Electrical Stimulation Techniques

2005

FA Davis

Current Flow


Electron Flow
(shown in red)

Between the generators and electrodes To and from the generator



Ion Flow
(shown in yellow)

Occurs within the tissues Negative ions flow towards the anode and away from the cathode Positive ions flow towards the cathode and away from the anode

+ + -

Electrodes


Purpose
Completes the circuit between the generator and body Interface between electron and ion flow Primary site of resistance to current

Materials
Metallic (uses sponges) Silver Carbon rubber Self-adhesive Self-

Electrode Size
Determines the Current Density  Equal size


Bipolar arrangement Approximately equal effects under exach

Electrode Arrangements


Based on: Current Density Proximity to Each Other Anatomic Location (Stimulation Points)

Current Density


Bipolar Technique
Equal current densities Equal effects under each electrode (all other factors being equal)

Monopolar Technique
Unequal current densities
 At least 4:1 difference

Effects are concentrated under the smaller electrode

Active Dispersive

  

Active electrode(s) Dispersive electrode

No effects under larger electrode

Quadripolar Technique
Two bipolar electrode arrangements Two independent electrical channels TENS is a common example

Electrode Proximity


Determines the number of parallel paths The farther apart the electrodes the more parallel paths are formed More current is required to produce effects as the number of paths increases

Stimulation Points


Motor Points
Superficial location of motor nerve Predictably located Motor nerve charts

Trigger Points
Localized, hypersensitive muscle spasm Trigger referred pain Arise secondary to pathology

Acupuncture Points
Areas of skin having decreased electrical resistance May result in pain reduction

Traumatized Areas
Decreased electrical resistance (increased current flow)

Path of Least Resistance



Ion flow will follow the path of least resistance

Nerves Blood vessels

The current usually does not flow from electrode-toelectrode-toelectrode (the shortest path) The path of least resistance is not necessarily the shortest path

Selective Stimulation of Nerves



Nerves always depolarize in the same order

Sensory nerves Motor nerves Pain nerves Muscle fiber

 

Based on the cross-sectional diameter crossLarge-diameter nerves depolarize first Large-

Location of the nerve

Superficial nerves depolarize first

Phase Duration and Nerve Depolarization



Phase duration selectively depolarizes tissues Phase Duration Short Medium Long DC Tissue Sensory nerves Motor nerves Pain nerves Muscle fiber

Adaptations
Patients get used to the treatment  More intense output needed  Habituation


Central nervous system Brain filters out nonmeaningful, repetitive information



Accommodation
Peripheral nervous system Depolarization threshold increases

Preventing Adaptation
Vary output (output modulation) to prevent The longer the current is flowing, the more the current must be modulated.

Electrical Stimulation Goals

Muscle Contractions [Instructor Note: More detail on these techniques are found in the CH 13 ppt: Treatment Strategies]

2005

FA Davis

MotorMotor-level Stimulation
Comparison of Voluntary and Electrically-Induced Contractions Electrically-

Voluntary  Type I fibers recruited first  Asynchronous

Decreases fatigue


ElectricallyElectrically-induced  Type II fibers recruited first  Synchronous recruitment

Based on PPS


GTO protect muscles

GTOs do not limit contraction

MotorMotor-level Stimulation


Parameters: Amplitude: Amplitude: Contraction strength increases as amplitude increases Phase duration: 300 to 500 sec targets motor duration: nerves:
The shorter the phase duration, the more amplitude required Longer durations will also depolarize pain nerves Pain often limits quality and quantity of the contraction

Pulse frequency: Determines the type of frequency: contraction

Pulse Frequency
 

Frequency determines the time for mechanical adaptation Lower pps allows more time (longer interpulse interverals)
Label Low Medium High Range < 15 pps* 15-40 pps* 15>40 pps* Result Twitch: Twitch: Individual contractions Summation: Summation: Contractions blend Tonic: Tonic: Constant contraction

* Approximate values. The actual range varies from person-toperson-toperson and between muscle groups

Effect of Pulse Frequency on Muscle Contractions

1 pulse per second Twitch Contraction The amount of time between pulses the interpulse interval is long enough to allow the muscle fibers to return to their original position

20 pulses per second Summation The amount of time between pulses allows some elongation of the fibers, but not to their starting point.

40 pulses per second Tonic Contraction The current is flowing so rapidly that there is not sufficient time to allow the fibers to elongate

Electrical Stimulation Goals

Pain Control

2005

FA Davis

Pain Control
SensorySensory-level Target Tissue Phase Duration
A-beta fibers

Motor-Level MotorMotor nerves

Noxious Level
A-delta C fibers

< 60 sec

120 to 250 sec

1 msec

60 to 100 pps Pulse Frequency 80 to 120 pps Intensity Submotor

2 to 4 pps

Variable

Moderate to To tolerance Strong contraction

Electrical Stimulation Goals

Edema Control and Reduction

2005

FA Davis

Edema Control
    

Cathode placed over injured tissues High pulse frequency Submotor intensity Thought to decrease capillary permeability Do not use if edema has already formed

Edema Reduction


  

Muscle contractions milk edema from extremity Electrodes follow the vein s path Alternating rate targets muscle groups Elevate during treatment

Electrical Stimulation Goals

Fracture Healing

2005

FA Davis

Fracture Healing
Electrical current triggers bone growth  Piezoelectric effect within the collagen matrix  Alternating current


Applied transcutaneously Similar to diathermy units (no heat production)



Direct current
Implanted electrodes

Contraindications and Precautions

2005

FA Davis

Contraindications and Precautions



Areas of sensitivity
Carotid sinus Esophagus Larynx Pharynx Around the eyes Temporal region Upper thorax

   

  

Severe obesity Epilepsy In the presence of electronic monitoring equipment

  

Cardiac disability DemandDemand-type pacemakers Pregnancy (over lumbar and abdominal area) Menstruation (over lumbar and abdominal area) Cancerous lesions (over area) Sites of infection (over area) Exposed metal implants