ELECTRO THERAPY FILE WORK

DEMONSTRATE MOTOR POINT STIMULATION

BY: APOORV GARG
B. P. T. 2ND YEAR
ROLL NO. 04
20TH BATCH

INTRODUCTION
1. Therapeutic currents can broadly be defined as electrical
currents, produced by electrotherapeutic devices,
induced to the body tissues to elicit certain physiological
and clinical effects or the currents which are used to treat
various musculoskeletal, neurological and other sports
conditions are termed as therapeutic currents.
2. Classification of currents
a. Currents are classified on the basis of direction of
flow, frequency and voltage.
I. Direction of flow
A. Alternating Current
B.Direct Current
C.Pulsed Current
 II. Frequency
A.Low frequency currents- between 50 and
100Hz
B.Medium frequency currents-between 100 and
4000Hz
C.High frequency currents- above 1MHz
III. Voltage
A.Low voltage currents- less than 100volts
B.High voltage currents- greater than 100volts
3. DIRECT CURRENT
Direct current has a single phase of impulse which flows
in unidirectional towards positive or negative poles;
therefore, it is also called as mono-phasic current.
The direct current is modulated for the clinical
applications by interrupting the current flow after one
second, reversing the polarity and gradually increasing or
decreasing the amplitude.
Interruption is the most useful modification of direct
current. Interruption makes the flow of current
commence and cease at regular intervals.
4. ALTERNATING CURRENT
It is a biphasic current, which flows in bidirectional. This
current may have symmetrical and asymmetrical wave
forms.
The symmetrical biphasic square wave allows selective
treatment of smaller muscles. It dictates that the current
flows equally “hard and fast” in both phases, thus
allowing both electrodes to act as active electrodes.
Symmetrical biphasic waveform is preferred over the
asymmetric biphasic waveforms.
5. LOW FREQUENCY CURRENTS
• Frequency range is between 1 to 1000 Hz
• Skin resistance- 3200 ohms
• Types of low frequency current:
1. Constant direct current: These are unidirectional
current that pass for more than 1 millisecond. These
current are used in iontophoresis.
2. Interrupted direct current: These currents are produced
by creating interruption in constant direct current. These
are of short duration IDC and long duration IDC. The
short duration IDC has pulse duration from 0.1 to 1
millisecond. Faradic, TENS, HVPGS (high voltage pulse
galvanic stimulation) are included in short duration IDC.
The long duration IDC has pulse duration more than 1
millisecond and includes galvanic current.
6. FARADIC CURRENTS
 It is short duration interrupted direct current
 Pulse duration- 0.1millisecond-1millisecond
 Frequency- 50-100Hz
 Faradic currents are always surged for treatment
purposes to produce a near normal tetanic-like
contraction and relaxation of muscle.
 Current surging means the gradual increase and
decrease of the peak intensity.
 Now the faradic current produced by electronic
stimulators has same physiological effect as original
faradic current with difference only in the
waveform, with remaining the positive part of
waveform only.
 The positive portion is of short duration, high
amplitude and is spiked.
PHYSIOLOGICAL EFFECTS OF FARADIC CURRENT

1. Stimulation of sensory nerves- The flow of current to the

superficial structures on the skin is perceived by the
superficial nerve ending, which leads to pricking
sensation and stimuli are of short duration. The sensory
stimulation causes a reflex vasodilatation of the
superficial blood vessels which produces slight erythema
on the skin.
2. Stimulation of motor nerves- Faradic current stimulates
motor nerves as well, of intensity which is sufficient to
cause contraction of the muscles which these nerve
supply.
3. Increase Metabolism- The tetanic like contraction of the
muscles or group of muscles increases metabolic rate,
with consequent increase in the demand for oxygen and
foodstuff. There is increased output of the waste
products including metabolites.
4. Increase Vasodilatation- Increase metabolism and
demand for oxygen increases dilatation of the blood
vessels. The pumping action helps in increasing venous
and lymphatic returns.

THERAPEUTIC EFFECTS OF FARADIC CURRENT

1. Strength Training-Faradic current facilitates muscle
contractions by depolarization of the motor nerve
innervating a muscle or a group of muscles evokes
muscle tetanic muscle contraction so strength is
increased.
2. Re-Education of Muscle Activity-Electrical stimulation
not only helps in re-educating the muscle by providing
proprioceptive, kinaesthetic and sensory input. The
electrical stimulation facilitates muscle action during
functional training involving gait training.
3. Oedema-Control-Faradic current causes intermittent
muscle contraction, which mechanically compresses the
adjacent soft walled venous and lymphatic vessels to
increase the centripetal flow of their content. The
consequent reduction of interstitial pressure is considered
to be effective for all oedema whatever the stage or
cause.
4. Temporary Control of Spasticity-Electrical stimulation
of antagonistic muscle temporarily inhibits spasticity of
the agonist muscle by the effect of reciprocal inhibition.
Electrical stimulation of the spastic muscles itself
induces fatigue and temporarily inhibits spasticity of the
muscle by an autogenic inhibition mechanism.
FINDING MOTOR POINT AND STIMULATION OF A
MUSCLE

MOTOR POINT:
A small area on a muscle at which a minimal amount of
electrical stimulation will cause the muscle to contract. It is
basically the point where the motor nerve enters the muscle. In
general case, motor point of a muscle is located approximately
at junction of lower ⅔ and upper ⅓ from the point of origin of
muscle.

