ELECTROTHERAPY

□ Basics of Electricity
1. Electrical Current: The flow of electrons through the conducting medium.
2. Amperes: The rate of flow of electrons
3. Voltage: The force that moves electron through the conductor.
4. Resistance: impedance to the flow of electron, opposes flow of electron.
5. Ohm’s Law: Expresses the relationship of ampere, voltage and resistance: “The current is directly proportional to the voltage
and inversely to the resistance.”
I. ELECTRICAL STIMULATION (ES)
□ Categories of E.S. according to frequency:
 Low frequency: 1-1000 pps
 Medium frequency: 1,000 to 10,000 pps
 High frequency: >10,000 pps
□ Characteristics of ES
A. Wave forms
1. Monophasic (direct or Galvanic current)
 The current flows on one direction only (Figure 3-A)
2. Biphasic (alternating current)
 Currents flows in two direction: Half of the cycle above the baseline, one half below (Figure 3-B)
 Single impulse is one complete cycle
3. Polyphasic
 Modified biphasic current having three or more phases in a single pulse (Figure 3-C)

B. Wave form shapes

 Traditionally by shape: rectangular, sinusoidal, spike, square, triangular
 Traditionally by characteristics : faradic, high voltage pulse galvanic, interferential, Russian
 Biphasic as symmetrical
 Biphasic as asymmetrical
- Balanced
- Unbalanced
C. Current modulation
 Continuous mode: Uninterrupted flow
 Interrupted mode: Intermittent cessation of current
 Surge mode: Slow increase and decrease in current intensity
 Ramped mode: Gradual rise in intensity of current, maintained at a determined level for an amount of time followed by a
gradual or sudden drop to zero.
□ Contraindications for ES
 Should NOT be placed over
 Healing fractures
 Areas of active bleeding
 Malignancies or phlebitis in treatment area
 Superficial metal implants
 Pharyngeal or laryngeal muscles
 Patient with demand-type pace maker, myocardial disease
 Precaution: Over areas of impaired sensation and severe edema
 Electrical modalities with broken or frayed wires or unit that is not connected to a ground fault circuit interrupter

□ GENERAL INDICATIONS OF ELECTRICAL STIMULATION

A. Pain Modulation
1. Activation of Gait Mechanism : ( Gate Theory )
2. Initiation of descending inhibition mechanism : ( endogenous opiate production )
B. Decrease Muscle Spasm
1. Muscle Fatigue: continuous mode, tetanic contraction for several minutes
2. Muscle Pump : interrupted or surge mode, rhythmic contraction & relaxation
3. Muscle Pump and Heat : ES + US

Electro Notes 1 E. Sitchon

 C. Impaired Range of Motion ( Increase in or maintenance of joint mobility )
1. Mechanical stretching of connective tissue and muscle associated with joint.
2. Decrease pain
3. Decrease in edema
D. Soft Tissue Repair (wound healing)
1. Pulsed Current (mono,bi,polyphasic), interrupted
 Muscle pump (á circulation)
2. Monophasic Current  Galvanotaxic effect
 Low volt continuous current  Inflammation Phase:
 High volt pulsed current  Macrophages – (+)
 Effects  Mast cells – (-)
 Electrical Potential  Neutrophils – (+)/(-)
 Bactericidal effect  Proliferation Phase: (+)
 Biochemical effects  Wound Contraction Phase: (+) / (-)
 Galvanotaxic effect  Epithelialization Phase: (+)
ð low amplitude, 30 – 60 min
E. Spasticity: ( ES to reduce hypertonicity )
1. Fatigue of the agonist
2.  Reciprocal inhibition. : (stimulate antagonist/inhibit agonist)

