1. Electrical Stimulation Treatment Strategies

2. HVPS: Neuromuscular Stimulation Output Intensity Strong, intense, comfortable contractions. Pulse frequency If duty cycle cannot be adjusted: Low for individual muscle contractions (<15 pps). Adjustable duty cycle: Moderate for tonic contractions (>50 pps). Duty Cycle Initial treatments should begin with a low (e.g, 20%) duty cycle and be increased as the muscle responds. Electrode placement Bipolar: Proximal and distal to the muscle (or muscle group) to be stimulated. This method offers the most direct method of stimulating specific areas. Monopolar: Over motor points or muscle belly. Place the cathode over motor points Bipolar electrode arrangement

3. HVPS: Sensory-level Pain Control Output IntensitySensory level Pulse frequency60 to 100 pps Phase duration<100 µsec* ModeContinuous Electrode arrangementMonopolar or bipolar PolarityAcute: Positive Chronic: Negative Electrode placementDirectly over or surrounding the painful site * Not adjustable on most HVPS units.

4. HVPS: Motor-level Pain Control Output IntensityMotor level Pulse rate2–4 pps Phase duration150–250 µsec ModeContinuous Electrode arrangementMonopolar or bipolar PolarityAcute: positive Chronic: Negative Electrode placementDirectly over the painful site, distal to the spinal nerve root origin, trigger points, or acupuncture points

5. HVPS: Brief-Intense Pain Control Protocol Output IntensityNoxious Pulse rate>120 pps Phase duration300 to 1000 µsec ModeProbe 15 to 60 sec at each site Electrode arrangementMonopolar (probe) PolarityAcute: Positive Chronic: Negative Probe placementGridding technique, stimulating hypersensitive areas working from distal to proximal

6. HVPS: Sensory-level Edema Control Intensity: Sensory level Pulse duration: Maximum possible duration Pulse frequency: 120 pps. Polarity: Negative electrodes over injured tissues Mode: Continuous Electrode placement: The immersion method should be used when possible, or the active electrodes should be grouped over and around the target tissues. Treatment duration –Four 30-minute treatments, followed by 60- minute rest periods or –Four 30-minute treatments, each followed by 30-minute rest periods. Comments –Start treatment as soon as possible after the trauma. –The body part should be wrapped and elevated between sessions. –This treatment regimen should not performed if gross swelling is present. Cathode (-) Anode (+)

7. HVPS: Edema Reduction Intensity: Strong, yet comfortable muscle contraction –Avoid contraindicated joint motio Pulse frequency: Low Polarity: Positive or negative. Mode: Alternating. Electrode placement –Bipolar: Proximal and distal ends of the muscle group proximal to the edematous area. –Monopolar: Active electrodes follow the course of the venous return system. Comment: Ice may be applied to the injured area, but this could impede venous return by increasing the viscosity of fluids in the area

8. IFS: Sensory-level Pain Control Carrier Frequency: Based on patient comfort Burst Frequency: 80 to 150 Hz Sweep: Fast Electrode Arrangement: Quadripolar Electrode Placement: Around the periphery of the target area Output Intensity: Strong sensory level Treatment Duration: 20 to 30 minutes

9. Premodulated Neuromuscular Stimulation Carrier Frequency: 2500 Hz Burst Frequency: 30 to 60 bps Burst Duty Cycle: 10 percent Cycle Duration: 400 µsec On/off Duty Cycle: 10:50 sec Ramp: 2 sec Electrode Placement: Bipolar: Proximal and distal ends of the muscle Output Intensity: Strong muscle contraction. Discomfort may be experienced Treatment Duration: 10 cycles or until fatigue occurs