DPT 633 Concepts and Skills in Physical Therapy II

Electrotherapy Terminology Assignment

Due Date: 4/14/21

Objective: To actively develop a comprehensive terminology study guide that will assist the
group in understanding and utilizing clinical electrotherapy procedures.

Instructions: Each student has been assigned terms. Explore the meaning of each term. Post
definitions below and Include your name and peer-reviewed references. See the examples

Term Definition Author

Anion A negatively charged ion. An anion has more electrons than protons Rivard
giving it the net negative charge; one or more electrons is gained. The
positive electrode (anode) attracts negatively charged ions and repels
positively charged ions. Example: chloride (Cl-) (Cameron M.
Physical Agents in Rehabilitation, 5th ed, 2018)

Cation A positively charged ion. A cation has more protons than electrons Rivard
giving it the net positive charge; one or more electrons is lost.The
negative electrode (cathode) attracts positively charged ions and
repels negatively charged ions. Example: sodium (Na+) (Cameron M.
Physical Agents in Rehabilitation, 5th ed, 2018) Image:
https://steemit.com/science/@elemenya/chemistry-express-ions-and-
ionization-energy

Waveform A graphic representation of the shape, direction, amplitude, duration, Rivard

and frequency of the electrical current. The waveform is displayed by
the oscilloscope. (Prentice W. Therapeutic Modalities in
Rehabilitation, 5th ed, 2018)
Burst Bursts are two or more consecutive pulses separated from the next Singh
series of consecutive pulses OR it can be bursts of cycles of
alternating current as shown below. (Bellew J, Michlovitz S, Notan T.
Michlovitz’s Modalities for Therapeutic Intervention, 6th ed, 2016.)

Example of Burst Alternating Current

These are bursts of cycles.
Image: Figure 9.13 (Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for Therapeutic Intervention, 6th
ed, 2016.)

Conductor Material that permits the free movement of electrons. Electrons can Singh
move in a current only if there is a relatively easy pathway to move
along. Metals are good conductors of electricity, as are electrolyte
solutions, because both are composed of large numbers of free
electrons that are given up readily. Conductor example: copper, gold,
silver, aluminum (Prentice W. Therapeutic Modalities in Rehabilitation,
5th ed, 2018)

Insulator Material that resists current flow. Insulators contain relatively fewer Singh
free electrons and thus offer greater resistance to electron flow.
Insulator example: air, wood, glass (Prentice W. Therapeutic
Modalities in Rehabilitation, 5th ed, 2018)

Coulomb (C) The measurement of an electrical charge. Charge is the basic property Gamble
of matter, can be a negative, positive, or neutral charge. (Cameron M.
Physical Agents in Rehabilitation, 4th ed, 2013)

Ampere (A) The measurement of electrical current. 1 Ampere = 1 Coulomb per Gamble
second. Electrical current is the flow or movement of charged particles
through a conductor in response to an applied electrical field.
(Cameron M. Physical Agents in Rehabilitation, 4th ed, 2013)

Dispersive A large electrode that is used to disperse the current over a greater Gamble
Electrode treatment area, providing an increased level of comfort for the patient,
that does not limit the intensity of stimulation of the active electrode.
Not the electrode used for treatment, it is used to complete the circuit,
and should be placed several inches away from the treating electrode
on intact skin. (Cameron M. Physical Agents in Rehabilitation, 4th ed,
2013)
Symmetrical A modulated type of alternating or pulsed current that contains two Pfeiffer
biphasic current phases on opposite sides of the baseline within an individual cycle.
Current flow is bidirectional and changes polarity at least once every
cycle. All of the waveform variables are identical for each phase in
both directions.
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Asymmetrical A modulated type of alternating or pulsed current that contains two Pfeiffer
biphasic current phases on opposite sides of the baseline within an individual cycle.
Current flow is bidirectional and changes polarity at least once every
cycle. At least one of the waveform variables for each phase is
unequal in relation to the isoelectric line; however, this current can be
balanced or unbalanced with respect to the net charge. (Prentice W.
Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Burst modulated A type of alternating current that is modulated to incorporate a Pfeiffer

alternating frequency burst and duty cycle. This type of alternating current may
current result in either a Russian or Aussie current.
(Ward AR. Electrical Stimulation Using Kilohertz-Frequency
Alternating Current. Physical Therapy and Rehabilitation Journal.
2009;89(2):181-190. doi:10.2522/ptj.20080060)

Train The uninterrupted generation of pulses at a fixed frequency or a brief Lozada

period of alternating current. (Bellew JW, Michlovitz SL, Nolan T.
Modalities for Therapeutic Intervention. Philadelphia, PA: F.A. Davis
Company; 2016.)
Image:https://www.electronics-tutorials.ws/waveforms/waveforms.html

Pulse An isolated electrical event separated from the next by a finite period Lozada
of time. (Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic
Intervention. Philadelphia, PA: F.A. Davis Company; 2016.)

Period The inverse of frequency (𝑓) calculated as 1/𝑓. Period is the duration of Lozada
one cycle in a repeated event such as alternating current. (Bellew JW,
Michlovitz SL, Nolan T. Modalities for Therapeutic Intervention.
 Philadelphia, PA: F.A. Davis Company; 2016.)
Image:https://zone.ni.com/reference/en-XX/help/370466AH-01/daqhelp/measperiod/

Motor Point Area on the skin located closest to the motor nerve’s entry into the Ahner
muscle. It is an anatomical site characterized by high electrical
conductance, low resistance. (Cameron M. Physical Agents in
Rehabilitation, 5th ed. Elsevier, 2017)

Acupuncture Points close to the skin surface along meridians (channels of energy) Ahner
Point that flow from organ system to organ system. These points cause
events that affect many aspects of mind, body and spirit when
stimulated. (Cameron M. Physical Agents in Rehabilitation, 5th ed.
Elsevier, 2017)

Trigger Point Hypersensitive palpable nodule in a taut band that causes pain in a Ahner
characteristic zone of reference, pain with passive or active stretching,
limited range of motion, and pain with resistance. (Cameron M.
Physical Agents in Rehabilitation, 5th ed. Elsevier, 2017)

Accommodation Accommodation is the process that occurs during repetitive and Armington
sustained simulation, when intensity was introduced gradually.
Accommodation to the constant intensity overtime causes fewer
nerves to depolarize, lessening the treatment effect at that specific
intensity.
(Grando F, Bernardino GR, Carvalho JAM, et al. Comparison of
interferential current accommodation and comfort using three different
base frequencies. Int j ther rehabil res. 2014;3(2). doi:
10.5455/ijtrr.00000027)

