LOW FREQUENCY PRINCIPLES OF APPLICATION

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Receiving the patient Greet the patient & introduce yourself. Develop a good rapport with the patient. Provide them a comfortable position to sit/laydown

Case sheet reading/History Taking

Name – Identification of the patient Age – Modulation of treatment (Adult/Old ) Sex – Provide privacy (Male/Female) Occupation – Correlate the symptoms/signs of the patient for ergonomic advice if

applicable Chief Complaints – Generation of problem list & Setting goals (Short & long term) for

the treatment Side – Right or Left side of the involvement. Site – Specific area/region to be treated (Anterior/Posterior/Medial/Lateral) Duration of the condition – Acute/Sub-acute/Chronic (Treatment planning & Setting) Diagnosis – Condition of the patient Verify the absence of General contraindications

Hyperpyrexia Epilepsy Severe renal and cardiac problems Cardiac pacemakers Severe Hypotension and hypertension Infections Pregnant women Metal Implants Mentally retarded patients/ Mentally upset patients Malignancy Eyes Anterior aspect of neck & carotid sinus

Ask about previous treatments & check the treatment notes

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Explanation regarding the need for the treatment to the patient

Explain the therapeutic benefits of ES

Collection of equipment & other essential Materials

Tray Preparation:

Patient Tray or Skin Resistance Lowering Tray & Skin Sensation Testing Tray

1. Pillows 2. Cotton 3. Soap 4. Towel 5. Mackintosh 6. Kidney Tray 7. Petroleum jelly or Vaseline 8. U – pin (sharp & blunt) 9. Clips 10. Bowel of water

Treatment Tray

1. Pillow 2. Towel 3. Bed sheet 4. Cotton 5. Adhesive tapes 6. Straps 7. Salt 8. Powder 9. Scissor 10. Paper 11. Graph paper 12. Pencil 13. Eraser 14. Scale 15. Crepe bandages 16. Machine & accessories

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Checking Local Contraindications:

Place the patient in any comfortable position and then check for local contraindications.

Open wounds Scars Local skin infections Cuts Abrasions Eczema Localized hemorrhagic spots

Skin sensitivity (testing)

Demonstrate with U – pin.

Testing of equipment & Self Demonstration Ask the patient to watch you while performing testing of the machine & Self-

demonstration, so as to gain the self-confidence & cooperation of the patient for the treatment.

Check for mains output by using the tester, look for any frayed part of power cords, integrity of cables & electrodes.

Verify that all the knobs/controls in the apparatus are at zero. Connect the machine power cord to the mains (220/110 Volts) & switch on the mains.. Switch on the machine by turning on the power knob/switch of the machine. Set the timer Keep your index and middle fingers on active and indifferent electrodes to check whether

the machine is working or not Demonstrate a muscle contraction to the patient by placing the electrodes on therapist’s

hand. Positioning of the patient Place patient in a well-supported, comfortable & relaxed position. Use adequate pillows, towels & bed sheets. Expose the body part to be treated, have patient remove all jewelry from the area.

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Drape the untreated part of the patient to preserve modesty, protect clothing, but allow easy accesses to the body part.

If possible give the position in which patient can see the treatment.

Positioning of the Therapist Appropriate walk stand position The therapist should be close to the machine for operating the machine & also near to the

affected side of the patient. If possible the therapists should position so as to observe the face of the patient.

Preparation of the part to be treated/ Skin Resistance Lowering

Uncover the part to be treated Clean the area with water & soap to remove any oil/cream/gel/dust Use mackintosh and towel for supporting and wiping off the water. Wipe the treatment area with saline water for better current conduction.

Instructions & Warning to the patient

Instruct the patient NOT TO move the treatment part, NOT TO touch the power cord & the generator, NOT TO sleep during the treatment. Inform the patient that he/she should feel a mild prickling sensation; if it becomes too

intense the patient should immediately report to the physiotherapist. If there is any burning sensation immediately inform the therapist, as it might lead to

burn. Inform if the position is not comfortable. The warning given should be noted on the patient’s record card.

Technique/Methods of application of Treatment Select appropriate method of treatment Make sure the power cords are not touching the patient. Provide some towelling between the patient skin & the cables if it comes in contact with

the patient. Select the current, Faradic, IDC, TENS etc.

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Select parameters like frequency, pulse, duration etc. Set appropriate treatment time for the patient condition. Gradually increase the current. Periodically ask patient if feeling too vigorous sensation or comfortable. Periodically check under the electrodes if using both pad electrodes. The patient must be observed throughout to ensure that treatment is progressing

satisfactorily and without adverse effects.

Termination of Treatment

Reduce the intensity gradually to zero Switch off the machine and the main supply. Remove the electrodes and clean the patient. After the termination of treatment inspect the treated part for any adverse reactions. If there is any mild Erythema, apply powder. If it is too severe, then summon the physician or advise him/her to go to the physician. An explanation of what to expect is given as well as instructions of when to come again

and what must be done between treatments. Then do winding up procedure.

Recording

An accurate record of all parameters of treatment including region treated, technique, dosage, and the resultant effect must be made.

This is for both assessment purposes and for legal requirements.