Transcript No Slide Title

Current electrotherapy concept
Micro Current (MET)
in Physiotherapy
Dj. TANIGAISELVANE.PT,MICP.,MISCP.
PMR Hospital
Goals
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To know what is Microcurrent?
The physiological effects
Therapeutic effects
Clinical evidence
Decision
Materials
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www.ovid.com
www.coherence.com
www.nhl.lib.org
www.pubmed.com
www.medline.com
www.ptjournal.org
www.jama.com
www.electrotherapy.org
Definition
“low-intensity direct current that delivers
monophasic or biphasic pulsed microamperage
currents across the intact surface of the skin’’
MET uses currents that are 1/1000th of an ampere
smaller than those delivered by standard
TENS devices (milliamperes)
American Physical Therapy Association.
Electrotherapeutic terminology in physical therapy: Report by the Electrotherapy
Standards Committee of the Section on Clinical Electrophysiology of The
American Physical Therapy Association (APTA).Alexandria, VA: APTA, 1990.
Terminologies
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Microcurrent electrical nerve stimulation
Microamperage stimulation
Low-intensity direct current and
Pulsed low intensity direct current
History
Carlos Matteucci(1830)
Dubois Reymond(1843)
injured tissue
1 microamp
Wolcott et.al 1960
200-800 microamps.on variety of wounds
200-350% faster healing rates in exp.group
Gault and Gatens 1975-76
Q.plegia, CVA, Brain Tumor, PVD, Burns,
DM, TB, Fracture and Amputation
History contd..
Illingsworth and Barker (1980)
stump of a finger tip
10-30 micro amperes
Borgens et al 1980
Barker, Jaffe, and Vanable 1982
Healing of wounds and union of bones
History contd..
Bio stimulation and Bio electric therapy
Cheng et al (1982) effect of current on
various intensities
At 500 microamps level
At milliamps level
ATP generation 500%
Amino acid uptake 30-40%
Protein synthesis
ATP generation
Amino acid uptake 20-73%
Protein synthesis 50%
Arnold-Shulz Law
(Dorland 1985)
Weak stimuli increase physiologic activity
and very strong stimuli inhibit or abolish
activity.
Dermatron
• The first commercial device
• Dr. Reinhold Voll of Germany in1960
• Primarily used for electro-diagnostic testing
and also therapeutically
• Pulse frequencies between 0.5pps and 150 pps with periodic reversals in
polarity
• Delivered using probe electrodes(sometimes in the form of a pen) or
pad electrodes
• Applied to acupuncture points,trigger points or over the site of pain.
• MET can also be administered on ear lobes and transcranially, where it is
claimed that it will relieve migraine, headache, insomnia and stress
Heffernan MS. Comparative effects of microcurrent
stimulation on EEG spectrum and correlation dimension.
Integrative Physiol Behav Sci 1996; 31:202–209.
• Some MET devices have a point finder to detect areas of the
skin with low resistance, which are believed to
correspond to acupuncture points
DuPont JS, Graham R, Tidwell JB. Trigger point
identification and treatment with microcurrent.
Cranio 1999; 17: 293–96.
• MET developed from the claim that tissue health is maintained by a direct
current electrical system in the human body and that a shift in this‘normal
current flow’ occurs when tissue is Damaged
Watson T. Electrical stimulation for wound healing: a review of current knowledge. In: Kitchen S ed.
Electrotherapy: evidence-based practice, eleventhedition. Edinburgh: Churchill Livingstone, 2002:313–34
• This direct current shift described as the
‘current of injury’, with a magnitude in the microampere
range
• Advocates claim that MET simulates this current
of injury to assist tissue growth and healing, and that
milliampere currents delivered by standard TENS
devices are detrimental to this process of repair
Cheng N, Hoof HV, Bockx E. The effects of electric current on ATP generation, protein
synthesis, and membrane transport in rat skin. Clin Orthop Rel Res 1982; 171: 264–72.
