Appendix A NATURE OF AN ELECTRIC CURRENT An electric current is a flow of electric charges. Electrons, protons and ions are the charges involved, although other subatomic particles may carry charges. Conductors are materials in which the outer shell electrons are free to move between constituent atoms. Normally this movement is random but if a voltage (an electric pressure) is applied to the material electrons will move away from the negative towards the positive charge. Although the motion of electrons is very rapid the movement of electrons from atom to atom (the electron drift) is quite slow. This is a conduction current and it is how charges move in metals and carbon and hence in electrical apparatus. Current is a rate of flow, that is a quantity of electrons per unit time. A rather large number of electrons (6.25 x 10") is the unit of quantity called a coulomb and when this quantity passes a point in 1s the rate of flow, or current intensity, is called 1 ampere. It is important to recognize that random electron movement occurs constantly at normal temperatures and that the electric current is super- imposed on this. It is analogous to the arrivals channel of a large international airport; aircraft deliver passengers who pass through passport control, customs etc. and eventually leave by car, bus or train. Looked at over a time- period of, say, a day the number of passengers leaving the airport is the same as the number arriving—the rate of flow may be expressed as so many thousand passengers per day—yet individual passengers have followed different pathways and spent different lengths of time at the airport. Some have been delayed by customs, some have had to wait for friends to meet them, some have gone to the restaurant for a meal and so forth, while others have passed through as quickly as they could. On a normal working day the airport is full of people as a conductor is full of electrons, In a conductor it is only the electrons that move because the atoms are firmly held in crystalline structures which are typical of metal (and metalloid) solids; it is therefore called a conduction current. In fluids, liquids and gases, the atoms and molecules are free to move and therefore can take part in the flow of charges if they become charged. When an atom gains or loses an electron—hence it becomes negatively or positively charged—it is called an ion. Electrolytes are solutions containing ions. Body fluids are electrolytes and current can pass by the movement of these ions. Positive ions move towards the negative pole, the source of additional electrons, while negative ions move to the positive pole where electrons are being removed. Thus there is a two- way motion of ions which constitutes the current, called a convection current. 356Appendix A +357 The rate of flow of charges (the current intensity) is measured in amperes. In any given conductor it will simply depend on the electric pressure or electric force, known as the voltage. It is ultimately due to the attraction of electrons for protons, that is the electric force of the atom. This is measured in volts and is known, descriptively, as an electromotive force. The difficulty electrons have in moving within a solid conductor, or ions have in moving in an electrolyte, will also determine the rate of flow and this is described as the resistance, measured in ohms. Thus a conductor with a greater resistance will allow a smaller flow of electrons. These concepts are expressed in Ohm's law which states that the current intensity (I) in amperes is directly proportional to the electromotive force (E) in volts and inversely proportional to the resistance (R) in ohms. I= E/R thus A= V/Q. This is analogous to the flow of water from a tap which depends on the pressure driving it (height of the tank) and the resistance offered by the tap (how far it is turned on).Appendix B ELECTROLYSIS Electrolytes are solutions containing ions. When crystalline substances dis- solve in water some separation into ions occurs so that there are always a number of negatively and positively charged particles due both to the dissolved solid and dissociation of the water molecule to form OH™ and H* ions. If an electric field is applied by means of a pair of metal electrodes the ions will move through the solution, as shown in Figure Al. Thus positive ions move towards the negative electrode or cathode and are sometimes, rather confusingly, called cations. Negative ions move to the positive electrode or anode, hence these may be called anions. When the ions reach the metal plate or electrode they lose their charge. Positive ions gain an electron from the negatively charged metal plate and the negative ions give up their extra electron to the positive plate. The current in the solution is transmitted as ions (charges) moving in both directions. This is called a convection current. As the ions are neutralized electrically to form atoms they will act chemically. Jons ‘used up’ in this way are replaced in the solution by further dissociation to maintain the supply of charges. The chemical interactions that can occur at the electrodes are often complex and can involve the metal of these electrodes, so that metal may sometimes be removed from one plate and deposited on the other. Sodium chloride solutions are utilized in transmitting current to and from the tissues for treatment purposes and will be considered, but similar effects occur where other salts, acids or bases are involved. Acid solutions are formed at the anode with the liberation of oxygen gas and alkaline solutions at the cathode where hydrogen is given off. This occurs because OH™ ions are neutralized at the anode to give OH radicals which combine to form water and release oxygen. Fig. A1 358Appendix B +359 Thus: OH” +OH +an electron 40H2H,O+ 0, Similarly Cl~ ions when neutralized react with water to form HCl and release oxygen. Consequently the excess H makes the region acidic. At the cathode H * ions are neutralized to form hydrogen gas and Na forms sodium hydroxide (NaOH) with the water when neutralized. Thus: 2Na+2H,O2NaOH+H, The solution therefore becomes alkaline in this region and hydrogen gas is released. These effects of altered pH and release of oxygen and hydrogen will occur whatever the salt, acid or base in solution with inert electrodes. The amount of gas produced is small in therapeutic situations and tends to remain dissolved in the water. However, if the current density is made high—say by passing a large current between two wires placed in a bow! of water—gas bubbles can be seen. These are especially evident at the cathode because of the larger quantity of hydrogen produced; in fact this can be used to determine the polarity as can the acidity/alkalinity test with litmus paper.Appendix C TRANSFORMERS A transformer consists of two coils of insulated wire wound over one another on a common axis or on a common iron core. If a varying current is passed in one coil it will set up a varying magnetic field which affects both coils, This changing magnetic field will induce an electromotive force in the second coil and, if the circuit is completed, a current will flow. The effect between the two coils is called mutual induction; it will of course only occur as a result of a varying current. This type of arrangement is widely used to alter the voltage of the mains for many applications, hence it is known as a voltage transformer. Since there is no physical connection between the two circuits they also serve to isolate the mains from the circuit in the apparatus; as the mains supply is earthed this allows the circuit to be ‘earth-free’ (see Chapter 3). A commonly employed structure is shown in Figure A2 together with the circuit symbol for a transformer (see Fig. A3). The magnetic field across each turn influences all other turns and there is an equal voltage across each turn so that the voltage across the coils is proportional to the number of turns in each coil. If the mains RMS voltage of 240 V is applied across one coil—the Soft iron core (made up of a set of flat plates to reduce eddy currents) Represents coil 1 (actually many Represents hundreds of turns) coil 2 Fig. A2_ Low-frequency transformer. 360Appendix C +361 primary—and the other—secondary —coil is made up of twice as many turns, the voltage across it will be doubled. Similarly if the secondary has only a quarter of the number of turns of the primary the voltage will be reduced to one-quarter of that across the primary. The transformer is able to change the voltage but the total power output must equal the power input. Thus the maximum current from the secondary coil is limited by the power (in watts) of the primary coil. Thus: V x A (W) of primary = V x A (W) of secondary (+ small energy loss in transformer). The actual current in a circuit to which the secondary current is applied will depend on the resistance of the circuit; this is known as Ohm’s law. The energy transfer from one coil to another will only occur when the current, and hence the magnetic field, changes and depends on the rate of change. The regular sinusoidal variation of the mains current will lead to a similar sinusoidal secondary voltage, but out of phase. {It will be out of phase because current following a sinusoidal variation will have the highest rate of change as it is reversing direction and therefore leads to the highest induced voltage in the secondary at this point. The lowest rate of change—zero—will occur when the primary current is at maximum intensity in one direction, having stopped rising and not yet started to fall. The induced voltage will thus also be zero. The variation between these two points will follow a sine curve) The soft iron core is used with low-frequency transformers to provide a strong magnetic field close to the coils. The magnitude of the induced effects also depends on the length and number of turns of the coils, but