Prepared by: Jellen R.

Agbuya, PTRP
 Discuss membrane potential of muscles and nerves
 Basis for resting membrane potential
 Events during discharge of action potential
 Events during propagation of action potential
 Differentiate nerve from muscle action potential
 Discuss effects of electrical current stimulation on nerves and
muscles.
 Explain the ionic effects of electrical currents.
 Define electrotherapy
 Define common terms used in electrotherapy.
 Discuss electrical currents used in PT in terms of:
 Frequency
 Waveforms
 Purpose
 Define the various types and uses of MFCs and LFCs.
 Explain the two types of electrical stimulator devices.
Review of Physiology of Nerve and Muscle
Function

Basic Concepts in Electrotherapy

Introduction to Low Frequency Currents (LFCs) and

Medium Frequency Currents (MFCs)
 Biological tissues exhibit electrical characteristics

 Bioelectric activity is essential to cell/tissue form and function

 Behavior and response to adverse events (injury, pathology)

 Influence on the practice of electrotherapy

 Cell Membrane
 Ions move in and out of the cell
membrane depending on their
permeability, affecting its charge

 Extracellular: More Na+, K+

and Ca++ ions
 Intracellular: Few K+ ions
 Cell Membrane
 Readily permeable to K+ ions
 Slightly permeable to Na+ ions
 Non-permeable to large negative proteins and phosphates

 Movement of ions may be through:

▪ Passive diffusion
▪ Active transport (uses ATP)
 Resting membrane potential
 Actively generated
 Dependent on voltage-gated Na+-K+ ATPase pump
 Negative !
▪ peripheral nerve fibers: -75mV
▪ muscle fibers: -90mV
Stimulus
Chemical disturbance, activation of synapse or receptor, other
disturbance (eg. electrical impulse)
Depolar- Reduction of negative charge Must reach threshold to initiate
ization due to influx of Na+ ions AP (10-15mV)
Hyper-
polarizati Influx of K+ ions causing membrane potential to become negative
on
Repolar-
ization Na-K pump returns ions to original concentrations
 Action potential in one region of an excitable membrane can
trigger an AP in a neighboring region
 If a nerve or muscle fiber is large: AP can be propagated over the
entire membrane

 Types of Propagation:
 Orthodromic conduction – normal direction
 Antidromic conduction – occurs in opposite direction; can be evoked
by electrical stimulation
 Important observations:
 Ionic current always flows down the ion’s concentration gradient
 Membrane potential only changes when there is capacitive current
• Nerve fiber diameter
• Small fibers vs. larger fibers
• Presence of myelin sheath
• Myelinated vs. unmyelinated
• Membrane resistance
• Lower resistance vs. higher resistance
• Type of fiber
• Muscle fiber vs. nerve fiber
• Temperature
• High vs. low
 Nerve action potential passes rapidly along peripheral axons
and sweeps over the membrane of motor nerve terminals
producing muscle contraction
 Purpose
 Induce an outward capacitive current across the membrane
 Electrotherapy
 Application of electricity for therapeutic purposes
 Use of outdated, vague and erroneous terms brought confusion
and misunderstanding when used to describe electrophysical
agents

 American Physical Therapy Association (APTA) commissioned

its Section on Clinical Electrophysiology in 1990
 Monograph of Terminology
 Recommended Term Outdated, Erroneous Term

Direct current (DC) Galvanic current

Pulsed Biphasic Asymmetric Balanced

Faradic current
Current

High-Voltage Pulsed Current High-Voltage Pulsed Galvanic Current

Pulse duration Pulse width; pulse length

 Recommended Term Outdated, Erroneous Term

Current amplitude Current intensity

Frequency Rate

Waveform Impulse

ON:OFF ratio Mark-space ratio

Ramp Surge
 High Frequency Current (HFC)
 US, SWD, MWD, IRR, UVR, LASER

 Medium Frequency Current (MFC)

 IFC and TENS

 Low Frequency Current (LFC)

 DC-innervated, ES, FES, NMES
 Electrical Current
 Flow (current) of electrons from an electron source (stimulator) to the
wires and electrodes used to deliver such an electric current to soft
tissues
 Unit of measurement: Ampere (A)

 Biological Current
 Flow (current) of ions (biological) in the targeted tissues resulting from
the passage of the electrical current
 Interaction
 Flow of electrical current is transformed, within the soft tissues, into a
flow of biological current.
 Electrical energy  Bioelectrical energy (for therapeutic purposes)

