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Electrical Stimulation HVPC
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© 2005 – FA Davis© 2005 – FA Davis
Electrical StimulationElectrical Stimulation
Clinical ApplicationClinical Application
ParametersParameters
Amplitude:Amplitude:0 to 500 mA0 to 500 mA
VoltageVoltage::0 to 500V0 to 500V
Pulse Frequency: Pulse Frequency: 1 to 120 pps1 to 120 pps
Pulse Duration:Pulse Duration:13 to 100 13 to 100 µµsec sec
Phase DurationPhase Duration::20 to 45 20 to 45 µµsec sec
Adjustable ParametersAdjustable Parameters Duty cycleDuty cycle Electrode alternating rateElectrode alternating rate Electrode balanceElectrode balance IntensityIntensity PolarityPolarity Probe electrodeProbe electrode Surge/Ramp Surge/Ramp
Current: Monophasic
TheoryTheory
Short-duration, high amplitude (voltage) pulses Short-duration, high amplitude (voltage) pulses can produce comfortable, moderate can produce comfortable, moderate contractions.contractions. Short phase duration targets sensory nerves and Short phase duration targets sensory nerves and
motor nervesmotor nerves Wave form is modified to decrease total current to Wave form is modified to decrease total current to
improve comfortimprove comfort Each electrode has a known polarityEach electrode has a known polarity
May cause galvanic (ion) changesMay cause galvanic (ion) changes Short phase duration and long interpulse interval Short phase duration and long interpulse interval
probably negates any effectprobably negates any effect
UsesUses
Reeducation of Reeducation of peripheral nervesperipheral nerves
Delay denervation and Delay denervation and disuse atrophy by disuse atrophy by stimulating muscle stimulating muscle contractionscontractions
Reduction of post-Reduction of post-traumatic edematraumatic edema
Increase in local blood Increase in local blood circulation circulation (unsubstantiated) (unsubstantiated)
Restoring range of Restoring range of motion:motion:
Reduction of muscle Reduction of muscle spasmspasm
Inhibition of spasticityInhibition of spasticity Reeducation of partially Reeducation of partially
denervated muscledenervated muscle Facilitation of voluntary Facilitation of voluntary
motor function motor function
EffectsEffects
Neuromuscular StimulationNeuromuscular Stimulation Moderate to strong muscle contractionsModerate to strong muscle contractions Less torque production than NMESLess torque production than NMES
Pain ControlPain Control Sensory-level (short-term)Sensory-level (short-term) Motor-levelMotor-level Acute pain: Positive electrode over painful siteAcute pain: Positive electrode over painful site Chronic pain: Negative electrode over siteChronic pain: Negative electrode over site
EffectsEffects
Edema ControlEdema Control Negative electrode Negative electrode maymay prevent the prevent the
formation of edemaformation of edema Causes the gaps between endothelial cells Causes the gaps between endothelial cells
to close, preventing leakageto close, preventing leakage
Edema ReductionEdema Reduction Motor-level stimulation “milks” the venous Motor-level stimulation “milks” the venous
and lymphatic vessels.and lymphatic vessels.
EffectsEffects
Blood FlowBlood Flow Associated with frequency and intensity of Associated with frequency and intensity of
muscle contractionmuscle contraction Wound HealingWound Healing
Electrode polarity kills or repels different Electrode polarity kills or repels different microbesmicrobes
Assists healing and inhibits bacteria growthAssists healing and inhibits bacteria growth Direct current techniques are more effective Direct current techniques are more effective
than HVPSthan HVPS
Notes and PrecautionsNotes and Precautions
Motor-level stimulation can cause unwanted Motor-level stimulation can cause unwanted tension on the muscle fibers, the tendons, or tension on the muscle fibers, the tendons, or the bony insertion.the bony insertion.
Muscle fatigue can occur if the duty cycle is too Muscle fatigue can occur if the duty cycle is too high.high.
Intense or prolonged stimulation may result in Intense or prolonged stimulation may result in muscle spasm and/or muscle soreness.muscle spasm and/or muscle soreness.
Improper use can cause electrode burns or Improper use can cause electrode burns or irritation.irritation.
