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PT 158: Physical Agents II DIADYNAMIC CURRENTS

PT 158: Physical Agents II DIADYNAMIC CURRENTS. Gilbert O. Madriaga , PTRP Department of Physical Therapy UP- College of Allied Medical Professions. Revised by: Mark David S. Basco, PTRP Department of Physical Therapy UP - College of Allied Medical Professions. Objectives.

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PT 158: Physical Agents II DIADYNAMIC CURRENTS

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  1. PT 158: Physical Agents IIDIADYNAMIC CURRENTS Gilbert O. Madriaga, PTRP Department of Physical Therapy UP- College of Allied Medical Professions Revised by: Mark David S. Basco, PTRP Department of Physical Therapy UP - College of Allied Medical Professions

  2. Objectives • Describe diadynamic currents and its physical properties. • Discuss the physiologic effects of diadynamic currents on the body. • Identify the various indications, contra-indications and precautions with regards the use of diadynamic currents. • Enumerate the different methods of application of diadynamic currents for common clinical problems. • Prescribe correct dosage, intensity, duration and frequency of diadynamic currents on given problems. • Appreciate the value of evidence-based clinical practice in providing quality care to patients.

  3. Diadynamic Currents • Monophasic pulsatile current • Usually a sine wave • F=100Hz

  4. Full wave rectification • reversal of the the direction of AC during alternate half-cycles. The current is unidirectional and pulsed.

  5. Half wave rectification • use of a rectifier to allow current to pass in one direction only, as the flow is blocked during alternate half-cycles of the AC. The current is pulsed direct current.

  6. Diadynamic Currents • Pulse rate • 50 pps for half wave rectified. • 100pps for full wave rectified • Pulse duration= 10 ms

  7. Diadynamic Currents • Provide excitatory responses but its long pulse duration is very uncomfortable • Effects are similar with DC because its flow is also unidirectional and it has short or no interpulse interval

  8. PHYSICAL PROPERTIES OF DIADYNAMIC CURRENTS

  9. Fixed Diphase(DF) • Full wave rectified AC • f = 50Hz • most effective in producing a masking effect

  10. Fixed Monophase (MF) • Half wave rectified AC • f = 50Hz

  11. Short Periods (CP) • DF+MF • equal phases are attenuated without intervening pauses

  12. Long Periods (LP) • 10 sec MF + 5 sec DF • peak intensity is varied and has a tendency to rise and fall

  13. Syncopal Rhythm (RS) • 1 sec MF + 1 sec rest period

  14. PHYSIOLOGIC EFFECTS OFDIADYNAMIC CURRENTS

  15. Masking • sensory nerve excitability is altered Vasomotor effects • ↑ vasodilation & hyperaemia as result of release of histamine in tissues

  16. Diadynamics affect only superficial tissues, but if by reflex activity it is possible to have effects on deeper structures Muscle stimulation • For CP & LP currents muscle contraction is stimulated which increases blood flow to the muscles Stimulation of vibration sense

  17. Indications • Soft tissue injury • Sprains • Contusions • Epicodylitis

  18. Indications • Joint Disorders • Post-immobilization • Arthritis

  19. Indications • Circulatory disorders • Raynaud’s disease • Migrane

  20. Indications • Peripheral Nerve Disorders • Neuralgia • Neuritis • Herpes zoster • Radiculopathies

  21. Contraindications • Skin Lesions • To prevent burns, large cuts, abrasions or open areas • Eczema, psoriasis, acne, dermatitis can be exacerbated by electric currents

  22. Contraindications • Infection • Can be aggravated by electric currents and it is possible to spread the infection

  23. Contraindications • Impaired sensation • Must be checked first before any treatment • Density of current must be governed by the patient’s subjective feeling of current tolerance

  24. Methods of Application

  25. Pain Spot Application • 2 electrodes using bipolar technique • Anode over painful site, cathode adjacent to it • Cathode may be applied proximally on the limb or over the nerve supplying the painful area (monopolar technique)

  26. Nerve Trunk Application • Apply electrodes where the nerve is superficial • A tingling sensation will be felt in the area stimulated

  27. Paravertebral Application • Applied on both sides of the spine at the level of the nerve root supplying the painful area • If there are several nerve roots, apply alongside the spine at the highest and lowest nerve root levels

  28. Vasotropic Application • Electrodes are placed over the vascular paths affected in the circulatory system

  29. Myo-energetic Application • at each end of the muscle belly to produce stimulation • or monopolar technique with one electrode on the motor point of the muscle belly and the other proximal to it

  30. Transregional Application • To treat a joint, electrodes on opposite sides of joint

  31. Dosage

  32. DF-fixed diphase • For initial treatment and before the application of any other current • For the treatment of circulatory disorders • Prickling sensation which subsides/ fine tremors • Muscle contraction occurs at high intensities

  33. MF-fixed monophase • Pain without muscle spasm after DF • Strong penetrating vibration which persist for longer than the sensation in DF • Muscle contraction occurs at lower intensities than with DF

  34. CP-short periods • For traumatic pain • DF phase - Fine tremor rapidly diminishes • MF phase – strong constant vibration • Rhythmic contraction of muscle

  35. LP-long periods • Long lasting analgesic effect particularly in the treatment of mylagias • Used in combination with CP for the treatment of neuralgia • Strong vibration

  36. RS-syncopal rhythm • For faradic-type stimulation • Test the excitability of nerves

  37. Intensity • Gradually increased until a definite vibration or prickling is felt but without pain of burning sensation • Tetanic ms contraction should not occur

  38. Duration • Not more than 10-12 mins • 3 minutes for single applications

  39. Frequency • 6-7 treatments given daily or every 2nd day

  40. Diadynamic Currents • The effects of diadynamic currents can be achieved by modern TENS with greater comfort and ease because of its microsecond pulses

  41. What research tells us . . . TITLE: Changes in pain by different types of diadynamic current in gonarthrosis and lumbar syndrome • No differences concerning the changes in pain can be demonstrated concerning the different types of current. Nor could any differences concerning changes in pain be found comparing the different weeks of therapy. (Volklein & Callies, 1990)

  42. We have just . . . . . . . described diadynamic currents and its physical properties. . . . discussed the physiologic effects of diadynamic currents on the body. . . . identified the various indications, contra-indications and precautions with regards the use of diadynamic currents. . . . Enumerated the different methods of application of diadynamic currents for common clinical problems. . . . prescribed correct dosage, intensity, duration and frequency of diadynamic currents on given problems.

  43. References • Clinical Electrotherapy by Roger M. Nelson & Dean P. Currier • Clayton’s Electrotherapy by Sheila Kitchen & Sarah Bazin • Principles and Practice of Electrotherapy by Joseph Kahn • Electrophysical Agents in Physiotherapy Therapeutic and Diagnostic Use by Hilary Wadsworth & A.P.P. Chanmugam • www.pedro.fhs.usyd.edu.au/ Physiotherapy Evidence Database (PEDro)h

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