Therapy Devices

1- Infrared Therapy
Infrared (IR) or thermal radiation is a band of energy in the

complete electromagnetic spectrum. IR are the radiations of longer
wavelength than the red end of the visible spectrum and extend to the
microwave region, i.e., from 760 nm to 1 mm (1), IR radiation is
generated by Sun. Many ancient therapies have utilized sunlight for
wound healing and pain relief. When Sun rays reach the ground, they
get absorbed by gases or water molecules in the atmosphere. The
human body is made of 70% water, so it can potentially accumulate a
large amount of energy that could modulate biological processes by
strong resonant absorption of IR radiation from sunlight mediated by
water molecules (2).
Any heated body emits infrared. Any material with temperature

above absolute zero emits IR. IR radiations are produced in all matter
by molecular vibration; the molecular movement causes infrared
emission of different wavelengths and frequencies. The frequencies at
which maximum radiations are emitted are proportional to the
1
temperature which means the higher the temperature, the higher the
frequency and so shorter the wavelength.
IR includes wavelengths between the 780 nm to 1000 μm. IR is

divided into different bands: Near-Infrared (NIR, 0.78~3.0 μm), Mid-
Infrared (MIR, 3.0~50.0 μm) and Far-Infrared (FIR, 50.0~1000.0 μm)
as defined in standard ISO 20473:2007 Optics and photonics --
Spectral bands. Classification
The classification of the International Commission on

(3)
Illumination (CIE) has three sub-divisions for the IR radiation .
2
2-Electrical stimulation therapy
Losing the ability to move voluntarily can have devastating

consequences for the independence and quality of life of a person. Stroke
and spinal cord injury (SCI) are two important causes of paralysis which
afect thousands of individuals around the world. Extraordinary eforts
have been made in an attempt to mitigate the efects of paralysis. In recent
years, rehabilitation of voluntary movement has been enriched by the
constant integration of new neurophysiological knowledge about the
mechanisms behind motor function recovery. One central concept that
has improved neurorehabilitation signifcantly is neuroplasticity, the
ability of the central nervous system to reorganize itself during the
(4)
acquisition, retention, and consolidation of motor skills . In this
document, we present one of the interventions that has fourished as a
consequence of our increased understanding of the plasticity of the
nervous system:
Functional electrical stimulation therapy or FEST. The document,

which is not a systematic review, is intended to describe early work that
played an important historical role in the development of this field, while
providing a general understanding of the technology and applications that
continue to be used today. Readers interested in systematic reviews of
functional electrical simulation (FES) are directed to other sources (5).
Functional
electrical stimulation
3
Electrical current can elicit a response in excitable cells including
neurons. Devices that can deliver controlled discharges have made it
possible to assist individuals with different medical conditions. Cochlear
implants to restore hearing, phrenic pacemakers that assist respiration,
systems to void the bladder, cardiac pacemakers to ensure cardiac
function, and deep brain stimulation to control tremor due to Parkinson’s
disease are examples of applications of electrical stimulation systems.
Neuromuscular stimulation
Neuromuscular stimulation (NMES) is one application of

electrical stimulation used in rehabilitation of movement. In it, electrical
stimulation produces contractions of paralyzed muscles that are still
innervated (6). NMES can increase the patients’ participation in voluntary
activities by reducing impairment. For example, NMES can be used to
increase muscle strength, improve shoulder subluxation (dislocation),
reduce muscle tone, and produce movement.
3- Interferential Therapy
The basic principle of Interferential Therapy (IFT) is to utilise

the significant physiological effects of low frequency (<250pps) electrical
stimulation of nerves without the associated painful and somewhat
unpleasant side effects sometimes associated with low frequency
stimulation.
Recently, numerous ‘portable’ interferential devices have

become easily available. Despite their size, they are perfectly capable of
delivering ‘proper’ interferential therapy, though some have limited
functionality and ability for the practitioner to ‘set’ all parameters.
4
TREATMENT PARAMETERS:
Stimulation can be applied using pad electrodes and sponge