Seegers JC, Engelbrecht CA, van Papendorp DH.Activation of signal-transduction mechanisms may
underlie the therapeutic effects of an appliedelectric field. Med Hypotheses 2001; 57: 224–30
Becker’s theory
• Polarity reversal sets up a current of injury
• Initiates and signals beginning of tissue repair and regeneration
Injury currents(DC)
The body does have a means of activating its own
semiconductor bioelectric circuits to send endogenous
biological electricity where it is needed for healing
•
the classical description of acupuncture meridians are actually maps of this glial cell network
which parallel the peripheral nervous system
•
these electrical signals are conducted through the Schwann cell and glial cell perineural
sheath
•
injury currents conducted through this system are the naturally occurring bioelectric signals
for tissue repair and regeneration
acupuncture points are maximally conductive windows into this bioelectric system serving as
amplifiers to compensate for downstream damping of signal strength
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•
the insulation properties of the arterial microcapillaries can be adjusted by the body to shunt
bioelectricity into the area of injury
through the blood stream
Robert O. Becker, M.D. (Becker 1985); Bjorn Nordenstrom, M.D. of Sweden; and Richard Borgens, Ph.D. at Purdue University
Injury currents(DC)
•
The body does have a means of activating its own
semiconductor bioelectric circuits to send
endogenous biological electricity where it is
needed for healing
These electrical signals are
conducted through the Schwann
cell and glial cell perineural
sheath
•
•
•
•
the classical description of acupuncture meridians
are actually maps of this glial cell network which
parallel the peripheral nervous system
injury currents conducted through this system are
the naturally occurring bioelectric signals for
tissue repair and regeneration
acupuncture points are maximally conductive
windows into this bioelectric system serving as
amplifiers to compensate for downstream
damping of signal strength
the insulation properties of the arterial
microcapillaries can be adjusted by the body to
shunt bioelectricity into the area of injury
through the blood stream
Injury currents(DC)
•
•
The body does have a means of activating its own
semiconductor bioelectric circuits to send endogenous
biological electricity where it is needed for healing
these electrical signals are conducted through the
Schwann cell and glial cell perineural sheath
The classical description of
acupuncture meridians are actually
maps of this glial cell network which
parallel the peripheral nervous system
•
•
•
injury currents conducted through this system are the
naturally occurring bioelectric signals for tissue repair and
regeneration
acupuncture points are maximally conductive windows
into this bioelectric system serving as amplifiers to
compensate for downstream damping of signal strength
the insulation properties of the arterial microcapillaries
can be adjusted by the body to shunt bioelectricity into the
area of injury
through the blood stream
Injury currents(DC)
•
•
•
•
The body does have a means of activating its own
semiconductor bioelectric circuits to send endogenous
biological electricity where it is needed for healing
These electrical signals are conducted through the
Schwann cell and glial cell perineural sheath
the classical description of acupuncture meridians are
actually maps of this glial cell network which parallel
the peripheral nervous system
injury currents conducted through this system are the
naturally occurring bioelectric signals for tissue repair
and regeneration
Acupuncture points are maximally
conductive windows into this bioelectric
system serving as amplifiers to
compensate for downstream damping of
signal strength
•
the insulation properties of the arterial
microcapillaries can be adjusted by the body to shunt
bioelectricity into the area of injury
through the blood stream
Injury currents(DC)
•
•
•
•
•
The body does have a means of activating its own
semiconductor bioelectric circuits to send endogenous
biological electricity where it is needed for healing
These electrical signals are conducted through the
Schwann cell and glial cell perineural sheath
the classical description of acupuncture meridians are
actually maps of this glial cell network which parallel the
peripheral nervous system
injury currents conducted through this system are the
naturally occurring bioelectric signals for tissue repair and
regeneration
acupuncture points are maximally conductive windows
into this bioelectric system serving as amplifiers to
compensate for downstream damping of signal strength
The insulation properties of the arterial
microcapillaries can be adjusted by the
body to shunt bioelectricity into the
area of injury through the blood
stream and there is an intracellular
influx of calcium
Injury currents(DC)
•
•
•
•
•
•
The body does have a means of activating its own
semiconductor bioelectric circuits to send endogenous
biological electricity where it is needed for healing
These electrical signals are conducted through the
Schwann cell and glial cell perineural sheath
the classical description of acupuncture meridians are
actually maps of this glial cell network which parallel
the peripheral nervous system
injury currents conducted through this system are the
naturally occurring bioelectric signals for tissue repair
and regeneration
acupuncture points are maximally conductive windows
into this bioelectric system serving as amplifiers to
compensate for downstream damping of signal strength
the insulation properties of the arterial microcapillaries
can be adjusted by the body to shunt bioelectricity into
the area of injury through the blood stream and there is
an intracellular influx of calcium
Uncapping of insulin receptors on the cell
membrane and enhancement of protien and
DNA synthesis
Acupuncture and Microcurrent
Becker and Nordenstrom et al.
