Clinical applications of Ultima IFT4160 Interferential Therapy unit

Transcription

1 Tenscare Ltd 9 Blenheim Road, Epsom, Surrey KT19 9BE United Kingdom Tel Fax painaway@tenscare.co.uk Rev 1.2 3/06 Copyright Tenscare Ltd Clinical applications of Ultima IFT4160 Interferential Therapy unit

2 Contents Page No How interferential therapy works 1 Two Pole and four pole modes 2 Frequency and Program Selection 3 Interferential Therapy as part of a whole treatment Positioning the electrodes Treatment Protocols Rheumatic Conditions (B Savage) Osteoarthritis of the hip joint (B Savage) Osteoarthritis of the knee joint Ankylosing Spondylitis Treatment of Recent Injuries Post-Operative Pain and Edema of the Knee Back Pain Knee-ACL Repair/reconstruction Epicondylitis (Tennis & Golfer s Elbow) Ankle injuries 1 Interferential Therapy works Many users will be familiar with TENS, which delivers intermittent pulses to stimulate surface nerves and block the pain signal. Unlike TENS, Interferential Therapy delivers a continuous stimulation deep into the affected tissue. IFT achieves this deep penetration by using a 4000Hz carrier wave to overcome the skin impedance. TENS signals travel around the top 1cm of the skin surface. IFT signals travel almost directly between the electrodes. Interferential Therapy uses two medium frequency 4000Hz currents that interfere with each other to produce a beat frequency that the body recognises as a low frequency energy source. The range of this beat frequency is usually 1 250Hz as experience has shown that these are the most effective therapeutically. In addition to providing pain relief by the same mechanism that TENS uses, most physiotherapists consider that IFT s major role is to accelerate the inflammatory or healing rate. IFT is believed to work by passing currents across cell membranes; these currents vary depending upon the tissue involved. By using particular frequencies in the range, different systems within the body can be stimulated or used to increase the blood supply, which in turn hastens the healing rate. IFT is used to treat almost any condition where inflammation is a problem. For example, sports injuries; arthritic conditions; bruising and swellings, back pain, osteo arthritis, rheumatoid arthritis, muscular pain 2

3 Two pole and Four Pole Modes In theory, the interference current described above is generated in the pattern shown in the diagram. In practice, the tissues do not conduct uniformly, so the currents rarely interfere in the expected target area. Therapists commonly use moveable electrodes to hunt for the best electrode positions. This is a real problem for unskilled home use. Many patients find just positioning and connecting up four electrodes a problem, without having to optimise the position. 4 pole interference pattern Frequency and Program Selection Different frequencies are thought to have the following effects: 2Hz Around this frequency the metencephalins are stimulated which will result in short term pain relief. 10Hz This frequency has a beneficial effect on the immune system and tends to make patients wakeful yet relaxed. 130Hz This frequency stimulates the production of endorphins and results in longer term pain relief and some local anaesthesia Hz This frequency sweep will increase the inflammatory rate Hz This frequency sweep will depress the sympathetic nervous system so allowing increased activity of the parasympathetic system, and increase the blood supply. Some expensive machines use vectored fields. These are a partial solution to this problem as they constantly move the interference zone around the volume between the electrodes, but this means that treatment is only delivered to the affected area for part of the treatment time. In Bipolar mode, the Ultima IF4160 overcomes these problems Early IF units used analog circuits, and were limited in the waveforms they could produce. Ultima IF4160 uses digital waveform generation to produce true sinusoidal bipolar IF. It uses a 4000 Hz carrier wave, but delivers an amplitude modulated low frequency signal to the whole area between the electrodes, not just the interference pattern. Occasionally it is difficult to position the electrodes to cross the area of interest. In these circumstance, it may be possible to use the 4 pole positioning to deliver therapy to the right place. 3 Bi-Polar treatment area IF 4160 Programs are as follows: Program Characteristic Brief Description of Output No. of Output 1 Constant 2 to 160bps. Adjustable 2 Sweep Hz Ramped Frequency Modulation in 12- second cycle 3 Sweep Hz Ramped Frequency Modulation in 20- second cycle 4 Sweep ω-2ω-ωhz Ramped Frequency Modulation in 12- second cycle, where ω is the selected beat frequency 5 Abrupt The beat frequency changes abruptly between the selected value (i.e. ω) & +200% of it (i.e. 2ω) every 1 second. The total cycle repeats in 2 seconds. 6 Abrupt The beat frequency changes abruptly between the selected value (i.e. ω) & +200% of it (i.e. 2ω) every 6 seconds. The total cycle repeats in 12 seconds. 4

