PHYSIOLOGICAL RESPONSE TO

ELECTRICAL CURRENT,NERVE
IMPULSE AND STRENGTH
DURATION CURVE
Physiologic Response To Electrical Current

 Effects may be direct or indirect

 Direct effects occur along lines of current flow and under electrodes
 Indirect effects occur remote to area of current flow and are usually the
result of stimulating a natural physiologic event to occur
 As electricity moves through the body's conductive medium, changes in
the physiologic functioning can occur at various levels
 Cellular

 Tissue

 Segmental

 Systematic
 Effects at Tissue Level
 Skeletal muscle contraction
 Smooth muscle contraction
 Tissue regeneration
 Effects at Segmental Level
 Modification of joint mobility
 Muscle pumping action to change circulation and lymphatic activity
 Alteration of the microvascular system not associated with muscle
pumping
 Increased movement of charged proteins into the lymphatic channels
 Transcutaneous electrical stimulation cannot directly stimulate lymph
smooth muscle or the autonomic nervous system but also stimulating
a motor nerve
 Systematic Effects
 Analgesic effects as endongenous pain suppressors are released and act
at different levels to control pain
 Analgesic effects from the stimulation of certain neurotransmitters to
control neural activity in the presence of pain stimuli
Effects at Cellular Level
 Excitation of nerve cells
 Changes in cell membrane permeability
 Protein synthesis
 Stimulation of fibroblasts and osteoblasts
 Modification of microcirculation
Muscle and Nerve Responses To Electrical Current

 Excitabilitydependent on cell membrane‘s voltage sensitive

permeability
 Producesunequal distribution of charged ions on each side of
the membrane
Creates a potential difference between the interior and
exterior of cell
 Potential difference is known as resting potential
 Cell
tries to maintain electrochemical gradient as its normal
homeostatic environment
Nerve Depolarization
 To create transmission of an impulse in a nerve, the resting
membrane potential must be reduced below threshold level
 Changes in membrane permeability may then occur creating
an action potential, which propagates impulse along nerve in
both directions causing depolarization (detail from clayton)
 Stimulus must have adequate intensity and last long enough
to equal, or exceed membrane's basic threshold for excitation
 Stimulus must alter the membrane so that a number of ions
are pushed across membrane exceeding ability of the active
transport pumps to maintain the resting potential, thus forcing
membrane to depolarize resulting in an action potential
 Depolarization Propagation
 Difference in electrical potential between depolarized region and
neighboring inactive regions causes the electrical current to flow from the
depolarized region to the inactive region
 Forms a complete local circuit and makes the wave of depolarization
“self-propagating”
Depolarization Effects
 Asnerve impulse reaches effector organ or another
nerve cell, impulse is transferred between the two at a
motor end plate or a synapse
 At the motor end plate, a neurotransmitter is released from
nerve
 Neurotransmitter causes depolarization of the muscle cell,
resulting in a twitch muscle contraction
Nonexcitable Tissue and Cells Response To Electrical
Current
 Cell function may speed up
 Cell movement may occur
 Stimulation of extra-cellular protein synthesis
 Increase release of cellular secretions
 Gap junctions unit neighboring cells
 Allow direct communication between adjacent cells (forms electrical
circuit)
 Cells connected by gap junctions can act together when one cell receives
an extracellular message
 The tissue can be coordinated in its response by the gap junction’s
internal message system
 All structures within the cell, membrane, and microtubes are dipoles
 Therefore, all cell structures carry a permanent charge and are capable
of…
 Piezoelectric activity
 Electropiezo activity
 Piezoelectric activity
 Mechanical deformation of the structure causes a change in surface
electrical charge
 Electropiezo activity
 Change in surface electrical charge causes the structure to change
shape
 Important concepts regarding the effects electrical stimulation has on
growth and healing
STRENGTH DURATION CURVE
 Strength duration/Intensity duration curve shows the relationship between
the magnitude of the change of stimulus and the duration of the stimulus.
 The curve provides valuable information regarding the state of excitability
of nerve lesion. It should be done only after 21 days following nerve injury
 Wallerian degeneration: Nerve degenerates proximally to nearest node of
Ranvier and distally throughout whole length. Debris is cleared by
macrophagic activity.
 Process takes up to 21 days to complete and is a preparation for
regeneration.
 Nerve regeneration
 1. Regeneration of axons send out many branches one of which becomes
myelinated and continues to grow down the neural tube.
 2. Growth rate approximately 1 mm per day.
 It occurs unevenly throughout the regeneration period being initially
faster.
 Factor influencing rate of regeneration
 1. Age of the patient – Faster in younger age group
 2. Site of lesion – Faster when lesion is more proximal to spinal cord.
 3. Nature of lesion – Faster following spontaneous regeneration than
following nerve suture.
 Types of Injury
 Seddon’s classification of injury
 Neuropraxia:
 – Loss of conduction without degeneration
 – Nerve conduction possible below lesion
 – Sensory part frequently least affected than motor.
 Axonotmesis:
 – Disruption of axon, but nerve sheath intact
 – Wallerian degeneration is followed by axons regrowing to own end organs.
 Neurotmesis:
 – Disruption of axon and nerve sheath.
 Surgery required approximating nerve sheaths and enabling growing axon to reach
correct end organ.
Shapeof the Curve
Normal innervation
 When all the nerve fibers supplying the muscles are intact, the
strength duration curve has a shape characteristic of normally
innervated muscle (Figs 2.29A and B).
 The curve is of this typical shape because the same strength of
stimulus is required to produce a response with all the impulses of
longer duration, while those of shorter duration require an increase in
the strengths of the stimulus each time the duration is reduced
Figs 2.29A and B: Normally innervated muscle: (A) In constant current; (B) In constant voltage
Complete Denervation
 When all the nerve fibers supplying a muscle have degenerated, the
strength duration produced is characteristic of complete denervation.
 For all impulses with duration of 100 ms or less the strength of the
stimulus must be increased each time the duration is reduced and no
response is obtained to impulses of very short duration.
 So that the curve rises steeply and is further to the right than that of
a normally innervated muscle (Figs 2.30A and B
Complete denervated muscle: (A) In constant current; (B) In constant voltage
Partial Denervation
 1. As impulses shortened—denervated fibers respond less readily.
So that a stronger stimulation is required.
 2. With impulse of shorter duration—innervated fibers responses
(Fig. 2.31).
 When some of the nerve fibers supplying a muscle have degenerated
while others are intact, the characteristic curve obtained clearly
indicates partial denervation. The righthand part of the curve clearly
resembles that of denervated muscle, the left hand part that of
innervated muscle, and a kink is seen at the point where the two
parts meet
Partially denervated muscle
Rheobase
 The rheobase is the smallest current that produces a muscle
contraction if the stimulus is of infinite duration. In practice an
impulse of 100 ms (0.1 s) is used.
 In denervation,the rheobase may be less than that of innervated
muscle and often rises as reinnervation commences.
 The rheobase varies considerably in various muscles and according
to the skin resistance and temperature of the part. The rise of
rheobase may be due to fibrosis of the muscle.
 Chronaxie
 The chronaxie is the duration of shortest impulse that will produce a
response with a current of double the rheobase.
 The chronaxie of the innervated muscle is appreciably less than that
of denervated muscle, the former being less and the latter more than
1 ms if the constant-voltage stimulator is used.
 As practically seen the chronaxie of a muscle with 25% of its fibers
innervated would be the same as that of a complete denervated
muscle.
 Thus, chronaxie is not a satisfactory method of testing electrical
reactions as partial denervation is not clearly shown.