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Electrotherapy E-Book
Electrotherapy E-Book

Electrotherapy

E-Book

Electrotherapy E-Book
Electrotherapy E-Book

Electrotherapy

Overview

Electrotherapy Overview

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

Introduction

Contraindications

Precautions

Indications

Waveforms

Product Overview

Notes/References

Notes/References Introduction Contraindications Precautions Indications Waveforms Product Overview Notes/References
Notes/References Introduction Contraindications Precautions Indications Waveforms Product Overview Notes/References
Notes/References Introduction Contraindications Precautions Indications Waveforms Product Overview Notes/References

Electrotherapy

Overview

Introduction

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References What is Electrotherapy? • The application of exogenous

What is Electrotherapy?

• The application of exogenous electrical stimulation transmitted through the body via electrodes for a therapeutic purpose

What does it do?

• The waveform current flows through the body from one electrode to the other and causes different physiological reactions depending on the type of current selected, the parameters of the selected current and the output intensity

reactions depending on the type of current selected, the parameters of the selected current and the
reactions depending on the type of current selected, the parameters of the selected current and the

Electrotherapy

Overview

Forms of Electrotherapy

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References NMES ( Neuromuscular Electrical Stimulation) • Stimulation

NMES (Neuromuscular Electrical Stimulation)

• Stimulation through an intact peripheral nerve with therapy goals of increasing muscle strength or to recover motor control

EMS (Electrical Muscle Stimulation)

• Direct stimulation of membranes of devenerated muscle. Treatment goal is to retard muscle atrophy, improve local blood flow

stimulation of membranes of devenerated muscle. Treatment goal is to retard muscle atrophy, improve local blood
stimulation of membranes of devenerated muscle. Treatment goal is to retard muscle atrophy, improve local blood
stimulation of membranes of devenerated muscle. Treatment goal is to retard muscle atrophy, improve local blood
stimulation of membranes of devenerated muscle. Treatment goal is to retard muscle atrophy, improve local blood

Electrotherapy

Overview

Forms of Electrotherapy

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References FES ( Functional Electrical Stimulation) • NMES to

FES (Functional Electrical Stimulation)

• NMES to facilitate a function (i.e. walking, grasping etc.)

• Stimulation delivered in timed manner

• Difficult to achieve coordinated movement

TENS (Transcutaneous Electrical Nerve Stimulation)

• For pain management

• Externally applied

• Portable

movement TENS ( Transcutaneous Electrical Nerve Stimulation) • For pain management • Externally applied • Portable
movement TENS ( Transcutaneous Electrical Nerve Stimulation) • For pain management • Externally applied • Portable
movement TENS ( Transcutaneous Electrical Nerve Stimulation) • For pain management • Externally applied • Portable
movement TENS ( Transcutaneous Electrical Nerve Stimulation) • For pain management • Externally applied • Portable

Electrotherapy

Overview

Current Flow

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Flow of charged particles between electrodes • Current

• Flow of charged particles between electrodes

• Current flow is measured in mille-Amperes (mA)

• Neurons in the path of current flow depolarize when critical threshold is reached

is measured in mille-Amperes (mA) • Neurons in the path of current flow depolarize when critical
is measured in mille-Amperes (mA) • Neurons in the path of current flow depolarize when critical
is measured in mille-Amperes (mA) • Neurons in the path of current flow depolarize when critical

Electrotherapy

Overview

Polarity

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Difference in electrical charge between two sides of a

Difference in electrical charge between two sides of a membrane

Nerve cell

• Positive outside

• Negative inside

Difference in electrical charge between two sides of a membrane Nerve cell • Positive outside •
Difference in electrical charge between two sides of a membrane Nerve cell • Positive outside •
Difference in electrical charge between two sides of a membrane Nerve cell • Positive outside •

Electrotherapy

Overview

Depolarization

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Polarity reverses temporarily • Positive inside •

Polarity reverses temporarily

• Positive inside

• Negative outside

Functions • Program Navigation Notes/References Polarity reverses temporarily • Positive inside • Negative outside
Functions • Program Navigation Notes/References Polarity reverses temporarily • Positive inside • Negative outside
Functions • Program Navigation Notes/References Polarity reverses temporarily • Positive inside • Negative outside
Functions • Program Navigation Notes/References Polarity reverses temporarily • Positive inside • Negative outside

Electrotherapy

Overview

Action Potential

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Depolarization travels muscle and or spine resulting in: •

Depolarization travels muscle and or spine resulting in:

• Contraction • Sensation
• Contraction
• Sensation
Navigation Notes/References Depolarization travels muscle and or spine resulting in: • Contraction • Sensation
Navigation Notes/References Depolarization travels muscle and or spine resulting in: • Contraction • Sensation

Electrotherapy

Overview

Current Intensity (Amplitude)

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Increasing the intensity (current flow) will do the

Increasing the intensity (current flow) will do the following:

• Increase the depth of penetration

• Increase the number of neurons depolarized

both superficially and deeper

• Increase the depth of penetration • Increase the number of neurons depolarized both superficially and
• Increase the depth of penetration • Increase the number of neurons depolarized both superficially and

VS

• Increase the depth of penetration • Increase the number of neurons depolarized both superficially and
• Increase the depth of penetration • Increase the number of neurons depolarized both superficially and
• Increase the depth of penetration • Increase the number of neurons depolarized both superficially and

Electrotherapy

Overview

Ohm’s Law

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Current flow (intensity/amplitude) changes with changing

• Current flow (intensity/amplitude) changes with changing resistance

• Ohms’ law (I = V/R) governs the relationship between intensity and resistance

I= Current
I= Current
= V/R) governs the relationship between intensity and resistance I= Current V = V o l

V = Voltage

R = Resistance

= V/R) governs the relationship between intensity and resistance I= Current V = V o l
= V/R) governs the relationship between intensity and resistance I= Current V = V o l

Electrotherapy

Overview

CV or CC

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Constant Voltage • Machine keeps voltage constant

Constant Voltage

• Machine keeps voltage constant regardless of changing resistance

• Intensity level can fluctuate (and therapeutic effect )

• Ideal for dynamic, high intensity applications since risk of discomfort is low

Constant Current

• Machine keeps intensity constant by changing the voltage to compensate of changing resistance

• Very constant stimulation

• Possible discomfort with small electrodes

voltage to compensate of changing resistance • Very constant stimulation • Possible discomfort with small electrodes
voltage to compensate of changing resistance • Very constant stimulation • Possible discomfort with small electrodes

Electrotherapy

Overview

Constant Current (CC)

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • When Current is needed to remain Constant • If

• When Current is needed to remain Constant

• If Resistance (skin impedance, electrode issues, etc.) goes up

• What does Voltage have to do to keep Current Constant?

