ELECTROTHERAPY

□ Basics of Electricity
1. Electric field: Area around the charge body wherein the force resulting from the charge are apparent
2. Electrical Current: The flow of electrons through the conducting medium. V
3. Intensity of Electric Current: The rate of flow of electrons (Unit: Amperes = coulomb/second) I α
4. Voltage: The force that moves electron through the conductor.(pd/EMF)
R
5. Resistance: impedance to the flow of electron, opposes flow of electron. (Unit: Ohms Ω)
Bone > Cartilage > Tendon > Skin > Muscle > Blood > Nerve = High to Low Resistance
6. Ohm’s Law: Expresses the relationship between Intensity, voltage and resistance: “ The current is directly proportional to the
voltage and inversely to the resistance .”
Intensity of Electric Current depends Electrical Potential:
Important factors for Electric Current: on: • The properties exhibited by a charged
1. Potential Difference (pd) 1. Potential Difference body that results from a stored-up,
2. Pathway 2. Resistance potential, or energy of its electric
charge and its electrical condition
I. ELECTRICAL STIMULATION (ES)
□ Categories of E.S. according to frequency:
 Low frequency: 1-1000 pps (Wadsworth: 1-2,000Hz)
 Medium frequency: 1,000 to 10,000 pps (Wadsworth:3,000-6,000Hz)
 High frequency: >10,000 pps
□ Muscle Stimulating Current:
□ Therapeutic Electricity Points to consider:
are Characterized by:
1) Duration of Current flow
• Amplitude 2) Frequency of impulses
•    Duration 3) Waveform
• Frequency 4) Depolarization
• Waveform
□ Duration of Current: Frequency of impulse
 May range from 0.01ms to 3,000ms
 more than 10 ms; impulse of long duration • Number of cycles per second ( Hz ).
 less than 10 ms; impulse of short duration • The number of impulse per unit time (pps).
□ Wave forms • Depends partly on pulse duration and mainly
 (Clayton) 1. rectangular 2. trapezoidal 3. triangular 4. saw – tooth on the interval between them.
 Siegelmann •    pd of 1 ms = frequency of 50 to 70 Hz
1. Monophasic (direct or Galvanic current) •    pd of 10 ms = frequency of 50 Hz
 The current flows on one direction only •    pd of 100 ms = frequency of 1.5 Hz
2. Biphasic (alternating current)
 Currents flows in two direction: Half of the cycle above the baseline, one half below
 Single impulse is one complete cycle
 Symmetrical or asymmetrical  Exponential
3. Polyphasic Trapezoidal Progressive Current
 Modified biphasic current having three or more phases in a single pulse Triangular  Selective current
 interferential, Russian Saw-tooth  Accommodation
Current modulation Current
 Continuous mode: Uninterrupted flow
 Interrupted mode: Intermittent cessation of current
 Surge mode: Slow increase and decrease in current intensity
 Ramped mode: Gradual rise in intensity of current, maintained at a determined level for an amount of time followed by a
gradual or sudden drop to zero.
□ Electrolysis: The chemical effects produces by a passage of direct current through an electrolytes
Cathode Anode
 Negative electrode  Positive electrode
 Attraction of positive ions (Na, H)  Attraction of negative ions (OH,Cl)
 Formation of tiny bubbles of H  Formation of large bubbles of O2
 Alkaline reaction  Acidic reaction
 Marked red coloration of skin  less red coloration of skin

Electro Notes (LFC/MFC) 1

□ Erb’s Law; Normal Polar Formula; Pfeugger’s Law : CCC>ACC>AOC>COC
 Catelectrotonus: the state of increasing excitability of a nerve or muscle near the cathode
 Anaelectrotonus: the state of deminished excitability of a nerve or muscle near the anode
□ Innervated v.s denervated (M)
INNERVATED DENERVATED
1 Hz = muscle twitch Sluggish
• Type of (M) Contrn
10 Hz = tremor
50 Hz = tetanic contraction
(vermicular)
• ELECTRICAL EXCITABILITY OF NERVE
AND MUSCLE are governed by the
• Rate of change of current Sudden gradual following:
1.    Intensity of current
• Strength of contraction # of motor unit stim # of muscle fiber 2.   Duration of current flow
3.   Speed at which the current reaches
• Duration of impulse Short long peak intensity

