Basic Concepts of Electrophysical Agents

Lecture I
Dr. AMAL HASSAN MOHAMMED Ibrahim
Professor of Physical Therapy

Course Specification
1. Course title and code: Physical Therapy
Procedures I (RHS 321) 2. Credit hours: 3 hours 2 theoretical hours 1 practical

Physical Therapy program

Dr. AMAL HASSAN MOHAMMED Ibrahim Professor of Physical Therapy
Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Objectives
Upon the completion of this course, students should have a clear understanding of the followings: The basic principles and procedures relating to some of the electrotherapy modalities. The physiological and therapeutic effects of the different electrotherapy modalities The advantages and disadvantages of the previous modalities. Know the indications, contraindications, dangers and precautions including techniques of applications. Able to make planning and managing the appropriate way of application for each modality Demonstrate and acquire meaningful communications for instruction to the patient and ensure his/her comfort through out the treatment
Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Description of the knowledge to be acquired

1. Electrical properties of cell 2- Types of tissues 3- Structure of the skin 4- Thermal agents: heat and cold 5- Electromagnetic Spectrum 6- Infra-Red radiation, Ultraviolet Radiation, shock wave therapy- Short-wave diathermy, Micro-wave diathermy, Laser Therapy, Ultrasound Therapy.

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5. Schedule of Assessment Tasks for Students During the Semester Assess ment 1 Assessment task (eg. essay, test, group project, examination etc.) Week due Proportion of Final Assessmen t

1st midterm Theoretical

2 3 Quizzes 4 Presentations and assignment 5 Final Practical Exam 6 Final
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Middle of term All along All along

20%
15% 10%

1st midterm Practical

At the end 10%

Week 14 Week 15

15% 30%

INTRODUCTION

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The skin
Objectives: 1. To know the Structure and classification of skin 2. Identify sensory functions - skin sensory receptors 3. List the functions of skin

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Structure and Classification

Most of the skin is 1-2mm thick. although eyelids (0.5mm) and 6mm between the shoulder blades, variation is due to the thickness of the dermis. Hairless (Glabrous) skin has an epidermal layer of about 1.5 mm in thickness and a dermis of about 3 mm. Hairy skin has an epidermal layer of 0.07 mm in thickness and a dermis of about 1-2 mm.
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The Structure of The Skin

It is covered by a mixture of sweat and sebum, the hydro-lipid film, the first protective barrier which limits the development of bacteria through its acidity. This fine emulsion also maintains cutaneous moisturisation and gives the skin its velvety look.
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The Structure of The Skin

The skin is made up of three successive levels from the surface to in depth: 1- The epidermis 2- The dermis 3- Hypodermis.
Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

The Epidermis
Consist of a surface comprised of dead cells packed with keratin (a tough protein). Does not contain blood vessels. but it contains sparse nerve endings for touch and pain (But most sensations are due to the dermis). Cell types: 1. Keratinocytes - produce keratin 2. Melanocytes - produce melanin 3. Dendritic (Langerhans) cells immune function cells

The Epidermis
The superficial layer (the corneal layer) is made of keratinised cells. Skin, hair and nails are keratinized, meaning they have a dead and hardened impermeable surface made of a protein called keratin

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The Epidermis
The corneal layer varies in thickness according to the area of the body, the thickest part covering the palms of the hands and soles of the feet act against friction and constraints. However, the skin covering the mucous membrane does not contain keratin and is therefore without a corneal layer.
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The Epidermis
The deepest layer of the epidermis, made up of germinal cells, ensures the continuous renewal of the corneal layer after cellular growth. The epidermis takes four to six weeks to be completely renewed.
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The Epidermis
In the deeper part of the epidermis there is another type of specialized cells called melanocytes (pigment-producing cells) that govern skin colour through the production of melanin. This pigment is found in greater quantities in darkskin people than in fairskin people.

2- The Dermis
The dermis is the skins supporting tissue (fibrous connective tissue). The major fibers of dermis are: 1- Collagen fibers. 2- Elastin.

2- The Dermis
1- Collagen fibres have enormous tensile strength and provide the skin with strength and toughness. 2- Elastin: this type of fibre provides the properties of elasticity.

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The Dermis
Finer elastin gives the skin suppleness and elasticity. They decrease in number during ageing process and disappear completely after the age of 45.

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The Dermis
These fibers are swimming in a gel rich in hyaluronic acid, which plays a part in skin moisturisation, locking water into molecules. The dermis also contains blood vessels, which carry out the role of feeding the above epidermis and also participate in thermal regulation.