ELECTRODES:
The appropriate selection of electrodes for nerve and muscle
stimulation is important. Electrodes could be of pad or plate type
or pen type. Pad or plate electrodes are kept in between the lint
pads for even distribution of current. The edges of plate
electrode should be blunt. It should be smaller than the lint pad
so that it cannot come in contact with the skin. Pen electrode is
used for smaller muscles or for specific motor points.
Basically electrodes are of 2 types:
• One is Passive electrode which is generally in red colour, have
positive polarity and larger than the other electrode. This
electrode is placed the point either where the nerve is most
superficial or at the nerve trunk. This electrode is used to
complete the circuit for flow of current.
• Other electrode which is Active; is black in colour, have
negative polarity, is smaller in size. This one is placed on the
motor point of the muscle. This electrode is used for stimulation
of nerves and muscles and is held at 90° to the skin surface for
the proper transmission of current. For stimulation purpose,
instead of pad electrode, a pen electrode is used.

Technique of finding out motor point of a muscle and

thereby stimulating the muscle:

• Preparation of apparatus:
The apparatus is tested prior to administration. Make sure that
the stimulator is properly functioning, each part of the stimulator
like the intensity knob, display; all must be properly working.
After thorough inspection, the electrodes are connected to their
respective terminals, i.e., black with black and red with red. The
red electrode which is passive and positive; is covered with wet
electrode rubber strap.
The black electrode being active one; is connected with pen
electrode. The tip of pen electrode is covered with cotton plug to
prevent any irritation on the patient’s skin.
• Briefing to the patient:
The therapist explains the patient about the procedure, its
effects on the muscle during the treatment and post
treatment.
• Checking the contraindications:
The therapist checks out all kind of contraindications
before proceeding to the treatment by asking history of
patient or by getting the demographic data.
• Preparation of the patient:
Clothing is removed from the arm till the axilla and patient
is supported well in a good light. Patient is asked to remove
all kind of ornaments from his body, as they only hinder the
procedure.
The skin is washed with soap and water to remove the
natural oils and other kind of dirt to reduce the skin
resistance for the electric current; before the pads are
applied. For the stimulation of medial head of triceps
muscle, most comfortable position for the patient is high
sitting; with pronated forearm and with extended elbow and
support of pillow behind the back to maintain proper
posture. If the patient is unable to sit, prone lying position
is preferred.
  Setting up of the parameters:
For both denervated and innervated triceps muscle,
Interrupted galvanic current is chosen. For innervated one,
diagnosis treatment is selected, with pulse duration of 30
milliseconds and on time is set on 2 seconds. After this,
therapists self-test the apparatus prior to application on the
patient, by increasing the intensity knob.
Interrupted galvanic is preferred over surged faradic
because interrupted galvanic current has pulse duration
more than 1 millisecond, but surged faradic has from 0.1 to
1 millisecond, so to achieve stimulation more intensity of
current will be required to produce the contraction of that
muscle and that intensity will become uncomfortable for
patient.

•Finding the motor point of medial head of triceps

muscle:
After setting up the parameters, the red electrode covered
with wet strap is placed at the cervical region of the neck or
where the radial nerve is superficial; to complete the circuit
and the black which is an active pen electrode is used to
locate the motor point. Pen electrode is held at 90° to skin
surface and moved gradually between the lower ⅔ and ⅓
junction from the point of origin of muscle.
 About the Medial head of Triceps Muscle
Origin= the medial head of triceps arises
proximally in the humerus, just inferior to the
groove of the radial nerve; from the dorsal
surface of the humerus and from the medial
intermuscular septum.
Insertion= It inserts into olecranon process of
ulna.
Nerve Supply= Radial Nerve
Action= It helps in extension of the elbow joint
and also act as an antagonist of the biceps and
brachialis.
The medial head of triceps brachii also helps to
stabilize the shoulder by keeping the head of the
humerus in its correct position in the shoulder
joint.
 Stimulating the medial head of Triceps brachii
After finding the muscle motor point, stimulation
is done for the muscle.

 Indications
• Facilitation of muscle contraction
• Re-education of muscle action
• Training a new muscle action after tendon
transplant or reconstructive surgery
• In Neuropraxia of motor nerve
• Improve venous and lymphatic drainage
• Prevention and loosening of adhesion
• Denervation
 • Re-education of recovering muscles in early
stages of re-innervation.

 Contraindications:
• Infection
• Haemorrhage
• Deep vein thrombosis
• Fractures
• Open wounds
• Skin lesion such as eczema
• Neoplasm
• Absent sensation
• Stimulation of autonomic nerves may
disturb cardiac rhythm
THANK
YOU