most critically on the rate of change. At higher frequencies so much self-induction occurs as to block the current partly or entirely. Therefore to act as a high-frequency transformer the coils are made of fewer turns. At very high frequencies such as the 27.12 MHz of the shortwave described in Chapter 10 only four or five large-diameter turns are needed, to transmit energy between the oscillator coil and that in the patients’ circuit. The same principle is used, of course, to transmit energy from the coil in the drum-type applicator of a shortwave apparatus to the tissues of the patient; the tissues are behaving as the secondary coil. Low-frequency transformers are extensively used to alter the mains voltage, both increasing it (a ‘step-up’ transformer) and decreasing it (a ‘step-down’ transformer) for the many pieces of equipment that operate on higher or lower voltages. Voltage changes are also essential for the efficient transmission of electric power (see Appendix D).Appendix D MAINS SUPPLY The mains current is generated at power stations by dynamos converting mechanical energy into electrical energy. The mechanical energy is derived either directly, from falling water in hydroelectric stations, or indirectly from the heat of burning coal, oil gas or nuclear fission, which provides steam for turbines. The electrical energy is transmitted around the country at a very high voltage—several hundred thousand volts for the main power lines—connect- ing power stations in different regions and users. The high transmission voltages are reduced at transformer substations to the familiar 240 V of the household mains supply. This system allows the transmission of electrical energy to all parts of the country efficiently and economically. The distribution is made by a single cable, the ‘return’ being effected by earthing both ends, ie. at the power station, the various substations and the home or hospital supplied (see Fig. A3). The word ‘return’ is in quotation marks because the earth is a vast reservoir of electrons and to suggest that electrons flow back to the power station is simplistic, rather like suggesting that to remove a bucket of water from the sea at one point, run along the beach with it and empty it back will cause a current in the sea between the two points! The use of a single cable is obvious economic sense; numbers of cables can be seen suspended on pylons in rural areas but in towns they are often underground, Transmission of high voltages is essential to obviate energy losses. The heating of a conductor, and hence the energy loss, depends principally on the current intensity. (Joule’s law: HocI*Rt; heating, H, is proportional to the current squared, P, multiplied by the resistance of the conductor, R, and time, t, for which the current flows.) Since any practical conductor would have significant resistance over the many miles of transmission the passage of large currents would lead to enormous losses as the wire dissipated its heat to the surroundings. What matters, fortunately, is the transfer of power which is determined by the product of voltage and current, ie. W=V A. Thus if power is transmitted at high voltage with low currents very little energy is wasted as heat. At the substation the voltage is reduced (see Appendix C) to the 240 V supplied to all electricity users. One terminal is earthed and is thus at zero potential to earth; the other is alternately at higher or lower potential and is called the ‘live’ (or sometimes the ‘active’ wire). These two wires pass to buildings where the neutral is again earthed. The voltage, and hence current, supplied is of an evenly alternating sinusoidal form with a frequency of 50 cycles per second, ie. 50 Hz, and a root mean square electromotive force of 362Appendix D +363 High-voltage distribution Transformer substation 3 pin socket aah 0 Switch = Neutral ooh Fuse live Meter t+ = House. Mains supply Fig. A3 240 V. Since it is a sinusoidal variation the maximum or peak voltage is only applied for a brief instance so it is more usual to give the RMS voltage, which is 0.707 of the peak voltage. The alternating current is thus supplied to the building by two wires which pass the current through a meter, main switches, and fuses before being distributed in various circuits (Fig. A3). Circuits for the lighting carry small currents and are often protected by 5 A fuses whereas circuits designed to be used for equipment taking higher currents are protected by 13 (or 15) A fuses and connected by three-pin plug systems; most electrotherapeutic apparatus is connected by these latter.364+ Electrotherapy explained Three-pin plug and socket These are designed to connect in only one way so that the live, neutral and earth wires are always correctly connected and make good electrical contact. The earth pin is the longest so that it inserts first and is removed last. This ensures that there is no time when the live is connected but the earth