Guidelines for ES Application

1. For Muscle Stimulation:
a. Characteristics of E.S. that are needed to initiate depolarization of excitable cells
 Amplitude / intensity must be strong enough for the membrane potential to reach the threshold levels.
 Duration of impulse must be sufficient to depolarize the cell membrane.
 1 ms or less for nerve cells
 longer that 1ms for muscle cells
 Speed at which the peak intensity is reach
 Fast rate will prevent accommodation (Square wave)
b. Type of Electrodes:
 Metal plate/sponge: remove sponge from water and take off excess water
 Carbonized rubber: place enough amount of gel at the center.
 Pregelled electrode: remove protective cover and place a small amount of gel if metal mesh/foil type, or water if
using Karaya electrode
c. Electrode size:
 To complete a circuit, two electrodes are needed.
 One electrode is called “Active” (stimulating) electrode.
 The second electrode, the larger “Dispersive” electrode.
 Current density: the amount of current concentrated under the electrode. Higher in smaller (active) electrode
producing a strong stimulation.
 Large electrode on small treatment area results in overflowing of stimulus to surrounding muscles causing
undesirable effects.
 Small electrodes applied on large muscles increases the current density causing pain.
d. Electrode Placement:
 Active electrode is usually placed over the motor points, the dispersive electrode is placed on a remote site
 Methods:
(1) Unipolar / monopolar technique:
 A single or multiple (bifurcated) active electrode over treatment area.
 A larger dispersive electrode placed ipsilaterally away from treatment area.
(3) Bipolar technique:
 Active and dispersive are of the same size and placed over same muscle group or treatment area
(3) The space between electrodes should be at least the diameter of the active electrode. The farther the electrode
are, the lesser current density on the superficial tissues

1. For Muscle Strengthening, muscle spasm or edema (muscle pump), ROM

a. Slowly increase intensity until muscle contraction is observed.
b. 10 to 25 muscle contractions may be enough.
c. Duty cycle:

Electro Notes 2 E. Sitchon

  Interrupted/ramped modulation: Allows muscle to rest between stimulus
 On to off ration of 1:3 or more: Minimize the effect of fatigue
2. For muscle spasm (fatigue): Apply a continuous mode
3. For muscle re-education:
a. Parameters are similar to muscle strengthening
b. Multiple sets of singular or multiple muscle repetitions
c. Treatment sessions of 10-30 minutes depending on patient’s mental and physical tolerance.

II. IONTOPHORESIS
 The transfer of medicinal agent into the tissue through the skin by the use of continuous direct current.
 Principle
 Like charges repel each other
 Unlike charges attract each other
 Positive ions move toward the negative pole (cathode) where a secondary alkealin reaction (NaOH) occurs
 Negative ions move toward the positive pole (anode) where an acidic reaction is formed
 The amount of Ions transferred through the skin is directly related to the following;
 Duration of the treatment
 Current density
 Concentration of ions in the solutions.
Indication Ion Polarity
o Current form
Analgesia Lidocaine, Xylocaine Positive
 Wave form: Monophasic Salicylate Negative
 Modulation: Continuous
o Electrode Placement Calcium deposit Acetate Negative
 Active electrode is the same as the medication to be Dermal ulcer Zinc Positive
use. Edema reduction Hyalurodinase Positive
 The active electrode should be twice as large as the Fungal infection Copper Positive
positive, regardless of the active electrode to prevent Hyperhydrosis Water Positive/Neg.
the alkaline effect. Muscle spasm Calcium Positive
 Dispersive may be place proximally or distally 4-6 Magneseum Positive
inches away Musculoskeltal Infla. Dexamethasone Negative
 Space between electrodes should be at least the conditions Hydrocortisone Positive
diameter of the active electrode.

o Dosage
 The product of time and current intensity
 Safe limit: anode-1.0 mA/cm2, Cathode-0.5 mA/cm2
 Treatment duration: 10-40 minutes
 Observe treatment every 3-5 minutes
o Contraindication:
1. Impaired skin sensation
2. Allergy or sensitivity to medical agent or direct current
3. Denuded area or recent scar
4. Cuts, bruises or broken skin
5. Metal in or near the treatment area
6. Same as for ES

III. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

□ Electrical Stimulation designed to provide afferent stimulation for pain reduction
□ Principle of Pain Relief
1. Gate Control Theory: Activation of central inhibition of pain transmission
 Stimulating the Large diameter A-Beta fibers activates the inhibitory interneuron (substantia gelatinosa) in the dorsal horn
(lamina 2 & 3) of the spinal cord causing Inhibition of smaller A-Delta and C-fibers (pain fibers).
 Closing of the “gate” and modulation pain by presynaptic inhibition of the T-cells.
2. Descending inhibition/ Endogenous Opiates Theory:
 Pain stimulus stimulates the pituitary gland to produce endorphins
 Strong stimuli also activate the endogenous opiate-rich nuclei, periaqueductal graymatter (PAG), in the midbrain and
thalamus.

Electro Notes 3 E. Sitchon

  Neurotransmitterfrom the PAG facilitates the cells of the nucleus raphe magnus (NRM), and reticularis gigantocellularis
(RGC).
 Efferent fibers travels through the dorsal lateral funiculus and terminate on the enkephalinergic interneurons in the spinal
cord to presynaptically inhibit the release of substance P from the A-Delta and C-fibers
□ Current form
 Wave form: Asymmetrical biphasic with a zero net direct current component. Other variation may be used.
 Modulation: continuous or burst
□ Methods of Application (Table 3)
1. Conventional (high rate) TENS
 The most commonmode of TENS.
 Can be applied during the acute or chronic phase of pain.
2. Acupuncture-like (strong low rate) TENS
 Can be applied during the chronic phase of pain.
3. Brief intense TENS
 Pulsed for painful procedures (wound debridement, deep frictionmassage,joint mobilization or passive stretching)
4. Burst mode (pulse trains) TENS
 A combination of both high and low TENS.
 Current is more tolerable to patient than low TENS
5. Hyperstimulation (point stimulation) TENS
 Use of a small probe to locate and painfully stimulate acupuncture or trigger points.
 Multiple sites maybe stimulated per treatment.
6. Modulation mode TENS
 Modulating the parameters to prevent neural or perceptual adaptation due to constant electrical stimulation.

□ Electrode Placement: Electrodes can be placed over;

 Acupuncture site
 Dermatomal distribution of affected nerve
 Painful site
 Proximal or distal to painful site
 Segmentally related myotomes
 Trigger points
□ Indication: Acute and Chronic Pain
□ Contraindication:
 Patient with demand-type pacemaker or over chest of patient with cardiac disease
 Over eyes, laryngeal or pharyngeal muscles, head and neck of patient following CVA or epilepsy
 Over mucosal membranes NOTE:
Best Current type for
IV. HIGH VOLTAGE PULSED MONOPHASIC STIMULATION (HVPC) wound healing
1. low volt continuous
□ Monophasic twin-peaked pulses of short duration monophasic
 Skin provides high resistance (impedance) to the flow of low voltage current (1MΩ) 2. HVPGS
 Skin provides low impedance to HVPC due to passage of current in the skin capacitors rather than in the skin resistors.
 Thermal effects are negligible.
□ Current form:
 Wave form: paired monophasic with abrupt rise and exponential fall in intensity
 Modulation: continuous, surged or interrupted
□ Procedure:
a. For muscle stimulation: Same with E.S.
b. For Wound Healing
 Intact skin surface is normally negative in respect to the deeper dermal layer
 A break in the skin initially develops a positive potential, becoming negative during the healing process
 Tissue healing is retarded with absence or insufficient positive potentials
 Healing can be hasten or promoted by adding a positive potentials through the anode.
 Parameters:
o Amplitude/Intensity: comfortable tingling sensation, paresthesia, no muscle response
o Pulse rate: 50-200 pps
o Pulse duration: 20-100 μsec
o Treatment Duration: 20-60 minutes
 Procedure:

