Electrotherapy

Last updated

Electrotherapy
BTL-6000 super inductive system elite.jpg
SIS Super Inductive System electromagnetic therapy; used at a hospital in Budapest, Hungary
MeSH D004599

Electrotherapy is the use of electrical energy as a medical treatment. [1] In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. The use of EMS is also very wide for managing muscular pain. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments. Evidence supporting the effectiveness of electrotherapy is limited.

Contents

Medical uses

Electrotherapy is primarily used in physical therapy for:

There is limited evidence supporting electrotherapy. [3] [4] [5] [6] [7] [8] [9] [10] Some of the treatment effectiveness mechanisms are little understood, with claims of their effectiveness and best practices for their use still anecdotal.

Musculoskeletal conditions

In general, there is little evidence that electrotherapy is effective in the management of musculoskeletal conditions. [3] In particular, there is no evidence that electrotherapy is effective in the relief of pain arising from osteoarthritis, [4] and little to no evidence available to support electrotherapy for the management of fibromyalgia. [5]

Neck and back pain

A 2016 review found that, "in evidence of no effectiveness," clinicians should not offer electrotherapy for the treatment of neck pain or associated disorders. [6] Earlier reviews found that no conclusions could be drawn about the effectiveness of electrotherapy for neck pain, [11] and that electrotherapy has limited effect on neck pain as measured by clinical results. [12]

A 2015 review found that the evidence for electrotherapy in pregnancy-related lower back pain is "very limited". [7]

Shoulder disorders

A 2014 Cochrane review found insufficient evidence to determine whether electrotherapy was better than exercise at treating adhesive capsulitis. [8] As of 2004, there is insufficient evidence to draw conclusions about any intervention for rotator cuff pathology, including electrotherapy; [13] furthermore, methodological problems precluded drawing conclusions about the efficacy of any rehabilitation method for impingement syndrome. [14]

Other musculoskeletal disorders

There is limited, low quality evidence for a slight benefit of noxious-level electrotherapy in the treatment of epicondylitis. [15]

A 2012 review found that "Small, single studies showed that some electrotherapy modalities may be beneficial" in rehabilitating ankle bone fractures. [9] However, a 2008 review found it to be ineffective in healing long-bone fractures. [16]

A 2012 review found that evidence that electrotherapy contributes to recovery from knee conditions is of "limited quality". [17]

Chronic pain

A 2016 Cochrane review found that supporting evidence for electrotherapy as a treatment for complex regional pain syndrome is "absent or unclear." [18]

Chronic wounds

A 2015 review found that the evidence supporting the use of electrotherapy in healing pressure ulcers was of low quality, [19] and a 2015 Cochrane review found that no evidence that electromagnetic therapy, a subset of electrotherapy, was effective in healing pressure ulcers. [10] Earlier reviews found that, because of low-quality evidence, it was unclear whether electrotherapy increases healing rates of pressure ulcers. [20] [21] By 2014 the evidence supported electrotherapy's efficacy for ulcer healing. [22]

Another 2015 Cochrane review found no evidence supporting the user of electrotherapy for venous stasis ulcers. [23]

Mental health and mood disorders

Since the 1950s, over 150 published articles have found a positive outcome in using cranial electrostimulation (CES) to treat depression, anxiety, and insomnia. [24]

Contraindications

Electrotherapy is contraindicated for people with: [25]

History

Electric shock treatment with an Oudin coil Oudin coil - Treatment by the effiuvation method.jpg
Electric shock treatment with an Oudin coil
Use of electrical apparatus. Interrupted galvanism used in regeneration of deltoid muscle. First half of the twentieth century. Reeve 41480.jpg
Use of electrical apparatus. Interrupted galvanism used in regeneration of deltoid muscle. First half of the twentieth century.