• Voltage has to increase when Resistance goes up in order to keep Current Constant

when Resistance goes up in order to keep Current Constant C = Current · V =
when Resistance goes up in order to keep Current Constant C = Current · V =
when Resistance goes up in order to keep Current Constant C = Current · V =

C = Current · V = Voltage · R = Resistance

Constant C = Current · V = Voltage · R = Resistance Therefore, when in CC,

Therefore, when in CC, the Voltage level will increase as the Resistance level increases

· V = Voltage · R = Resistance Therefore, when in CC, the Voltage level will
· V = Voltage · R = Resistance Therefore, when in CC, the Voltage level will

Electrotherapy

Overview

Constant Voltage (CV)

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • When Voltage is needed to remain Constant • If

• When Voltage is needed to remain Constant

• If Resistance (skin impedance, electrode issues, etc.) goes up

• What does Current have to do to keep Voltage Constant?

• Current has to decrease when Resistance goes up in order to keep Voltage Constant

Therefore, when in CV, the Current level will decrease as the Resistance level increases, thus making CV a potentially more comfortable form of delivery.

increases, thus making CV a potentially more comfortable form of delivery. C = Current · V

C = Current · V = Voltage · R = Resistance

increases, thus making CV a potentially more comfortable form of delivery. C = Current · V
increases, thus making CV a potentially more comfortable form of delivery. C = Current · V
increases, thus making CV a potentially more comfortable form of delivery. C = Current · V

Electrotherapy

Overview

Pulse

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Isolated electrical event separated by a finite time

• Isolated electrical event separated by a finite time from the next event

• Pulse duration usually measured in microseconds (µs)

• Each Pulse contains one or more phases

• Phase duration determines which size neuron is stimulated

(µs) • Each Pulse contains one or more phases • Phase duration determines which size neuron
(µs) • Each Pulse contains one or more phases • Phase duration determines which size neuron
(µs) • Each Pulse contains one or more phases • Phase duration determines which size neuron

Electrotherapy

Overview

Pulse and Size Principle

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References < 150µs • Sensory - touch, vibration and

< 150µs

• Sensory - touch, vibration and proprioception

• Large Motor - fast twitch contractions

150 – 250µs

• Large Motor - fast twitch contractions 150 – 250µs • Small motor - slow twitch

• Small motor - slow twitch contractions

• Sensory - pinprick, intense heat or cold

> 250µs

• Nociceptive noxious “slow” pain

slow twitch contractions • Sensory - pinprick, intense heat or cold > 250µs • Nociceptive noxious
slow twitch contractions • Sensory - pinprick, intense heat or cold > 250µs • Nociceptive noxious

Electrotherapy

Overview

Frequency

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Number of pulses per second • Expressed as pulses

• Number of pulses per second

• Expressed as pulses per second (pps) or Hertz (Hz)

• Determines which neurons are stimulated most effectively

• Large neurons 80-150 Hz

» A sensory

» Fast twitch motor

Large neurons 80-150 Hz » A sensory » Fast twitch motor Frequency • Slow twitch motor

Frequency

• Slow twitch motor neurons: 25-35Hz

• Small myelinated A sensory neurons: 1-10Hz

» Fast twitch motor Frequency • Slow twitch motor neurons: 25-35Hz • Small myelinated A sensory
» Fast twitch motor Frequency • Slow twitch motor neurons: 25-35Hz • Small myelinated A sensory

Electrotherapy

Overview

Electrodes

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Always clean and prepare the skin prior to use

• Always clean and prepare the skin prior to use and monitor throughout treatment

• Electrodes should be placed so the flow of current can reach the target tissue

• Should have low impedance

• Conduct current uniformly

• Maintain uniform contact

• Allow for movement of the skin and muscle

• The farther apart the deeper the

penetration

and muscle • The farther apart the deeper the penetration • Placed to close the potential

• Placed to close the potential exists for greater concentration superficially this can result in discomfort or burn

• Placed to close the potential exists for greater concentration superficially this can result in discomfort
• Placed to close the potential exists for greater concentration superficially this can result in discomfort

Electrotherapy

Overview

Contraindications

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Should not be used for pain relief unless the

• Should not be used for pain relief unless the etiology is established or pain syndrome has been diagnosed

• When cancerous lesions are present in the treatment area

• There should not be any use of any TENS waveforms or powered muscle stimulators on patients with cardiac demand pacemakers

• Stimulation should not be applied over swollen, infected, inflamed areas of skin eruptions (e.g. phlebitis, thromobophlebitis, varicose veins, etc.

• Electrode placement must be avoided that apply current to the carotid sinus region (anterior neck) or trancerebrally (through the head)

• Safety has not been established for the use of therapeutic electrical stimulation during pregnancy

(through the head) • Safety has not been established for the use of therapeutic electrical stimulation
(through the head) • Safety has not been established for the use of therapeutic electrical stimulation

Electrotherapy

Overview

Precautions

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

• Individuals who cannot give clear feedback or over anesthetic skin

» Patient can not indicate when current is hurting

• Over areas of peripheral vascular disease (PVD) or thrombophlebitis

» Strong contractions may trigger the release emboli

• In patients with pacemakers or other implanted electrodes

» Electrical field may interfere with function of implanted device

» Extreme caution in patients with ICD

• Over areas of excess adipose tissue

» High intensity stimulation may be required to overcome resistance of fat –may lead to adverse autonomic response

• In conditions where active motion is contraindicated

» Stimulation may cause movement through muscle contraction

• In known seizure disorders

» Stimulation may trigger a seizure

• Over open wounds, unless specifically treating the wound

» Except for specialty electrodes, electrodes are usually not sterile

wounds, unless specifically treating the wound » Except for specialty electrodes, electrodes are usually not sterile
wounds, unless specifically treating the wound » Except for specialty electrodes, electrodes are usually not sterile
wounds, unless specifically treating the wound » Except for specialty electrodes, electrodes are usually not sterile