• Polarity used Cathode Anode

□ Sinusoidal current
 Not often use nowadays Physiologic effect & Therapeutic
 Often used for large muscle stimulation Uses of DC
 Rarely used for local muscle stim. 1) Sensory stimulation
 For pain, continues mode is used 2) Hyperemia
 For edema, intermittent 3) Electrotonus
□ Contraindications for ES 4) Relief of Pain
 Should NOT be placed over 5) Acceleration of Healing
 Healing fractures
 Areas of active bleeding
 Malignancies or phlebitis in treatment area
 Superficial metal implants
 Pharyngeal or laryngeal muscles
 Patient with demand-type pace maker, myocardial disease
 Precaution: Over areas of impaired sensation and severe edema
 Electrical modalities with broken or frayed wires or unit that is not connected to a ground fault circuit interrupter

□ GENERAL INDICATIONS OF ELECTRICAL STIMULATION

A. Pain Modulation
1. Activation of Gait Mechanism : ( Gate Theory )
2. Initiation of descending inhibition mechanism : ( endogenous opiate production )
B. Decrease Muscle Spasm
1. Muscle Fatigue: continuous mode, tetanic contraction for several minutes
2. Muscle Pump : interrupted or surge mode, rhythmic contraction & relaxation
3. Muscle Pump and Heat : ES + US
C. Impaired Range of Motion ( Increase in or maintenance of joint mobility )
1. Mechanical stretching of connective tissue and muscle associated with joint.
2. Decrease pain  Galvanotaxic effect
3. Decrease in edema  Inflammation Phase:
D. Soft Tissue Repair (wound healing) o Macrophages – (+)
1. Pulsed Current (mono,bi,polyphasic), interrupted o Mast cells – (-)
 Muscle pump (á circulation) o Neutrophils – (+)/(-)
2. Monophasic Current  Proliferation Phase: (+)
 Low volt continuous current  Wound Contraction Phase: (+) / (-)
 High volt pulsed current  Epithelialization Phase: (+)
 Mechanism: ð low amplitude, 30 – 60 min
 Electrical Potential: Restoration of electrical changes in wound area
 Bactericidal effect: Disruption of DNA, RNA synthesis or cell transport system of microorganism

Electro Notes (LFC/MFC) 2

  Biochemical effects: Increased ATP concentration, amino acid intake, increase protein & DNA synthesis
 Galvanotaxic effect: Attraction of tissue repair via polarity

E. Spasticity: ( ES to reduce hypertonicity )

1. Fatigue of the agonist
2.  Reciprocal inhibition. : (stimulate antagonist/inhibit agonist)

Guidelines for ES Application

1. For Muscle Stimulation:
a. Characteristics of E.S. that are needed to initiate depolarization of excitable cells
 Amplitude / intensity must be strong enough for the membrane potential to reach the threshold levels.
 Duration of impulse must be sufficient to depolarize the cell membrane.
 1 ms or less for nerve cells
 longer that 1ms for muscle cells
 Speed at which the peak intensity is reach
 Fast rate will prevent accommodation (Square wave)
b. Electrode size:
 To complete a circuit, two electrodes are needed.
 One electrode is called “Active” (stimulating) electrode.
 The second electrode, the larger “Dispersive” electrode.
 Current density: the amount of current concentrated under the electrode. Higher in smaller (active) electrode
producing a strong stimulation.
 Large electrode on small treatment area results in overflowing of stimulus to surrounding muscles causing
undesirable effects.
 Small electrodes applied on large muscles increases the current density causing pain.
c. Electrode Placement:
 Active electrode is usually placed over the motor points, the dispersive electrode is placed on a remote site
 Methods:
(1) Unipolar / monopolar technique:
 A single or multiple (bifurcated) active electrode over treatment area.
 A larger dispersive electrode placed ipsilaterally away from treatment area.
(3) Bipolar technique:
 Active and dispersive are of the same size and placed over same muscle group or treatment area
(3) The space between electrodes should be at least the diameter of the active electrode. The farther the electrode
are, the lesser current density on the superficial tissues
PARAMETERS:
1. For Muscle Strengthening, muscle spasm or edema (muscle pump), ROM
a. Slowly increase intensity until muscle contraction is observed.
b. 10 to 25 muscle contractions may be enough.
c. Duty cycle:
 Interrupted/ramped modulation: Allows muscle to rest between stimulus
 On to off ration of 1:3 or more: Minimize the effect of fatigue
2. For muscle spasm (fatigue): Apply a continuous mode
3. For muscle re-education:
a. Parameters are similar to muscle strengthening
b. Multiple sets of singular or multiple muscle repetitions
c. Treatment sessions of 10-30 minutes depending on patient’s mental and physical tolerance.

