What are the Techniques of Treatment with Faradic-Type Currents

 

TECHNIQUES OF TREATMENT WITH FARADIC-TYPE CURRENTS

Applying faradic-type current can be done in a variety of ways, depending on the desired results. Both the methods required to elicit a collective response and those required to cause a single muscle to contract will be discussed. Preliminary procedures include the following for all approaches.

Setting up the equipment

Most physiotherapists employ a low-frequency electronic stimulator with automatic surge control, although others like the Smart-Bristow faradic coil. Attaching the leads and electrodes to the terminals, holding the two electrodes in a moistened hand, inserting the core if a Smart-Bristow coil is being used, and increasing the current until a slight prickling sensation and a muscle contraction are felt are the recommended methods for testing the apparatus. Make sure the patient can see the muscle contraction that is being created and explain to them the sensation you are experiencing. Testing the length and frequency of the surge is necessary if it occurs automatically. Verify that the device is sufficiently remote (about two meters) from a short-wave treatment machine in use to avoid radio frequency (RF) energy disrupting the output. A tiny lint or sponge pad with a flat plate electrode can serve as the active electrode in place of a disc electrode. Large muscles like the quadriceps and glutei respond better to the latter since it is simpler to form to the surface and achieve good contact.

Optimizing Electrode Setup for Safe Stimulation

To finish the circuit, an indifferent electrode made of a lint/sponge pad and a flat plate electrode are employed. The pads are thick enough to establish good contact with the tissues and the electrode and to absorb any chemicals that may accumulate because they are made of at least eight layers of lint. There should be no wrinkles and they should be folded equally to prevent unequal current distribution and discomfort. One percent saline solution is warmed and used to soak the pads and lint covering the disc electrode. You can use tap water, however adding salt makes the wetting solution less resistant. One percent saline has a resistance that is somewhat lower than that of tissue fluids. To minimize the risk of electrodes coming into contact with the skin, generating an unpleasant concentration of current and potential chemical harm to the tissues, electrodes should be one centimeter smaller overall than the pads. The electrodes' corners should be rounded since sharp edges could bend and dig into the pad, which would result in another concentration of current.

Patient preparation

The patient is supported comfortably in a bright light after having any clothing removed from the area that has to be treated. The patient must be warm in order for the muscles to respond to stimulation effectively.. When a portion is held in a shorter posture, it is typically simplest to get muscular contractions in response to electrical stimulation. However, depending on the desired results, it can be wise to adjust this location. If the goal of the treatment is to retrain a muscular activity, the patient may be positioned so that the movement occurs when the muscle contracts; for example, when training the quadriceps, the knee may be slightly flexed so that the muscle contraction causes the leg to extend.. In certain situations, it is possible to achieve movement by keeping the affected limb in slings while receiving treatment. For example, when strengthening the deltoid muscle, shoulder joint movements are frequently possible when the arm is supported in slings, whereas they are rarely possible in any other configuration. However, if the joint movement causes pain, it should be avoided as this will prevent the muscles from contracting.

Skin Preparation for Safe Stimulation Therapy

 The outermost layers of skin are devoid of ions due to their dryness, which results in a high electrical resistance. Washing with soap and water to eliminate natural oils and moistening with saline right before applying the pads to supply ions reduces resistance. Skin breaks result in a significant decrease in resistance, which in turn concentrates the current and causes discomfort for the sufferer. In order to prevent this, a little piece of non-absorbent cotton wool is placed atop a small amount of petroleum jelly to protect the split skin and the pad. To minimize the current density beneath it, the indifferent pad ought to be sizable. This avoids overstimulating the skin and lessens the chance of unintentional muscular contractions, since it might not be able to avoid covering some muscles' motor sites. The indifferent electrode can be secured by a rubber band or bandage, or it can be held in place by the user's body weight. The pad is coated with jaconet, a type of plastic sheeting, to keep moisture out of the bandage and patient clothes if it is bound in place or likely to come into touch with them.

