- Tonolysis methodology
- Tonolysis – indications
- Tonolysis – contraindications
Tonolysis is a modification of the Hufschmidt method. It involves stimulating spastic muscles with a short rectangular or triangular pulse. The difference between these treatments is that in the Hufschmidt method both spastic muscles as well as antagonistic ones are stimulated by a single short pulse. In tonolysis, on the other hand, a series of impulses are applied to the stretched muscles.
The spastic muscle is stimulated by a short rectangular or triangular pulse, and during the period of its relaxation, the antagonistic muscle is stimulated by a series of pulses with a trapezoidal, triangular or sinusoidal envelope. The possibility to regulate the duration of modulation, or to be more precise, the time of reaching the maximum value of the current in the packet of pulses, enables more precise selection of the time of delay appropriate for a given pair of muscles.
The parameters used for tonolysis treatment can be outlined as follows:
- the shape of the pulse – triangular or rectangular for spastic muscles and a pulse package with a sinusoidal, rectangular or triangular envelope for antagonistic muscles;
- pulse duration – 0.2-0.5 ms for spastic muscles, 100-1000 ms for antagonistic muscles;
- duration of break – upper limb: 1 s, lower limb: 1,5 s;
- delay – upper limb: 20- 30 ms, lower limb: 50-60 ms;
- current intensity – to achieve a visible submaximal contraction;
- duration of treatment – 15- 20 minutes.
Tonolysis should be always performed from proximal to distal joints. Unipolar pulses are used for more severe conditions, while bipolar pulses are used for lighter conditions. The other principles of the methodology are the same as for other treatments with the use of current – including ensuring proper moisturisation of the pad, positioning the electrodes on the body and the position for the treatment.
Tonolysis – indications
As is well known, the procedure is performed on patients with spasticity. Spasticity describes a condition that can occur regardless of age. In case of muscles, it means abnormal, increased muscle tension. This condition is unfortunately very troublesome as it disables the movement. Therefore, it is recommended to perform tonolysis before further rehabilitation steps during the day, as this electro-stimulation relaxes the affected muscles. This makes it possible to carry out further exercises or treatments. The disease entities in the course of which spasticity most frequently develops are:
- multiple sclerosis;
- injuries of the spinal cord;
- brain tissue injury;
- amyotrophic lateral sclerosis;
- cerebral palsy.
Spasticity can also be a side effect of neurosurgical procedures. Tonolysis is considered a safe and harmless procedure – students in physical therapy classes perform it on themselves to learn the correct methodology. However, there are exceptions when the procedure should not be performed.
Tonolysis – contraindications
The main contraindications to perform tonolysis include:
- ulcerations on the skin, disruption of the skin in the vicinity of the treatment site;
- implanted cardiac pacemaker;
- metal implants in the body;
- bacterial infection of skin and soft tissues;
Each time before the procedure, make sure that the patient has removed all metal items – especially jewellery. This is because its presence can disrupt the proper flow of electricity and cause burns at the metal-skin interface.
- Olchowik B., Sobaniec W., Sołowiej E., Sobaniec P. Aspekty kliniczne zwalczania spastyczności, Neurologia Dziecięca, 18 /2009.
- Mika T., Kasprzak W., Fizykoterapia, Wydawnictwo Lekarskie PZWL, Warszawa 2013.