IONTOPHORESIS
 The transfer of medicinal agent into the tissue through the skin by the use of continuous direct current.
 Principle
 Like charges repel each other; Unlike charges attract each other
 Positive ions move toward the negative pole (cathode) where a secondary alkaline reaction (NaOH) occurs
 Negative ions move toward the positive pole (anode) where an acidic reaction is formed
 The amount of Ions transferred through the skin is directly related to the following;
 Duration of the treatment
 Current density

Electro Notes (LFC/MFC) 3

o Current form Indication Ion Polarity
 Wave form: Monophasic
Concentration of ions in the solutions. Analgesia Lidocaine, Xylocaine Positive
 Modulation: Continuous Salicylate Negative
o Electrode Placement
Calcium deposit Acetate Negative
 Active electrode is the same as the medication to be
Dermal ulcer Zinc Positive
use.
 The active electrode should be twice as large as the Edema reduction Hyalurodinase Positive
positive, regardless of the active electrode to prevent Fungal infection Copper Positive
the alkaline effect. Hyperhydrosis Water Positive/Neg.
 Dispersive may be place proximally or distally 4-6 Muscle spasm Calcium Positive
inches away Magneseum Positive
 Space between electrodes should be at least the Musculoskeltal Infla. Dexamethasone Negative
diameter of the active electrode. conditions Hydrocortisone Positive

o Dosage

The product of time and current intensity

Safe limit: anode-1.0 mA/cm2, Cathode-0.5 mA/cm2

Treatment duration: 10-40 minutes

Observe treatment every 3-5 minutes
o Contraindication:
1. Impaired skin sensation
2. Allergy or sensitivity to medical agent or direct current
3. Denuded area or recent scar
4. Cuts, bruises or broken skin
5. Metal in or near the treatment area
6. Same as for ES

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

□ Electrical Stimulation designed to provide afferent stimulation for pain reduction

□ Principle of Pain Relief
1. Gate Control Theory: Activation of central inhibition of pain transmission
 Stimulating the Large diameter A-Beta fibers activates the inhibitory interneuron (substantia gelatinosa) in the dorsal horn
(lamina 2 & 3) of the spinal cord causing Inhibition of smaller A-Delta and C-fibers (pain fibers).
 Closing of the “gate” and modulation pain by presynaptic inhibition of the T-cells.
2. Descending inhibition/ Endogenous Opiates Theory:
 Pain stimulus stimulates the pituitary gland to produce endorphins
 Strong stimuli also activate the endogenous opiate-rich nuclei, periaqueductal graymatter (PAG), in the midbrain and
thalamus.
 Neurotransmitterfrom the PAG facilitates the cells of the nucleus raphe magnus (NRM), and reticularis gigantocellularis
(RGC).
 Efferent fibers travels through the dorsal lateral funiculus and terminate on the enkephalinergic interneurons in the spinal
cord to presynaptically inhibit the release of substance P from the A-Delta and C-fibers
□ Current form
 Wave form: Asymmetrical biphasic with a zero net direct current component. Other variation may be used.
 Modulation: continuous or burst
□ Methods of Application (Table 3) PARAMETERS (wadsworth)
1. Conventional (high rate) TENS Output = 0 to 100 mA
 The most common mode of TENS. Voltage = up to 150 volts
 Can be applied during the acute or chronic phase of pain. Frequency = 10 to 300 pps
2. Acupuncture-like (strong low rate) TENS Pulse duration = 50 to 500 microseconds
 Can be applied during the chronic phase of pain.
3. Brief intense TENS
 Pulsed for painful procedures (wound debridement, deep friction massage, joint mobilization or passive stretching)
4. Burst mode (pulse trains) TENS
 A combination of both high and low TENS.
 Current is more tolerable to patient than low TENS
5. Hyperstimulation (point stimulation) TENS

Electro Notes (LFC/MFC) 4

  Use of a small probe to locate and painfully stimulate acupuncture or trigger points.
 Multiple sites maybe stimulated per treatment.
6. Modulation mode TENS
 Modulating the parameters to prevent neural or perceptual adaptation due to constant electrical stimulation.

