Assist. Prof.

Baha NACI
2022-2023 Spring Semester
27.02.2023
 The feedback mechanism in the human organism
includes the process of perceiving, interpreting and
responding to changes in the system.

 Pain, muscle atrophy and paralysis occur as a clinical

result of the malfunction in this feedback system.

 This system can be rearranged with electrical currents

created using electronic devices.
 In this context, electrotherapy is an approach that
provides control of pathological events by creating
non-physiological feedback systems.

 Electrotherapy has two basic elements:

electrical current used for treatment
tissues to which this treatment is applied.

 In order to understand the effects of electrotherapy,

the characteristics of the electrical current and the
tissues to which it is applied electrophysiologically
should be well known.
 There are two opposite electric charges in nature. Positive
and negative charges.

 The amount of positive or negative charge an atom or a

substance carries is called electrical charge. It is
expressed in Coulombs.
 If there is a difference in electric charge between any two
points on a conductive object, electrons are forced to move
from the point where the negative electric charge is greater
to the positive.

 This force that enables the movement of electrons is called

electromotor force or electrical potential difference or
voltage. Its unit is volt.
 The number of electrons passing through any point of a
conductor in one second is defined as the current intensity
and its unit is ampere.

 This electric current passes easily through some materials

and passes hardly through others.

 The force that determines the conductivity of the object and

makes the flow of electrons difficult despite the electrical
potential is called resistance. Its unit is ohm.
Electrical Current
 Since the fluids in the human body contain acids, bases
and salts, they easily transmit electric current.
Types of Currents
1. According to the current direction
 Direct current
 Alternating current

2. According to its clinical and electro-physiological effects

 Low frequency currents
 Medium frequency currents
 High frequency currents
Classification according to the
direction of the current
 The direction of the electric current is from the negative
pole to the positive pole.

 The direction of the electric current may remain constant

or change periodically.

 In this framework, two types of waves can be mentioned.

Direct current
 The direction of the electric current is constant. For this
reason, it is also called monophasic (unidirectional,
unipolar) or galvanic current.

 Physiologically, the current that does not change direction

for more than 1 second is accepted as direct current.

 Direct current is a unidirectional flow of electrons toward

the positive pole.
Alternating current
 The direction of the electric current changes constantly.
This type of current is also called biphasic (bidirectional,
bipolar) or faradic current.

 In alternating current, the current intensity rises from the

zero point to the highest positive value, then decreases to
the zero point, and then returns to the zero point by
reaching the lowest negative value. The time elapsed
during this time is called the period.
 The number of periods per second is called frequency. Its
unit is Hertz (Hz).

 In the devices used in electrotherapy, alternating current

is converted into direct current with the help of a special
electronic arrangement.
 Each of the periods when the current rises from the zero
point to the peak value and then returns to the zero point is
called a phase.

 Alternating current consists of two opposite phases in

duration of one period. So it's biphasic.

 The shape of these phases can be sinus wave, triangular

or square.
 If the opposite phases have the same shape, it is said to be
a symmetrical alternating current.
 Electrons flowing in alternating current always move from
the negative to positive pole, reversing direction when the
polarities are reversed.
What is the frequency of the AC signal below?
Classification according to clinical and
electrophysiological effects of currents

 The clinical and electrophysiological effects of currents

vary depending on their frequency. Accordingly, there are
3 types of current.
1. Low frequency currents

▪ Current frequency between 1-1000 Hz.

▪ Usually 1-200 Hz. frequencies are used.

▪ Faradic, diadynamic flow and TENS are in this group.

2. Medium frequency currents

 Its frequency is between 1000 and 1.000.000 Hz and is

generally used at a frequency of 4000-20.000 Hz.

 The most important example of this group is interferential

currents.
3. High frequency currents

 Its frequency is more than 1.000.000 Hz.

 Sense of this type of the current is not perceived, as with

medium and low frequency currents,

 Vibration and heat effects are primary.

Modulation of the currents
➢ Modulation is important to increase the physiological effect.

➢ The weakest current that can stimulate the tissue in the shortest time
is used.

➢ In the meantime, both the accommodation, which reduces efficiency,

and the development of polarization, which causes side effects, can
also be prevented.

➢ In this way, in direct, low or high frequency currents, the transit time
of the current through the tissue, and shape, frequency and direction
of the current can be changed.
➢ There are 3 different modulations in direct current.

1. Reversed direct current

 The direction of the current changes constantly, as in

alternating current.

