

� Chief Complaints: Generation of problem list

� Side: Right or Left side of the involvement.

� Site: Specific area/region to be treated

(Anterior/Posterior/Medial/Lateral)

� Duration of the condition: Acute/Sub-acute/Chronic (Treatment

planning & Setting)

� Diagnosis: Condition of the patient

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General contraindications

� Hyperpyrexia

� Epilepsy

� Severe renal and

cardiac problems

� Cardiac pacemakers

� Severe Hypotension

and hypertension

� Infections

� Pregnant women

� Metal Implants

� Mentally retarded

patients

� Mentally upset

patients

� Malignancy

� Eyes

� Anterior aspect of

neck & carotid sinus

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Tray Preparation

� Skin Resistance Lowering Tray � Pillows

� Cotton

� Soap

� Towel

� Mackintosh

� Kidney Tray

� Petroleum jelly or Vaseline

� U – pin (sharp & blunt)

� Clips

� Bowel of water

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Tray Preparation

Treatment Tray

� Pillow

� Towel

� Bed sheet

� Cotton

� Adhesive tapes

� Straps

� Salt

� Powder

� Scissor

� Paper

� Graph paper

� Pencil

� Eraser

� Scale

� Crepe bandages

� Machine & accessories

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Local Contraindications

� Open wounds

� Scars

� Local skin infections

� Cuts

� Abrasions

� Eczema

� Localized haemorrhagic spots

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Skin sensitivity testing

� With the patient's eyes

closed, alternate

touching the patient

with the needle and the

brush at intervals of

roughly 5 sec

� instruct the patient to

tell the therapist if they

notice a difference in

the strength of

sensation on each side

of their body.

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Testing of equipment & Demonstration

� This is to gain the self-confidence & cooperation of the patient for

the treatment.

� Check for mains output by using the tester, look for any frayed part

of power cords, integrity of cables & electrodes.

� Verify that all the knobs/controls in the apparatus are at zero.

� Connect the machine power cord to the mains (220/110 Volts) &

switch on the mains..

� Switch on the machine by turning on the power knob/switch of the

machine.

� Set the timer

� Keep your index and middle fingers on active and indifferent

electrodes to check whether the machine is working or not.

� Demonstrate a muscle contraction to the patient by placing the

electrodes on therapist’s hand.

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Positioning of the patient

� Place patient in a well-supported, comfortable &

relaxed position.

� Use adequate pillows, towels & bed sheets.

� Expose the body part to be treated, have patient

remove all jewelry from the area.

� Drape the untreated part of the patient to

preserve modesty, protect clothing, but allow

easy accesses to the body part.

� If possible give the position in which patient can

see the treatment.

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Positioning of the Therapist

� Appropriate walk stand position

� The therapist should be close to the

machine for operating the machine & also

near to the affected side of the patient.

� If possible the therapists should position

herself so as to observe the face of the

patient.

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Preparation of the part to be treated

Skin Resistance Lowering

� Uncover the part to be treated

� Clean the area with water & soap to

remove any oil/cream/gel/dust

� Use mackintosh and then towel for

supporting and wiping off the water.

� Wipe the treatment area periodically with

saline water for better current conduction.

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Instructions & Warning to the patient

Instruct the patient,

� NOT TO move the treatment part,

� NOT TO touch the power cord & the generator,

� NOT TO sleep during the treatment.

� Inform the patient that he/she should feel a mild prickling

sensation;

� if it is too intense should immediately report to the

physiotherapist.

� If there is any burning sensation immediately inform the

therapist, as it might lead to burn.

� Inform if the position is not comfortable.

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Application of Treatment

� Select appropriate method of treatment

� Make sure the power cords are not touching the

patient.

� Select the current.

� Select parameters.

� Set treatment time.

� Gradually increase the current.

� The patient must be observed throughout to

ensure that treatment is progressing

satisfactorily and without adverse effects.

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Termination of Treatment

� Reduce the intensity gradually to zero

� Switch off the machine and the main supply.

� Remove the electrodes and clean the patient.

� Inspect the treated part for any adverse

reactions.

� If there is any mild Erythema, apply powder.

� If it is too severe, summon the physician or

advise the patient to go to the physician.

� Set the next appointment.

� Do winding up procedure.

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Recording

� An accurate record of all parameters of

treatment including

� region treated,

� technique,

� dosage, and

� the resultant effect must be made.

� This is for both follow up assessment

purposes and for legal requirements.

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References

1. Singh J. Textbook of Electrotherapy. 2 edition. Jaypee. 2012. p 94 – 125

2. Forster A, Palastanga N. Clayton’s Electotherapy, Theory ans Practic. 9th Ed. W B Saunders;

2006. p

3. http://en.wikipedia.org/wiki/Radial_nerve

4. http://en.wikipedia.org/wiki/Median_nerve

5. http://en.wikipedia.org/wiki/Ulnar_nerve

6. http://en.wikipedia.org/wiki/Femoral_nerve

7. http://en.wikipedia.org/wiki/Sciatic_nerve

8. http://en.wikipedia.org/wiki/Tibial_nerve

9. http://en.wikipedia.org/wiki/Superficial_fibular_nerve

10. http://en.wikipedia.org/wiki/Deep_fibular_nerve

11. http://www.microsurgeon.org/facialpalsy

12. http://en.wikipedia.org/wiki/Temporal_branch_of_the_facial_nerve

13. http://en.wikipedia.org/wiki/Zygomatic_branch_of_the_facial_nerve

14. http://en.wikipedia.org/wiki/Buccal_branch_of_the_facial_nerve

15. http://en.wikipedia.org/wiki/Marginal_mandibular_branch_of_the_facial_nerve

16. http://informatics.med.nyu.edu/modules/pub/neurosurgery/sensory.html

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THANK YOU