4 September 2014 BPHTI PTH 3201(Rev) 1

4 September 2014 BPHTI PTH 3201(Rev)

Learning Objectives:
The lecture aims to brief students about the
following:
Nature of faradic currents
Therapeutic & Physiological effects of
faradic currents
Techniques of application
Clinical applications of faradic currents.
2
4 September 2014 BPHTI PTH 3201(Rev)
Learning Outcomes:

Successful student therapist will be able to
explain about the following:
1. Explain about accommodation
2. Explain about the nature of faradic currents
3. Explain about the therapeutic and physiological
effects
4. Techniques of application
5. Clinical applications of faradic currents.
3
ACCOMMODATION
When a current flows at a constant intensity the
nerve adapts itself, to the altered conditions, this
is known as accommodation.
So an unvarying current is not effective in
initiating an impulse.
While the current flows at constant intensity
accommodation of the nerve takes place and the
potential difference resulting from the current
flow no longer affects the excitability of the nerve
fiber.
BPHTI PTH 3201(Rev) 4 September 2014 4
A fall in the intensity of current is less effective
than a rise in initiating an impulse.
It is the side of the nerve nearer to the anode
that is affected and so the anode produces a
greater stimulation than the cathode.
Because the nerve has the property of
accommodation a current which rises or falls
suddenly in intensity is more effective in
initiating an impulse than one which changes
slowly.
BPHTI PTH 3201(Rev) 4 September 2014 5
When the variation of the current is gradual
there is time for accommodation to take place
and a greater intensity is needed to be
effective, than if the variation is sudden.
A current that changes very slowly does not
initiate a nerve impulse.

4 September 2014 BPHTI PTH 3201(Rev) 6
IMPORTANCE OF SURGING AND INTERRUPTION
When the current is interrupted the
contraction commences and ceases suddenly,
being maintained during the period of current
flow
When the current is surged the contraction
gradually increases and decreases in strength
in a matter similar to a voluntary contraction

BPHTI PTH 3201(Rev) 4 September 2014 7
4 September 2014 BPHTI PTH 3201(Rev)


FARADIC
CURRENTS
8
Faradic current is unevenly alternating current
each cycle consists of two unequal phases, the
first of long duration and low EMF, the second
of short duration and high EMF.
Faradic currents have a stimulus with a
duration of 0.1to 1 milliseconds and repeated
50-100 times per second.

BPHTI PTH 3201(Rev) 4 September 2014 9
PHYSIOLOGICAL EFFECTS
Stimulation of sensory nerves: a mild prickling
sensation is experienced. This is due to the
stimulation of the sensory nerves and is very mild
because the stimuli are of short duration.
The sensory stimulation causes a vasodialation of
the superficial blood vessels, so there is mild
reddening of the skin, or erythema.
This vasodialtion takes place only in the
superficial tissues.

BPHTI PTH 3201(Rev) 4 September 2014 10
Stimulation of motor nerves : faradic current
stimulates the motor nerve and if it is of
adequate intensity it causes contraction of the
muscles which they supply.
As the stimuli are repeated 50 times per
second or more, the contraction is tetanic.
So the current is surged or interrupted to
allow for muscle relaxation.


BPHTI PTH 3201(Rev) 4 September 2014 11
Effects of muscle contraction: when a muscle
contracts as a result of electrical stimulation, the
changes taking place are similar to that of a
voluntary contraction.
increased metabolism.

increase in demands of oxygen and food stuffs.

an increased output of waste products, including
metabolites.

BPHTI PTH 3201(Rev) 4 September 2014 12
Metabolites cause dilatation of capillaries and
arterioles

Increased blood supply to muscle.

BPHTI PTH 3201(Rev) 4 September 2014 13
As the muscles contract and relax they exert a pumping
action on the veins and lymphatic vessels lying within
and around them.

Thus these vessels ensure the fluid they contain are
moved towards the heart.

If muscle contractions are strong enough to cause joint
movements this also exert a pumping effect.

Increased venous and lymphatic return.


BPHTI PTH 3201(Rev) 4 September 2014 14
If a muscle contracts sufficient number of
times against the resistance of an adequate
load there is increase in the bulk of the muscle
fibers and the muscle is strengthened.
It is not sure if contractions caused by faradic
stimulation can cause this effect.


