Electrotherapy Modalities | Various Advanced Physiotherapy Interventions for Pain Management

In the world of physiotherapy, an electrical modality is considered a kind of therapeutic agent that helps physiotherapists in rendering treatment to their patients. Electrical modalities are a series of tools that a physiotherapist commonly uses with other physiotherapy tools like exercises, manual therapy techniques, patient education, and advice for treating an injury, ailment, or deformity. These electrical modalities use the administration of thermal, mechanical, electromagnetic, and light energies for therapeutic purposes. The use of these machines is widely based on the condition being treated. The physiotherapist prefers methods and emerging technologies that can help the patient to lead a quality life. In this blog, we aim to discuss a few of the electrical modalities that are often used for therapeutic purposes.

 

Electrotherapy

Electrotherapy or Therapeutic modalities are also known as electrophysical modalities as they create physiological therapeutic effects. Electrotherapy uses electrical signals that interfere with the transmission of neural pain signals into the brain. It slows down or distracts the message from the nerve to the brain, affecting one's Pain Gate. Electrotherapy can also involve the use of this electric current to speed up the healing process where tissue damage has also occurred.  Given below are the benefits of electrotherapy and its different forms.

• Pain relief.
• Reduces inflammation.
• Improves circulation.
• Increases ROM.
• Reduces edema.
• Tissue healing.
• Enhances muscle activation.
• Scar tissue remodeling.
• Skin condition treatment.
• Decrease unwanted muscular activity.
• Preservation of strength after trauma or surgery.

 

Thermotherapy

Thermotherapy includes superficial heat and deep heat.

Superficial heat:

Superficial heat induces a temperature increase and physiologic changes to the superficial layers of the skin, tissues, fat, muscles, ligaments, tendons, blood vessels, nerves, and joints. Superficial heat penetrates up to usually less than 1 cm. Whereas the deep heat penetrates up to about 3-5 cm. Commonly used superficial heat modalities include hot packs, heating pads, paraffin baths, ultrasound, infrared, and fluid therapy. High temperature provides pain relief, increases local blood flow, metabolism, and elasticity of connective tissues, and subsequently may induce edema and exacerbate acute inflammation.

Deep Heat

Deep heat modalities include therapeutic ultrasound (US), shortwave diathermy (SWD), and microwave diathermy (MWD). Ultrasound is the most commonly used deep heating agent. Heat penetrates up to 3-5 cm or more without overheating underlying subcutaneous tissue or skin.

 

Cryotherapy

Cryotherapy or cold therapy includes cold packs, ice massage, cold baths, vapor coolant sprays, and cold compression units. These modalities lower the local tissue temperature. Lo temperature decreases pain, blood flow, edema, inflammation, muscle spasm, and metabolic demand of tissues. Cold therapy is commonly used for acute musculoskeletal pains, swelling, bruising, inflammation, and strains/sprains.

 

Transcutaneous Nerve Stimulation (TENS)

A TENS unit is a device used to apply low-frequency electrical stimulation through wires and electrodes attached to the patient's skin. There are different types of simulators conventional, acupuncture, hyperstimulation, pulsed, and modulated.  TENS is used for acute/chronic pain, joint effusion/edema, neuromuscular disease, disuse muscle atrophy, and wound/bone healing.

 

Interferential Therapy (IFT)

IFT delivers low-frequency strong physiological stimulation (<250pps) to nerves. IFT uses two high-frequency currents that are slightly out of phase, and are passed through the skin at the same time where they are set up so that their paths cross and simply interfere with each other. This gives way to a beat frequency which causes low-frequency stimulation deep under the skin. IFT causes pain relief, prevents muscle wastage, maintains a range of motion, increases local blood flow, and reduces edema.

 

Neuromuscular Electrical Stimulation (NMES)

NMES is a device that can electrically stimulate above the motor threshold to cause a muscle contraction, it is used to cause repetitive stimulation and is thus applied to minimize atrophy and maintain range of motion and also is used in performing a functional task. NMES is used for muscle strengthening, neuromuscular re-education, cardiovascular conditioning, preventing disuse atrophy, osteoporosis, venous thrombosis, spasticity management, shoulder subluxation in hemiplegic limb, phrenic nerve pacing, and urinary incontinence.

 

Iontophoresis

Iontophoresis is a gel plate that uses a low electrical current to deliver a substance bearing a charge through the skin. Commonly used medications are anti-inflammatory agents for conditions like palmar-plantar hyperhidrosis, plantar fasciitis, tendonitis, and bursitis.

