Biofeedback

Contraindications & Precautions
There remains some controversy over exactly what does and does not constitute a contraindication to eachmodality. In addition to any list produced, it is essential that the therapist makes a professional judgementas no listing can cover all variations and clinical circumstances.
The lists of contraindications (by modality) below are derived from consensus rather than claiming to be adefinitive list. They are included here to assist and the author makes no claim for their mutual exclusivity orcomprehensiveness.
Biofeedback
CONTRAINDICATIONSDermatological conditions (e.g. eczema, dermatitis)Allergy to the electrode or contact material (tape / gel)Patients who are unable to understand or respond to the instructions of the therapistPatients with pacemakers (although not directly affected by the EMG Biofeedback, they may be susceptibleto electromagnetic fields in the therapy environment. If in doubt, check with the appropriate authority.)Electrodes should not normally be placed over the eyes or other sensitive tissue PRECAUTIONSIf a patient has a diminished skin sensation, the full benefit of the therapy may not be realised. If alternativeplacement of the electrodes over normally sensitive skin is not possible, extra care should be taken.
Patients with epilepsy may experience an adverse response to the visual display (flashing lights / computerscreen). Such patients should be treated with caution and careful monitoring following consultationbetween the therapist and the appropriate medical practitioner.
Cryotherapy
CONTRAINDICATIONSGeneral, advanced cardiovascular diseaseLocal areas of impaired peripheral circulationExtensive scar tissue – poor blood supply may lead to ice burnsDeep X Ray therapy or other ionising radiations in the last 6 months in the region being treatedMalignant tissueSubjects with reduced levels of consciousness or impaired understandingAcute febrile illnessSome acute skin conditions e.g. eczema, dermatitisOpen or infected wounds (without appropriate precautions)Vasospasm (e.g. Raynauds disease)CryoglobulinaemiaCold urticaria PRECAUTIONSDo not allow tissue to become waterloggedVery large areas (e.g. bilateral lower limbs) should never be subjected to temperatures below 20CCryotherapy is usually applied with a wet / damp surface against the skin Electrotherapy Contraindications
Tim Watson
Hot Packs
CONTRAINDICATIONSImpaired circulationAreas of recent bleeding or haemorrhageLack of local thermal sensationDevitalised tissue e.g. after deep X ray therapyOpen woundsImpaired circulation of the part to be treatedMalignancy PRECAUTIONSNever allow a patient to lie on top of a hot pack, particularly if treating the trunkAvoid using hot packs on very overweight patients as the tissues may not dissipate the heat effectively andthus lead to a burnMoisture may encourage damaged or infected skin to break down Interferential Therapy
CONTRAINDICATIONSPatients who do not comprehend the physiotherapist’s instructions or are unable to co-operate should not betreatedPatients who are taking anticoagulation therapy or have a history of pulmonary embolism or deep veinthrombosis should not be treated with the vacuum electrode applicationsSimilarly, patients whose skin may be easily damaged or bruisedApplication over : The trunk or pelvis during pregnancyActive or suspected malignancy except in hospice careThe eyesThe anterior aspect of the neckThe carotid sinuses (stimulation in this area may cause a drop in blood pressure) Patients with pacemakersDermatological conditions e.g. dermatitis, broken skinDanger of haemorrhage or current tissue bleeding (e.g. recent soft tissue injury)Avoid active epiphyseal regions in children PRECAUTIONSCare should be taken to maintain the suction at a level below that which causes damage / discomfort to thepatientIf there is abnormal skin sensation, electrodes should be positioned in a site other than this area to ensureeffective stimulationPatients who have abnormal circulationFor patients who have febrile conditions, the outcome of the first treatment should be monitoredPatients who have epilepsy, advanced cardiovascular consitions or cardiac arrhythmias should be treated atthe discretion of the physiotherapist in consultation with the appropriate medical practitionerTreatment which involves placement of electrodes over the anterior chest wall Electrotherapy Contraindications
Tim Watson
InrfaRed
CONTRAINDICATIONSAreas with poor or deficient skin sensationGeneralised advanced cardiovascular diseaseLocal areas of impaired peripheral circulationExtensive scar tissueDeep X Ray treatment or other ionizing radiation (in the last 6 months) in the region being treatedMalignant tissue (except in terminal / palliative / hospice care)Subjects with reduced levels of consciousness or impaired understandingAcute febrile illnessSome acute skin conditions e.g. eczema, dermatitisSensitive structures (e.g. eyes and testes) PRECAUTIONSNever position the lamp such that it could drop onto the patient Laser Therapy