Excitation Excitation is the process of how an electrical current can stimulate a Armington
peripheral nerve fiber to its threshold by activating sodium ion
channels in order to generate an action potential.
(Taghipour-Farshi H, Frounchi J, Ahmadiasl N et al. Assessment on
selectivity of multi-contact cuff electrode for recording peripheral nerve
signals using Fitzhugh-Nagumo model of nerve excitation. J back
musculoskelet rehabil. 2016;29(4):749-756. doi: 10.3233/BMR-
160684)

Sensitization Sensitization is the process where ongoing and concentrated Armington

nociceptive input overtime alters brain sensory processes and the
descending pain inhibitory mechanisms, lowering the threshold for
peripheral stimulation from low threshold mechanoreceptors.
(Beckwee D, Hertogh WD, Lievens P et al. Effect of TENS on pain in
 relation to central sensitization in patients with osteoarthritis of the
knee: study protocol of a randomized controlled trial. Trials.
2012;13(1):21-27. doi: 10.1186/1745-6215-13-21)

Ramp Up / Ramp up: The amount of time it takes for the current’s amplitude to Curry
Ramp Down increase during the off time to its maximum amplitude during the on
time
Ramp down: the amount of time it takes for the current amplitude to
decrease from its maximum amplitude during the on time to zero
during the off tim
(Cameron M. Physical Agents in Rehabilitation, 5th ed. Elsevier, 2017)

Phase Width / Pulse width, also known as pulse duration, is the time between the Curry
Pulse Width beginning of the first phase of a pulse to the end of the last phase of a
pulse measured in microseconds (Cameron M. Physical Agents in
Rehabilitation, 5th ed. Elsevier, 2017)

On Time / Off On Time: time in which a train of pulses occurs Curry

Time Off Time: time between trains of pulses during which no current will
flow
Both together are often expressed as a ratio

Ex. on time produces a muscle contraction, off time allows the muscle
to relax

(May also refer to the On:Off period of other types of current besides
pulsed current)
(Cameron M. Physical Agents in Rehabilitation, 5th ed. Elsevier, 2017)

Pulsed current Usually contain three or more pulses grouped together. These groups Cao
(PC) of pulses are interrupted for short periods of time and repeat
themselves at regular intervals. PC can be unidirectional or
bidirectional. (Prentice W. Therapeutic Modalities in Rehabilitation, 5th
ed, 2018)

Direct current Uninterrupted unidirectional flow of electrons towards the positive Cao
(DC) pole. On most modern DC devices, the polarity and thus the direction
of current flow can be reversed. (Prentice W. Therapeutic Modalities
in Rehabilitation, 5th ed, 2018)

Alternating Bidirectional and constantly changing direction (reversing polarity) flow Cao
current of electrons. Electrons flowing in an AC always move from the
negative to positive pole, reversing direction when polarity is reversed.
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)
Analog vs digital Analog control stimulator: usually dials, no digital display Chiauzzi
control
stimulator

example: analog TENS unit

Image: https://www.alibaba.com/product-detail/N601-Medical-Analog-TENS-Unit-Nerve_60649560879.html

Digital control stimulator: usually buttons, may have pre-programmed

protocols

example: digital TENS unit

Image: https://www.tenspros.com/tens-7000-2nd-edition-digital-tens-unit-
dt7202.html

(Michlovitz S, Bellew J, Nolan TP. Modalities for Therapeutic

Intervention, 5th ed, 2012.)

Zero net DC Zero net DC is when there is no net charge between the phases of a Chiauzzi
bi or polyphasic waveform. The current “alternates” between positive
and negative regularly (over and under the line), leading to a zero net
charge. (Michlovitz S, Bellew J, Nolan TP. Modalities for Therapeutic
Intervention, 5th ed, 2012.)

Resistance The measure of the opposition of flow of electrical current in a Chiauzzi

material. It is a part of Ohm’s law and is measured in Ohms. If there is
more resistance to the flow of current, there will be less current.
(Michlovitz S, Bellew J, Nolan TP. Modalities for Therapeutic
Intervention, 5th ed, 2012.)

Functional FES is a means for producing a contraction in a paralyzed or weak Stetson

Electrical muscle to enable function through electrical excitation of the
Stimulation innervating nerve. The electric charge stimulates the target muscle
(FES) and helps it perform its usual actions. This can be effective for patients
with MS to help correct a foot drop, due to disruptions in the nerve
pathways.
(Barrett CL, Mann GE, Taylor PN, Strike P. A randomized trial to
investigate the effects of functional electrical stimulation and
therapeutic exercise on walking performance for people with multiple
sclerosis. Mult Scler. 2009 Apr;15(4):493-504. doi:
10.1177/1352458508101320. Epub 2009 Mar 12. PMID: 19282417.)

Cycle A cycle is defined as one complete wave measured at corresponding Stetson

points of alternating current or voltage.
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Hertz Unit describing the number of cycles in one second. Stetson

1Hz = 1 Cycle (wave) per second (ex. 5 cycles/ second = 5 Hz)
(This is also referred to as Pulses per second, pps)
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Acupuncture AKA AL-TENS/ACUTENS is a different category of TENS, the other Murphy

like TENS being Conventional TENS. It is a treatment modality that can be used
to temporarily reduce pain by the descending endogenous opiate
system. AL-TENS parameters include low frequency (2-10Hz), high
intensity (above pain threshold) stimulations, and a longer pulse width
(100-400 μs). (Tousignant-Laflamme Y, Brochu M, Dupuis-Michaud C, Pagé C, Popovic D,
Simard ME. Duration of Analgesia Induced by Acupuncture-Like TENS on Experimental Heat
Pain. ISRN Pain. 2013;2013:792383. Published 2013 Apr 7. doi:10.1155/2013/792383)

Periaqueductal A midline structure composed of densely packed heterogeneous Murphy

gray matter neurons that surrounds the cerebral aqueduct throughout the
mesencephalon of the brainstem. It is a major component of pain
modulation.
(Renn, C. L., & Dorsey, S. G. (2005). The physiology and processing of pain: a review. AACN
clinical issues, 16(3), 277–415. https://doi.org/10.1097/00044067-200507000-00002)

Endogenous A class of molecules that are produced in the brain and circulate Murphy
opiate widely throughout all organ systems. They are neuropeptides and are
derived from precursor genes, either pre-proenephalins A or pro-
opiomelanocortin (POMC). Are often termed neuromodulators or nero-
immunomodulators, with their presumed binding site being an opioid
receptor within the brain tissue. (Zagon, I. S., & McLaughlin, P. J. (2017).
Endogenous Opioids in the Etiology and Treatment of Multiple Sclerosis. In I. S. Zagon (Eds.) et.
al., Multiple Sclerosis: Perspectives in Treatment and Pathogenesis. Codon Publications.)