© 2005 – FA Davis© 2005 – FA Davis
Transcutaneous Transcutaneous Electrical Nerve Electrical Nerve StimulationStimulation
ParametersParameters
Total current flowTotal current flow0 to 100 mA0 to 100 mA
Pulse frequencyPulse frequency1 to 150 pps1 to 150 pps
Pulse durationPulse duration10 to 500 10 to 500 µµsec sec
Phase durationPhase duration5 to 250 5 to 250 µµsec sec
Adjustable ParametersAdjustable Parameters IntensityIntensity Mode (output Mode (output
modulation)modulation) Pulse durationPulse duration Pulse frequency Pulse frequency
Current: Biphasic
TheoryTheory
Adjustable phase durations specifically Adjustable phase durations specifically target sensory, motor, and pain fiberstarget sensory, motor, and pain fibers
Phase duration is matched with pulse Phase duration is matched with pulse frequency to produce specific effectsfrequency to produce specific effects
Biphasic form prevents net residual Biphasic form prevents net residual chargecharge
UsesUses
Control of acute or chronic painControl of acute or chronic pain Management of postsurgical painManagement of postsurgical pain Reduction of post-traumatic acute pain Reduction of post-traumatic acute pain
EffectsEffects
High – Frequency TENS (Sensory Level)High – Frequency TENS (Sensory Level) Short phase duration (< 100 Short phase duration (< 100 µsec)µsec) High pulse frequency (60 to 100+ pps)High pulse frequency (60 to 100+ pps) Sensory-level outputSensory-level output Activates spinal gateActivates spinal gate Long-term treatmentLong-term treatment
Output must be modulated to reduce Output must be modulated to reduce accommodationaccommodation
EffectsEffects
Low – Frequency TENS (Motor level)Low – Frequency TENS (Motor level) Long phase duration (150 to 250 Long phase duration (150 to 250 µsec)µsec) Low pulse frequency (2 to 4 pps)Low pulse frequency (2 to 4 pps) Motor-level outputMotor-level output Pituitary gland releases:Pituitary gland releases:
ACTHACTH ββ-lipotropin-lipotropin
Causes the release of Causes the release of ββ-endorphin-endorphin Binds to the A-beta and C fiber receptor sitesBinds to the A-beta and C fiber receptor sites Blocks the transmission of painBlocks the transmission of pain
EffectsEffects
Brief – Intense TENS (Noxious level)Brief – Intense TENS (Noxious level) Long phase duration (300 to 1,000 Long phase duration (300 to 1,000 µsec)µsec) High pulse frequency (> 100 pps)High pulse frequency (> 100 pps) Noxious-level outputNoxious-level output
Very short treatment durationVery short treatment duration
Creates a negative feedback loop in the CNSCreates a negative feedback loop in the CNS Theoretically “short circuits” the pain carrying loopTheoretically “short circuits” the pain carrying loop Opiates inhibit the release of Substance POpiates inhibit the release of Substance P
Blocks or reduces pain transmissionBlocks or reduces pain transmission
Notes and PrecautionsNotes and Precautions
Do not use to treat pain of unknown originDo not use to treat pain of unknown origin TENS is a symptomatic treatmentTENS is a symptomatic treatment Improper use can result in electrode burns or Improper use can result in electrode burns or
skin irritation.skin irritation. Intense or prolonged stimulation may result in Intense or prolonged stimulation may result in
muscle spasm and/or muscle soreness.muscle spasm and/or muscle soreness. Intake of 200 mg or more of caffeine may Intake of 200 mg or more of caffeine may
reduce the effectiveness of TENSreduce the effectiveness of TENS Narcotics decrease the effectiveness of TENSNarcotics decrease the effectiveness of TENS
ParametersParameters
CurrentCurrent: : 1 to 100 mA1 to 100 mACurrent flow (RMS)Current flow (RMS) 0 to 50 mA0 to 50 mAVoltageVoltage:: 0 to 200 V0 to 200 VCarrier FrequencyCarrier Frequency: :
Fixed at 2500 to 5000 HzFixed at 2500 to 5000 HzBeat FrequencyBeat Frequency: : 0 to 299 Hz0 to 299 HzSweep FrequencySweep Frequency: : 10 to 500 µsec 10 to 500 µsec
Adjustable ParametersAdjustable Parameters IntensityIntensity Beat frequency – Analogous to the Beat frequency – Analogous to the
number of cycles or pulses per number of cycles or pulses per secondsecond
Burst duty cycle – Bursts separated Burst duty cycle – Bursts separated by periods of no stimulation by periods of no stimulation (interburst interval)(interburst interval)
Interburst interval – Duration of time Interburst interval – Duration of time between burstsbetween bursts
Premodulation (e.g., Russian Premodulation (e.g., Russian Stimulation)Stimulation)
RampRamp Sweep – Variation in the beat Sweep – Variation in the beat
frequency; Set with a low value and a frequency; Set with a low value and a high valuehigh value
Vector/Scan – Variation in current Vector/Scan – Variation in current intensity intensity
Current: Alternating
Two alternating currents form a single interference current. Premodulated output is based on a single alternating current.
