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the application of any substance to the body resulting in a withdrawal or abstraction of heat from the body, effectively lowering the temperature of the tissue

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the application of either heat or cold that results in a biophysiological change in tissue temperature, either tissue temperature elevation or temperature decrease.

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focuses on measuring and providing feedback on muscle activity

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acoustic energy that is inaudible by the human ear that can facilitate the healing process, speed recovery, and decrease pain.

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Electrotherapeutic agents are those procedures or interventions that:

Are systematically applied to modify specific client factors that may be limiting occupational performance

Use electricity and the electromagnetic spectrum to facilitate tissue healing, improve muscle strength and endurance, facilitate or stabilize movement, decrease edema, modulate pain, and decrease or modify the healing process

Are used as an adjunctive or preparatory method to engagement in occupation and functional tasks and activities.

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the form of laser and energy that is used for a variety of therapeutic reasons and clinical conditions. Other common terms used for light therapy include phototherapy, which is the use of light delivered through a variety of clinical devices for a specific therapeutic effect.

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There are many techniques and methods of applying cold agents to tissue, including ice massage, cold or ice packs, cold baths, cold compression units, and vapocoolant sprays.

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Readily available methods include electric heating pads, hot water bottles, heated wraps, heated stones, microwavable packs filled with grain or rice, poultices, hot towels, hot baths, sauna, steam, infrared heat lamps, and paraffin.

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Thermal ultrasound, cavitation, mechanical ultrasound

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Commonly used electrotherapy devices in occupational therapy include transcutaneous electrical nerve stimulation (TENS), which uses alternating current (AC) for pain control; NMES, which uses AC for strengthening, neuromuscular reeducation, preventing disuse atrophy, muscle spasm, or edema; high-voltage pulsed current (HVPC) for wound healing and edema control; electrical muscle stimulation (EMS), which uses direct current (DC) for denervated muscle stimulation; functional electrical stimulation (FES), which uses AC as an orthotic substitute or functional activity such as feeding; and iontophoresis, which uses DC for transcutaneous drug delivery.

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Induction methods use either a cable that is wrapped over the extremity or treatment area, or drum, both of which use alternating current (AC) flowing through the wires

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Electrodes are applied to the skin covering the muscle and the muscle tension is made visible or audible for the patient as feedback in the form of graphs, music or films

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presence of edema, post-exercise edema and pain, arthritic exacerbations or flare-up, acute bursitis or tendinitis, spasticity, acute or chronic pain secondary to muscle spasm, and post-exercise to maintain soft tissue elongation

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any medical condition in which vasoconstriction will aggravate symptoms, such as impaired circulation, peripheral vascular diseases, hypersensitivity to cold, impaired sensation, open wounds, skin conditions (e.g., psoriasis), and infections

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The physiological effects can last several hours, and rewarming of the extremity tissues takes at least 20 minutes.

Monitor the patient’s skin closely to ensure that there are no adverse reactions.

Numbness indicates analgesia. The patient’s protective sensation is removed and patient cautioned.

Side effects include itching, hives, sweating, and wheal areas with reddened borders, blanched centers.

Never apply gel packs or ice packs directly to the skin surface and never longer than 20 minutes.

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Subacute and chronic inflammation

Subacute or chronic pain

Subacute edema removal

Decreased ROM

Resolution of swelling

Myofascial trigger points

Muscle guarding

Muscle spasm

Subacute muscle strain

Subacute ligament sprain

Subacute contusion

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Impaired sensation (superficial, skin graft, scar, or inability to determine temperature changes)

Poor thermal regulation

Tumors/cancer

Acute inflammation, including acute edema

Deep vein thrombophlebitis

Pregnancy—full immersion (the systemic effects of circulating blood on a fetus are unclear, superficial application over an extremity can be used)

Bleeding tendencies

Infection

Primary repair of tendon or ligament

Advanced cardiac disease

Semicomatose or impaired mental status (or patients with speech and language difficulties, they may not be able to inform or understand the therapists directions)

Rheumatoid arthritis (vigorous dosages of heat may facilitate proteins that act as catalysts to increase enzyme activity, exacerbating joint inflammation; Schmidt et al., 1979)

Acute musculoskeletal conditions

Compromised circulation

Peripheral vascular disease

Skin anesthesia

Open wounds or skin conditions

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Monitor blood pressure, respiration, and skin color.

Discontinue if increased redness, petechiae, and blistering are observed.

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Used to treat various musculoskeletal pathologies like osteoarthritis, soft tissue shoulder pathology, and myofascial pain.

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Patients with vascular disease, deep vein thrombosis, emboli, atherosclerosis

Patients with hemophilia not covered by factor replacement

Over the eye, sex organs, over the uterus during pregnancy

Over stellate ganglions

Over the spinal cord following laminectomy

Directly over external metal implants

Over pacemakers, the heart, or implanted electronic devices

Cancer, areas of malignancy

Over rash, eczema, areas of skin irritation

Carotid sinus

Over anesthetic areas

Over areas that have been irradiated

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Over metal implants

Over epiphyseal growth plates or immature bone

Areas with sensory loss or decreased sensation

Over plastic or cemented implants

Subcutaneous or bony prominences

Care should be used in the vicinity of a cardiac pacemaker and implanted devices

Patients with decreased mentation, cognition, or unable to communicate

Avoid stationary transducer

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a method of topically delivering medication or ionized drugs into a localized area of tissue using the force of a low-intensity, direct electrical current to create a therapeutic effect

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Direct Current (DC) Iontophoresis: This is the most common type, where a continuous, unidirectional electrical current is used.

