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Galvanic current, indications & parameters of IDC - Coggle Diagram

- - - - motor unit
        
        Muscle fibre type
        
        type IIb
        FG
        
        fast glycolytic
        
        least oxidative
        
        least fatigue resistance
        
        highest fastest force production
        
        physiological sequence in contraction
        
        asynchronous motor unit pattern
        
        smooth graded contraction
        
        related to- no.of motor units firing (spatial summation)
        
        rate of motor unit firing (temporal summation)
        
        normal contraction
        
        Increase no of motor units in early contraction
        (to incr force)
        
        Then increase firing rate to increase force further
        
        Type I MU fire first, then Type II, Type IIb brought in last of all.
        
        Electrical Stimulation pattern:
        
        SYNCHRONOUS firing pattern (all MU’s fire together)
        
        Type II neurons are LARGER (therefore have a lower threshold,
        therefore fire first-reverse of the natural sequence)
        
        physiological effects of IDC
        
        contraction of denervated muscle
        .
        
        denervated ms- accommodation not same as motor nerve
        .
        
        slowly rising current can produce contraction of denervated ms
        .
        
        impulse with a duration of 100ms
        .
        
        stimulation of sensory nerves- stabbing or burning sensation, reflex dilation of the superficial blood vessels & consequent erythema of the skin
        .
        
        stimulation of motor nerves-contraction of the ms supplied.
        
        type IIa
        FOG
        
        fast oxidative glycolytic
        
        intermediate,
        
        some oxidative metabolism
        therefore some fatigue resistance
        
        type I
        SO
        
        slow oxidative
        
        vascular +++
        
        fatigue resistant
        
        (red fibers-old term)
        
        anterior horn cell
        1 alpha motor neuron
        n all the ms fibers it innervates
      - image
    - - Different waveforms
        
        The impulses in which the current rises gradually are often
        termed ‘selective’
        
        rectangular
        sawtooth
        triangular
        trapezoidal
        
        image
- - - - Techniques of application
        
        Parameters
        
        Dosage
        
        one pad-origin of the ms group
        .
        
        active electrode - a disc or small pad electrode - lower end of the fleshy belly of the muscle or stroked slowly down (labile technique)
        .
        
        Two disc electrode may be used
        .
        
        Two pads may be fixed – stabile technique-one over the origin and the other over the lower end of the muscle group
        .
        
        preparation of the equipment
        .
        
        preparation of the patient
        .
        
        application of IDC- test the electrode
        (anode or cathode) for effective ms contraction.
      - stimulation of denervated ms
        though many controversies exist for this
        
        its recognized as an imp tx modality in the early stages of periperal nerve inj.
        
        the rationale is to maintain the ms in as healthy a state as possible by electrically induced artificial exercise, while awaiting reinnervation
        
        this would substitute for the beneficial effects of normal ms contraction/
        
        for electrodiagnosis
        in SD curve plotting & faradic IDC tests
    - - cardiac disease
        patients with known Hx of
        
        cardiac disease
        
        previous MI
        
        other congenital & acquired cardiac abnormalities
        should be applied with proper measures as the isometric contraction produced might put extra stress on the affected heart.
        
        anesthetic/ hypoesthetic skin
        should be applied with caution & adequate skin care as patient cannot report of any discomfort
        
        small children/ & subjects with impaired mentation
        
        cannot understand the necessities of the Tx
        
        cannot report any discomfort or damage
        
        if patient has undergone iontophoresis/ phonophoresis
        
        as strong ms contraction & enhanced blood flow frm ES might disperse the introduced drug
  - - - recent radiotherapy
        contraindicated within 6 mnths following therapy
        tissues are devitalized & cannot bear the stress due to enhanced metabolic activity caused by ES
        
        carotid sinus
        
        should not be placed over ant & lateral neck
        may cause a rapid fall in BP n cause the patient to faint.
        
        areas of venous & arterial thrombosis & thrombophlebitis
        
        stimulating these areas may incr circulation thereby incr risk of embolism- absolute local ContraIndication
        
        pregnancy
        
        over pelvis, low back, abdomen & trunk to be avoided
        
        effect on fetous has not been established
        
        early tendon transfer/ repair
        
        contraindicated before the completion of 5th week
        as strong ms contraction can cause tendon damage.
        
        malignancy
        
        is contraindicated as it may accelerate secondary spread (metastasis)
        
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