TheoryTheory
High-frequency waves easily overcome High-frequency waves easily overcome skin resistanceskin resistance
The two waves are slightly out of The two waves are slightly out of frequencyfrequency
They cancel each other out and produce They cancel each other out and produce a frequency of 1 to 299 Hz in the tissuesa frequency of 1 to 299 Hz in the tissues
Results in a comfortable stimulation Results in a comfortable stimulation capable of depolarizing sensory and capable of depolarizing sensory and motor nervesmotor nerves
Carrier Wave
=
Variable Wave
Interference Wave
EffectsEffects
Pain ControlPain Control Similar to TENSSimilar to TENS Most frequently used for motor-level pain Most frequently used for motor-level pain
controlcontrol
Muscle ContractionsMuscle Contractions Neuromuscular re-educationNeuromuscular re-education Edema reductionEdema reduction
Notes and PrecautionsNotes and Precautions
Do not use in the presence of unknown Do not use in the presence of unknown pain or pain of central originpain or pain of central origin
Can cause electrode burns, skin irritationCan cause electrode burns, skin irritation Motor-level use can cause muscle spasm Motor-level use can cause muscle spasm
or muscle sorenessor muscle soreness
© 2005 – FA Davis© 2005 – FA Davis
Neuromuscular Neuromuscular Electrical StimulationElectrical Stimulation
ParametersParameters
Total current:Total current:0 to 200 mA0 to 200 mA
Pulse frequency:Pulse frequency:1 to 200 pps1 to 200 pps
Phase duration:Phase duration:20 to 300 20 to 300 µµsecsec
Intrapulse interval:Intrapulse interval:Appx. 100 Appx. 100 µµsecsec
Adjustable ParametersAdjustable Parameters IntensityIntensity Pulses per secondPulses per second Duty cycleDuty cycle Reciprocal rateReciprocal rate Ramp Ramp
Current: Biphasic, Premodulated
TheoryTheory
Current type varies by manufacturerCurrent type varies by manufacturer Tends to have long phase durationTends to have long phase duration Biphasic and alternating current Biphasic and alternating current
decreases possibility of electrode decreases possibility of electrode irritationirritation
UsesUses
Maintaining range of motionMaintaining range of motion Muscle reeducationMuscle reeducation Prevention of joint contracturesPrevention of joint contractures Prevention of disuse atrophyPrevention of disuse atrophy Increasing local blood flowIncreasing local blood flow Decreasing muscle spasm Decreasing muscle spasm
EffectsEffects
Can produce substantial muscular Can produce substantial muscular tensiontension
Capable of increasing strengthCapable of increasing strength Used when limb is immobilizedUsed when limb is immobilized Also slows the onset of atrophyAlso slows the onset of atrophy
Duty cycle is required to prevent fatigueDuty cycle is required to prevent fatigue
Notes and PrecautionsNotes and Precautions
Improper use may result in electrode burns or Improper use may result in electrode burns or skin irritationskin irritation
Intense or prolonged stimulation may result in Intense or prolonged stimulation may result in muscle spasm and/or muscle soreness.muscle spasm and/or muscle soreness.
An electrically induced contraction can An electrically induced contraction can generate too much tension within the musclegenerate too much tension within the muscle
Use caution:Use caution: Musculotendinous lesions, the tension from the Musculotendinous lesions, the tension from the
contraction may injure the muscle or tendon fiberscontraction may injure the muscle or tendon fibers Cases where the muscle’s bony attachment is not Cases where the muscle’s bony attachment is not
securesecure
ParametersParameters
Total current:Total current:Up to 5 mAUp to 5 mA
Voltage:Voltage:80 V80 V
DosageDosage: : 0 to 80 mA/min 0 to 80 mA/min
Adjustable ParametersAdjustable Parameters:: Dosage:Dosage:
AmperageAmperage DurationDuration
PolarityPolarity
Current: Direct
TheoryTheory
The charges associated with a DC can “drive” The charges associated with a DC can “drive” medications into the tissuemedications into the tissue
Medication must have an electrical chargeMedication must have an electrical charge Negative charges driven from the cathodeNegative charges driven from the cathode
Attracted towards the anodeAttracted towards the anode And vice-versaAnd vice-versa
Requires specialized electrodes to hold the Requires specialized electrodes to hold the medicationmedication
Dose-Oriented TreatmentsDose-Oriented Treatments
Medications are Medications are delivered in mA/Mindelivered in mA/Min Milliamp MinutesMilliamp Minutes
Function of the amount Function of the amount of current times the of current times the duration of the duration of the treatment:treatment: 5 mA applied for 20 5 mA applied for 20
minutesminutes 5mA * 20 min = 100 5mA * 20 min = 100
mA/MinmA/Min 4 mA applied for 25 4 mA applied for 25
minutesminutes 4mA * 25 minutes = 100 4mA * 25 minutes = 100
mA/MinmA/Min
Dose-oriented treatments provide the basis for the Ionotopatch™ which delivers the medication using a low current applied for an extended time.
