BASIC PRINCIPLES OF ELECTRICITY & electrons which are negatively

ELECTROTHERAPY charged and circling at highly speeds.

HISTORY OF ELECTRICITY & ELECTROTHERAPY - They are basically neutral (static)

1. 600 B.C. – Greeks IONS

- 1st form of electricity was lightning
- Static Energy through rubbing
- They are atoms which are no longer in
2. 1600 – De Magnete by William Gilbert its original neutral state.

- 1st Physician to do electric current on - They tend to move from an area of

medicine higher concentration to
3. 1646 – “Electricity” Sir Thomas Browne - Ions with (+) lose electrons
4. 46 AD – Aetius - Ions with (-) gains electrons
- Shocks of an electric fish (torpedo) for
pain management.
5. 18 & 19th Century
th

- Revival of interest in electrotherapy

6. 1791 – Luigi Galvani’s Animal Electricity
a. Muscle twitching by electricity
through metal contact with a frog’s
leg.
b. Galvanic Current ELECTRIC CURRENT (I)
- Use of electricity from battery to
produce muscle contractions. - Net movement or flow of current
c. Duchenne’s Motor Points - Higher potential to lower potential:
- Areas in the body that when electric *Opposite Attracts
current is applied it produces greatest - The unit of measurement is Ampere
muscle contraction. (A)
7. 1830 – Faraday’s Faradic Current
- 1A= movement of 1 coulomb per
- Source is induced by moving magnets. second or 6.25x1018 electrons per
8. 1905 – Lapicque’s Law of Excitation and second.
Strength Duration Curve
- In the case of therapeutic modalities,
9. 1906 – Electric Currents for Controlling
milliamperes (mA) or microamperes
pain based on gate control theory.
(μA) is used to describe current.
10. In the Philippines, Electrotherapy was a
subject taught in UST’s Dept. of Medicine - In order to be tolerated by the human
as early as 1919 body.

ATOMS & IONS ELECTRICAL CURRENT PARAMETERS

ATOMS 1. ELECTRIC CHARGE (Q)

- A measure of the number of free
- They are the basic building blocks of electrons that an atom has lost or
matter. gained.
- A small, dense nucleus, which is -
Unit of Measurement: Coulomb
positively charged and surrounded by (6.25x1018 Electrons)
2. VOLT (V)
 - AKA: Potential Difference 6. Resistance

- The electromotive force, which must - The opposition of the flows of the
be applied to produce a flow of charged particles.
electrons -
The unit of measurement is Ω (ohms)
- Difference in electron population 7. OHMS’ LAW
between 2 points. - Which states that the current in an
- Force that starts the electrical circuit is directly
current/movement proportional to the voltage and
3. VOLTAGE inversely proportional to the
resistance
- The force resulting from an
accumulation of electrons at one point
in an electrical circuit.
- Amplitude, magnitude, intensity or
strength of the current. 8. FREQUENCY
4. CONDUCTANCE - Describe the number of cycles or
- The ease with which current flows pulses per second
along a conducting medium - Expressed in Hertz (Hz) or cycles per
a. Conductors second (cps) for cycles and pulses per
- Refers to the easily flow of electrons second (pps) for pulses
a. Cycles
- Example: Metals, water and human
tissue
- Continuous Mode
b. Insulators b. Pulses

- Resist electric flows -Pulse Mode

9. IMPEDANCE (Z)
- Example: Rubber, air and Paper
5. Polarity
- The total-frequency dependent
opposition to current flow.
- The property of having 2 oppositely
charged conductors
- The unit of measurement is Ω (ohms)

- Polarity means Direction - Form of resistance that is frequency

dependent
a. Anode: Positive
b. Cathode: Negative - Better to use in regards with body
tissues.
ELECTROTHERAPEUTIC CURRENTS
 - Intersecting 2 currents
- For pain modulation and control of
muscle contractions
- Interferential Currents cancels out
their frequency that’s why they need
slightly different frequencies.
- It will interfere in the patient’s tissues.
- It is proposed that interferential
current is more comfortable than
other waveforms because it allows a
low amplitude current to be delivered
through the skin, where most
discomfort is produced, while
delivering a higher current amplitude
to deeper tissues.

