There is a need for outcome measurement tools which are able to provide accurate and reliable information regarding the efficiency and efficacy of therapeutic intervention of soft tissue injury e.g. ligament tear. Electrical activity within the body tissues has been shown to be influenced by the tissue state, and following injury, bioelectric changes have been demonstrated for example in bone healing and nerve regeneration. This project considers the relationship between the electrical potentials recorded from the skin surface and clinical recovery following a soft tissue lesion. The measurement of the skin potential is not new but the application and approach used is novel in that a non invasive differential skin surface potential is used instead of the traditional and invasive transcutaneous potential. The differential potential was initially investigated in non injured subjects in order to gain an understanding of its character and behaviour. Simultaneous monitoring of environmental, physiological and psychological factors enabled evaluation of their influence on the generation mechanisms. In order to carry out the work, specialist instrumentation was designed and computer software developed. Injured subjects were recruited during two test series and the results compared with those obtained from the non-injured subjects. Differences in potential profiles were marked on occasions. However a significant percentage of injured subjects presented a profile which was very similar to the non injured subject potentials. The failure to demonstrate consistent differences between potentials from the groups may reflect the lability of tissue potentials or that their behaviour is not purely related to local tissue state. Psychological factors were shown to exert influences on the potentials and differences in environmental and physiological conditions may also be responsible for the variations seen. The refinement of the test apparatus and protocol which is discussed may facilitate more discriminative data collection.

No description available.

Microcurrent therapy (MCT) involves the application of sub-sensory electric current and can promote tissue repair, possibly by mimicking endogenous electrical cues for healing. It has been used successfully to treat recalcitrant bone fractures and skin ulcers, but its effects on other forms of tissue have received little attention. This study aimed to investigate the potential of MCT to promote healing and alleviate symptoms in a selected soft connective tissue disorder. A systematic review of human studies involving MCT for soft connective tissue damage was conducted. A survey of 93 musculoskeletal physiotherapists was used to help select a common, recalcitrant disorder to treat with microcurrent in a clinical trial. Novel sonographic scales to quantify tendon structural abnormality and tissue healing were developed, and their measurement properties evaluated along with several clinical and patient-rated outcome measures. Two preliminary clinical trials, involving 62 people with the selected disorder – chronic tennis elbow - were conducted, comparing four different types of microcurrent applied daily for 3 weeks. The review found fair quality evidence that certain forms of MCT can relieve symptoms, and low quality evidence that they can promote healing, in several soft connective tissue disorders, including those affecting tendons. Optimal treatment parameters are unknown. In the survey, clinicians identified frozen shoulder, plantar fasciitis and tennis elbow as particularly problematic, and tennis elbow was selected for treatment in the trials. The sonographic scales of hyperaemia had fair-to-good inter-rater and test-retest reliability. Minimum Detectable Change values are calculated for the sonographic scales and for pain-free grip strength measurements. The trials suggest that monophasic microcurrent of peak amplitude 50 µA applied for 35 hours was most effective in symptom alleviation, with a 93% treatment success rate three months after treatment. By final assessment, pain-free grip strength increased by 31% (95%CI:5,57%), pain measured on a multiple-item questionnaire reduced by 27% (95%CI:16,38%) and patient-rated functional disability by 26% (95%CI:14,28%). MCT with a current amplitude of 500 µA was significantly less effective, and varying the waveform appeared less important in determining outcomes. Differences between groups were non-significant on several measurs, though there was a risk of type II error in the tests used. No significant differences between any groups were seen in sonographic assessments, although consistent patterns in bloodflow chage suggested that MCT may modulate hyperaemia levels. Higher baseline hyperaemia was associated with sustained falls in hyperaemia levels after treatment, and with improved clinical outcome. MCT’s analgesic effect does not rely on sensory stimulation, and further investigation of its influence on tendinous blood flow and vascularity, or on the local biochemical milieu, may help elucidate its mechanism of action. On the basis of this investigation, a fully-powered controlled clinical trial is justified. A protocol, combining MCT with an exercise programme, is proposed.