NMES A modality to stimulate contractions to improve motor function by Reinhold

 depolarizing motor neurons by use of electrodes in very weak
muscles. NMES can be used to reeducate muscle, improve ROM,
decrease edema and treat disuse atrophy. (O’Sullivan S, Schmitz T,
Fulk G. Physical Rehabilitation, 6th ed, 2014)

Electrical EMS is the application of an electrical current directly to a muscle to Reinhold

Muscle produce a contraction and can be used for denervated muscles. EMS
Stimulation requires pulses of electricity lasting 10ms or longer in order for the
(EMS) electrical current applied to depolarize the muscle cells. (Cameron M.
Physical Agents in Rehabilitation, 4th ed, 2013)

Aussie Aussie stimulation is a form of a burst modulated alternating current Reinhold

Stimulation with 1000Hz applied in bursts with a duration of 4ms and a 20% duty
cycle. It is known to have a large torque production while the patient
experiences less discomfort compared to other currents when applied
for muscle strengthening. (Ward A, Oliver W, Buccella D, Wrist
Extensor Torque Production and Discomfort Associated with Low-
Frequency and Burst-Modulated Kilohertz-Frequency Currents, Phys
Ther 2006;86:1360-1367)

Twin Peak Twin peak monophasic pulsed currents are characterized by high- Schulz
Monophasic amplitude, short duration waveforms, with long interpulse intervals.
Pulsed Current Although the peak amplitude is very high, the long interpulse interval
means that the total average delivery of current to the patient will be
low. Twin peak monophasic pulsed currents can stimulate both motor
and sensory nerves, and is often used for pain modulation, stimulation
of muscle contractions, and tissue healing.

Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for Therapeutic Intervention,

6th ed. FA Davis, 2016.

Electroanalgesia Electroanalgesia refers to the use of electrical stimulation as a form of Schulz

pain relief / management. For example, TENS is used for
electroanalgesic effects.

White PF, Elvir Lazo OL, Galeas L, Cao X. Use of electroanalgesia and laser
therapies as alternatives to opioids for acute and chronic pain management.
F1000Res. 2017;6:2161. doi:10.12688/f1000research.12324.1

Modulation Modulation refers to the alteration of certain parameters of electrical Schulz

stimulation such as frequency, amplitude, duty cycle, phase duration,
 etc. Modulation can be used to increase patient comfort, target
specific nerves or achieve specific goals (such as a muscle
contraction or sensory stimulation), or decrease habituation to the
stimulus.

Avendaño-Coy J, Bravo-Esteban E, Ferri-Morales A, Martínez-de la Cruz R, Gómez-

Soriano J. Does frequency modulation of transcutaneous electrical nerve stimulation
affect habituation and mechanical H\hypoalgesia? A randomized, double-blind, sham-
controlled crossover trial. Phys Ther. 2019 July; 99(7): 924-932.

TENS Transcutaneous electrical nerve stimulation (TENS) is the application McCardle

of electrical stimulation of varying frequency, intensity and pulse
duration to the skin for pain relief. TENS is a safe non-invasive
intervention which may produce significant analgesia in patients with
moderate predictable pain.

Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain.
Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003222. DOI:
10.1002/14651858.CD003222.pub2

MENS Microcurrent electrical neuromuscular stimulation (MENS) is a McCardle

subsensory modality that employs current intensities between 1 and
999 uA, and is most commonly used to enhance soft tissue healing
and to treat fracture nonunion.

Allen J, Mattacola C, Perrin D. Effect of microcurrent stimulation on delayed-onset muscle

soreness: A double blind comparison. Journal of Athletic Training. 1999;34(4):334-337.

Impedance Impedance refers to resistance within biological systems, including McCardle

capacitive and inductive resistance, and can be affected by skin,
electrodes, and choice of current. It is measured in Ohms.

(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Anode With an electrical current, an anode has a relatively lower number of Bott
electrons and is also called a positive electrode. It will attract negative
ions and electrons.
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Cathode A cathode is an electrode that has the greatest number of electrons Bott
and is also called a negative electrode. It will attract positive ions.
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Charge Charge is the basic property of matter carried by some elementary Bott
particles that governs how the particles are affected by an electric or
magnetic field. Charges can be positive or negative and can neither be
created nor destroyed.
(Britannica, T. Editors of Encyclopaedia (2020, May 27). Electric
charge. Encyclopedia Britannica.
https://www.britannica.com/science/electric-charge)
Electron Negatively charged subatomic particle. Can be a free particle or bound Mace
to the nucleus of an atom
(Palma P, Famiglini G, Trufelli H, Pierini E, Termopoli V, Cappiello A.
Electron ionization in LC-MS: recent developments and applications of
the direct-EI LC-MS interface. Anal Bioanal Chem. 2011;399(8):2683-
2693)

Galvanotaxis The directed motion of charged cells guided by an electric field or Mace
current of the opposite charge; the cells with an opposite charge of the
electric field will move towards the electrical field and cells of the same
charge will be repelled away.
(Mycielska ME, Djamgoz MB. Cellular mechanisms of direct-
current electric field effects: galvanotaxis and metastatic
disease. J Cell Sci. 2004;117(9):1631-1639 )

Ionization The process by which an atom acquires a new charge (negative Mace
or positive charge) by gaining or losing electrons. An atom that
loses electrons will have a positive charge and an atom that
gains electrons will have a negative charge.
(Palma P, Famiglini G, Trufelli H, Pierini E, Termopoli V, Cappiello
A. Electron ionization in LC-MS: recent developments and
applications of the direct-EI LC-MS interface. Anal Bioanal Chem.
2011;399(8):2683-2693)

Interrupted Interrupted direct current is a type of Frechette

Direct Current: direct current that occurs when current
ceases to flow (i.e. gets interrupted)
for > 1 second following > 1 second of
direct current & then flows again for >
1 second. Interrupted direct current is
issued clinically to cause twitch
contraction of denervated muscles
during electrodiagnostics or treatment.
(Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)

