Review of Physiology - Excitable Tissue Response of Electrical Stimulation

Reference

1. Cameron MH. Physical Agents in Rehabilitation from Research to Practice. 4th ed. Missouri: Saunders, 2013. Part IV Electrical Current. Chapter 11

Introduction to electric currents.

2. Watson T. Electrotherapy: Evidence-based Practice. 12th ed. Elsevier, 2008.

3. Nelson RM, Hayes KW, Currier DP. Clinical Electrotherapy 3rd ed. London: Appleton & Lange; 1999.

4. Watson T. Electrotherapy: Evidence-Based Practice. 12 rd ed. London: Churchill Livingstone Elsevier; 2008。

Properties of excitable cell membranes

⚫ Resting membrane potential
1. The resting membrane potential can be measured and is typically between -60 to -90 mV, the inside
of the cell being negative with respect to the outside.
2. In normal muscle or nerve cell, the sodium (Na+) concentration is higher outside the cell, however
the potassium (K+) concentration is higher inside the cell.
3. The membrane has a great permeability to K+ than to Na+.
4. A net negativity develops inside the cell.

⚫ Discharge of an action potential

1. An action potential is the basic unit of nerve communication and is achieved by rapid sequential
depolarization and repolarization in response to stimulation.
2. When a sufficient stimulus is applied, sodium channels in the cell membrane open rapidly, whereas
potassium channels open slowly.
3. Na+ rush into the cell through the open channels, which makes the inside of the cell more positively
charged (Depolarization).
4. If a depolarization reaches threshold, membrane permeability to Na+ dramatically increases.
(Positive feedback)
5. When the membrane potential reaches +30 mV, the permeability to Na+ decreases and K+ channels
rapidly open, increasing the permeability to K+.
6. K+ then flow out of the cell, returning the membrane polarization to its resting state of -60 to -90
mV. (Hyperpolarization)
7. An active Na-K pump returns the ions to their original concentration.
8. Absolute refractory period (0.5s): while a nerve is depolarized, the nerve cannot be further excited,
no matter how strong a stimulus is applied.
 9. Relative refractory period (0.5 – 1s): after depolarization, before the nerve returns to its resting
potential, a greater stimulus than usual is required to produce another AP.
⚫ Propagation of an action potential
1. In normal physiological stimulation, AP propagation occurs in only one direction. (Orthodromic
conduction)
2. With electrically stimulated APs, propagation occurs in both directions from the site of stimulation.
(Antidromic conduction)
3. The greater the diameter of the nerve, the faster the AP will travel.
4. APs also travel faster in myelinated nerves (saltatory conduction) than in unmyelinated nerves
(create localized eddy currents).
5. 神經纖維傳遞順序：A > B > C (unmyelinated); α>β>γ>δ.
6. Nerve fibers conduct faster if the temperature in the surrounding environment is raised.
7. An APs can be prevented in number of ways: local pressure, anoxia, injection of a local anesthetic,
and extreme cooling.

Response of an excitable membrane to electrical stimulation

⚫ Strength-duration curve
1. Whether the membrane reaches the threshold depends on the stimulus amplitude and duration.
2. The amount of electricity required to produce an AP depends on the type of nerve and can be
represented by the nerve’s strength-duration curve.
3. 越細的神經纖維，所需產生動作電位的 amplitude 越大，所需要刺激的 duration 越長
4. Short pulses and low-current amplitudes are used for sensory stimulation (less than 80 μs), and
longer pulses and higher amplitudes are used for motor stimulation (150 to 350 μs).
⚫ Stimulating with different types of nerve fiber or denervated muscle
1. Fibers that provide the sensation of cutaneous pain are typically of small diameter.
2. Keep pulse duration below 1 ms, pain is minimized.
3. Use of short duration, lower stimulus amplitude, or both, reduce the painful sensation accompanying
stimulation.
4. The difference in both axonal diameter and anatomical orientation to the current, the stimulus
amplitude may have to be quite high (sometimes beyond tolerance) to recruit all of the motor axons.
5. Much longer pulses, of more than 10ms, are required to produce contraction of denervated muscle