The research to date, of transcutaneous electric nerve stimulation on cutaneous blood flow, is equivocal. The purpose of this report is to review the TENS body of knowledge, in particular synthesizing the literature on acupuncture stimulation of cutaneous blood flow with the two fold goal of creating a protocol to increase skin blood flow through the exogenous application of electrical stimulation, as well as creating an engaging engineering challenge for high school anatomy and physiology students. The hypothesis developed was TENS stimulation with electrode placement on specific acupuncture points would influence cutaneous blood flow as measured using laser Doppler flowmetry. The findings of this project did not support the hypothesis of TENS or Interferential electrical stimulation, in combination with acupuncture points or not, influencing skin blood flow. Perhaps this is due to the physiological differences between glabrous and non-glabrous skin and the different electrical resistances of each dermal layer, nerve stimulation, age and gender of subject or some combination thereof. These equivocal findings may also be the result of inconsistencies in testing protocols, such as subject preconditioning or not, subject’s position during administration of stimulation, electrode size and placement to name a few. Ultimately, this report provides a summary of the research to date, as well as outlining how this research could be adapted to supply engaging bio engineering challenges in the classroom including challenges to develop a model for delivering current to muscle; develop a model for skin blood flow management to name a few. / text

Objective: The primary aim of this research was to examine the temporal pattern of neuromuscular quadriceps deficits in both the involved and uninvolved limbs of patients assigned to the control group after anterior cruciate ligament reconstruction (ACLr), by assessing quadriceps strength, voluntary activation, and corticomotor excitability prior to surgery (baseline), three months after ACLr, and six months after ACLr. A secondary aim of this research was to determine whether quadriceps strength, voluntary activation, and/or corticomotor excitability assessed in patients prior to ACLr and/or at three months after surgery, is predictive of lower extremity postural control and/or self-reported function at six months after ACLr. Lastly, a tertiary aim of this research was to determine if a 12-week home-based neuromuscular electrical stimulation (Home-NMES) program elicits greater bilateral improvements in quadriceps strength, voluntary activation, and corticomotor excitability of patients at three and six months after ACLr compared to a 12-week standard home-exercise program (control group). Participants: Fifty patients scheduled to undergo unilateral ACLr were randomly allocated to the home-NMES group (19 Female, 6 Male; age: 18.9 ± 5.4 years; height: 170.8 ± 9.7 cm; weight: 74.6 ± 18.5 kg; 28.0±20.0 days-post-injury) or control group (14 Female, 11 Male; age: 19.4 ± 4.5 years; height: 171.1 ± 11.5 cm; weight: 70.7 ± 11.9 kg). Methods: A randomized clinical trial design was used in this study. Prior to ACLr, isometric quadriceps strength and voluntary quadriceps activation were assessed in both limbs of patients, and corticomotor excitability was assessed in the involved limb. Three days after ACLr, both groups were instructed to begin their allocated interventions. The Home-NMES group administered NMES to their involved limb’s quadriceps three sessions a day for 15 minutes, and five days a week for 12 weeks using a portable NMES device. The control group was treated according to the current standard-of-care, but they were also instructed to perform volitional isometric quadriceps contractions for the same duration and frequency as the Home-Based NMES protocol. The outcomes measures were reassessed in both groups at three and six months post-ACLr. Main Outcome Measures: Quadriceps strength and voluntary activation were assessed using maximal voluntary isometric contractions and the superimposed burst technique, respectively. Normalized peak knee extension torque and central activation ratio were used to quantify isometric quadriceps strength and activation, respectively. Corticomotor excitability was evaluated with transcranial magnetic stimulation, and quantified with active motor threshold). The Y-balance test anterior reach (YBT-A) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess the patients lower extremity knee function at six months post-ACLr. Statistical Analyses: Specific Aim 1: A 2x3 (limb x time) mixed model, ANOVA with repeated measures was performed in the control group to assess differences between the involved limb and the uninvolved limb for isometric quadriceps strength, and voluntary quadriceps activation over time. A one-way mixed model, ANOVA with repeated measures was performed in the control group to assess differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Specific Aim 2: Separate, mixed model, linear regression analyses were performed in the control group (involved limb) to determine the effect that the neuromuscular quadriceps outcome measures assessed at baseline and 3 months post-ACLr, had on lower extremity knee functional outcome measures assessed at 6 months post-ACLr. Specific Aim 3: A 2x2x3 (group x limb x time) mixed model, ANOVA with repeated measures was performed to assess group differences between the involved limb and the uninvolved limb in isometric quadriceps strength, and voluntary quadriceps activation over time. A 2x3 (group x time) mixed model, ANOVA with repeated measures was performed to assess group differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Results: Aim 1: Patients demonstrated lower quadriceps strength on their involved limb compared to their uninvolved limb at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps strength progressively decreased in the involved limb of patients from baseline to 3 months post-ACLr, baseline to 6 months post-ACLr, and increased from 3 months to 6 months post-ACLr. Quadriceps strength was also decreased in the uninvolved limb of patients from baseline to 6 months post-ACLr. ). Irrespective of when it was assessed, voluntary quadriceps activation was higher in the involved limb of patients compared to their uninvolved limb. There were no changes in corticomotor excitability of the involved limb over time. Specific Aim 2: The quadriceps strength of patients at three months post-ACLr had a significant positive effect on their 6-month YBT-A performance KOOS score. ). Neither voluntary quadriceps activation or corticomotor excitability or AMT (at baseline or 3-month post-ACLr) had a significant effect on any of the 6-month lower extremity functional outcome measures. Specific Aim 3: Irrespective of limb or when it was assessed, quadriceps strength was higher in the control group compared to the Home-NMES group. Both groups demonstrated lower quadriceps strength on their involved limbs compared to their uninvolved limbs at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps progressively decreased in the involved limbs of both groups from baseline to three months post-ACLr and baseline to six months post-ACLr, and increased from three months to six months post- ACLr. At baseline, voluntary quadriceps activation was higher in the involved limbs of both groups compared to their uninvolved limbs. There were no group differences or changes over time observed in the involved limb of both groups with corticomotor excitability. Conclusion: Although quadriceps weakness is more apparent in the involved limb of patients after ACLr, the quadriceps strength of their uninvolved limb was also affected. Clinicians are encouraged to not rely on a quadriceps strength limb symmetry index when making return-sport-decisions for their patients after recovering from ACLr. The quadriceps in the uninvolved limb of patients demonstrated more inhibition, which may explain the quadriceps strength deficits observed in the uninvolved limb of patients following ACLr. To reduce the risk of subsequent injury upon return-to-sport and protect against the development of knee OA, we recommend that clinicians incorporate bilateral interventions aimed at restoring quadriceps strength and disinhibiting the quadriceps. Intensive quadriceps strengthening should be performed in the early stages of ACLr rehabilitation, so that lower extremity function can be improved in patients later on. Lastly, the effectiveness of home-based NMES as a modality for restoring quadriceps strength and activation in patients after ACLr is inconclusive. Home-based NMES provides patients with the ability to receive higher doses of NMES to the quadriceps; but its effectiveness may be limited by low contraction intensities and poor treatment compliance in patients.

