Lecture 5:

Introduction to Electrical Stimulation

Steve Milanese
 Specific Learning goals
• Describe the characteristics of therapeutic currents

• Describe the different forms of currents used

clinically.
• Understand the physiological effects of ES.
• Understand the therapeutic effects of ES.
• Describe the precautions/contraindications
associated with the application of ES
 Remember …........

• Underlying premise = external application of

energy can beneficially alter physiological
processes.
• Proposed mechanisms
– High energy therapies
– Low energy therapies
 Electrical Stimulation

The application of electricity directly to the body

for therapeutic effects
 Electrical Stimulation
The Set-up

Electrical Stimulator
Electrical Stimulation - Principles
Frequency
Electrical Stimulation - Principles
Frequency

Pulse frequency vs Beat frequency

Electrical Stimulation - Principles
Intensity/Amplitude

Voltage vs Ampere
Electrical Stimulation - Principles
Pulse shape / Waveform
Electrical Stimulation - Principles
Pulse Duration Pulse Interval
Electrical Stimulation - Principles
Polarity
Electrical Stimulation - Principles

Modulation

Amplitude Modulation

Frequency Modulation
 Types of current
Current Classification Current Form
Direct Current •Direct Current/Galvanic current
Low Frequency (<1000Hz) •Interrupted DC (IDC)
•Faradic Current
•Transcutaneous Electrical Nerve Stimulation (TENS)
•High Voltage Galvanic Stimulation (HGVS)
•Sinusoidal alternating current
•Diadynamic
Medium Frequency •Interferential (IFT)/Modulated Medium Frequency
(>1000Hz) (MMF)
•Russian Currents
 Direct Current

• Unipolar current
• Anions (-ve ions) move from negative to positive
• Potential for chemical burns
 Direct Current
Physiological effects
1. Stimulates nerves
2. Endogenous energy

Therapeutic effects
3. Pain control
4. Wound healing
5. Muscle fibre stimulation
6. Iontophoresis
Direct Current - Iontophoresis
Movement of chemical depends on
1. Size of chemical molecule
2. Chemical charge
Rate of exchange depends on
3. Skin condition
4. Skin vascularisation under electrode
5. Skin location
6. Current level used
 Low Frequency Current
Interrupted Galvanic – Long pulse durations

• Pulse duration > 1ms

 Interrupted Galvanic
Therapeutic Uses

• Used to stimulate denervated muscle

particularly post Reaction of Degeneration.
 Low Frequency Current
Short pulse durations (<1ms)

1. Faradic currents

Monophasic Biphasic
 Faradic currents
• Pulse Duration: 1ms (0.1 – 1ms)
• Waveform: Triangular
• Pulse interval: 20ms (10ms-33ms)
• Frequency : 30 – 100Hz
 Faradic currents
Therapeutic Effects
• Neuromuscular stimulation – innervated
muscle
– Triangular shape of wave allows greater
accommodation of the sensory nerve fibres
 Transcutaneous Electrical Nerve
Stimulation (TENS)

• Pulse Duration: 0.01ms (0.04 – 0.25ms)

• Waveform: Triangular or square
• Pulse interval: 0.5s – 0.005s
• Frequency : 2 – 200Hz
 TENS
Therapeutic uses

• Pain relief

• Neuromuscular stimulation
High Voltage Galvanic Stimulation
(HVGS)
 HVGS
• Pulse Duration: 0.1ms (0.04 – 0.25ms)
• Waveform: Triangular (of sorts)
• Pulse interval: 0.5s – 0.01s
• Frequency : 2 – 100Hz

Therapeutic Effect
• Wound healing
 Diadynamic Current

• Invented by a French dentist

 Diadynamic Current
Therapeutic use

• ?????????????
 Medium Frequency current (>1KHz)
• Interferential Therapy/Current (IFT/IFC)

• When two currents of different frequencies interact

they interfere with each other and produce a beat
frequency
 Interferential Therapy/Current (IFT/IFC)