• Needle generates measurable electric charges when
twirled in the skin
• Needles left in tend to drain excess electric charge
from tense or inflamed tissue
• Play to balance the charge between.
Physiological effects
1) Spasmolysis of smooth muscles of the circulatory,
lymphatic and hollow organ systems.
2) Tonification of elastic fibers, for example, increasing lung
capacity in emphysema patients.
3) Reduction of inflammatory processes through reducing
infiltrative, proliferative, and exudative processes.
4) Reduction of degenerative process by restoring diffusionosmotic equilibrium.
5) Restoration of polarization to the nerves.
6) Stimulus of ATP function in freshly injured striated muscle.
Usage in PT
• Pain relief
Anti nociceptive? (primary)
(not percieved)
Tissue healing (secondary)
Protein synthesis
• Tissue healing
Antimicrobial effects
MET and pain relief
Weber et al- No significant differences
Massage, UBC , MET and NO treatment
On induced DOMS of 40 healthy adults.
Weber MD, Servedio FJ, Woodall WR. The effects of three modalities on delayed onset muscle
soreness. J Orthop Sports Phys Ther 1994; 20: 236–42.
Lambert et al- Reduction of pain
Double blind,Placebo controlled conditions
on induced DOMS over 30 adults.
Lambert MI, Marcus P, Burgess T, Noakes TD. Electro-membrane microcurrent therapy reduces
signs and symptoms of muscle damage. Med Sci Sports Exerc 2002; 34: 602–607
Clinical trials
Lerner et al- Significant reduction of pain
Double blind, placebo controlled trial
On 40 chronic low back pain patients
MET administered for two 6 secs period to 16 points on
low back, 3 times /week for 2 weeks.
Lerner F, Kirsch D. A double blind comparative study of micro-stimulation and placebo effect
In short term treatment of the chronic back pain patient. J Chiropract 1981; 15: 101–106
No physiological rationale given to such a prescriptive
treatment regimen
Other clinical trials
Relieves pain in combination with low level laser and other alternative therapies.
36 carpal tunnel cases
3 treatments/week for 4-5 weeks
Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture,
microamps transcutaneous electrical nerve stimulation, and other alternative therapies – an
open protocol study. J Altern Complement Med 1999; 5: 5–26
not possible to determine the exact contribution of MET
MET effects are comparable to TENS for patients with migraine and chronic
head aches
Annal N, Soundappan S, Palaniappan K, Chandrasekar S. Introduction of transcutaneous,
low voltage, non-pulsatile direct current (DC) therapy for migrane and chronic headaches. A
comparison with transcutaneous electrical nerve stimulation (TENS). Headache Q 1992; 3: 434–37
Less effective than LASER for improving mobility and relieving pain in patients
with degenerative joint diseases.
Bertolucci LE, Grey T. Clinical comparative study of microcurrent electrical stimulation to mid-laser
and placebo treatment in degenerative joint disease of the temporomandibular joint. Cranio 1995; 13: 116–20
Clinical trials
Specific Frequency Microcurrent for Fibromyalgia
and Myofascial Pain
January 2006
Carolyn McMakin ,Portland
McMakin CR, Gregory WM, Phillips TM 2005. Cytokine changes with microcurrent treatment of
fibromyalgia associated with cervical spine trauma. J Bodywork Move Ther 9:169-176
McMakin CR 2004. Microcurrent therapy: A novel treatment method for chronic low back
myofascial pain. J Bodywork Move Ther 8:143-153
McMakin C. 1998. Microcurrent treatment of myofascial pain in the head, neck and face. Top
Clin Chiro 5(1):29-35
Relieves pain?
• Contradictory results
• Inconclusive evidences from clinical trials
• Clinical trials lack methodological rigor
“Putative pain relief may be a by-product of the
accelerated healing process’’
MET and wound healing
Experiments in vitro suggested that
MET accelerates the healing of damaged tissue
Wolcott L, Wheeler P, Hardwicke H, Rowley B. Accelerated healing of skin ulcers by electrotherapy. South Med J 1969; 62: 795–801
Nessler J, Mass D. Direct-current electrical stimulation of tendon healing in vitro. Clin Orthop Rel Res 1987; 217: 303–12
Oweye I, Spielholz N, Fetto J, Nelson J. Lowintensity pulsed galvanic current and the healing of tenotomized rat achilles tendons:
preliminary report using load-to-breaking measurements. Arch Phys Med Rehabil 1987; 68: 415–18
Richez J, Chamay A, Bieler L. Bone changes due to pulses of direct electric microcurrent. Virchows Arch A Pathol Anat 1972; 357: 11–18
possibly through increased protein synthesis or
Cheng N, Hoof HV, Bockx E. The effects of electric current on ATP generation, protein synthesis, and membrane transport in rat skin.
