TYPES OF CURRENT AND WAVEFORMS

 Waveform is the geometric configuration of a current, which is described based on its

phase, symmetry, electrical balance, and shape.
 The characteristics of electrical currents can be described as parameters.
 The Clinical Electrophysiology Section of the American Physical Therapy
Association (APTA) in 1986 published a guide to electrical stimulation terminology
that included recommended standard terminology and definitions; a second edition
was published in 2000.
 Electrical current waveforms can be considered to be of three types: direct current
(DC), alternating current (AC), and pulsed current (PC).
 All currents have parameters in the vertical (y coordinate) and horizontal (x
coordinate) directions. Parameters in the horizontal axis are used to describe and
quantify time or duration characteristics of current in (milli- or microseconds),
whereas parameters in the vertical axis are used to describe or quantify magnitude or
intensity (in milli- or microamps or milli- or microvolts).
 By convention, deviation from the isoelectric baseline in the upward direction
implies current flow in the positive direction; conversely, deviation in the downward
direction implies flow in the negative direction.
 DIRECT CURRENT
 Direct current is the continuous unidirectional flow of electrons for atleast 1 second.
 Variations of DC exist, but to accurately be called DC, they must remain
unidirectional and uninterrupted for a period of time. Other forms of DC include
interrupted DC, where the direction of flow ceases after 1 second before resuming
in the same direction for at least 1 second; reversed DC, where the flow ceases after
1 second before resuming in the opposite direction for at least 1 second; and
interrupted reversed DC, which is a combination of both.
 The most common clinical uses of DC are for iontophoresis and wound care.

ALTERNATING CURRENT
 In contrast to DC, alternating current (AC) is the uninterrupted bidirectional
flow of ions or electrons and must change direction at least one time per
second. The rate at which AC switches direction is termed frequency and is
described with the international unit hertz (Hz) or in the unit cycles per
second.
 Clinical use of pure sinusoidal AC is not common; however, modulated forms
of AC, such as burst-modulated AC (i.e., Russian current) and amplitude-
modulated AC (i.e., interferential current), are commonly used.
PULSED CURRENT
 Because the electrophysiological effects of DC or AC are not well suited for
most electrotherapeutic applications, a third category of current has been
designated: pulsed current (PC). Pulsed current, sometimes termed pulsatile
current, is the uni- or bidirectional flow of ions or electrons that periodically
ceases for a period of time before the next electrical event.
 Pulsed current is an interrupted flow of charged particles where the current flows
in a series of pulses separated by periods where no current flows. The current
may flow in only one direction during a pulse, which is known as a monophasic
pulsed current, or it may flow back and forth during a pulse, which is known as a
biphasic pulsed current.
 Monophasic pulsed currents may be used for any clinical application of electrical
stimulation but are most commonly used to promote tissue healing and for acute
edema management. The most commonly encountered monophasic pulsed
current is high-volt pulsed current (HVPC), also known as pulsed galvanic
current.
 Common forms of pulsed current include square, rectangular, and triangular
pulses.

 The generation of two or more consecutive pulses separated from the next series
of consecutive pulses is termed a burst, and the time between bursts is the
interburst interval.
 Pulsed current may be monophasic or biphasic, with a phase being the flow of
current in one direction for a short period of time. A monophasic pulse deviates
from the isoelectric line in only one direction, depending on what direction the
current initially flows before ceasing (i.e., returning to the isoelectric line).
 Monophasic pulsed current is the delivery of repeated monophasic pulses
separated from each other by an interpulse interval; it is produced by
intermittently interrupting a DC current source.
 In contrast to a monophasic pulse, a biphasic pulse is one that deviates from the
isoelectric line first in one direction, then in the other direction. Biphasic pulsed
current, therefore, is the delivery of repeated biphasic pulses separated from the
next pulse by an interpulse interval. By definition, with monophasic pulsed
current, a pulse and a phase are synonymous.

 A biphasic pulsed current may be symmetrical or asymmetrical, and if

asymmetrical, may be balanced or unbalanced. With a symmetrical or a balanced
asymmetrical biphasic pulsed current, the charge of the phases are equal in
amount and opposite in polarity, resulting in a net charge of zero. With an
unbalanced asymmetrical biphasic current, the charge of the phases are not
equal, and there is a net charge. In general, the biphasic pulsed current
waveforms available are balanced.
 The amplitude-dependent characteristics used to describe waveforms reflect the
y coordinate when plotting waveforms. Amplitude, often referred to as intensity,
is the magnitude of current or voltage with respect to the isoelectric or baseline
on the x-y current-time plot.
 Amplitude is reported in units of current (amps, milliamps, or microamps) or
voltage (volts, millivolts, or microvolts) and can be described in terms of a single
phase or both phases. Most uses of ES use milliampere amplitude. The highest
current or voltage reached in a phase of a monophasic pulse or in any one phase
of a biphasic waveform is termed the peak amplitude. The highest value
measured from the peak of the first phase to the peak of the second phase of a
biphasic waveform is termed the peak-to-peak amplitude. For monophasic
waves, there is no peak-to-peak value.
 The time-dependent characteristics used to describe waveforms reflect the x
coordinate when plotting waveforms. Phase duration is the time from the
beginning of one phase to its end. Pulse duration is the time from the beginning
to the end of all phases plus the interphase interval within one pulse. The
interphase interval (or intrapulse interval) is the time between phases of a single
pulse, whereas the interpulse interval is the time between successive pulses.
Phase and pulse duration are most commonly reported in milliseconds (msec) or
microseconds (sec).
 Pulse duration is the total time elapsed from the beginning to the end of a single
pulse, including the inter-phase (intrapulse) interval.
 Pulse duration is often labeled pulse width on many devices. This terminology is
not preferred because pulse duration is a unit of time, whereas width implies a
unit of linear measure.
 MODULATION OF PULSED CURRENT
 Modulation of pulsed current is widely used in electrotherapeutics to impart a
variety of different effects. The duration for which a series of pulses or bursts is
delivered is termed the on-time, and the duration or time between a series of
pulses or bursts is the off-time. The percentage of the on-time to the total time
(on-time plus off-time) multiplied by 100% is termed the duty cycle.
 For example, a clinical application for muscle strengthening may use an on-time
of 10 seconds with an off-time of 40 seconds. The duty cycle of this application
would be 10 seconds (on-time) divided by 50 seconds (total-time) multiplied by
100%, or 20%.
Amplitude Modulation
 Modulation of the amplitude characteristics of pulsed current is used for
differing effects. Often it is necessary to gradually or progressively increase the
amplitude of a current to the desired intensity. Take, for example, stimulating
muscle. A gradual increase in current amplitude and muscle activation may be
more tolerable and ultimately beneficial than a rapid increase and abrupt muscle
contraction.
 Ramp refers to the progressive increase or decrease in amplitude. When the
amplitude is progressively increased, it is termed ramp-up, and when amplitude
is decreased, it is ramp-down. Use of stimulation to facilitate a functional hand
grasp–release may incorporate ramp-up and ramp-down to produce a controlled
and functional activity.
 The terms rise time and fall time are used to describe the time required for the
leading edge of a single phase to reach peak amplitude and the time required for
the trailing edge of a single phase to return to the isoelectric line, respectively.
Ramps are specific to the increase or decrease in the amplitude of a series of
pulses.
 It is important to read the user’s manual for electrotherapeutic devices
so the clinician understands how ramps are incorporated into the total
on- and off-times. For example, some manufacturers include ramp-
down time in the off-time. However, this is problematic because current
is still being delivered during the rampdown and should be considered
on-time.