EPTI 神Note

*Baseline pain level/MMT !!!!!!!!
EPT I
US
Parameter & Dosage Physiological Effect Therapeutic Effect Contraindication
-‐ SH: Rx area/3-‐4 Thermal -‐ Promote healing -‐ Pregnancy over hip/back/abd
-‐ TA: no. of SH/1.5 -‐ Improve blood flow o Stimulate cellular activities -‐ Malignancy
-‐ Rx Time (min) -‐ Increase pain threshold o Stimulate capillary growth -‐ Post radiotherapy
o Acute: 1-‐2/TA -‐ Change nerve conduction velocity o Proliferation of capillary -‐ Cardiac pacemaker & neural
o Subacute/Chronic: 2-‐3/TA -‐ Promote healing o Break down adhesion implant
-‐ Freq. -‐ Increase extensibility o Increase extensibility -‐ Metal implant
o 1MHz: Deep (1-‐2cm) Mechanical -‐ Pain relief -‐ Acute infection
o 3MHz: Superficial (3-‐6mm) -‐ Cavitation -‐ Break down scar -‐ Vascular abnormalities
-‐ Intensity (W/cm2) o Tiny bubble -‐ Normalize microcirculation o DVT
o Acute: 0.5-‐0.8 o Alter cell function -‐ Activate macrophage reaction o Severe atherosclerosis
o Subacute: 0.8-‐1.0 -‐ Acoustic streaming acute: stimulate cellular activities; promote o Severe ischemic tissue
o Chronic: 1.0-‐1.5 o Alter permeability -‐ Recent venous thrombosis
cell membrane permeability (non-thermal)
-‐ Mode o Alter metabolic process -‐ Risk of hemorrhage
proliferative: angiogenesis, fibroblasts
o Acute: P1:4(20%) -‐ Micro-‐massage o Hemophiliac
o Subacute: P1:2(33%), o Enhance fluid interchange proliferation -‐ Over
P1:1(50%), Cont’d o Reduce edema remodelling: increase extensibility of o Eye & testes
o Chronic: Cont’d collagen, break down adhesion o Stellate ganglion
o Cardiac area
o Exposed nerve tissue
o Cranium
o Active epiphyseal region
Preparation Application Indication Precaution
-‐ Test -‐ Gel -‐ TE -‐ Anesthetic area
o Sharp & Blunt o Smooth contour -‐ OA knee -‐ Subcutaneous nerve
o Hot & Cold -‐ Water immersion -‐ Shoulder pain -‐ Bony prominence
-‐ Checking o Hand & Foot -‐ Pressure sore -‐ Keep moving
o Cont’d mode o 2-‐3cm distance small circular motion -‐ CTS carpal tunnel o Standing wave
§ Water ripple -‐ No pain, discomfort & unexpected -‐ Heel spur -‐ Perpendicular
§ Gel vibration sensation -‐ Calcified tendinitis o Shear wave
-‐ No feeling or slightly warm -‐ Localized neck/back pain -‐ Lowest intensity produce
therapeutic response
warning: no pain, don't touch, danger of being burnt
Contraindication?
1. General health ok? (fever) 2. systemic disease (heart disease, hypertension, diabetes) 3. Circulation 4. Skin 5. Implant (metal, cardiac pacemaker, neural implant)
6. medication 7. Radiotherapy? Cancer?

SWD
-‐ CSWD -‐ Electrical field -‐ Thermal effect without depolarize -‐ Cardiac Pacemaker / Neural
o Time: 15-‐20min o Vibration of ions nerve & muscle Implant
o Intensity (0-‐1000W) o Molecular distortion o Increase metabolic rate -‐ Metal Implant
§ Adjustment -‐ EM field o Increase extensibility -‐ Malignant tumor
• Dial o Dipole rotation o Improve circulation -‐ Active TB
• Distance -‐ CSWD o Pain relief -‐ Open wound
o Deep heat vasodilation -‐ Promote healing -‐ Acute inflammation
• Towel
-‐ PSWD (100-‐1000W) for Acute o Decrease viscosity -‐ Impair thermal sensation
o Pulse freq.: 15-‐200Hz o Increase metabolic rate -‐ Impair circulation
§ Acute: 20-‐82Hz (100-‐200W) o Increase extensibility o Thrombosis
§ Subacute & chronic: 200Hz o Pain-‐gate (heat) o Unstable BP
(1000W) -‐ PSWD -‐ Danger of Hemorrhage
o PD: 400μs (fixed) o Restore cell membrane o Hemophiliac
o Minimal thermal effect (mean potential o Menstruating
power <25W) o Restore membrane transport & -‐ Pregnancy
§ 20-‐40Hz: 1000W W ion balance -‐ Inability to communicate
§ 40-‐110Hz: 400-‐800Hz
§ 150-‐200Hz: 100-‐200W
Preparation Application Indication Precaution
-‐ Test -‐ Capacitor field (E field) -‐ CSWD -‐ Cables
o Hot & Cold o Disc/Pad x 2 o OA o Not contact with patient
-‐ Checking o Contraplanar cross-‐fire / o Chronic neck / back pain o Not contact with each other
o Neon tube coplanar / longitudinal o Frozen shoulder (<25mm)
o Same size, even space, parallel, o Muscle / tendon / ligament o Fully plugged
Tune the machine
larger than body part injury -‐ Moisture skin
put hand under electrode to test the warmth -‐ Inductothermy (E field + EM o Deep tissue injury -‐ Metal / synthetic material
field) -‐ PSWD o Watch
o Diplode/Drum/Flexiplode o Chronic condition o Jewelry
o Eddy current § Pressure sore o Metal bras
o More on muscle § Open wound o Clothes
-‐ PSWD through wet o Metal within 30cm
dressing/metal implant -‐ Thick layer of subcutaneous fat
-‐ Comfortable warm but not hot -‐ Hearing aid should turn off
-‐ Start with mild warm only -‐ 3m between SWD and other
electrical equipment
*Check wet surface *Towel cover untreated area
***Take out all the metal before starting the treatment