Electro Notes 4 E. Sitchon

 o Clean and debride wound site. Pack with sterile saline soaked gauze.
o Both HVPC & low intensity continuous low volt DC can be used for would healing. Parameters are the same.
o Active electrode (negative for bactericidal effect, positive for clean wound) is placed over the gauze.
 Goals / indications:
a. Inflammatory phase: free from necrosis and exudates. Promote granulation
b. Proliferation phase: reduce wound size including depth, diameter and tunneling
c. Epithelialization phase: stimulate epidermal proliferation and capillary growth.
V. MEDIUM FREQUENCY CURRENTS
□ E.S. that uses the frequency between 2,000 to 5,000 pps that are modulated to produce physiologically applied frequencies.
□ Techniques include Russian current (time-modulated) and interferential E.S. (amplitude-modulated).
VI. RUSSIAN CURRENT:
□ Also called “medium frequency, burst alternating current”
□ Uses a carrier frequency of 2,500Hz interrupted with 10ms impulse followed by 10ms interval producing 50 ten-millisecond burst in
one second.
 Current form:
 Wave form: biphasic sinusoidal
 Modulation: continuous pulse with burst modulation
 Indication
 Muscle strengthening  Muscle Spasm
o Amplitude: tetanic muscle contracture o Muscle fatigue using continuous isometric
o Pulse rate: 50-70 pps contraction for several minutes to tolerance
o Pulse Duration: 150-200 μsec o Duty cycle of 1:1 for muscle pump
o Modulation: Ramp 1-5 seconds based on patient’s o Duty cycle of 2:5 for ROM
tolerance; Duty cycle 1:5
o Current are applied with;
1. Isometric exercise at several points through ROM
2. Slow isokinetic exercise;me.g., 5-100/sec
3. Short arc joint movement when ROM is restricted

 Contraindication: Same as for E.S.

VII. INTERFERENTIAL THERAPY (IFC)

□ Uses two sinusoidal medium frequency applied crossing each other producing an amplitude modulated low frequency (Beat
frequency)
□ The beat frequency is the difference between the two carrier frequency
□ Principles
1. Constructive interference: The sum of the two waves is large when they are in phase
2. Destructive interference: The sum to of the two waves are zero when the waves are180 0 out of phase
3. Beat frequency: Resultant frequency produced by the two frequencies going into and out of phase
a. Constant: When both carrier frequencies are fixed.
b. Variable:
o When one carrier frequency are fixed and the other varies generating a variable or sweep frequency.
o Sweep used to minimize accommodation.
4. Produces a cloverleaf-like pattern, the stimulating effect is at 45 0 angle to the flow of current in the two circuit.
a. Static interferential field: Generated by using four electrodes (two circuits).
b. Dynamic (scan) interferential field:
o Generated when the field is rotated 450 by the vectoring effect of rhythmically unbalancing the IFC.
o Changes the stimulating area, purported to provide the greater area of stimulation in contrast with the static field.
c. Full field scanning: same effect as with dynamic field by bursting the current over the two circuits
5. For small area (two electrodes) the interference occurs in the unit, the pre-modulated current is delivered in one circuit.
□ Current form
 Wave form: sinusoidal (amplitude-modulated)
 Modulation: continuous (pain); interrupted (muscle exercise)
□ Electrode placement
 Bipolar (pre-modulated IFC): Active and dispersive electrodes are placed over or around small area.
 Quadripolar (IFC): Two sets of electrodes placed diagonally to one another over large area.

Electro Notes 5 E. Sitchon

□ Parameter
 For pain control: Similar to high or low TENS
 For muscle strengthening: Similar to low of medium frequency E.S.
□ Indication
 Pain modulation, muscle strengthening and increasing ROM
□ Contraindication: Same with E.S.