□ Electrode Placement: Electrodes can be placed over;

 Acupuncture site
 Dermatomal distribution of affected nerve
 Painful site
 Proximal or distal to painful site
 Segmentally related myotomes
 Trigger points
□ Indication: Acute and Chronic Pain
□ Contraindication:
 Patient with demand-type pacemaker or over chest of patient with cardiac disease
 Over eyes, laryngeal or pharyngeal muscles, head and neck of patient following CVA or epilepsy
 Over mucosal membranes

HIGH VOLTAGE PULSED MONOPHASIC STIMULATION (HVPC)

□ Monophasic twin-peaked pulses of short duration
 Skin provides high resistance (impedance) to the flow of low voltage current (1MΩ)
 Skin provides low impedance to HVPC due to passage of current in the skin capacitors rather than in the skin resistors.
 Thermal effects are negligible.
NOTE:
□ Current form: Best Current type for
 Wave form: paired monophasic with abrupt rise and exponential fall in intensity wound healing
 Modulation: continuous, surged or interrupted 1. low volt continuous
□ Procedure: monophasic
2. HVPGS
a. For muscle stimulation: Same with E.S.
b. For Wound Healing
 Intact skin surface is normally negative in respect to the deeper dermal layer
 A break in the skin initially develops a positive potential, becoming negative during the healing process
 Tissue healing is retarded with absence or insufficient positive potentials
 Healing can be hasten or promoted by adding a positive potentials through the anode.
 Parameters:
o Amplitude/Intensity: comfortable tingling sensation, paresthesia, no muscle response
o Pulse rate: 50-200 pps
o Pulse duration: 20-100 μsec
o Treatment Duration: 20-60 minutes
 Procedure:
o Clean and debride wound site. Pack with sterile saline soaked gauze.
o Both HVPC & low intensity continuous low volt DC can be used for would healing. Parameters are the same.
o Active electrode (negative for bactericidal effect, positive for clean wound) is placed over the gauze.
 Goals / indications:
a. Inflammatory phase: free from necrosis and exudates. Promote granulation
b. Proliferation phase: reduce wound size including depth, diameter and tunneling
c. Epithelialization phase: stimulate epidermal proliferation and capillary growth.

FUNCTIONAL ELECTRICAL STIMULATION (FES)

□ Also called “functional neuromuscular stimulation” or “Neuromuscular stimulation (NMES)”
□ Uses a wide range of units and techniques for disuse atrophy, impaired ROM, muscle spasm, muscle re-education and
management for spasticity.
□ Use as an alternative or supplement to orthotic devices
□ Indication
1. Shoulder Subluxation:
 Weakness of supraspinatus and posterior deltoid
 Current form:

Electro Notes (LFC/MFC) 5

 o Wave form: asymmetric biphasic square
o Modulation: interrupted
 Electrode placement: Bipolar, supraspinatus and posterior deltoid
 Parameters:
o Amplitude: tetanic muscle contraction to tolerance
o Pulse rate: 12-25pps
o Treatment time: 15-30 minutes. Three times per day up to 6-7 hours
o On/off ratio – 1:3 (2sec: 6sec) progressing to 12:1 (24sec:2sec)
2. Dorsiflexion Assist in Gait Training
 To control foot drop, facilitate dorsiflexion and evertion during swing phase in hemiplegic patient.
 Current form:
o Wave form: Asymmetric biphasic square
o Pulse duration: 20-250 μsec
o Modulation: interrupted by foot switch
 Electrode placement:
o Bipolar: Peroneal nerve (near head of fibula) and tibialis anterior muscles
 Parameters:
o Amplitude: tetanic muscle contraction (enough to decrease plantar flexion)
o Pulse rate: 30-300 pps
o Pressure in swing heels switch stops the stimulus during stance phase or a hand switch held by therapist

MEDIUM FREQUENCY CURRENTS

□ E.S. that uses the frequency between 2,000 to 5,000 pps that are modulated to produce physiologically applied frequencies.
□ Techniques include Russian current (time-modulated) and interferential E.S. (amplitude-modulated).

