Dr .

Mohammed Taher Ahmed

Omar
Assistant professor of physical therapy
1-Member
Board

of International
for
Indian

Advisory

Editor

Journal
of
Occupational

Physiotherapy
and
Therapy 2009.
2- Doctoral Degree in Physical Therapy
(PT.D) for Surgery 2007.
3- Master Degree in Physical Therapy (M
Sc.) 2001.
4-B.Sc.
Degrees in Physical Therapy
1995.

Basic Principle of Electrotherapy

Part I

Objectives
Define electricity, potential difference, ampere,
&watt.
Interpret Ohms
expression.

law

Categorize different
characteristics.

and

its

waveforms

mathematical

and

pulse

Contrast different types of current modulation.

Discriminate between series and parallel circuit.

Objectives
Explain current flow through various
types of biological tissue.
Explain muscle and nerve response to
electrical stimulation.
Enumerate
the
contraindication
stimulation.

clinical
of

use and
electrical

Be able to create a safe environment

when using electrical equipment.

Electricity

Electricity - Flow of e- from higher to

lower concentration

Cathode (-): the electrode connected to

the negative terminal of battery point of
high e- concentration.
Anode (+): the electrode connected to the
positive terminal of battery point of low econcentration.

Electron

is particles that have a

negative electrical charge found revolving

around the nucleus in fixed orbits & very
small mass.

Voltage (potential difference )

Amperage

The force resulting from an accumulation of e- at

one point in an electrical circuit.
Higher voltages results deeper penetration

Unit to measure intensity of electric

current is the rate of e- flow from cathode
(-) to anode (+)
1 amp = 6.25 x 1018 e- / sec

Wattage

Unit to measure the power of an electric current

1 Watt = 1 amp of current flowing with a pressure of 1 volt
Wattage = Volts X Amps

Voltage

Resistance

Quantitative degree of impedance to e- flow in

conductor.

The unit of electrical resistance measure is Ohms

1 Ohm - resistance developing 0.24 cal of heat when 1 amp
flows for 1 sec. Resistance is directly proportional to length and
inversely proportional to cross section area of conductor.

Ohms Law

Study the relationship between intensity of current (I) ,

potential differences (Ve), and resistance (R)

Ohm's law which states that the current flowing through a

resistor is proportional to the potential difference across the
resistor and is inversely proportional to the resistance.
I=V/R
Where
I=current flow , V=Potential differences, R=Resistance

Conductors

Conductors are elements whose atoms have few e- in

their outer orbit, and facilitate passage of an electrical
current.

Higher conductance materials: free flow of e-s

Silver, Copper, Electrolyte solutions

The greater the percentage of H2O in tissues, the better the
conductance
Blood: highest ionic & H20 concentration of any tissue results
best conductor
Inner layer of skin

Low conductance materials: few free e-s

Air, Wood, Glass, Rubber

Bone has the lowest H2O percentage results poorest
conductor
Skin has keratinized epithelium (little H20) acts as insulator

Electric Circuits

Series Circuit

Parallel Circuit

Only one pathway for flow of the

current
R total = R1 + R2 + R3
Voltage will decrease at each
resistance component
Series has higher resistance and
lower current flow

More than one pathway exists

for flow of electrons
1 / R total
= 1 / R1
+
1 / R2 +
1 / R3
Voltage will not decrease at each
resistance component
Parallel has lower resistance and
higher current flow

Electrical Circuits in the Body

Types of Electric
Current

Direct Current

Direct current (DC) is unidirectional

continuous flow of e-s toward (+) pole
Also called galvanic current
Interrupted direct current,
interrupted galvanic
Used to

Introduce medication into the body

(Iontophoresis)

Stimulate denervated muscle, (long duration

interrputed direct current )

Alternating Current (AC)

The e- flow in alternating directions from ()

pole to (+)pole.
Reversing direction when polarity is
reversed.
Sinusoidal current,
Used for

Pain relief
Neuromuscular stimulation.

Pulsed current

The e- flow in alternating directions from

( )pole to (+)pole.
Contain three or more pulses grouped
together.
These groups of pulses are interrupted for
short periods of time (interpulse intervals),
and repeat.
interferential current, Russian current

Waveforms

Waveforms
Waveforms
Waveform means a graphic representation
of shape, direction, amplitude, duration
and frequency of the electrical current.

I-Waveforms shape:

Sine wave
Rectangular wave
Square wave
Triangular wave
Saw tooth wave

Alternating current, direct current , and pulsed

current may take on any of the waveform

Pulse:

An individual waveform is referred to

as a pulse.
A pulse may contain either one , or two
phases.