Reversed Direct Reversed direct current is a type of direct current in which the direction Frechette
Current: of current flow is reversed and flows for >1 second. The direction of
current is controlled by the polarity of the voltage, so by reversing the
voltage, the current flows in the opposite direction. Reversal of current
can be accomplished using a hand switch or automatic switch inside
the unit. (Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)
Low Intensity Low intensity direct currents are microcurrents of an intensity < 1 mA Frechette
Direct Current (1000 μA). LIDC is an example of a microcurrent level stimulation. The
(LIDC): pulsed version of this is called MES or MENS (microcurrent electrical
stimulation & microcurrent electrical nerve stimulation) whereas LIDC
is continuous direct currents. Both however, are subsensory level
stimulation in that their amplitude is too weak for nerve depolarization
(be careful with the term MENS in that this does not actually stimulate
the nerve). The proposed clinical effect of microcurrent is to increase
circulation & facilitates wound healing. (Balakatounis KC & Angoules
AG. Low-intensity electrical stimulation in wound healing: review of the
efficacy of externally applied currents resembling the current of injury.
Eplasty. 2008)

High Frequency In general, frequency = # of events per second Conway

Current Frequency indicates the numbers of impulses or cycles produced by
an electrical stimulating device in 1 second and is referred to as:
● Cycles per second (cps) → alternating current
● Pulses per second (pps) → pulsed current
● Beats per second → interferential current
● Bursts per second → Russian Current
● Hertz (Hz), can also be called the “rate” (Prentice W.
Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

High Frequency Current: > 100,000 pps or Hz

● Not electrical stimulation application
*High Frequency TENS: high rate/conventional TENS (> 50 pps or Hz)
● (Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed,
2018)

Medium Medium Frequency Current: 1,000-10,000 pps or Hz Conway

Frequency ● Russian current (2,500 Hz bursted)
Current ● Aussie current (1,000 Hz bursted)
● Interferential current (4,000 Hz, 5,000 Hz)

Low Frequency Low Frequency Current: 1-1,000 pps or Hz Conway

Current *Low Frequency TENS: low rate/acupuncture-like TENS (< 10 pps or
Hz)
● (Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed,
2018)

*TENS for pain modulation = high rate & low rate (this is different than
electrical stimulation)
Russian Russian Current (also referred to as Russian Protocol) is a medium- Joyce
frequency alternating current with a frequency of 2500 Hz delivered in
50 bursts/second. Each burst is 10 ms long and is separated from the
next burst by a 10-ms interburst interval.

(Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)

High Volt High-voltage electrical stimulation (high-voltage pulsed current - Joyce

Stimulation HVPC) is a monophasic pulsed electric current that consists of double-
peaked impulses with a very short duration (5-100 μs) and longer
interpulse intervals, which generates a low total current (1.5 mA), and
a voltage greater than 150 V.

(Sandoval MC, Ramirez CR, Camargo DM, Russo TL, Salvini TF.
Effect of high-voltage electrical stimulation on the albumin and
histamine serum concentrations, edema, and pain in acute joint
inflammation of rats. Braz J Phys Ther. 2015;19(2):89-96.
doi:10.1590/bjpt-rbf.2014.0079)
Image: (Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)

Low Volt Low volt stimulation is a result of devices or currents that produce Joyce
Stimulation peak amplitudes of up to 150 V (any voltage over 150 V is considered
to be high-volt stimulation).
(Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology:
Electrotherapy and Electrophysiologic Testing. 3rd ed. LWW; 2008.)

Interferential Interferential current is a type of alternating current that is created by Barbella

Current the interference of 2 medium frequency currents that are of different
frequencies. IFC is sinusoidal, symmetrical, biphasic, and continuous
rather than pulsed. IFC is amplitude modulated, meaning that the net
frequency produced is equal to the difference between the 2 original
alternating currents. (Cameron, M. Physical Agents in Rehabilitation,
4th ed, 2013.)
Premodulated Premodulated interferential current is a type of alternating current of a Barbella
Interferential medium frequency that gradually increases and decreases amplitude.
Current The main difference between IFC and premodulated IFC is that in
normal IFC, the modulation occurs on the patient; in premodulated
IFC, the modulation is predetermined by the manufacturer and occurs
in the machine. IFC usually requires 4 electrodes, while premodulated
IFC only requires 2. (Cameron, M. Physical Agents in Rehabilitation,
4th ed, 2013.)

Tetany Tetany is a muscular condition that occurs due to the over-excitation Barbella
of a muscle’s motor units. In terms of NMES, the muscle fibers get
repeatedly stimulated, which results in spastic contractions of the
muscle. Tetanic contractions are more fatiguing than normal muscle
contractions, and they can be assessed via palpation or visualization
(Prentice, W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018.)
Beat Frequency The two alternating currents intersect in between the pads and the Stock
result of the interconnecting currents is a new frequency (called a beat
frequency) which has the desired effect of either stimulating muscle
contraction (when the beat frequency is low) or achieving pain relief
(when the beat frequency is higher).
(G. (n.d.). Interferential therapy. Retrieved April 13, 2021, from
http://glenroyphysiotherapy.com.au/view/lib/interferential-
therapy/148#:~:text=The%20two%20alternating%20currents
%20intersect,the%20beat%20frequency%20is%20higher)

Frequency Nerves will accommodate to a constant signal & a sweep (or gradually Stock
Sweep changing frequency) is often used to overcome this problem. The
principle of using the sweep is that the machine is set to automatically
vary the effective stimulation frequency using either pre-set or user set
sweep ranges. The sweep range employed should be appropriate to
the desired physiological effects.
(Watson, T., & Nussbaum, E. L. (2021). Electrophysical agents:
Evidence-based practice [13th edition]. Edinburgh: Elsevier. Retrieved
April 13, 2021, from https://www.elsevier.com/books/electrophysical-
agents/watson/978-0-7020-5151-7)

Vector Scan Measured in percentages, vector scans are the rhythmic changes of Stock
the position of the vector. (Vector scans are typically present in
interferential current stimulation)

(C. (n.d.). Intelect Transport: 2 Channel Electrotherapy [Pamphlet].

User Manual Operation & Installation Instructions for: 2783-Two
Channel Transportable Electrotherapy Unit)

Substance P Substance P is a neuropeptide made up of 11 amino acids. Yang

Substance P’s major function is acting as neurotransmitter and
modulator of pain perception by altering cellular signaling pathways.
The hypothesis is that substance P helps sensitize the postsynaptic
neurons to glutamate, aiding in the transmission of pain signals to the
somatosensory area of the brain.

