TENS - CONTINUOUS ES - BURST FES - FITFUL
(Transcutaneous Electrical Nerve (Electrical Stimulation) (Functional Electrical Stimulation)
Stimulation)
● continuous pain ● muscle grade: 0 - 1 ● muscle grade: only 2
● frequency: 9 Hz ● frequency: 1-3 Hz ● frequency: 5 Hz
● duration: 15 - 20 min / 1 hour ● duration: 5 - 10 min ● duration: 5 - 10 min
● solid red light ● blinking light ● solid red light on/off
● tingling sensation felt (parang ● Fx: to retard onset of atrophy ● not used if muscle grade is alr 3
langgam na gumagapang) ● tingling sensation felt (parang ● on/off tingling sensation felt
langgam na gumagapang) ● for movement dysfunction
INDICATIONS INDICATIONS INDICATIONS
● post-traumatic or post-surgical ● acute stage of stroke ● foot drop
pain (acute/chronic) (flaccid → spastic → recovery) ● spinal cord injury
● phantom pain ● edema control & reduction (ms ● shoulder subluxation
● causalgia (nerve pain) contraction “milk” edema from ● cerebral palsy
● arthritic pain extremity) ● multiple sclerosis
● low back pain ● healing fracture (electrical current
● neck pain triggers bone growth) RATIONALE
● post-herpetic pain ● spasticity (↓ hypertonicity; ● to improve or restore function of
stimulate antagonist, inhibit movement & ms strength
agonist) improvement
RATIONALE
● to alleviate pain CONTRAINDICATIONS USES
● areas of sensitivity ● if the goal is to restore functional
USES ● epilepsy movements, especially in
● if pain control is the priority ● presence of electronic monitoring neurological cases.
equipment
● cardiac disability
● demand-type pacemakers DO NOT FORGET TO RE-EDUCATE
THE MUSCLE
USES
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● if muscle activation/strengthening
is the goal.
GENERAL CONTRAINDICATIONS PROCEDURE
● Pregnancy (local CI) Check the patient's sensation.
● Anesthesia Pt’s position; proper draping
Palpate first the affected area
● compromised sensation
Connect electrodes to lead wires.
● obese patients Connect lead wires to devices.
● Hemorrhage Put gel on electrodes; inform the patient it’s cold.
● CA If an open wound is present, find for dermatomes
● Thrombophlebitis depleting on the localized pain.
● Active TB 1-2 inches placement of pads/electrodes.
● Young/Old Secure pads with tape.
Perform (TENS, ES, FES)
● Poor skin integrity (local CI)
If TENS - solid red
● exposed metal implants If ES - blinking light
● sites of infection If FES - solid red on/off
INTENSITY: Pt’s tolerance
Check patient every 5 minutes.
CASE 1: Patient X comes to the clinic and is unable to evert his (L) foot after suffering from severe ankle injury. Perform the
appropriate intervention. (ES; peroneus ms - electrodes must be placed on the lateral aspect of leg)
CASE 2: Patient Z complains of difficulty walking. Upon examination, it was discovered that the problem was due to weakness of the
(L) dorsiflexors (MMT ⅖). Perform the appropriate intervention. (FES: tibialis anterior)
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CASE 3: Patient Z comes to the clinic complaining of difficulty in reaching for objects overhead with the (L) UE. Upon assessment, it
was determined that the deltoid of the affected extremity has a muscle grade of ⅖. Perform the appropriate intervention.
(FES; deltoid)
CASE 4: Patient Z comes to the clinic with weakness on (L) shoulder abduction. Patient is observed to have difficulty in initiating
abduction and sustaining the movement. Perform the appropriate intervention. (FES; supraspinatus)
CASE 5:
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NOTE: The frequency and duration of the following is ALREADY FIXED within the machine. You just have to carefully set which
among the three are you going to use.
INTERFERENTIAL CURRENT RUSSIAN / NEUROMUSCULAR FARADIC CURRENT
ELECTRICAL STIMULATION
● frequency: 4000 - 4500 Hz (500 ● for ms strengthening ● sensation felt: tingling sensation
Hz input only) ● no movement required by (parang langgam na gumagapang)
● duration: 10 mins patient ● pads SHOULD NOT BE PLACED
● flow of current: lateral ● frequency: 2500 Hz OVER BONY PROMINENCES
● placement of pads: crossed (4 ● duration: 10 mins
poles) INDICATIONS
● sensation felt: tingling sensation INDICATIONS ● swelling / edema
(parang langgam na gumagapang) ●
RATIONALE
CONTRAINDICATIONS ●
INDICATIONS ●
● pain / ms pain USES
USES ●
CONTRAINDICATIONS (same w/ TENS) ● if muscle activation/strengthening
● pregnancy (local CI, first 3 is the goal.
months) PROCEDURE
● anesthesia PROCEDURE 1. Check the patient's sensation.
● compromised sensation 1. Check the patient's sensation. 2. Pt’s position; proper draping
● obese patients 2. Pt’s position; proper draping 3. Palpate first the affected area.
3. Palpate first the affected area. 4. Place wet pads/sponges; inform
● hemorrhage
4. Place wet pads/sponges; inform the patient it’s wet/cold.
● CA the patient it’s wet/cold. 5. Secure pads with velcro.