Clin Orthop Rel Res 1982; 171: 264–72
Seegers JC, Engelbrecht CA, van Papendorp DH. Activation of signal-transduction mechanisms may underlie the therapeutic effects of an applied
electric field. Med Hypotheses 2001; 57: 224–30
Seegers JC, Lottering ML, Joubert AM et al. A pulsed DC electric field affects P2-purinergic receptor functions by altering the ATP levels in in
vitro and in vivo systems. Med Hypotheses 2002; 58: 171–76
through antimicrobal effects
Rowley BA. Electrical current effects on E. coli growth rates. Proc Soc Exp Biol Med 1972; 139: 929–34
Rowley BA, McKenna JM, Chase GR, Wolcott LE. The influence of electrical current on an infecting microorganism in wounds.
Ann N Y Acad Sci 1974; 238: 543–51
Rowley BA, McKenna JM, Wolcott LE. Proceedings: The use of low level electrical current for enhancement of tissue healing. Biomed Sci
Instrum 1974; 10: 111–14
Clinical trials
2 well controlled animal studies
MET not accelerating induced wound
healing in rats and Yucatan pigs.
Leffmann D, Arnall D, Holmgren P, Cornwall M. Effect of microamperage stimulation on the rate of
wound healing in rats. A histological study. Phys Ther 1994; 74: 195–200
Byl NN, McKenzie AL, West JM et al. Pulsed microamperage stimulation: a controlled study of
healing of surgically induced wounds in Yucatan pigs. Phys Ther 1994; 74: 201–13
Clinical trials
Carley and Wainapel et al.- 30 patients
2 hours twice a day for 6 weeks
MET accelerated healing against conventional wound dressing
Carley P, Wainapel S. Electrotherapy for acceleration of wound healing: low intensity
Direct current. Arch Phys Med Rehabil 1985; 66: 443–46
Absence of placebo control group
Healing of wounds and ulcers are undermined by lack of
appropriate control groups
Wolcott L, Wheeler P, Hardwicke H, Rowley B. Accelerated healing of skin ulcers by
electrotherapy. South Med J 1969; 62: 795–801
Assimacopoulos D. Low intensity negative electric current in the treatment of ulcers of the leg
due to chronic venous insufficiency. Preliminary report of three cases. Am J Surg 1968; 115: 683–87
Sinitsyn L, Razvozva E. [Effects of electrical microcurrents on regeneration processes in skin
wounds.] Ortop Travmatol Protez 1986; Feb (2): 25–28 (Rus)
MET in sports injuries
William Stanish, M.D., physician for the
Canadian Olympic team, found that implanted
electrodes delivering 10-20 microamps of
electrical current hastened recovery from
ruptured ligaments and tendons. Using
microcurrent stimulation, Stanish shortened the
normal 18-month recovery period to only 6
months. (Stanish 1984).
Clinical trial -ROM
• Pilot study of impedance-controlled microcurrent
therapy for managing radiation-induced fibrosis in
head-and-neck cancer patients.
• 26 patients -treatment sequelae in head and neck
cancer patients impedance-controlled microcurrent
therapy for 1 week
• 92% exhibited improved cervical rotation,
85% had improved cervical extension/flexion, and
81% had improved cervical lateral flexion
• Some patients also reported symptom improvement for
tongue mobility, facial asymmetry, xerostomia,
cervical/facial muscle spasms, trismus, and soft tissue
tenderness
ennox AJ, Shafer JP, Hatcher M,. Int J Radiat Oncol Biol Phys. 2002 Sep 1;54(1):23-34
Indications
Alleviation of
• Pain
• Inflammation
• Spasm
Promotion of
• Healing
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Osteoarthrotis
Osteoporosis
Sports injuries
Fractures
Wounds and
Ulcers
Precautions and Contraindications
• Cardiac pacemakers
• Near eyes and carotid sinus
• Transcerebral stimilation
• Pregnancy
• Pain of central origin
Rebox devices 1970
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Pulse type
Pulse mode
Shape
Pulse frequency
Pulse duration
Amplitude
Type of Electrode
: Train
: Unipolar
: Rectangular
: 200-5000 Hz
: 50–250 μs
: 1–300 μA
: Probe
Low J, Reed A. Electrical stimulation of nerve and muscle. In: Low J, Reed A eds. Electrotherapy
explained: principles and practice. Oxford: Butterworth-Heinemann, 1994: 39–116.
