Electrical Stimulation Methods in Rehabilitation

Therapeutic Equipment 3 2024

• Course taught by Dr. Shafeea Al Sharar, PhD, PT
• Focuses on key concepts and components of electrical currents
• Explores theoretical underpinnings (ions, electrical potentials, currents)
• Discusses various types of stimulators and their clinical applications.
• Integrates latest research

Week 1: Components of Electrical Currents and Electrotherapeutic Currents

• Electrical currents play a foundational role in therapeutic interventions.
• Ions are charged particles critical in generating/propagating electrical signals in biological systems.
  • Sodium (Na+): Essential for depolarization phase of action potentials.
  • Potassium (K+): Vital for repolarizing cells after an action potential.
  • Calcium (Ca2+): Crucial in neurotransmitter release and muscle contraction.
  • Chloride (Cl-): Also plays a role in establishing membrane potential.
• Electrical potentials represent the differences in electric charge between two points .
  • Resting Membrane Potential (RMP): Maintains a negative charge inside the cell (-70 mV in neurons; -90 mV in muscle).
  • Action Potential: A rapid change in membrane potential crucial for nerve signaling and muscle contraction.
• Ion channel therapies aim to restore normal electrical activity in neuromuscular diseases.
• Nanotechnology improves drug delivery to ion channels in neuromodulation therapies.
• Key concepts of electrical currents (ion channels, electrical potentials, currents, and voltage) are crucial for applying electrotherapy effectively.

Week 1 (continued): Ion Channels and Latest Research

• Ion channel therapies focus on manipulating ion channel activity to treat conditions like multiple sclerosis, myotonia, and epilepsy.
• Ion channel therapies improve drug delivery to ion channels in neuromodulation therapies.

Week 1 (continued): Latest Research and Therapeutic Advances

• Ion channel therapies aim to restore normal electrical activity.
• Nanotechnology is part of developing more efficient neuromodulation treatments.
• Patch-clamp techniques allow precise measurement of ion channel activity.
• Electrotherapy devices can restore RMP in pathological conditions, which improves nerve regeneration and muscle function.

Week 2: Waveforms in Electrotherapy

• Waveforms are crucial in electrotherapy, influencing the physiological responses and effectiveness of treatments.
• Sine waves: Smooth, continuous, used in alternating current (AC) therapies.
• Square waves: Abrupt transitions between on/off states, effective for neuromuscular electrical stimulation (NMES).
• Triangular waves: Gradually increasing/decreasing amplitudes.
• Rectangular waves: Balance between sine and square waves, providing precise motor responses with minimal discomfort.

Week 3: Nerve-Muscle Physiology in Electrotherapy

• Action potentials are a fundamental process in the nervous and muscular systems.
• Depolarization: Initial step in action potential generation; a reduction in the membrane potential of a cell.
• Propagation of Action Potentials: The process of action potential spreading along the nerve or muscle fiber.
• Mechanisms of Propagation.
• Important role in nerve and muscle function that is crucial for understanding electrotherapy's mechanisms.

Week 4: Therapeutic Uses of Electrical Stimulation (ES)

• Electrical stimulation induces muscle contractions, improving strength, endurance, and preventing muscle wasting in conditions like atrophy and weakness.
• It has applications in: Muscle strengthening and re-education.
• Post-surgical rehabilitation: Maintaining muscle tone
• Athlete training and performance: Muscle function gain.
• Injury prevention: Improving muscle and joint coordination
• Chronic pain relief: Reducing pain signals, muscle spasms, and improving range of motion.

Week 5: Stimulation of Denervated Muscle

• Denervated muscles lack nerve function; electrotherapy directly stimulates muscle fibers.
• Mechanisms: Direct depolarization of muscle membranes, generating action potentials (using longer pulse durations).
• Importance: Preventing atrophy, maintaining muscle mass, improving circulation, neuromodulation.
• Treatment Parameters: pulse duration, frequency and intensity.

Week 6: Faradic Current

• Faradic current: a type of alternating current used for stimulating innervated muscles.
• Key features: Interrupted or pulsed nature, frequency between 50-100 Hz short pulse durations.
• Modifications: surged and interrupted faradic current
• Key applications : Muscle strengthening, pain relief, edema reduction, post-surgical rehabilitation.
• Safety considerations, contraindications and precautions

Week 7: Galvanic Current

• Galvanic Current: A direct current (DC) that is used in iontophoresis, a technique for drug delivery.
• Application: Drug delivery, pain management, and wound healing via iontophoresis.
• Positive effects of cathode and negative effects of anode
• Modifications: interrupted & surged galvanic current

Week 8: Sinusoidal Current

• Sinusoidal current: a smooth sine-wave alternating current used for various applications.
• Physiological effects: muscle stimulation, pain relief, nerve stimulation, increasing circulation.
• Applications: Muscle strengthening, neuromuscular therapy, treating chronic musculoskeletal conditions or injuries.
• Precautions and Contraindications.

Week 9: Transcutaneous Electrical Nerve Stimulation (TENS)

• TENS: A very common form of electrotherapy.
• Low-voltage electrical currents used to stimulate sensory nerves.
• Key mechanisms: Gate control theory, influencing the transmission of pain signals, and the release of endogenous opioids.
• Uses in treating acute and chronic pain, conditions like arthritis, back pain, and neuropathies.
• Types of TENS and precautions

Week 10: Interferential Therapy (IFT)

• IFT: Uses the interference of two high-frequency alternating currents.
• IFT creates a low-frequency beat, helping to relieve pain, reduce inflammation and improve tissue healing.
• Benefits: deep tissue penetration, reduced discomfort and muscle stimulation as needed.
• Types of IFT, dosage parameters, and precautions

Week 11: Biofeedback

• Biofeedback: A technique that uses electronic devices to provide real-time information about biological processes, allowing conscious control over bodily functions.
• Mechanisms: Biofeedback utilizes various sensors and displays physiological signals in real-time, helping the patient develop physiological self-regulation skills
• Applications include: muscle and nerve stimulation, pain management, and relaxation.
• Types of biofeedback

Week 12: Iontophoresis

• Iontophoresis is a non-invasive technique that uses direct electrical current to drive medications through the skin.
• Mechanism: Uses ion exchange to deliver drugs like dexamethasone, lidocaine, etc. to reduce inflammation and pain.
• It can be used for various conditions such as pain management and excessive sweating (hyperhidrosis).
• Precautions and contraindications

Week 13: Russian Current

• Russian Current: A medium-frequency alternating current treatment
• Effects: Muscle strengthening, pain relief, muscle re-education
• Considerations: Dosage parameters, frequency, and pulse duration

Week 14: Functional Electrical Stimulation (FES)

• FES: Electrical stimulation used for muscle rehabilitation.
• FES benefits: Muscle strengthening, pain management, and functional recovery.
• Considerations, techniques, and application of FES