The first recorded treatment of a patient by electricity was by Johann Gottlob Krüger in 1743. John Wesley promoted electrical treatment as a universal panacea in 1747 but was rejected by mainstream medicine. Giovanni Aldini treated insanity with static electricity 1823–1824. [26]

The first recorded medical treatments with electricity in London were in 1767 at Middlesex Hospital in London using a special apparatus. The same apparatus was purchased for St. Bartholomew's Hospital ten years later. Guy's Hospital has a published list of cases from the early 19th century. [27] Golding Bird at Guy's brought electrotherapy into the mainstream in the mid-19th century. [28] In the second half of the 19th century the emphasis moved from delivering large shocks to the whole body to more measured doses, the minimum effective. [26]

Apparatus

An early 20th century electrotherapy apparatus Electrotherapy apparatus.jpg
An early 20th century electrotherapy apparatus

Electrotherapy equipment has historically included:

People

Some important people in the history of electrotherapy include;

Notable historic fringe practitioners

Muscle stimulation

In 1856 Guillaume Duchenne announced that alternating was superior to direct current for electrotherapeutic triggering of muscle contractions. [29] What he called the 'warming effect' of direct currents irritated the skin, since, at voltage strengths needed for muscle contractions, they cause the skin to blister (at the anode) and pit (at the cathode). Furthermore, with DC each contraction required the current to be stopped and restarted. Moreover, alternating current could produce strong muscle contractions regardless of the condition of the muscle, whereas DC-induced contractions were strong if the muscle was strong, and weak if the muscle was weak.

Since that time almost all rehabilitation involving muscle contraction has been done with a symmetrical rectangular biphasic waveform. During the 1940s, however, the U.S. War Department, investigating the application of electrical stimulation not just to retard and prevent atrophy but to restore muscle mass and strength, employed what was termed galvanic exercise on the atrophied hands of patients who had an ulnar nerve lesion from surgery upon a wound. [29] These galvanic exercises employed a monophasic (single-pulse) direct current waveform.

The American Physical Therapy Association, a professional organization representing physical therapists, accepts the use of electrotherapy in the field of physical therapy. [30] [31]

See also

Related Research Articles

<span class="mw-page-title-main">Acupressure</span> Alternative medicine technique similar to acupuncture

Acupressure is an alternative medicine technique often used in conjunction with acupuncture or reflexology. It is based on the concept of life energy (qi), which purportedly flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points, or ashi trigger points, with the aim of clearing blockages in these meridians. Pressure may be applied by hand, by elbow, or with various devices. There is no scientific evidence for the existence of acupuncture points, meridians, or qi.

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical syndrome which causes chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and a general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and certain infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome".

<span class="mw-page-title-main">Cranial electrotherapy stimulation</span> Form of neurostimulation

Cranial electrotherapy stimulation (CES) is a form of neurostimulation that delivers a small, pulsed, alternating current via electrodes on the head. CES is used with the intention of treating a variety of conditions such as anxiety, depression and insomnia. CES has been suggested as a possible treatment for headaches, fibromyalgia, smoking cessation, and opiate withdrawal, but there is little evidence of effectiveness for many of these conditions and the evidence for use in acute depression is not sufficient to justify it.

Diabetic neuropathy includes various types of nerve damage associated with diabetes mellitus. The most common form, diabetic peripheral neuropathy, affects 30% of all diabetic patients. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropathies affecting motor, sensory, or autonomic nerve fibers result in different symptoms. More than one type of fiber may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Low back pain</span> Medical condition

Low back pain or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute, sub-chronic, or chronic. The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.

<span class="mw-page-title-main">Transcutaneous electrical nerve stimulation</span> Therapeutic technique

A transcutaneous electrical nerve stimulation is a device that produces mild electric current to stimulate the nerves for therapeutic purposes. TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation, but the term is often used with a more restrictive intent—namely, to describe the kind of pulses produced by portable stimulators used to reduce pain. The unit is usually connected to the skin using two or more electrodes which are typically conductive gel pads. A typical battery-operated TENS unit is able to modulate pulse width, frequency, and intensity. Generally, TENS is applied at high frequency (>50 Hz) with an intensity below motor contraction or low frequency (<10 Hz) with an intensity that produces motor contraction. More recently, many TENS units use a mixed frequency mode which alleviates tolerance to repeated use. Intensity of stimulation should be strong but comfortable with greater intensities, regardless of frequency, producing the greatest analgesia. While the use of TENS has proved effective in clinical studies, there is controversy over which conditions the device should be used to treat.