VIII. FUNCTIONAL ELECTRICAL STIMULATION (FES)

□ Also called “functional neuromuscular stimulation” or “Neuromuscular stimulation (NMES)”
□ Uses a wide range of units and techniques for disuse atrophy, impaired ROM, muscle spasm, muscle re-education and
management for spasticity.
□ Use as an alternative or supplement to orthotic devices
□ Indication
1. Shoulder Subluxation:
 Weakness of supraspinatus and posterior deltoid
 Current form:
o Wave form: asymmetric biphasic square
o Modulation: interrupted
 Electrode placement: Bipolar, supraspinatus and posterior deltoid
 Parameters:
o Amplitude: tetanic muscle contraction to tolerance
o Pulse rate: 12-25pps
o Treatment time: 15-30 minutes. Three times per day up to 6-7 hours
o On/off ratio – 1:3 (2sec: 6sec) progressing to 12:1 (24sec:2sec)
2. Dorsiflexion Assist in Gait Training
 To control foot drop, facilitate dorsiflexion and evertion during swing phase in hemiplegic patient.
 Current form:
o Wave form: Asymmetric biphasic square
o Pulse duration: 20-250 μsec
o Modulation: interrupted by foot switch
 Electrode placement:
o Bipolar: Peroneal nerve (near head of fibula) and tibialis anterior muscles
 Parameters:
o Amplitude: tetanic muscle contraction (enough to decrease plantar flexion)
o Pulse rate: 30-300 pps
o Pressure in swing heels switch stops the stimulus during stance phase or a hand switch held by therapist

ULTRASOUND
□ Method of Heat Transfer
Conversion: Mechanical energy produced by sound waves at frequencies between 85 KHz and 3 MHz and intensities between 0
and 3W/cm2 when absorbed by the tissues is change to heat energy.
□ Transducer (Applicator)
 Contains crystal that converts electrical energy into sound energy via reverse piezoelectric effect (electrical energy to
Mechanical energy)
 The alternating voltage causes mechanical deformation of crystal; the frequency of vibration is the same as the current
frequency
 The oscillating sound wave produces mechanical pressure in fluids or tissues
 Size of transducers may range from 1cm2 to 10 cm2 with 5 cm2 as the most commonly used
□ Characteristics of Ultrasound
 Spatial characteristics are important during continuous ultrasound
 Temporal characteristics are important during pulsed ultrasound
 Spatial characteristics:
o For thermal effect (e.g., chronic conditions) continuous US is used.
o Intensity of US energy emitted is non-uniform across the surface of the transducer.
o High level of energy are in the center of the beam producing “hot spot” (peak spatial intensity)
o Spatial average intensity: the total power (watts) divided by the area (cm 2) of the transducer head.

Electro Notes 6 E. Sitchon

 o Beam Non uniformity ratio (BNR): the ratio of the highest intensity to the spatial average intensity. More uniform beam and
less risk of tissue damage are produced with lower BNR. BNR should be between 2:1 and 6:1.
 Temporal Characteristics:
o For nonthermal effect like acute soft tissue injury, pulsed US is used.
o Duty cycle: the time when the US beam is on during one pulse period (on time+ off time). 20% duty cycle has 2ms on time
and 8ms off time.
o Temporal Peak Intensity: the intensity during the on time
o Temporal average intensity: the intensity averages over one pulse period
□ Depth of Penetration: 3-5cm
 3 MHz has greater absorption in superficial tissue and therefore has less depth of penetration.
 1 MHz has less absorption in superficial tissue therefore has more heat production in deeper tissues.