RUSSIAN CURRENT:
□ Also called “medium frequency, burst alternating current”
□ Uses a carrier frequency of 2,500Hz interrupted with 10ms impulse followed by 10ms interval producing 50 ten-millisecond burst in
one second.
 Current form:
 Wave form: biphasic sinusoidal
 Modulation: continuous pulse with burst modulation
 Indication
 Muscle strengthening
o Amplitude: tetanic muscle contracture  Muscle Spasm
o Muscle fatigue using continuous isometric
o Pulse rate: 50-70 pps
contraction for several minutes to tolerance
o Pulse Duration: 150-200 μsec
o Duty cycle of 1:1 for muscle pump
o Modulation: Ramp 1-5 seconds based on patient’s
o Duty cycle of 2:5 for ROM
tolerance; Duty cycle 1:5
o Current are applied with;
1. Isometric exercise at several points through ROM
2. Slow isokinetic exercise;me.g., 5-100/sec
3. Short arc joint movement when ROM is restricted
 Contraindication: Same as for E.S.

INTERFERENTIAL THERAPY (IFC)

□ Uses two sinusoidal medium frequency applied crossing each other producing an amplitude modulated low frequency (Beat
frequency)
□ The beat frequency is the difference between the two carrier frequency
□ Principles
1. Constructive interference: The sum of the two waves is large when they are in phase
2. Destructive interference: The sum to of the two waves are zero when the waves are180 0 out of phase
3. Beat frequency: Resultant frequency produced by the two frequencies going into and out of phase
a. Constant: When both carrier frequencies are fixed.
b. Variable:
o When one carrier frequency are fixed and the other varies generating a variable or sweep frequency.

Electro Notes (LFC/MFC) 6

 o Sweep used to minimize accommodation.
4. Providing the amplitude of the two individual currents are the same, the resultant current frequency will be the mean of the two
5. Produces a cloverleaf-like pattern, the stimulating effect is at 45 0 angle to the flow of current in the two circuit.
a. Static interferential field: Generated by using four electrodes (two circuits).
b. Dynamic (scan) interferential field:
o Generated when the field is rotated 450 by the vectoring effect of rhythmically unbalancing the IFC.
o Changes the stimulating area, purported to provide the greater area of stimulation in contrast with the static field.
c. Full field scanning: same effect as with dynamic field by bursting the current over the two circuits
6. For small area (two electrodes) the interference occurs in the unit, the pre-modulated current is delivered in one circuit.
□ Current form
 Wave form: sinusoidal (amplitude-modulated) • 100 Hz Constant : Fine vibrations of ion w/o
 Modulation: continuous (pain); interrupted (muscle exercise) heat, Analgesic effect, Vasodilation on
□ Electrode placement sympathetic ganglion (RSD)
 Bipolar (pre-modulated IFC): Active and dispersive electrodes are • 1 to 10 Hz Constant : Muscle contraction only for
placed over or around small area. innervated muscle
 Quadripolar (IFC): Two sets of electrodes placed diagonally to one • 1 to 100 Hz Rhythmic : increase venous &
another over large area. lymphatic flow; for edema & healing process.
□ Parameter • 90 to 100 Hz Rhythmic : Analgesic (neuralgia),
 For pain control: Similar to high or low TENS vasodilation
 For muscle strengthening: Similar to low of medium frequency E.S. • 1 to 10 Hz Rhythmic : muscle contraction for
□ Indication tenacious & gross edema.
 Pain modulation, muscle strengthening and increasing ROM • Electrokinesy : use a glove electrode, deblocking
□ Contraindication: Same with E.S. muscle spasm
□ Physiological Effect :

ELECTROMYOGRAPHY (EMG)
 A graphic representation of the electric currents associated with muscular action.
 Abnormalities at rest
1. Spontaneous fibrillation – characterized by the presence of spontaneous single muscle fiber activity. The most
common cause is interruption of the axon responsible for the innervation of the muscle fibers.
2. Fasciculation – spontaneous discharge of motor units. Clinically visible as a flickering of the muscle under the skin if
they affect motor units near the surface of the muscle.
3. Positive sharp waves – monophasic positive potentials recorded in a muscle the nerve supply of which has been
interrupted. They are sign of denervation.
4. Myotonia – high frequency spontaneous discharges of muscle fibers initiated by touching or moving the muscle or by
voluntary contraction.
5. High frequency discharges – motor unit potentials fire rapidly at high rates at rest.

