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
 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” electrode(s)
“Active” “Dispersive”
– No effects under larger electrode
 “Dispersive” 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-to-
electrode (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
– Large-diameter nerves depolarize first
 Location of the nerve
– Superficial nerves depolarize first
 Phase Duration and
Nerve Depolarization
 Phase duration selectively depolarizes
tissues

Phase Duration Tissue

Short Sensory nerves
Medium Motor nerves
Long Pain nerves
DC 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
 Motor-level Stimulation
Comparison of Voluntary and Electrically-Induced Contractions

Voluntary Electrically-induced
 Type I fibers recruited  Type II fibers recruited
first first
 Asynchronous  Synchronous
– Decreases fatigue recruitment
 GTO protect muscles – Based on PPS
 GTOs do not limit
contraction
 Motor-level Stimulation
 Parameters:
Amplitude: Contraction strength increases as
amplitude increases
Phase duration: 300 to 500 µsec targets motor
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
contraction
 Pulse Frequency
 Frequency determines the time for mechanical
adaptation
 Lower pps allows more time (longer interpulse
interverals)
Label Range Result
Low < 15 pps* Twitch: Individual contractions
Medium 15-40 pps* Summation: Contractions blend
High >40 pps* Tonic: Constant contraction

* Approximate values. The actual range varies from person-to-

person and between muscle groups
 Effect of Pulse Frequency on
Muscle Contractions

1 pulse per second 20 pulses per second 40 pulses per second

Twitch Contraction Summation Tonic Contraction
The amount of time The amount of time The current is flowing so
between pulses – the between pulses allows rapidly that there is not
interpulse interval – is some elongation of the sufficient time to allow the
long enough to allow the fibers, but not to their fibers to elongate
muscle fibers to return to starting point.
their original position
 Electrical Stimulation
Goals
Pain Control

© 2005 – FA Davis
 Pain Control
Sensory-level Motor-Level Noxious Level
Target A-beta fibers Motor nerves A-delta
Tissue C fibers

Phase < 60 µsec 120 to 250 µsec 1 msec

Duration

Pulse 60 to 100 pps 2 to 4 pps Variable

Frequency 80 to 120 pps

Intensity Submotor 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  Cardiac disability
– Carotid sinus  Demand-type pacemakers
– Esophagus  Pregnancy (over lumbar
– Larynx and abdominal area)
– Pharynx
– Around the eyes
 Menstruation (over
lumbar and abdominal
– Temporal region
area)
– Upper thorax
 Cancerous lesions (over
 Severe obesity area)
 Epilepsy  Sites of infection (over
 In the presence of area)
electronic monitoring  Exposed metal implants
equipment