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Physiotherapy II
Electrotherapy
Lecture 1
TENS (Transcutaneous Electrical
Nerve Stimulation)
able to:
application
2
Identify Precautions and
Contents
Introduction
Features of TENS
Applications of TENS
Electrode Placement
4
For palliative care of malignant conditions
Keys principles
Outcome of treatment is based on the:
Knowledge of intent of TENS
application
Dosage
5
Principles of Nerve Fibre
Activation
Initially- stimulation of non-nociceptive
nerve fibres like A-alpha, A beta fibres
which have low threshold of stimulation
causing tingling
TENS
5. Modulated TENS
10
Techniques of TENS application:
1. Conventional or High Frequency
TENS
5. Modulated TENS
11
1. Conventional /High Frequency
TENS
Paresthesia is created without motor
response
12
1. Conventional /High Frequency
TENS
13
Application of High TENS
Pulse rate: high 75-100 Hz (generally
80), constant
14
Techniques of TENS application:
1. Conventional or High Frequency
TENS
5. Modulated TENS
15
2. Low frequency/ Acupuncture like
TENS
Activation of descending pain
suppression pathway activating
endorphins
TENS
5. Modulated TENS
17
3. Brief, Intense TENS:
hyper-stimulation analgesia
Similar to high frequency TENS
18
3. Brief, Intense TENS:
hyper-stimulation analgesia
Treatment time is only 15 minutes, if
no relief then treat again after 2-3
minutes
TENS
5. Modulated TENS
20
4. Burst TENS
Carrier frequency is at a certain rate with a
built in duty cycle
21
4. Burst TENS
Pulses within burst can vary
22
4. Burst TENS- Application
Pulse width: high 100-200 micro
seconds
TENS
5. Modulated TENS
25
5. Modulated Stimulation:
Keeps tissues reactive so no
accommodation occurs
Features of TENS
Applications of TENS
Electrode Placement
27
Precautions and contraindications
USES of TENS
28
Biophysical Effects
Primary use is to control pain through
Gate Control Theory
Various methods
High TENS (Activate A-delta fibers)
Low TENS (release of -endorphins)
Brief-Intense TENS (noxious
29
stimulation to active C fibers)
Common conditions where TENS is
used
Relief of Acute Pain:
Post operative pain
Labour pain
Dysmenorrhoea
Angina Pectoris
Orofascial pain, dental procedures
Physical trauma- fracture ribs, minor
medical procedures
30
Common conditions where TENS is
used
Relief of Chronic Pain:
Low back pain
Arthritic pain: RA, OA
Myofascial pain
Neuropathic pain- trigeminal neuralgia,
phantom pain, post-herpes pain
Cancer pain
CRPS (Complex Regional Pain
syndrome)
31
Other conditions where TENS is
used
Non-analgesic effects:
Reducing symptoms of Alzheimers
dementia
Neuromuscular stimulating effects
Faecal and urinary incontinence
Antiemetic effects:
Morning sickness, motion sickness, post
chemotherapy, nausea due to other drugs
Improving blood flow
Wound healing/ Fracture healing
Raynauds disease
32
Electrode placement
33
Electrode Placement:
Directly over painful sites: trigger points
Dermatomes, Myotomes
Accupunture points
Horizontal or vertical
34
Electrode Placement:
35
Contraindications:
Pacemakers
Malignancy
Over carotid sinus (vasovagal reflex)
Pregnancy
Active infections, Skin conditions
Areas over impaired or absent sensation
Cardiac conditions- arrhythmia
Neurological conditions: epilepsy, stroke
Non-cooperative patients
36
Precautions/ side effects:
Dysaethesia
Contact dermatitis
Autonomic reactions- nausea, dizziness,
fainting
37
Summary
Uses of TENS
Precautions/ Contraindications
38
References
Tim Watson. Electrotherapy: Evidence Based
Practice. 2008. Churchill Livingstone. 12th
edition.
Joseph Kahn. Principles and Practice of
Electrotherapy. 2000. Churchill Livingstone.
4th Edition.
John Low, Ann Reed. Electrotherapy
Explained. Principles and Practice.
Butterworth Heinemann. 3rd Edition.
Forster and Palastanga. Claytons
39
Electrotherapy Theory and Practice. Aitbs
Publishers. 9th edition