 Charge
 Carried by ions
 May be (+) or (-)
 Unit of measurement: Coulumb (C)
 Electromotive Force
 A difference in the potential between two ends or at any two points of
a circuit
 Driving force required for a continuous flow of charges
 Measure of maximum work per unit charge
 Unit of measurement: Volts (V)
 Resistance
 Hindrance to current flow encountered in direct current (DC) circuit
 Unit of measurement: Ohm (Ω)

 Impedance
 Hindrance to current flow encountered in alternating current (AC)
circuit
 Unit of measurement: Ohm (Ω)
 Capacitance
 Enables a device or circuit to store electrical charges in an electrostatic
field
 Unit of measurement: Farads (F)

 Inductance
 Enables a device or circuit to store electrical energy in an
electromagnetic field
 Unit of measurement: Henries (H)
 Pulse
 Current flow in each direction of the phases for a determined period
of time
 Can be monophasic or biphasic

 Cycle
 A pulse that is always biphasic
 Pulse/Cycle Duration
 Time elapsed from the beginning to the end of the two phases within a
pulse or cycle, including the interphase duration if present

0 t

-
 Pulsed current
 Noncontinuous, interrupted, or periodic flow of DC or AC currents

+
0 t

-
 Phase
 Current flow in one direction for a determined period of time

+
0 t

-
 Phase Duration
 Determined period of time elapsing from the beginning to the end of
one phase, usually expressed in microseconds or milliseconds
+
0 t

-
 Interphase Duration
 Time elapsed between two successive phases, usually expressed in
microseconds or milliseconds.
+
0 t

-
 Phase Rise Time
 Time it takes for the leading edge of phase to rise from the zero
baseline to its maximum amplitude.
 Related to nerve accommodation

+
0 t

-
 Phase Decay Time
 Time it takes for the trailing edge of phase to decay from maximum
amplitude to the zero baseline

+
0 t

-
 Burst
 Successive delivery of pulses or cycles at a pre-set amplitude, frequency
or duration during a determined period of time
 Aka interrupted train

+
0 t
-
 Burst Duration
 Time elapsed between the beginning of the first and at the end of the
last pulse or cycle within the burst

+
0 t
-
  Interburst Duration
 Time elapsed between two successive bursts

+
0 t
-
 Beat
 Summation of 2 or more sinusoidal AC delivered at different
frequencies and intersecting during a determined period of time.

+
t
0
-
 Interbeat Duration
 Does not exist!
 Each beat ends with the beginning of the next beat

+
t
0
-
• Frequency
• Number of times per second that a pulse, cycle, burst or beat will
repeat itself

• Period
• Phase duration + interphase duration
• Cycle duration + intercycle duration

• Pulse Frequency
• Number of pulses per second (pps)
 Cycle Frequency (cps)
 Number of cycles per second
 Expressed in Hertz

 Burst frequency
 Number of bursts per second

 Beat Frequency
 Number of beats per second
• Amplitude
• Magnitude of current relative to the isoelectric zero (0) baseline
• Expressed in amperes (A)

• Train
• Continuous series of pulses, cycles, bursts or beats delivered over time

• Duty cycle
• Ratio of ON-time to the summation of ON-time plus OFF-time,
expressed in percentage
 Modulation
 Random and successive variations of waveform parameters such as
current amplitude, pulse duration, and pulse frequency over time.
 Modulation can be done individually, in pairs or all together
 Commonly used in TENS to optimize comfort while reducing sensory
habituation and nerve accommodation to the pattern of stimulation
over time.
 Waveform
 Geometrical description of current
 Can be:
▪ Monophasic
▪ Biphasic
▪ Polyphasic
 Monophasic
 A pulse or cycle that moves in only one direction
 From zero (0) baseline towards (+) or (-) polarity
 Returns to zero baseline after finite amount of time
 Includes CDC
+
0
-
 Biphasic
 A pulse or cycle that moves in one direction and then in the opposite
direction
 From zero (0) baseline towards (+) or (-) polarity
 Returns to zero baseline after finite amount of time
 Includes even and uneven AC
+
0 t

-
 Symmetrical
 Has positive phase geometrically identical to its negative phase
 Always balanced

+
0 t

-
 Asymmetrical
 Has one of its two phases geometrically different from the other
 Can be balanced or unbalanced

+
0 t

-
 Balanced Assymetrical
 Has equal electrical charges in each phase

+
0 t

-
 Unbalanced Assymetrical
 Has unequal electrical charges in each phase

0 t

-
 Polyphasic
 Has many phases
 Includes interferential current (IFC) and Russian currents

