Hi Henry and Michael,
Knowing the operation of any epa machine is mandatory as the standing
operation procedures are different from machine to machine.
So do read the operating manual first, I believe that it does not instil
confidence to the patient of your ability if you are working your way though
the workings of the machine in front of the patient. Even worse in my
opinion is trying to guess the intensity of the machine.
Equally testing the machine prior to application / regular calibrating of
the machine are also important aspect of epa operation too.
Going back to the Likon / fibromyalgia. When Likon was first developed,
Professor Jiang Xiao Wen based it on the electrical stimulation of the
acupuncture meridian system. As some of the Likon users will have noticed
the placement of electrodes are on the lines of the meridians / potent
acupoints. In terms of using the Likon on Fibromyalgia, I have not used
Likon on these patients in the past. But, I have used acupuncture on
Fibromyalgic patients in the past with mixed successes. I have found the
patients are easily fatigued by the acupuncture treatment, the technique of
needling is usually very short duration (i.e.. leave it in for a few minutes
and remove instead of the usual 30 minutes) and very few needles are used
(usually 2 - 3 needles maximum per treatment). As more needles and longer
time of needle left in situ will 'drain' the patient and make the patient
worsens.
So maybe using the same example that I have given above, you may need to
play down on the time / intensity of the Likon treatment for these patients.
How much and how long will be difficult for me to give without using the
Likon on these patients before?
Once again, 'dosage' in epa (and in any other PT modalities too) is another
fascinating area that we all need to explore and come to some common
consensus in the near future.
Regards,
Kam
>-----Original Message-----
>From: Michael Warburton [mailto:[log in to unmask]]
>Sent: 25 October 2000 09:23
>To: physio
>Subject: Re: Likon
>
>
>Henry wrote:
><The Likon on the other hand is a very powerful machine,
>however there is no
>manual on what the settings mean...I put it on a patient with
>fibromyalgia
>on Monday...she called me on Tuesday saying that she left on
>Monday feeling
>drained and very bitchy>
>
>Henry.
>Finding out what the settings mean is usually best done prior to any
>machine's application. At least you then have a starting point
>should you
>ever end up in court defending an adverse event from the Likon and are
>cross-examined by expert opinion.
>Get a manual from the manufacturer or photocopy one from one
>of the many
>Likon owners in the City.
>
>Michael Warburton
>----- Original Message -----
>From: "Henry Tsao" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Wednesday, October 25, 2000 8:17 AM
>Subject: RE: Likon
>
>
>> Kam,
>>
>> I know a research article in the Am J of Rehab Medi. which
>showed that US
>> was as effective as dry needling in combination with stretches to
>deactivate
>> MTrP.
>>
>> IF on the other hand I have found can aggravate and increase
>the activity
>of
>> trigger points in some patients, and hence I am very weary
>of using this
>> machine. It is my own theory, but I think the IFT was
>designed to shorten
>> the muscles into a more comfortable position, hence reducing
>the pain the
>> patients will feel when they wake up. However, this is only
>speculation on
>> my part. There is no research on the efficacy of IF with deactivating
>> trigger points that I could find.
>>
>> The Likon on the other hand is a very powerful machine.
>However, there is
>no
>> manual on what the settings mean (because I have a second
>hand one... a
>new
>> machine costs $1000!!). I put it on a patient with
>fibromyalgia on Monday,
>> and she called me on Tuesday saying that she left on Monday feeling
>drained
>> and very "bitchy!" This has never happened before until I
>tried the Likon
>on
>> Monday. I believe the Likon activated her psoas or sympathetic nevous
>> system, and hence increased her anxiety and emotion. Can
>anybody help??
>>
>> Henry***
>>
>>
>> >From: Kam-wah Mak <[log in to unmask]>
>> >Reply-To: [log in to unmask]
>> >To: "[log in to unmask]" <[log in to unmask]>,
>> >"[log in to unmask]" <[log in to unmask]>
>> >Subject: RE: Likon
>> >Date: Tue, 24 Oct 2000 10:27:18 +0100
>> >
>> >Hi Henry,
>> >
>> >Have you come across combination therapy (using US and IF
>together) for
>the
>> >deactivation of trigger points?
>> >
>> >Again, claims made by manufacturers but no substantiation
>from published
>> >research / articles (to my knowledge), unless list members
>can provide
>more
>> >information on this.
