E-Stim

Electrical Stimulation
Techniques
2005 FA Davis
Current Flow
Electron Flow
(shown in red)
Between the generators
and electrodes
To and from the generator
Ion Flow
(shown in yellow)
Occurs within the tissues
+
Negative ions flow towards -
+
the anode and away from -
the cathode
Positive ions flow towards
the cathode and away
from the anode
Electrodes
Purpose
Completes the circuit between the generator
and body
Interface between electron and ion flow
Primary site of resistance to current
Materials
Metallic (uses sponges)
Silver
Carbon rubber
Self-adhesive
Electrode Size
Determines the Current Density
Equal size
Bipolar arrangement
Approximately equal effects under
exach
Electrode Arrangements
Based on:
Current Density
Proximity to Each Other
Anatomic Location (Stimulation
Points)
Current Density
Bipolar Technique
Equal current densities
Equal effects under each electrode
(all other factors being equal)
Monopolar Technique
Unequal current densities
At least 4:1 difference
Effects are concentrated under the smaller
electrode
Active Dispersive Active electrode(s)
No effects under larger electrode
Dispersive electrode
Quadripolar Technique
Two bipolar electrode arrangements
Two independent electrical channels
TENS is a common example
Electrode Proximity
Determines the
number of parallel
paths
The farther apart the
electrodes the more
parallel paths are
formed
More current is
required to produce
effects as the
number of paths
increases
Stimulation Points
Motor Points
Superficial location of motor nerve
Predictably located
Motor nerve charts
Trigger Points
Localized, hypersensitive muscle spasm
Trigger referred pain
Arise secondary to pathology
Acupuncture Points
Areas of skin having decreased electrical resistance
May result in pain reduction
Traumatized Areas
Decreased electrical resistance (increased current flow)
Path of Least Resistance
Ion flow will follow the path
of least resistance
Nerves
Blood vessels
The current usually does not
flow from electrode-to-
electrode (the shortest
path)
The path of least resistance
is not necessarily the
shortest path
Selective Stimulation of
Nerves
Nerves always depolarize in the same order
Sensory nerves
Motor nerves
Pain nerves
Muscle fiber
Based on the cross-sectional diameter
Large-diameter nerves depolarize first
Location of the nerve
Superficial nerves depolarize first
Phase Duration and
Nerve Depolarization
Phase duration selectively depolarizes
tissues
Phase Duration Tissue

Short Sensory nerves
Medium Motor nerves
Long Pain nerves
DC Muscle fiber
Adaptations
Patients get used to the treatment
More intense output needed
Habituation
Central nervous system
Brain filters out nonmeaningful, repetitive information
Accommodation
Peripheral nervous system
Depolarization threshold increases
Preventing Adaptation
Vary output (output modulation) to prevent
The longer the current is flowing, the more the current
must be modulated.
Goals
Muscle Contractions
[Instructor Note: More detail on
these techniques are found in the
CH 13 ppt: Treatment Strategies]
2005 FA Davis
Motor-level Stimulation
Comparison of Voluntary and Electrically-Induced
Contractions
Voluntary Electrically-induced
Type I fibers Type II fibers
recruited first recruited first
Asynchronous Synchronous
Decreases fatigue recruitment
GTO protect Based on PPS
muscles GTOs do not limit
contraction
Motor-level Stimulation
Parameters:
Amplitude: Contraction strength increases
as amplitude increases
Phase duration: 300 to 500 sec targets
motor nerves:
The shorter the phase duration, the more
amplitude required
Longer durations will also depolarize pain nerves
Pain often limits quality and quantity of the
contraction
Pulse frequency: Determines the type of
contraction
Pulse Frequency
Frequency determines the time for
mechanical adaptation
Lower pps allows more time (longer
interpulse interverals)
Label Range Result
Low < 15 pps* Twitch: Individual contractions
Medium 15-40 pps* Summation: Contractions blend
High >40 pps* Tonic: Constant contraction
* Approximate values. The actual range varies from person-

to-person and between muscle groups
Effect of Pulse Frequency on
Muscle Contractions
1 pulse per second 20 pulses per second 40 pulses per second

Twitch Contraction Summation Tonic Contraction
The amount of time The amount of time The current is flowing so
between pulses the between pulses allows rapidly that there is not
interpulse interval is some elongation of the sufficient time to allow the
long enough to allow the fibers, but not to their fibers to elongate
muscle fibers to return to starting point.
their original position
Goals
Pain Control
2005 FA Davis
Pain Control
Sensory-level Motor-Level Noxious
Level
Target A-beta fibers Motor nerves A-delta
Tissue C fibers
Phase < 60 sec 120 to 250 sec 1 msec

Duration
Pulse 60 to 100 pps 2 to 4 pps Variable

Frequency 80 to 120 pps
Intensity Submotor Moderate to To tolerance

Strong contraction
Goals
Edema Control and Reduction
2005 FA Davis
Edema Control
Cathode placed over
injured tissues
High pulse frequency
Submotor intensity
Thought to decrease
capillary
permeability
Do not use if edema
has already formed
Edema Reduction
Muscle contractions
milk edema from
extremity
Electrodes follow
the veins path
Alternating rate
targets muscle
groups
Elevate during
treatment
Goals
Fracture Healing
2005 FA Davis
Fracture Healing
Electrical current
triggers bone growth
Piezoelectric effect
within the collagen
matrix
Alternating current
Applied transcutaneously
Similar to diathermy units
(no heat production)
Direct current
Implanted electrodes
Contraindications and
Precautions
2005 FA Davis
Contraindications and
Precautions
Areas of sensitivity Cardiac disability
Carotid sinus Demand-type
Esophagus pacemakers
Larynx Pregnancy (over lumbar
Pharynx and abdominal area)
Around the eyes Menstruation (over
Temporal region lumbar and abdominal
Upper thorax area)
Severe obesity Cancerous lesions (over
area)
Epilepsy Sites of infection (over
In the presence of area)
electronic monitoring
equipment
Exposed metal implants

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Electrical Stimulation

Phase Duration Tissue

* Approximate values. The actual range varies from person-

1 pulse per second 20 pulses per second 40 pulses per second

Phase < 60 sec 120 to 250 sec 1 msec

Pulse 60 to 100 pps 2 to 4 pps Variable

Intensity Submotor Moderate to To tolerance

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