INTERRUPTED DIRECT

CURRENT
DEFINITION
A direct current when it is made to cease flow
for less then 1 second and then allowed to flow
after a pause of determined duration, the
current is said to be interrupted direct current.
OR
The term interrupted direct current is used to
describe continuous unidirectional current,
when it is interrupted to give pulse or phases of
any duration, shape or frequency.
Interrupted direct current can be of;
 short duration pulse (short-duration are those whose duration is less than 10
millisecond)
 Long duration pulse (Long-duration pulses are those whose duration is more than 10
millisecond)
 Various waveforms of interrupted direct current, such as saw tooth, triangular,
depolarized, trapezoidal and rectangular can be used in clinical applications.
TYPES OF WAVES
There are two types of waves;
 Rectangular wave pulse.
 Accommodation pulse.
 RECTANGULAR WAVE PULSE
Sudden rise and fall of intensity will lead to rectangular wave
pulse.
 Duration may be 1 ms to 600 ms
 Used to stimulate the innervated muscles fiber and nerve fiber.
 Symmetrical waveforms are preferred for large muscles
 ACCOMMODATION PULSE
• Gradually rise and fall of intensity will lead to accommodation pulse.
It may be sine, triangular, trapezoid and saw tooth.
Its duration is about 300 ms to 1000 ms
It is used to stimulate the denervated muscles fiber and nerve fiber.
Asymmetrical waveforms are preferred for small muscles.
Rectangular impulses is capable of producing muscular contractions but selective impulses is
always satisfactory.
A low intensity and gradual rise in current is often best for the stimulation of denervated
muscles as it bring out satisfactory contractions in normal muscular manner with less sensory
stimulation then with the rectangular impulses.
Proper selection of current leads to elimination of unwanted contraction of innervated
muscles in the close proximity.
The nerve and muscle tissue possess the property to adapt it self to slowly increasing
stimulation intensities.
This cause a decrease of excitability membrane, thus requiring more intensity for stimulation
Nerve fiber has a high accommodation rate
EFFECTS UNDER ELECTRODES
 EFFECTS OF IDC
Nerves & muscles can be excited by a electrical stimulus.

Shorter duration pulses (0.02to 1ms) used to stimulate a nerve fiber.

Longer duration pulses (100 to 1000ms) used to stimulate a muscle fiber.

STIMULATION OF MOTOR NERVE

Contraction of muscle occur.

Repetitive stimulation cause burst contractions in muscles followed by immediate relaxation.

STIMULATION OF SENSORY NERVE

When interrupted direct current is applied to the body, there is

feeling of stabbing or burning sensation.

Stimulation of sensory nerves also causes reflex vasodilation of

superficial blood vessels leading to reddening of the skin or
erythema.
Strong stimulation blocks the transmission at the level of spinal
cord by pain gate theory.
PHYSIOLOGICAL EFFECTS
 Dilation of superficial blood vessels.

Increases in superficial blood circulation.

Temperature increase.

Stimulates cell metabolism due to iron movement between

cells regeneration.

Erythema of the skin.

 THERAPEUTIC EFFECTS
Pain relief.
Acceleration of healing.
Effects on healing of superficial and open wounds.
Denervated muscle stimulation.
Improve ROM.
Facilitate muscular contraction.
Increase muscular strength.
Improve circulation.
SELECTION OF IMPULSES

FOR NERVE FIBER

 Short duration pulses from (0.02 ms-1ms )interrupted current
will cause depolarization generation of action potential and
induce a muscle contraction
FOR MUSCLE FIBER
 Muscle fiber do not respond to shorter duration stimulus (0.02 to
1ms).
 Pulse duration of more then 1ms used to excite the muscle fiber
to facilitate muscular contraction.
 Thus shorter the duration of impulse, with the high intensity
needed to produce muscle contraction
 DURATION & FREQUENCY

The duration and frequency of impulses can be adjusted.