□ Physiological Effects of Ultrasound

 Thermal
 Non-Thermal
 Cavitation
□ Thermal Effects of Ultrasound
 Produced by using a continuous beam of enough intensity, range 0.5 to 3cm 2
o Increased tissue temperature
o Increased pain threshold
o Increased collagen tissue extensibility
o Alteration of nerve conduction velocityIncreased tissue perfusion
o Increased tissue temperature at interfaces of tissue due to reflection
o Periosteal pain: sudden strong ache due to overheating of periosteal tissue, reduce intensity or increase surface area of
treatment.
o “hot spot” due to insufficient coupling agent especially with stationary technique
□ Non-thermal effect: Produced by using a very low intensity or pulsed beam
□ Cavitation
 Alternating compression (condensation phase) and expansion (rarefaction phase) of small gas bubbles in tissue fluids.
 Types:
1. Stable cavitation: bubbles resonate with out producing tissue damage. Maybe responsible for diffusion changes in cell
membranes.
2. Unstable cavitation: tissue destruction caused by severe collapse of gas bubbles during compression phase.
a. Acoustic streaming:
 Mechanical pressure waves caused by movements of fluids along the boundaries of cell membranes
 May also produce alterations in cell membranes, vascular permeability and increases in fibroblastic activity
(protein synthesis)
□ Methods of Application
1. Direct contact
a. Moving technique
 Us requires a homogenous medium such as mineral oil, water, or commercial gel) for effective sound transmissions
 Cover area two to three times the size of the effective radiating area (ERA) per minute of treatment
 Intensity: 0.3 to 1.5 w/cm2, lower for acute conditions or thin tissues and higher for chronic conditions or thick tissues
 Periosteal pain is due to high intensity, momentary slowing or cessation of moving head. Stop treatment and readjust
US intensity
 Treatment time: 3-10 minutes depending on size of area
b. Stationary technique
 Continuous US not generally used due to danger of “hot spot’ production and generation of standing waves which
can result to blood cell stasis
 Pulsed US may be used if non-thermal effects are needed
 Treatment intensity: 0.2 – 1.0 w/cm2
 Treatment time: 3 – 5 minutes
2. Indirect contact
a. Water Immersion, for irregular body parts
 Plastic container has the advantage of less reflection of acoustic energy than metal container.
 Sound head are placed in water at a distance of ½” to 1” from the skin surface at right angle.
 Move sound head as in direct contact technique
 Periodically wipe off any air bubbles that may form on sound head or body part during treatment.

Electro Notes 7 E. Sitchon

 b. Fluid-filled bag
 Thin walled bag like balloon, condom or surgical gloves are used.
 Apply coupling agents to skin and place bag over treatment area.
 Move sound head slowly within bag. Do not slide bag on skin

□ Indications □ Contraindications
 Joint contractures  Acute infections  Impaired cognitive function
 Musculoskeletal pain  Impaired circulation  Impaired sensation
 Muscle spasm  Malignancy  Healing fracture
 Subacute and chronic traumatic and inflammatory conditions  Very young or old patients
 Open wounds  Acute inflammatory joint pathologies
 Neuromas  Thrombophlebitis
 Periarticular conditions  Use of radium or radioactive isotopes
□ Precautions  Over vital areas (brain, ear, epiphysis of bone, eye,
 Metal implant in field heart, cervical ganglia or carotid sinuses,
 Osteoporosis reproductive organs, spinal cord)
 Plastic implants  Directly over cardiac pacemaker or pregnant uterus
 Primary repair of tendons or ligaments or scar tissue

□ Phonophoresis
 The use of sound wave to drive medications through the skin into deeper tissues.
 Often used are local analgesic (lidocaine) and anti-inflammatory drugs (dexamethasone, salicylates).
 Direct contact method is used.
 Treatment intensity: 1-2 w/ cm2
 Treatment time: 5-10 minutes.
The lower the intensity and the longer the time, the more effective in driving medication into the skin

ELECTROMYOGRAPHY (EMG)
 A graphic representation of the electric currents associated with muscular action.
 Abnormalities at rest
1. Spontaneous fibrillation – characterized by the presence of spontaneous single muscle fiber activity. The most
common cause is interruption of the axon responsible for the innervation of the muscle fibers.
2. Fasciculation – spontaneous discharge of motor units. Clinically visible as a flickering of the muscle under the skin if
they affect motor units near the surface of the muscle.
3. Positive sharp waves – monophasic positive potentials recorded in a muscle the nerve supply of which has been
interrupted. They are sign of denervation.
4. Myotonia – high frequency spontaneous discharges of muscle fibers initiated by touching or moving the muscle or by
voluntary contraction.
5. High frequency discharges – motor unit potentials fire rapidly at high rates at rest.

