This document discusses several types of low-frequency electrical stimulation techniques including diadynamic currents, high voltage pulsed galvanic stimulation, microcurrent, and Trabert current. It provides details on the waveform characteristics, physiological effects, indications, contraindications and application parameters for each technique. Diadynamic currents have five classic types that use rectified alternating current to produce monophasic pulses. High voltage galvanic stimulation uses twin peak monophasic pulses of short duration and low duty cycle. Microcurrent uses even lower intensities in the microampere range to stimulate tissue healing. Trabert current is a direct current with a 2 ms pulse and 5 ms interval, producing a frequency of around 143 Hz.

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Low Frequency Stimulation
Advanced Applications

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Diadynamic currents

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Introduction
• Introduced by Pierre Bernard nearly 60 years ago
• rectified alternating current, with a frequency which is
derived directly from the mains supply, resulting in
• monophasic sinusoidal pulses with a duration of 10
ms.

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Types
• Five classic diadynamic current types:
1.Diphasé Fixe (DF)
2.Monophasé Fixe (MF)
3.Courtes Périodes (CP)
4.Longues Périodes (LP)
5.Rhythm Syncopal (RS)

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Diphasé Fixe (DF)
• Fixed di-phase
• full wave rectified AC.,
• Frequency 100Hz
• muscle contraction at high
intensities
• Used for circulatory disorders

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Monophasé Fixe (MF)
• Fixed mono-phase
• Half wave rectified AC.
• Frequency 50Hz
• Strong penetrating vibration
sensation,
• muscle contraction at lower
intensities than DF
• Used for pain without muscle
spasm.

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Courtes Périodes (CP)
• Short periods
• Rapid alternation
• 1 second of DF current and
1 second of MF without
interval pauses.
• Used for traumatic pain
1 sec DF 1 sec MF 1 sec DF

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Longues Périodes (LP)
• Long periods
• Slow alternation
• 6 seconds phase of MF,
followed by 6 seconds phase
of DF
• peak intensity is varied
• Tx of myalgia & neuralgia
• long lasting analgesic effect
6 sec MF 6 sec DF 6 sec MF

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Rhythm Syncopal (RS)
• Syncopal Rhythm
• It comprises 1second phase
of MF, followed by a 1second
rest phase.
• Used for muscle stimulation.
1 sec MF 1 sec Rest 1 sec MF

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Physiological Effects
• Pain masking
• Vasodilatation
• Muscle stimulation
• Sensory stimulation

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Indications
• Soft tissue injury
• Joint disorders
• Circulatory disorders
• Peripheral nerve disorders

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Contraindications
• Open skin: The current tends to concentrate at this point; small
broken areas can be insulated by Vaseline.
• Bony areas: It may produce burn.
• Loss of sensation: It can produce burn.
• Skin lesions: Eczema fungi can be irritated and made worse.
• Infections: It may cause spreading of infection.
• Thrombosis.
• Cardiac pace makers.
• Superficial metal.

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Dosage
• Intensity: It should be increased gradually until definite
vibration or prickling sensation occurs.
• Duration: Not more than 12 minutes; each type for 3
minutes.
• Frequency: Daily or every other day for 12 sessions.

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High Voltage Galvanic Stimulation

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HVPGS
• Originally developed in 1945 by Haslip in the USA and
called ‘Dyna-wave neuromuscular stimulation’.
• High voltage galvanic stimulation (HVGS)
• High Voltage Pulsed Galvanic Stimulation (HVPGS).
• High Voltage Pulsed Current Stimulation (HVPCS)
• Twin Peak Monophasic current

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A. direct current
B. monophasic pulsed DC
C.symmetric biphasic pulsed
D.twin peak monophasic
basic stimulating current forms

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Characteristics of HVPGS
Waveform : Monophasic twin-peak wave
E
BA
D
9900 μs100μs500
V
A. Pulse Duration : 100 μs (Very Short)
B. Interpulse Interval : 9900 μs (Very Long)
C. Duty Cycle : A + B = 10000 μs (10 ms)
D. Peak Amplitude : 500 V
E. Average Current : 1.5 - 2 mA (Very Low)
Although the pulses are high
voltage, they are of very
short duration (microsec)
and thus the actual
(averaged) current flow
through the tissues will be
low.

