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Basics of Electrical Stimulation

 

Indications For Sensory Level TENS

  • Pain relief during stimulation

Indications For Motor Level TENS

  • Pain relief following stimulation

Indications For Noxious Stimulation

  • For long lasting pain relief after stimulation

Contraindications/Precautions

  • Pacemakers

  • Over the abdomen of pregnant women

  • Cardiac arrhythmia

  • Over the carotid sinus area

  • Patient with hypersensitivity 

Complications

  • Skin irritation due to electrodes

Parameters:

Neuromuscular Electrical Stimulation

Strengthening

  • ​​​Patient Position: Place the muscle at resting length or slightly lengthened.

  • Type of Contraction: Isometric (treat the patient at several points in the range of motion)

  •  Frequency: 50 pps (Hz) 

  • Amplitude: Increase the amplitude until a strong, preferably maximal, contraction is obtained

  • Duty Cycle: 1:6 on/off ratio. (6-10 seconds on, rest interval 5-6 times the on time. 

  • Treatment Duration: 8-10 contractions per session.

  • Treatment Frequency: 3 times per week for approximately 4 weeks

Endurance 

  • Frequency: < 40 pps (Hz)

  • Duty Cycle: 1:1

  • Treatment Duration:10-30 minutes.

  • Treatment Frequency: 1-3 times per day.

  • Amplitude: Increase the amplitude until a strong, preferably maximal, contraction is obtained

Reeducation 

  • Type of Contraction: Concentric   

  • Frequency: <40 pps (Hz)

  • Amplitude: should approximate the size needed for the activity

  • Technique: May utilize a hand or foot switch to trigger stim during a functional task

  • Duty Cycle: Adjust the ramp and fall times in accordance with the functional task.

  • Treatment Duration: 10-30 minutes

  • Treatment Frequency: 2-3 times per day

Spasticity reduction

  • Type of Contraction: Concentric contraction of the non spastic antagonist muscle is needed

  • Frequency: < 40 Hz

  • Duty cycle: 1:6

  • Ramp: Provide a gradual ramp to avoid a quick stretch

  • Treatment Duration: 10-30 minutes

  • Treatment Frequency: Prior to functional training activities

Peripheral Circulation

  • Frequency: 20-30 Hz or 3 Hz.

  • Amplitude: 10-30% of max

  • Duty cycle:1:6

  • Treatment Duration: 10-30 minutes

  • Treatment Frequency:As frequent as comfortable for the patient

Pain Control E-Stim

Sensory Level (High Rate) TENS

  • —Current Type: Asymmetric biphasic

  • Frequency : 100-150 Hz (pps)

  • Pulse Duration: < 100 usec (many units preset at 50-80 usec)

  • —Amplitude:Tolerated tingling

  • Ramp: None

  • —On/off: Continuous

  • Intensity: Determined by patient perception

  • —Treatment Time: May be worn 24 hours, or as needed

  • —Electrode Placement: Over or around the painful area

Motor Level (Low Rate) TENS

  • —Current Type: Biphasic or Russian

  • —Pulse duration:100-600 us

  • —Amplitude: Visible tolerated contraction 

  • —Ramp: None

  • —On/off: Continuous

  • —Pulse frequency: 2-10 pps

  • —Treatment Time: 20-30 min

  • —Electrode Placement: Over or around the painful area

Noxious Stimulation

  • Current Type: Alternating Current unit (Russian)

  • —Carrier Frequency: 2500 Hz

  • —Frequency: 50 bursts / second

  • —On / Off Time: 12 sec on / 8 seconds rest

  • —Amplitude: maximum tolerable

  • —Treatment Time: 10-15 minutes 

  • —Electrode Placement: Small electrodes directly over the site of pain

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