BIOFEEDBACK
 GOAL: To increase motor performance by facilitating motor learning
 TYPES:
1. Kinematic (Joint motion) Feedback
2. Standing (Balance) Feedback
3. Kinetic (Dynamic Force) Feedback
4. EMG Biofeedback

Kinematic (Joint motion) Feedback

 Uses goniometer or electrogoniometer that corresponds to position of limb segment
 Facilitates an increase in the range of motion
Standing (Balance) Feedback
 Also known as posturography feedback
 Usually used for elderly and others who are at risk of falling
Kinetic (Dynamic Force) Feedback
 Gives information about the amount or rate of loading in the limbs
 GOAL: to inform the patient on the amount of weight bearing on the limbs

Electro Notes 8 E. Sitchon

 ELECTROMYOGRAPHIC BIOFEEDBACK
□ Reinforcement of voluntary control by using audiovisual signals produced by amplified and converted signals (motor unit action
potentials) generated by contracting muscles.
□ EMG Biofeedback Principles:
 Motor Unit: The functional unit of the neuromuscular system. Consist of anterior horn cell, its axon, the neuromuscular junction
and all the muscle fiber it innervates
 Microvolts (μV): the unit of Motor Unit Potentials (MUP)
 Compound action potential (CAP): MUP’s signals that contains both positive and negative phase
 Signals undergo amplification, rectification (signals are made unidirectional), and integration.
 Integrated signals in microvolt-second (μV/s) are displayed as the EMG biofeedback signals.
 The biofeedback signals produced by patient’s muscle contraction are used to increase or decrease muscle activity.
□ Types of Electrodes
1. Surface electrodes
 For Global detection, detects signals from more than one muscle.
 Easy to apply and good patient/client acceptance
 Superficial muscles are mostly detected and frequently from more than one muscle group
 Types of surface electrode:
 Metal electrode (silver-silver chloride)
 Disposable electrodes
 Carbonized rubber electrodes
2. Needle electrode/sensors
 For local detection: signals from specific muscle or muscle group
 For detection of deep muscles
 Mainly used for diagnosis or research. Rarely used for biofeedback
 Requires skill to apply and less acceptable to patient/client.
□ Application
o Electrode Selection:
 Small electrodes (0.02cm) for specific muscles (hand, forearm, face)
 Large electrode (1.0 cm) for large or group of muscles
o Techniques:
 Bipolar methods: two active (positive and negative) and a single reference (ground) electrode.
o Electrode Placement:
 Active Electrode: on or near the motor point of targeted muscle or muscle group
 Reference electrode: between or adjacent to the active electrode, Placed near the treatment site
o Electrode Distance:
 Active electrode are placed 1 to 5 cm apart and parallel to muscle fibers
 Small distance: Reduces cross talk, yield small signals, more precise signal
 Large distance: Produces large signals, detects signals from more than one muscle Answer the ff:
1.When to use?
• Uses 2.Machine sensitivity?
• Muscle strengthening 3. Inter-electrode
• Muscle relaxation space?
□ Motor Recruitment Protocol (for weak muscles) 4. Instruction?
 GOAL: to increase EMG signals 5. Progression?
 Start with widely spaced electrode and high instrument sensitivity to increase detection 6. Facilitation?
 For single weak muscle, use a closely placed electrode to achieve more precise signals
 Ask patient to make an isometric contraction and hold it for 6-10 sec. To produce an audiovisual signals
 As the motor recruitment ability improves, lower the sensitivity for a more difficult production of signals
 If necessary, use facilitation techniques (tapping, cross facilitation, vibration)
 As patient increasing gains control, progress to a more complex functional movement
 Treatment time: from 5-10 minutes to 30 minutes or more depending on patient’s tolerance
□ Muscle relaxation protocol (for hypertonicity)
 GOAL: to decrease EMG signals
 Start with a closely spaced electrode with low sensitivity to reduce cross talks.
 Ask patient to relax and try to lower the audiovisual signals.
 If necessary, apply relaxation techniques (deep-breathing, imaginary).
 Increase the instrument’s sensitivity as the patient gains muscle relaxation.
 Treatment time: from 5-10 minutes to 30 minutes or more depending on patient’s tolerance.

Electro Notes 9 E. Sitchon