TENS: afferent stimulation for pain mx by Gate control theory

AMPLITUDE PULSE PULSE MODE DURATI DURATION MECHANISM OF

RATE DURATION ON OF OF PAIN ACTION/
TX RELIEF IMPORTANT POINT
CONVENTIONAL Comfortable Inhibition of pain
(HIGH RATE) tingling fibres by large
sensation, 50-80 50-100 continuous 20-60 temporary diameter
parasethesia, pps microsec mins activation( A beta)
no muscle
response
ACUPUNCTURE- Strong but Analgesia produced
LIKE(STRONG comfortable 1-5pps 150-300 continuous Long through stimulation
LOW RATE) rhythmic microsec 30-40 lasting evoked production of
muscle mins endogeneous opiates.
twitches
Brief TENS To patients Used in pain mx
tolerance 80- 50-250 continuous 15 mins Temporary during wound
150pps microsec (30-60 debridement,deep
min) friction massage,joint
mob or passive
stretching
BURST(PULSE Comfortable, Characteristics of high
TRAINS) Intermittent 50- 50-200 continuous 20-30 Long and low rate TENS
parasthesia 100pps microsec mins lasting
delivered (hours)
in
packets
of burst
of 1-4
pps
Hyperstimulation Probe used to
(point Strong to 1-5 pps 150-300 15-30 Long noxiously stimulate
stimulation) patients microsec mins lasting acupuncture or
tolerance increme trigger points.pain
nts relief by acupuncture
tens mechanism

Modulation mode TENS :Frequencies, intensities or pulse durations can be altered by >= 10%, one or
two times per second to prevent perceptual adaptation due to constant ES.
Current CHARACTERISTIC IMPORATANT POINTS
HVPC Wave: paired monophasic Wound healing parameters: Active electrode
with instantaneous rise Amplitude:comfortable tingling should be
and exponential fall of sensation,parastesia,no muscle NEGATIVE for
current twitch BACTERICIDAL
Current: Pulse rate: 50-200pps EFFECT and
continuous,surged or Pulse duration: 20-100microsec POSITIVE for
interrupted pulsatile Mode continuous culture free
current Duration:20-60 mins wound.

MEDIUM CATEGORIES:
FREQUENCY Low frequency: 1 – Capacitive skin resistance or
CURRENTS 2000pps impedance decreases as current
Medium frequency: 1000 frequency increases.
– 10,000 pps
High frequency: > 10,000
pps

RUSSIAN Wave: polyphasic Muscle strengthening 2500 sine

CURRENT sinusoidal burst parameters: wave(carrier
Current: TIME modulated frequency) which is
to create pulsatile burst Amplitude: tetanic contraction interrupted for 10
current Pulse rate: 50-70 pps millisec at 10
Pulse duration: 150-200 millisec interval
microsec or 50% duty cycle producing fifty 10
Mode is interrupted: ramp- 1-5 millisec bursts per
sec based on patients tolerance sec.
Duty: 1:5
Also known as
For muscle pumping,duty cycle is medium frequency
1:1 burst alternating
For ROM, duty cycle is 2:5 current.

INTERFERENTIAL Static interferential-

CURRENT: cloverleaf Pain protocol: similar to high or
low rate TENS
Dynamic(scan )
interferential: fileds are Muscle strengthening protocol:
rotated at 45 degree Similar to low or medium
frequency ES.
Full field scanning bursts
 the currents over two
circuits

Premodulated IFC

FUNCTIONAL ES Also known as Neuromuscular

electrical stimulation Other gait assisted
protocol:electrodes
Shoulder subluxation protocol: are placed on
Electrodes placed on appropriate
supraspinatus and posterior muscles for
deltoid (bipolar placement) control,

AMPLITUDE: titanic muscle 1)Push off- plantar

contraction till patient can flexors
tolerate
Pulse rate: 12-25pps 2)late swing
Duration: 15-30 mins.Three phase: hamstrings
times daily,upto 6-7
hours.On/Off ratio is 1:3 3) Stance phase:
progressing to 12:1. quadriceps or
gluteal muscles.
Dorsiflexion assist protocol in
gait training:
Wave form: asymmetric biphasic
square
Pulse duration: 20-250 microsec
Mode is interrupted by foot
switch

Electromyographic Biofeedback: PG 322