Electrotherapy

Overview

FDA Cleared Indications

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Pain Management » » Chronic Acute • Relaxation of

• Pain Management

»

» Chronic

Acute

• Relaxation of Muscle Spasms

• Maintaining/Increasing Joint Range of Motion

• Prevent/Retard Muscle Atrophy

• Muscle Re-Education

• Increase Local Blood Circulation

• Stroke Muscle Re-Education (sEMG +Stim)

Muscle Atrophy • Muscle Re-Education • Increase Local Blood Circulation • Stroke Muscle Re-Education (sEMG +Stim)
Muscle Atrophy • Muscle Re-Education • Increase Local Blood Circulation • Stroke Muscle Re-Education (sEMG +Stim)

Electrotherapy

Overview

Pain Management

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Pain Modulation • Melzack and Wall first to formulate the

Pain Modulation

• Melzack and Wall first to formulate the “Gate Control Theory” 1965 • Refinement and research identified two mechanisms of pain modulation in the dorsal column of the spinal cord

» Gate System through peripheral neural activity

» Opiate System through central neural activity

of the spinal cord » Gate System through peripheral neural activity » Opiate System through central
of the spinal cord » Gate System through peripheral neural activity » Opiate System through central
of the spinal cord » Gate System through peripheral neural activity » Opiate System through central

Electrotherapy

Overview

Gate System

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Large diameter myelinated peripheral sensory nerves

• Large diameter myelinated peripheral sensory nerves (A-Beta) respond to electrical stimulation and inhibit the transmission of pain signals

• This occurs in the spinal cord

(A-Beta) respond to electrical stimulation and inhibit the transmission of pain signals • This occurs in
(A-Beta) respond to electrical stimulation and inhibit the transmission of pain signals • This occurs in
(A-Beta) respond to electrical stimulation and inhibit the transmission of pain signals • This occurs in

Electrotherapy

Overview

Opiate System

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Peripheral sensory neurons (A-delta) stimulate endorphin

• Peripheral sensory neurons (A-delta) stimulate endorphin release (CNS)

• Released endorphins stimulate descending neurons to spinal cord

• These stimulate inhibitory spinal neurons

(CNS) • Released endorphins stimulate descending neurons to spinal cord • These stimulate inhibitory spinal neurons
(CNS) • Released endorphins stimulate descending neurons to spinal cord • These stimulate inhibitory spinal neurons
(CNS) • Released endorphins stimulate descending neurons to spinal cord • These stimulate inhibitory spinal neurons

Electrotherapy

Overview

Gate vs. Opiate

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Gate System • Therapy Goal: Immediate analgesia •

Gate System

• Therapy Goal: Immediate analgesia

• Stimulating Aß fibers in the segment of pain

• Low to medium intensity stimulation

• Frequency: 50-100 Hz

• Therapeutic effect:

Immediate pain relief of short duration

Opiate System

• Therapy Goal: Long term analgesia

• Stimulating the A fibers in the general area of pain

• High to noxious stimulation

• Frequency: 1-10 Hz

• Therapeutic effect; Slow onset pain relief of long duration

• High to noxious stimulation • Frequency: 1-10 Hz • Therapeutic effect; Slow onset pain relief
• High to noxious stimulation • Frequency: 1-10 Hz • Therapeutic effect; Slow onset pain relief

Electrotherapy

Overview

Sensory Level Electroanalgesia Protocol

Introduction

Contraindications

   

Precautions

Parameter

Setting

   
 

Mechanism of

Gate System

Indications

effect

• Pain Management

Target Neurons

Aß in pain dermatome

• Relaxation of Muscle Spasms

Waveform

IFC or Premod

• Muscle Strengthening

Frequency

>80 Hz or sweep 80-150

Hz

• Muscle Re-Education

• Increasing Circlulation

Duty cycle

Continuous

• Edema Management

Duration of Rx

20 minutes or longer as determined by

clinician

• sEMG +Stim

Waveforms

 

Perceptible tingling, no motor or pain response should be

Product Overview

Intensity

• Features and Functions

elicited

• Program Navigation

Current mode

CV

Notes/References

Electrode

In dermatome of pain

Location

CV Notes/References Electrode In dermatome of pain Location Electrode Placement Dermatome Distribution
CV Notes/References Electrode In dermatome of pain Location Electrode Placement Dermatome Distribution

Electrode Placement Dermatome Distribution

CV Notes/References Electrode In dermatome of pain Location Electrode Placement Dermatome Distribution
CV Notes/References Electrode In dermatome of pain Location Electrode Placement Dermatome Distribution

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Notes: • This Rx is believed to relieve pain through

Notes:

• This Rx is believed to relieve pain through the Gate Control Theory of Pain Modulation via hyperstimulation of A-beta nerves 1,2

• The literature reports little residual pain relief post Rx ( 1 hour). Pain relief beyond this time may occur if the pain-spasm cycle has been interrupted

• To dose to correct amplitude: turn up to the point of producing muscle twitch and then back off slightly. No observable, palpable, or perceptible muscle contraction

• This Rx can be performed using pulsed current, interferential current (AC), Premodulated current (AC), and high volt pulsed current

References (Sensory level electroanalgesia):

1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-976.

2. Wall PD. The gate control theory of pain mechanisms: a reexamination and restatement. Brain. 1978;101:1-18

3. Gallo JA. Analysis of strength duration in 20 subjects. Unpublished data. 2005

and restatement. Brain. 1978;101:1-18 3. Gallo JA. Analysis of strength duration in 20 subjects. Unpublished data.
and restatement. Brain. 1978;101:1-18 3. Gallo JA. Analysis of strength duration in 20 subjects. Unpublished data.

