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© 2005 – FA Davis Electrical Stimulation Clinical Application.

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Presentation on theme: "© 2005 – FA Davis Electrical Stimulation Clinical Application."— Presentation transcript:

1 © 2005 – FA Davis Electrical Stimulation Clinical Application

2 © 2005 – FA Davis High Volt Pulsed Stimulation

3 Parameters Amplitude: 0 to 500 mA Voltage: 0 to 500V Pulse Frequency: 1 to 120 pps Pulse Duration: 13 to 100 µsec Phase Duration: 20 to 45 µsec Adjustable Parameters  Duty cycle  Electrode alternating rate  Electrode balance  Intensity  Polarity  Probe electrode  Surge/Ramp Current: Monophasic

4 Theory  Short-duration, high amplitude (voltage) pulses can produce comfortable, moderate contractions.  Short phase duration targets sensory nerves and motor nerves  Wave form is modified to decrease total current to improve comfort  Each electrode has a known polarity  May cause galvanic (ion) changes  Short phase duration and long interpulse interval probably negates any effect

5 Uses  Reeducation of peripheral nerves  Delay denervation and disuse atrophy by stimulating muscle contractions  Reduction of post- traumatic edema  Increase in local blood circulation (unsubstantiated)  Restoring range of motion:  Reduction of muscle spasm  Inhibition of spasticity  Reeducation of partially denervated muscle  Facilitation of voluntary motor function

6 Effects  Neuromuscular Stimulation  Moderate to strong muscle contractions  Less torque production than NMES  Pain Control  Sensory-level (short-term)  Motor-level  Acute pain: Positive electrode over painful site  Chronic pain: Negative electrode over site

7 Effects  Edema Control  Negative electrode may prevent the formation of edema  Causes the gaps between endothelial cells to close, preventing leakage  Edema Reduction  Motor-level stimulation “milks” the venous and lymphatic vessels.

8 Effects  Blood Flow  Associated with frequency and intensity of muscle contraction  Wound Healing  Electrode polarity kills or repels different microbes  Assists healing and inhibits bacteria growth  Direct current techniques are more effective than HVPS

9 Notes and Precautions  Motor-level stimulation can cause unwanted tension on the muscle fibers, the tendons, or the bony insertion.  Muscle fatigue can occur if the duty cycle is too high.  Intense or prolonged stimulation may result in muscle spasm and/or muscle soreness.  Improper use can cause electrode burns or irritation.

10 © 2005 – FA Davis Transcutaneous Electrical Nerve Stimulation

11 Parameters Total current flow 0 to 100 mA Pulse frequency 1 to 150 pps Pulse duration 10 to 500 µsec Phase duration 5 to 250 µsec Adjustable Parameters  Intensity  Mode (output modulation)  Pulse duration  Pulse frequency Current: Biphasic

12 Theory  Adjustable phase durations specifically target sensory, motor, and pain fibers  Phase duration is matched with pulse frequency to produce specific effects  Biphasic form prevents net residual charge

13 Uses  Control of acute or chronic pain  Management of postsurgical pain  Reduction of post-traumatic acute pain

14 Effects  High – Frequency TENS (Sensory Level)  Short phase duration (< 100 µsec)  High pulse frequency (60 to 100+ pps)  Sensory-level output  Activates spinal gate  Long-term treatment  Output must be modulated to reduce accommodation

15 Effects  Low – Frequency TENS (Motor level)  Long phase duration (150 to 250 µsec)  Low pulse frequency (2 to 4 pps)  Motor-level output  Pituitary gland releases:  ACTH  β-lipotropin  Causes the release of β-endorphin  Binds to the A-beta and C fiber receptor sites  Blocks the transmission of pain

16 Effects  Brief – Intense TENS (Noxious level)  Long phase duration (300 to 1,000 µsec)  High pulse frequency (> 100 pps)  Noxious-level output  Very short treatment duration  Creates a negative feedback loop in the CNS  Theoretically “short circuits” the pain carrying loop  Opiates inhibit the release of Substance P  Blocks or reduces pain transmission

17 Notes and Precautions  Do not use to treat pain of unknown origin  TENS is a symptomatic treatment  Improper use can result in electrode burns or skin irritation.  Intense or prolonged stimulation may result in muscle spasm and/or muscle soreness.  Intake of 200 mg or more of caffeine may reduce the effectiveness of TENS  Narcotics decrease the effectiveness of TENS

18 © 2005 – FA Davis Interferrential Stimulation

19 Parameters Current: 1 to 100 mA Current flow (RMS) 0 to 50 mA Voltage:0 to 200 V Carrier Frequency: Fixed at 2500 to 5000 Hz Beat Frequency: 0 to 299 Hz Sweep Frequency: 10 to 500 µsec Adjustable Parameters  Intensity  Beat frequency – Analogous to the number of cycles or pulses per second  Burst duty cycle – Bursts separated by periods of no stimulation (interburst interval)  Interburst interval – Duration of time between bursts  Premodulation (e.g., Russian Stimulation)  Ramp  Sweep – Variation in the beat frequency; Set with a low value and a high value  Vector/Scan – Variation in current intensity Current: Alternating Two alternating currents form a single interference current. Premodulated output is based on a single alternating current.

