Interrupted direct current IDC

lecture 7
dr. amal hm. ibrahim

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Objectives
To define the different types of IDC. To know the IDC current characteristics and uses. To know the Faradic current characteristics. To know physiological effects of faradic current. To define the TENS current. To know physiological effects of TENS.

Interrupted Direct Current IDC The term interrupted direct current (IDC) is used to describe continuous unidirectional current when it is interrupted to give pulses or phases of any duration, shape, or frequency.

Interrupted Direct Current IDC

Interrupted direct current is commonly described the currents of long duration (1msec or more).

Interrupted Direct Current IDC

There are two types of long duration interrupted direct current: 1- Rectangular wave pulses. 2- Accommodation pulses.

Interrupted Direct Current IDC

1- Rectangular wave pulses: pulses of any duration between 1 and 600msec separated by pulse interval of any duration from 1 to many seconds. Used to stimulate sensory and motor nerves but it is unique in stimulation of denervated muscles.

Interrupted Direct Current IDC

2- Accommodation pulses: have many types like triangular, trapezoidal, and saw-tooth. The pulse duration ranged from 300 to 1000msec. These pulses are used for stimulation of denervated muscle.

Faradic-type Current

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Faradic-type Current
Faradic-type currents are short duration interrupted direct current of pulses ranged from 0.1 to 1ms and frequency of 30 to 100 Hz. With frequency 100Hz the time for each cycle is 10ms so, with a 1ms pulse the interval period will be 9ms. The waveform of faradictype current may be unidirectional or biphasic (asymmetrical)

Faradic-type Current
The faradic-type currents are always surged when used for therapeutic purposes. The comfortable pulse is either 0.1ms with frequency 70Hz or 1ms pulse with frequency 50Hz.

Faradic-type Current The effective nerve stimulus is the spike of the voltage which can be about 1ms in duration, the rest of the pulse having much lower voltage, does not cause nerve stimulation.

Faradic-type Current
Faradic current causes a titanic contraction of stimulated muscle. Treatment by faradic current is called faradism.

Faradic-type Current
The active electrode should be connected to the cathode as muscle contraction will be more easily produced with less current.

Physiological Effects of Faradic-type Current

1. Stimulate innervated muscles whose motor nerves are intact producing titanic contraction. The number of motor units brought into action will depend on the strength of current and placement of electrodes.

Physiological Effects of Faradic-type Current

Stimulation of motor points can be done by using guide chart indicate all superficial muscles of body

Physiological Effects of Faradic-type Current

As mentioned before if you stimulate muscle by using fixed pad electrodes it is preferable to use constant current to be more comfortable as the skin resistance fluctuates (change) the voltage will fluctuate to maintain constant current. But if you move the pad, it is better to use constant voltage because the current will be altering.

Physiological Effects of Faradic-type Current 2. Stimulation of sensory nerves to produce a mild prickling sensation for reducing pain feeling 3. Stimulate motor nerves of large proximal muscles to reduce edema.

Clinical Uses of Faradic-type Current

Faradic-type current is still frequently applied in the form of functional electrical stimulation (FES). In this technique the application of the faradic current is combined with the patient activity.

Clinical Uses of Faradic-type Current

1. Facilitation of muscle contraction inhibited by pain like post operative or post-traumatic inability to achieve voluntary contraction of certain muscles. 2. Early stage of muscle reinnervation.

Clinical Uses of Faradic-type Current

3. Treatment of hysterical paralysis. 4. Treatment of atrophied and weak muscles following long duration immobilization.

Clinical Uses of Faradic-type Current

5. Treatment of muscle imbalance as in faulty posture (flat foot and scoliosis). NOTE: Faradic-type currents never used to stimulate denervated muscles.

Contraindications
1- Skin lesions as cuts and abrasions to avoid the difference of skin resistance which may lead to more concentration of current on some points especially under electrodes causing discomfort and pain. 2- Cardiac pacemaker.

Contraindications
3- Infection to avoid spread of infection by low frequency current. 4- Superficial metal to avoid concentration of current on metal and cause burn.

Transcutaneous Electric Nerve Stimulation TENS

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Transcutaneous Electric Nerve Stimulation TENS

Transcutaneous electrical nerve stimulation (TENS) is a non invasive modern electrical method of managing both acute (short term pain) and chronic (long term pain).