Phase:

Phase is the portion of pulse that rises

above or below the baseline for some
period of time.

In monophasic current ( pulse =phase) .

In biphasic (alternating )
current (pulse=
separate phases)
In polyphasic current (pulse=polyphasic)

two

1-Monophasic Current
This type of current has only positive OR
negative phases,
High Volt Pulsed Current (HVPC).
Interrupted direct current

2. Biphasic Current
This type of current has both positive and
negative phases.
The current can be symmetrical, asymmetrical,
balanced or unbalanced,
Transcuteanous electrical nerve stimulation
(TENS)

Waveforms

Symmetrical waveforms
each phase equal in
amplitude, shape ,size
and net charge is zero.

Waveforms

Asymmetrical waveforms
:each phase not equal in
amplitude, shape, size
and
net
charge
is
greater than zero,

3. Polyphasic Current
A current has multiple phases with
interpulse
intervals,
such
as
Interferential and Russian.

Pulse period

The combined
duration (PD)
interval (IPI).

time of the pulse

and the interpulse

1-Pulse duration (PD):

Pulse duration is the length of time a

current is flowing in one cycle.

2-Interpulse interval (IPI) ;

Interpulse interval indicates the length

of time in which the current is not
flowing

In monophasic current pulse duration is same as phase

duration.
In biphasic current pulse duration is combination of
phase durations

Pulse amplitude

The maximum pulse amplitude is tip

of highest point of each phase from
baseline.

Pulse charge

pulse charge is the total amount of

electricity being delivered to the
patient during each pulse.

In monophasic current, the pulse charge and

phase charge is the same.
In biphasic current, pulse charge equal the sum of
the phase charge.
In symmetrical pulse the net pulse charge is zero.
In asymmetrical pulses the net pulse charge is
greater than zero.

Phase Duration (A), Pulse Duration (B), Amplitude (C),

Interpulse interval (D), Phase Charge (E)

Rise time and decay time

Rise time indicates the time taken by a

pulse to reach its maximum amplitude
in each phase.
Decay time indicates the time taken by
a pulse to return to neutral.

In sine wave there is gradual increase and decrease

increase in amplitude.
In rectangular wave there is an instantaneous increase in
amplitude followed by plateau for period of time and
then instantaneous decrease in amplitude.
In triangular wave there is an instantaneous increase and
decrease in amplitude.
The more rapid increase in amplitude or the rate of rise ,
the greater the current abilitys to excite the nervous
tissue.

Frequency
Frequency

Frequency is the number of pulse per

second, and measured by Hz.
Pulse frequency < 50Hz produces twitch
muscle contraction.
Pulse frequency >50Hz produces moderate
tetanic muscle contraction.
Electrical
current
can
be
classified
according to frequency as

Low frequency current<1000Hz (TENS, faradic)

Medium
frequency
current
100010000Hz(sionsudal , interferential)
High frequency current > 10000Hz.(short wave and
microwave)

Current Modulation

Modulation
Modulation is the ability to change current
magnitude and duration.
Modulation may be

Continuous,
Interrupted ,
Burst ,
Ramped (surge) ,

For both AC and DC currents

Continuous modulation
The amplitude of current flow remains the same for
several seconds or minutes.
Usually associated with long pulse duration.
Used clinically as medical galvanism & Iontophoresis .

Interrupted modulation
The current flow for some period of time called on
time (1-60seconds) and is then periodically turned
off during the off time(1-120seconds)
Usually associated with monophasic or biphasic
current.
Used different waveforms (sine, rectangular , &
triangular)
Used clinically
strengthening.

for

muscle

reeducation

and

Burst modulation
The current flow for short duration of time
(milliseconds) and is then turned off for short
duration of time (milliseconds), in a repetitive cycle.
Usually associated with polyphasic current.
Set of pulse are combined and referred as burst or
beats.
Burst duration (BD)& Inter burst interval (IBI)
Used different waveforms (sine, rectangular , &
triangular).
Used clinically for muscle reeducation and strength.

Ramping modulation =(surged)

The current amplitude will increase or ramp up
gradually to some preset maximum and may also
decrease or ramp down in intensity.
Ramp time usually 1/3 of on time.
Used clinically for muscle contraction as it allow
gradual increase of intensity.