 

Spinal Traction

Spinal traction is a technique aiming to reduce pressure on the affected painful segments of the spine and stretch soft tissues.  This is done by pulling the vertebra away from the disc, pressure is released from the disc and associated structures. Spinal traction provides a pulling force to the cervical or lumbar spine by using a special device, manual techniques, or a pulley system. Spinal traction is used for conditions like joint hypomobility, narrowed intervertebral foramen, disc herniation with nerve impingement, spondylolisthesis, and degenerative facet joints.

 

Ultrasound (US)

Therapeutic ultrasound uses sound waves via the piezoelectric effect to deliver superficial and/or deep heat.  It is used to enhance wound healing, range of motion, pain, inflammation, contractures, and a wide variety of soft tissue disorders. The physiologic effects of therapeutic ultrasound can be divided into thermal i.e heat and non-thermal effects i.e cavitation, acoustic streaming, and standing waves. The non-thermal effects of ultrasound may enhance the process of soft tissue repair, the inflammatory response, protein synthesis, and modulate membrane properties.

 

Phonophoresis (Sonophoresis)

Phonophoresis uses ultrasound to drive medications into and through the skin by increasing cell permeability for deep heat. Stroking with the probe on affected areas and administering anesthetics or corticosteroids. Phonophoresis is used for osteoarthritis, tendinitis, tenosynovitis, bursitis, epicondylitis, carpal tunnel syndrome, fasciitis, and rapid skin anesthesia.

 

Shortwave Diathermy (SWD)

Shortwave Diathermy converts high-frequency alternating electromagnetic current to thermal energy to provide deep heat to a large area. It is used for short-term musculoskeletal pain like knee osteoarthritis in pain reduction.

 

Microwave Diathermy (MWD)

Microwave Diathermy converts electromagnetic microwaves to thermal energy to provide deep heat. It is used for superficial muscles and shallow joints.

 

Extracorporeal Shock Wave Therapy (ESWT)

Extracorporeal Shock Wave Therapy uses high-intensity pulsed mechanical waves to treat musculoskeletal disorders, it does not produce a thermal effect. It is used for chronic recalcitrant tendinopathies, trigger points, pseudoarthrosis, lateral epicondylitis, and plantar fasciitis.

 

Low-Level Laser Therapy (LLLT)

Low-Level Laser light is absorbed by enzymes, hemoglobin, fibroblasts, and neurologic tissue. It stimulates cell degranulation causing the release of potent inflammatory mediators, activates phagocytic processes at the site of injury, and activates fibroblast cell function to increase collagen deposition and improves tensile strength, decreases edema produced by inflammation following laser therapy. Also, absorption by hemoglobin releases nitric oxide causing endothelial cell proliferation and increased microcirculation, wound healing, and localized pain control.

 

Magnetic Therapy

Magnetic therapy exposes the body to a low-frequency magnetic field. This exposure of the body tissues to a weak electrical current enhances cellular permeability and reduces swelling, improves blood circulation through a vasodilating effect, regulates painful stimuli, and reduces pain, promotes muscle relaxation and bone healing.

 

Ultraviolet (UV) Therapy

UV light is electromagnetic radiation with high energy, used for stimulating collagen metabolism, wound healing, and localized pain control. UV therapy is used for many skin disorders.

Electrotherapy, as a whole, includes a range of treatments that use electricity to reduce pain, improve circulation, repair tissues, and strengthen muscles, resulting in improvements in physical functioning. Though one should take care of its contraindications like skin infection, disturbed skin sensation, open wound, metal in the tissue, patient with a cardiac pacemaker, pregnancy, tumors, over areas of thrombosis or other vascular abnormalities, etc.

 

Post-Concussion Rehabilitation | How Physiotherapy can help in improving the functionality of the body?

Concussion has received a lot of attention in recent years. A concussion is a rehabilitative brain injury that can affect your life, and cause various cognitive, physical, and behavioral symptoms. It has been linked to contact sports participation workplace accidents and falls causing long-lasting brain changes. After sustaining a brain injury seeking immediate medical help is a must after sustaining a brain injury. For proper treatment and quick recovery, an expert in physiotherapy exercises for concussions should be consulted. In this blog, we have discussed concussions and physiotherapy exercises for it.

 

What is a Concussion?

A concussion occurs when the head sustains a direct hit or the brain is rapidly shaken. Concussion means that the brain is not actually "damaged," but blood flow and cellular function in the brain are changed. Depending on the injured area, it may lead to temporary or permanent brain function problems. Physical symptoms of a concussion include nausea, headaches, dizziness, blurred vision, and inability to move or maintain balance. Some individuals may become highly sensitive to light or noise and might experience ringing in the ears. Problems associated with memory and concentration, sleep, and mood imbalances can also arise after a concussion injury.