(Graefe S. Biochemistry, Substance P. StatPearls [Internet].

https://www.ncbi.nlm.nih.gov/books/NBK554583/#:~:text=Substance
 %20P's%20most%20well%2Dknown,and%20cell%20growth%20and
%20proliferation.
Published May 7, 2020. Accessed April 13, 2021).
Image: https://www.mdpi.com/1422-0067/20/7/1596/htm

Serotonin Serotonin is a neurotransmitter that has a great importance in the Yang

human body, being involved in the regulation of many key activities
(behavior, mood, and memory). It is utilized as the primary treatment
for many psychiatric and neurological disorders. Serotonin also
regulates physiological processes such as pain perception (it can
potentiate and inhibit nociceptive processes at various levels of the
nervous system).
( Berger M, Gray JA, Roth BL. The expanded biology of serotonin.
Annual review of medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864293/. Published
2009. Accessed April 13, 2021.)

Gamma- GABA (gamma-aminobutyric acid) is an amino acid that functions as Yang

Aminobutyric the primary inhibitory neurotransmitter for the central nervous system.
acid (GABA) It functions by reducing neuronal excitability via inhibiting nerve
transmission. GABA neurons and receptors are found in supraspinal
sites that are known to coordinate the perception and response to
painful stimuli.
Allen MJ. GABA Receptor. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK526124/. Published February
17, 2021. Accessed April 13, 2021.

Brief intense Jaber

TENS A motor level TENS applied at the site of pain at an intensity that is just
tolerable to activate a small diameter of a delta noxious afferents to elicit
peripheral nerve blockage and extrasegmental analgesia by using a high
frequency (100-150 pps) over a short period of time (phase duration of 150-
300 microsec, treatment duration of 5-15 min). This short term relief can be
used for minor procedures like wound dressing or suture removal. Johnson
M. Transcutaneous electrical nerve stimulation: mechanisms, application and
evidence. Reviews in Pain. 2007;1(1):7-11.
doi:10.1177/204946370700100103

Noxious level Noxious level TENS is also known as hyperstimulation level TENS and may be Jaber
TENS used when other modes of TENS are unsuccessful or accommodating. The
goal of this treatment is to produce painful stimulus (burning, needle-like
sensation to tolerance) at an already painful site to trigger endorphin-
mediated mechanisms by activating the reticular formation and
periaqueductal gray to initiate descending inhibition at spinal cord level
through enkephalins. This is accomplished using a low frequency (1-5 Hz, 80-
100 pps) and a long phase duration (10microsec-1sec). When appropriate,
this is a time efficient treatment since the duration of relief is long lasting
(days to weeks) and the onset of relief after application is rapid (30sec-2
 min). Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018.

Galvanic current This is a continuous low volt monophasic current that uses polar and Jaber
vasomotor effects to create an acidic reaction around the positive
pole and an alkaline reaction around the negative pole to increase
blood flow between electrodes, encourage hyperkeratinization to
manage hyperhidrosis, and can be used to promote resorption of
topical drugs through a process called iontophoresis. Blake E et al.
Electrotherapy Modalities. Naturopathic Physical Medicine. 2008:539-
562. doi:10.1016/b978-044310390-2.50017-1
Voltage The force that causes movement of electrons (charged particles). Allen
(Electromotive
Force) Bellow J, Michloviz S, Nolan T. Modalities For Therapeutic
Intervention. 6th ed. F.A. Davis Company; 2016.

Phase Duration Phase duration: the time from the beginning of one phase to the end Allen
of the phase (msec, µsec).

Bellow J, Michloviz S, Nolan T. Modalities For Therapeutic

Intervention. 6th ed. F.A. Davis Company; 2016.

Pulse Duration Pulse Duration: total time from the beginning to the end of a single Allen
pulse. This includes the interphase (intrapulse) interval.
Example:
- Phase duration of biphasic pulse are 150 µsec each
- Interphase interval = 50 µsec
- Pulse duration = 350 µsec
 Bellow J, Michloviz S, Nolan T. Modalities For Therapeutic
Intervention. 6th ed. F.A. Davis Company; 2016.

Endorphin One of the families of endogenous opioid peptides. These peptides are Faria
produced primarily in the pituitary gland bind mainly to delta opioid
receptors. Involved in decreasing perception of pain. When acting as
neurotransmitters, they are secreted by neurons to affect the actions of
other neurotransmitters, including serotonin or enkephalins. When acting
as hormones, they can cause responses in distal target tissues.
Froehlich J. Opioid Peptides. Alcohol Health Res World. 1997; 21(2):132-136.

Enkephalin One of the families of endogenous opioid peptides. Produced in many Faria
areas, including along the central nervous system, adrenal medulla, in the
brain. This binds primarily to mu-opioid receptors. Enkephalin decreases
the pain response by binding to these receptors in the spinal cord and
periaqueductal grey in the brain. Enkephalin can also inhibit the release of
Substance P to decrease afferent pain signals.
Froehlich J. Opioid Peptides. Alcohol Health Res World. 1997; 21(2):132-136.

Dynorphin One of the families of endogenous opioid peptides. These are produced Faria
primarily in the hypothalamus and prefer to bind kappa opioid receptors.
These peptides produce responses farther away from where they are
produced but act similarly to the other endogenous opioid peptides.
Froehlich J. Opioid Peptides. Alcohol Health Res World. 1997; 21(2):132-136.

Surge Mode Surge mode modulates the amplitude of the pulse train so that the Liptak
amplitude of each successive pulse progressively increases to a peak
over the duration of the on-time. Think of this as a ramp up function
that other pulsatile currents use.
 Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic
Intervention. Philadelphia, PA: F.A. Davis Company; 2016.

Reciprocal Reciprocating mode delivers current to one active electrode first and Liptak
Mode then to the other active electrode in an alternating manner. A clinician
will set the amount of time the current is delivered to an electrode
before it switches to the other electrode. In addition, amplitude of each
pulse remains the same for the session duration.

Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic

Intervention. Philadelphia, PA: F.A. Davis Company; 2016.

Synchronous Used for multichannel ES devices. In synchronous mode, ES is Liptak

Mode delivered through two channels simultaneously. This can be used to
stimulate two muscle groups at the same time.