Aims: To study practices and procedures with respect to electrotherapy in physiotherapy departments and to study physiotherapists’ perception of health risk, health consequences and protection of health from different risks including electromagnetic field emissions from electrotherapy devices. Methods: This cross-sectional study was conducted in three phases from June 2002 to December 2003. The first phase was an audit of the practices and procedures regarding electrotherapy in National Health Service physiotherapy departments (N = 46 including 7 departments in pilot study) located in 12 counties in the southeast and southwest of England including Greater London. The second phase comprised one observational visit to each of the same physiotherapy departments to characterise their occupational environment. The third phase was a questionnaire survey of 584 physiotherapists working in these departments. Variables concerned perception of health risk, health consequences and protection of health associated with different risk factors. Results: In the first two phases, the recruitment rate of the departments was 80.7% (46 out of 57) and response rate of those recruited was 100% (n=46). The response rate for the last phase of the study was 66.8% (390 out of 584). Results of the practices and procedures audit show that ultrasound was the most common form of electrotherapy while microwave diathermy was neither available nor used in these departments. Pulsed shortwave diathermy was used 4-5 days per week while continuous shortwave diathermy was used rarely. Electrotherapy was provided to up to 50% of patients per week in the departments. The observational visits to the departments revealed that there were metallic objects within close proximity of diathermy equipment and wooden treatment couches for treatment with PSWD and CSWD were rare. The risk perception survey showed that physiotherapists generally perceived a moderate health risk and health consequences (harm) from exposure to EMF emissions from electrotherapy devices. Protection from EMFs in physiotherapy departments was generally perceived as ‘usually’ possible. Conclusions: Physiotherapy departments report safe electrotherapy practices. Use of diathermy devices that use RF EMFs is declining. The key predictors of physiotherapists’ perception of health risk were perception of health consequences and vice versa. Gender was a significant predictor of the perception of health risks and health consequences. The main predictor of perception of protection against risk was the knowledge of environmental and health issues. Latent dimensions of perceptions of health risk, health consequences and protection from risk were identified and confirmed and their predictors were determined.

This study presents the findings of an investigation of the effects of two different treatments, progressive relaxation and cerebral electrotherapy, on heart rate. With progressive relaxation, the subject relaxes by following instructions. With cerebral electrotherapy, relaxation is due to an external source of stimulation. Decreases in heart rate for subjects receiving progressive relaxation were compared with decreases for subjects receiving cerebral electrotherapy. A placebo group was used to evaluate the effects of both treatments independently. While decreases in heart rate were observed for both treatments, only progressive relaxation produced decreases significantly greater than those of the placebo group. However, decreases in heart rate produced by progressive relaxation were not significantly greater than decreases produced by cerebral electrotherapy.

Author: Bc. Lenka Pitnerová Title: The effectiveness of high intensity laser therapy for plantar fasciitis Objectives: The aim of this work is to assess the effect of high and low intensity laser therapy for plantar fasciitis compared with therapeutic ultrasound. Methods: The study included 50 patients with diagnose of heel spur syndrome. Patients were divided into three groups according to undergoing therapy. Group A (n = 20) received 10 applications of high intensity laser therapy, group B (n = 20) obtained 10 applications of low intensity laser therapy and group C (n=10) received 10 applications of therapeutic ultrasound. Intensity and character of the pain were assessed before and after therapeutic intervention using non- standardized questionnaire and numeric pain rating scale. For the assessment and description of the results were used standard statistical indicators and methods. Results: High intensity laser therapy had according to the obtained results positive effect on the clinical course of the disease and was markedly more effective than therapeutic ultrasound in treatment of plantar fasciitis. Almost all parameters reached the highest percentage improvement in the group treated with high intensity laser. The results are influenced by a smaller sample of patients and by inhomogeneity of...