<span class="mw-page-title-main">Pressure ulcer</span> Skin ulcer (bed sore)

Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.

Manual therapy, or manipulative therapy, is a part of Physiotherapy, it is a physical treatment primarily used by physical therapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.

<span class="mw-page-title-main">Venous ulcer</span> Medical condition

Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS). Several therapies for it exist, although there is no known cure.

<span class="mw-page-title-main">Extracorporeal shockwave therapy</span> Ultrasonic, non-invasive, outpatient treatment

Extracorporeal shockwave therapy (ESWT) is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in physical therapy and orthopedics.

Therapeutic ultrasound refers generally to any type of ultrasonic procedure that uses ultrasound for therapeutic benefit. Physiotherapeutic ultrasound was introduced into clinical practice in the 1950s, with lithotripsy introduced in the 1980s. Others are at various stages in transitioning from research to clinical use: HIFU, targeted ultrasound drug delivery, trans-dermal ultrasound drug delivery, ultrasound hemostasis, cancer therapy, and ultrasound assisted thrombolysis It may use focused ultrasound or unfocused ultrasound.

<span class="mw-page-title-main">Neck pain</span> Medical condition

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.

<span class="mw-page-title-main">Patellofemoral pain syndrome</span> Medical condition

Patellofemoral pain syndrome is knee pain as a result of problems between the kneecap and the femur. The pain is generally in the front of the knee and comes on gradually. Pain may worsen with sitting down with a bent knee for long periods of time, excessive use, or climbing and descending stairs.

<span class="mw-page-title-main">Radionics</span> Form of alternative medicine

Radionics—also called electromagnetic therapy (EMT) and the Abrams method—is a form of alternative medicine that claims that disease can be diagnosed and treated by applying electromagnetic radiation (EMR), such as radio waves, to the body from an electrically powered device. It is similar to magnet therapy, which also applies EMR to the body but uses a magnet that generates a static electromagnetic field.

<span class="mw-page-title-main">Low-level laser therapy</span> Treatment using irradiation with light of low power intensity

Low-level laser therapy (LLLT), cold laser therapy, photobiomodulation (PBM) or red light therapy is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, it is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function. The effects appear to be limited to a specified set of wavelengths and new research has demonstrated effectiveness at myopia control. Several such devices are cleared by the United States Food and Drug Administration (FDA), and research shows potential for treating a range of medical problems including rheumatoid arthritis and oral mucositis.

<span class="mw-page-title-main">Platelet-rich plasma</span> Blood product used in transfusion medicine

Platelet-rich plasma (PRP), also known as autologous conditioned plasma, is a concentrate of plasma protein derived from whole blood, centrifuged to remove red blood cells but retaining platelets. Though promoted for treating various medical conditions, evidence of its benefits was mixed as of 2020, showing effectiveness in certain conditions and ineffectiveness in others.

<span class="mw-page-title-main">Diabetic foot ulcer</span> Medical condition

Diabetic foot ulcer is a breakdown of the skin and sometimes deeper tissues of the foot that leads to sore formation. It may occur due to a variety of mechanisms. It is thought to occur due to abnormal pressure or mechanical stress chronically applied to the foot, usually with concomitant predisposing conditions such as peripheral sensory neuropathy, peripheral motor neuropathy, autonomic neuropathy or peripheral arterial disease. It is a major complication of diabetes mellitus, and it is a type of diabetic foot disease. Secondary complications to the ulcer, such as infection of the skin or subcutaneous tissue, bone infection, gangrene or sepsis are possible, often leading to amputation.