 Unlike alternating current, the time of each phase takes

longer than 1 second.
2. Interrupted direct current

 The direction of the current is constant.

 However, the current is interrupted periodically.

 Periods when the current is cut off last 1 second or

longer. Between these interruptions, the current flows
for not less than 1 second.

 The most common endication of interrupted galvanic

current is denervated muscle stimulation.
3. Surged (ramped) direct current

 It is similar to interrupted galvanic current, but the current

intensity does not rise suddenly from 0 to its peak value.

 This rise lasts between 0-5 seconds.

 The flow decreases suddenly or slowly from its peak value

to 0.
➢ In the modulation of alternating current, the time or amplitude
of the current is changed.

1. Time

a. Burst Type modulation

▪ The passage of alternating current cuts for a few ms.

▪ The periods in which the current passes last also a few ms.

▪ Russian current is an alternating current modulation created

in this way. Polyphasic.
b. Interrupted alternating current

 The interruption lasts longer than 1 second and the current

passes for a few seconds.

 The main difference of interrupted alternating current

modulation from the burst type is that after muscle
contraction it provides sufficient resting time for the
muscle to relax.
2. Amplitude Modulation

 Two alternating currents with different frequencies are

applied to the same tissue at the same time.

 Since these two currents spread in the same tissue, they

combine with each other resulting in a single current
effect.

 In clinical practice, this modulation is known as the

interference current.
➢ Currently, there is no
known physiological or
clinical advantage of
alternating currents
modulated by time or
amplitude.
Pulsed current
 Pulsed current is the
unidirectional or
bidirectional flow of charged
particles that periodically
stop for a limited period of
time before the next event.
 More specifically, a pulse is
an isolated electrical event
separated by a finite period of
time from the next event.
Pulsed currents
 Pulsed current is defined as electrical current transmitted
in the form of short-duration signals.

➢ The parameters that determine the characteristics of these

currents are as follows:
1. Current rise time

 It is the time the pulse amplitude rises

from 0 to the maximum value.

2. Pulse duration

 To stimulate the nerve with minimum

electrical energy, the pulse duration is
kept equal to the chronaxie of the
nerve to be stimulated.

 It can range from a few milliseconds

to a few microseconds.

3. Time between pulses (Interpulse

interval)

 Generally ranges from 10 to 999

milliseconds.
4. Current frequency

 Muscle contraction occurs when the current amplitude

increases or decreases.
 Therefore, it is preferred that the current rise time is short.
 In currents with an impulse duration of 1 millisecond or
less, the motor effect is primary.
 If this time is shorter than 10 ms, there is no difference
between triangular and quadrangular currents in terms of
motor effect.
 The current rise time should be shorter than 60
microseconds to prevent the development of
accommodation.

 Accommodation develops faster in nerve fibers than

muscle fibers.

 The pulse duration is adjusted according to the chronaxis

of the nerve to be stimulated.

 Chronaxis is 30 microseconds in A alpha fibers, 200

microseconds in A beta fibers, 450 microseconds in A
delta fibers and 1500 microseconds in C fibers.
 During the pulse period, when the amplitude is constant,
sensory stimuli such as tingling, burning, stinging occur.

 These effects are most pronounced when the amplitude remains

constant for 20 milliseconds or more.

 To eliminate or reduce these unpleasant sensory effects, the

ideal phase duration should be less than 200 microseconds.

 Because, at currents with a pulse duration longer than 200

microseconds, very small fluctuations in current intensity cause
motoric or sensory stimulation to become painful.
 The number of pulses per second is defined as the pulse
frequency. Its unit is pps (pulse per second).

 The pulse frequency in the stimulators used at the present

time ranges from 1 to several hundred pps.

 In practice, low-frequency stimulation is used.

 Pulsed currents can be monophasic or
biphasic.

 The shape of the pulse phases can be

square, triangular or sinusoidal.

 In this respect, biphasic pulsed currents

can be symmetrical or asymmetrical.

 Biphasic symmetric pulsed currents are

important because they do not create
polarization in the tissue under the
electrode.
 In pulsed currents, since the total amount of current
passing to the tissue in one second is low, it provides a
safe and comfortable stimulation.

 In general, this amount does not exceed 20 milliamperes,

and most are 2-5 milliamperes.

 However, it is 80 milliamperes in Russian current, and 100

milliamperes in interferential current.
Modulation in pulsed currents
 The current rise time is kept
very short to prevent
accommodation.

 Rectangular currents are

generally used to achieve
optimal effect with the smallest
electric current intensity.

