Basic concepts of electrotherapy

Lecture III
 General Principles of Electrical
Stimulation

• What is electrotherapy?
Electrotherapy is the use of different electric
currents (low frequency currents) to stimulate
peripheral nervous system to control pain or cause
muscle contraction.
General Consideration of Therapeutic
Currents

• The simple fact of electrotherapy is that all currents

used therapeutically are transcutaneous electrical
stimulation (TES), or sometimes called
transcutaneous electrical nerve stimulation (TENS)
because they work through skin to axcite nerve or
stimulate muscle.
General Consideration of Therapeutic
Currents
• All stimulators must provide sufficient voltage in order to
conduct appropriate current against the impedance of the
conductive medium.
• Most clinical stimulators are designed electronically as
either Constant-current or Constant-voltage stimulator.
Constant voltage means that the voltage output level set by
the therapist will remain the same, if the impedance of the
tissue or of the tissue-electrode interface or both are
changed, the current will also change but the voltage will
remain constant.
General Consideration of Therapeutic
Currents
• Conversely, any change of impedance during the
application of a constant current stimulator will
change the voltage output but will leave the current
unaffected, provided that the stimulator is
appropriately designed to function in the full range
of tissue impedance.
• Basic physiological responses and clinical results
are most likely to be identical whether constant-
current or constant-voltage is used.
General Consideration of Therapeutic
Currents
• The clinical advantage of a constant-voltage
stimulator is the automatic reduction of current
when electrode size is reduced or if electrode
contact with the skin become loose.
• The disadvantage is apparent if the pressure
between the tissue and the electrode is suddenly
increased, impedance is reduced and current
amplitude is automatically increased.
General Consideration of Therapeutic
Currents
• The advantage of the constant-current is the more
consistent level of stimulation. The disadvantage of
the constant-current is apparent when electrode size
or pressure with the skin or both is reduced and
lead to a sudden increase of current concentrations.
The result is a sudden discomfort of the stimulation
and in extreme cases, electrical burns.
• This hazard can be eliminated by limiting the
maximum voltage output.
 Types of Electric Currents

• Therapeutically there are three types of currents:

1- Direct current.
2- Alternating current.
3- Pulsed current.
 Direct Current (DC)
• Direct current is the flow of electric charges in one
direction for 1 second or more.
 Alternating Current (AC)
• Alternating current (AC):
is the continuous
bidirectional flow of
electric charge. An electric
current that rises to a
maximum in one direction,
falls back to zero and then
rises to a maximum in the
opposite direction and then
repeats.
 Alternating Current (AC)
• In AC current there are inverse relationship
between frequency and pulse duration, as the
frequency increase the pulse duration decrease.
• Modulation of AC current:
Modulation of AC current is done by modulating
TIME or AMPLITUDE.
 Alternating Current modulation
• The modulation by time can
be classified into BURST
and INTERRUPTED
modes.
1- Burst AC is created by
flow of current for a few
milliseconds and then stop
to flow (inter burst interval
or pause period) and repeat
cycle again. The clinical
example of burst
modulation is Russian
Current.
 Alternating Current modulation
• Alternating current can also be modulated as
interrupted AC. This modulation done when the
current flow for few seconds then stop to flow for 1
second or more. This interrupted AC is differ from
burst AC because the interpulse interval is longer
than the inter burst interval and this is an advantage
for the interrupted AC because it permits relaxation
from muscle contraction.
 Alternating Current modulation
• Amplitude Modulation: the
most common example of
amplitude modulated AC
is to mix two AC current
with different frequency.
This is clinically known as
interferential current (IFC).
 3- Pulsed Current (PC)
• A pulsed current is defined as
an electric current that is
conducted as signal (or
signals) of short duration.
Each pulse lasts for only a
few milliseconds (ms) or
microsecond (µsec) followed
by an interpulse interval. AC
has many names according to
waveform like pulsating DC,
square, faradic and triangular.
 Parts of The Wave Form
• A wave form is a visual
shape of a pulsed electrical
current. It include the
following components:
1- Amplitude: the magnitude
or intensity of the current.
Measured in peak mA.
tim e
 Parts of The Wave Form
2- Phase duration: the time
elapsed from the beginning
to the termination of one
phase. Measured in
microsecond (µsec).
p hase
d u ra tio n

p u ls e phase
d u ra tio n d u ra tio n
 Parts of The Wave Form
3- Pulse duration (pulse
width): the time elapsed
from the beginning to the
end of all phases plus the phase
interphase interval within d u ra tio n
one pulse. Measured in
microsecond (µsec).

p u ls e phase
d u ra tio n d u ra tio n
 Parts of The Wave Form
4- Interphase interval
(interpulse interval): the
time between two
successive components of in te rp h a s e
pulse when no electrical in te rv a l
activity occurs. Measured
in microsecond (µsec).
in te rp u ls e
in te rv a l
 Parts of The Wave Form
5- Interpulse interval: the time
between two successive pulses.

in te rp u ls e
in te rv a l
6- pulse rate (frequency): the
number of pulses per measure
time (one second).
 The role of rate change of the electric
pulse on physiologic changes
1- If there is very slow changes or even no changes
due to steady flow of ions (as in unidirectional
currents). This will cause chemical changes at the
electrode tissue junction.
2- If the rate of changes is somewhat faster and the
pulse has a long enough duration, the ionic balance
across the excitable membrane is disturbed
stimulating nerves and muscles. If the current is
unidirectional it will lead to chemical changes.
 The role of rate change of the electric
pulse on physiologic changes
3- if the rate of changes is fast and the current is
alternating current no changes can occur because
any changes in one direction will be cancelled
when the current reversed.
4- if the rate of changes is very high there is
insufficient time for trans-membrane excitation to
occur so that much longer currents can be
employed which lead to heating.
 Rate of Rise of The Pulse
• If the rate of rise of the current is very slow it will
not provoke a nerve impulse because the ionic
balance across the nerve fiber membrane is able to
adjust itself, this process is called accommodation.
The rate at which accommodation occur is limited
so that the threshold may be reached by the slow
rising pulses at higher intensity. This fact is used to
discriminate between innervated and denervated
muscle.
 The Role of Current Intensity on
Physiological Changes

• If we apply low current density (current intensity

/unit area²) to the skin, the nerves transmit touch,
temperature and pressure are the first to be
stimulated causing mild tapping sensation.
• Higher current densities will affect more sensory
nerves causing tingling sensation.
 The Role of Current Intensity on
Physiological Changes
• increase of current will affect more motor units
resulting in strong and wide As still higher currents
are applied the impulses will spread to the motor
nerves causing muscle contraction. Further spread
of muscle contraction.
• Much increase of current density will stimulate
pain fibers causing pain.
 Stimulating Different Nerves
• The amplitude (intensity) of current needed to
stimulate a nerve fiber is inversely proportional to
its diameter. The larger fibers have a lower
electrical resistance.
• The difference in sensitivity between motor and
sensory fibers is due to their different depth;
sensory nerves in the skin receive higher current
density than deep motor fibers.
 Stimulating Different Nerves
• From strength
duration curve you
can see that it easy to
excite sensory and
motor nerves without
eliciting pain by using
short duration pulses
say around 0.05msec.