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Electrical Stimulation

Electrical Stimulation. All Kinds of Choices. Stimulating Units. Fall into one of two categories: Low Volt (Less than 100V) TENS (9V battery) High Volt (Greater than 100V) Pretty much everything else. Carrier Frequencies. Low-frequency currents 1000 pps or less (Monophasic, Biphasic)

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Electrical Stimulation

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  1. Electrical Stimulation All Kinds of Choices

  2. Stimulating Units • Fall into one of two categories: • Low Volt (Less than 100V) • TENS (9V battery) • High Volt (Greater than 100V) • Pretty much everything else

  3. Carrier Frequencies • Low-frequency currents • 1000 pps or less (Monophasic, Biphasic) • Medium-frequency currents • 1000 pps – 100,000 pps (IFC, Russian) • High-frequency currents • 100,000 pps and higher (Diathermies)

  4. Waveforms • Monophasic • Biphasic • Interferential • Pre-modulated Interferential • Russian • TENS • Microcurrent

  5. Monophasic Unidirectional flow of electrons Negative / Positive polarity “Twin Peaked Monophasic”

  6. Peak Current 75 µs Pulse Duration

  7. Biphasic Positive and Negative Phases Symmetrical / Asymmetrical

  8. Interferential Current Two channels at separate frequencies Less skin resistance Quadripolar Electrode Configuration

  9. Interferential Channel1 5,000 Hz Channel 2 5,100 Hz

  10. InterferenceCurrent Beat Frequency: 100 Hz

  11. Ch 1 Ch 2 Ch 2 Ch 1

  12. Pre-modulated IFC Bipolar electrode configuration “Mixing” of currents occurs inside the machine Less penetration than IFC

  13. Russian Classical Russian Stim involves 2500 Hz carrier frequency w/ beat frequency from 1 – 100 Hz Thought to allow more current to reach motor nerve at lower intensities Results have never been duplicated

  14. TENS “Transcutaneous Electrical Nerve Stimulation” Primarily used for pain reduction Gate Control Endogenous-opiate release

  15. Microcurrent Subsensory or very low sensory level Very small current amperage / Very high pulse duration Very theoretical / not much supporting research Attempts to re-establish body’s natural electrical balance by allowing ATP supply to increase  metabolic energy for healing to occur

  16. Levels of Electrical Stimulation • Subsensory • Sensory • Pain Relief • Edema Control • Motor • Pain Relief • Edema Control • Muscle Re-education • Noxious

  17. Subsensory • Microcurrent • Unable to stimulate nerve or muscle • Variety of recommended parameters • Generally consists of 2 – 10 minute Tx’s

  18. 1st Treatment Frequency: 30 Hz Intensity: 600 µA 2nd Treatment Frequency: .3 Hz Intensity : 60 µA Lynn Wallace Pain Mode Frequency: 30 Hz Intensity: 80-100 µA Healing Mode Frequency: .3 Hz Intensity: 20-40 µA Parameters

  19. Sensory Level Pain Relief • Stimulation at or above sensory threshold but below motor level • Stimulation of Aβ fibers • Gate Control Theory

  20. Frequency: 50 – 150 Hz • Phase Duration: Less than 100 µs • Intensity: Comfortably strong

  21. Sensory Level Edema Control • Done immediately following injury to limit formation of edema • Not widely researched but a few theories • Decreased capillary pressure and permeability which keeps plasma and proteins from entering extracellular tissues • Vascular spasm preventing leaking from vessels

  22. Waveform: Monophasic • Frequency: 120 pps • Phase Duration: As high as possible • Intensity: Comfortably strong • Monopolar electrode configuration • Negative electrodes over injured area

  23. Motor Level Pain Control • Best used with subacute / chronic pain • Endogenous opiate release • Longer duration of pain relief • Also good for trigger points

  24. Frequency: Low; 2-4 pps • Phase Duration: Wide; 200-300 µs • Intensity: Strong, twitch contractions

  25. Motor Level Edema Control • Muscular contractions encourage venous and lymphatic “milking” fluids from the area • Electrodes arranged to follow primary vein exiting swollen area • May be continuous or on / off time

  26. Continuous Frequency: 1 – 2pps (or as low as possible) Phase Duration: 200 – 400 µs Intensity: Strong, twitch contractions On / Off time Frequency: 25 – 50pps Phase Duration: 200 – 400 µs Intensity: Strong, tonic contractinons Duty Cycle: 50% 5 on / 5 off 10 on / 10 off

  27. Muscle Re-education • Neuromuscular Electrical Stimulation (NMES) • Muscle re-education, reduction of spasticity, delay of atrophy, muscle strengthening • Stronger type of current, not as comfortable as other forms of ES • Not as effective as voluntary contractions

  28. Frequency: 25 – 50 pps • Phase Duration: 200 – 400 µs • Intensity: Strong tonic contractions

  29. NMES Principles • Duty Cycle • 1:5 (10 on / 50 off)  Strength • 1:2 (10 on / 20 off)  Endurance • 1:1 (10 on / 10 off)  Fatigue • Ramp Times • Fast ramp on: .5 – 1 sec  Power • Long ramp on: 1 – 2 sec  Strength • Long ramp off: 3 – 5 sec  Eccentrics

  30. Noxious Stimuli • Causing pain to relieve pain • Stimulation of Aδ and C fibers • Electrode placement is variable • Generally used as a last resort • Longer lasting pain relief

  31. Frequency: 1-5 pps or 80-100 pps • Phase Duration: 1 ms or higher • Intensity: Noxious (painful)

  32. Conclusion Lots of machines, lots of choices. Everybody is different, so don’t be afraid to try different things if things aren’t going as planned.

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