>> >
>> >Regards,
>> >Kam
>> >
>> > >-----Original Message-----
>> > >From: Henry Tsao [mailto:[log in to unmask]]
>> > >Sent: 23 October 2000 15:30
>> > >To: [log in to unmask]
>> > >Subject: Re: Likon
>> > >
>> > >
>> > >To Sarah and Kam-wah,
>> > >
>> > >Personally, it was very difficult to find a good Likon Machine
>> > >in Brisbane,
>> > >because from what I have been told, many large companies don't
>> > >make this
>> > >machine anymore. Since I work with trigger points, the last
>> > >thing I need is
>> > >for a machine such as the interferential to tighten up the
>> > >muscles again.
>> > >Therefore, I think this is why my boss prefers to use the
>> > >Likon. I have not
>> > >found any recent research or articles on the Likon, but if
>> > >anybody know
>> > >anything about this machine, please let me know!!
>> > >
>> > >Henry***
>> > >
>> > >
>> > >>From: Kam-wah Mak <[log in to unmask]>
>> > >>Reply-To: [log in to unmask]
>> > >>To: "[log in to unmask]" <[log in to unmask]>,
>> > >>"[log in to unmask]" <[log in to unmask]>
>> > >>Subject: Likon
>> > >>Date: Mon, 23 Oct 2000 12:55:09 +0100
>> > >>
>> > >>Hi Sarah,
>> > >>
>> > >>Likon is a concept that was developed in China by Professor
>> > >Jiang Xiao Wen
>> > >>in the 1970's and a machine was launched worldwhile by
>> > >Healthtronics Pte
>> > >>Limited in Singapore in 1987.
>> > >>
>> > >>Likon is described by the operation manual as 'Modulation
>> > >Electro Therapy
>> > >>(MET), it generates mid frequency 2KHz to 5 KHz that are
>> > >modulated by a low
>> > >>frequency current ranging from 5 to 100 Hz. The mid frequency
>> > >acts as a
>> > >>carried wave, 'carrying' the low frequency pulses deep into
>> > >the tissues.
>> > >>Unlike IF therapy which utilises 2 medium frequency waves to
>> > >produce a low
>> > >>frequency 'beat' at their intersection. Likon generates mid
>> > >frequency waves
>> > >>that are modulated by low frequency pulses, thus combining the
>> > >>characteristics and advantage of mid and low frequency
>> > >stimulation via a
>> > >>single output.
>> > >>
>> > >>The list of applications was long ranging from musculoskeletal to
>> > >>neurological conditions.
>> > >>
>> > >>The above was deduced from the machine manual.
>> > >>
>> > >>In reality, to my knowledge, there are no published paper on
>> > >the Likon. I
>> > >>have seen a few articles on Likons but these were confined to
>> > >undergraduate
>> > >>dissertations in the early 1990's. I have seen Likons in
>> > >action at my local
>> > >>hospitals, yes, they are around and it seems that there are
>> > >pockets of epa
>> > >>community in UK that 'swear' by the efficacy of this modality.
>> > >>
>> > >>Anyone who uses this modality would like to further
>comment on this.
>> > >>
>> > >>Regards,
>> > >>Kam
>> > >>
>> > >>
>> > >> >-----Original Message-----
>> > >> >From: Sarah Fern Striffler [mailto:[log in to unmask]]
>> > >> >Sent: 20 October 2000 06:45
>> > >> >To: [log in to unmask]
>> > >> >Subject: Re: THE ELECTROTHERAPY ISSUE
>> > >> >
>> > >> >
>> > >> >Dear Henry,
>> > >> >
>> > >> >What is Likon & now is it used for psoas?
>> > >> >
>> > >> >Thank you.
>> > >> >
>> > >> >Sarah Fern Striffler, PT
>> > >> >
>> > >> >
>> > >> >Henry Tsao wrote:
>> > >> >
>> > >> >> To Mr Cheng, Bruce, and others who are interested in this
>> > >> >contraversial
>> > >> >> field of electrotherapy:
>> > >> >>
>> > >> >> I have been following the debate recently between the EPA
>> > >> >and Bruce, and
>> > >> >> since I started this whole contraversial debate, I thought I
>> > >> >might go and
>> > >> >> have a look a the latest literature on electrotherapy. I
>> > >> >don't believe in
>> > >> >> personal attacks, and think that physiotherapists should be
>> > >> >able to make up
>> > >> >> their minds on the issue.
>> > >> >>
>> > >> >> Before I go on, I will just explain. I work in a busy
>> > >> >private practice where
>> > >> >> we allocate 30 min. roughly per patient. I do use US on
>> > >> >trigger points after
>> > >> >> acupressure, and Likon on the sympathetic nervous
>> > >> >system/psoas (especially
>> > >> >> in chronic fatigue and fibromyalgia patients) to reduce its
>> > >> >activity, but I
>> > >> >> don't use any electro for any other reason unless the
>> > >> >patient themselves
>> > >> >> request it (and let's face it, I get old clients who come in
>> > >> >and just want
>> > >> >> to be mob'ed, US'ed and IFT'ed... and that is their
>choice!!).
