APPLICATIONS OF BIOMEDICAL ENGINEERING IN ORTHOPAEDIC PHYSICALTHERAPY

Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young.

The greatest thing in life is to keep your mind young. Henry Ford

Orthopaedic physical therapy

Orthopaedic physical therapy is a branch of physical therapy which mainly deals with bone and joint related problems The main aims of treatment are to relieve pain, enhance healing, strengthen muscles and improve mobility

Modalities

A method of therapy that involves physical or electrical therapeutic treatment Physical therapists use a variety of modalities to help treat their patients. There are a variety of treatment modalities that can help strengthen, relax, heal muscles and reduce pain.

Classification of modalities

Electromagnetic Electrical Sonic Radiation Mechanical

How are Modalities Related?

Electromagnetic energy modalities

Shortwave and microwave diathermy

Faradic and galvanic currents TENS IFT Iontophoresis Ultrasound

Electrotherapy

Acoustic energy modalities

Radiation modalities
Infrared

therapy ultraviolet therapy Laser hterapy

Conduction modalities
paraffin

wax contract bath

Mechanical modalities
Traction CPM

Shortwave Diathermy

Heats tissue by introducing high frequency electrical current Performs through electrostatic field heating or electromagnetic/induction field heating Pulsed diathermy is relatively new
Not continuous reduces likelihood of significant tissue temperature increase Utilizes drum electrode Produces both thermal and non-thermal effects

Equipment High frequency generator with an oscillator along with amplifier for converting AC current to DC Also has circuit that tunes to patient Treatment applicator is either condenser or inductive type With condenser, patient is part of circuit and requires use of flexible electrodes Inductive utilizes drum or cable electrodes

Electrotherapy

Low frequency

Electrical stimulation Iontophoresis

IFT

Medium frequency

High frequency

SWD MWD

Electrotherapy

Physical Principles
Electricity
Volume

displays magnetic, chemical, mechanical, and thermal effects on tissue

of current (ampere) Rate of flow Resistance Force that current moves along = voltage

Electricity

is applied to nerve tissue at certain intensities and duration to reach tissue excitability thresholds resulting in membrane depolarization
Target

sensory, motor, and pain nerve fibers in an effort to produce specific physiological effects

Electrical Stimulating Units

Three types of units

TENS - transcutaneous electrical nerve stimulators NMES/EMS - neuromuscular electrical stimulators or electrical muscle stimulators MENS/LIS - microcurrent electrical nerve stimulators or low-intensity stimulators

Generate 3 types of current

Monophasic

Direct current or galvanic current - flow in one direction only from (+) to (-) or vice versa Used to produce muscle contraction, pain modulation, ion movement (determined by specific parameters) Alternating current where direction of flow reverses during each cycle Useful in pain modulation and muscle contractions

Biphasic

Ionotophoresis

Chemical ions are transported through intact skin using electrical current -- used to treat skin infections or to produce a counterirritant effect
Requires use of low voltage direct current on continuous mode w/ a long pulse duration (allows for migration of ions) Polarity of pads is set relative to the medication/solution being used

Low Intensity Stimulators

Microcurrent electrical nerve stimulator Operates at low frequencies and intensities (subsensory) Used to stimulate healing of soft tissue and bone

INTERFERENTIAL THERAPY
The name Interferential therapy stems from the concept of two currents interfering with each other This becomes readily apparent when one views the four electrodes (quadripolar) that are necessary to produce the standard interferential effect in a patient

Makes use of 2 separate generators, emitting current at slightly different frequencies Quad polar pad placement is used creating interference pattern

Creates a broader area of stimulation

Transmission of Thermal Energy

Conduction
Heat is transferred from a warmer object to a cooler one Dependent on temperature and exposure time Temperatures of 116.6o F will cause tissue damage and temperatures of 113o F should not be in contact w/ the skin longer than 30 minutes Examples include moist hot packs, paraffin, ice packs and cold packs

Convection
Transfer of heat through movement of fluids or gases Temperature, speed of movement, and conductivity of part impact heating Whirlpools

Radiation
Heating is transferred from one object through space to another object Shortwave diathermy, infrared heating and ultraviolet therapy

Conversion

Generation of heat from another object (sound, electricity or chemical agents)

Paraffin Bath

Equipment

A paraffin wax and mineral oil combination, heated to 126-130o F

Indications
Useful in treating chronic injuries Effective for angular areas of body such as hands, wrists, elbows, ankles and feet

Contrast Bath

Equipment

Requires use of hot and cold tubs

Ultrasound

Modality which stimulates repair of soft tissue and pain relief Form of acoustic energy used for deep tissue heating
Operates at inaudible frequency Sound scatters and is absorbed as it penetrates tissues -- losing energy = attenuation Impedance and penetration are determined by properties of media (densities)

Equipment

High frequency generator which provides electrical current through a coaxial cable to a transducer applicator

Through piezoelectric effect electrical current is transformed into acoustic energy through contraction and expansion of piezoelectric crystals 1 MHz ultrasound allows for deeper penetration while 3 MHz is absorbed more superficially

Frequency ranges between .75 and 3.0 MHz

Traction

Drawing tension applied to a body segment

Low Level Laser Therapy

Light Amplification by Stimulated Emission of Radiation Used for collagen synthesis, control of microorganisms, increased vascularization, and pain/inflammation reduction Helium-neon and gallium-arsenide lasers are currently being explored by the FDA

Continuous Passive Motion (CPM)

Purposes

Produce passive joint motion Moves the limb through ROM by grasping it proximal and distal to the joint Effects:
Enhance nutrition Increase metabolic activity Stimulate tissue remodeling and re growth of healing tissues:

Articular cartilage Tendons Ligaments

Safety in Using Therapeutic Modalities

Equipment must be used and maintained in appropriate manner Following manufacturer recommendations

Regarding use and maintenance

Failure to follow recommendations = negligence