covers (which when wet provide a reasonable conductive path), though
electroconductive gel is an effective alternative. The sponges should be
thoroughly wet to ensure even current distribution. Self adhesive pad
electrodes are also available (similar to the newer TENS electrodes) and
make the IFT application easier in the view of many practitioners. The
suction electrode application method has been in use for several years,
and whilst it is useful, especially for larger body areas like the shoulder
girdle, trunk, hip, knee, it does not appear to provide any therapeutic
advantage over pad electrodes (in other words, the suction component of
the treatment does not appear to have a measurable therapeutic effect).
Care should be taken with regards maintenance of electrodes, electrode
covers and associated infection risks (7).
5
Whichever electrode system is employed, electrode positioning should
ensure adequate coverage of the area for stimulation. Using larger
electrodes will minimize patient discomfort whilst small, closely spaced
electrodes increase the risk of superficial tissue irritation and possible
damage / skin burn. The bipolar (2 pole) application method is perfectly
acceptable, and there is no physiological difference in treatment outcome
despite several anecdotal stories to the contrary. Recent research evidence
supports the benefit of 2 pole application. Treatment times vary widely
according to the usual clinical parameters of acute/chronic conditions &
the type of physiological effect desired. In acute conditions, shorter
treatment times of 5-10 minutes may be sufficient to achieve the effect. In
other circumstances, it may be necessary to stimulate the tissues for 20-30
minutes. It is suggested that short treatment times are initially adopted
especially Interferential Therapy (IFT) © Tim Watson 2015 Page 7 with
the acute case in case of symptom exacerbation. These can be progressed
if the aim has not been achieved and no untoward side effects have been
produced. There is no research evidence to support the continuous
progression of a treatment dose in order to increase or maintain its effect.
6
References
- John Low & Ann Reed. 2nd edition, Infrared and visible radiations.
Electrotherapy Explained principles and practice.
- Tsai SR, Hamblin MR. Biological effects and medical

applications of infrared radiation. Journal of Photochemistry and
Photobiology B: Biology. 2017 May 1;170:197-207.
- Vatansever F, Hamblin MR. Far infrared radiation (FIR): its

biological effects and medical applications. Photonics & lasers
in medicine. 2012 Nov 1;1(4):255-66.
- Dayan E, Cohen LG. Neuroplasticity subserving motor skill

learning. Neuron. 2011;72:443–54
- Burridge JH, Swain ID, Taylor PN. Functional electrical

stimulation: a review of the literature published on common
peroneal nerve stimulation for the correction of dropped foot. Rev
Clin Gerontol. 1998;8:155–61.
- Baker LL. Neuromuscular electrical stimulation: a practical guide.

Los Amigos Research & Education Institute, Incor- porated; n.d.
- Lambert, I. et al. (2000). "Interferential therapy machines as

possible vehicles for cross infection." Journal of Hospital Infection
44: 59-64.

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1- Infrared Therapy

Infrared (IR) or thermal radiation is a band of energy in the

Any heated body emits infrared. Any material with temperature

IR includes wavelengths between the 780 nm to 1000 μm. IR is

The classification of the International Commission on

Losing the ability to move voluntarily can have devastating

Functional electrical stimulation therapy or FEST. The document,

Neuromuscular stimulation (NMES) is one application of

The basic principle of Interferential Therapy (IFT) is to utilise

Recently, numerous ‘portable’ interferential devices have

Stimulation can be applied using pad electrodes and sponge

- Tsai SR, Hamblin MR. Biological effects and medical

- Vatansever F, Hamblin MR. Far infrared radiation (FIR): its

- Dayan E, Cohen LG. Neuroplasticity subserving motor skill

- Burridge JH, Swain ID, Taylor PN. Functional electrical

- Baker LL. Neuromuscular electrical stimulation: a practical guide.

- Lambert, I. et al. (2000). "Interferential therapy machines as

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