is interrupted. The wiring is identified by the colour of the insulation, thus the live is brown, the neutral blue and the earth wire is yellow and green. Modern plugs also contain cartridge fuses which provide safety and protection for the individual piece of equipment, Appendix E TABLE OF SMALL UNITS Name Symbol Relation Fraction of to metre a metre Metre m 1 Centimetre cm 107? one-hundredth Millimetre mm 10° one-thousandth Micrometre, micron yen. 1034 one-millionth Nanometre nm 109 ‘one thousand- i millionth Angstrom unit 4 (not an SI unit) A Om one ten thousand- millionth Picometre pm 10—% one million-millionthAppendix F BASIC GUIDELINES FOR THE APPLICATION OF ELECTROTHERAPY Before applying any modality of electrotherapy to a patient the following questions should be considered: What effect is intended and can this treatment achieve this effect? In many instances it cannot be known if treatment is effective until it is tried, Sometimes effectiveness can be seen at once, e.g. relief of pain due to transcutaneous electric nerve stimulation or ice; in other cases it cannot be recognized for days or weeks. Is it safe, i.e. will the desired effect be achieved without undesirable effects? There is no effective treatment that does not carry some risks but for most electrotherapy treatment the risks are negligible provided reasonable and proper precautions are taken. Each modality has its own potential dangers and contraindications and no treatment should be considered without a thorough knowledge of these. Is it the best method of treatment to achieve this effect? Is it the most economical in terms of patient and/or therapist time, or other costs? Nu we Usually electrotherapy is part of an overall treatment plan which is selected and modified on the basis of repeated examination and assessment. However, there are some basic guidelines which can provide the framework for sound practice: 1 Assembly of apparatus: all the apparatus and equipment needed should be assembled and suitably positioned. 2 Preparation of patient a Explanation. An explanation of the treatment is an essential precursor of application. This not only reassures the patient but ensures informed consent. b Examination and testing. This refers to specific examination of the part to be treated for possible dangers and contraindications plus any relevant tests, e.g. for normal thermal sensitivity. The results should be recorded. c Preparation of the part to be treated. This involves any preparatory procedure, e.g. washing the area and positioning the patient, and in particular the part to be treated comfortably and appropriately, so that he or she is relaxed and unnecessary movement is avoided. 365366+ Electrotherapy explained 3 Preparation and testing of apparatus: this includes setting up the apparatus and any necessary testing of it prior to application. When this has been done satisfactorily treatment can begin. 4 Instructions and warnings: before the treatment commences it is mandatory to instruct the patient in what he or she must and must not do, e.g. keep still and not touch the apparatus, and to give essential warnings, e.g. ‘If this becomes more than a comfortable warmth it can burn’. The warning given should be noted on the patient's record card. 5 Treatment; the patient must be observed throughout to ensure that treatment is progressing satisfactorily and without adverse effects. Accurate timing is essential. © Termination of treatment: at the termination of treatment the part treated should be examined to ensure that the desired effects have occurred if visible, e.g, superficial vasodilation, and that there are no unwanted effects. If electrotherapy is a precursor to another form of treatment, the patient is prepared for that. If it forms the whole treatment, e.g. UVR, an explanation of what to expect is given as well as instructions of when to come again and what must be done between treatments. 7 Recording: an accurate recording of treatment must be made for assessment, planning at the next appointment and for legal requirements.Index Abductor hallucis stimulation 74 Abscess of skin 293 Accommodation 46, 47 (fig) Accommodation pulses 33 Achilles tendon injuries $2 Acne vulgaris 331-2 Acoustic streaming 10 Active transport 1 Acupuncture points 309 Adrenaline 19, 180 Alopecia 334 Alpine sunlamp (medium-pressure mercury arc lamp) 319-21, 345-7 Anginal pain 217 Angstrom unit 365 (table) Ankle sprains 250, 251 Antibiotics, application by iontophoresis 20 Anti-cholinergics, iontophoresis side-effects 25 Anti-inflammatory drugs, application by iontophoresis 20 Applied electric charges 9-10 Arteriosclerosis 196 Axthritis 198, 199, 252; see also rheumatoid arthritis Astable multivibrator (fipflop circuit) 39-40 Athlete's foot (tinea pedis) 21, 196 ‘Autonomic nervous system, electrical pulse effect 65 Axonotmesis 101, 102 (fig) Axon reflex 183 Back pain 251, 309 Basic guidelines for application of electrotherapy 366-7 