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ELECTRICALSTIMULATION
Application of suitably modified electric current to
stimulate excitable tissues like nerves and muscles to
produce therapeutic benefits
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ELECTRIC CURRENT
• Flowof electric charge
• Twotypes: direct current andalternating current
• Direct current (DC): theunidirectional flowof electric
charge.
• Alternatingcurrent(AC) : flowof electric charge
periodicallyinreverses direction
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• Electric current can stimulate excitable tissue in body.
• Intermittent current are used
• Current durationrange used:(0.01ms-3sec)
• Short durationless than10msis faradictype-usedfor
stimulation ofnormalmuscle
• Longdurationmorethan10ms is called interrupted
galvanictype–usedfor stimulationofdenervated muscles
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FARADIC CURRENT
• Interrupteddirect current
• Pulseduration- (0.1–1ms)
• Frequency(50–100Hz)
• Surgedformofcurrent is used
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PHYSIOLOGICAL EFFECT OF FADADIC
CURRENT
• Sensorynerve stimulation
• Motornerve stimulation
stimulationwith50Hzfrequency and0.1 –1mswith
surged current
• Effectonmusclecontraction:
• Effectondenervated muscles
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CHEMICAL EFFECTS
• Produces chemicalchanges inelectrodes
• Currentflowinonedirectionforshortperiods
• Noserious danger ofburns
9. STIMULATION OF MOTOR POINTS
• Superficial locationofmotornerve
• Usuallylocated at upper andmiddleone-third of bellyof
muscles
• Suitable frequency anddurationis used
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INDICATIONS OF FARADIC CURRENT
• Facilitation of musclecontraction
• Re–education ofmuscleaction
• Training ofnewmuscleaction
• Neuropraxia of amotornerve
• Severed motornerve
• Improvedvenousandlymphatic drainage
• Prevention andloosening of adhesions
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PHYSIOLOGICALEFFECTSOF
INTERRUPTEDDIRECTCURRENT
• Stimulation of denervated muscles
• Stimulation of sensory nerves
• Stimulation of motornerves
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INDICATIONS
• Toproducecontractions ofdenervated muscles
• Re–education ofmusclesinearlyphase of
re-innervation
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PHYSIOLOGICALRESPONSETO
ELECTRICALCURRENT
• As electricity moves through the body's conductive
medium, changes in the physiologic functioning can
occur at various levels
Cellular
Tissue
Segmental
Systematic
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EFFECTSATSEGMENTALLEVEL
• Modificationof joint mobility
• Musclepumpingaction to change circulationand
lymphatic activity
• Alteration ofthe microvascular systemnotassociated
withmusclepumping
• Increased movementofcharged proteins into the
lymphatic channels
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SYSTEMIC EFFECTS
• Analgesic effects as endogenous pain suppressors are
released andact at different levels to control pain
• Analgesic effects fromthestimulationof certain
neurotransmittersto control neural activity in the presence
of painstimuli
21. ELECTRODES
• Purpose
– Completes the circuit
– Interface between
electron andionflow
– resistance tocurrent
• Materials
– Metallic
– Carbonrubber
– Self-adhesive
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ELECTRODEPLACEMENT
• Electrodesspaced far apart penetrate moredeeply with less
current density
• Largerthe electrode the less density
• Amultitude ofplacement techniques maybeusedto create
desire able clinical andphysiological effects
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STIMULATIONPOINT
• MotorPoints
– Superficial location of motor
nerve
• Trigger Points
– Localized, hypersensitive
musclespasm
– Trigger referred pain
– Arisesecondary to
pathology
• AcupuncturePoints
– Areasofskinhaving
decreasedelectricalresistance
– Mayresult inpainreduction
• Traumatized Areas
– Decreasedelectrical resistance
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NMES
NMESapplieselectrical impulsestothe nervous system to
stimulatesensory and/or motorneurons
CommonUses
• Relaxationof musclespasms
• Preventionor retardation of disuse atrophy
• Improvementof localbloodcirculation
• Re-education ofthe muscle
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FUNCTIONALELECTTRICAL
STIMULATION
• Techniquethat usedelectric currents toactivate nerves
innervatingextremities affected byparalysis and
neurological disabilitiesto restore normal functions
27. MECHANISMOFFES
• Stimulate muscles in aprogrammedsynergysticsequence
that allowpatient toaccomplishaspecific functional
movementpattern
• Multichannel microprocessors
are pre-programmedto execute
varietyofspecific movement
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USES
• Prevent or correct diffuseatrophy
• ImproveROMinstiff joints andspasticity
• Re- education of newmuscleaction inmuscleand
tendon transfers
• Supplementation or substitutionoforthosis
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PARAMETEROFFESCURRENT
• Frequency-(12-100Hz)
• Intensity of current-(90-200)mA
• Pulse duration(20-300)msec
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TENS
• Electrical stimulationwhichprimarilyaims to providea
degree of symptomaticpain relief byexcitingsensory
nerves
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MECHANISMOFTENS
• GateControl Theory(Malzack andWall)
• Activationof peripheral sensory Aβ fibers stimulates the
inhibitoryinterneuroninsubstansiagelatinosa in dorsal
hornsof thespinalcord
• Activated interneuronsproduces inhibitionof pain
carryingA-delta andCfibres andcloses spinal paingate
toprevent painful impulse toreach at sensorycortex
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DESCENDINGPAINCONTROL
• stimulationofsmallerperipheral Aδ andCfibers through
theCNScauses arelease of enkephalins blockingpainat
the spinal cord
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ENDOGENOUSOPIATEPAINCONTROL
• Noxiousstimuluscauses release of β–endorphins and
dynorphinresultingin analgesia
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TYPES OF TENS
High TENS (Sensory Level)
o Duration (100-500µsec)
o Frequency (100-150Hz)
o Sensory-level output
o Activates spinal gate
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LOW TENS
• Duration(100to150µsec)
• Lowpulse frequency(1to5Hz)
• Motor-level output
• Modulationthroughrelease of β-endorphin
38. ELECTRODEPLACEMENT
Negative electrode
• Spinal nerveroots
• Painfulsites
•Dermatomes
• Myotomes
• Trigger points
• Acupuncturepoints
Positive electrodes
• Placed close to spinal
segment
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INTERFERENTIALTHERAPY
• Twomediumfrequency currentspass throughthetissues
simultaneously
• Their pathscross; andinterfere witheachother
• Givesaninterferenceor beat frequency whichhas low-
frequency stimulation
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MECHANISMOFINTERFERENTIAL
THERAPY
• Lowfrequency stimulation of muscleandnervetissues at
sufficient depth withoutpainful and side effects
• Mediumfrequency currents penetrate the tissues with little
resistance, but the resulting interference current allows
effective stimulation of the biological tissues
41. ELECTRODE PLACEMENT
• Whenelectrodes are arranged ina square and
interferential currents are passed throughahomogeneous
medium- apatternofinterferencewill occur
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42. ELECTRODEPLACEMENT
• Ensureadequate coverage of thestimulatedarea
• Placement oftheelectrodes shouldbesuchthat a
crossover effect is achieved in the desiredarea
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