CONTRAINDICATIONSActive or suspected carcinoma (except in hospice care)Direct irradiation of the eyesCognitive difficulties or unreliable patientsIncreased sensitivity to lightIrradiation over the pregnant uterus PRECAUTIONSAvoid irradiation of the gonadsAvoid irradiation of patients with a history of epilepsyAvoid irradiation of areas of altered skin sensitivityEnsure that the patient understands the nature of the treatment and related dangersAvoid active epiphyseal regions in children Low Frequency Current
CONTRAINDICATIONSPatients who do not comprehend the physiotherapist’s instructions, or who do not cooperate should not betreatedPatients with pacemakersPatients who have an allergic response to the electrode / tape / gelPatients with skin conditions (e.g. eczema, dermatitis)Patients with current or recent bleeding / haemorrhagePatients with open woundsPatients with compromised circulation e.g. ischaemic tissue, thrombosis and associated conditionsApplication over : The anterior aspect of the neck or carotid sinusLower trunk, abdomen or pelvis during pregnancyThe eyesAnaesthetic areas Electrotherapy Contraindications
Tim Watson
PRECAUTIONSIf the skin sensation is not normal, it is preferable to position the electrodes at an alternative site whichensures effective circulationAvoid active epiphyseal regions in childrenSelect stimulation parameters appropriate to the effect deasired. Inappropriate stimulation parameters maycause muscle damage, reduction in blood flow through the muscle and low frequency muscle fatigueAppropriate care should be taken to ensure that the level of muscle contraction initiated does notcompromise the muscle nor the joint(s) over which it actsPatients with a history of epilepsy should be treated at the discretion of the physiotherapist in consultationwith the appropriate medical practitioner Microwave Diathermy
CONTRAINDICATIONSAreas of poor or deficint skin sensationMetal in the tissuesCirculatory compromise or deficit including ischaemia, thrombosis and associated conditionsAdvanced cardiovascular conditionsPacemakersPregnancyRecent or current haemorrhageAviod irradiation to the abdomen or pelvis during menstruationMalignancyActive tuberculosisDeep X Ray treatment or other ionizing radiation (in the last 6 months) in the region to be treatedPatients who are unable to understand the instructions provided or who are unable to cooperate with thetreatment demands PRECAUTIONSAvoid active epiphyseal regions in childrenIrradiation of the eyes should be avoided and when exposure is likely, protective goggles should be wornby the patientAvoid other specialised tissues (e.g. testes) Electrotherapy Contraindications
Tim Watson
Pulsed Shortwave Diathermy (PSWD)
CONTRAINDICATIONSThere is some controversy as to the thermal nature od PSWD, but in the light of recent research, it issuggested that in order to stay below the level at which thermal accumulation may occur, a mean power ofless than 5 Watts should be employed, especially if tissue heating is considered inappropriate. If meanpower levels are employed such as to achieve tissue heating, then the contraindications listed forcontinuous shortwave must be employed. It is acceptable to use PSWD machines as a thermal interventionso long as the appropriate precautions are taken.
Non Thermal Applications (below 5 Watts mean power) Circulatory compromise or deficit including ischaemic tissue, thrombosis and associated PacemakersPregnancyRecent or current haemorrhageAvoid treatment of the abdomen and pelvis during menstruationMalignancyActive tuberculosisDeep X Ray therapy or other ionizing radiations (in the last 6 months) in the region to be treatedPatients who are unable to comprehend the therapists instructions or who are unable to cooperateIt is considered safe to deliver a low dose (less than 5 Watts mean power) when there is metal in Metal plinths are generally considered acceptable when the applied mean power is less than 5 PRECAUTIONSAvoid active epiphyseal regions in childrenAvoid specialised tissues (e.g. eye and testes) PHYSIOTHERAPIST SAFETYIn the interest of physiotherapist safety, it is recommended that once the machine has been switched on, thephysiotherapist and all other personnel should keep at least 1 metre from the operating machine, leads andelectrodes. Pregnant physiotherapists or others with concerns may want to ask a colleague to turn the SWD/ PSWD machine on. Almost all moderm machines will turn off automatically. It si recommended thatphysiotherapists consult the ‘Safe Practice with Electrotherapy(shortwave Therapies)’ document (CSP1997) for further information.
OTHER ELECTROTHERAPY APPARATUSIt is recommended that other electrotherapy devices, especially electrical stimulation apparatus, are kept atleast 2 metres from the SWD / PSWD machine. The output of some machines (e.g. interferential therapydevices) can be affected by close proximity to an operating SWD / PSWD machine. Departments /physiotherapists should establish the conflicts between their particular SWD / PSWD and electricalstimulation apparatus as these will not be the same for all combinations of equipment. It is consideredunwise to operate two SWD / PSWD machines simultaneously without maintaining a separation of at least3 metres.