BPHTI PTH 3201(Rev) 4 September 2014 15
Effects on denervated muscle: it is not
possible for a completely denervated muscle
to contract by a stimulus as short as 1
millisecond, because the impulse is too brief
to affect muscle tissue directly.
so faradic type of current is not effective for
the stimulation of denervated
BPHTI PTH 3201(Rev) 4 September 2014 16
THERAPEUTIC EFFECTS
1) Facilitation of muscle contraction
2) Re-education of muscle action
3) Training of a new muscle action
4) Exercise for paralyzed muscle
5) Strengthening and increased bulk of muscle
6) Increase in blood supply
7) Improved venous and lymphatic drainage
8) Prevention and loosening of adhesions
9) Counter irritation.

BPHTI PTH 3201(Rev) 4 September 2014 17
Facilitation of muscle contraction: when a patient is
unable to produce a muscle contraction,
electrical stimulation may be of use in assisting
voluntary contraction
When contraction is inhibited by pain or recent
injury or there has been prolonged disuse or
faulty use of muscle.
For example active contraction of quadriceps in
painful rheumatoid arthritis of knee or after
menisectomy, faradic stimulation may be helpful
in establishing voluntary contraction.

BPHTI PTH 3201(Rev) 4 September 2014 18
Re-education of muscle action: when inability to
contract a muscle is the result of prolonged
disuse or incorrect use as seen in intrinsic foot
muscles in longstanding flat foot or the
abductor hallucis in hallux valgus, faradic
stimulation may be used to produce
contractions and so help to restore the sense
of movement.

BPHTI PTH 3201(Rev) 4 September 2014 19
The brain appreciates movts not muscle
actions, so the current should be applied in
such a way that it causes the movement that
the patient is unable to perform
Active contractions should be attempted at
the same time as the electrical stimulation,
the treatment being a preliminary to active
exercise.

BPHTI PTH 3201(Rev) 4 September 2014 20
Training a new muscle action: after a tendon
transplantation or other reconstructive
operations, a muscle may be required to perform
a different action from that which it did before.
A new movement pattern has to be established.
The muscle is stimulated so that its new action is
performed and the patient must concentrate on
the movement and attempt to assist with
voluntary contraction.

BPHTI PTH 3201(Rev) 4 September 2014 21
Exercise for paralysed muscle: when there is neuropraxia
of a motor nerve, impulses from the brain are unable
to pass the site of lesion to reach the muscle supplied
by the affected nerve and so voluntary power is lost.
There is no degeneration of nerve so if it is stimulated
with faradism below the site of lesion , impulses passes
to the muscles causing them to contract.
It may be used to exercise the paralysed muscles to
keep them in good condition untill the nerve conduct
impulses.

BPHTI PTH 3201(Rev) 4 September 2014 22
When a nerve has been severed,
degeneration of the axon takes place.
In early period of degeneration interrupted DC
may be used but later has be replaced by
faradic current.
Faradism is used only to prevent disuse
atrophy and subsequent fibrosis of muscle.

BPHTI PTH 3201(Rev) 4 September 2014 23
Strengthening and increased bulk of muscle:
When a muscle is very weak the weight of the
part to be moved forms an adequate load and
electrical stimulation can be of assistance in
restoring muscle bulk and power.
Inflammation,injury of joint- active exercise
not possible
The stimulation along with an attempt to
perform active movement is used.

BPHTI PTH 3201(Rev) 4 September 2014 24
It is better for the patient that the results of
the treatment should depend on his own
efforts, active exercise is of more value than
electrical stimulation in restoring normal
function.
Muscle strength and endurance improvement
Overload, Specificity principle


BPHTI PTH 3201(Rev) 4 September 2014 25
For strength gains: 50% of MVIC(healthy
muscle), 10% of MVIC (injured muscle)
For endurance: prolonged period of
stimulation along with lower force of
contraction.
4 September 2014 BPHTI PTH 3201(Rev) 26
Increase in blood supply: increased blood supply is
brought about primarily by the vasodialation in
the working muscles.
The treatment is more effective if many muscles
are stimulated.
Treatment is usually applied in baths and
sinosoidal currents are chosen(more sensory
stimulation)
The treatment may be used for circulatory
defects such as chill blains or following a long
period of immobilization
BPHTI PTH 3201(Rev) 4 September 2014 27
Improved venous and lymphatic drainage:
Increased venous and lymphatic return is
brought about by the pumping action of the
alternating muscle contraction and relaxation
and of joint movements on the veins and
lymphatics.
It is used in the treatment of oedema

BPHTI PTH 3201(Rev) 4 September 2014 28
Prevention and loosening of adhesions:
When there is effusion into the tissues adhesions
are liable to form, but these can be prevented by
keeping the structures moving on each other.
If adequate active exercise is not possible,
electrical stimulation may be used for this
purpose
When a generalized effect is required sinusoidal
baths are satisfactory but for localized application
the faradic current is used and may be applied
with the muscles under tension.
BPHTI PTH 3201(Rev) 4 September 2014 29
Counter irritation:
The faradic current may be used to relieve
pain by counter irritation.
If a strong, unsurged current is applied in the
region of a sensory nerve, accommodation
first takes place and then the conductivity is
reduced, blocking the pain impulses and thus
reducing the sensation of pain.