Bell’s palsy 54, 106 Benzydamine hydrochloride (Difflam cream) 150 Bilirubin 294 Biofeedback 120-32 Effectiveness 129-30 Electromyographic (EMG) 122-6 application 124-6 blepharospasm 123 dystonic conditions 123 evaluation 130-2 hemiplegia 123 hyperventilation 124 motor control 122-4 muscle activity training 124 peripheral nerve injury 123 posture control 123 spasticity 123 writer's cramp 123 Temperature 128-9 Uses 122-9 cardiac arrhythmia 127 epilepsy 127 essential hypertension 127 migraine 127 raynaud’s disease 127 tension headache 127 Biomagnetism (Taiki therapy) 256 Blepharospasm 123 Blood pressure, cold therapy effect 218 Blue light 294-5 Body temperature 173-81 behavioural control 179-80 core 173 counter-current heat exchange 175-6 cutaneous thermoreceptors 176-8 homeothermy maintenance 174-5 isotherms 175 (fig) metabolic control 178 physiological effects of changes 182—4 blood 184 blood vessels 183-4 collagenous tissues 184 metabolic activity 182 nerve stimulation 182-3 viscosity 182 Regulation 180-1 Sweating control 179 Temperature ranges 177 (table) Vasomotor control 178-9 Body tissues I electrical properties 1 Bone: formation, direct current effect 18 mechanical stress on 250 remodel Bradykinin 183 Brown adipose tissue 178, 181 Bucrger’s disease (thromboangilis obliterans) 196, 217 Burns 184-5, 296-7 chemical 13, 25 electrochemical 95 shortwave 243 sun 326 Bursitis 20, 309 Bunsen-Roscoe reciprocity law 337 Cancer, pain control by superficial heat 183 Capacitance-resistance circuit 37368+ Carbuncle 293 Cardiac arrhythmias 127 Cardiac disease 217 Cardiac pacemaker: electric current effect 95 microwave effect 283 shortwave diathermy effect 244 Carpal tunnel syndrome 117 Cataracts 297 Causalgia 252 Cell: alteration of ionic balance around 65 membrane 1-2 lipid layer 1 resting potential 2 necrosis, cold-induced 208 Centimetre 365 (table) Central nervous system, evoked potentials 118 Cerebral palsy 123 Charges generated by the body 1-2 Chlorine 21 Chloroftucrocarbons 271 Chondromalacia patella 52 Chronaxie 110 Cold-compression unit 215 Cold packs 213-14 Cold induced vasodilation 204 Cold therapy (cryotherapy) 202-19 dangers/contraindications 216-19 ‘emotional/psychological factors 218 general effects 207 heat treatment contrasted 215-16 hypersensitive areas 219 local effects 204-7 motor skills 205-6 muscle strength 206 nerve fibres 205-6 methods 212-15 cold-compression unit 215 cold packs 213-14 ‘evaporating spray 215 general immersion 213 ice massage 214 ice towel 214 local immersion 212 precautions with particular methods 219 uses 207-12 chronic inflammatory conditions 210-11 chronic oedema 211 joint effusion 211 muscle spasm 209 muscle strengthening 210 muscle tear 211 Pressure sore 211 recent injury 207-8 spasticity 209-10 Cold urticaria 217 Colour therapy 295 Conduction heating, therapeutic 187-200 Contractures 53, 148 Contrast baths 194 Index Coronary thrombosis 217 Counter-current heat exchange 175-6 Cryoglobinaemia 217 Cryotherapy see cold therapy Current flow in tissues 68-9 Cutaneous thermoreceptors 176-8 Cutaneous wound healing 17-18, 65 Cystic fibrosis 181 Demyelinating disease 118 Dental extraction 148 Dental surgery 251 Diadynamic currents 36, 82-4 Diapulse 247 Dielectric constants 233 Difflam cream (benzydamine hydrochloride) 150 Direct current (d.c.) 12-25, 32 application 21-4 dangers. 25 dosage 24-5 interrupted 33-6 accommodation pulses 33 faradic-type pulses 33 high-voltage galvanic stimulation 36 high-voltage pulsed galvanic stimulation 36 microshock 91 nature 13 physiological effects/therapeutic uses 16-18 bone formation 18 chronic skin ulcer healing 18 electrophoresis 18 healing acceleration 17-18 hyperaemia 17 pain relief 17 sensory stimulation 17 production 16 transmission 13 Drionic unit 20 Dupuytren’s contracture 148 Dystonic conditions 123 Ear chondritis 20 Eddy currents 224 Electric apparatus, safety features 93-4 Electric charges: on tissues. 28-9 use in evaluation/diagnosis 99-119 Electric current 29-32, 222 alternating 32 biphasic pulses 31-2 contraindications, therapeutic 96 diadynamic 36, 83-4 direct see direct current evenly alternating 36-7 frequency-time period relationship. 31 (fig) high-frequency 37 interferential see Interferential current macroshock 91-3 immediate treatment 92-3Index therapeutic nerve/muscle-stimulating currents 94-5 microshock 91 nature 356-7 pulses (phases) see electrical pulses Russian 36, 84-5 safety 91-6 sinusoidal 36 surging (ramping) 31 time-current relationship 31 Electric heating pads 197 Electric pulses (phases) 31 effects on excitable cells 66 (table) generator structure 41-2 low-frequency, effects on tissues 42-50 nerve stimulation 44-6, 49-50 secondary effects 50 production 37-40 strength-duration curves 46-9 tissue penetration 49 Electric reflex testing 117-18 Electric shock 94-5 mains current, treatment 92-3 Electroacupuncture 78-9 Electrocardiogram 71, 99 Electrochemical burns. 