Therapeutic uses

• Pain relief – nerve stimulation

• Neuromuscular stimulation

• Same effects as with other currents but deeper

 Russian currents
• An alternating current with frequency of 2.5KHz
• Modulated into small bursts of 50Hz, with 50%
duty cycle
 Physiological Effects of ES on tissues
• Nerve stimulation = Action Potentials
• Sensory/motor and pain nerves all have
different ‘sensitivity’ to current i.e. Strength-
Duration curves
 Physiological Effects of ES
• Skin resistance is related to pulse length i.e.
Higher skin resistance to longer pulse length
(i.e. lower frequency). Higher frequency
currents get in deeper as there is less skin
resistance.
 Physiological Effects of ES

• ?? Effect on endogenous currents

• ?? Influences Galvanataxis

• There is some evidence of a low energy effect

of ES on cell activity
 Therapeutic Effects of ES
Muscle stimulation
• Motor Nerve stimulation
– Strengthening
– Facilitate muscle control
– FES

• Denervated Muscle
 Muscle stimulation
• Electrical stimulation to produce muscle
contraction is different from voluntary
contraction as:
- Synchronous firing of all motor neurons stimulated.
- Large diameter motor neurons (type II) are stimulated
first.
- The frequency of firing is fixed unlike voluntary
contraction.
- Sensory nerves are inevitably stimulated.
- Superficial motor units stimulated
 Muscle stimulation
• Electrical stimulation of muscle through motor
nerve will lead to rapid muscle fatigue due to
fixed stimulated number of motor units and
stimulation of type II fast muscle fibers first.
• The degree and duration of muscle fatigue is
directly related to the extent of the electrical
stimulation.
 Muscle stimulation
• Hon Sun Lai et al. (1988) showed that
electrical stimulation of muscles for 3 weeks
gain more muscle strength in group treated
with high intensity current than other group
treated with low intensity current.
• The force of isometric contraction showed
greater gain than that of concentric
contraction.
• Eccentric contraction showed no significant
gain.
 Sensory nerve stimulation
Non-Nociceptor fibres i.e. Touch (Aβ fibres) have
lower thresholds of excitation and therefore
are stimulated first
Nociceptors i.e. Aδ fibres next, followed by C
fibres
Remember strength-duration curves
Sensory nerve stimulation
 Sensory nerve stimulation
Pain control via
Pain gate control: Lower intensity, comfortable
feeling (> stimulation of Aβ and limited
excitation of nociceptors)
Endorphin system: Higher intensity, less
comfortable (> stimulation of Aδ fibres)
Cortical control: Use of distracting stimulation to
override pain perception
 Other effects

1. Increased Blood flow - ?muscle pump

2. Reduction in Oedema - ?muscle pump or
galvanotaxis
3. Stimulates Autonomic Nervous system
4. Stimulates wound healing
General Principles for Application
of Electrical Stimulation
 Remember........

Electrical Stimulator
 Electrodes
Many different types

Most common are:

a) Self adhesive electrodes
b) Carbon electrodes
 Electrode size
Depends on use.
• Examples
– Pain control
– Muscle stimulation – Innervated vs Denervated
Electrode placement

Unipolar

Bipolar
 Skin Preparation

• Check skin for wounds or skin defects

• Use alcohol wipe or soap to clean off oil
• Ensure patient comfortable
• Check condition of skin following removal of
electrodes
 Precautions with ES
• Circulatory insufficiency.
• Risk of dissemination.
• Exacerbation of existing conditions.
• Unable to communicate.
• Reduced sharp/blunt discrimination
• Over broken skin
 Contraindications with ES
• Where muscle contraction is contra-indicated.
• Over carotid sinus region.
• Transthoracic applications
• To the pelvic region during pregnancy.
• Over an Implanted stimulator.
• Within 3 m of operating Short Wave Diathermy.