+
0 t
-
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Aka Galvanic Current
 Continuous, unidirectional flow of charged particles
 1 sec or longer
 Polarity determines direction of current
 Commonly used for wound healing, weakness
+ t
0
-
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Always monophasic
 Includes Iontophoresis
+
0 t
-
+
0 t
-
 Iontophoresis
 Is the transfer of ions of drugs into the body through the skin through
the use of a constant DC.
 Principle is based on the fact that ions will migrate to the electrode of
opposite charge under the influence of an electromotive force.
 Since ions migrate to the oppositely-charged electrode, the positive
ions must be introduced from the (+) electrode and the negative ions
from the (-) electrode.
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
+
0 t

+
0 t

-
+
0 t

+
0 t
-
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Aka Faradic-type of current
 Frequency: 50-70Hz
 Pulse duration: 0.5-1ms
 Includes:
 Russian Current
 HVPC (HVPGC)
 Russian Current
 Used for muscle spasm and strengthening of muscles
 Utilizes a twin spike/peak
 Always polyphasic
 Uses 2500 Hz
 HVPC (High Voltage Pulse Current)/HVPGC
 Produces high voltage current with a high peak amplitude but a low
average current, and a very short pulse duration
 Produces a twin pulse/peak that can reach up to 300-400mA
▪ Safe due to very short PD
 Not polyphasic (unlike Russian current)
 Can stimulate deep nerves and innervated muscles
 Cannot contract denervated muscles
 Faradism Under Pressure (FUP)
 ES with compresion at:
▪ Arm: Biceps brachii
▪ Forearm: Anterior aspect
▪ Wrist: Dorsal aspect
▪ Thigh: Anterior aspect
▪ Leg: Gastrocnemius
▪ Foot: Dorsum of foot
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
• Pulse duration: 1-3000ms
• Principles:
• Excitation
• Nerve: -70mV
• Muscle: -90mV
• Accommodation
• Nerve (sensory): Greater accommodation
• Muscle (motor): Lesser accommodation
• Firing
• Normal: asynchronous firing (Type I  Type II)
• With electricity: synchronous firing (Type II  Type I)
 If there would be sudden variance or change in current, muscle
contraction will be produced.
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Used for innervated muscles
 Includes FES/NMES
 NMES
 For innervated weak muscle
 Used to:
▪ Retard muscle atrophy
▪ Muscle re-education
▪ Increase muscle strength
▪ Increase endurance
▪ Decrease spasticity
 FES
 For innervated weak muscle
 Used as an orthotic substitute
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Uses EPC (Exponential Progressive Current)
 For denervated muscles
 Includes ES to retard muscle atrophy

+
0 t
-
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Continuous, bidirectional flow of charged particles
 1 sec or longer
 Relative to the isoelectric (zero) baseline
 Commonly used for pain and skeletal healing
+
0 t
-
 Aka Even AC / Sinusoidal Current
 Typical AC
 May be delivered in various shapes
 Sinusoidal
+
 Rectangular
 Trapezoidal 0 t
 Triangular -
 Interferential Current (IFC)
 4100 Hz + 4000Hz to overcome skin resistance = 1-100 Hz (beat
frequency) interferenctal current
 2 sinusoidal waves with mixing
 Slightly out of phase
 Used for:
▪ Pain (diffused)
▪ Muscle re-educaiton
▪ Muscle strengthening
▪ Bone/fx healing
 TENS
 Frequency: 100pps
 Pulse duration: 40 microseconds
 Used for:
▪ Pain (Gate Control Theory)
 Current

Direct Current (DC)/Galvanic Current Alternating Current (AC)

Continuous DC Interrupted DC Even/Symmetrical Uneven/ Asymmetrical

(CDC) (IDC) AC/Sinusoidal current AC/Faradic current

Short IDC /Faradic- Long IDC

type
Rectified LIDC Exponential LIDC
 Aka Uneven AC / Faradic Current
 May be delivered in various shapes
 Sinusoidal
 Rectangular
+
 Trapezoidal
 Triangular 0 t

-
 Constant Current (CC) Stimulator
 Device that delivers an electric current that flows at the same
amplitude regardless of changes in tissue impedance over time
 Most commonly used today
 Provide consistent level of amplitude throughout therapeutic
application
▪ More comfortable for the patient and predictable for the PT
 Constant Voltage (CV) Stimulator
 Device that delivers a source of voltage at the same amplitude
regardless of changes in tissue impedance over time
PT 4 INTRODUCTION TO
ELECTROTHERAPY

Revised for instruction by:

Jellen R. Agbuya, PTRP

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