BPHTI PTH 3201(Rev) 4 September 2014 30

TECHNIQUE OF
APPLICATION:
FARADIC CURRENTS.
4 September 2014 BPHTI PTH 3201(Rev) 31
PREPARATION OF APPARATUS:
The therapist tests the apparatus by attaching
leads and electrodes to the terminals, holding
the two electrodes in a moistened hand.
Increasing the intensity of current untill a mild
prickling sensation is felt.
Two types of electrodes are used-the active
electrode and the indifferent electrode.


BPHTI PTH 3201(Rev) 4 September 2014 32
The active electrode may be a pen electrode
or a disc electrode or a small lint pad with a
flat plate electrode.
A flat plate electrode and lint pad are used
for the indifferent electrode to complete the
circuit.
The pads consist of 8 layers of lint so that
they are thick enough to make good contact
with tissues and with the electrode.
BPHTI PTH 3201(Rev) 4 September 2014 33
They should be folded evenly with no creases, or
there will be uneven distribution of current and
so discomfort.
Electrodes should be half an inch smaller all
round than the pads, to reduce the danger of
their coming in contact with the skin and causing
uncomfortable concentration of current.
Corners of the electrodes should be rounded as
points may be become bent and dig in to the
pad again causing concentration of current.
BPHTI PTH 3201(Rev) 4 September 2014 34
PREPARATION OF THE PATIENT :
Clothing is removed from the area to be treated
and the patient supported comfortably in good
light.
If the aim of the treatment is to re educate a
muscle action, the patient may be arranged so
that movement is produced when the muscle
contracts e.g.
for training quadriceps muscle , the knee must be
arranged in slight flexion so that extension takes
place when muscles are stimulated.
BPHTI PTH 3201(Rev) 4 September 2014 35
APPLICATION OF ELECTRODES:
The skin has to be cleaned with soap and water
to remove the natural oils and to reduce the skin
resistance.
The skin can be moistened using saline water
immediately before the application of pads as
ions can be provided by the saline water.
The area chosen to apply the indifferent pad
must be such that it does not cause any muscle
contraction other than those to be treated.
BPHTI PTH 3201(Rev) 4 September 2014 36
It is usually applied over the nerve trunk supplying the
group of muscles eg: over medial epicondyle of
humerus for the flexor muscles of the forearm.
Care must be taken not to cover motor points of any
muscles to be stimulated.
The indifferent pad must be large, to reduce the
current density under it to a minimum, thus preventing
excessive skin stimulation.
The indifferent electrode may be bandaged in position
or secured with rubber straps or body weight may be
used to hold them in position.
BPHTI PTH 3201(Rev) 4 September 2014 37
APPLICATION OF CURRENT:
The active electrode is placed over the motor
point of the muscle to be stimulated.
The motor point is the point at which the best
contraction is obtained, usually being situated
over the point at which the main nerve enters the
muscle.
It is frequently present at the junction of the
upper and middle one thirds of the fleshy belly of
the muscle, although there are exceptions.
BPHTI PTH 3201(Rev) 4 September 2014 38
The exact position of motor points varies in
different individuals.
The intensity of the current is slowly raised
untill a good contraction is obtained.
The duration of treatment depends upon the
condition of the patients muscles and on the
purpose for which it is being used.
Muscle fatigue is indicated by weakening of
contraction but it does not happen rapidly
with faradic stimulation.
BPHTI PTH 3201(Rev) 4 September 2014 39
Treatments lasts for 20- 30 minutes and about
90 contractions can be obtained for each
muscle and this is regarded as the minimum
treatment that can be effective.
Usually 20-30 contractions are produced on
one motor point.
BPHTI PTH 3201(Rev) 4 September 2014 40
METHODS OF APPLICATION:
Stimulation of motor points: This method has
the advantage that each muscle performs its
own individual action and the optimum
contraction of each muscle can be obtained.
It has the disadvantage that if many muscles
are to be stimulated then large number of
contractions for each muscle can not be
produced.
BPHTI PTH 3201(Rev) 4 September 2014 41
Stimulation of muscle groups: in this method all
the muscles of a group work together.
Two electrodes are fixed one over the nerve trunk
supplying the group of muscles or over their
origin and the other so that it covers the motor
points or over the lower ends of the fleshy bellies
of the muscles.
All muscles of the group work together and it is a
satisfactory method to re educate the group of
muscles which work together normally as a group
such as quadriceps or small muscles of foot.