20 Theory  High-frequency waves easily overcome skin resistance  The two waves are slightly out of frequency  They cancel each other out and produce a frequency of 1 to 299 Hz in the tissues  Results in a comfortable stimulation capable of depolarizing sensory and motor nerves Carrier Wave = Variable Wave Interference Wave

21 Uses  Acute pain  Chronic pain  Muscle spasm

22 Effects  Pain Control  Similar to TENS  Most frequently used for motor-level pain control  Muscle Contractions  Neuromuscular re-education  Edema reduction

23 Notes and Precautions  Do not use in the presence of unknown pain or pain of central origin  Can cause electrode burns, skin irritation  Motor-level use can cause muscle spasm or muscle soreness

24 © 2005 – FA Davis Neuromuscular Electrical Stimulation

25 Parameters Total current: 0 to 200 mA Pulse frequency: 1 to 200 pps Phase duration: 20 to 300 µsec Intrapulse interval: Appx. 100 µsec Adjustable Parameters  Intensity  Pulses per second  Duty cycle  Reciprocal rate  Ramp Current: Biphasic, Premodulated

26 Theory  Current type varies by manufacturer  Tends to have long phase duration  Biphasic and alternating current decreases possibility of electrode irritation

27 Uses  Maintaining range of motion  Muscle reeducation  Prevention of joint contractures  Prevention of disuse atrophy  Increasing local blood flow  Decreasing muscle spasm

28 Effects  Can produce substantial muscular tension  Capable of increasing strength  Used when limb is immobilized  Also slows the onset of atrophy  Duty cycle is required to prevent fatigue

29 Notes and Precautions  Improper use may result in electrode burns or skin irritation  Intense or prolonged stimulation may result in muscle spasm and/or muscle soreness.  An electrically induced contraction can generate too much tension within the muscle  Use caution:  Musculotendinous lesions, the tension from the contraction may injure the muscle or tendon fibers  Cases where the muscle’s bony attachment is not secure

30 © 2005 – FA Davis Iontophoresis

31 Parameters Total current: Up to 5 mA Voltage: 80 V Dosage: 0 to 80 mA/min Adjustable Parameters:  Dosage:  Amperage  Duration  Polarity Current: Direct

32 Theory  The charges associated with a DC can “drive” medications into the tissue  Medication must have an electrical charge  Negative charges driven from the cathode Attracted towards the anode  And vice-versa  Requires specialized electrodes to hold the medication

33 Dose-Oriented Treatments  Medications are delivered in mA/Min  Milliamp Minutes  Function of the amount of current times the duration of the treatment:  5 mA applied for 20 minutes  5mA * 20 min = 100 mA/Min  4 mA applied for 25 minutes  4mA * 25 minutes = 100 mA/Min Dose-oriented treatments provide the basis for the Ionotopatch™ which delivers the medication using a low current applied for an extended time.

34 Uses  Delivers medication to the tissues to treat:  Acute inflammation  Chronic inflammation  Arthritis  Myositis ossificans  Myofascial pain syndromes  Delivering local anesthetics before injection or other minor invasive procedures  Hyperhidrosis

35 Sample Medications MedicationPathologyConcentrationDosagePolarity Acetic acidMyositis ossificans2%80 mA/MinNegative DexamethasonInflammation4mg Decadron41 mA/MinNegative and lidocainePain control4% Xylocaine 40 mA/MinPositive Lidocaine andPain control4% Lidocaine30 mA/MinPositive epinephrine0.01 mL/1:50,00030 mA/MinPositive DexamethasoneInflammation2cc 4mg/mL41 mA/MinNegative Refer to the prescription for the exact treatment parameters. Each electrode size has a maximum treatment amperage. Consult the packaging information included with the electrodes.

36 Notes and Precautions  Controlled medications require a physician’s prescription:  Each patient requires his/her own prescription  Follow any notes or instructions provided by the pharmacist.  State practice acts may further regulate the delivery of iontophoresis.  The exact medication dosage delivered is unknown.  Erythema under the electrodes is common  Too intense of a treatment dose can result in electrode burns  Do not reuse electrodes  Medications remain, contaminating the electrode

37 © 2005 – FA Davis Microcurrent

38 Parameters Total current flow: 1 to 999 µA (Peak current) 25 to 600 µA (RMS) Pulse frequency: 0.1 to 1000 Hz Pulse duration: 0.5 to 5000 µsec Phase duration: 0.5 to 5000 µsec Adjustable Parameters:  Intensity  Polarity/alternating polarity  Ramp  Threshold – Ohm Meter Current:Monophasic. (Polarity reverses)

39 Theory  Small, subsensory pulses can affect the function of healing tissues  Injured tissues have a reversal of their normal electrical charges (“injury potential”)  MET attempts to normalize the electrical potential  Activation of ATP and increased ATP levels  The efficacy of MET has not been substantiated.

40 Uses*  Acute and chronic pain  Acute and chronic inflammation  Reduction of edema  Sprains  Strains  Contusions  Temporomandibular joint dysfunction  Carpal tunnel syndrome  Superficial wound healing  Scar tissue  Neuropathies * Efficacy has not been established

41 Notes and Precautions  If the patient is dehydrated, nausea, dizziness, and/or headaches may result.  Electrical “shocks” may be reported by the patient when MET is applied to scar tissue.  Caused by decreased electrical resistance.


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