- DC: One phase, one direction and one

- Interferential current also delivers
more total current than pulsed
polarity
waveforms and may stimulate a larger
- AC: Two phase, two direction and two area than other waveforms
polarity a. Carrier Frequency
- PC: 3 or more phase, direction and - Original Frequency that is lower.
polarity.
1. DIRECT CURRENT (DC)
- 5000 vs 5100 Hz
b. Beats
- AKA: Galvanic Current
- Lower Frequency
- Continuous (uninterrupted)
unidirectional flow of charged
- Currents with higher amplitude.
c. Beat Frequency
particles
- Monophasic
- Difference between 2 frequency
2. ALTERNATING CURRENT (AC) - For example, when a carrier frequency
- Continuous flow of electrons is of 5000 Hz interferes with a current
with a frequency of 5100 Hz, a beat
bidirectional, constantly changing
frequency of 100 Hz will be produced
direction or, stated differently,
in the tissue
reversing its polarity
B. Pre-Modulated Current
- Biphasic
- Sequentially increasing and
- Medium-Frequency AC (Interferential, decreasing current amplitude,
Pre-modulated and Russian): produced with a single circuit.
Therapeutically ranges from 1000-
10000Hz
- Outside of the Machine produces
Beats
A. Interferential Current
- Produced by the interference of 2
- This current has the same waveform
as an interferential current that is
medium frequency (1,000-10,000Hz)
produced by the interference of two
sinusoidal AC’s of slightly different
frequencies
 medium-frequency sinusoidal ACs 1. Transcutaneous Electrical Stimulators
requiring four electrodes. - Allows the current to flow to the skin.
C. Russian Protocol 2. Transcutaneous Electrical Nerve
- Developed by Kots Stimulator (TENS)
- Carrier Frequency: 2500Hz - Stimulates the peripheral nerves
- Produces 50 beats per second - For pain control
- Burst duration and interburst interval 3. Neuromuscular Electrical Nerve
=10 milliseconds. Stimulator (NMES)
- It has a constant parameter - Stimulates muscle and nerve

- Electrical stimulation with a - Produce contraction in innervated

waveform with specific parameters muscle
intended for quadriceps muscle 4. Electrical Muscle Stimulator (EMS)
strengthening during one Russian - Stimulates muscle that are denervated
Olympics or injured innervation
3. PULSATILE CURRENTS 5. Microcurrent Electrical Nerve Stimulators
- Interrupted/Discontinuous (MENS)

- Pulsed Currents - Not usually used in rehab (derma

clinic only)
- Interrupted flow of charged particles
where the current flows in a series of
- Used for lower intensity
pulses separated by periods where no - Cannot stimulate nerves
current flows. 6. Low-Intensity Stimulator
A. Monophasic Pulsed - A new name for MENS
- One direction, one polarity
NOTE: One machine can produce TENS, NMES,
B. Biphasic Pulsed
EMS just change the parameters required
- 2 directions and 2 polarities
- 1 Pulse = 2 phase (1 in + and 1 - ) - There is no relationship between the
a. Symmetrical type of current being delivered to the
patient by the generator and the type
- Equal duration and amplitude
of current being used as power source
- For larger muscles, such as to the drive the generator (i.e. wall
quadriceps, soleus and hamstrings outlet or battery (AC) )
b. Asymmetrical
CONVERTING AC TO DC
- Balanced: Equal amplitude and
unequal duration a. Transformer
- Unbalanced: Unequal amplitude and - Regulates Voltage; wall outlets;
unequal duration decrease voltage
b. Rectifier
- For smaller muscle group such as
hands and feet - Converts AC to pulsatile DC
c. Filter
Note: Asymmetrical and Symmetrical are used
for pain management (equally effective)
- Smoothens DC from Pulsed to
Continuous
GENERATORS OF ELECTROTHERAPEUTIC d. Regulator
CURRENTS
 - Regulates/controls voltage
e. Output Amplifier
- Strengthen amplitude
f. Oscillator
- Produced specific waveforms

WAVEFORMS

- Indicates a graphic representation of

the shape, direction, amplitude,
duration, and pulse frequency of the
electrical current the
electrotherapeutic device produces, as
displayed by an instrument called an
oscilloscope.
WAVEFORMS SHAPE
 - Should not be confused with the total
amount of current
being delivered to
the tissues.
B. Peak to Peak
Amplitude
- Twice of the
amplitude
- Distance from one
peak on one direction to peak to other
direction.
PULSE VS PHASE a. Asymmetrical: X
b. Symmetrical: 2X
Pulse
Pulse Charge
- It is an individual waveform, which
may contain one or two phases. - The total amount of electricity being
delivered to the patient during each
Phase pulse.
a. Monophasic Phase Charge = Pulse
- They are the portion of the pulse that Charge
rises above or below the baseline for b. Biphasic Pulse Charge = Sum of phase
some period of time. charge.