Bjordal JM. Electrical currents. In: Bjordal JM, Johnson MI, Couppe C eds.Clinical electrotherapy.
Your guide to optimal treatment. Kristians andHoyskoleForlaget Norwegian Academic Press, 2001:102–16
CellStim®400T
INDICATIONS
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chronic and acute pain
inflammation - edema
synovitis
musculoskeletal dysfunctions
sports injuries - sprains, strains and
contusions
arthritic conditions - osteoarthritis
sciatica
neuropathies
temporalmandibular joint dysfunction
TMJ
fibromyalgia FMS
plantar fasciitis
tennis elbow
carpal tunnel syndrome CTS
fractures - bone reunion
wound healing - ischemic ulcers
CONTRAINDICATIONS
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on pain syndromes where the etiology has
not been established
pregnancy
demand type cardiac pacemakers
wound infections
through malignant or benign tumors
through the eyeball
through carotid sinus
osteomyelitis
over laryngeal musculature
over the thorax intersecting the heart
presence of topical substances containing
metal ion
Microcurrent 850
Specifications
Channels
:Dual
Power Source
:9V alkaline
battery
Output Voltage
:12 volts
Timer
:20, 40 min and
constant
Frequency
:0.3, 8 and 80Hz
Patches
Occular & Dental MET
• Macular Degeneration and MicroCurrent therapy
• Evaluation of microcurrent electrical nerve
stimulation (MENS) effectiveness on muscle pain
in temporomandibular disorders patients
Journal of Applied Oral Science Print ISSN 1678-7757
J. Appl. Oral Sci. vol.14 no.1 Bauru Jan./Feb. 2006
doi: 10.1590/S1678-77572006000100012
MC in cosmetic therapy
Conclusion
Clinical Decision Making?
Can it be used to relieve pain ?
Can it be used for Soft Tissue healing?
For improving ROM ?
Analyse and Decide
HAVE FUN
Discussion
References
1.Picker R, Micro electrical neuromuscular
stimulation. Network-Electrix 1987; (March):
S72–S74. Efficacy of TENS and TENS-like devices in
pain relief 41
Pain Reviews 2001; 8: 00–00
stimulation parts 1 and 2. Clin Man Phys Ther 1988; 9:
10–33.
2. Mercola JM, Kirsch DL. The basis for microcurrent
electrical therapy in conventional medical practice.
J Adv Med 1995; 8(2). Available from: URL:
http://www.harborside.com/naspenmed/page8.htm
[Accessed 15-Jan-03]
3.Kirsch DL, Lerner FN. Electromedicine: The other
side of physiology. In: Weiner R ed. The Textbook
of the America Academy of Pain Management,
Innovations in pain management: a practical guide
for clinicians, vol. 4 update. Winter Park, FL: GR
Press, 1995. Available from: URL:
http://www.alternatives.com/raven/cpain/chap230.html [Accessed 15-Jan-03]
4.DuPont JS, Graham R, Tidwell JB. Trigger point
identification and treatment with microcurrent.
Cranio 1999; 17: 293–96.
5. Heffernan MS. Comparative effects of microcurrent
stimulation on EEG spectrum and correlation
dimension. Integrative Physiol Behav Sci 1996; 31:
202–209.
6. Becker R, Selden G. The body electric. New York:
Morrow, 1985.
7. Becker R, Murray D. Method for producing cellular
dedifferentiation by means of very small electrical
currents. Trans N Y Acad Sci 1967; 29: 606–15.
8. Watson T. Electrical stimulation for wound healing:
a review of current knowledge. In: Kitchen S ed.
Electrotherapy: evidence-based practice, eleventh
edition. Edinburgh: Churchill Livingstone, 2002:
313–34.
9. Cheng N, Hoof HV, Bockx E. The effects of
electric current on ATP generation, protein
synthesis, and membrane transport in rat skin. Clin
Orthop Rel Res 1982; 171: 264–72.