Electrotherapy

Overview

Motor Level Analgesia Protocol

Introduction

Contraindications

   

Precautions

Parameter

Setting

   
 

Mechanism of

Opiate System

Indications

effect

• Pain Management

Target Neurons

A (sensory, pinprick)

• Relaxation of Muscle Spasms

Waveform

IFC or Premod

• Muscle Strengthening

Frequency

1-10 Hz

• Muscle Re-Education

Sweep

Yes

• Increasing Circlulation

Duty cycle

Continuous

• Edema Management

Duration of

Literature suggests 30-45 minutes. 2-3 times per day if used at home. Clinically 20 minute treatments are more commonly used.

sEMG +Stim

Treatment

Waveforms

Product Overview

• Features and Functions

Intensity

Strong visible rhythmical

contraction

• Program Navigation

Current mode

CV

Notes/References

   
 

Electrode

Bracketing area of pain Electrode Placement Bracketing Area of

Location

Pain

Electrode Placement Bracketing Area of Location Pain Electrode Placement Bracketing Area of Pain Option A: Four
Electrode Placement Bracketing Area of Location Pain Electrode Placement Bracketing Area of Pain Option A: Four

Electrode

Placement

Bracketing Area of Pain Option A: Four electrodes Option B: Two electrodes

of Location Pain Electrode Placement Bracketing Area of Pain Option A: Four electrodes Option B: Two
of Location Pain Electrode Placement Bracketing Area of Pain Option A: Four electrodes Option B: Two

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Notes • This Rx is believed to relieve pain through

Notes

• This Rx is believed to relieve pain through the activation of endogenous opiates.

• The literature reports greater carry over of pain relief when compared to sensory level stimulation. Up to several hours of pain relief.

• Research suggests that stronger contractions may produce greater analgesia.

• Not indicated over areas of acute pain/injury.

• This Rx can be performed using pulsed current, interferential (AC), and

• Premodulated current (AC).

References (motor level electroanalgesia)

1. Karla A, Urban MO, Sluka KA. Blockade of opioid receptors in rostral ventral medulla

prevents antihyperanalgesia produced by transcutaneous electrical nerve stimulation (TENS). J Pharmacol Exp Ther. 2001;298:257-263.

2. Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology. 2nd ed. Baltimore, Md:

Williams & Wilkins;1995.

2. Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology. 2nd ed. Baltimore, Md: Williams & Wilkins;1995.
2. Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology. 2nd ed. Baltimore, Md: Williams & Wilkins;1995.

Electrotherapy

Overview

Recent Literature Reviews:

Introduction

Pain Management

Contraindications

 
 

Precautions

• Johnson, M. and M. Martinson (2007). “Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials.” Pain 130(1-2): 157-65.

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Brosseau, L., et al. (2002). “Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain.” Spine 27(6): 596-603.

• Muscle Strengthening

• Chesterton, L. S., et al. (2002). “Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects.” Pain 99:

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References 253-262. • Chen, C., et al. (2008). “Does the pulse

253-262.

• Chen, C., et al. (2008). “Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia? A systematic review of studies using experimental pain and healthy human participants.” Physiotherapy 94(1): 11-

20.

• Chesterton, L. S., et al. (2003). “Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects.” Pain 106: 73-80.

and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects.” Pain 106: 73-80.
and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects.” Pain 106: 73-80.

Electrotherapy

Overview

Relaxation of Muscle Spasms

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Myofascial pain with associated trigger points. These

• Myofascial pain with associated trigger points. These painful areas may result from muscle strain and result in increased metabolizism and decreased circulation.

• Muscles or areas of muscle in spasm have ischemic pain due to decreased circulation and waste buildup in the muscle.

• Electrical stimulation is an option to assist in breaking the muscle spasm pain cycle by increasing local blood circulation and inhibiting pain to allow the administration of manual techniques

pain cycle by increasing local blood circulation and inhibiting pain to allow the administration of manual
pain cycle by increasing local blood circulation and inhibiting pain to allow the administration of manual
pain cycle by increasing local blood circulation and inhibiting pain to allow the administration of manual

Electrotherapy

Overview

Relaxation of Muscle Spasms

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • As far back as 1986 research was carried out

• As far back as 1986 research was carried out on the use of electrical stimulation in chronic angina pectoris noting improved lactate metabolism and improved blood flow to the stimulated area.

metabolism and improved blood flow to the stimulated area. » Motor level stimulation is cited to

» Motor level stimulation is cited to enhance local blood circulation

» Sensory level stimulation is cited to increase blood circulation

• Pulsed current most frequently noted in the literature

• High Volt Pulsed Current

• VMS - Symmetrical Biphasic Pulsed Current

current most frequently noted in the literature • High Volt Pulsed Current • VMS - Symmetrical
current most frequently noted in the literature • High Volt Pulsed Current • VMS - Symmetrical

Electrotherapy

Overview

Relax Muscle Spasm Protocol

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Sensory Stimulation Parameters Settings Waveform

Sensory Stimulation

Parameters

Settings

Waveform

 

HVPC

Polarity

Negative

Cycle Time

Continuous

Frequency

80

-120 Hz

Sweep

Yes

Ramp

2 seconds

Amplitude

To sensory tolerance. Sensory stimulation is cited to increase blood flow

Duration of Rx

20

to 60 minutes depending on clinician and

patient needs

Current mode

CV

Electrode

The treating electrode (lead wire with red ending) positioned over the muscle in spasm The return electrode (lead wire with the black ending) positioned close by Electrode Size: Muscle size dictates electrode size

placement

Size: Muscle size dictates electrode size placement Electrode Placement • The treating electrode (lead wire

Electrode Placement

• The treating electrode (lead wire with red ending) positioned over the muscle in spasm

• The return electrode (lead wire with the black ending) positioned close by

• Electrode Size: Muscle size dictates electrode size

electrode (lead wire with the black ending) positioned close by • Electrode Size: Muscle size dictates
electrode (lead wire with the black ending) positioned close by • Electrode Size: Muscle size dictates

Electrotherapy

Overview

Relax Muscle Spasm Protocol

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Motor Level Stimulation Parameters Settings Waveform

Motor Level Stimulation

Parameters

Settings

Waveform

VMS

Mode

Synchronous

Cycle Time

1:1 (10 seconds on 10 seconds off)