BPHTI PTH 3201(Rev) 4 September 2014 42
This method also permits many more
contractions to be elicited from each muscle
than if individual motor points are
stimulated.
It is important that a satisfactory contraction
of each muscle in a group is obtained. If some
muscles contract less strongly than others,
because they are weaker or more deeply
placed this method is not suitable.
BPHTI PTH 3201(Rev) 4 September 2014 43
Nerve conduction: if a motor nerve is
stimulated contractions are produced of all
the muscles that is supplied beyond the point
of stimulation.
For this method an indifferent electrode is
applied to a convenient area and the active
electrode to some point where the nerve
trunk is superficial.
BPHTI PTH 3201(Rev) 4 September 2014 44
The motor points may be inaccessible because of
wound or splinting or in the case of oedema the
current spreads in fluid and so it may be difficult
to obtain contractions on attempting to stimulate
the motor points.
It is the most comfortable method of stimulating
the muscles of facial expression. For this purpose
three points over the branches of the facial nerve
are stimulated , one behind the lateral corner of
the eye, one in front of ear and one just above
the angle of jaw.
BPHTI PTH 3201(Rev) 4 September 2014 45
Bath treatment: application of current in baths
have the advantage that the water makes good
contact with the tissues and the prolonged
soaking reduces the skin resistance and
widespread effects are produced.
It is particularly valuable when the aim of the
treatment is to increase the blood supply to
the area.
BPHTI PTH 3201(Rev) 4 September 2014 46
The main disadvantage is the treatment can not be
localized and although many muscles are stimulated
they do not all contract to the same degree, those
which are strongest and most superficial responding
most readily.
Using this method flat foot can be treated by applying
faradic foot bath. The electrodes may be arranged in
different ways.
One method for stimulation of muscles of the
longitudinal arch is to place electrodes transversely
across the bottom of the bath, one under the heels and
other under the anterior part of the feet.
BPHTI PTH 3201(Rev) 4 September 2014 47
The muscles of the anterior transverse arch
may be stimulated by placing the electrodes
one on each side of the feet, level with
metatarsal shafts and with the edges of the
electrodes just under the lateral borders of
the feet.
In the both the methods the water in the bath
should just cover the toes.

4 September 2014 BPHTI PTH 3201(Rev) 48
Faradism under pressure: this method is used
to increase the venous and lymphatic drainage
from an oedematous area.
Contractions of many muscles are required
and may be obtained by placing large pads so
they cover motor points of many groups of
muscles or by nerve conduction, the nerve
trunks supplying the limb are stimulated above
the oedematous area.
BPHTI PTH 3201(Rev) 4 September 2014 49
The limb is supported in elevation so that gravity
assists the venous and lymphatic drainage and
the limb is covered by elastic bandage.
The elastic bandage increases the pressure on the
vessels when the muscles contract and its recoil
on muscle relaxation exerts a further pumping
action.
The current is applied and surged fairly slowly, in
order to obtain a good pumping effect. The
treatment lasts up to 20 minutes and adequate
rest periods given in between as it is fatiguing.
BPHTI PTH 3201(Rev) 4 September 2014 50
Faradism under tension: the aim of this
treatment is to stretch and loosen adhesions.
The limb is fixed so that the muscles involved
are in a stretched position.
The current is then applied either to individual
motor points or to whole group of muscles and
increased untill a contraction is obtained.
BPHTI PTH 3201(Rev) 4 September 2014 51
Movement is not permitted and so
contractions are isometric and so increased
tension in the muscle stretches the muscle
adhesions
The current is usually surged, but may be
interrupted . Interruption causes a more
sudden stretch but needs high skill of the
operator for its use.
BPHTI PTH 3201(Rev) 4 September 2014 52
REFERENCES:
Claytons Electrotherapy and Actinotherapy
4
th
edition.

4 September 2014 BPHTI PTH 3201(Rev) 53
`

4 September 2014 BPHTI PTH 3201(Rev) 54

4 September 2014 BPHTI PTH 3201(Rev) 55