Current Modulation

Physiological Responses
to Electrical Current

Physiological Response to Electrical Currents

Response depends on
Type of tissue
Response characteristics
Nature of the current applied

cellular

Tissue

Segmental

Systematic

Effect of electrical stimulation

at cellular level
Excitation of nerve cells
Changes of cell membrane
permeability
Protein synthesis
Stimulation of
fibroblast & osteoblast

Effect of electrical stimulation

at Tissue level
(Multiple cellular events)

Skeletal muscles
contraction
Smooth muscles
contraction

Tissue regeneration

Effect of electrical stimulation

at segmental level
regional effects of previous two level

Modification of
joint mobility
&Changes circulation
Lymphatic activity

Effect of electrical stimulation

at systemic level

Analgesic effects

Endogenous pain
suppressors

Physiological Responses to Electricity

Effect on musculoskeletal system:

Muscle excitation result in contraction & increase muscle

blood flow.

Increase quantity of aerobic enzymes in stimulated

muscle.

Decrease quantity of anaerobic enzymes.

Muscle fiber hypertrophy

both type I and type II fibers

Possible increase in proportion of type I fibers.

Attenuation of the decrease in ATP-ase that is usually seen

Physiological Responses to Electricity

Effect on wound healing:

Increase capillary permeability (animal study)

Increase blood flow
Reduction of edema.
Increase macrophage and leucocytes activities.
Increase fibroblast and osteoblast activity.
Induce bactericidal effects.

Effect on pain perception:

Modifying pain perception through central and peripheral
level.

Effect of Electrical Current on Tissue

Excitable Tissues
Muscle &nerve.
Sensitive permeability
Polarized cell membrane
Resting potential
Action potential
Depolarization
Absolute Refractory
period
Repolarization

Effect of Electrical Current on Excitable Tissue

Neuromuscular Responses to Electrical Current

All-or-none Principle
Either stimulus causes depolarization or it
does not
Changing intensity of contraction influenced
by changing parameters

Frequency
Intensity
Pulse duration
Quantity of motor unit stimulated

Effect of Electrical Current on Tissue

Non-Excitable Tissues
Tissue Types
Cellular Electrical
Circuits

Cell Membrane
Intercellular Structures
Gap Junctions
Electropiezo activity in
Cells

Clinical Use of Electrical

Stimulation

To stimulate muscle contraction through nerve

and muscles
1.
2.
3.
4.
5.
6.

Facilitation or initiation of muscle contraction.

Re-education or re-learning of muscle contraction.
Increase muscle strength and endurance
Prevent disuse atrophy
Reduce abnormal muscle tone.
Improve motor control.

Clinical Use of Electrical

Stimulation

To stimulate central and peripheral mechanism

for pain relief (acute, chronic & postoperative
pain).

To maintain and increase range of motion.

To stimulate biological tissue for promotion of

healing (wound healing, bone healing).

To
facilitated
(Iontophoresis)

transmission

of

drugs

Contraindications to Electrotherapy
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Pacemakers
Osteogenesis imperfecta
Thrombophlebitis
Recent fracture , external fixation
Near the operating diathermy devices.
Over anterior neck to avoid stimulation of the vagus or phernic
nerve.
Over the lumber , lower abdomen or perineal area of pregnant
woman.
Over the eye .
Malignancy( region of neoplasm).
Hemorrhage .

Safety in Clinical Environment

Safety is a freedom from unacceptable risk.
Basic Safety is a protection against direct
hazards (physical ,mechanical , & electrical)
when electrical equipment is used under
normal or other reasonably conditions.
Integrity Safety Level is a qualitative measure
of the level of assurance that a system will
function as intended or, if it malfunctions, will
do so in a safe manner.

Hazards
Hazard is a situation of potential harm to people
or property.
Electrical hazards
Electrical shocks is due to equipment failure, failure
of power delivery systems, ground failures, burns,
fire, etc.
Microshock is imperceptible electrical shock because
of leakage of current less than 1mA.
Macroshock is perceptible electrical shock because of
leakage of current greater than 1mA.

Physiological effects of different current

amplitudes

Current
amplitude
0-1 mA
1-15 mA

Physiological effects
Imperceptible sensation

15-100 mA

Tingling sensation and muscle

contraction
Painful shock.

100-200mA

Cardiac and respiratory arrest

<mA200

Instant tissue burning and

destruction

Safety in use of electricity

The therapist should be very familiar with the equipment
being used and any potential problems that may exist or
developed.

It should not be assumed that all three pronged wall outlets

are automatically grounded to the earth, the ground must be
checked.
Any defective equipment should be removed from the clinic
immediately.

Safety in use of electricity

The plug should not be jerked out of wall by
pulling on the cable
Extension cords or multiple adaptors should be
never used.
Equipment should be reevaluated on a yearly
basis.