Frequency

80-120 Hz

Ramp

2 seconds

Current Mode

CV

Amplitude

Motor level stimulation is cited to increase blood flow

Duration of Rx

20 min to 60 minutes

Electrode

Locate areas of tenderness (trigger points). Bracket area of muscle spasm with anatomy specific sized

electrodes

Placement

spasm with anatomy specific sized electrodes Placement Electrode Placement Locate areas of tenderness (trigger

Electrode Placement Locate areas of tenderness (trigger points). Bracket area of muscle spasm with anatomy specific sized electrodes

Placement Locate areas of tenderness (trigger points). Bracket area of muscle spasm with anatomy specific sized
Placement Locate areas of tenderness (trigger points). Bracket area of muscle spasm with anatomy specific sized

Electrotherapy

Overview

Trigger Point

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Relax Muscle Spasm Protocol Parameters Settings

Relax Muscle Spasm Protocol

Parameters

Settings

Waveform

VMS or Asymmetrical biphasic

Mode

Synchronous

Cycle Time

1:1 (10 seconds on 10 seconds off)

Frequency

10

Hz

Phase Duration

250 microseconds

Ramp

2 seconds

Current Mode

CV

Amplitude

Very strong to noxious; moderate muscle contraction may be visible

Duration of Rx

10

minutes daily

Electrode

Locate areas of tenderness (trigger points). Place one smaller electrode on trigger point and one larger electrode 4” away

Placement

point and one larger electrode 4” away Placement Electrode Placement Smaller electrode over trigger point

Electrode Placement Smaller electrode over trigger point Larger electrode 4” away

electrode 4” away Placement Electrode Placement Smaller electrode over trigger point Larger electrode 4” away
electrode 4” away Placement Electrode Placement Smaller electrode over trigger point Larger electrode 4” away

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Relax Muscles In Spasm Notes: • Muscle spasms and trigger

Relax Muscles In Spasm

Notes:

• Muscle spasms and trigger points in an area of sympathetic hyperactivity, usually within a muscle characterized by hypertonus, ischemia, referred pain and local point pain on palpation

• Electrical stimulation will help increase local blood flow

• Instruct patient to relax during electrotherapy session

• Gently stretch muscles after trigger point activity has decreased

References

1. Travell JG “Mysofscial Pain and Dysfunction

2. Baker A., NeuroMuscular Electrical Stimulation A Practical Guide. 3rd Edition 1993. Rehabilitation Engineering

Program, Los Amigos Research & Engineering Institute, Rancho Los Amigos Medical Center. Pages 67-72.

3. Gersh MR, ed: Electrotherapy in Rehabilitation. FA Davis Co, Philadelphia, PA, 1992. Pages 242-244

Center. Pages 67-72. 3. Gersh MR, ed: Electrotherapy in Rehabilitation. FA Davis Co, Philadelphia, PA, 1992.
Center. Pages 67-72. 3. Gersh MR, ed: Electrotherapy in Rehabilitation. FA Davis Co, Philadelphia, PA, 1992.

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Relax Muscles In Spasm References (continued): 4. Nelson RM,

Relax Muscles In Spasm References (continued):

4. Nelson RM, Currier DP, eds: Clinical Electrotherapy: Appleton & Lang, Norwalk, CT, 1987. Pages 126-130

5. Hecox B, Physical Agents A Comprehensive Text for Physical Therapists: Appleton & Lang Norwalk, CT, 1994.

Pages 286-289

6. Morris L, Newton RA, Use of High voltage Pulsed Galvanic Stimulation for Patients with Levator Ani Syndrome,

Physical Therapy, Volume 67, Number 10, October 1987. Pages 1522-1525

7. Sohn N, et.al, The Levator Syndrome and its Treatment with High-Voltage Electrogalvanic Stimulation. The

American Journal of Surgery, Volume 144, 1982

8. Avoiding ischemia in latissimus dorsi muscle grafts: electrical prestimulation versus vascular delay. Ann Thorac

Surg. 2002 Jun;73(6):1927-32. Woo EB, Jarvis JC, Hooper TL, Salmons S.

prestimulation versus vascular delay. Ann Thorac Surg. 2002 Jun;73(6):1927-32. Woo EB, Jarvis JC, Hooper TL, Salmons
prestimulation versus vascular delay. Ann Thorac Surg. 2002 Jun;73(6):1927-32. Woo EB, Jarvis JC, Hooper TL, Salmons

Electrotherapy

Overview

Muscle Focused Indications

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References • Prevent or retard muscle atrophy • Muscle re-education

• Prevent or retard muscle atrophy

• Muscle re-education

• Maintaining or increasing joint range of motion

• Stroke muscle re-education (sEMG +Stim)

• Muscle re-education • Maintaining or increasing joint range of motion • Stroke muscle re-education (sEMG
• Muscle re-education • Maintaining or increasing joint range of motion • Stroke muscle re-education (sEMG

Electrotherapy

Overview

Muscle Strengthening

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength / Prevent or Retard Muscle Atrophy /

Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM

• Two broad approaches using electrotherapy for muscle re- education and to facilitate strength

• Strengthening the static postural strength

» Slow twitch muscle fibers

» Endurance fibers

» Improved joint stability

fibers » Endurance fibers » Improved joint stability • Strengthening of the explosive strength » Fast

• Strengthening of the explosive strength

» Fast twitch muscle fibers

» Increase speed of contraction

» Increase bulk strength

of the explosive strength » Fast twitch muscle fibers » Increase speed of contraction » Increase
of the explosive strength » Fast twitch muscle fibers » Increase speed of contraction » Increase

Electrotherapy

Overview

Muscle Fiber Types

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength / Prevent or Retard Muscle Atrophy /

Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM

• Muscle contains two types of muscle fibers

» Type I (slow twitch)

» Type II (fast twitch)

/ Increasing Joint ROM • Muscle contains two types of muscle fibers » Type I (slow
/ Increasing Joint ROM • Muscle contains two types of muscle fibers » Type I (slow
/ Increasing Joint ROM • Muscle contains two types of muscle fibers » Type I (slow
/ Increasing Joint ROM • Muscle contains two types of muscle fibers » Type I (slow

Electrotherapy

Overview

Muscle Fiber Types

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength / Prevent or Retard Muscle Atrophy /

Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM

 

Type I “Slow Twitch”

Type II “Fast Twitch”