4 Interferential Therapy as part of a whole treatment The use of IFT should be considered a part of the whole treatment of the condition. The whole treatment may include: - exercises to stretch injured muscles - exercises to move stiff joints - exercises to strengthen muscle groups to support the joints and your physiotherapist will advise you accordingly. Stiff joints are invariably painful so it is important to appreciate that gentle movement is generally better than resting. A TENS unit, which also treats pain using electrotherapy but in a different way, can be used simultaneously if you need extra pain control to enable you to keep the joints or muscles moving. If you are interested in knowing more, please speak to your physiotherapist. Positioning the Electrodes This section is divided into (a) Joints, and (b) Muscles & Ligaments. It identifies the best positions for treating specific areas of the body. As a general guide, the source of the pain should be in a straight line midway between the electrodes. Two pole mode Four pole mode Ch 1 Ch 2 Ch 1 The diagrams shown in this manual illustrate the positioning for 2 Pole mode. For 4 pole mode, use the second pair of electrodes at right angles to these. 5 6

5 Positioning the Electrodes a) Joints (listed alphabetically) Ankle - on either side, under the ankle bones; or - from front to back of the ankle joint Positioning the Electrodes cntd. Back - midway (between the shoulder blades) - on either side of the spine at the painful level - or down the spine from above to below the painful area Back - low - either side of the spine at the painful level; or - down the spine from above - to below the painful area Elbow - from front to back of the elbow 8 7

6 Fingers - wrap the electrodes around the fingers concerned Hand - from front to back of the wrist; or - from front to back of the palm Foot - from the top of the foot to the sole Hip - from mid groin to mid buttock; or - from the side of the hip to the upper, inner side of the thigh 9 10

7 Knee (front) - from below the kneecap to the back of the knee; or - from above the kneecap to the back of the knee; or - from above the kneecap to below the kneecap Neck - on either side of the spine; or - on either side of the neck, between the neck and shoulder Knee (within) - from front to back of the knee Shoulder - from front to back of the shoulder; or - from the top of the shoulder to a third of the way down the arm 11 12

8 Toes - from the top to the underneath of the toes; or - wrapped around the toes, in the same way as for the fingers Treatment Protocols Rheumatic Conditions (Ref: B Savage, Interferential therapy) Application Interferential therapy can be used effectively in the acute and chronic stages of rheumatoid arthritis, in osteoarthritis and spondylitis. Wrist - from front to back of the wrist Rheumatic Conditions: Acute phase (joints are red, shiny and swollen.) Aims of Treatment: Relief of pain Decrease of inflammation Increase of range of movement. (b) Muscles & Ligaments Place one electrode on the injured site, and one close UNLESS there is marked bruising in which case place the electrodes on either side of the area and not on top. Settings Program 1: Constant, Frequency: 130 Hz, Timer: Start at 15 minutes and gradually increase to 30 minutes Level: A comfortable tingling intensity but short of producing any contraction. Treatment Duration The relief may be short lived at first, but treatment is repeated daily and freedom from pain increases at each treatment

9 Treatment Protocols - cntd. Rheumatic Conditions : Chronic phase Aims of Treatment: Relief of pain Decrease of inflammation Increase of range of movement. First half of treatment Settings Program 1: Constant, Frequency: 130 Hz, Timer: 15 minutes Level: A comfortable tingling intensity but short of producing any contraction. The relief may be short lived at first, but treatment is repeated daily and freedom from pain increases at each treatment. Second half of treatment Settings Program 4: Sweep, Frequency: Set to 50 Hz, Timer: 15 minutes Level: The intensity of current is such that it just fails to produce a contraction for the constant treatment, but during the sweep produces a contraction only as the optimum frequency for stimulation of the motor nerves is reached, followed by relaxation for the rest of the cycle. Treatment Protocols - cntd. Osteoarthritis of the hip joint (Ref: B Savage, Interferential therapy) Aims of Treatment Reduce pain Increase blood flow Electrode Position: Four pole mode illustrated Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. Program 1 Constant, Frequency 130 Hz, Timer - 15 minutes Program 3 Sweep, Frequency Hz, Timer - 15 minutes 15 16

10 Treatment Protocols - cntd. Treatment is given two or three times a week for 12 treatments. Daily treatment is not necessary, but once a week is ineffective. After 12 treatments the patient should cease attending for a month to prevent him becoming over-tired. After treatment the patient should rest for at least 15 minutes, preferably longer, and undertake no severe exercises for at least an hour. The longer the rest period, the longer the relief of pain will last. If an exercise class is to be undertaken this must precede, not follow, treatment. Immediately after treatment the patient has less pain and the range of movement is increased. This may last only a short time at first but is more prolonged after each treatment. Osteoarthritis of the Knee Joint Application Non-surgical approach in conjunction with other therapies Post-op procedures Aims of Treatment Reduce pain Increase blood flow Treatment Protocols - cntd. Electrode Position: With the knee joint, some patients find that treatment with the two-electrode method is more effective. Here, one pad is placed over the most painful area and the other directly opposite directing the current straight through the joint. The patient usually reports that the current is 'picking out the painful spot'; if he does not the electrode is moved until he does. The increased pain dies away after a few minutes and relief persists after treatment. Program 1 Constant, Frequency 130 Hz, Timer - 15 minutes Program 3 Sweep, Frequency Hz, Timer - 15 minutes Some patients, even in the chronic stage, find relief from the constant current but increased pain if any sweep is introduced. In this case the whole treatment, 15 minutes, is given with the constant current and a good result is obtained but more slowly

