Electrostimulation therapy is a well-established physical therapy technique utilizing direct and alternating current to manage musculoskeletal and neurological issues. Key concepts include galvanic and faradic currents for muscle stimulation, with specific applications for pain relief, muscle re-education, and enhancing wound healing. Proper electrode placement and precautions are essential for effective treatment, ensuring patient safety and optimal stimulation.

1. Electrostimulation

2. Electrotherap
y
is one of the
oldest
modalities used
in physical
therapy for the
management of a
wide range of
musculoskeletal
and
neurological
problems

8. Direct (galvanic) Current (DC)
unidirectional Constant electron flow from the
negative to the positive electrode with no
alterations (with constant polarity) .
Alternating Current (AC)
that rhythmically flows between anode & cathode.
An electric current that rise to maximum in one
direction and full back to zero and the rise to
maximum in opposite direction and then repeat .
When the alternating phases are smooth and equal
in energy, they are often referred to as sine
waves .
Currents

16. Physiology

20. Skeletal muscles action
potential

22. • Chronaxie is the minimum time required for an electric current
double the strength of the rheobase to stimulate a muscle or a
neuron.
• Rheobase is the lowest intensity with indefinite pulse duration
which just stimulated muscles or nerves

23. Galvanic current

27. High voltage pulsed galvanic
current

30. Faradic current

32. :

35. Burst AC
Created by flow of
current for a few
milliseconds and then
stop to flow (inter burst
interval or pause period)
and repeat cycle again.
The clinical example of
burst modulation is
Russian Current.

36. Interrupted AC
Done when the current flow for few seconds then
stop to flow for 1 second or more. This
interrupted AC is differ from burst AC because
the inter-pulse interval is longer than the
inter burst interval and this is an advantage
for the interrupted AC because it permits
relaxation from muscle contraction .
The most common example of amplitude modulated
AC is to mix two AC current with different
frequency, and known as interferential current
(IFC) .

39. Tissue response to
electrostimulation

40. Chemical Effects:Ion migration, where ions move
through tissue in response to continuous DC
current (iontophoresis)
Magnetic Effects: electrical current flows in a
conductor causing a magnetic field

41. Kinetic Effects elcsum & noitasnes edulcni(
)noitcartnoc
:
• Moderate-amplitude, high frequency pulsed or AC
stimulation that facilitates wound healing
(twin pulse), edema reduction (twin pulse), and
pain reduction (interferential).
• Twitch contraction, followed by relaxation from
low freq, moderate amp AC facilitates muscle
re-education (biphasic, Russian) and tendinitis
treatments (twin pulse, biphasic, & Russian).
• Tetanic contraction from high amp, high freq AC
(>20-30pps) helps strength development and
spasm reduction (biphasic, Russian)

42. Indications

43. Galvanic current

44. Faradic current

48. FES (Functional Electro-
Stimulation).
Is electrical stimulation of muscle deprived of
normal control to prouduce a functional useful
contraction FES serve to provoke contraction of
paralyzed muscle and to affect sensory pathway
contributing to the normalization of basic
reflex motor activity In this technique, the
application of the electrical stimulus is
combined with activty on the part of patient

50. Precautions
• Burning of the skin
• Electrical discharges (sparks) may occur
• Do not use in the presence of inflammable
anesthetics
• Do not apply over an area where the hair has
been shaved in the past 24hours.
• Known skin allergie

51. Treatment
procedures

52. Preparation of The patient
The skin in the area of electrode placement
should be cleaned thoroughly.
Special gels, sprays or water is applied to the
skin as a condition medium for better
stimulation.
Electrodes should be fixed in position, using
mending tapes to maintain good contact
throughout the treatment period.

53. Securing the device

54. These devices are needed to prevent movement of
the electrodes during treatment. They have to be
of an insulating material coverage to prevent
current conduction on their surfaces.
-Soft-rubber sandbags.
-Lightweight sandbags.
-Adhesive tapes.
-Velcro bands.
-Adhesive gels .

55. Electrodes types

60. Electrodes placement

61. • Unipolar
The unipolar technique is usually termed motor
point stimulation, The motor point is the point
where the motor nerve enters the muscle. This is
usually found at the junction of the proximal
third with the distal two-thirds of the muscle
bellyv or either end of the muscle belly, in
which the active (stimulating) electrode is
placed on the target muscle, while the
indifferent one is placed elsewhere.

62. •Bipolar:
In such a technique, two electrodes are placed
on the target muscle, close to origin /
insertion.
• Bilateral unipolar :
The electrodes are placed on each of two separate
muscles or muscle groups.
•Reciprocal :
In which an active electrode is placed on each of
two separate muscles or muscle groups, either
agonist / antagonist or bilaterally, with the
indifferent electrode placed elsewhere as in
uniploar technique.

63. •Trans-arthral:
The electrodes are
placed on both sides of
the target joint. It
should be clear in mind
that the current does
not pass across the
joint, but instead
flows around the joint
between electrodes

64. Motor points for electrodes
placement