UsesUses
Delivers medication to the tissues Delivers medication to the tissues to treat:to treat: Acute inflammationAcute inflammation Chronic inflammationChronic inflammation ArthritisArthritis Myositis ossificansMyositis ossificans Myofascial pain syndromesMyofascial pain syndromes Delivering local anesthetics before Delivering local anesthetics before
injection or other minor invasive injection or other minor invasive proceduresprocedures
Hyperhidrosis Hyperhidrosis
Sample MedicationsSample MedicationsMedication Pathology Concentration Dosage Polarity
Acetic acid Myositis ossificans 2% 80 mA/Min Negative
Dexamethason Inflammation 4mg Decadron 41 mA/Min Negative and lidocaine Pain control 4% Xylocaine 40 mA/Min Positive
Lidocaine and Pain control 4% Lidocaine 30 mA/Min Positive epinephrine 0.01 mL/1:50,000 30 mA/Min Positive
Dexamethasone Inflammation 2cc 4mg/mL 41 mA/Min Negative
Refer to the prescription for the exact treatment parameters.Each electrode size has a maximum treatment amperage. Consult the packaginginformation included with the electrodes.
Notes and PrecautionsNotes and Precautions
Controlled medications require a physician’s Controlled medications require a physician’s prescription: prescription: Each patient requires his/her own prescriptionEach patient requires his/her own prescription Follow any notes or instructions provided by the pharmacist. Follow any notes or instructions provided by the pharmacist. State practice acts may further regulate the delivery of State practice acts may further regulate the delivery of
iontophoresis.iontophoresis. The exact medication dosage delivered is unknown.The exact medication dosage delivered is unknown. Erythema under the electrodes is commonErythema under the electrodes is common Too intense of a treatment dose can result in electrode Too intense of a treatment dose can result in electrode
burnsburns Do not reuse electrodesDo not reuse electrodes
Medications remain, contaminating the electrode Medications remain, contaminating the electrode
ParametersParameters
Total current flow:Total current flow:1 to 999 1 to 999 µµA (Peak current)A (Peak current)25 to 600 25 to 600 µµA (RMS)A (RMS)
Pulse frequency:Pulse frequency:0.1 to 1000 Hz 0.1 to 1000 Hz
Pulse duration:Pulse duration:0.5 to 5000 0.5 to 5000 µµsecsec
Phase durationPhase duration::0.5 to 5000 0.5 to 5000 µµsec sec
Adjustable ParametersAdjustable Parameters:: IntensityIntensity Polarity/alternating Polarity/alternating
polarity polarity
RampRamp Threshold – Ohm Meter Threshold – Ohm Meter
Current:Monophasic. (Polarity reverses)
TheoryTheory
Small, subsensory pulses can affect the Small, subsensory pulses can affect the function of healing tissuesfunction of healing tissues
Injured tissues have a reversal of their normal Injured tissues have a reversal of their normal electrical charges (“injury potential”)electrical charges (“injury potential”)
MET attempts to normalize the electrical MET attempts to normalize the electrical potentialpotential
Activation of ATP and increased ATP levelsActivation of ATP and increased ATP levels The efficacy of MET has not been The efficacy of MET has not been
substantiated.substantiated.
Uses*Uses*
Acute and chronic Acute and chronic painpain
Acute and chronic Acute and chronic inflammationinflammation
Reduction of edemaReduction of edema SprainsSprains StrainsStrains Contusions Contusions
Temporomandibular Temporomandibular joint dysfunctionjoint dysfunction
Carpal tunnel Carpal tunnel syndromesyndrome
Superficial wound Superficial wound healinghealing
Scar tissueScar tissue Neuropathies Neuropathies
* Efficacy has not been established
Notes and PrecautionsNotes and Precautions
If the patient is dehydrated, nausea, If the patient is dehydrated, nausea, dizziness, and/or headaches may result.dizziness, and/or headaches may result.
Electrical “shocks” may be reported by Electrical “shocks” may be reported by the patient when MET is applied to scar the patient when MET is applied to scar tissue. tissue. Caused by decreased electrical resistance. Caused by decreased electrical resistance.