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 Dispersive

Active electrode(s)

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 Localized, hypersensitive muscle spasm Trigger referred pain Arise secondary to pathology Areas of skin having decreased electrical resistance May result in pain reduction Decreased electrical resistance (increased current flow)

Trigger Points

Acupuncture Points
Traumatized Areas

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 (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 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

Comparison of Voluntary and Electrically-Induced Contractions

Motor-level Stimulation

Voluntary Type I fibers recruited first Asynchronous

Decreases fatigue

Electrically-induced Type II fibers recruited first Synchronous recruitment

Based on PPS

GTO protect muscles

GTOs do not limit contraction

Motor-level Stimulation

Parameters: Amplitude: Contraction strength increases as amplitude increases Phase duration: 300 to 500 sec 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 Twitch Contraction

20 pulses per second Summation

40 pulses per second Tonic Contraction

The amount of time between pulses the interpulse interval is long enough to allow the muscle fibers to return to their original position

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

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
Sensory-level Target A-beta fibers Tissue Phase Duration
< 60 sec

Motor-Level
Motor nerves

Noxious Level
A-delta C fibers

120 to 250 sec

1 msec

Pulse 60 to 100 pps Frequency 80 to 120 pps Intensity

2 to 4 pps

Variable

Submotor Moderate to Strong contraction

To tolerance

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 veins 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 Demand-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