Nussbaum EL, Houghton P, Anthony J, Rennie S, Shay BL, Hoens

AM. Neuromuscular Electrical Stimulation for Treatment of Muscle
Impairment: Critical Review and Recommendations for Clinical
Practice. Physiotherapy Canada. 2017;69(5):1-76.
doi:10.3138/ptc.2015-88.

Absolute The amount of time after a neuron generates an action potential where Stewart
Refractory you cannot initiate another action potential, regardless of how strong
Period the stimulus is.

Venes D, ed. Period. Taber’s Cyclopedic Medical Dictionary, 22nd ed.

2013.

https://content.byui.edu/file/a236934c-3c60-4fe9-90aa-
d343b3e3a640/1/module5/images/Refractory.JPG

Relative The amount of time after a neuron generates an action potential where Stewart
Refractory you can initiate another action potential, but a stronger stimulus is
Period needed, due to the hyperpolarization that occurs following an action
potential.
 Venes D, ed. Period. Taber’s Cyclopedic Medical Dictionary, 22nd ed.
2013.
https://content.byui.edu/file/a236934c-3c60-4fe9-90aa-
d343b3e3a640/1/module5/images/Refractory.JPG

Unbalanced vs In a balanced biphasic current, the positive and negative phases of the Stewart
Balanced waveform have the same amplitude and cancel one another out,
Biphasic resulting in no overall net charge of the electrodes. In an unbalanced
Currents biphasic current, the positive and negative phases have differing
amplitudes, resulting in an overall net charge, depending on which
phase had a higher amplitude.

Kloth LC. Electrical Stimulation Technologies for Wound Healing. Adv

Wound Care (New Rochelle). 2014;3(2):81-90.
doi:10.1089/wound.2013.0459
Pulse The number of pulses per second for a pulsed current. This is defined Fitzsimmons
Frequency as pulse per second (pps).

Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for Therapeutic

Intervention, 6th ed. FA Davis, 2016.

Carrier The carrier frequency is the frequency of the current delivered in Fitzsimmons
Frequency bursts during the application of pulsed current. Not to be confused with
the burst frequency, which is the frequency at which bursts are
delivered during the application of pulsed current.

Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for Therapeutic

 Intervention, 6th ed. FA Davis, 2016.

Duty Cycle The duty cycle is a percentage that represents the ratio of on-time to Fitzsimmons
total time for an electrical current. Total time is calculated by adding
on-time and off-time.

For example; a clinician looking to strengthen muscle may opt to use

10 seconds on and 40 seconds off. In this case, the duty cycle would
be 10 ÷ 50 = .20 or 20%.

Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for Therapeutic

Intervention, 6th ed. FA Davis, 2016.

Constant current Smith

Constant current instruments provide current that flows at a constant
amplitude within a specified range of impedances. According to Ohm’s
Law, the voltage output of the device varies to maintain the current at
a constant level as the tissue impedance changes. Constant current
stimulators will automatically reduce the driving voltage when
electrode contact improves or when electrical transmission increases,
thereby maintaining the desired level of stimulation. In cases where
electrode contact or transmission is reduced, constant current
stimulators will automatically increase the driving voltage, which may
result in skin burns as current density rises to very high levels.

Robinson AJ, Snyder-Mackler L, eds. Clinical Electrophysiology:

Electrotherapy and Electrophysiologic Testing. 3rd ed. Lippincott
Williams and Wilkins; 2007

Constant Smith
voltage Constant voltage instruments provide a constant amplitude voltage
within a specified range of impedances. The current flow varies
inversely with impedance to maintain the voltage output of the device.
In cases where electrode contact or electrical transmission is reduced,
constant voltage stimulators will automatically reduce the current
produced and thereby lessen the chance of skin burns resulting from
increased density. Conversely, if the electrode/tissue contact improves
and transmission is better with a constant voltage device, induced
currents could significantly increase, resulting in an undesirably high
level of stimulation.

Robinson AJ, Snyder-Mackler L, eds. Clinical Electrophysiology:

Electrotherapy and Electrophysiologic Testing. 3rd ed. Lippincott
Williams and Wilkins; 2007
 Smith
Denervation Denervation – In denervated muscle, no contraction will be elicited by
stimuli with very high short pulse durations, regardless of the
amplitudes applied. The strength-duration curve for the denervated
muscle is shifted markedly up and to the right because denervated
muscle fibers are inherently less excitable than motor nerve fibers and
hence require higher levels of stimulation to reach threshold excitation.

Robinson AJ, Snyder-Mackler L, eds. Clinical Electrophysiology:

Electrotherapy and Electrophysiologic Testing. 3rd ed. Lippincott
Williams and Wilkins; 2007

Rise Time vs. Rise Time - The time it takes for a current to increase from zero to its Stadler
Decay Time peak during any one phase.

Decay Time - The time it takes for a current to decrease from its peak
to zero during any one phase.

https://www.google.com/search?q=rise+time+and+decay+time&tbm=isch&ved=2ahUKEwi6os_mkPzvAhUoSN8KHV86BvsQ2-
cCegQIABAA&oq=rise+time+and+dec&gs_lcp=CgNpbWcQARgAMgQIABAYOgQIABBDOgIIAFDvvAFYjc8BYITbAWgAcAB4AIABbogB8QSSAQM3LjGYAQCgAQGqAQtnd3Mtd2l6LWltZ8ABAQ
&sclient=img&ei=mwh2YProEqiQ_Qbf9JjYDw&authuser=0&bih=754&biw=1536&hl=en#imgrc=0RM-8znT7so5-M

(Precise rise and decay time measurements of inorganic scintillators

by means of X-ray and 511 keV excitation. Nuclear Instruments and
 Methods in Physics Research Section A: Accelerators,
Spectrometers, Detectors and Associated Equipment. 2018;891:42-
52. doi:10.1016/j.nima.2018.02.074)

Capacitance The ratio of electric charge stored on a conductor to the difference in Stadler
electric potential.

https://www.google.com/search?q=capacitance+definition&rlz=1C1CHBF_enUS915US915&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiq1OLck_zvAhU7FVkFHSO-
BO0Q_AUoAXoECAEQAw&biw=1536&bih=754&dpr=1.25#imgrc=uxit7nCUnEf7JM

(Heerens W. Application of capacitance techniques in sensor design.

J Phys E Sci Instrum. Published online 1986.)