Transcutaneous Electric Nerve Stimulation TENS

It is used for providing a degree of pain relief (symptomatic) by stimulating sensory nerves. TENS is an alternating current characterized by variable phase duration and a variable phase interval which can be used to vary frequency

Electrotherapy: Evidence-based Practice By Sheila Kitchen, Sarah Bazin, Edward Bellis Clayton Contributor Sheila Kitchen, Sarah Bazin Published by Elsevier Health Sciences, 2002

Transcutaneous Electric Nerve Stimulation TENS

The phase duration is very short, varying from 0.01 to 0.4ms. The frequency is usually variable and ranged from 2 to 200Hz. The maximum peak current is about 100mA. Although it is a small current but it is sufficient because the primary target for the therapy is the sensory nerves.

Electrotherapy: Evidence-based Practice By Sheila Kitchen, Sarah Bazin, Edward Bellis Clayton Contributor Sheila Kitchen, Sarah Bazin Published by Elsevier Health Sciences, 2002

Transcutaneous Electric Nerve Stimulation TENS

1- Conventional TENS It is a current with high frequency from 50-100Hz, pulse duration around 0.05ms and low intensity

Electrotherapy: Evidence-based Practice By Sheila Kitchen, Sarah Bazin, Edward Bellis Clayton Contributor Sheila Kitchen, Sarah Bazin Published by Elsevier Health Sciences, 2002

Transcutaneous Electric Nerve Stimulation TENS

1- Conventional TENS
The intensity is turned up slowly until a prickling or tingling sensation is felt without painful feeling or muscle contraction. This current with low intensity, high frequency will stimulate large low threshold mechanoreceptors A fibers which go up in the spinal cord without synapse and give collateral to A and C fibers to inhibit them.

1- Conventional TENS

This mechanism is called pre-synaptic inhibition by Hi-TENS or traditional or conventional TENS. Conventional TENS is used for self treatment with recommended duration from 30 to 60 minutes, once or twice a day or may be used for all 24 hours of the day.

2- Acupuncture-like TENS
It is high intensity low frequency (less than 10Hz, commonly 2-4Hz), with pulse duration of around 0.2ms. The intensity is very high close to the patient tolerance to stimulate A and C fibers leading to the release of endorphins and encephalin.

The acupuncture-like TENS is applied to acupuncture point which is considered as a place where a small bundle of A and sympathetic efferent fibers pierce the deep fascia to become more superficial

 Acupuncture-like TENS is applied once per day for 20 to 30 minutes. Although this type of TENS is more effective than conventional TENS, but many patients can not tolerate the high intensity. The acupuncture TENS is applied for patient who do not respond to conventional TENS.

3- Burst TENS
Burst TENS consists of a train or burst of pulses of 2Hz (some times varying from 1-5Hz). Each burst lasts for 70 ms and as the internal frequency of the bursts is at the usual conventional TENS frequency of 50- 100Hz, this result in release of endorphins at the central level which have a pain reducing effect.

 Burst TENS is combines both conventional and acupuncture-like TENS and therefore provides pain relief by both routs. Burst TENS is practically suitable for the treatment of deeperlying painful regions (myofascial pain) and cases of chronic pain.

 The treatment duration is up to 30 minutes to be effective and treatment can be repeated during the same day.

4- Modulated TENS In modulated TENS the pulse width, frequency and intensity are all constantly and automatically varied. This type of TENS is useful for prevent adaptation of the nerve to the current.

Application of TENS

Before applying TENS to any patient you must make pain assessment to evaluate the treatment results. There are many methods for pain assessment, the common subjective way is known as visual analogue scale or VAS.

Application of TENS
Visual analogue scale or VAS. (on which a 10 cm line, start with no pain, in its middle tolerable pain and at the end worst pain) and the patient marks the intensity of pain between no pain and worst pain).

 Another subjective method is faces at which there are six faces start with happy face and end with very angry and crying face, the patient chose one who is like. The only objective way of pain assessment is the measurement of range of motion.

Electrode Placement
Over painful points. Over dermatome, myotome, or sclerotome. Trigger or acupuncture points which can be located by their lower resistance compared with surrounding skin. To determine acupuncture point we use an electronic probe. Electrodes are placed over the line of nerve superficially. Electrodes are covered with gel and fixed to the skin with adhesive tape or bandage. Electrodes may be self adhesive and gelled.

Indications

Contraindications
Undiagnosed pain. Pregnancy (especially during first three months of pregnancy). Heart pacemaker. The eyes or near to them. Over carotid sinus to avoid cardiac arrhythmias.

Contraindications
Over pharyngeal region to avoid interfere with normal breathing and swallowing. Skin lesions or wounds (different resistance). Over non sensation area. With implanted hear aid. Over infected or inflamed area.

Questions?????