>> > >> >>
>> > >> >> I found an interesting article the other day in the Pain
>> > >> >journal on the
>> > >> >> effectiveness of ultrasound therapy on musculoskeletal pain
>> > >> >(Pain 81, 1999
>> > >> >> 257-271). It basically evaluated the use of US, and looked
>> > >> >at the existing
>> > >> >> research on the topic. They basically concluded that
>for lateral
>> > >> >> epicondylitis, soft tissue shoulder disorders, deegn
>> > >> >rheumatic disorders,
>> > >> >> ankle distorsions and TMJ disorders, US showed no
>> > >> >significant clinical
>> > >> >> effect. Even when they combined US with exercise therapy,
>> > >there was
>> > >> >> clinically important or statistically significant
>> > >> >differences in favour of
>> > >> >> US (which I was surprised to read, as we always thought
>> > >that US was
>> > >> >> effective only when it is used as an adjunct!!). Even though
>> > >> >this does not
>> > >> >> totally rule out the uselessness of US therapy, it
>> > >> >definitely has some
>> > >> >> strong gound to stand on!
>> > >> >>
>> > >> >> On the contrary, I found in the Am J of Physical Medicine
>> > >> >and Rehab(79, 1,
>> > >> >> p48-52, 2000) an article that looked at the use of US, dry
>> > >> >needle, and
>> > >> >> stretches of myofascial trigger points in the Upper Trap
>> > >> >muscles. They found
>> > >> >> that US combined with stretches and dry needle combined with
>> > >> >stretches
>> > >> >> produced significant results compared to simply stretching
>> > >> >alone. However,
>> > >> >> there was no difference between dry needle and the use of US
>> > >> >in combination
>> > >> >> with stretches.
>> > >> >>
>> > >> >> I find it interesting that even though Mr Cheng has noted a
>> > >> >few articles
>> > >> >> that claim to have clinical evidence of electrotherapy,
>> > >most of the
>> > >> >> literature out there disproves the effectiveness of
>> > >> >electrotherapy, and
>> > >> >> these should not be ignored. However, this issue will still
>> > >> >continue to be
>> > >> >> contraversial, the research will go on, and physiotherapists
>> > >> >will form their
>> > >> >> own opinions of what electro to use. Despite this, I
>> > >support Bruce's
>> > >> >> statement that time and cost is a big factor in this, and
>> > >> >should not be
>> > >> >> ignored. Unless we are in the field of sport physio and see
>> > >> >athletes 3x a
>> > >> >> day, 5x a week, I don't see the point of 15min/2x/week - how
>> > >> >much difference
>> > >> >> is it going to make because that is less than 1% of their
>> > >> >week's time!!
>> > >> >> Emphasis in this case should be on teaching the patients
>> > >> >ultimately how to
>> > >> >> look after themselves thus preventing future injury. Most
>> > >> >people want to get
>> > >> >> better, but also want to know how to keep themselves
>better, and
>> > >> >> electrotherapy does not do this.
>> > >> >>
>> > >> >> Going through an undergraduate degree whereby electrotherapy
>> > >> >was focused so
>> > >> >> much and yet despised by most students(including myself), I
>> > >> >am not for or
>> > >> >> against electrotherapy. However, I believe (and this is only
>> > >> >my opinion)
>> > >> >> that unless there is more research for the efficacy of
>> > >> >electrotherapy, not
>> > >> >> too many future physiotherapists will include it in their
>> > >> >treatment regime.
>> > >> >>
>> > >> >> Henry***
>> > >> >>
>> > >> >> >From: "Goh Ah Cheng" <[log in to unmask]>
>> > >> >> >Reply-To: "Goh Ah Cheng" <[log in to unmask]>
>> > >> >> >To: <[log in to unmask]>, <[log in to unmask]>
>> > >> >> >Subject: Fw: EPA and evidence based practice
>> > >> >> >Date: Thu, 19 Oct 2000 18:18:00 +0900
>> > >> >> >
>> > >> >> >Dear Fellow EPA and PHYSIO Mail-list members,
>> > >> >> >
>> > >> >> >Below is the reply from Bruce. He has chosen to reply to
>> > >> >me directly
>> > >> >> >instead of the list, so I am doing him a favour by
>> > >> >forwarding it to the
>> > >> >> >both
>> > >> >> >lists (It must have been an oversight on his part....
>> > >perhaps due to
>> > >> >> >another
>> > >> >> >hard day at work).