95 Electrodes 67-8 arrangements 69-70 bipolar system 70-1 electro-tissue interface 67 lowering electrical resistance at skin surface 71 unipolar system 70-1 Electroencephalogram 99 Electrolysis 358-9 Electrolytes 358 Electromagnetic fields, effects/safety 256-8 Electromagnetic induction 223 Electromagnetic radiation 222, 261-73 interactions with matter 266-73 absorption 270-1 penetration 269 (fig), 270-1 reflection 267-8 refraction 268 (fig), 270 scattering 271-2 total internal reflection 272 inverse square law 265, 266 (fig) phase dfference/ochesion 268 polarization 265~6 rectilinear propagation 265 Electromagnetism 222-5 Electromyography 103-5 biofeedback 105 Electrons 300-2 Electrophoresis 18 Electrostatics 222 Encephalin 61, 63 Endorphin 61 Energy: application to body for therapy 8-9 conversions 167, 168 (fig) introduction into matter 302 Epilepsy 127 +369 Episiotomy 148 scar 148 Erythema 17 Ethylmorphine hydrochloride (Renotin) 21, 24 Eutrophic electrotherapy 54 Evaporating spray 215 Evoked action potentials 99, 114 Evoked potentials 118-19 CNS 118 sensory cortex 118 spinal 118 Visual-evoked 119 Facial (VII cranial) nerve stimulation 106 Faradic stimulators 29 Faradic-type pulses 33, 35 (fig) Fel apparatus 254-5 Fibrous tissue, remodelling 65 Flipflop circuit (astable multivibrator) 39-40 Fluidotherapy 197 Fluorescence 273, 336 Fluorescent lamps 318-19 Fractures, ununited 256 Frozen shoulder 218 Functional breathing disorders 124 Fungal infections 196, 294 Fwave 117-18 Gallium aluminium arsenide 306 Gases 164 Gentamicin sulphate 20 Globular proteins 1 Glycopyrronium bromide 19 ‘Greenhouse effect’ 271 Guillain-Barré syndrome 101 Haematoma 252 Half value depth 271 Hand: injuries 293 whole hand treatment 293 Head injury 123 Healing, by: direct current 17-18 infrared radiation 293 superficial heat 199 Heat 163-85 addition 166-7 conduction 168 convection 169 quantity 165-6 radiation 169 specific 165-6 transfer 167-70 Heated air treatment 196-7 Heating: conduction 187-200 deep 187-9 reflex 199-200 superficial 187-90, 197-9 healing encouragement 199370+ joint motion increase 199 pain relief 198 Heat stroke 181 Heat syncope 181 Heat treatment, cold treatment contrasted 215-16 Heliotherapy 352 Hemiplegia 53 biofeedback 123 electrical stimulation of: deltoid muscle 55 dorsiflexors 55 Herpes zoster 19, 148 Hertzian waves (radiowaves) 224, 225, 262 High-frequency currents 37, 228-31 transmission to tissues 229-31 High-voltage galvanic stimulation 36 High-voltage pulsed galvanic stimulation 36, 79-81 uses 80-1 muscle stimulation 81 pain modulation 80-1 wound healing 80 Histamine 25, 147 Histamine diphosphate 20 Histamine like substances. 183 Homeothermy maintenance 174 Hot moist packs (Kenny packs) 193 H reflex 117 Hunting reaction (Lewis) 204 Hyaluronidase 21 S-hydoxytryptamine (serotonin) 63 Hydrocollator packs 193 Hydrocortisone 150 Hydrotherapy 194-6 contraindications to treatment with hot water 195-6 Hyperaemia 17 Hypertension, essential 127 Hyperventilation 124 Hypothalamus 180, 207, 232 Hypothermia 181 ICE (ice, compression, elevation) 208 Ice bags 219 Ice massage 211, 214-15 Ice pack 211, 214-15 Idiopathic hyperhidrosis 19-20 Incontinence 52, 74, 90-1 Inductothermy 232, 237-9 Infections, chronic 332-3 Inflammatory states, chronic 199 cold therapy 210-11 microwave therapy 280 Infrared energies 187 Infrared radiation 287-94 absorption 290-1 application 295-6 contraindications 298 dangers 296-8 blood pressure lowered 297 burns 296-7 Index cataract 297 defective arterial blood flow 297 dehydration 298 skin irvitation 297 lamp 289-90 penetration 290-1 physiological effects 291-2 production 288 uses 292-4 acceleration of healing/repair 293 muscle spasm 293 oedema of extremities 293 pain 293 precursor of other treatment 294 Pressure sore prophylaxis 293 skin diseases 294 Interferential current 36-7, 85-91 application 88-9 pain relief 64 stereodynamic 87 Iodine 21 Ton(s) 1-2 transfer see lontophoresis Ionization 264 energy 301 Ionozone therapy 353 lontophoresis (ion transfer) 12—13 application 23-4 copper 21 dosage 24-5 slycopyrronium bromide 19 mechanism 14-16 physiological/therapeutic effects 18-21 iotics application 20 anti-inflammatory drugs application 20 idiopathic hyperhidrosis 19-20 atari 19 neurogenic pain 20-1 systemic effects. 