11 Treatment Protocols - cntd. Ankylosing Spondylitis Application Relieving the persistent aching of ankylosing spondylitis. Interferential therapy must be combined with exercises which encourage extension, performed either before or some hours after the treatment. Pain is reduced and range of movement improved. Program 1 Constant Frequency 130 Hz Timer - 15 minutes Program 3 Sweep Frequency Hz Timer - 15 minutes Level - Set just short of producing a contraction Treatment is given three times week for a month, followed by a rest of two or three weeks. Most spondylitic patients require treatment two or three times a year. Treatment Protocols - cntd. Treatment of Recent Injuries Examples: Sprained left ankle, Ruptured fibres of calf muscle, Strained medial ligament of knee, Tennis elbow Overview Treating the pain that accompanies a soft-tissue sports injury sometimes requires a delicate balancing act: making the patient comfortable enough to comply with rehabilitation- -or, in some instances, to return to play--without nullifying pain's protective function. The first step is to minimize swelling and related discomfort by using rest, ice, compression, and elevation immediately after injury. In the postacute stage, the patient's symptoms and activity level will guide the choice of pain-control options. From the sprained ankle of a recreational basketball player to the masticated ear of heavyweight boxer Evander Holyfield, sports and acute soft-tissue pain all too often go hand in hand. And the decision about appropriate pain control falls squarely to the physician. TENS has been used successfully to treat pain associated with fractures, surgery, and acute nerve injuries. For chronic knee, shoulder, ankle, or back pain, a deeper form of electrical stimulation--interferential current--can sometimes yield good results. Show patients how to use the stimulator at the office, then prescribe units they can use at home as needed. "When you can give an athlete a sense of being in control of the pain, it hurts a lot less. "Ref : James S. Thornton THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO OCTOBER

12 Treatment Protocols - cntd. Treatment of Recent Injuries - Relief of pain Application Relief of pain is of first importance not only as an end in itself but because pain produces spasm, unnatural movement and production of further strains. However, it must not be forgotten that spasm may be protective and its removal may leave the injured structure open to repetition of the original injury. Therefore when spasm has been relieved, support must be given with bandage or strapping to prevent uncontrolled or excessive range of movement. Aims of Treatment Reduce pain Use the maximum current the patient can tolerate for three minutes. Program 4 Sweep, Frequency 70 Hz, Timer - 15 minutes Level Same as first half To produce the most rapid and satisfactory result,start treatment as soon as possible. There appears to be no danger of increasing bleeding or bruising. Daily treatment is given until the pain does not return significantly between treatments, then dropped to alternate days. After treatment avoid prolonged exercise for at least an hour. The longer the period of rest between treatment and exercise, the longer the freedom from pain will last. Electrode Position: Four-electrode method:; Two electrodes are placed immediately above and two below so that the currents cross at the site of injury. Program 1 Continuous, Frequency 130 Hz, Timer - 15 minutes Level Definite prickling sensation well within patients tolerance. If a single point of acute tenderness can be located, a strong dose may be given to anaesthetise the part but this may well not be indicated at the first treatment

13 Treatment Protocols - cntd. Treatment of Recent Injuries - Reduction of bruising and swelling Application Reduction and/or removal of bruising and swelling, with minimum delay, is important because organisation of the exudate leads to the formation of adhesions and impairment of function. Since no passive congestion is produced by interferential therapy it is possible to institute treatment immediately after injury without risk of haemorrhage. If the skin is broken there is no increase of exudate, but care must be taken to avoid introducing any infection. Settings Program 1 Constant, Frequency 130 Hz, Timer - 15 minutes Level: Set at maximum comfort level Program 3 Sweep, Frequency Hz, Timer -15 minutes Level Just sufficient to produce contraction at lower frequencies Treatment duration The colour of the bruise will be seen to change from the first treatment, though deep and extensive bruising, or a haematoma, may take several weeks to disperse. Treatment Protocols - cntd. Post-Operative Pain, Edema, and Range of Motion of the Knee (G. J. JARIT ET AL. 18 Clin J Sport Med, Vol. 13, No. 1, 2003) Application Chondroplasty /Menisectomy Aims of Treatment Electrode Position: Across the joint Reduce pain / Reduce edema /Increase range of motion Program 2 Sweep, Frequency 2-10 Hz, Timer - 15 minutes Program 4 Sweep, Frequency 80Hz (sweep to 160Hz), Timer - 15 minutes 3 times daily for 7-9 weeks