>> > >> >> >You may want to know that I, Panos and the entire academic
>> > >> >community have
>> > >> >> >been dismissed by Bruce as unworthy of providing evidence
>> > >> >for EPA (or any
>> > >> >> >subject for that matter) because WE LEFT THE CLINIC. I am
>> > >> >not even going
>> > >> >> >to
>> > >> >> >respond to this.....
>> > >> >> >Secondly, the scientific method has also been
>denounced as being
>> > >> >> >inappropriate for any discussion on evidence based practice
>> > >> >(I assume not
>> > >> >> >only for EPA, but for our entire base of knowledge!!). Am
>> > >> >I missing out on
>> > >> >> >something here??
>> > >> >> >Thirdly, EPA can be dismissed by all of us from this day
>> > >> >henceforth because
>> > >> >> >it has been around for the past 50 years and the world was
>> > >> >not impressed!!
>> > >> >> >I must have missed out when everyone was out there casting
>> > >> >their votes.
>> > >> >> >Fourthly, God is dead.
>> > >> >> >And finally, any discussion that goes contrary to Bruce's
>> > >> >point of view is
>> > >> >> >immature, incurs opportunity costs and is a waste of
>> > >> >taxpayers dollars.
>> > >> >> >That is the FINAL WORD, according to Bruce, Chapter 4,
>> > >> >Verse Sick (I mean,
>> > >> >> >Six).
>> > >> >> >Now if you'll excuse me, I have to go look for another God.
>> > >> >> >Completey Devastated,
>> > >> >> >Cheng
>> > >> >> >
>> > >> >> >----- Original Message -----
>> > >> >> >From: Bruce Gray <[log in to unmask]>
>> > >> >> >To: <[log in to unmask]>
>> > >> >> >Sent: Thursday, October 19, 2000 5:46 PM
>> > >> >> >Subject: Re: EPA and evidence based practice
>> > >> >> >
>> > >> >> >
>> > >> >> > > Hi Gohac
>> > >> >> > >
>> > >> >> > > On this website, I have found the greatest support for
>> > >> >electrotherapy
>> > >> >> >comes from academics. I have no idea how much clinical
>> > >> >experience they draw
>> > >> >> >on, or why they left the clinic.
>> > >> >> > > These critics, esp yourself and Panos, seem to make a
>> > >> >lot of time to
>> > >> >> >reply
>> > >> >> >with verbose highbrow sarcasm, using one or two papers here
>> > >> >and there to
>> > >> >> >give your point invincible Truth status.
>> > >> >> > > As anyone who has read knows, the scientific method does
>> > >> >not deal in
>> > >> >> >deduced ultimate truths, instead it induces enough evidence
>> > >> >for a consensus
>> > >> >> >to be reached by field peers.
>> > >> >> > >
>> > >> >> > > That electrotherapy has been around for 50 years and not
>> > >> >wowed the world
>> > >> >> >with its superior healing powers let alone drawn together
>> > >> >scientific peer
>> > >> >> >consensus is enough for me to burst the bubble on its
>> > >> >overinflated cult
>> > >> >> >following.
>> > >> >> > >
>> > >> >> > > Let's face it guys, your God is dead.
>> > >> >> > >
>> > >> >> > > And please show some maturity by recognising the
>> > >> >opportunity costs of
>> > >> >> >continuing this argument. Anything I wanted to say has been
>> > >> >said. And I
>> > >> >> >assume the same for yourselves. Let it rest at that, and
>> > >> >get on with doing
>> > >> >> >something more productive with tax payers' dollars.
>> > >> >> > >
>> > >> >> > >
>> > >> >> > >
>> > >>
>> > >>______________________________________________________________
>> > >_________
>> > >> >> > >
>> > >> >> > > Free Unlimited Internet Access! Try it now!
>> > >> >> > > http://www.zdnet.com/downloads/altavista/index.html
>> > >> >> > >
>> > >> >> > >
>> > >>
>> > >>______________________________________________________________
>> > >_________
>> > >> >> > >
>> > >> >> > >
>> > >> >> >
>> > >> >>
>> > >> >>
>> > >> >_______________________________________________________________
>> > >> >__________
>> > >> >> Get Your Private, Free E-mail from MSN Hotmail at
>> > >> >http://www.hotmail.com.
>> > >> >>
>> > >> >> Share information about yourself,
>> > >> >create your own public profile at
>> > >> >> http://profiles.msn.com.
>> > >> >
>> > >
>> > >_______________________________________________________________
>> > >__________
>> > >Get Your Private, Free E-mail from MSN Hotmail at
>> > >http://www.hotmail.com.
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>> > >Share information about yourself,
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>> > >
>>
>>
>_______________________________________________________________
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