References

  1. ↑ Institute of Electrical and Electronics Engineers, "The IEEE standard dictionary of electrical and electronics terms". 6th ed. New York, Institute of Electrical and Electronics Engineers, c1997. IEEE Std 100-1996. ISBN   1-55937-833-6 [ed. Standards Coordinating Committee 10, Terms and Definitions; Jane Radatz, (chair)]
  2. ↑ Pieber K, Herceg M, Paternostro-Sluga T (2010). "Electrotherapy for the treatment of painful diabetic peripheral neuropathy – a review". Journal of Rehabilitation Medicine. 42 (4): 289–295. doi: 10.2340/16501977-0554 . PMID   20461329.
  3. 1 2 Hurley MV, Bearne LM (2008). "Non-exercise physical therapies for musculoskeletal conditions". Best Practice & Research: Clinical Rheumatology . 22 (3): 419–433. doi:10.1016/j.berh.2008.01.001. PMID   18519097.
  4. 1 2 Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Canesi B (2005). "Osteoarthritis: an overview of the disease and its treatment strategies". Seminars in Arthritis and Rheumatism. 35 (1 Suppl 1): 1–10. doi:10.1016/j.semarthrit.2005.01.013. PMID   16084227.
  5. 1 2 Sim J, Adams N (1999). "Physical and other non-pharmacological interventions for fibromyalgia". Baillière's Best Practice & Research: Clinical Rheumatology . 13 (3): 507–523. doi:10.1053/berh.1999.0041. PMID   10562382.
  6. 1 2 Côté P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, Ameis A, Carroll LJ, Nordin M, Yu H, Lindsay GM, Southerst D, Varatharajan S, Jacobs C, Stupar M, Taylor-Vaisey A, van der Velde G, Gross DP, Brison RJ, Paulden M, Ammendolia C, David Cassidy J, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M, Krahn M, Salhany R (2016). "Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration". European Spine Journal . 25 (7): 2000–2022. doi:10.1007/s00586-016-4467-7. PMID   26984876. S2CID   4417594.
  7. 1 2 Gutke A, Betten C, Degerskär K, Pousette S, Olsén MF (2015). "Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities". Acta Obstetricia et Gynecologica Scandinavica . 94 (11): 1156–1167. doi: 10.1111/aogs.12681 . PMID   26018758.
  8. 1 2 Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R (2014). "Electrotherapy modalities for adhesive capsulitis (frozen shoulder)". The Cochrane Database of Systematic Reviews . 2014 (10): CD011324. doi:10.1002/14651858.CD011324. PMC   10898218 . PMID   25271097.
  9. 1 2 Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM (2012). Lin CW (ed.). "Rehabilitation for ankle fractures in adults". The Cochrane Database of Systematic Reviews . 11: CD005595. doi:10.1002/14651858.CD005595.pub3. PMID   23152232.
  10. 1 2 Aziz Z, Flemming K (2015). "Electromagnetic therapy for treating pressure ulcers" (PDF). Cochrane Database Syst Rev. 2015 (9): CD002930. doi:10.1002/14651858.CD002930.pub6. PMC   7138036 . PMID   26334539.
  11. ↑ Kroeling P, Gross A, Graham N, Burnie SJ, Szeto G, Goldsmith CH, Haines T, Forget M (2013). "Electrotherapy for neck pain". The Cochrane Database of Systematic Reviews . 2013 (8): CD004251. doi:10.1002/14651858.CD004251.pub5. PMC   10696490 . PMID   23979926.
  12. ↑ Borenstein DG (2007). "Chronic neck pain: how to approach treatment". Current Pain and Headache Reports . 11 (6): 436–439. doi:10.1007/s11916-007-0230-4. PMID   18173978. S2CID   46620725.
  13. ↑ Grant HJ, Arthur A, Pichora DR (2004). "Evaluation of interventions for rotator cuff pathology: a systematic review". Journal of Hand Therapy. 17 (2): 274–99. doi:10.1197/j.jht.2004.02.013. PMID   15162111.
  14. ↑ Michener LA, Walsworth MK, Burnet EN (2004). "Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review". Journal of Hand Therapy. 17 (2): 152–164. doi:10.1197/j.jht.2004.02.004. PMID   15162102.