Electrotherapy Contraindications
Tim Watson
Shortwave Diathermy
CONTRAINDICATIONSAreas of poor or deficient thermal skin sensationMetal in the tissuesCirculatory compromise or deficit including ischaemic tissue, thrombosis and associated conditionsAdvanced cardiovascular conditionsPacemakersPregnancyRecent or current haemorrhageAvoid irradiation of the lower trunk, abdomen or pelvis during menstruationMalignancyActive tuberculosisDeep X Ray therapy or other ionizing radiations (in the last 6 months) in the region to be treatedPatients who are unable to cooperate PRECAUTIONSAvoid active epiphyseal regions in childrenAvoid specialised tissues (e.g. eye and testes) Transcutaneous Electrical Nerve Stimulation (TENS)
CONTRAINDICATIONSPatients who do not comprehend the physiotherapist’s instructions or who are unable to cooperateAvoid the application of the electrodes over the trunk abdomen or pelvis during pregnancy with theexception of the use of TENS for labour painPacemakerPatients who have an allergic response to the electrodes, gel or tapeDermatological conditions e.g. dermatitis, eczema PRECAUTIONSIf there is abnormal skin sensation, the electrodes should be positioned in a site other than this area toensure effective stimulationElectrodes should not be placed over the eyesPatients who have epilepsy should be treated at the discretion of the physiotherapist in consultation with theappropriate medical practitionerAvoid active epiphyseal regions in childrenThe use of abdominal electrodes during labour may interfere with foetal monitoring equipment Electrotherapy Contraindications
Tim Watson
Ultrasound
CONTRAINDICATIONSAvoid exposure to the developing foetusMalignancyVascular abnormalities including DVT and severe atherosclerosisAcute infectionsHaemophiliacs not covered by replacement factorApplication over : Specialised tissue e.g. eye and testesThe stellate ganglionThe cardiac area in advanced heart diseaseThe spinal cord following laminectomyThe craniumActive epiphyseal regions in children PRECAUTIONSAnaesthetic areas should be treated with caution if a thermal dose is being appliedSubcutaneous major nerves and bony prominencesAlways use the lowest intensity which produces a therapeutic responseEnsure that the applicator is moved throughout the treatmentEnsure that the patient is aware of the nature of the treatment and the expected effectsIf pain, discomfort or unexpected sensations are experienced by the ptient, the treatment intensity should bereduced. If the symptoms persist, the treatment should be terminated.
Ultraviolet Radiation (UVR)
xeroderma pigmentosumGorlin’s syndromeHereditary dysplastic naevus syndromeSystemic lupus erythematosusDermatomyositisTrichothlodystrophyBloom’s syndromeCockayne’s syndromePrevious malignant melanoma Age less than 10 yearsPrevious or current non-melanoma skin cancerPrevious exposure to arsenic or ionising radiationCurrent premalignant skin lesionsConcomitant immunosupressive therapyPregnancy (applies to PUVA treatments only)Some forms of porphyria Age less than 16 yearsCataracts (applies to PUVA treatments only)Bullous pamphigoidPemphigus Electrotherapy Contraindications
Tim Watson
Previous or concomitant treatment with methotrexateSignificant hepatic dysfunction (applies to PUVA treatments only)Patients with a history of epilepsy should be treated at the discretion of the physiotherapist in consultation with the appropriate medical practitioner PRECAUTIONSAvoid unnecessary exposure to sunlight on treatment daysPatient should wear UV opaque eye protection during treatment (and for the remainder of the day in thecase of PUVA)Ensure that the patient is not taking photosensitising medicationFemale patients and male patients’ female partners should preferably avoid conception during treatment(applies to PUVA treatments only) Wax
CONTRAINDICATIONSImpaired circulationAreas of recent bleeding or haemorrhageLack of thermal sensationDevitalised tissue (e.g. after Deep X Ray therapy)Open woundsInfectionMalignancyAcute inflammationSkin conditions (e.g. acute dermatitis, eczema)Unstable, fragile or early stage skin grafts PRECAUTIONSThe ‘dip and re-immerse’ method should be avoided in patients with significant oedemaCooler wax temperatures are required for the foot than the handMoisture may encourage damaged or infected skin to break down Electrotherapy Contraindications
Tim Watson

Source: http://electrostimulateurs-manuels.fr/fichiers/publications/Contraindications-et-Precautions/contraindications.pdf