The Dermis
The dermis is also particularly rich in nerve endings, which are specifically sensitive to touch, to pain, and to temperature, making the skin a sensorial organ.
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The Dermis
The normal cell in the dermis include: Mast cells: contains granules packed with histamine and other chemicals, released when the cell is disturbed. Vascular smooth muscle cells: allow blood vessels to contract and dilate, required to control blood temperature. Fibroblasts: cells are produce and deposit collagen and other elements for repair wounds.
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The Dermis
Immune cells: the role of tissue macrophage (histocytes) is to remove and digest foregein material (this is known as phagocytosis). Specialized muscle cells: myoepithelial cells are found around sweat glands and contract to expel sweat.

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The Hypodermis
The hypodermis is the organisms adipose mattress giving the figure a more or less harmonious outline. It is the most important reservoir the body has, working through the stocking and liberation of fatty acids.
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Nerve Endings
The types of somato-sensory receptors are: Mechanoreceptors e.g. Pacinian corpuscles, Meissners corpuscles, Merkels discs, Ruffini endings and free nerve endings. Thermoreceptors e.g. hot and cold spots. Nociceptors e.g. high threshold mechanoreceptors and pilymodal nociceptors. Proprioceptors e.g. muscle spindle and golgi tendon organs.
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Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Mechanoreceptors
Pacinian corpuscles: Pacinian corpuscles are highly sensitive pressure receptors located deep in the dermis, as well as other areas such as joint capsules and Dr. Amal HM. Ibrahim mesenteries. aebrahim123@hotmail.com

Mechanoreceptors
Pacinian corpuscles are respond best to vibration rather than to prolonged pressure. They are associated with Ab nerve fibers.

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Merkel's Discs
Merkel's discs are touch receptors which are located deep in the dermis, especially of the thick skin over the palms of the hands and soles of the feet.
Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Merkel's Discs
Merkel's discs are incompletely (or slowly) adapting and are associated with Ab fibres.

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Meissner's Corpuscles
Meissner's corpuscles are touch and superficial pressure receptors which are located on the epidermis-dermis boundary, especially on the fingertips, palm, sole of the foot and nipple. They are oval in shape and consist of many stacked, flattened Schwann cells.
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Free Nerve Endings

Free nerve endings are widely distributed throughout the body, and are found as branches of unmyelinated, or lightly myelinated fibres grouped in bundles beneath the epithelium. As they penetrate the epithelium, they lose their myelin, and branch among the epithelial cells. Branches of one nerve may cover a wide area and overlap the territories of other nerves. The free nerve endings detect pain, touch, pressure and temperature, and are associated with C fibres.

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Thermoreceptors
Thermoreceptors sense the temperature of the skin, are found in the dermis, and are associated with Ad and C fibres. There are two categories of thermoreceptors, cold and warm receptors. They are both incompletely (slowly) adapting, have tonic activity, and their territories do not overlap.

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Thermoreceptors
There are differences between the cold and warm spots (receptors): The cold spots are found 5 to 10mm apart, and their maximum firing frequency is at 27C. The warm spots are found 10 to 15mm apart, and their maximum firing frequency is at 45C.
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Nociceptors
Nociceptors respond to stimuli that threaten or produce damage to an organism. There is an important different between nociception and pain.

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Nociceptors
Nociception is the reception of signals in the central nervous system that are evoked by activation of specialized sensory receptors (nociceptors) that provide information about tissue damage. Pain is a subjective perception of an aversive or unpleasant sensation that originates from a specific region of the body.

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

1- Bulbs of Krause 2-Free Nerve Endings 3-Pacini's Corpuscles 4-Organs of Ruffini 5-Merkel's Disks 6-Meissner's Corpuscles

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

The main functions of the skin can be summarized as 1. Protection 2. Thermoregulation 3. Sensory Perception 4. Excretion 5. Synthesis of vitamin D

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

1. Protection the skin is an anatomical barrier against infection and is impervious to most microbes. Melanin in the epidermis screens out excess UV rays from the sun.

2. Thermoregulation - small arterioles in the skin are able to vasodilate and vasoconstrict under the influence of the sympathetic nervous system. Vasodilation brings more blood to the surface of the body and heat is lost to the atmosphere. Vasoconstriction reduces blood flow so less heat is lost and more heat is retained in the body core. Sympathetic activity also causes sweating when body temperature rises and the evaporation of sweat cools the body.

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3. Sensory Perception - millions of nerve endings in the skin detect our interface with the external environment. Receptors for pressure, temperature and pain send impulses along first order neurons into the spinal cord on their way to the brain. 4. Excretion more of a by-product than a purposeful function but waste products such as urea and lactic acid are lost when we sweat along with sodium chloride. 5. Synthesis of vitamin D The first stage of vitamin D (which is actually a hormone rather than a vitamin) production takes place in the skin when 7dehydrocholesterol, a derivative of cholesterol, is to vitamin D3 which is subject to further biochemical modification in the liver and kidneys.
Dr. Amal HM. Ibrahim aebrahim123@hotmail.com

Questions??????

Dr. Amal HM. Ibrahim aebrahim123@hotmail.com