Motor point stimulation

The benefit of this approach is that every muscle can contract to its maximum potential and that each one works independently. For this reason, it can be chosen when learning a new muscle movement or when it makes sense to isolate a particular muscle; for example, the vastus medialis can be activated to overcome a quadriceps lag, or the abductor hallucis can be used to treat muscle weakness. The patient and equipment need to be set up as previously mentioned. In a suitable location, the indifferent electrode is applied and fastened. The active electrode can be a tiny pad that is placed in the hand's palm or a disc electrode that is held between the index and middle fingers. It is positioned above the targeted muscle's motor point for stimulation. In order to minimize discomfort, it is important to make sure that the patient feels as much pressure as possible from the operator's hand. This allows the patient to feel how strong the contractions are.

Optimizing Surge Parameters for Muscle Stimulation

 The right amount of surge frequency and duration must be chosen. At the peak of each surge, the current intensity is progressively increased until a strong muscle contraction is achieved. Then, the surging is maintained to cause alternate muscle contraction and relaxation. Voluntary contractions may be attempted concurrently with electrical stimulation to retrain muscle activity, and electrical treatment may be combined with active workouts. The amount of time the patient can focus on the movement and help produce it dictates how long the treatment session will last. Weakening of the contraction, which does not happen quickly with faradic-type stimulation, is a sign of muscle exhaustion. various motor points' approximate locations.. Though there are certain exceptions, such as the motor point of the vastus medialis, whose nerve enters the lower half of the muscle, which is located a short distance before the knee joint, motor points are typically found at the intersection of the upper and middle one-thirds of the fleshy belly of muscle. Where deeper muscles emerge from beneath the superficial ones, such as the extensor hallucis longus in the lower third of the lower thigh, is where deeper muscles can be most satisfactorily stimulated.

Muscle group stimulation

One effective way to retrain the action of muscles that typically function as a group, including the quadriceps, the tiny muscles in the foot, and the pelvic floor muscles, is to use stimulation that causes all the muscles in the group to contract simultaneously.

Quadriceps

As previously mentioned, get the patient and the equipment ready. With the afflicted knee supported in the appropriate range of flexion, place the patient on a plinth. In the femoral triangle, one electrode and pad (about 12 by 9 cm in size) are put over the femoral nerve and either securely wrapped or secured with a sandbag. The other electrode pad, which measures 15 by 8 cm, is positioned across the motor points and secured with a bandage or strap. Choose an appropriate surge duration and frequency to achieve a strong contraction and total muscle relaxation. After a few mild contractions to help the patient become used to the current, progressively increase the force until a significant contraction is attained. While the current is being delivered, the patient should be urged to contract their muscles voluntarily. Active exercises may also be used with electrotherapy. Stop the electrical stimulation as soon as the patient is able to contract voluntarily. This is frequently accomplished in just one or two treatments. 

Small muscles of the foot.

Baths can benefit from electrical stimulation using a faradic-type current. Perfect contact between water and tissues is made, pads and electrodes are not burdensome, and skin resistance is decreased with continued soaking. As said earlier, get the patient and equipment ready. Place the patient's feet on a plastic-covered stool and their back firmly supported while they sit on a plinth. This position has the benefit of allowing the physiotherapist to sit and manage the machine while simultaneously monitoring the accomplished muscular contraction, albeit it may need to be modified for elderly patients or patients with a history of vertigo. The patient's foot should be submerged in a bath that has enough warm water to reach the toes.