Contraction speed

Slow

Fast

Endurance

High

Low

Fatigue

Slow

Fast

Strength

Low

High

Function

Static, postural

Dynamic, explosive

Normal muscle:

Size of Type II is approximately twice the size of Type I

Static, postural Dynamic, explosive Normal muscle: Size of Type II is approximately twice the size of
Static, postural Dynamic, explosive Normal muscle: Size of Type II is approximately twice the size of
Static, postural Dynamic, explosive Normal muscle: Size of Type II is approximately twice the size of

Electrotherapy

Overview

Disuse Muscle Atrophy

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength / Prevent or Retard Muscle Atrophy /

Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM

• Most condition seen in rehab exhibit some form or muscle atrophy

• Muscle atrophy occurs in muscle after a period of reduced activity

• Most obvious/visual change is decrease in bulk and size of type II muscle fibers

Type II Muscle Fibers
Type II Muscle
Fibers
and size of type II muscle fibers Type II Muscle Fibers Atrophied muscle type II now

Atrophied muscle type II now half the size of type I

Type I

Muscle

Fibers

II muscle fibers Type II Muscle Fibers Atrophied muscle type II now half the size of
II muscle fibers Type II Muscle Fibers Atrophied muscle type II now half the size of
II muscle fibers Type II Muscle Fibers Atrophied muscle type II now half the size of

Electrotherapy

Overview

Muscle Recruitment

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength / Prevent or Retard Muscle Atrophy /

Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM

• During normal muscle contraction

muscle fibers are recruited according to the “size-principal”

» Small type I muscle fibers are recruited first

» Large type II muscle fibers are recruited later when effort increases

• Practical implication of size principal in rehabilitation

» Type I muscle fibers receive primary benefit from typical therapeutic exercise

» Larger type II muscle fibers only benefit from exercise which calls for their recruitment which is rare in rehab

» Larger type II muscle fibers only benefit from exercise which calls for their recruitment which
» Larger type II muscle fibers only benefit from exercise which calls for their recruitment which
» Larger type II muscle fibers only benefit from exercise which calls for their recruitment which

Electrotherapy

Overview

Muscle Recruitment with Electrotherapy

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength / Prevent or Retard Muscle Atrophy /

Muscle Strength / Prevent or Retard Muscle Atrophy / Increasing Joint ROM

• Recruitment patterns during electrical stimulation are reversed

» Type II muscle fibers are recruited first to contract

» Type I muscle fibers contract only when there is volitional activation or when the pulse width and intensity are raised above a certain threshold

width and intensity are raised above a certain threshold • Impact of recruitment pattern with electrical

• Impact of recruitment pattern

with electrical stimulation and exercise

» Voluntary exercise should occur simultaneously to electrical stimulation

exercise should occur simultaneously to electrical stimulation » Muscle contraction should be in a functional pattern
exercise should occur simultaneously to electrical stimulation » Muscle contraction should be in a functional pattern

» Muscle contraction should be in a functional pattern

exercise should occur simultaneously to electrical stimulation » Muscle contraction should be in a functional pattern
exercise should occur simultaneously to electrical stimulation » Muscle contraction should be in a functional pattern

Electrotherapy

Overview

Slow Twitch Muscle Fiber Protocol

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Lumbar Stabilization: Retrain transverse abdominis and

Lumbar Stabilization: Retrain transverse abdominis and multifidus

Parameter

Setting

Target neurons

Slow twitch muscle fibers

Waveform

VMS (symmetrical biphasic)

Frequency

35 Hz

Duty Cycle

1:1 (10 sec. – 10 sec. off)

Pulse Duration

300 To 400 microseconds

Rise/fall Time

2 seconds

Duration of Rx

Clinician decision – commonly 5 to 10 minute sessions

Amplitude

Sub-max motor - patient should activate the transverse abdominus and multifidus muscles - (use of Pressure Biofeedback device can help facilitate contraction)

Current mode

CC

Electrode

Channel 1 on abdominals lateral to linea semiluminaries just inferior to 12th rib Channel 2 lower lumbar over erector spine superior to PSIS

Placement

lumbar over erector spine superior to PSIS Placement Electrode Placement Lumbar Stabilization Channel 1:

Electrode Placement Lumbar Stabilization Channel 1: Abdominals Channel 2: Lower Lumbar

superior to PSIS Placement Electrode Placement Lumbar Stabilization Channel 1: Abdominals Channel 2: Lower Lumbar
superior to PSIS Placement Electrode Placement Lumbar Stabilization Channel 1: Abdominals Channel 2: Lower Lumbar

Electrotherapy

Overview

Fast Twitch Muscle Fiber Protocol

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Quadriceps Strength Augmentation Parameters Settings

Quadriceps Strength Augmentation

Parameters

Settings

Waveform

Russian

Carrier

2,500 Hz

Frequency

Frequency

75

burst/second (bps)

On/Off Time

10

seconds on 50 seconds off (10/50)

Ramp

2 sec up and 2 sec down

Electrode

Proximally over the upper vastus lateralis and distally over the vastus medialis

Placement

Patient Position

This protocol uses a modified position of supine or long-sitting with the knee fully extended rather than braced isometrically at 60 degrees knee extension, as in Snyder-Mackler protocol

Amplitude

Maximum tolerated. Additional criteria:

Tetanic contraction (no fasciculation’s), and observable superior glide of the patella

Duration of Rx

15

minutes

superior glide of the patella Duration of Rx 15 minutes Electrode Placement Vastus Lateralis Vastus Medialis

Electrode Placement Vastus Lateralis Vastus Medialis

superior glide of the patella Duration of Rx 15 minutes Electrode Placement Vastus Lateralis Vastus Medialis
superior glide of the patella Duration of Rx 15 minutes Electrode Placement Vastus Lateralis Vastus Medialis

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength · Prevent or retard muscle atrophy ·

Muscle Strength · Prevent or retard muscle atrophy · Increasing joint ROM

Notes:

• Not as great of strength gains as traditional Snyder-Mackler protocol. However, Fitzgerald et al showed 75.9% quad recovery in NMES/ex group compared to 67.0% in comparison group (exercise only) at 12 wks S/P ACL Recon.