25 tapwater 20 zinc 21 Joint effusion 211 Joint motion 53, 199 Kenny packs (hot moist packs) 193 Keratin 328 Knee effusion 198 Kromayer lamp 321-3, 347-50 Langerhans cells 330 Lasers 299-312 application principles 310 contraindications 312 dangers 312 dosage 310-11 effects on tissues 307-8 helium-neon 305 infrared radiation compared 305 (fig) ‘measurement of laser energy 303 principles 300-1 ruby 303Index semiconductor diode 306 therapeutic uses 308-10 fracture consolidation 309 nerve degeneration prevention 309 pain control 309 tissue healing 308-9 types 304 (table) uses 304-5 Law of conservation of energy 166 Lignocaine 19 Liminal current gradient 56, 57 (figs) Liquids 164 Local anaesthesia 19 Low back pain 148 Low frequency currents, muscle stimulation by 73-5 Low-power pulsed high-frequency energy 254-5 Luminous light sources (radiant heat) 295 Magretic fields low-frequency 256 static 256 Magnetism 255 Mains current shock, treatment 92-3 Mains supply 362-4 Medium pressure mercury arc lamp (Alpine sunlamp) 319-21, 345~7 Mercury atoms wavelengths 317, 318 (table) Metabolism, source of heat 180 Metatarsalgia 52 Metre 365 (table) Micrometre 365 (table) Micron 365 (table) Microwaves 274-85 application principles 281-2 contraindications 284-5 dangers 282-3 cardiac pacemaker 283 eyes 283 metal 282 testes 283 physiological effects 276-9 pattern of heat in tissues 277-9 production 275-6 safety 283-4 therapeutic use 280-1 Migraine 127, 129 Millimetre 365 (table) Morphine 60-1 Motor nerve: action potentials in 56 transplant 52 Motor points 44 (fig), 72 (fg), 73 Motor unit 8, 103 (fig), 104 (fig) Mud packs (peloids) 194 Multiple sclerosis 123 Muscle: atrophy 51 eutrophic electrotherapy effect 54 retardation by electrical stimulation 58 +371 blood flow in, electrical stimulation effect 53-4 Control facilitation 52 Denervated 55-9 Electric charges generated by 7-8 Electrical stimulation 50-9 spasticity control 55 splinting replaced 54-5 Fast twitch change to slow twitch 54 Innervated, stimulation of 50 Metabolism, electrical stimulation effect 53-4 Microwave heating 280-1 Proteins 54 Pumping action 58, 75 Spasm 209, 280, 293 denervated muscle 5-9 high-voltage pulsed galvanic stimulation 81 innervated muscle 50 joint motion maintenance/increase 53 low frequency currents 73-5 muscle strengthening effect 50-1 Strengthening 50-2, 210 Strength of contraction 29 Structure changes 54 Tear 211 Tetanic contraction 29 Transplant 52, 124 Trauma 124 Voluntary contraction force 51 Weakened/weakening 51 ‘Worm-like’ contraction 56 Nanometre 365 (table) Neonatal jaundice 294-5 Nernst equation 2 Nerve(s): afferent, stimulation of 59 all-or-none response 45 establishing continuity 106-7 liminal current gradient 56, 57 (figs) peripheral see peripheral nerves resting membrane potential 2 stimulation see nerve stimulation Nerve conduction test 106 Nerve conduction velocity studies 115-17 Nerve fibre, myelinated 7 (fig) Nerve impulse 3-5 absolute refractory period 47, 48 (fig) all-or-none event 7 relative refractory period 47, 48 (fig) saltatory conduction 5 speed of propagation 5-7 Nerve stimulation’ 27-96 by electrical pulses 44-6 peripheral nerves 42-4 Neurogenic pain 20, 252, 293 Neuropraxia 100-1 Neurotmesis 101, 102 (fig) Nodes of Ranvier 5 Non-luminous radiation 295 Noradraneline 63372+ Occupational injury 148 Oedema 146, 211, 293 Ohm's law 13 Orchidoplexy 251 Osteoarthritis 148, 309 knee 64 Osteoporosis 252 Ozone 321, 351 atmospheric, destruction of 271 Pain 59-64 A delta pain fibres 60, 63 cold therapy 208-9 control 60-4 C pain fibres 60, 63 modulation by high-voltage pulsed galvanic stimulation 80-1 pathways 60, 61 (fig) receptors 60 relief by: direct current 17 infrared therapy 292 microwaves 280 superficial treatment 198 ‘Pain gate’ theory 17, 60, 62 (fig), 63 Pain nerve endings 176 Paraffin wax baths 190-3 contraindications 192-3 dangers 192-3 Paranasal sinusitis 252 Paraplegic patients 55 Paronychia 196 Peloids (mud packs) 194 Pelvic floor muscle re-education 52, 74 Penetration depth 271 Peripheral nerves: classification 42, 43 (table) lesions 100-1, 1-2 (fig) biofeedback’ 123 recovery from 52 pathological changes 100-1 Perthes’ disease 256 Phantom limb pain 148, 252 Phonophoresis 149-51 application 150-1 contraindications 151 drugs used 150, 151 (table) Photochemotherapy 331 Photon 301 Phototherapy 315 Picometre 365 (table) Plantar fasciitis 148 Poldine methylsulphate 20 Polyneurites 101 Poliomyelitis 193 Population inversion 302 Post-herpetic neuralgia 21, 309 Postpartum conditions 148 Post-traumatic osteodystrophy (Sudeck’s atrophy) 191, 252, 293 Postural flatfoot 52 Pressure sore 148, 211 prophylaxis 293 Index Procaine 19 Psoriasis 294, 318, 330-1 photochemotherapy 331 Pulse (wrist) 37 Pulsed shortwave 246-54 application 252 contraindications 254 dosage 252-3 physiological effects 251-2 therapeutic uses 252 PUVA treatment 344-5 ‘Quadriceps muscle stimulation 51-2 after knee surgery/injury 52 effect on blood flow in femoral artery 54 Radiation 315 Radio waves (hertzian waves) 224, 225, 262 Raynaud's disease (phenomenon) 127, 129, 217 Rebox 79 Red light 295, 308 Red visible radiations 293 Relaxation training 127 Renotin (ethylmorphine hydrochloride) 21, 24 Resting membrane potential 2 nerves 2 Retinal detachment 304 Rheobase 45, 56, 108, 113-14 high 109 low 109 Rheumatic conditions 148 Rheumatoid arthritis 199, 309; see also arthri Rheumatoid nodules 148 RICE (rest, ice, compression, elevation) 208 Russian current 36, 84-5 Ryodu-Raku 78-9 Scar tissue 148 Scoliosis 53 Seasonal affective disorder 294 Seawater 3, 5 Sebaceous glands 330 Sensory cortex, evoked potentials 118 Sensory deficiency areas. 