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• The skin resistance to HVPGS is less because of high
voltage.
• Produces a comfortable tingling sensation and
paresthesia like in high TENS
• The intensity must be gradually increased to comfortable
level
• Treatment duration is 30 - 60 minutes

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Indications
• Wound Healing
• Pain Management
• Edema
• Muscle Strengthening

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Contraindications
1.Do not use on
a. Patient with pacemaker
b. Lumbar and abdominal area of pregnant women
c. Potential malignancies
d. Anterior cervical area

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HVPGS for Wound Healing
• Position patient
• Clean and debride wound
• Cover the wound with layers of sterile gauze soaked in
saline
• Place active electrode over the gauze
• For infected wound active electrode should have
negative polarity
• Positive polarity to promote healing

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Micro current

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• Microcurrent Electrical Neuromuscular Stimulation (MENS)
• Microcurrent Electrical Stimulation (MES)
• Microcurrent therapy (MCT)
• Microamperage stimulation
• Pulsed low intensity direct current
• low-intensity direct current that delivers monophasic or biphasic
pulsed micro amperage currents across the intact surface of the
skin

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MCT
• low-intensity direct current that delivers monophasic or
biphasic pulsed micro amperage currents across the
intact surface of the skin
• the current is so small that there is no tissue resistance
• MCT uses currents that are smaller than those delivered
by standard TENS devices (milliamperes)

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Arndt-Schulz Law
A weak stimuli excite physiological
activity, moderate stimuli favours
it, strong stimuli retards it, and very
strong stimuli arrests it.
A. Pre-threshold: No biological
activation
B. Bio stimulation: activation of
biological response
C. Bio inhibition: Inhibition of biological
process
A B C

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• Chang et al found that 500 microamperes caused
adenosine triphosphate (ATP) to increase by 500% while
a current over 5 milliamperes caused ATP to drop below
baseline norms.
• Further, at 100-500 microamperes, amino acid transport
rose 30-40% above controls.4

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Current of Injury
• Tissue health is maintained by a
direct current electrical system in
the human body
• a shift in this ‘normal current flow’
occurs when tissue is damaged.
• This shift described as the ‘current
of injury’, with a magnitude in the
microampere range
• MET simulates this current of injury
to assist tissue growth and healing.

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Parameter Recommendations
• Exact amplitude, freq, polarity, time & method of application are varied
and debated
• Amplitude: 0 - 900 microamps
• Frequency: 0.1 - 100 Hz
• Polarity: alternating
• Time: 15 - 90 minutes
• Application: probes or silver electrodes

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Effects
• restoring metabolic processes that are responsible for
healing.
• promoting ATP (adenosine triphosphate) production
• remove metabolic wastes is enhanced
• preventing accumulation of toxic substances
• enhancing nutrient distribution and improving blood
circulation

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INDICATIONS
• Pain
• Inflammation
• Spasm
• Wound

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Träbert Current

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• Also known as '2-5 Current'
or 'Ultra-Reiz Current'
• direct current with a
rectangular pulse
• phase duration of 2 ms and a
• phase interval of 5 ms.
• frequency of the current is
approximately 143 Hz.
Träbert Current

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Träbert Current, Application
• Used for pain relief
• Examples of application:
– EL I is used to treat both
headaches and neck
pain.
– EL IV is particularly
suitable for the treatment
of intermittent
claudication

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Träbert Current, Application
• accommodation will occur fairly quickly, due to the absence of frequency
changes or interruptions.
• amplitude is increased in steps, up to the limit of tolerance.
• The muscle contractions must be palpable or just visible.
• As soon as the contractions start to reduce, the current amplitude should
be increased again.
• i.e. at intervals of one minute
• use thick sponges (minimum thickness 1 cm) that are thoroughly wet to
electrodes

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References
1. Adel den RV, Luykx RHJ. Low and medium Frequency Electrotherapy. Enraf-Nonius B.V; 2005: pp 12-13
2. Low J, Reed A. Electrotherapy Explained Principles and practice. 2 edition. Butterworth Heinemann. pp 13,
3. www.kau.edu.sa/Files/0053044/Files/73334_7_Didynamic.doc
4. lib.pt.cu.edu.eg/Diadynamic%20currents%20-%20Copy.ppt
5. www.electrotherapy.org/modality/diadynamic-therapy-
6. http://www.holisticphysicaltherapy.org/Micro_current_therapy.html
7. Watson T. Electrical stimulation for wound healing: a review of current knowledge. In: Kitchen S ed.Electrotherapy: evidence based
practice, 11 edition. Edinburgh: Churchill Livingstone, 2002:313–34
8. Cheng N, Hoof HV, Bockx E. The effects of electric current on ATP generation, protein synthesis, and membrane transport in rat
skin. Clin Orthop Rel Res 1982; 171: 264–72.
9. Seegers JC, Engelbrecht CA, van Papendorp DH.Activation of signal-transduction mechanisms may underlie the therapeutic effects
of an appliedelectric field. Med Hypotheses 2001; 57: 224–30

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