Lumbrical muscles and interossei

Two electrodes should be positioned transversely across the bath's bottom to stimulate the lumbrical muscles: one under the heel and the other obliquely under the metatarsal heads. Put one electrode at the level of the metatarsal shafts on each side of the foot to activate the plantar interossei. Choose an appropriate surge duration and frequency for both techniques to achieve a strong contraction and total muscle relaxation. After a few mild contractions to help the patient become used to the current, progressively increase the force until a powerful contraction is produced. Urge the patient to voluntarily tense their muscles using the current. You can mix electrotherapy with active exercises. Stop the electrical stimulation as soon as the patient is able to contract voluntarily. Hallucinations caused by abduction Using a button electrode, place one electrode under the heel and use it to stimulate the muscle through the motor point. Proceed as directed for the lumbrical muscles. If a patient has an open cut that hasn't healed or an infection on their foot, for example, it might not be feasible to exercise their little muscle groups in the water. In these situations, electrodes and pads might be utilized as a substitute in the exact same locations as previously mentioned.

Muscles of the pelvic floor

In the early stages of pelvic organ prolapse and stress incontinence, electrical stimulation can be quite helpful in retraining these muscles. There are several ways to apply the current, but in order to achieve a proper contraction of the muscles, a vaginal electrode is frequently the most effective way to do it. The electrical stimulation and voluntary contractions have to be tried together; electrotherapy is an adjunct to the exercises, which are a vital component of the treatment. A rectal electrode may be used in a similar manner to treat male patients who experience incontinence after a prostatectomy. As previously mentioned, get the patient and the equipment ready. Place the pillow between the patient's lower legs as they lie on their side. Lay a plastic sheet underneath the sufferer. The big pad-equipped indifferent electrode is fastened to the lumbosacral area. The vaginal (or rectal) electrode is smeared with sterilized lubricating jelly before being put into the vagina (or rectum). Place a big button electrode over the urogenital region (or the anal region) if there is no vaginal (or rectal) electrode accessible or if this site is not usable. To obtain a decent muscle contraction, choose an appropriate surge duration and frequency. Then, progressively raise the intensity until a powerful contraction is obtained. The pelvic floor muscles are small and easily fatigued. brief.) As a result, the course of treatment should be brief.

Reduction of limb oedema

To reduce oedema and enhance venous and lymphatic return, electrical stimulation of the muscles that typically function as the muscle pump may be paired with limb elevation and compression. This method is often referred to as faradism under duress. As previously mentioned, get the patient and the equipment ready. Elevate the affected limb to facilitate the return of lymph and veins. Large electrodes and pads should be positioned to cover the motor sites of the major muscle groups engaged in the muscle pump since multiple muscle contractions are needed. For example, to target the lower extremities, place one electrode over the calf muscle and the other over the plantar aspect of the foot. Electrodes should be placed over the flexor aspects of the arm and forearm for the upper limb. Test the contraction that is created after securely fastening the pads in place, using straps if needed. As needed, adjust the pads. Next, begin applying an elastic bandage from a distance. It ought to be snug but not overly so. Don't leave spaces between the bandage's turns. When the muscles contract, the bandage raises the pressure on the capillaries, and when the muscles relax, its recoil exerts a more pumping action. To enable the muscles to contract as much as possible, the pace of contraction must be gradual.

Effective Nerve Conduction for Muscle Stimulation

The repetition rate is likewise slow to allow for relaxation and to allow the vessels to refill; a typical schedule would be a contraction lasting two to three minutes, followed by a five minute rest period. Muscle contractions lasting up to fifteen minutes per session result in an approximate thirty-five minute therapy duration. Since the limb is edematous, it may be challenging to stimulate motor sites to cause contractions since the current may spread throughout the fluid. In this instance, nerve conduction—an alternative application method may be used to stimulate the muscles. An indifferent electrode is applied to a convenient location for this stimulation method, and an active electrode is applied to the point where the nerve trunk is superficial. As a result, every muscle that is supplied by a single nerve contracts. The technique can also be applied in the event that a wound or splint prevents access to the motor sites. Additionally, it is the most comfortable way to activate the face expressive muscles. Three locations on the facial nerve's branches are stimulated for this purpose: one behind the lateral corner of the ear, one in front of the ear, and one directly above the angle of the jaw.