Frequency of current reduces with the increase in pulse duration.

Pulse duration of 100ms will have frequency of 30 cycles/minute.

The interval between the impulses should never be shorter then the impulses them selves,
usually it should be longer then the pulse duration so that chances of muscle fatigue reduces.
METHODS OF APPLICATION
• ELECTROTONUS
Electrotonus means the electrical and excitable changes occur with in the nerve membrane due to
electrical stimulation.

• TYPES OF ELECTROTONUS
 Catelectrotonus
 Anelectrotonus
 ANELECTROTONUS

 An electrotonus means the changes which occur at the region of anode.

 The RMP increase by addition of more positive charge on outer surface of membrane i.e.,
localized area of hyperpolarization.

 It is associated with decreased excitability of the nerve fiber to give the sedative effects.
CATELECTROTONUS
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 Catelectrotonus means the changes which occur at

region of cathode.

 The RMP decreases by addition of more negative

charge on outer surface of membrane i.e. Localized
area of depolarization.

 It is associated with increase of excitability to produce

effects.
METHODS OF APPLICATIONS
One pad electrode method (Labile technique)

• One electrode is fixed over the origin of muscle group and

other electrode ( which preferably pen or disc electrode) is
placed over the lower end of muscle belly to be stimulated.
Two disc electrode method (Stabile technique)

• In this method active electrode is placed over the muscle group to be

stimulated (E.g., extensor muscles of wrist in case of radial nerve palsy)
and large indifferent electrode is placed over convenient site to complete
the circuit. This is also known as group stimulation technique
PRECAUTIONS
 Cardiac Diseases

 Anesthetic /hypothetical skin

 Small children and subjects with impaired sensations.

 Patients who are under treatment of Iontophoresis

Electrical stimulation strong enough to produce contraction.

The duration of treatment should not be excessive as it will lead

to muscle fatigue.

Comfortable pulse duration should be used.

RESEARCH ARTICLE

• https://www.researchgate.net/profile/Babatunde-
Adegoke/publication/
9080211_Acceleration_of_pressure_ulcer_heali
ng_in_spinal_cord_injured_patients_using_inter
rupted_direct_current/links/
5a3c09370f7e9b10e23bb798/Acceleration-of-
pressure-ulcer-healing-in-spinal-cord-injured-
patients-using-interrupted-direct-current.pdf
 BCQS

1. A 40-year-old male was brought to physical therapy OPD with a complaint of

pain and inability to extend his right knee joint for the last 2 weeks. He had
undergone an anterior cruciate ligament (ACL) reconstruction surgery 2 weeks
back. On physical examination hypotonia with absence of terminal extension in
quadriceps muscle was noted. Which one of the following electrical currents is the
most appropriate in a given case?

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2. Which one of the following phenomena occurs under cathodal effect
when interrupted direct current is applied?

A. Depolarizes nerve fibers

B. Hardness tissue
C. Repels bases
D. Stop hemorrhage
E. Temperature increases

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3. A 35-year-old male came to OPD with the complaint of pain and
heaviness on his right elbow, after removal of the POP cast. On physical
examination flickering movement was observed in the affected region .
Which one of the following waves of interrupted direct current is most
appropriate in the given case?

A. Accommodation
B. Long
C. Medium
D. Rectangular
E. Short

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4. Which one of the following pulse durations (ms) of interrupted direct
current is required to generate action potential?

A. 0.2-1.0
B. 1.1-1.8
C.1.9-2.7
D. 2.8-3.7
E. 3.8-4.7

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5. A-35-year-old male was came to OPD with the complaint of pain in forearm
and inability to extend the wrist joint . On physical examination atrophy of
extensor compartment of forearm muscles was observed along with grade 1
strength in wrist extension. Which one of the following currents is more effective
in the given case?

A. Galvanic
B. HVPC
C. Interrupted direct
D. Russian
E. TENS

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