• It was previously believed that portable battery powered NMES devices were not capable of producing muscle contraction forces 50% MVC.

References

1. Fitzgerald et al. A modified neuromuscular electrical stimulation protocol for quadriceps training following ACL

reconstruction. J Orthop Sports Phys Ther. 2003;33:492-501.

2. Lyons et al. Differences in quadriceps femoris muscle torque when using a clinical electrical stimulator versus a

portable electrical stimulator. Phys Ther. 2005;85:44-51.

torque when using a clinical electrical stimulator versus a portable electrical stimulator. Phys Ther. 2005;85:44-51.
torque when using a clinical electrical stimulator versus a portable electrical stimulator. Phys Ther. 2005;85:44-51.

Electrotherapy

Overview

Treatment of the Hemiparetic Subluxed Shoulder

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Slow Twitch Muscle Fiber Protocol Parameters Settings

Slow Twitch Muscle Fiber Protocol

Parameters

Settings

Waveform

VMS

Phase Duration

200 to 400 microseconds

Frequency

25 pps

On/Off Time

2 seconds

Current Format

CV

Electrode

• Use 2 small electrodes (2” X 2”)

Placement

• One at supraspinatus muscle

• One at posterior deltoid muscle

Amplitude

Progress to sufficient intensity to produce palpable reduction of humeral head

Duration of Rx

Progress from 30-minute sessions to six hours per day. Progress gradually and monitor to avoid electrically fatiguing shoulder muscles.

and monitor to avoid electrically fatiguing shoulder muscles. Electrode Placement Supraspinatus Posterior Deltoid

Electrode Placement Supraspinatus Posterior Deltoid

and monitor to avoid electrically fatiguing shoulder muscles. Electrode Placement Supraspinatus Posterior Deltoid
and monitor to avoid electrically fatiguing shoulder muscles. Electrode Placement Supraspinatus Posterior Deltoid

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Strength · Prevent or retard muscle atrophy ·

Muscle Strength · Prevent or retard muscle atrophy · Increasing joint ROM

Notes:

• Baker et al used similar parameters to show an average reduction of 6mm in subluxation over 6-week period (from 14.8mm to 8.6mm). Phys Ther 1986;66:1930-1937.

• Re-adjust the electrode over supraspinatus if excessive upper trap contraction is noted.

• Lower frequency (25pps) is used to prevent excessive fatigue of shoulder muscles.

References

1. Baker et al Phys Ther 1986;66:1930-1937.

2. Currier DP, Mann R. Pain Complaint: Comparison of Electrical Stimulation with Conventional Isometric Exercise.

The Journal of Orthopedics and Sports Physical Therapy, Volume 5, Number 6, 1984. Pages 318-323

3. Faghri PD, et.al. The Effects of Functional Electrical Stimulation on Shoulder Subluxation, Arm Function Recovery,

and shoulder Pain in Hemiplegic Stroke Patients. Archives of Physical Medicine and Rehabilitation, Volume 75, January 1994. Pages 73-79

Pain in Hemiplegic Stroke Patients. Archives of Physical Medicine and Rehabilitation, Volume 75, January 1994. Pages
Pain in Hemiplegic Stroke Patients. Archives of Physical Medicine and Rehabilitation, Volume 75, January 1994. Pages

Electrotherapy

Overview

Muscle Reeducation

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Reeducation • Neuromuscular control may be impaired

Muscle Reeducation

• Neuromuscular control may be impaired after a neurological lesion such as a stroke. In some instances there may be a significant spastic component impeding normal movement.

• Current thinking with spasticity is that muscle weakness of the spastic muscle group may at least partly be responsible for the reactive spasticity.

• Functional exercise and strengthening of the spastic muscle group is therefore important to normalize balance between agonist and antagonist muscle groups.

of the spastic muscle group is therefore important to normalize balance between agonist and antagonist muscle
of the spastic muscle group is therefore important to normalize balance between agonist and antagonist muscle
of the spastic muscle group is therefore important to normalize balance between agonist and antagonist muscle

Electrotherapy

Overview

Muscle Reeducation

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Reeducation • EMG studies have demonstrated that

Muscle Reeducation

• EMG studies have demonstrated that agonist/antagonist muscle pairs co-contract during movements in predictable patterns

• In these contraction patterns agonist and antagonist muscles show alternating bursts of activity to initiate, sustain and finally stop the movement.

agonist and antagonist muscles show alternating bursts of activity to initiate, sustain and finally stop the
agonist and antagonist muscles show alternating bursts of activity to initiate, sustain and finally stop the
agonist and antagonist muscles show alternating bursts of activity to initiate, sustain and finally stop the

Electrotherapy

Overview

Sensory Level Muscle Reeducation

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Reeducation Parameters Settings Waveform

Muscle Reeducation

Parameters

Settings

Waveform options

Premodulated or Interferential

Carrier frequency

5000 Hz (equal to a cycle duration of 200 microseconds)

Frequency

50-150 Hz

Amplitude

Sensory level. Tingling sensation. No motor response.

On/Off

Time None

Duration of Rx

20-60 minutes TID

Electrode Placement

Dermatomes, peripheral nerves, spinal nerve roots of the spastic muscle, or the nerve innervating the antagonist muscle are all options.

nerves, spinal nerve roots of the spastic muscle, or the nerve innervating the antagonist muscle are
nerves, spinal nerve roots of the spastic muscle, or the nerve innervating the antagonist muscle are

Electrotherapy

Overview

Notes and References

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Reeducation Notes: • Sensory level e-stim can be

Muscle Reeducation

Notes:

• Sensory level e-stim can be applied to dermatomes, peripheral nerves, or spinal nerve roots corresponding to the spastic muscle(s).

• Sensory e-stim may also be administered to the nerve innervating the antagonists of the muscle(s).

• Parameters are similar to those for sensory level electroanalgesia.

• Bajd et al demonstrated a decrease in spasticity of the quadriceps in subjects with spinal cord injury via sensory stimulation (20 minutes) to the dermatome associated with the same level as the spastic muscle(L3, L4). However, the reduction in spasticity was not present at a post test 2 hours later. 1,2

• Levine et al demonstrated a decrease in spasticity of the plantarflexors, in subjects with hemiplegia, via sensory level stimulation to the nerve innervating the antagonists to the spastic muscle (common peroneal n.). Fifteen daily 60 minute sessions were applied over 3 weeks.