Pulsed Current (PC) Iontophoresis: The electrical current is delivered in pulses rather than continuously. This may be more comfortable for some patients and might be better suited for certain medications.

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Used to reduce inflammation that might be seen in musculoskeletal conditions such as lateral epicondylitis, medial epicondylitis, plantar fasciitis, tendo-nitis/bursitis, rheumatoid arthritis, and enthesopathic conditions of various origins

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Contraindications for the specific medications being used should also be researched by the therapist. Therapists should make sure to discuss with the pharmacist the medications being prescribed by the physician and any related questions, and the treatment protocol should be confirmed with the physician.

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Care should be used with patients who are pregnant or may be pregnant, as the safety and effectiveness of some medications have not been adequately established.

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The primary uses for LLLT have been in the areas of dentistry, wound or fracture healing, treatment of musculoskeletal conditions, and modulation of pain. Laser use in wound healing has been purported to stimulate phagocytosis and fibroplasia, as well as increase circulation.

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Lasers should not be applied to the vagus nerve or over the carotid sinus, or in patients with decreased sensation, infected tissue, or an active hemorrhage. Application over the gonads and sexual organs and the epiphyseal plates of children should be avoided. Lasers should not be applied over tumors or cancerous lesions, or over the endocrine glands.

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Damage can occur if the beam is directed toward the eyes or when viewing the beam or its specular reflections off of a smooth surface area. The laser beam should never be directed at the eyes, and the patient should be wearing protective goggles and instructed to not look directly at the laser beam.

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NMES can be used to strengthen or prevent disuse atrophy during or following immobilization or inactivity, maintain or improve range of motion (ROM), facilitate voluntary motor control, decrease edema through its muscle pumping action, decrease spasticity and muscle spasm, facilitate sensory neural pathways, and act as a substitute for orthotic devices allowing for engagement in functional movements and activities.

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Over the thoracic region as it may interfere with heart activity

Patients with demand-type pacemakers, defibrillator or deep brain stimulator, or implanted electrical device

Do not place over phrenic nerve or bladder stimulators

Do not place over the anterior neck or carotid sinus as this may cause cardiac arrhythmias; where placement of electrodes could adversely affect a reflex center (e.g., the heart, parasympathetic nerves, ganglion, laryngeal muscles)

Transcerebral or individuals with epilepsy

Peripheral vascular disease, venous thrombosis, or thrombophlebitis

Over the eyes or reproductive organs

Over or near superficial metal pins, plates, or hardware

Active cancer, malignancy, infection, tuberculosis, or active hemorrhage

Pregnant people, over a pregnant uterus during the first trimester

Over areas with pathology within the muscle (i.e., Duchenne’s muscular dystrophy)

Over areas where movement is contraindicated or to be avoided

Near diathermy devices

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Over areas with pathology of the cell body (polio)

Patients with hypertension or hypotension

Patients with obesity with excessive adipose tissue (may require higher levels of electrical current, which may cause skin irritation or burning)

Patients unable to provide clear feedback regarding the level of stimulation, such as infants or young children, patients with dementia or cognitive disorders, or individuals with mental disorders

Over areas with pathology of the myelin sheath (e.g., diabetic neuropathy, multiple sclerosis, peripheral neuropathy)

Over areas with pathology of the synapse points between muscle and nerve (e.g., myasthenia gravis)

Caution should be used in areas of absent or diminished sensation

Patients with skin conditions such as eczema, psoriasis, dermatitis

Patients with autonomic dysreflexia

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Muscle Retraining: After an injury or stroke, sEMG biofeedback can help people relearn how to activate weakened muscles and improve their coordination.

Pain Management: It teaches individuals to reduce muscle tension associated with chronic pain conditions like back pain, tension headaches, etc.

Relaxation Training: sEMG biofeedback can help people learn deep relaxation techniques to manage stress and anxiety.

Improved Posture: sEMG biofeedback can assist in developing awareness of muscle imbalances and promote better postural habits.

Pelvic Floor Dysfunction: It helps individuals with incontinence or pelvic pain by improving their awareness and control of their pelvic floor muscles.

Sports Performance: Athletes can use sEMG biofeedback to optimize movement patterns and muscle recruitment for improved efficiency and reduce injury risk.

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Open wounds or skin lesions: Placing sensors directly over broken skin can cause irritation and increase the risk of infection.

Implanted electrical devices: The electrical signals from sEMG could potentially interfere with the functioning of devices such as pacemakers or implantable cardioverter-defibrillators (ICDs). Consult with the patient's doctor in these cases.

Unstable Fractures or Recent Surgeries: sEMG might not be recommended immediately after a fracture or surgery until there's been sufficient healing.

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Skin sensitivity or allergies: Some people might experience mild skin irritation from the adhesive on the sensors. Testing a small area first and using hypoallergenic options can help.

Cognitive limitations: Individuals with significant cognitive impairments may have difficulty understanding and responding to the feedback provided during sEMG biofeedback.

Severe muscle weakness: In cases of extreme muscle weakness, the sEMG signal might be too faint to detect reliably, limiting its usefulness as a feedback tool.

Certain medications: Some medications could affect muscle activity and potentially influence sEMG biofeedback readings.