● thrombophlebitis 5. Secure pads with velcro. 6. Elevate area to be treated - use
● active TB Ensure NMES/RUSSIAN is to be pillows. (ABOVE HEART)
● young/old performed by the machine; check 7. Perform SPIRAL BANDAGING,
● poor skin integrity (local CI) either E1 or E2. covering the entire part to be
● exposed metal implants 6. Perform. treated.
INTENSITY: Pt’s tolerance 8. Ensure FARADIC CURRENT is to
● sites of infection
7. Check patient every 5 minutes. be performed by the machine;
● pacemaker check either E1 or E2.
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● skin injuries / open wounds 9. Perform.
● epilepsy INTENSITY: Pt’s tolerance
10.Check patient every 5 minutes.
RATIONALE
●
USES
●
PROCEDURE
1. Check the patient's sensation.
2. Pt’s position; proper draping
3. Palpate first the affected area.
4. Put gel on electrodes; inform the
patient it’s cold.
5. If an open wound is present, find
for dermatomes depleting on the
localized pain.
6. CROSSED placement of
pads/electrodes.
7. Secure pads with tape.
8. Ensure INTERFERENTIAL
CURRENT is to be performed by
the machine; check either E1 or
E2.
9. Perform.
INTENSITY: Pt’s tolerance
10.Check patient every 5 minutes.
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SPINAL TRACTION
INDICATIONS (SUBACUTE/CHRONIC) CERVICAL TRACTION LUMBAR TRACTION
● nerve root compression / ● 20-25% of total body weight (¼) ● 45-50% of total body weight (½)
impingement ● not used for patients w/ TMJ ● not used for pregnant women
● disc herniation / protrusion Dysfunction
● for condition involving narrowing of ● duration: PROCEDURE
spine 1. 5 - 10 mins for disk 1. Do history taking.
● spinal stenosis dysfunction 2. Patient should be weighed first to
● DJD 2. 10 - 15 mins for other calculate for the accurate lumbar
● facet joint pathology conditions traction force to be used.
● ms guarding 3. Pt positioning - SUPINE.
● ms spasm PROCEDURE 4. Give patient the kill switch; traction
● osteophyte formation 1. Do history taking. force should only be felt by the
● spinal ligament & other connective 2. Patient should be weighed first to patient.
tissue contractures calculate for the accurate cervical 5. Instruct patient if there’s too much
● subacute joint inflammation traction force to be used. pain felt on the lumbar area, just
● subacute pain 3. Pt positioning - NEUTRAL press the kill switch.
SITTING.
4. Put the ‘white thingy’ under the ❖ Low force on initial treatment to
CONTRAINDICATIONS chin & the other at the occiput. determine the patient’s reaction.
(acute, advanced) 5. Do manual test first; pull should be Disk Involvement - 60 sec on / 20 sec off
● instability of spinal segments felt on the occiput. Joint Involvement - 14 sec on, 15 sec off
● osteoporosis of spine 6. Give patient the kill switch; traction Nerve Root Involvement: 25 - 60
● acute strain / inflammation force should only be felt by the pounds
● aortic aneurysm patient.
● bone diseases 7. Instruct patient na if ever parang
● cardiac / pulmonary diseases mabekbekkel isunan or too much
● fracture pain, just press the kill switch.
● hiatal hernia
● extruded disk fragments Intermittent Traction
● unstable spine ● 20-30 mins; 60 sec on/ 15 sec off
● RA - advanced (pero sa machine, 1 min on/ 1 min
● subluxation off)
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RATIONALE
● ↓ pressure on IV disks Cervical Spine is placed in relative degree
● ↓ pressure on spinal nerve roots of flexion to target specific spinal levels:
● opens facet joints ● UPPER CERVICAL SPINE:
● elongates soft tissue 0-5° FLEXION
● MIDDLE CERVICAL SPINE:
10-20° FLEXION
EFFECTS ● LOWER CERVICAL SPINE:
● ↓ disk protrusion 25-35° FLEXION
● ↓ pain
● ↑ joint mobility
● ↑ soft tissue elasticity
WHIRLPOOL TANK
● uses properties of water s/a INDICATIONS (ACUTE) PROCEDURE
1. Buoyancy (upward force ● edema 1. Proper draping of patient.
exerted by water) ● assisted / resisted ROM 2. Adjust tub height according to
2. Hydrostatic pressure patient’s height.
3. Fluidity If lower extremity is to be treated,
● medicine can be applied CONTRAINDICATIONS the tub should be lower.
● specific gravity: 1.0 ● superficial nerves 3. Position the patient depending on
● duration: 15 - 20 mins ● circulatory insufficiency the goal aimed to be achieved,
● diminished sensation whether to assist or resist ROM.
● cold allergies Grade 1-2: assisted ROM
RATIONALE ● raynaud’s phenomenon Grade 3: pt should perform active
● for pain relief ● PVD ROM
● debridement of scar tissue ● skin anesthesia Grade 4-5: resisted ROM
● loosen scar tissue ● open wounds / skin conditions 4. Turn on the jet, adjust such thing if
● infection needed.
Jet Increases: Counterclockwise
Jet Decreases: Clockwise
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