Ohm’s Law Ohm’s law “states that the current in an electrical circuit is directly Stadler
proportional to the voltage and inversely proportional to the
resistance.”

https://www.google.com/search?q=ohms+law&tbm=isch&ved=2ahUKEwjajs3hk_zvAhXGZt8KHdJvC4EQ2-
cCegQIABAA&oq=ohms+law&gs_lcp=CgNpbWcQAzIFCAAQsQMyBQgAELEDMgUIABCxAzICCAAyAggAMgIIADICCAAyAggAMgIIADICCAA6BAgAEEM6BAgAEAM6BwgAELEDEENQtYIQWN
GOEGDBkBBoAHAAeACAAV-
IAfEEkgEBOJgBAKABAaoBC2d3cy13aXotaW1nwAEB&sclient=img&ei=tgt2YNrbBcbN_QbS362ICA&bih=754&biw=1536&rlz=1C1CHBF_enUS915US915#imgrc=lBoYE00MD8HPxM

(Prentice WE. Therapeutic Modalities in Rehabilitation.; 2018.

Accessed April 13, 2021.
http://accessphysiotherapy.mhmedical.com/qa.aspx?
resourceID=2225)

Monopolar When it is desirable to have stimulation under one electrode, an Bui

Electrode electrode of a single circuit may be placed over the treatment area
Placement while the other electrode is placed where the therapeutic effect is not
intended.

Bellew, J. & Michlovitz, S. & Nolan, T. (2016). MODALITIES FOR

 THERAPEUTIC INTERVENTION (6th ed.). F.A. Davis Company.

Bipolar Both electrodes of a single circuit are placed over the treatment area. Bui
Electrode The bipolar electrode placement for may be either parallel or
Placement perpendicular to the fiber direction of the muscle.

Bellew, J. & Michlovitz, S. & Nolan, T. (2016). MODALITIES FOR

THERAPEUTIC INTERVENTION (6th ed.). F.A. Davis Company.

Quadripolar A quadripolar electrode placement involves the application of two Bui

Electrode electrodes from two separate circuits. There are typically two separate
Placement circuits with bipolar electrode arrangement over large areas. The
electrodes could be placed so that the currents could be intentionally
crossed or inferred as in the interferential current.

Bellew, J. & Michlovitz, S. & Nolan, T. (2016). MODALITIES FOR

THERAPEUTIC INTERVENTION (6th ed.). F.A. Davis Company.

Rheobase The minimum strength (mA) of a stimulus with a long duration that has Capone
the ability to produce a detectable motor response (action potential).
Rheobase is often looked at in reference to the strength duration
curve.
Using a stimulus with an amplitude greater than rheobase will not alter
the action potential.
Bellew, J. & Michlovitz, S. & Nolan, T. (2016). MODALITIES FOR
THERAPEUTIC INTERVENTION (6th ed.). F.A. Davis Company.

Chronaxie Capone

Chronaxie is the amount of time needed to produce a detectable

motor response (action potential) in a stimulus that is two times the
rheobase strength. A chronaxie< 1 msec indicates a healthy
innervated tissue. A chronaxie that is longer may indicate pathology of
 the tissue’s excitability or denervation.
Bellew, J. & Michlovitz, S. & Nolan, T. (2016). MODALITIES FOR
THERAPEUTIC INTERVENTION (6th ed.). F.A. Davis Company.

Resting Resting membrane potential is the balance of the amount of sodium Capone
Membrane and potassium inside and outside of the cell. A neuron at rest typically
Potential has a resting membrane potential between -90 and -70mV. The inside
of the neuron is negative in relation to the outside of the cell.
Bellew, J. & Michlovitz, S. & Nolan, T. (2016). MODALITIES FOR
THERAPEUTIC INTERVENTION (6th ed.). F.A. Davis Company.

Hyperstimulatio A form of noxious-level stimulation often using monophasic currents of Fusco

n long pulse durations or direct current. It is often applied over
acupuncture points or dermatomal distributions of a peripheral nerve
and it is thought to lessen pain through descending methods via the
release of endogenous opioids. (Bellew JW, Michlovitz SL, Nolan T.
Modalities for Therapeutic Intervention. Philadelphia, PA: F.A. Davis
Company; 2016.)

Watt A watt is a SI unit of electrical power, which is the product of the Fusco
voltage or electromotive force and the amperes or amount of current
flowing. Watts indicate the rate at which electrical power is being used.
They are defined as the electrical power needed to produce a current
flow of 1 A at a pressure of 1 V. (Prentice W. Therapeutic Modalities in
Rehabilitation, 5th ed, 2018)

Polarity Polarity is the property of having a charge, either positive or negative. Fusco
Generally the negative electrode is placed distally and the positive
electrode is placed proximally to mimic naturally occurring electrical
flow. (Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic
Intervention. Philadelphia, PA: F.A. Davis Company; 2016.) (Prentice
W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Average Amplitude is often referred to as intensity and is an important Collette

amplitude characteristic for differentiating and defining pulsed waveforms. When
plotting waveforms, amplitude-dependent characteristics reflect the y
coordinate. Average amplitude is the average magnitude of current
(amps) or voltage (volts) for the cycle duration relative to the
isoelectric or baseline on the x-y current-time plot.
Electrical stimulation parameters most commonly use milliampere
amplitude (Bellow J, Michloviz S, Nolan T. Modalities For Therapeutic
Intervention, 5th ed, 2016).
 https://www-r2library-
com.ezproxy.simmons.edu/Resource/detail/0803645635/ch0009s0280#goto=ch00
09s0280fg0150

Peak amplitude Peak amplitude is the highest current or voltage reached in a phase of Collette
a monophasic pulse or in any phase of a biphasic waveform (Bellow J,
Michlovitz S, Nolan T. Modalities For Therapeutic Intervention, 5th ed,
2016).

https://www-r2library-
com.ezproxy.simmons.edu/Resource/detail/0803645635/ch0009s0280#goto=ch00
09s0280fg0152

Peak to peak In a biphasic waveform, the peak to peak amplitude is the highest Collette
amplitude value measured from the peak of the first phase to the peak of the
second phase. There is no peak-to-peak value for a monophasic
 waveform (Bellow J, Michlovitz S, Nolan T. Modalities For Therapeutic
Intervention, 5th ed, 2016).

https://www-r2library-
com.ezproxy.simmons.edu/Resource/detail/0803645635/ch0009s0280#goto=ch00
09s0280fg0152

Iontophoresis A technique that utilizes current to induce the transcutaneous Diniz

movement of ions across the skin to the tissue that is being targeted.
This allows for therapeutic benefits via the delivery of a medicinal ion.
(Bellow J, Michlovitz S, Nolan T. Modalities For Therapeutic
Intervention, 5th ed. FA Davis Company, 2016.)