218 Sensory stimulation by direct current 17 Serotonin (5-hydroxyiryptamine) 63 Shock, mains current, treatment 92-3 Shortwave diathermy 225-8 application principles 232-41 capacitator field method 232-5 coplanar technique 236 contraplanar technique 238 cross-fire technique 237 electrode positioning 234 (fig), 236 electrode size 235-6 tissue nature/relationship 236-7 application technique 238 (fig), 239-46 continuous shortwave 241, 242 (fig)Index contraindications 245-6 dangers 242-5 burns 243 cardiac pacemaker 244 concentration of electric field 243-4 distance from machine 245 implanted slow-release hormone capsules 245 obese patients 245 pregnancy 245 synthetic materials 244 dosage 241, 243 (table) local tissue heating 231-2 Shoulder, painful 143 Sinusoidal currents 36, 81-2 Skin: “battery potential’ 18 erythema 326-7 fungal infection 21 growth increase 327 hypersensitive 334 keratinization 328 Langerhans cells 330 pigmentation 327, 329-30 sebaceous glands 330 surface, lowering electrical resistance 71 ultraviolet radiation effect 323-4, 324-8 vitamin D production 327-8 Small units 365 Snow blindness 324 Sodium-potassium pump 2 Soft tissue injury 148, 208 Solids 163 Sonic waves 134-7 absorption 140-1 boundaries between media 139-40 transmission 139-41 Spasticity: biofeedback 123 cold therapy 209-10 control by electrical stimulation 55 Spinal-evoked potentials 118 Spinal motor neurone pools 50 Sports injury 148, 251 Square wave pulses 33 Stimulated emission 302 Strength-duration testing 107-14, 115 (fg) accommodation pulse use 114 daily variations 111 interpretation 109-10 reliability 110-11, 112-13 (figs) technique 108-9 uses 113-14 Stress, extremes of temperature induced 181 Subacromial bursitis 148 Sudeck’s atrophy (posttraumatic ‘osteodystrophy) 191, 252, 293 Sunbeds 352-3 Sunburn 326 Surface electromyogram 71 Surgical wound 148 Sweat glands 179 +373 Sweating 179 Synovitis, acute traumatic 252 Taiki therapy (biomagnetism) 256 Temperature 164-5 biofeedback 128-9 body see body temperature Tendinitis 20 Tendon: establishing integrity 105-6 transplant 124 Tension headache 127 Tetanic contraction strength 48 Therafield beta and Q pulse 255 Theratkin lamp 318, 343-4 Thermal sensation testing 200 Thermography 172-3 Thermometers 171-2 Thermoreceptors, cutaneous 176-8 Three-pin phe eeter 363-4 Thromboangiitis obliterans (Buerger's disease) 196, 217 Tinea pedis (athlete's foot) 21, 196 Tissue destruction, direct current effect 18 Tissue healing, lasers 308-9 Transcutaneous electrical nerve stimulation (TENS) 28, 29, 33-4 brief intense 76, 77 (fig) contraindications. 78 current parameters 76-8 high-intensity, low frequency 76, 77 ig) low-intensity, high frequency 77 low-intensity currents 41 modulated 77-8 pain relief 63-4, 75-6 transformer 360-1 Transistor 38-40 Trigeminal neuralgia 19, 309 Tuberculosis of skin 333 Ulcers, skin 18, 309 Ultrasound 133-60 absorption of waves (in parallel beam) 140-1 application 152-5 direct contact 152 (fig), 153 solid sterile gel as couplant 155 water bag 152 (fig), 154 water bath 154 attenuation in tissues 141-2, 143 (fig) boundaries between media 139-40 contraindications 158-60 dosage 155-8 frequency 155 intensity 156 mode 155 progression 158 time 156-7 timing 158 effect on inflammation/repair process 147 physiological effects: non-thermal 146374+ Ultrasound —cont. acoustic streaming 10, 146 cavilation 146 micromassage 146 standing waves 146 physiological effects: thermal 145 production 137-9 pulsed 144 therapeutic mechanisms 145 therapeutic uses 147-8 transmission 139-41 Ultraviolet radiation 314-53 application principles 343-4 romayer lamp 347-50 local, face 347, 348 (fig) local, with Alpine sunlamp 345-7, 348 PUVA treatment 344-5 theraktin lamp 343-4 biological response 338 assessment 338-9 contraindications 352 dangers 351 dosage 336-42 progression 340 drug sensitization 341 eye protection 351 ; Auorescent lamps 318-19 Kromayer lamp 321-3, 345 luminescence 335-6 measurement 323 medium pressure mercury arc lamp (Alpine sunlamp) 319-21 overdose 351 phosphorescence 336 physiological effects 323-8 erythema 325 (table), 326-7 eyes 324 pigmentation 327 skin 323—4, 324-8 vitamin D 324, 327-8 records 350 Index Test doses 339 uses/indications 330-6 acne vulgaris 331-2 chronic infection 332-3 diagnostic 335-6 esophylactic 334 hypersensitive skin protection 334 pruritus due to biliary cirrhosis/uraemia 335 psoriasis 330-1 psychological 336 tuberculosis of skin 333 uninfected wounds 333 vitamin D deficiency 335 vitiligo 333-4 Van't Hoff’s law 182, 293 Vapocoolant spray 211 Vasodilation 64-5 Cold cutaneous 184 cold induced 184 Heat induced 183 Vasospasm 217 Venous ulcer 148 Vincristine 20-1 Visible radiations 294-5 Visual-evoked potentials 119 Vitamin D 324, 327-8 deficiency 328 treatment 335 Vitiligo 333-4 Warm water 194-5 Water baths 70-1 Whirlpool baths 195 Wien's law 288 Wound healing 80, 256 lasers 308 uninfected 333 Writer's cramp 123 Xanthinol nicotinate 20