The electrochemical treatment (EChT) of tumours entails thattumour tissue is treated with a continuous direct currentthrough two or more electrodes placed in or near the tumour.Promising results have been reported from clinical trials inChina, where more than ten thousand patients have been treatedwith EChT during the past ten years. Before clinical trials canbe conducted outside of China, the underlying destructionmechanism behind EChT must be clarified and a reliabledose-planning strategy has to be developed. One approach inachieving this is through mathematical modelling. Mathematical models, describing the physicochemical reactionand transport processes of species dissolved in tissuesurrounding platinum anodes and cathodes, during EChT, aredeveloped and visualised in this thesis. The consideredelectrochemical reactions are oxygen and chlorine evolution, atthe anode, and hydrogen evolution at the cathode. Concentrationprofiles of substances dissolved in tissue, and the potentialprofile within the tissue itself, are simulated as functions oftime. In addition to the modelling work, the thesis includes anexperimental EChT study on healthy mammary tissue in rats. Theresults from the experimental study enable an investigation ofthe validity of the mathematical models, as well as of theirapplicability for dose planning. The studies presented in this thesis have given a strongindication of the destruction mechanism involved in EChT. It isshown by the modelling work, in combination with theexperiments, that the most probable cause of tissue destructionis acidification at the anode and alkalisation at the cathode.The pH profiles obtained from the theoretical models have showngood correlation with the experimentally measured destructionzones, assuming that a pH above and below certain values causetissue destruction. This implies that the models presented inthis thesis could be of use in predicting the tumourdestruction produced through EChT, and thereby provide a basisfor a systematic dose planning of clinical treatments.Moreover, the models can serve as valuable tools in optimisingthe operating conditions of EChT. Modelling work of theanode processes has explained the roleof chlorine in the underlying destruction mechanism behindEChT. It is found that the reactions of chlorine with tissueplay important roles as generators of hydrogen ions. Thecontribution of these reactions to the acidification of tissue,surrounding the anode, is strongly dependent on the appliedcurrent density and increases with decreasing currentdensity. <b>Keywords:</b>cancer, direct current, dose planning,electrochemical treatment (EChT), electrotherapy, mathematicalmodelling, tumour.

<p>The electrochemical treatment (EChT) of tumours entails thattumour tissue is treated with a continuous direct currentthrough two or more electrodes placed in or near the tumour.Promising results have been reported from clinical trials inChina, where more than ten thousand patients have been treatedwith EChT during the past ten years. Before clinical trials canbe conducted outside of China, the underlying destructionmechanism behind EChT must be clarified and a reliabledose-planning strategy has to be developed. One approach inachieving this is through mathematical modelling.</p><p>Mathematical models, describing the physicochemical reactionand transport processes of species dissolved in tissuesurrounding platinum anodes and cathodes, during EChT, aredeveloped and visualised in this thesis. The consideredelectrochemical reactions are oxygen and chlorine evolution, atthe anode, and hydrogen evolution at the cathode. Concentrationprofiles of substances dissolved in tissue, and the potentialprofile within the tissue itself, are simulated as functions oftime. In addition to the modelling work, the thesis includes anexperimental EChT study on healthy mammary tissue in rats. Theresults from the experimental study enable an investigation ofthe validity of the mathematical models, as well as of theirapplicability for dose planning.</p><p>The studies presented in this thesis have given a strongindication of the destruction mechanism involved in EChT. It isshown by the modelling work, in combination with theexperiments, that the most probable cause of tissue destructionis acidification at the anode and alkalisation at the cathode.The pH profiles obtained from the theoretical models have showngood correlation with the experimentally measured destructionzones, assuming that a pH above and below certain values causetissue destruction. This implies that the models presented inthis thesis could be of use in predicting the tumourdestruction produced through EChT, and thereby provide a basisfor a systematic dose planning of clinical treatments.Moreover, the models can serve as valuable tools in optimisingthe operating conditions of EChT.</p><p>Modelling work of theanode processes has explained the roleof chlorine in the underlying destruction mechanism behindEChT. It is found that the reactions of chlorine with tissueplay important roles as generators of hydrogen ions. Thecontribution of these reactions to the acidification of tissue,surrounding the anode, is strongly dependent on the appliedcurrent density and increases with decreasing currentdensity.</p><p><b>Keywords:</b>cancer, direct current, dose planning,electrochemical treatment (EChT), electrotherapy, mathematicalmodelling, tumour.</p>