PRINCIPLES OF

CLINICAL
APPLICATION OF
ELECTROTHERAPY

CONTENTS: Factors

affecting

nerve

stimulation:
Sensory levels:
Clinical
application
of
the
electrodes:
Techniques of Application
Basic Guidelines for application of
electro-therapy.

FACTORS AFFECTING NERVE

STIMULATION

1) The Relative Diameter of the

nerve:
)The
amplitude of the current
necessary to stimulate a nerve is
inversely
proportional
to
the
nerves diameter.
)Nerves with larger diameters are
stimulated to threshold before
nerves with smaller diameters.

FACTORS AFFECTING NERVE

STIMULATION
During electrical stimulation
sensory nerves are stimulated first
followed by motor nerves and then
pain fibers.
So, small c-fibers need great
current to be stimulated and are
the last nerve fibers to be
stimulated

FACTORS AFFECTING NERVE

STIMULATION
2) The Duration of the Pulse:
)Short pulse duration allow the
greatest range in stimulation
intensity for excitation of
nerves
)As the pulse duration is
increased, less amperage is
required to stimulate nerves

 Pulse

duration less than 1 msec

will not be able to stimulate
denervated muscle regardless
of the current's amplitude.
Pain fibers are stimulated with
longer pulse duration and high
intensity.

3) RATE OF RISE OF THE PULSE

Rapidly

rising pulses cause

nerve depolarization and if the
rate of rise is slow, the nerve
accommodates to the stimulus.
Muscle fibers accommodate
more slowly than nerve fibers,
so gradual pulse rise may be
used.

4) THE DEPTH OF THE NERVE:

Superficial

sensory
nerves
receive a greater amount of
stimulation
than
deeply
situated motor nerves.

SENSATION LEVELS

Subsensory level

Sensory level

SENSATION LEVELS

Motor level

Noxious level

CLINICAL APPLICATION
)

Definition of Electrode:
the means of making an
electrical connection to the
body.
1- Transcutaneous stimulation.
2- Percutaneous stimulation.

CLINICAL APPLICATION
TYPE OF ELECTRODES MATERIALS
1) A malleable metal electrode:

TYPES OF ELECTRODES MATERIALS

2) Carbon rubber electrodes:

TYPES OF ELECTRODES MATERIALS

Advantages:
a) They conform to the body surface
more easily than metal electrodes.
b) It is inert and compatible
c) Has a much higher resistivity than
metal
d) Durable enough so can be used
repeatedly over a period of a week
or more and adhere well enough to
stay attached.

3) Adhesive electrode

Types of Electrodes Material

In general carbon rubber and

similar
electrodes
used
with
conducting gel are convenient for
long
use
and
repeated
self
application
by
the
patient,
whereas the water pad conduction
methods.

TYPES OF ELECTRODES
Active Electrode:

EarthElectrode:

TYPES OF ELECTRODES
Needle Electrode

Surface
electrodes

ELECTRODE CONNECTIONS

ELECTRODE CONNECTIONS

PREPARATION OF THE ELECTRODES SETS

The following measures should be

taken to decrease skin resistance
Remove dirt or oil by washing the
skin areas under the electrodes.
Moisten electrodes with electrode
coupling.

ELECTRODE COUPLING

Carbonized electrodes require a

(conductive pads, electrolytic gel)

The
conductive
media
should
completely cover the electrode
surface to avoid focal areas of high
current density

 Gel

conductive media should be

applied in a thin, even layer on the
electrode
surface
prior
to
attachment to the skin

The

lead wire should be attached

to the electrodes prior to the
application of the conductive media

ELECTRODE PLACEMENT

When apply electrodes to the tissues,

certain points needed to be considered.
a)

b)

There are certain areas of the skin more

conductive to electrical stimulation.
These sites referred to as stimulation
points, represent motor points, trigger
points, and acupuncture points.
Proximity of electrodes to one another:

ELECTRODE PLACEMENT
c) The orientation of the electrodes
in relation to the body part must
be considered.

TECHNIQUE OF APPLICATION

1) Monopolar technique
Monopolar application involves the
use of two electrodes

(1) an active electrode placed

where the treatment effect occurs.
(2) a dispersive electrode used to
complete the circuit and placed at
distant location.

MONOPOLAR TECHNIQUE

TECHNIQUES OF APPLICATION
2) Bipolar Technique
Bipolar application involves the use
of two electrodes of equal size.
Both electrodes are located in the
target treatment area
Because the current densities under
each electrode are equal, an equal
amount of stimulation should occur
under each electrode.

MONOPOLAR TECHNIQUE

BIPOLAR TECHNIQUE

TECHNIQUES OF APPLICATION

TECHNIQUES OF APPLICATION
3) Quadripolar Technique

BASIC GUIDELINES
FOR PRACTICAL
APPLICATION OF
ELECTROTHERAPY

1.

2.

3.

Before applying any of the Electrotherapy

modalities, the following points should be
considered:
The intended effect, and does the modality I
gonna use will achieve this effect?
Safety i.e. will the desired effect be achieved
without the undesired effect.
The used method should be economical for
the patient.

1. PREPARATION OF THE PATIENT

a. Explanation:

To reassure the patient.

The type of sensation to be experienced is
explained.
Explain the purpose of the treatment.
The patient is warned of any affect that
should be reported.

PREPARATION OF THE PATIENT

b. Examination and Testing:

Specific examination for the part to be treated for

any dangers or contraindications should be
conducted, plus, any relevant tests e.g. thermal test
sensation.

PREPARATION OF THE PATIENT

A

check should be made to ascertain if the

patient might suffer reaction to any substance
being applied to the skin.

Electrodes

must not be placed on any areas

with erosion or hyposthetic skin.

2- ASSEMBLY OF THE
APPARATUS

All the apparatus and equipment needed should

be assembled and suitably positioned.

Visual checks are made of electrodes, leads,

Cables, Plugs, power outlets, switches, controls,
dials and indicator lights.

3- PREPARATION AND TESTING OF APPARATUS

This includes setting up the apparatus and any

necessary testing of it prior to application.

When this has been done satisfactorily treatment

can begin. The operator should minimize their
own exposure to the effects of the modality being
used.

4- PREPARATION OF THE PART TO BE TREATED

This involves any preparatory procedure, e.g.

washing the area and positioning the patient, and
in particular the part to be treated, comfortably
and appropriately, so that he or she is relaxed and
unnecessary movement is avoided.

5- SETTING UP

The apparatus is set up to ensure

optimum therapeutic effect and safety.

6- INSTRUCTIONS AND
WARNINGS

Before the treatment commences it is mandatory

to instruct the patient in what he or she must and
must not do

Give essential warnings

The warning given should be noted on the

patient's record card.

7- APPLICATION

The patient must be observed throughout to

ensure that treatment is progressing satisfactorily
and without adverse effects

Accurate timing is essential

8- TERMINATION OF THE
TREATMENT
At the termination of treatment the part treated
should be examined to ensure that the desired
effects have occurred if visible
If appropriate, an explanation of what to expect is
given as well as instructions of when to come
again and what must be done between treatments.

9- RECORDING

An accurate record of all the parameters of

treatment including region treated, technique,
dosage, and the resultant effect must be made.

This is both for assessment purposes and for legal

requirements.