This document discusses superimposed current, which is a type of neuromuscular stimulator that delivers a high voltage, low amperage, short duration current. It can produce both mechanical muscle contractions and chemical changes in the body. Typical uses include increasing range of motion, reducing edema, and managing pain. The document outlines different types of superimposed currents and their physiological effects, as well as precautions for safe use.

1. Superimposed current
Dr. Aasma Ahmed

2. superimposition
 To impose, place or set above or over or on
something else
Or
To put or join as as addition

3. SUPERIMPOSED CURRENT
 A type of neuromuscular stimulator is a short
duration (microsecond), microamperage current
driven by a high voltage current (up to 300 volts)
that is delivered as a twin-peak monophasic
waveform of fixed duration (100
microseconds).
 This direct current can produce both a mechanical
contraction and a chemical change within the body.

4.  While used clinically over the last 45years, this type
of stimulation and its applications have received
much more attention in the last five years.
 Typical indications for use include a wide range of
clinical problems where high voltage may be
applied alone or in combination with other
modalities

5.  HVPGS is the use of a high driving
voltage (up to 500V) to produce analgesia, muscle
contractions, and to facilitate wound healing

6.  Galvanic stimulation combines very short
pulse duration (of constant intensity) and
high peak voltage, yet low total current per
second, to give relative comfort and avoid tissue
damage while stimulating deep tissues. It is also an
efficient means of exciting nerve fibers.

7.  Type; low frequency modified direct current
Duration ... less than 10ms

8. types
 Superimposed direct currents
 Superimposed modified direct currents

9. PHYSIOLOGICAL EFFECTS
 Maintaining or increasing range of motion.
 Re-educating muscles.
 Edema/swelling/inflammation reduction.
 Reducing motor spasticity.
 Increasing local blood circulation to injured
 area and promoting fluid movement to and
 from treatment area

10.  Preventing or retarding muscle disuse
atrophy.
 Managing chronic/post-traumatic/postsurgical pain
conditions allowing patient to participate in their
pain management program.
 Stimulation and acceleration of wound healing by
promoting blood circulation to wound.

11. FOR PAIN MANAGEMENT
 Few studies which concludes that it is not
effective as a pain management
intervention was pblished by Akarcali et al.

12. FOR MUSCLE STRENGTHENING
 Range of research over the years looking
to see if muscle strengthening can be achieved with
EStim - ranging from Interferential therapy, through
Russian Stimulation to NMES based interventions.

13. FOR OEDEMA MANAGEMENT
 Not be directly applicable in the clinical
environment until the transfer of effect has been
verified.

14. CAF
 The central governor is a proposed process in the brain that
regulates
 exercise regarding a neutrally calculated safe exertion by the
body. In particular, physical activity is controlled so that its
intensity cannot threaten the body’s homeostasis by causing
anoxic damage to the heart muscle. The central governor
limits exercise by reducing the neural recruitment of muscle
fibers. This reduced recruitment causes the sensation of
fatigue.
 failure or lack of efficiency of this central governor causes
central activation failure.
 (CAF of quadriceps is associated with osteoarthritis of knee)

15.  Muscle fatigue or neuromuscular disease may result in central
activation failure during maximal voluntary contractions (MVCs).
Superimposition of an electrically stimulated contraction during an
MVC has been used to detect central activation failure.
 To determine the most sensitive means of quantitating central
activation failure using this technique, compare the increment in
isometric force from single, double, and high-frequency trains (50 Hz,
500 or 1000 ms) of stimuli of the nerve imposed during three
separate MVCs of muscles. Completeness of activation can be
quantitated with the central activation ratio (CAR)

16. Method of application
 Two superimposed techniques can be used:
 (i) the twitch interpolation technique (ITT), which
consists of interjecting an electrical stimulus onto
the muscle nerve
 (ii) the percutaneous superimposed electrical
stimulation technique (PST), where the stimulation is
applied to the muscle belly.( burst superimposition)
 treatment session: 5-6 days a week

17. Contraindications
 Skin lesions
 fever
 Infections
 Cardiac pacemakers
 Open skin wounds
 Pregnancy(pregnant uterus)

18. precautions
 take care in case of open skin wound..
 do not apply over pregnant uterus
 do not apply in the vicinity of cardiac pace maker
 educate the patient before the application of
current
 patient should b mentally relaxed.

19. dangers
 electric shock
 hypovolemia
 burns