Electrical Stimulation

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Electrical Stimulation

• All Kinds of Choices

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Stimulating Units

• Fall into one of two categories
• Low Volt (Less than 100V)
• TENS (9V battery)
• High Volt (Greater than 100V)
• Pretty much everything else

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Carrier Frequencies

• Low-frequency currents
• 1000 pps or less (Monophasic, Biphasic)
• Medium-frequency currents
• 1000 pps 100,000 pps (IFC, Russian)
• High-frequency currents
• 100,000 pps and higher (Diathermies)

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Waveforms

• Monophasic
• Biphasic
• Interferential
• Pre-modulated Interferential
• Russian
• TENS
• Microcurrent

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Monophasic

• Unidirectional flow of electrons
• Negative / Positive polarity
• Twin Peaked Monophasic

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Peak Current
75 µs
Pulse Duration
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Biphasic

• Positive and Negative Phases
• Symmetrical / Asymmetrical

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Interferential Current

• Two channels at separate frequencies
• Less skin resistance
• Quadripolar Electrode Configuration

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Interferential
Channel 1
5,000 Hz
Channel 2
5,100 Hz
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Interference Current
Beat Frequency 100 Hz
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Ch 2
Ch 1
Ch 1
Ch 2
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Pre-modulated IFC

• Bipolar electrode configuration
• Mixing of currents occurs inside the machine
• Less penetration than IFC

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Russian

• Classical Russian Stim involves 2500 Hz carrier
  frequency w/ beat frequency from 1 100 Hz
• Thought to allow more current to reach motor
  nerve at lower intensities
• Results have never been duplicated

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TENS

• Transcutaneous Electrical Nerve Stimulation
• Primarily used for pain reduction
• Gate Control
• Endogenous-opiate release

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Microcurrent

• Subsensory or very low sensory level
• Very small current amperage / Very high pulse
  duration
• Very theoretical / not much supporting research
• Attempts to re-establish bodys natural
  electrical balance by allowing ATP supply to
  increase ? metabolic energy for healing to occur

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Levels of Electrical Stimulation

• Subsensory
• Sensory
• Pain Relief
• Edema Control
• Motor
• Pain Relief
• Edema Control
• Muscle Re-education
• Noxious

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Subsensory

• Microcurrent
• Unable to stimulate nerve or muscle
• Variety of recommended parameters
• Generally consists of 2 10 minute Txs

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Parameters

• 1st Treatment
• Frequency 30 Hz
• Intensity 600 µA
• 2nd Treatment
• Frequency .3 Hz
• Intensity 60 µA

• Lynn Wallace
• Pain Mode
• Frequency 30 Hz
• Intensity 80-100 µA
• Healing Mode
• Frequency .3 Hz
• Intensity 20-40 µA

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Sensory Level Pain Relief

• Stimulation at or above sensory threshold but
  below motor level
• Stimulation of Aß fibers
• Gate Control Theory

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• Frequency 50 150 Hz
• Phase Duration Less than 100 µs
• Intensity Comfortably strong

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Sensory Level Edema Control

• Done immediately following injury to limit
  formation of edema
• Not widely researched but a few theories
• Decreased capillary pressure and permeability
  which keeps plasma and proteins from entering
  extracellular tissues
• Vascular spasm preventing leaking from vessels

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• Waveform Monophasic
• Frequency 120 pps
• Phase Duration As high as possible
• Intensity Comfortably strong
• Monopolar electrode configuration
• Negative electrodes over injured area

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Motor Level Pain Control

• Best used with subacute / chronic pain
• Endogenous opiate release
• Longer duration of pain relief
• Also good for trigger points

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• Frequency Low 2-4 pps
• Phase Duration Wide 200-300 µs
• Intensity Strong, twitch contractions

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Motor Level Edema Control

• Muscular contractions encourage venous and
  lymphatic milking fluids from the area
• Electrodes arranged to follow primary vein
  exiting swollen area
• May be continuous or on / off time

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• Continuous
• Frequency 1 2pps
• (or as low as possible)
• Phase Duration
• 200 400 µs
• Intensity
• Strong, twitch contractions

• On / Off time
• Frequency 25 50pps
• Phase Duration
• 200 400 µs
• Intensity
• Strong, tonic contractinons
• Duty Cycle 50
• 5 on / 5 off
• 10 on / 10 off

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Muscle Re-education

• Neuromuscular Electrical Stimulation (NMES)
• Muscle re-education, reduction of spasticity,
  delay of atrophy, muscle strengthening
• Stronger type of current, not as comfortable as
  other forms of ES
• Not as effective as voluntary contractions

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• Frequency 25 50 pps
• Phase Duration 200 400 µs
• Intensity Strong tonic contractions

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NMES Principles

• Duty Cycle
• 15 (10 on / 50 off) ? Strength
• 12 (10 on / 20 off) ? Endurance
• 11 (10 on / 10 off) ? Fatigue
• Ramp Times
• Fast ramp on .5 1 sec ? Power
• Long ramp on 1 2 sec ? Strength
• Long ramp off 3 5 sec ? Eccentrics

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Noxious Stimuli

• Causing pain to relieve pain
• Stimulation of Ad and C fibers
• Electrode placement is variable
• Generally used as a last resort
• Longer lasting pain relief

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• Frequency 1-5 pps or 80-100 pps
• Phase Duration 1 ms or higher
• Intensity Noxious (painful)

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Conclusion

• Lots of machines, lots of choices.
• Everybody is different, so dont be afraid to try
  different things if things arent going as
  planned.