Instrumentation and Product Safety

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

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

Wave form terminology

⚫ Electrical current parameter
1. The amplitude is the magnitude of the current.
2. Frequency is the number of cycles or pulses per second and is measured in Hz or pulses per second.
3. The on time produces the muscle contraction, and the off time allows the muscle to relax. (When
electrical stimulation is used to reduce muscle fatigue)
4. Ramp up and ramp down times
 Ramp up is the time it takes for current amplitude to increase from zero to maximum amplitude.
 Ramp down is the time it takes for current amplitude to decrease from its maximum amplitude
during the on time to zero during the off time.
 Ramps are used to improve patient comfort when electrical currents are used to produce muscle
contractions.

⚫ The dependent parameter

1. Pulse duration is how long each pulse lasts.

 Pulse duration is usually measured in microseconds (10-6 seconds).
 Shorter pulse durations are usually used for pain control, and longer pulse durations are needed
to produce muscle contractions.
2. Phase duration is the duration of one phase of the pulse.
 It is equal to the pulse duration with a monophasic pulsed current.
3. The interpulse interval is the amount of time between pulses.
⚫ Waveform amplitude
1. Peak current
2. Average current
3. Root mean square (RMS) current
Therapeutic currents
⚫ Waveform overview
1. Direct current (DC): a continuous unidirectional flow of charged particles in one direction.
 It is commonly used for iontophoresis and for stimulating contractions in denervated muscle.
 Electrical current that flows in one direction for about 1 sec or longer.
 Historically, DC is also termed galvanic current (GA).
2. Alternating current (AC): current that changes the direction of flow, with reference to the zero
baseline, at least once every second.
 Medium frequency of AC between 1000 and 10000 Hz.

3. Pulsed current (PC): an interrupted flow of charged particles where the current flows in a series of
pulses separated by periods where no current flows.
 Application: pain control, tissue healing, and muscle contraction, and is the most often used
for electrical stimulaton.
 Each pulse lasts for only a few msec or 𝜇sec followed by an interpulse interval.
 The current may monophasic pulsed current or biphasic pulsed current.
 A biphasic pulsed current may be symmetrical or asymmetrical, balanced or unbalance.

⚫ Other common terminology of electrical stimulation

1. Transcutaneous electrical stimulation (TENS)
 Is applied transcutaneously with the physiologic objective of exciting peripheral nerves.
 TENS, applied to modulate pain.
2. Faradic current
 An asymmetric biphasic pulse.
 The duration of the main phase of the faradic pulse is typically 1 msec.
3. Disdynamic current
 A monophasic pulsed current, usually a sine wave at a carrier frequency of 100 Hz.
 Provides direct excitatory response, but its long pulse duration cause patient very uncomfortable.
 Diadynamic current are outmoded.
4. Interferential current (IFC)
 The typical IFC stimulator utilized two sinusoidal AC output circuits that differ in frequency.
 The frequency of two circuits is commonly used with 4000 and 4100 Hz. (5000 and 5100 Hz)
 When these two outputs intersect, the frequency difference causes the sine waves’ amplitudes to
summate, resulting in the beat or envelope.
 Beat frequency is 100 Hz (4100-4000).
 Four electrodes, cross arrangement.
 Commonly combined with vacuum (吸盤) electrodes.
 Lack of polarity choice.

5. Russian current
 Russian protocol is electrical stimulation with a waveform with specific parameters intended for
quadriceps muscle strengthening.
 A continuous sine wave output of about 2500 to 5000 Hz is modulated to yield 50 bps.
 Lack of polarity choice.
 Commonly known as medium frequency stimulation.

6. High-voltage stimulation
 High-voltage pulsed current, is not a galvanic stimulator.
 The typical twin-peak pulse, very short duration (< 200 𝜇s) with high voltage (> 100 volts).
7. Subliminal stimulation
 It delivery of low peak current that is designed not to cause peripheral nerve excitation.
Safety considerations
⚫ Electrical shock
1. Electrical chock involves the flow of current through human tissue, usually with adverse effects.
2. Such effects are related to a number of factors including current amplitude, individual susceptibility,
size of area contacted, and tissue impedance.
3. microchock (generally imperceptible) is produced by low levels of current applied to the surface of
the heart that result in an unwanted physiologic response.
4. Microshock on the order of 20 𝜇A through a ventricular pacing catheter can induce fibrillation.
5. Macroshock is the physiologic response to an electrical current applied to the surface of the body.
6. Electrical shock may also result from leakage current, which is a normal characteristic of electrical
circuit.
⚫ Ground and ground fault circuit interrupters
Patient and other safety consideration
⚫ Contraindications
1. Avoid current path phrenic or vague nerve or cardiac muscle.
 Stimulation across or through the chest.
 Over the carotid sinuses in the neck (anterior or lateral).
2. Avoid on patient with implanted stimulators or pacemakers or arrhythmias.
3. Avoid areas where venous or arterial thrombosis or thrombophlebitis.
4. Avoid over or around the pelvic, abdomen or low back of pregnancy.
⚫ Precaution
1. Cardiac disease.
2. Impaired mentation.
3. Malignant tumors.
4. Areas of skin irritation or open wounds.
5. Decrease or absent sensation.
6. Iontophoresis after physical agents.
7. Avoid burning of both the skin and subcutaneous fat.
8. Treatment table or bed should wood material.
9. Away from diathermy.