Electrotherapy

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Electrotherapy

Electrotherapy is the use of electrical energy as a medical treatment[1] In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electrical current to speed wound healing. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments.


History

In 1855 Guillaume Duchenne, the father of electrotherapy, announced that alternating was superior to direct current for electrotherapeutic triggering of muscle contractions.[2] What he called the 'warming affect' of direct currents irritated the skin, since, at voltage strengths needed for muscle contractions, they cause the skin to blister (at the anode) and pit (at the cathode). Furthermore, with DC each contraction requiring the current to be stopped and restarted. Moreover alternating current could produce strong muscle contractions regardless of the condition of the muscle, whereas DC-induced contractions were strong if the muscle was strong, and weak if the muscle was weak.

Since that time almost all rehabilitation involving muscle contraction has been done with a symmetrical rectangular biphasic waveform. In the 1940s, however, the US War Department, investigating the application of electrical stimulation not just to retard and prevent atrophy but to restore muscle mass and strength, employed what was termed galvanic exercise on the atrophied hands of patients who had an ulnar nerve lesion from surgery upon a wound.[3] These Galvanic exercises employed a monophasic wave form, direct current - electrochemistry.

Current use

Although a 1999 meta-analysis found that electrotherapy could speed the healing of wounds,[4] in 2000 the Dutch Medical Council found that although it was widely used, there was insufficient evidence for its benefits.[5] Since that time, a few publications have emerged that seem to support its efficacy, but data is still scarce. [6]

The use of electrotherapy has been widely researched and the advantages have been well accepted in the field of rehabilitation[7] (electrical muscle stimulation). The American Physical Therapy Association acknowledges the use of Electrotherapy for: [8] 1. Pain management Improve range of joint movement 2. Treatment of neuromuscular dysfunction Improvement of strength Improvement of motor control Retard muscle atrophy Improve local blood flow 3. Improve range of joint mobility Induce repeated stretching of contracted, shortened soft tissues 4. Tissue repair Enhance microcirculation and protein synthesis to heal wounds Restore integrity of connective and dermal tissues 5. Acute and chronic edema Accelerate absorption rate Affect blood vessel permeability Increase mobility of proteins, blood cells and lymphatic flow 6. Peripheral blood flow Induce arterial, venous and lymphatic flow 7. Iontophoresis Delivery of pharmacological agents 8. Urine and fecal incontinence Affect pelvic floor musculature to reduce pelvic pain and strengthen musculature Treatment may lead to complete continence

Electrotherapy is used for relaxation of muscle spasms, prevention and retardation of disuse atrophy, increase of local blood circulation, muscle rehabilitation and re-education electrical muscle stimulation, maintaining and increasing range of motion, management of chronic and intractable pain, post-traumatic acute pain, post surgical acute pain, immediate post-surgical stimulation of muscles to prevent venous thrombosis, wound healing and drug delivery.

Reputable medical and therapy Journals have published peer-reviewed research articles that attest to the medical properties of the various electro therapies. Yet some of the treatment effectiveness mechanisms are little understood. Therefore effectiveness and best practices for their use in some instances are still anecdotal.

Electrotherapy devices have been studied in the treatment of chronic wounds and pressure ulcers. A 1999 meta-analysis of published trials found some evidence that electrotherapy could speed the healing of such wounds, though it was unclear which devices were most effective and which types of wounds were most likely to benefit.[4] However, a more detailed review by the Cochrane Library found no evidence that electromagnetic therapy, a subset of electrotherapy, was effective in healing pressure ulcers[9] or venous stasis ulcers.

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