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MENS and IONTOPHORESIS

MENS and IONTOPHORESIS. MENS. No universally accepted definition or protocol & has yet to be substantiated This form of modality is at the sub-sensory or very low sensory level current less than 1000 A (approx 1/1000 amp of TENS). Biophysical Effects. Theory:

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MENS and IONTOPHORESIS

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  1. MENS and IONTOPHORESIS

  2. MENS • No universally accepted definition or protocol & has yet to be substantiated • This form of modality is at the sub-sensory or very low sensory level • current less than 1000A (approx 1/1000 amp of TENS)

  3. Biophysical Effects • Theory: • Currents below 500A increases the level of ATP (high Amp decreases ATP levels) • Increase in ATP encourages amino acid transport and increased protein synthesis • MENS reestablishes the body’s natural electrical balance allowing metabolic energy for healing without shocking the system (other types of e-stim)

  4. Duration 30 min to 2 hours up to 4x a day Precautions Dehydrated patients on Scar tissue (too much impedance) Contraindications Pain of unknown origin Osteomyelitis Indications Acute & Chronic Pain Acute & Chronic Inflammation Edema reduction sprains & Strains Contusion TMJ dysfunction Neuropathies Superficial wound healing Carpal Tunnel Syndrome MENS

  5. Electrode Placement • Electrodes should be placed in a like that transects the target tissues • Remember that electrical current travels in path of least resistance, thus it is not always a straight line. TARGET

  6. Application Techniques • Standard electrical stimulation pads • generator may have bells & Whistles since MENS is subsensory • Probe

  7. Bone Stimulating Current: • MENS • Has been advocated in the healing of bone, using implanted electrodes and delivering a DC current with the negative pole at the fracture site. Further use of MENS has allowed increased rate of fracture healing using surface electrodes in a non-invasive technique. Theories on the physiology behind the healing focus on the electrical charge present in the normal tissue as compared to the electrical charge found with the injured tissue. MENS is said to allow an induction of an electrical charge to return to he tissues to a better “healing” environment

  8. Iontophoresis

  9. Iontophoresis: • The transfer of ions across the skin (transdermal)by use of continuous direct current • Iontophoresis is based on the principle that an electrically charged electrode will repel a similarly charged ion (first reported by LeDuc in 1903). • Delivers a low-volt High-amp DC current • Local lood flow is increased for 1 hour post tx

  10. Duration of Tx: Based on intensity desired usually every other day for 3 weeks Indications Acute or Chronic Inflam Arthritis Myositis Myofacial Pain Syndromes Invasive method for delivering drugs Contraindications Hypersensitivity to electrical currents Contraindications to meds. Pain of unknown origin Precautions Prescription Dosage Do not reuse electrode Burns if intensity to great Iontophoresis

  11. Iontophoresis • Effects of treatment depends on the ion(s) delivered • musculoskeletal inflammatory conditions (tendonitis, bursitis) have been successfully treated: • Using desamethosone sodium phosphate (decadron) and Xylocaine • Reduction of edema has been achieved by driving hyaluronidase • Transitory (5min) local anesthesia has been produced by delivering lidocaine to the tissues. The anesthesia was better than that achieved by topical application but less effective than infiltration of the area with lidocaine.

  12. Medication Dosage • Medication dose delivered during tx is measured in mA based on relationship of amperage, tx duration • Current Amp (mA) x Tx Duration - mA/min • Iontophoresors are doe-oriented - where user indicated desired tx does and generator calculated duration and intensity

  13. Biophysical Effects • Dependant on Medication • See following chart

  14. Sample Medications

  15. Electrode Placement • Delivery Electrode (drug electrode) • placed over target tissue • Active electrode (dispersive electrode) • place 4-6 inches from drug electrode

  16. Side Effects: Tissue “burning” • An alkaline reaction occurs under the cathode (negative electrode) which is much more caustic to the skin than the acidic reaction occurring at the anode. The cathode may be increased in size to attempt to decrease this caustic reaction

  17. Side Effects: Tissue “burning” • Continuous unidirectional current (as needed for iontophoresis) tends to cause tissue irritation because skin will not tolerate current density greater than 1mA/sq.cm. Thin tissue areas, areas of skin abrasion and areas of scarring are certain areas to avoid. This potential for burn is exacerbated by the fact that there is an anesthetic effect of DC under the electrode. Thus tissue irritation may develop without the patient’s realization • Don’t need to drive every day 1-2x a week

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