Alkalinity Alkalinity refers to the ability of water to resist a change in pH that Diniz
would usually make the water more acidic. It is when there is less free
hydrogen ions relative to the amount of hydroxyl ions. Alkalinity is
indicated by a pH greater than 7.
(Singer MJ, George HA, Childers CD, Merrill-Davies ML. What Is PH
and Why Do We Care? University of California, Agriculture and
Natural Resources; 2012. doi:10.3733/ucanr.8488)

Acidity Acidity refers to the ability of water to neutralize an alkaline. It is when Diniz
there is more free hydrogen ions relative to the amount of hydroxyl
ions. Acidity is indicated by a pH of less than 7.
(Singer MJ, George HA, Childers CD, Merrill-Davies ML. What Is PH
and Why Do We Care? University of California, Agriculture and
Natural Resources; 2012. doi:10.3733/ucanr.8488)

Interphase/ Interphase interval is a short period of time when current is not flowing Faheem
Intrapulse between two successive phases of a biphasic pulse.
interval
 (Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for
Therapeutic Intervention, 6th ed. FA Davis, 2016)

Interpulse Interpulse interval is a period of time when current is not flowing Faheem
interval between two successive pulses.

(Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for

Therapeutic Intervention, 6th ed. FA Davis, 2016)

Current density Current density is the amount of current flow per unit area of the Faheem
electrode (mA/cm2 ). Current density is inversely proportional to
electrode size.1
 2

The current density is highest when it is closer to the skin and it gets
lower with deeper tissues. In addition, when the electrodes are spaced
closely together, the area of high density is more superficial, on the
other hand, if the electrodes are spaced farther apart, the current
density will be higher in deeper tissues.2

1) Bellew J, Michlovitz S, Notan T. Michlovitz’s Modalities for

Therapeutic Intervention, 6th ed. FA Davis, 2016.
2) Prentice W. Therapeutic Modalities in Rehabilitation, 4th ed, 2011

Action Potential A sudden, propagating change in the resting membrane potential, Gotts
used for neuronal communication. Action potentials are caused by
stimulus that changes the resting potential to reach the threshold
value; not all stimuli lead to the generation of an action potential.
Stimuli include temporary changes in membrane permeability for ions,
resulting in changes in the concentration gradient. An increase in
stimulus will increase the frequency of an action potential while the
length and amplitude remain the same.
Grider MH, Jessu R, Glaubensklee CS. Physiology, Action Potential. In: StatPearls [Internet]. Treasure Island,
FL: StatPearls Publishing; 2021 Jan. https://www.ncbi.nlm.nih.gov/books/NBK538143/
 Image:
https://www.researchgate.net/profile/Manish-Gupta-
8/publication/312023767/figure/fig3/AS:445997118693378@1483345407254/Different-Phases-
of-Action-Potential-10.png

Depolarization The phase in which an electrical stimulus opens voltage-gated sodium Gotts
ion channels, allowing an influx of sodium ions, creating a net positive
charge. If the threshold potential is achieved, the action potential
occurs at the end of depolarization.
Grider MH, Jessu R, Glaubensklee CS. Physiology, Action Potential. In: StatPearls [Internet]. Treasure Island,
FL: StatPearls Publishing; 2021 Jan. https://www.ncbi.nlm.nih.gov/books/NBK538143/

Repolarization Describes the phase that restores the resting membrane potential, Gotts
following depolarization. Sodium ion channels close, creating a
negative charge in the cell; potassium ion channels open in response,
encouraging the passage of potassium ions out of the cell. The
membrane potential becomes more negative and approaches the
resting potential. Typically this phase will end in a potential more
negative than resting, referred to as hyperpolarization.
Grider MH, Jessu R, Glaubensklee CS. Physiology, Action Potential. In: StatPearls [Internet]. Treasure Island,
FL: StatPearls Publishing; 2021 Jan. https://www.ncbi.nlm.nih.gov/books/NBK538143/

Conventional Conventional TENS is the most commonly used mode of TENS. The McNally
TENS combination of a low intensity, a high frequency (80-110 Hz), and a
short pulse duration (50–100 μsec) activates the Group II (Aβ) afferent
nerve fibers to produce a sensation of comfortable paresthesia (this
modality produces a sensory-only effect, without a motor response).
(Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic
Intervention. Philadelphia, PA: F.A. Davis Company; 2016)

Subsensory The subsensory level (microcurrent, low-intensity direct current) of McNally

level TENS stimulation uses an amplitude less than 1 mA (10–3A) and DC or
monophasic pulsed current. This type of current is below the sensory
and motor threshold
(Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic
 Intervention. Philadelphia, PA: F.A. Davis Company; 2016)

Gate control When there is pain in an area, providing maximum sensory cutaneous McNally
stimulation to Aβ fibers will “close the gate” to nociceptive impulses
carried on Aδ and C fibers in the dorsal horn, diminishing the
perception of pain as long as the maximum sensory cutaneous
stimulation is applied. The gate control theory is the most commonly
used theory to explain the inhibition of pain by TENS
(Bellew JW, Michlovitz SL, Nolan T. Modalities for Therapeutic
Intervention. Philadelphia, PA: F.A. Davis Company; 2016)
(Prentice W. Therapeutic Modalities in Rehabilitation, 5th ed, 2018)

Current An electrical current is the flow of electrically charged particles, such Alessio
as electrons or ions. Electrical currents can be used to change
physiological processes when applied to biological systems. For
example, electrical currents can produce muscle contraction, promote
tissue healing, or control pain when applied to specific tissues.
(Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)

Monophasic A pulsed current is the flow of charged particles that is interrupted by Alessio
current periods with no current flow. In a monophasic pulsed current, the
current only flows in one direction during a pulse. Monophasic pulsed
currents are most commonly used in a clinical setting for acute edema
management to promote tissue healing.
(Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)

Biphasic current A pulsed current is the flow of charged particles that is interrupted by Alessio
periods with no current flow. In a biphasic pulsed current, the current
flows back and forth during a pulse. Biphasic pulsed currents can be
used clinically to produce muscle contraction or control pain. An
alternating current is a continuous bidirectional flow of charged
particles. Alternating currents can also be biphasic.
(Cameron M. Physical Agents in Rehabilitation, 5th ed, 2018)