Dr.

SARAH
DPT ,MS-SPT*
 Electrical Stimulation of
Nerves
 Pain Assessment Scales
 Pain Gate Theories
 Electrical
Stimulation of
Nerves
Resting nerve is positive outside and
negative inside
Plasma membrane is not permeable to
sodium ions
 Stimulation of nerve by the stimulus
 Fall in the potential difference
 Alteration in the permeability of the
membrane to sodium ions
 Alteration in the concentration of ions
inside and outside the nerve membrane
 Reversal of polarity
 Initiated by Electrical Stimulus
 A varying current (Faradic Current) of adequate
intensity must be applied
 Adaptation of nerve due to constant flow of current
 Unvarying current (Galvanic Current) is not effective in
initiating an impulse
 Sensory stimulation experienced varies with
the duration of the impulse
 Long Pulse duration produce an
uncomfortable, stabbing sensation
 Less Pulse duration produces less
uncomfortable, stabbing sensation
 Impulses of 1ms and less produces a mild
prickling sensation
 Stimulus applied to a motor trunk,
impulses pass to all the muscles that
the nerve supplies below the point
at which it is stimulated, causing
them to contract (Group Stimulation)
 Single stimulus____ simultaneously to a number of
motor units resulting in brisk contraction, followed by
immediate relaxation (Group Stimulation)

 If one stimulus is applied per second, each produces

an isolated contraction and there is time for
complete relaxation between the impulses (Motor
Point Simulation)
 Increase frequency shortens the periods of
relaxation

 Frequency more than 20Hz there is no time for

complete relaxation between the
contraction_____ resulting in partial Tetany
 Frequency more than 60Hz there is no
perceptible relaxation ____resulting in full Tetany
Factors influences
 Number of motor units activated

 Intensity of current applied

 Rate of change of current

 Time of application
 If intensity of current suddenly rises there is no
time for accommodation to take place and a
muscle contraction results

 If the current rises more slowly, there is some

accommodation and a greater intensity is needed
to produce a contraction
 If a therapist apply Electrical Modality, What are the
changes that occurs at Tissues Level ?

 What type of Sensations are produced by Large

Duration Impulses?
 Pain
Assessment
scale
 Visual & Numeric Analogue
Scales
 None Severe

0 10
 Locate area of pain on a pictures
 McGill pain questionnaire
◦ Evaluate sensory, evaluative, &
affective components of pain
 20 subcategories, 78 words
There is a patient who comes to you in OPD with
muscle weakness in upper limb and you want to
improve muscle strength by electrical stimulation.
Among the following which factor doesn’t affect
strength of contraction?
 Intensity of current applied
 Number of motor units activated
 Change in Pulse Shape
 Rate of change of current
 Fast vs. Slow Pain –
◦ Fast – localized; carried through A-delta axons
in skin
◦ Slow – aching, throbbing, burning; carried by C
fibers
◦ Nociceptive neuron transmits pain info to
spinal cord via unmyelinated C fibers &
myelinated A-delta fibers.
 The smaller C fibers carry impulses @ rate of
15 pulses/sec.
 The larger A-delta fibers carry impulses @
rate of 40 pulses/sec.
 Types of Nerves
 Neurotransmitters:
Chemical substances that
allow nerve impulses to move
from one neuron to another
 Found in synapses
◦ Substance P - thought to be
responsible for the transmission of
pain-producing impulses
First Order Neuron:
 Stimulated by sensory receptors
 End in the dorsal horn of the spinal cord
Second Order Neuron:
 Receive impulses from the spinal cord to
thalamus
Third Order Neuron:
 Begins in thalamus
 Ends in specific brain centers (cerebral cortex)
PAIN RATING SCALE
 Gate Control Theory
Central Biasing Theory
Endogenous Opiates
Theory
 Melzack & Wall, 1965
 Substantia Gelatinosa (SG) in dorsal horn of
spinal cord acts as a ‘gate’ – only allows one type
of impulses to connect with the SON
 Transmission Cell (T-cell) – distal end of the SON

 If A-beta neurons are stimulated – SG is activated

which closes the gate to A-delta & C neurons
 If A-delta & C neurons are stimulated – SG is
blocked which closes the gate to A-beta neurons
 Central Biasing Theory
 Descending Pain Modulation (Descending Pain
Control Mechanism)
 Transmit impulses from the brain (corticospinal
tract in the cortex) to the spinal cord (lamina)
◦ Periaquaductal Gray Area (PGA) – release
Enkephalins
◦ Nucleus Raphe Magnus (NRM) – release
Serotonin
◦ The release of these neurotransmitters inhibit
ascending neurons
 Stimulation of the PGA in the midbrain & NRM in
the pons & medulla causes analgesia.
 Endogenous opioid peptides - Endorphins &
Enkephalins
 Least understood of all the theories
 ACTH/B-lipotropin is released from the anterior pituitary
in response to pain – broken down into B-endorphins and
corticosteroids

 Mechanism of action – similar to enkephalins to block

ascending nerve impulses
Frequency of stimulation effect the
electrical stimulation. Which one of
the following is best frequency of
stimulation to achieve complete
time for relaxation?
 One stimulus and five motor unit at single
point
 One stimulus is applied per second to each
motor unit
 Multiple stimulus to multiple muscles at one
time
 Single stimulus simultaneously to a number
Clayton’s Electrotherapy
Electrotherapy by
“Muhammad Salabat
Khan”