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# ATTR 362 Electrical Stimulation

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## Kenneth Games

on 12 September 2015

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#### Transcript of ATTR 362 Electrical Stimulation

Electrical Stimulation
Principles
Electricity Basics
Electricity
-force created by the imbalance of electrons
What is an electron?
The force of electricity is called electromagnetic force, potential difference, or voltage
Cathode
Anode
Always
Electrical Stimulating Currents
Direct Current
Alternating Current
Pulsed Current
+
-
Direct Current
on
-
-
+
+
t=1
t=2
Alternating Current
Amplitude
P-P Amp
A current that has been modified for specific biophysical effects.
Monophasic
-unidirectional flow of interrupted current (DC)
Biphasic
-bidirectional flow of interrupted current (DC)
Pulsed Current
Biphasic
Monophasic
Pulse
Duration
Phase
Duration
Phase
Duration
Pulse Duration
Important Characteristics
Pulse Period
Intrapulse
Interval
Interpulse
Interval
Pulse Period
Intrapulse
Interval
Interpulse
Interval
Pulse Rise/Decay

Pulse Trains

Amplitude Ramps
Measures of Electrical Current Flow
OHM'S LAW
Know and Understand This!
I = V/R
where I = current, V = voltage, and R = resistance
Knowledge Check
Describe Coulomb's Law in One Sentence
Two Minutes Only!!
Impedance
The resistance to flow
Inductance - ability to store electrical energy in electromagnetic field, negligible in biological tissues
Capacitance - ability to store energy by means of electrostatic field, cell membranes act as capacitors
Excitable Tissue
Skin
Gel
Electrode
Conductor
Insulator
Conductor
WATTAGE
Relationship between Voltage and Amperage
Amperage - Rate of electrical current flow (I)

Voltage - The POTENTIAL for electron flow (V)

Wattage - Used to designate the power of a current (W)
W = V x I
Techniques
Electrical Stimulation
Body Circuit
Excitable Tissue - nerves, muscle fibers, and cell membranes. Directly influenced by electrical current.
Nonexcitable Tissues - bone, cartilage, tendons, adipose, ligaments. Not directly influenced by electrical current.
Therapeutic Uses of Electrical Current
Controlling Pain
Reducing Edema
Reducing Spasm
Minimizing Atrophy
Facilitating Tissue Healing
Facilitating Muscle Re-education
Facilitating Fracture Healing
Effecting orthotic substitution
Path of Least Resistance
A
B
A
B
Electrodes and Electrode Sizes
Metal or carbon filled silicon
Junction point with unit and body
Must create a CLOSED Circuit
Need to reduce skin resistance!!
How?
30V/in2
60V/in2
300v
300v
5 in2
10 in2
Current flow inversely related to electrode size
Less current required in smaller electrodes
Electrode Placement
Monopolar
Bipolar

*Electrode Proximity
Selective Stimulation of Nerves
Subsensory - Zero to first perception - No Benefit

Sensory - Only sensory nerves, no contraction

Motor - Muscle contracts with no pain

Noxious - Stimulates pain fibers

Muscle Fiber - Direct muscle depolarization
EBM
With the exception of wound healing, bone growth stimulators, and iontophoresis, clinical stimulation affects the nerves and has little, if any direct effect on the inflammatory process
Current Attributes Which Can Be Manipulated
Pulse Amplitude (Intensity)
Phase Duration
Pulse Frequency
Twitch
Summation
Tonic
<15
14-40
>40
PPS
Individual Contractions
Blending Contractions
Constant Contraction
NM Effect
Descriptor
Pulse Frequency for Muscle Contractions
E-STIM for Pain Control
Sensory
Motor
Noxious
A-beta
Motor
A-delta C
<100 micro
200-400 micro
1-100 milli
60-100
2-4/80-120
Variable
Submotor
Strong Contraction
As Painful as tolerated
Sensory
Motor
Noxious
Approach
Approach
Nerves
PPS
Intensity
Phase Duration
Other Uses
Blood Flow
Wound Healing
Control and Reduction of Edema
Fracture Healing
EBM
Motor-level swelling reduction appears to be less effective in the acute inflammatory phase of injury response than in later stages