 

Physiotherapy Exercises for Concussion

Physiotherapist examines the cardiovascular, neurological, and orthopedic systems. A physiotherapist helps the patient to recover from a concussion. The right treatment plan can help him to restore physical and cognitive functions such as balance and concentration. The physiotherapy includes:

 

Rest:

It is important to limit physical activity after a concussion to ensure rest. As rest period sends the brain into recovery mode and helps the symptoms to disappear.

 

Neck Rehabilitation:

More often than not, the neck is likely to stiffen or tense before, during, and after a concussion, resulting in chronic pain that may reach the shoulders. The physiotherapist uses various strategies and interventions combination of manual physical therapy and progressive therapeutic exercises help to decrease pain and discomfort, and promote cervical and thoracic spine mobility.

 

Strength Restoration:

The rest period after a concussion can lead to decreased muscle weakness and physical endurance. Therefore, the physiotherapist will focus on restoring the strength without worsening the symptoms. He designs a therapeutic exercise program based on his needs.

 

Balance and Coordination Rehabilitation:

Physiotherapists are vestibular rehabilitation experts dedicated to helping concussion patients who experience loss of balance and dizziness and loss of balance. Vestibular physiotherapy greatly helps, as the inner ear and its connections with the brain can help prevent dizziness and helps to maintain balance. Specific exercises are also taught for balance improvement.

 

Headache Treatment:

Headaches are one of the worst symptoms of concussions. Physiotherapy for the treatment of headaches involves strength and motion exercises, specialized massage, stretches, eye exercises, and electric stimulation.

 

Eye Tracking and Early Vision Rehabilitation:

The concussion patients usually struggle with vision and might even face difficulty tracking objects. The physiotherapist offers oculomotor exercises in a safe environment to support the patient. Exercises such as pencil push-ups can help the eye adapt to the changes in visual depth, and the use of visual targets to improve the eye's ability to direct and hold attention without any head movements.

 

Aerobic Exercise Program:

Physiotherapists use graded exercise testing like the Buffalo Concussion Treadmill test. This aims to determine the level of exertion that is safe for patients without worsening their symptoms. This test can be used in the recovery process in patients with mild concussions. It particularly works well for those with persistent symptoms. The physiotherapist uses the information collected during the treadmill test and creates an individualized aerobic exercise program for the patient.

 

Autonomic Nervous System Rehabilitation:

The autonomic nervous system (ANS) is responsible for managing non-conscious bodily functions, such as blood pressure regulation and breathing. Autonomic dysfunction occurs when a concussion damages the parasympathetic nerves and as a result of this, the patient may experience several side effects, including excessive sweating, high blood pressure, and dizziness. If the patient has low blood pressure, the following lifestyle changes may help.

• Elevating the bed's head.
• Increasing fluid consumption.
• Wearing compression stockings.
• Adding salt to the diet.

If a patient experiences persistent autonomic dysfunction symptoms, an aerobic exercise program is recommended by the physiotherapist, comprising of the following exercises.

• Lower and upper limb stretching.
• Treadmill exercise.
• Walking/ jogging.
• Stair climbers.

Each exercise should be performed for 30 to 60 minutes twice a thrice a week.

 

These exercises should be done in such a way that they don't overload the brain and nervous system while increasing the activity level. This helps in the proper healing of the brain tissue and the patient expects to return to everyday life most safely and quickly possible.

 

Autism | Top 10 Exercises to Improve Neurodevelopmental Disorders

Does any child or adult around you or known to you is struggling with a problem in motor coordination or postural imbalance? Has he been diagnosed with Autism?  If yes, then physiotherapy can help that individual to improve motor functions by using proper exercise programs. An Exercise Program can be used to boost motor skills, posture, and confidence in children and adults with Autism Spectrum Disorder (ASD). Access to such Physiotherapy exercise programs can help an individual to build strength, improve posture, and enhance hand-eye coordination. In this blog we have mentioned a few exercises that can be done by children and adults with neuropsychiatric disorders, to promote motor skills, with a sense of self-efficacy and physical fitness.

 

Autism:

Autism is a complex neurological and developmental disability that can appear within the early developmental stages of life. Autism affects the normal functioning of the brain, communication as well as social skills of the child. This condition is regarded as a life-long condition and it cannot be cured. Although, severity may decrease through various treatments. The cause of Autism is still unknown, but the most common reason can be genetic, cognitive as well as neurodevelopmental factors that contribute to the characteristic of symptoms of Autism

Individuals with autism struggle with communication, which includes physical gestures to express themselves, and understanding body language, lower postural control, and stability can make basic activities like walking or standing more difficult. Another problem is dyspraxia, this term is used for general clumsiness, associated with developmental disorders, fine motor functions, and lower quality of movement. Autism patient has low muscle tone associated with repetitive motor movements and oral-motor problems, or issues with the tongue and jaw causing challenges with speaking.