TENS
Preparation & application Effect Indication Contraindication & Precaution
-‐ Test Pain relief (Aβ) -‐ LBP -‐ Cardiac Pacemaker / Neural
o Sharp & Blunt -‐ Gate control theory -‐ Neck Pain Implant
-‐ Checking o Stimulate large diameter fiber -‐ Post-‐op pain -‐ Epilepsy
o On self -‐ Endorphin release (Aδ) -‐ Labour pain -‐ Over Carotid Sinus
-‐ Skin preparation o Morphine like substance -‐ Cancer pain -‐ Anterior Neck
o Clean with warm water & soap -‐ Descending pain suppressing -‐ Phantom pain -‐ Transthoraxic
-‐ Placement system (Aδ) -‐ Frozen shoulder -‐ Pregnant Uterus
o Pain area o Long application (30-‐60min) -‐ Post stroke shoulder pain -‐ Acute inflammatory condition
o Same dermatome o Aδ fiber provoke impulse in -‐ OA -‐ Malignant, TB, Osteomyelitis
o Opposite border of post-‐op midbrain à track down spinal -‐ Precaution
wound cord à inhibit nociceptive o Eye
o Harmful on bony surface neuron o Inability to communicate
-‐ Involve noradrenalin & serotonin o Open wound
o Metal implant

Freq. Intensity PD Rx Time Feel Application

Low
Conventional 30-‐ Paresthesias Acute Pain
High (80-‐120Hz) Mild à gradual Short (30-‐75μs)
( Aβ) 60min Tingling 1st Rx of chronic pain
increase
Acupuncture High Rhythmic
Low (1-‐4Hz) Long (150-‐250μs) 45min Chronic dull pain
( Aδ) Max tolerable Pulsing
BF (2-‐4Hz) Burst on/off fixed Muscle twitch
Burst Deep aching chronic pain
High (70-‐100Hz / burst) Surging
Quick & profound
High Strongest
Brief Intense High (100-‐150Hz) Long (150-‐250μs) <15min analgesia
Max tolerable Less tolerable
5-‐10min (<15min)
Oscillate 40-‐100% Oscillate 40-‐100%
Modulation Minimize accommodation
Oscillation time 0.1-‐1.5s Oscillation time 0.1-‐1.5s
NMES

Parameter & Dosage Progression Contraindication
-‐ PD: 1ms -‐ Increase intensity -‐ Cardiac Pacemaker / Neural
-‐ Freq.: 0-‐100Hz (increase for more sustain contraction) -‐ Increase frequency Implant
-‐ Train: 1-‐10/min (usually 4/min) -‐ Increase on time -‐ Near Heart & ANS
-‐ Intensity: Max. Tolerable until response is noted (tolerable & comfortable) -‐ Decrease off time o Change cardiac rhythm /
-‐ Repetition: 10x3 -‐ Increase number of autonomic effect
contraction (treatment -‐ Pregnant uterus
Severe Weakness Moderate Weakness Mild Weakness duration) -‐ Open wound
Freq. 3-‐10Hz 10-‐30Hz 30-‐50Hz -‐ Add active contraction -‐ Infection
On 2-‐3s à5s 5-‐10s 10-‐15s -‐ Hemorrhage
Off 25-‐50s 20-‐30s 10-‐30s -‐ Acute inflammation
Rx Time 5-‐10min 15min 15min -‐ Inability to communicate
-‐ Malignant, TB, Osteomyelitis

