ELECTRICAL STIMULATION

PRESENTER:DR N. BROJENDRO SINGH

MODERATOR: PROF N.ROMI SINGH

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 ELECTRICAL STIMULATION

Application of suitably modified electric current to

stimulate excitable tissues like nerves and muscles to
produce therapeutic benefits

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 ELECTRIC CURRENT
• Flow of electric charge
• Two types: direct current and alternating current
• Direct current (DC) : the unidirectional flow of electric
charge.
• Alternating current(AC) : flow of electric charge
periodically in reverses direction

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• Electric current can stimulate excitable tissue in body.
• Intermittent current are used
• Current duration range used:(0.01ms-3sec)
• Short duration less than 10 ms is faradic type-used for
stimulation of normal muscle
• Long duration more than10ms is called interrupted
galvanic type –used for stimulation of denervated muscles

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 FARADIC CURRENT

• Interrupted direct current

• Pulse duration- (0.1 – 1 ms )
• Frequency (50 – 100 Hz)
• Surged form of current is used

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FORMS OF FARADIC TYPE CURRENT

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 PHYSIOLOGICAL EFFECT OF FADADIC
CURRENT
• Sensory nerve stimulation
• Motor nerve stimulation
stimulation with 50 Hz frequency and 0.1 – 1ms with
surged current
• Effect on muscle contraction:
• Effect on denervated muscles

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 CHEMICAL EFFECTS

• Produces chemical changes in electrodes

• Current flow in one direction for short periods
• No serious danger of burns

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 STIMULATION OF MOTOR POINTS
• Superficial location of motor nerve
• Usually located at upper and middle one-third of belly of
muscles
• Suitable frequency and duration is used

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 INDICATIONS OF FARADIC CURRENT

• Facilitation of muscle contraction

• Re – education of muscle action
• Training of new muscle action
• Neuropraxia of a motor nerve
• Severed motor nerve
• Improved venous and lymphatic drainage
• Prevention and loosening of adhesions

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 INTERRUPTED DIRECT CURRENT

• Frequency of 30 Hz
• Duration 100 ms
• Applied through a potentiometer

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 TYPES OF INTERRUPTED DIRECT
CURRENT

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 PHYSIOLOGICAL EFFECTS OF
INTERRUPTED DIRECT CURRENT

• Stimulation of denervated muscles

• Stimulation of sensory nerves
• Stimulation of motor nerves

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 INDICATIONS

• To produce contractions of denervated muscles

• Re –education of muscles in early phase of
re-innervation

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 PHYSIOLOGICAL RESPONSE TO
ELECTRICAL CURRENT
• As electricity moves through the body's conductive
medium, changes in the physiologic functioning can
occur at various levels
Cellular
Tissue
Segmental
Systematic

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 EFFECTS AT CELLULAR LEVEL

• Excitation of nerve cells

• Changes in cell membrane permeability
• Stimulation of fibroblast, osteoblast
• Modification of microcirculation

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 EFFECTS AT TISSUE LEVEL

• Skeletal muscle contraction

• Smooth muscle contraction

• Tissue regeneration

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 EFFECTS AT SEGMENTAL LEVEL
• Modification of joint mobility
• Muscle pumping action to change circulation and
lymphatic activity
• Alteration of the microvascular system not associated
with muscle pumping
• Increased movement of charged proteins into the
lymphatic channels

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 SYSTEMIC EFFECTS
• Analgesic effects as endogenous pain suppressors are
released and act at different levels to control pain
• Analgesic effects from the stimulation of certain
neurotransmitters to control neural activity in the presence
of pain stimuli

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 ELECTRICAL STIMULATOR

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 ELECTRODES
• Purpose
– Completes the circuit
– Interface between
electron and ion flow
– resistance to current
• Materials
– Metallic
– Carbon rubber
– Self-adhesive

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 ELECTRODE PLACEMENT
• Electrodes spaced far apart penetrate more deeply with less
current density
• Larger the electrode the less density
• A multitude of placement techniques may be used to create
desire able clinical and physiological effects

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 STIMULATION POINT
• Motor Points
– Superficial location of motor
nerve
• Trigger Points
– Localized, hypersensitive •
muscle spasm
– Trigger referred pain
– Arise secondary to
pathology
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• Acupuncture Points
– Areas of skin having
decreased electrical resistance
– May result in pain reduction
Traumatized Areas
– Decreased electrical resistance
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 TYPES