10.Seegers JC, Engelbrecht CA, van Papendorp DH.
Activation of signal-transduction mechanisms may
underlie the therapeutic effects of an applied
electric field. Med Hypotheses 2001; 57: 224–30.
11. Weber MD, Servedio FJ, Woodall WR. The effects
of three modalities on delayed onset muscle
soreness. J Orthop Sports Phys Ther 1994; 20:
236–42.
12. Lambert MI, Marcus P, Burgess T, Noakes TD.
Electro-membrane microcurrent therapy reduces
signs and symptoms of muscle damage. Med Sci
Sports Exerc 2002; 34: 602–607.
13. Johnson MI, Penny P, Sajawal MA. An
examination of the analgesic effects of microcurrent
stimulation (MES) on cold-induced pain in healthy
subjects. Physiother Theory Pract 1997; 13: 293–301.
14. Lerner F, Kirsch D. A double blind comparative
study of micro-stimulation and placebo effect in
short term treatment of the chronic back pain
patient. J Chiropract 1981; 15: 101–106.
15. Branco K, Naeser MA. Carpal tunnel syndrome:
clinical outcome after low-level laser acupuncture,
microamps transcutaneous electrical nerve
stimulation, and other alternative therapies – an
open protocol study. J Altern Complement Med
1999; 5: 5–26.
16.Annal N, Soundappan S, Palaniappan K,
Chandrasekar S. Introduction of transcutaneous,
low voltage, non-pulsatile direct current (DC)
therapy for migrane and chronic headaches. A
comparison with transcutaneous electrical nerve
stimulation (TENS). Headache Q 1992; 3: 434–37.
17. Bertolucci LE, Grey T. Clinical comparative study
of microcurrent electrical stimulation to mid-laser
and placebo treatment in degenerative joint disease
of the temporomandibular joint. Cranio 1995; 13:
116–20.
18. Wolcott L, Wheeler P, Hardwicke H, Rowley B.
Accelerated healing of skin ulcers by
electrotherapy. South Med J 1969; 62: 795–801.
19. Nessler J, Mass D. Direct-current electrical
stimulation of tendon healing in vitro. Clin Orthop
Rel Res 1987; 217: 303–12.
20. Oweye I, Spielholz N, Fetto J, Nelson J. Lowintensity
pulsed galvanic current and the healing of
tenotomized rat achilles tendons: preliminary report
using load-to-breaking measurements. Arch Phys
Med Rehabil 1987; 68: 415–18.
21. Richez J, Chamay A, Bieler L. Bone changes due
to pulses of direct electric microcurrent. Virchows
Arch A Pathol Anat 1972; 357: 11–18.
22. Seegers JC, Lottering ML, Joubert AM et al. A
pulsed DC electric field affects P2-purinergic
receptor functions by altering the ATP levels in in
vitro and in vivo systems. Med Hypotheses 2002; 58:
171–76.
23. Rowley BA. Electrical current effects on E. coli
growth rates. Proc Soc Exp Biol Med 1972; 139:
929–34.
24. Rowley BA, McKenna JM, Chase GR, Wolcott LE.
The influence of electrical current on an infecting
microorganism in wounds. Ann N Y Acad Sci 1974;
238: 543–51.
25. Rowley BA, McKenna JM, Wolcott LE.
Proceedings: The use of low level electrical current
for enhancement of tissue healing. Biomed Sci
Instrum 1974; 10: 111–14.
26. Leffmann D, Arnall D, Holmgren P, Cornwall M.
Effect of microamperage stimulation on the rate of
wound healing in rats. A histological study. Phys
Ther 1994; 74: 195–200.
27. Byl NN, McKenzie AL, West JM et al. Pulsed
microamperage stimulation: a controlled study of
healing of surgically induced wounds in Yucatan
pigs. Phys Ther 1994; 74: 201–13.
28. Rothstein J. Microamperage: a lesson to be learned
[editors note]. Phys Ther 1994; 74: 194
29.Assimacopoulos D. Low intensity negative electric
current in the treatment of ulcers of the leg due to
chronic venous insufficiency. Preliminary report of
three cases. Am J Surg 1968; 115: 683–87.
30. Gault W, Gatens P. Use of low intensity direct
current in management of ischemic skin ulcers.
Phys Ther 1976; 56: 265–69.