14 Treatment Protocols - cntd. Back Pain Application: Non-surgical approach in conjunction with other therapies. Post-op procedures Aims of Treatment: Reduce pain and increase blood flow Electrode Position: Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. First Half of Treatment Program 4- Sweep, Frequency 70 Hz, Timer - 15 minutes Program 4 Sweep, Frequency 10 Hz, Treatment Period - preset 15 minutes Combined (40) minute treatment three times daily Suggested treatment period: one to three months Epicondylities ( Tennis & Golfer s Elbow) Application: Post-op procedures Non-surgical approach in conjunction with other therapies Aims of Treatment: Reduce pain and increase blood flow Electrode position: Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. Program 4 Sweep, Frequency 70 Hz, Timer - 15 minutes Program 5 Abrupt, Frequency 5 Hz, Timer - 15 minutes Combined (40) minute treatment three times daily Suggested treatment period: one to three months 25 26

15 Ankle Injuries (conservative, non-surgical approach) Application: Non-surgical approach in conjunction with other therapies Inversion, eversion and lateral rotation injuries Sprains/strains and contusions / Tenosynovitis Aims of Treatment: Reduce pain and increase blood flow Electrode Position: Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. Program 4 Sweep, Frequency 70 Hz, Timer- 15 minutes Program 4 Sweep, Frequency 5 Hz, Timer- 15 minutes Combined (30) minute treatment three times daily Suggested treatment period: one to three months Ankle surgery (Post Op) Application: Post-op procedures Aims of Treatment: Reduce pain and increase blood flow Electrode Position: Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. Program 4 Sweep, Frequency 70 Hz, Timer- 15 minutes Program5 Abrupt, Frequency 5 Hz, Timer- 15 minutes Combined (30) minute treatment three times daily Suggested treatment period: one to three months 27 28

16 Carpal Tunnel Application: Post-op procedures Non-surgical approach in conjunction with other therapies Aims of Treatment: Reduce pain and increase blood flow Electrode Position: Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. Program 4 Sweep, Frequency 70 Hz, Timer- 15 minutes Program5 Abrupt, Frequency 5 Hz, Timer- 15 minutes Combined (30) minute treatment three times daily Suggested treatment period: one to three months Plantar Faciitis Application: Non-surgical approach in conjunction with other therapies Aims of Treatment: Reduce pain and increase blood flow Electrode Position: Current should cross so that most of the stimulation is felt in the area of pain. Placement adjustments may be made to allow for surgical site, density of tissues, underlying nerve position, etc. Program 4 Sweep, Frequency 70 Hz, Timer- 15 minutes Program4 - Sweep, Frequency 5 Hz, Timer- 15 minutes Combined (30) minute treatment three times daily Suggested treatment period: one to three months 29 30

17 Limitations of Advice These protocols are derived from clinical advice derived from practical experience. They are not the results of controlled, peer reviewed, research, and should be treated as general guidance only. Interferential Therapy should not be commenced before the cause of the problem has been properly diagnosed by a medical practitioner. Safety Information. Indications Interferential stimulators are used for the symptomatic relief and management of chronic (long-term) intractable pain and as an adjunctive treatment in the management of postsurgical and post-traumatic acute pain problems. Contraindications Interferential stimulators can adversely affect the operation of demand-type cardiac pacemakers. It is not recommended for patients with known heart disease without a physician s evaluation of risk. Do not stimulate over the eyes or carotid sinus nerves. Do not apply interferential stimulators for undiagnosed pain syndromes until etiology is established. Do not place electrodes in a manner that causes current to flow transcerebrally (through the head). Warnings Safety of interferential stimulator for use during pregnancy has not been established. Electronic equipment such as ECG monitors and ECG alarms may not operate properly when interferential stimulator is in use. Using this device in proximity to any object that produces an electromagnetic current such as a microwave oven or cellular telephone could affect the performance of the device. The user must keep the device out of the reach of children. Interferential stimulator is for external use only. Use of electrodes and accessories Electrodes used with the device should be no smaller than 3/4 in diameter. Please note that the smaller the size of the electrode used, the greater the intensity of stimulation at the electrode site that increases the likelihood of skin irritation at the site. Only Tenscare Ltd authorized electrodes and accessories are to be used with this device. If you have any questions, please contact your dealer/distributor. Precautions Avoid adjusting controls while operating machinery or vehicles. Turn the stimulator off before applying or removing electrodes. Isolated cases of skin irritation may occur at the site of electrode placement following long-term application. Adverse Reactions It is possible to have allergic reaction to tape or gel. Skin irritation or electrode burn may also be possible