 

Physiotherapy:

Physiotherapy helps to improve range of motion, muscle strength and control, and other aspects of physical health that may be impacted by this developmental condition.

A physiotherapist assesses the child's overall motor functioning, identifies the underlying difficulties, and provides an intervention program to help address or improve these difficulties and subsequently the child's overall functioning.  Exercises that may be used as part of a physiotherapy intervention plan include:

 

Exercises:

Here are some of the best exercises that are proven to be beneficial

 

Mirror Exercises

· An individual stands with hands by the side. Face towards the therapist.

· Make small movements for the individual and pursue them to repeat the same.

· Start with small movements like moving the shoulders up and down and eventually moving towards the complex ones.

· After the warm-up session start with the real practice.

· Ask an individual to lift the right hand up while mimicking like a mirror, the therapist picks the left one.

· Repeat the same for the legs, trunk, and neck.

· Continue this exercise for a minute and repeat it 4-5 times.

 

Arm Circles

· An individual is asked to stand with feet shoulder-width apart. and arms resting by the side.

· Slowly extend arms by the sides at shoulder level.

· Keeping the arms straight, start making small circles with the hands.

· Slowly, start making the circles bigger and continue creating the movement.

· First, do the exercise in the clockwise direction and then in the anti-clockwise direction repeat in each direction 20 times.

 

Bear Crawls

· Place hands under the shoulders and knees under the hip.

· Walk forward using the four across the floor.

· Next, move backward in the same position.

· When the person becomes comfortable, progression can be done in distance, speed, and direction.

 

Star Jumps

· Basic locomotor exercises like running and jumping can be performed

· Stand on the floor, with knees bent slightly, and tuck the arms in towards the chest.

· After counting 3, jump up from the squatting position, extending the arms and legs wide open. Making the body look like the symbol X.

· After landing on the floor, return to the starting position and repeat it 20 times.

· For running an individual is asked to start running at low speed over shorter distances, after the patient becomes comfortable the speed of running and distance to be covered are increased.

 

Hurdle Step-overs: -

· In these exercises, low hurdles are used, and the individual steps over each hurdle.

· The knees are raised high and the head is looking forward.

·  If the knees turn inward or outward, the examiner can prompt the individual by tapping the knee or holding a hand next to the foot.

· Walking forwards or backward, and sideways by crossing the hurdles,

 

Medicine Ball Slams

· Ask the person to hold a medicine ball in hand and stand straight.

· Raise the ball over the head with the arms straight.

· Slam the ball down on the floor with full force.

· Then just bend the knees and pick the ball.

· Repeat it 20 times.

 

Grab Ball Complex (GBC): -

· An individual stands in front of the therapist.

· Spot markers can be used.

· The therapist holds a ball at arm's length in various positions in front of the individual.

· The individual should bend, rotate, and reach to grab the object.

· One or both hands can be used in up, down, right, and left directions.

 

Ball Tap Complex (BTC): -

· The individual holds the ball while the therapist holds out a hand or other object.

· The individual taps the hand with the ball.

· The target can be held in a variety of positions and presented in random order or a particular sequence.

 

Activity-oriented Exercises:

To enhance the fine motor skill, tasks like

· Using a pencil.

· Cutting with scissors.

· Playing with pegs.

· Other activities like clapping hands, skipping, hopping and throwing, kicking or catching a ball, and standing on one leg.

· Horse riding.

· Bicycling.

 

Hydrotherapy Exercises:

Hydrotherapy or aquatic therapy has been commonly used to treat Autism patients. Water has a property that can provide sensory input, and improves range of motion and overall mobility. Warm water can decrease the body weight by 90%, relax the muscles, and reduces spasticity, thus making water the ideal medium for rehabilitating the body. This usually takes place in a swimming pool as the pressure and temperature of the water pressing against the body can soothe an autistic individual.

Physiotherapy can be a key intervention in the treatment of motor difficulties for patients with Autism. Access to physiotherapy may be important in early life, and also at various points throughout the person's life, or consistently throughout the entire life. While on the one hand exercises are useful in developing motor and social skills, on the other hand, they also help to manage weight and reduce hyperactivity and aggression. And thus, exercises should be made a part of the lifestyle of kids and adults with autism.