31. Sinitsyn L, Razvozva E. [Effects of electrical
microcurrents on regeneration processes in skin
wounds.] Ortop Travmatol Protez 1986; Feb (2):
25–28 (Rus).
32. Carley P, Wainapel S. Electrotherapy for
acceleration of wound healing: low intensity direct
current. Arch Phys Med Rehabil 1985; 66: 443–46.
33. Mulder G. Treatment of open-skin wounds with
electric stimulation. Arch Phys Med Rehabil 1991;
72: 375–77.
34. Feedar JA, Kloth LC, Gentzkow GD. Chronic
dermal ulcer healing enhanced with monophasic
pulsed electrical stimulation. Phys Ther 1991; 71:
639–49.
35. Gardner SE, Frantz RA, Schmidt FL. Effect of
electrical stimulation on chronic wound healing: a
meta-analysis. Wound Repair Regen 1999; 7:
495–503.
36.Low J, Reed A. Electrical stimulation of nerve and
muscle. In: Low J, Reed A eds. Electrotherapy
explained: principles and practice. Oxford:
Butterworth-Heinemann, 1994: 39–116.
37.Bjordal JM. Electrical currents. In: Bjordal JM,
Johnson MI, Couppe C eds. Clinical electrotherapy.
Your guide to optimal treatment. Kristiansand:
HoyskoleForlaget Norwegian Academic Press, 2001:
102–16.
38. Johannsen F, Gam A, Hauschild B, Mathiesen B,
Jensen L. Rebox: an adjunct in physical medicine?
Arch Phys Med Rehabil 1993; 74: 438–40.
39. Hatten E, Hervik J, Kalheim T, Sundvor T. Pain
treatment with Rebox. Fysioterapeuten 1990; 11:
8–13.
40. Nussbaum EL, Gabison S. Rebox effect on
exercise-induced acute inflammation in human
muscle. Arch Phys Med Rehabil 1998; 79: 1258–63.
41. Khan J. Electrical stimulation. In: Khan J ed.
Principles and practice of electrotherapy. New York:
Churchill Livingstone, 1987: 95–125.
42. Kloth LC, Feedar JA. Acceleration of wound
healing with high voltage, monophasic, pulsed
current. Phys Ther 1988; 68: 503–508.
43. Griffin JW, Tooms RE, Mendius RA, Clifft JK,
Vander Zwaag R, el-Zeky F. Efficacy of high
voltage pulsed current for healing of pressure ulcers
in patients with spinal cord injury. Phys Ther 1991;
71: 433–42.
44.Jette D. Effect of different forms of transcutaneous
electrical nerve stimulation on experimental pain.
Phys Ther 1986; 66: 187–93.
45. Morris L, Newton RA. Use of high voltage pulsed
galvanic stimulation for patients with levator ani
syndrome. Phys Ther 1987; 67: 1522–25.
46. Asbjorn O. Treatment of tennis elbow with
transcutaneous nerve stimulation (TNS). Available
from: URL: http://www.paingone.com/ 2000
[Accessed 01-Jul-02]
47. Ivanova-Stoilova T, Howells D. The usefulness of
PainGone pain killing pen for self-treatment of
chronic musculoskeletal pain - a pilot study
[Abstract]. In: The Pain Society of Great Britain
Annual Scientific Meeting Abstracts; 2002 Apr 9–12;
Bournemouth, UK; abstr. 104.
48. Kirsch DL, Smith RB. The use of cranial
electrotherapy stimulation in the management of
chronic pain: a review. NeuroRehabilitation 2000;
14: 85–94.
49. Limoge A, Robert C, Stanley TH. Transcutaneous
cranial electrical stimulation (TCES): a review 1998.
Neurosci Biobehav Rev 1999; 23: 529–38.
50. Southworth S. A study of the effects of cranial
electrical stimulation on attention and
concentration. Integrative Physiol Behav Sci 1999;
34: 43–53.
51. Taylor D, Lee C, Katims J. Effects of cranial
transcutaneous electrical nerve stimulation in
normal subjects at rest and during psychological
stress. Acupunct Electrother Res 1991; 16: 65–74.
WISH YOU A HAPPY FUTURE
“Happiness & Success are Voyage, not Destination”
MAY GOD BLESS YOU IN ALL YOUR FUTURE
ENDEVOUR
TO
MR. SUNDARA S. BALAMURUGAN
PHYSIOTHERAPIST
AL SABAH GENERAL HOSPITAL