  15. ↑ Dingemanse R, Randsdorp M, Koes BW, Huisstede BM (2014). "Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review". British Journal of Sports Medicine . 48 (12): 957–965. doi:10.1136/bjsports-2012-091513. PMID   23335238. S2CID   11549940.
  16. ↑ Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M (November 2008). "Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials". The Journal of Bone and Joint Surgery. American Volume. 90 (11): 2322–2330. doi:10.2106/JBJS.H.00111. PMID   18978400.
  17. ↑ Button K, Iqbal AS, Letchford RH, van Deursen RW (2012). "Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model". Physiotherapy . 98 (4): 288–299. doi:10.1016/j.physio.2011.08.003. PMID   23122433.
  18. ↑ Smart KM, Ferraro MC, Wand BM, O'Connell NE (2022-05-17). "Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II". The Cochrane Database of Systematic Reviews. 5 (8): CD010853. doi:10.1002/14651858.CD010853.pub3. ISSN   1469-493X. PMC   9112661 . PMID   35579382.
  19. ↑ Vélez-Díaz-Pallarés M, Lozano-Montoya I, Abraha I, Cherubini A, Soiza RL, O'Mahony D, Montero-Errasquín B, Cruz-Jentoft AJ (2015). "Nonpharmacologic interventions to heal pressure ulcers in older patients: an overview of systematic teviews (The SENATOR-ONTOP Series)". Journal of the American Medical Directors Association . 16 (6): 448–469. doi:10.1016/j.jamda.2015.01.083. PMID   25737261. S2CID   28533912.
  20. ↑ Reddy M (2011). "Pressure ulcers". BMJ Clinical Evidence. 2011. PMC   3217823 . PMID   21524319.
  21. ↑ Cullum N, Petherick E (2008). "Pressure ulcers". BMJ Clinical Evidence. 2008. PMC   2907959 . PMID   19450317.
  22. ↑ Barnes R, Shahin Y, Gohil R, Chetter I (April 2014). "Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomised controlled trials". European Journal of Clinical Investigation. 44 (4): 429–440. doi:10.1111/eci.12244. PMID   24456185. S2CID   35060756.
  23. ↑ Aziz Z, Cullum N, Flemming K (2015). "Electromagnetic therapy for treating venous leg ulcers" (PDF). Cochrane Database of Systematic Reviews. 2015 (7): CD002933. doi:10.1002/14651858.CD002933.pub6. PMC   6885063 . PMID   26134172.
  24. ↑ Cantor DS, Evans JR, eds. (2014). Clinical Neurotherapy. doi:10.1016/C2011-0-07624-X. ISBN   978-0-12-396988-0.[ page needed ]
  25. ↑ Wu C (2018). "Physical Agent Modalities". Braddom's Rehabilitation Care: A Clinical Handbook. pp. 119–125.e11. doi:10.1016/B978-0-323-47904-2.00017-9. ISBN   978-0-323-47904-2.
  26. 1 2 Chalovich JM (23 January 2012). Franklinization: Early Therapeutic Use of Static Electricity. hdl: 10342/3929 .
  27. ↑ Steavenson, William Edward (1892). Medical electricity. Philadelphia: P. Blakiston, Son & Company. pp.  3–4.
  28. ↑ Morus IR (1998). Frankenstein's Children: Electricity, Exhibition, and Experiment in Early-nineteenth-century London. Princeton University Press. pp. 234–237. ISBN   978-0-691-05952-5.
  29. 1 2 Licht S (1967). "History of Electrotherapy". Therapeutic electricity and ultraviolet radiation. Waverly. pp. 1–70. OCLC   901158561.
  30. ↑ Electrotherapeutic terminology in physical therapy. American Physical Therapy Association. 2001. ISBN   978-1-887759-88-5. OCLC   756896404. Archived from the original on 2021-09-08. Retrieved 2021-09-08.[ page needed ]
  31. ↑ Robinson AJ, Snyder-Mackler L (2008). Clinical electrophysiology: electrotherapy and electrophysiologic testing. Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. 151–196, 198–237, 239–274. ISBN   978-0-7817-4484-3. OCLC   141177550.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.