 In these rectangular currents, the

ideal flow duration is equal to
the chronaxie of the nerve to be
stimulated.
 However, if this current form is given monophase, the
polarization effect occurs.

 To prevent this, biphasic current can be given to the tissue

with a total current of 0 (symmetrical or asymmetrical).

 Since one of the phases is positive and the other negative

in biphasic currents, the net current passing to the tissue is
the difference of the currents given in these 2 phases.
 Symmetrical biphasic currents are more effective in motor
nerve stimulation than asymmetrical biphasic ones.

 Pulse or current modulations can be made.

Pulse Modulation
 In this modulation, the duration, amplitude or frequency
of the pulsed current automatically increases and then
decreases.

 Physiological or clinical superiority of these different

modulations to each other has not been demonstrated.

 The purpose of pulse modulation is to delay

accommodation.
Current modulation
 There are 3 forms.
a. Interrupted type

 The current passes for a few seconds, followed by a rest

period of few seconds.

b. Burst or packet type

 In fact, it is a type of interrupted pulsed current.

 The difference is that the current flow and subsequent rest

periods are a few milliseconds.

 Within a few milliseconds of the current, a few pulses pass

into the tissue in forms of packets.
c. Ramp type

 It is similar to interrupted type modulation.

 In interrupted current, the intensity of the current increases

suddenly, and decreases suddenly after a few seconds of
current flow.

 In the ramp current, the current amplitude gradually

increases, and the current is cut off by gradually decreasing.

 Then a rest period of a few seconds occurs, as in the

interrupted current.
General Physiological Effects of Electrotherapy
➢ Electrothermal effect

•Electrical charges cause heat generation in the

conductive environment with the effect of
microvibration and friction force.
•In thermal effect, the effect of current on vasomotor
nerves is more important.
•With the application of galvanic current for 20 minutes,
the skin circulation increases by 90% and there is a 0.4
degree heat increase in the subcutaneous and muscle
tissue.
General Physiological Effects of Electrotherapy
➢ Electrochemical effects

Electric currents cause the formation of new chemical

compounds in the conductive setting they pass through.
Acid is formed under the positive electrode, and base is
formed under the negative electrode.
Chemical burns can occur if the electrolytic reaction is
not buffered by tissue.
These reactions can be prevented by applying pulsed
current instead of direct current.
General Physiological Effects of Electrotherapy
➢ Electrophysical effects

The electrical current causes the ions to move.

As a result of these effects; muscle contraction,

activation of endogenous analgesic mechanisms, and
vascular response may occur.

The physiological effects of electrical current occur

directly or indirectly at four different biological levels:
cell, tissue, segmental and systemic.
General Physiological Effects of Electrotherapy

➢ Effects at the cellular level

Peripheral nerve stimulation

Changes in membrane permeability

Fibroblast and osteoblast formation

Increase in ATPase activity
Increase in protein synthesis
General Physiological Effects of Electrotherapy

➢ Effects at the tissue level

Skeletal and smooth muscle contraction and relaxation

Tissue regeneration

Joint effusion, and interstitial fluid resorption

Changes in thermal and chemical balances
General Physiological Effects of Electrotherapy

➢ Segmental effects

Contraction of muscle groups

Pumping effect on artery, vein and lymph flow

Increased arterial and lymphatic drainage independent

of skeletal muscle contraction
General Physiological Effects of Electrotherapy
➢ Systemic effects

Analgesic effect through increased endogenous peptide

secretion
Analgesic effect through serotonin release

Effects on circulation via vasoactive intestinal

polypeptide
Regulation of the functions of internal organs such as
kidney and heart
General Physiological Effects of Electrotherapy
➢ Muscle Stimulation through Electrical Current

Instead of direct stimulation of the healthy muscle

fiber with electrical current, it is stimulated indirectly
via the motor nerve being innervating by.
Stronger stimuli are required for stimulating the
muscle fiber than for the nerve fiber.
This is because the membrane resting potential and
excitation threshold are lower.
General Endications of Electrotherapy

▪ Muscle strengthening
▪ Prevention of muscle atrophy and degeneration

▪ Maintaining or increasing joint range of motion

▪ Spasticity

▪ Motor facilitation and reeducation

▪ Reduction of joint fluid and interstitial edema
▪ Eliminating pain
▪ Resolving muscle spasm

▪ Treatment of skin ulcers and wounds

▪ Prevention of the development of deep vein

thrombosis
▪ Fracture healing
Thank you…