• Decreased spasticity of the plantarflexors and increased voluntary dorsiflexion was noted. 3

References

1. Arch Phys Med Rehab. 1985;66:515-517.

2. J Physiol. 1984.

3. Electroenceph Clin Neurophys. 1992;85:131-142.

References 1. Arch Phys Med Rehab. 1985;66:515-517. 2. J Physiol. 1984. 3. Electroenceph Clin Neurophys. 1992;85:131-142.
References 1. Arch Phys Med Rehab. 1985;66:515-517. 2. J Physiol. 1984. 3. Electroenceph Clin Neurophys. 1992;85:131-142.

Electrotherapy

Overview

Muscle Reeducation Phasic Muscle

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Muscle Reeducation Parameters Settings Waveform

Muscle Reeducation

Parameters

Settings

Waveform

VMS FR

Current format

CC

Frequency

80

pps

Phase Duration

300 microseconds

Burst Duration

100-200 microseconds

Duty cycle On/off time

1:5 (10 seconds on 30 seconds off)

Duration of Rx

20

minutes

Amplitude

Sensory level minimal muscle

contraction

Electrode Placement

Channel 1: Agonist : 2 large electrodes over each end of the spastic muscle group Channel 2:

Antagonist : 2 large electrodes over each end of the of the flaccid muscle

group

over each end of the of the flaccid muscle group Weak dorsiflexors/evertors Channel 1: Dorsiflexors/evetors

Weak dorsiflexors/evertors

Channel 1: Dorsiflexors/evetors Channel 2: Plantarflexors

Step 1: increase extensor tone for 10 mins (min-mod intensity)

Step 2: do functional task (step through, sit to stand, etc) in sync with Burst Duration and On/Off ratio

intensity) Step 2: do functional task (step through, sit to stand, etc) in sync with Burst
intensity) Step 2: do functional task (step through, sit to stand, etc) in sync with Burst

Electrotherapy

Overview

Muscle Reeducation

Introduction

Contraindications

Muscle Reeducation

Precautions

• Neither muscle group is ever totally

Indications

silent during any phase of the

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

movement

• VMS FR waveform mimics this muscle

activity to facilitate the return of normal

muscle movement in conditions where

neuromuscular control is impaired

• Agonist channel initiates movement

with a brief burst of power, then

decreases

• Antagonistic channel follows with

brief burst of full output to slow down

the initial acceleration of the agonist,

followed by a low output to regulate

the movement of the agonist

• The movement is completed by a final

output to regulate the movement of the agonist • The movement is completed by a final

burst of output in both channels

output to regulate the movement of the agonist • The movement is completed by a final
output to regulate the movement of the agonist • The movement is completed by a final
output to regulate the movement of the agonist • The movement is completed by a final
output to regulate the movement of the agonist • The movement is completed by a final

Electrotherapy

Overview

Increasing Local Blood Circulation

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Increase Local Blood Circulation • The FDA allows

Increase Local Blood Circulation

• The FDA allows manufacturers to claim 6 indications for the use of powered muscle stimulators

• One being Increasing Local Blood Circulation

• High Volt Pulsed Current is the waveform most commonly referenced in the literature

Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in
Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in
Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in
Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in
Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in
Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in
Increasing Local Blood Circulation • High Volt Pulsed Current is the waveform most commonly referenced in

Electrotherapy

Overview

Increasing Local Blood Circulation

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Increase Local Blood Circulation • Blood flow increase to

Increase Local Blood Circulation

• Blood flow increase to a muscle is implied

• HVPC can be used to increase blood flow to target tissues such as ischemic tissue in a clinical setting

• HVPC increases microcirculation by a fast response and a slow response

such as ischemic tissue in a clinical setting • HVPC increases microcirculation by a fast response
such as ischemic tissue in a clinical setting • HVPC increases microcirculation by a fast response
such as ischemic tissue in a clinical setting • HVPC increases microcirculation by a fast response

Electrotherapy

Overview

Fast Response

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Increase Local Blood Circulation • Transient increase in

Increase Local Blood Circulation

• Transient increase in skin perfusion during a single electrotherapy session.

» Mawson et al. (Effect of high voltage pulsed galvanic stimulation on sacral transcutaneous oxygen tension levels in the spinal cord injured. Paraplegia 1993)

• For these subjects 30 minute sessions applied between T6 & T12 caused a significant but transient 35% increase in sacral TcPO2. The controls demonstrated no increase

• A fast response is an immediate increase in perfusion or skin oxygenation

TcPO2. The controls demonstrated no increase • A fast response is an immediate increase in perfusion
TcPO2. The controls demonstrated no increase • A fast response is an immediate increase in perfusion

Electrotherapy

Overview

Slow Response

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Increase Local Blood Circulation • Gradual increase in

Increase Local Blood Circulation

• Gradual increase in skin oxygenation over multiple treatment sessions

• Lundenberg et al. Effect of electrical stimulation on healing of ischemic skin flaps. Lancet 1988

• A slow response is a gradual increase in perfusion or skin oxygenation over multiple treatment sessions

Lancet 1988 • A slow response is a gradual increase in perfusion or skin oxygenation over
Lancet 1988 • A slow response is a gradual increase in perfusion or skin oxygenation over

Electrotherapy

Overview

Increase Local Blood Circulation

Introduction

Contraindications

Precautions

Indications

• Pain Management

• Relaxation of Muscle Spasms

• Muscle Strengthening

• Muscle Re-Education

• Increasing Circlulation

• Edema Management

• sEMG +Stim

Waveforms

Product Overview

• Features and Functions

• Program Navigation

Notes/References

and Functions • Program Navigation Notes/References Increase Local Blood Circulation Parameters Settings

Increase Local Blood Circulation

Parameters

Settings

Waveform

High Volt Pulsed Current (HVPC)

Polarity

Negative or positive depending upon target tissue needs

Cycle Time

Continuous

Frequency

100 to 120 Hz

Ramp

2 seconds

Amplitude

To sensory tolerance. Sensory stimulation is cited to increase blood flow (i.e. 100-150 volts)

Duration of Rx