• Neuromuscular electrical stimulation(NMES)

• Functional electrical stimulation(FES)
• Transcutaneous electrical nerve stimulation(TENS)
• Interferential therapy unit

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 NMES
NMES applies electrical impulses to the nervous system to
stimulate sensory and/or motor neurons
Common Uses
• Relaxation of muscle spasms
• Prevention or retardation of disuse atrophy
• Improvement of local blood circulation
• Re-education of the muscle

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 FUNCTIONAL ELECTTRICAL
STIMULATION

• Technique that used electric currents to activate nerves

innervating extremities affected by paralysis and
neurological disabilities to restore normal functions

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 MECHANISM OF FES

• Stimulate muscles in a programmed synergystic sequence

that allow patient to accomplish a specific functional
movement pattern
• Multichannel microprocessors
are pre-programmed to execute
variety of specific movement

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 USES
• Prevent or correct diffuse atrophy
• Improve ROM in stiff joints and spasticity
• Re- education of new muscle action in muscle and
tendon transfers
• Supplementation or substitution of orthosis

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 PARAMETER OF FES CURRENT
• Frequency-(12-100Hz)
• Intensity of current-(90-200)mA
• Pulse duration(20-300)msec

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 STRENGHT- DURATION CURVE

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 TENS
• Electrical stimulation which primarily aims to provide a
degree of symptomatic pain relief by exciting sensory
nerves

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 MECHANISM OF TENS
• Gate Control Theory(Malzack and Wall)
• Activation of peripheral sensory Aβ fibers stimulates the
inhibitory interneuron in substansia gelatinosa in dorsal
horns of the spinal cord
• Activated interneurons produces inhibition of pain
carrying A-delta and C fibres and closes spinal pain gate
to prevent painful impulse to reach at sensory cortex

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 DESCENDING PAIN CONTROL

• stimulation of smaller peripheral Aδ and C fibers through

the CNS causes a release of enkephalins blocking pain at
the spinal cord

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 ENDOGENOUS OPIATE PAIN CONTROL

• Noxious stimulus causes release of β–endorphins and

dynorphin resulting in analgesia

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 TYPES OF TENS
High TENS (Sensory Level)
o Duration (100-500 µsec)
o Frequency (100-150Hz)
o Sensory-level output
o Activates spinal gate

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 LOW TENS

• Duration (100 to 150 µsec)

• Low pulse frequency (1 to 5 Hz)
• Motor-level output
• Modulation through release of β-endorphin

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 CLINICAL APPLICATIONS
• Acute and chronic pain,
• Back and cervical muscular and disc syndromes,
• Arthritis
• Shoulder syndromes
• Neuropathies
• Many other painful conditions

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 ELECTRODE PLACEMENT
 Negative electrode Positive electrodes
• Placed close to spinal
• Spinal nerve roots segment
• Painful sites
•Dermatomes
• Myotomes
• Trigger points
• Acupuncture points

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 INTERFERENTIAL THERAPY
• Two medium frequency currents pass through the tissues
simultaneously
• Their paths cross; and interfere with each other
• Gives an interference or beat frequency which has low-
frequency stimulation

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 MECHANISM OF INTERFERENTIAL
THERAPY
• Low frequency stimulation of muscle and nerve tissues at
sufficient depth without painful and side effects
• Medium frequency currents penetrate the tissues with little
resistance, but the resulting interference current allows
effective stimulation of the biological tissues

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 ELECTRODE PLACEMENT
• When electrodes are arranged in a square and
interferential currents are passed through a homogeneous
medium - a pattern of interference will occur

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 ELECTRODE PLACEMENT
• Ensure adequate coverage of the stimulated area
• Placement of the electrodes should be such that a
crossover effect is achieved in the desired area

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 CONTRAINDICATIONS
• Undiagnosed pain
• Pacemakers
• Heart disease
• Epilepsy
• Pregnancy: first trimester-over the uterus
• Over the carotid sinus
• On broken skin
• On dysaesthetic skin
• Over the eyes, larynx, pharynx, over mucosal membranes
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 THANK YOU

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