RISE TIME & DECAY TIME

Rise Time
Pulse Amplitude
- The time it takes for the current to
- Reflects the intensity of the current increase from 0 to its peak during any
one phase
- The higher the amplitude, the greater
the voltage and intensity - AKA: Rate of Rise
A. Peak Amplitude Decay Time
 - It is the time it takes for the current to
decrease its peak level to 0 during any

one phase.
- Parameters which congregate to the
shape of waveform
Examples

Pulse Period

- On and Off Time

PULSE DURATION AND PHASE DURATION

PULSE DURATION

- It is the time form the beginning of the

first phase to the end of the last phase
of the pulse. (Sometimes referred as
pulse width)
PHASE DURATION

- Refers to the duration of one phase of

a pulse.
Usually expressed in micro or milliseconds.

a. Monophasic: Pulse Duration= Phase

Duration
b. Biphasic: Pulse Duration= Sum of Phase
Duration
 PULSE FREQUENCY

- Describes the number of cycles or

pulses per second.
- Expressed in Hertz (Hz) or pulses per
second (pps) for pulses.
- As the frequency of any waveform
increase, the amplitude tends to
increase and decrease more rapidly

DUTY CYCLE

- The ratio of the on time to the time

cycle.
- On Time: On+Off Time
- Expressed in percentage.

a. Muscle responds with individual

twitch contractions at less than
50 pps. (30- 50pps)
- Twitch contraction only
b. At 50pps or greater, a tetanic
contraction will result, regardless
of the current:
ON: OFF TIME - Sustained contraction
1. Pain Control - Tetanic Contraction: Physiologic
- Continuous PULSE FREQUENCY
- No off time
a. Low-Frequency Current
2. Tissue Healing
- Range: 1-1000 Hz
- Continuous
- TENS, DC
- No off time
b. Medium-Frequency Current
3. Muscle Spasm Relief
- Range: 1000-10,000 Hz
- 1:1
4. Edema Reduction - Interferential, pre-modulated and
Russian protocol.
- 1:1
c. High-Frequency Current
5. Muscle Strengthening
- Range: >10,000 Hz
- 1:5
- US, UVR and IRR
- Allow 50 seconds off time
- Radiant modalities
- Provide rest because the muscles are
weak. MODULATION
 - Refers to any pattern of variation in
one or more of the stimulation
parameters.
- Alteration
- Used to limit neural adaptation to an
electrical current

a. Frequency Modulation (Sweep)

- The frequency modulation of an
interferential current
b. Amplitude Modulation (Scan)
- Amplitude modulation of an
interferential current.
INTERRUPTED MODULATION
- Amplitude modulation of an
interferential current moves the - Current flows for some period of
effective field of stimulation, causing time (on time), and is periodically
the patient to feel the focus of the turned off (off time).
stimulation in a different location.
- Used in monophasic or biphasic
- This may allow the clinician to target a currents
specific area in soft tissue
- Muscle re-education and
c. Pulse or Phase Duration Modulation
strengthening: Commonly used here
PROGRESSION to allow for rest periods of weak
muscle.
- Simplest form of modulation
- Improve ROM
- Decrease Frequency followed by
- Current with sine, rectangular, or
increase amplitude and frequency
triangular shaped waveforms may be
CONTINUOUS MODULATION interrupted

- The amplitude of current flow BURST MODULATION

remains the same for several - AKA: Packets, envelopes, pulse trains
seconds or perhaps minutes.
or beats
- Remove off time
- Occurs when pulsed current flows for
- Associated with Long-pulse duration a short duration (milliseconds) and is
Monophasic Current Flow turned off for a short time
- Used in Iontophoresis: DC (milliseconds) in a repetitive cycle.
- Iontophoresis is used on transdermal - Series of pulses delivered in a package
drug delivery using electrical or envelopes in a single pulse.
currents; more superficial - The interburst interval is much too
short to have any effect on a muscle
contraction.
- Short period of burst
 - Short period of interval Special thanks to Louraine Dynne Dela Cruz
Notes  Copyright 2017
- Short period of burst/current flow

RAMPING MODULATION

- AKA: Surging Modulation

- Current amplitude will increase or
ramp up gradually to some preset
maximum and may also decrease or
ramp down in intensity
- Produce a soft start allowing patients
to be accustomed as it increases from
subsensory level to sensory level and
reach motor threshold.
- Gradual ramp up and ramp down
- Ramping modulation is used clinically
to elicit muscle contraction and is
generally considered to be a very
comfortable type of current since it
allows for a gradual increase in the
intensity of a muscle contraction.