Management of Postsurgical Hyperhidrosis With Direct Current and Tap Water

Background and Purpose. Excessive sweating, known as hyperhidrosis, involves the eccrine sweat glands of the axillae, soles, palms, and/or forehead. The use of iontophoresis to reduce or eliminate excessive sweating has been described since 1952. The purpose of this case report is to describe the use of tap water galvanism (TWG) using direct current (DC) with a patient who had postsurgical hyperhidrosis. Case Description. The patient was a 36-year-old male electrician with traumatic phalangeal amputation and postsurgical development of hyperhidrosis. Tap water galvanism was administered using a DC generator, 2 to 3 times per week for 10 treatments. The patient\u27s hands were individually submerged in 2 containers of tap water with the electrodes immersed directly into the containers. Each hand was treated with 30 minutes of TWG at 12 mA. Hyperhidrosis was measured by a 5-second imprint and subsequent tracing of the left hand placed on dry paper toweling. Outcomes. The patient\u27s hyperhidrosis decreased from the full left palmar pad, with a surface area of 10.3×12.0 cm, to a reduced area of wetness that covered a 2.2-×2.7-cm area. The patient returned to work as an electrician without needing absorbent gloves, which had prevented him from performing electrical work. Discussion. Following use of TWG, the patient\u27s palmar hyperhidrosis returned to normhidrosis

The effect of distal afferent input on the spasticity and motor control of the post stroke upper extremity

Spasticity is one of many components of the upper motor syndrome and is a common consequence of a stroke. It is characterized by an increased velocity-dependent resistance to passive stretch (Lance 1980). Spasticity has been used synonymously with enhanced or hyperactive stretch reflexes. This enhancement in the stretch reflex is thought to occur largely through a loss of descending inhibitory input that occurs post stroke. The effect of spasticity on motor control has been debated, but spasticity has been implicated in errors in motor control, joint contracture, and interference in activities of daily living (ADLs). As a result of these problems, spasticity is often clinically treated using a variety of techniques. To accurately determine the necessity and efficacy of one of these treatments, an accurate and reliable measure of spasticity must be available. Similarly, volitional movement of the upper extremity post stroke is also problematic. Strength, or the ability to generate torque in a desired direction, is often impaired post stroke. Movement in synergy patterns , as has been characterized by Brunnstrom and others (Brunnstrom 1970), is a typical form of discoordination seen post stroke. For example, abduction of the shoulder is often associated with flexion of the elbow. This impairs upper extremity movement as well as ADLs. Accurate assessment of these synergy patterns has been difficult as well. The Fugl-Meyer Scale addresses movement patterns loosely, along with other functional activities. However, the Fugl-Meyer scale does not appear to have adequate sensitivity to assess changes in movement patterns that may be a result of a given intervention. Thus, a sensitive, reliable measure of synergy patterns would be useful as well. Two common interventions for the impairments listed above have been electrical stimulation and injection of Botulinum Toxin A (Botox) into the spastic muscles. It has been anecdotally noted that when these interventions are applied at the distal upper extremity, the more proximal joints benefit as well. This study will use novel biomechanical tools to assess the effects of electrical stimulation and Botox applied at the distal arm on the spasticity and motor control of the proximal muscles of the arm. It is hoped that the results of this study will be used clinically to enhance the quality of life of stroke survivors

Biomechanics of Elastic Resistance in Therapeutic Exercise Programs

Resistive materials in the form of elastic bands and tubing are inexpensive and highly versatile tools that are often used in therapeutic exercise programs. Companies that manufacture elastic bands and tubing provide a line of products that cover a wide range of resistance levels, which are typically distinguished by color. Theoretically, the spectrum of resistance levels makes it possible for rehabilitation personnel to give a patient the band or tubing that best corresponds to the suitable degree of exercise resistance for that patient. Unlike a set of clearly labeled hand-held weights, however, elastic bands and tubing provide no quantitative information on their actual or relative resistance. Therefore, the selection and progression of resistance levels when elastic bands or tubing are used is relatively subjective and often is dependent upon the perceived effort of the patient. To our knowledge, only 2 of the several manufacturers of elastic bands and tubing used in rehabilitation (The Hygenic Corporation, Akron, OH, and Lifeline International, Inc, Madison, WI), provide users with information (limited) on the physical characteristics of their elastic material. The goals of our report were to establish the stress-strain relationship of representative samples of elastic bands and tubing used in the clinical setting, establish the fatigue characteristics of representative samples of elastic bands and tubing, and increase the awareness of rehabilitation professionals of the kinesiological concepts of resistive exercises, especially as they relate to the use of elastic-type resistive material