Indication & Effect Application Preparation Precaution

-‐ Neuromuscular facilitation -‐ Cont’d for set intensity à change to -‐ Test -‐ Metal Implant
-‐ Muscle re-‐education / training train mode after set o Sharp & Blunt -‐ Fragile skin
-‐ Prevent atrophy / post-‐op -‐ Monopolar -‐ Checking -‐ DC à skin irritation
weakness à increase muscle bulk o 1small active on muscle (Red) o On self -‐ Poor circulation
-‐ Retain muscle strength o 1 large inactive on bony part -‐ Skin Preparation -‐ Electrode should not touch each
-‐ Reduction of spasticity o Small muscle o Clean with warm water & other
-‐ Maintain / increase ROM o Sufficient far away soap
-‐ Train peripheral nerve damage with -‐ Bipolar o Protect lesion with
re-‐innervation o Equal size vaseline
-‐ Improve circulation o Parallel to muscle fiber
-‐ Better than exercise if exercise o Large muscle
intensity limited for elderly & -‐ Carbonized rubber with sponge
pre/post-‐op -‐ Probe with wet cloth
o Motor point
-‐ Some redness expected
IFT

-‐ CF: 4000Hz -‐ Similar with TENS -‐ Pain relief -‐ Anticoagulation drug
-‐ BF: 0-‐100Hz o Less skin resistance à less dose -‐ Reduce swelling -‐ PE, DVT (Suction)
-‐ Intensity: Max Tolerable needed à more comfortable -‐ Improve circulation -‐ Not follow instruction
-‐ PD: 0.1ms o Penetrate deeper than TENS -‐ Reduce muscle -‐ Cardiac Pacemaker / Brain
-‐ Sensory o Pain relief tightness Stimulator
o Freq. § Gate control theory -‐ Muscle strengthening & -‐ Hemorrhage
§ Acute: 80-‐100Hz § Endorphin release re-‐education -‐ Epiphyseal region
§ Chronic: 10-‐25Hz § Descending pain suppressing -‐ Circulatory problem
o Intensity system -‐ Infection
§ Acute: no contraction -‐ Improve circulation -‐ Transthoracic application
§ Chronic: mild to mod. Contraction o Axon reflex -‐ Pregnancy
o Rx Time: 10-‐15min -‐ Reduce muscle tension -‐ Malignancy
o Modulation o Decrease nerve conductive velocity -‐ Over
§ BF: 0-‐20Hz, 6s up/ 6s down -‐ Massaging effect o Eye
§ Intensity: 10% o Anterior neck
§ Vector: Max intensity in 1 or 2 -‐ Carotid sinus à Drop BP
channel keep changing Preparation & Application Indication Precaution
o Progression -‐ Sensation test -‐ Sensory -‐ Suction Cup
§ Increase intensity o Sharp & Blunt o Muscle, tendon, o Fragile & sensitive skin
§ Increase treatment time -‐ Sensory ligament injury o Excessive / uneven
-‐ Motor o Electrode: Suction o Chronic pain pressure à bruising
o Freq. (Subacute/Chronic) / Pad (Swelling) o Muscle tightness o Distinguish suction & IFT
§ Smaller muscle: 0-‐10Hz o Arrange o Joint stiffness current
§ Larger muscle: 30-‐50Hz § Quadripolar cross fire / Bipolar -‐ Motor -‐ Uneven thickness sponge
o On (off) (pre-‐modulate) o Muscle re-‐education -‐ Abnormal skin sensation
§ Severe weakness: 2-‐3s à 5s (25-‐50s) § Contraplanar (cross joint) / o Muscle strengthening -‐ Cable
§ Moderate Weakness: 5-‐10s (20-‐30s) Coplanar (superficial) -‐ Hx of epilepsy
§ Mild Weakness: 10-‐15s (10-‐30s) o Placement -‐ Advance heart disease. Cardiac
o Rx Time: 10-‐20min § Spine level arrhythmia
o Progression § Along nerve root, peripheral nerve, -‐ Anterior chest
§ Increase intensity dermatome, Myotome
§ Increase on time § Trigger point / acupuncture point
§ Increase no. of contraction -‐ Motor
§ Add active contraction o Pad
o Bipolar
*suction: tell patient the erythema is normal
SWD vs US vs HP
SWD US HP
Heat Depth Deep Superficial Superficial
Application Problem with Easily applied
Difficulties interference Use at home
Contraindication More Less
Contact No Yes Yes
Treatment Area Large Smaller Large / Small

IFT vs TENS

IFT TENS
Area Large Small / Acupuncture point
Effect Sensory / Motor Sensory
Sensation Strong Mild
Massage Effect Yes No
Depth Deeper Superficial
Lasting Longer Shorter

EPTI 神Note

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EPTI 神Note

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*Baseline pain level/MMT !!!!!!!!

Freq. Intensity PD Rx Time Feel Application

Indication & Effect Application Preparation Precaution

Parameter & Dosage Physiological Effect Therapeutic Effect Contraindication

IFT vs TENS

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