BIOFEEDBACK
 GOAL: To increase motor performance by facilitating motor learning
 TYPES:
1. Kinematic (Joint motion) Feedback
2. Standing (Balance) Feedback
3. Kinetic (Dynamic Force) Feedback
4. EMG Biofeedback
Kinematic (Joint motion) Feedback
 Uses goniometer or electrogoniometer that corresponds to position of limb segment
 Facilitates an increase in the range of motion
Standing (Balance) Feedback
 Also known as posturography feedback
 Usually used for elderly and others who are at risk of falling
Kinetic (Dynamic Force) Feedback
 Gives information about the amount or rate of loading in the limbs
 GOAL: to inform the patient on the amount of weight bearing on the limbs

Electro Notes (LFC/MFC) 7

 ELECTROMYOGRAPHIC BIOFEEDBACK
□ Reinforcement of voluntary control by using audiovisual signals produced by amplified and converted signals (motor unit action
potentials) generated by contracting muscles.
□ EMG Biofeedback Principles:
 Motor Unit: The functional unit of the neuromuscular system. Consist of anterior horn cell, its axon, the neuromuscular junction
and all the muscle fiber it innervates
 Microvolts (μV): the unit of Motor Unit Potentials (MUP)
 Compound action potential (CAP): MUP’s signals that contains both positive and negative phase
 Signals undergo amplification, rectification (signals are made unidirectional), and integration.
 Integrated signals in microvolt-second (μV/s) are displayed as the EMG biofeedback signals.
 The biofeedback signals produced by patient’s muscle contraction are used to increase or decrease muscle activity.
□ Types of Electrodes
1. Surface electrodes
 For Global detection, detects signals from more than one muscle.
 Easy to apply and good patient/client acceptance
 Superficial muscles are mostly detected and frequently from more than one muscle group
 Types of surface electrode:
 Metal electrode (silver-silver chloride)
 Disposable electrodes
 Carbonized rubber electrodes
2. Needle electrode/sensors
 For local detection: signals from specific muscle or muscle group
 For detection of deep muscles
 Mainly used for diagnosis or research. Rarely used for biofeedback
 Requires skill to apply and less acceptable to patient/client.
□ Application
o Electrode Selection:
 Small electrodes (0.02cm) for specific muscles (hand, forearm, face)
 Large electrode (1.0 cm) for large or group of muscles
o Techniques:
 Bipolar methods: two active (positive and negative) and a single reference (ground) electrode.
o Electrode Placement:
 Active Electrode: on or near the motor point of targeted muscle or muscle group
 Reference electrode: between or adjacent to the active electrode, Placed near the treatment site
o Electrode Distance:
 Active electrode are placed 1 to 5 cm apart and parallel to muscle fibers
 Small distance: Reduces cross talk, yield small signals, more precise signal Answer the ff:
 Large distance: Produces large signals, detects signals from more than one muscle 1. When to use?
• Uses 2. Machine sensitivity?
• Muscle strengthening 3. Inter-electrode space?
• Muscle relaxation 4. Instruction?
□ Strengthening Protocol (for weak muscles) 5. Progression?
 GOAL: to increase EMG signals 6. Facilitation?
 Start with widely spaced electrode and high instrument sensitivity to increase detection
 For single weak muscle, use a closely placed electrode to achieve more precise signals
 Ask patient to make an isometric contraction and hold it for 6-10 sec. To produce an audiovisual signals
 As the motor recruitment ability improves, lower the sensitivity for a more difficult production of signals
 If necessary, use facilitation techniques (tapping, cross facilitation, vibration)
 As patient increasing gains control, progress to a more complex functional movement
 Treatment time: from 5-10 minutes to 30 minutes or more depending on patient’s tolerance
□ Muscle relaxation protocol (for hypertonicity)
 GOAL: to decrease EMG signals
 Start with a closely spaced electrode with low sensitivity to reduce cross talks.

Electro Notes (LFC/MFC) 8

  Ask patient to relax and try to lower the audiovisual signals.
 If necessary, apply relaxation techniques (deep-breathing, imaginary).
 Increase the instrument’s sensitivity as the patient gains muscle relaxation.
 Treatment time: from 5-10 minutes to 30 minutes or more depending on patient’s tolerance.

Electro Notes (LFC/MFC) 9