1. Contraindications
1.1. Demand cardiac pacemaker
1.2. Implanted defibrillator
1.3. Unstable arrhythmia
1.4. Over carotid sinus
1.5. Over venous/arterio-thrombosis
1.6. Pregnancy (over trunk)
1.7. Skin irritation
2. Application Techniques
2.1. Electrodes
2.1.1. Type
2.1.2. Size
2.1.3. Placement
2.1.3.1. Monopolar
2.1.3.1.1. Single polarity
2.1.3.1.2. Active/dispersive leads
2.1.3.1.3. Monophasic waveform
2.1.3.1.4. Indications
2.1.3.2. Bipolar
2.1.3.2.1. Both polarities in treatment area
2.1.3.2.2. Indications
2.1.3.3. Premodulated Bipolar
2.1.3.3.1. Mimic IFC
2.1.3.3.2. One pt circuit
2.1.3.3.3. Modulation by stimulator circuitry
2.1.3.4. Quadripolar
2.1.3.4.1. Two bipolar patient circuits
2.1.3.4.2. Electrical energies summate in pt tissues
2.1.3.4.3. Interferential current
3. Pain Control (TENS)
3.1. Indications
3.1.1. Acute pain
3.1.2. Chronic pain
3.2. Effects
3.2.1. Pain gating
3.2.2. Release of endogenous opiates
3.3. Parameters
3.3.1. High-rate
3.3.1.1. Frequency: 100-150 pps
3.3.1.2. Duration: 50-80 us
3.3.1.3. Amplitude: to produce tingling
3.3.1.4. Modulation: use if available
3.3.1.5. Time: worn 24 hours as needed for pain control
3.3.1.6. MOA: Gating at SC
3.3.2. Low-rate
3.3.2.1. Frequency: 2-10 pps
3.3.2.2. Duration: 150-300 us
3.3.2.3. Amplitude: to visible contraction
3.3.2.4. Modulation: none or modulate
3.3.2.5. Time: 20-30 min
3.3.2.6. MOA: endorphin release
3.3.3. Burst mode
3.3.3.1. Frequency: generally preset at 10 bursts
3.3.3.2. Duration: generally preset with maximum of 100-300 us
3.3.3.3. Amplitude: to visible contraction
3.3.3.4. Modulation: generally not possible
3.3.3.5. Time: 20-30 min
3.3.3.6. MOA: endorphin release
3.3.4. Waveform
3.3.4.1. Monophasic
3.3.4.2. Biphasic
3.3.4.3. AC
3.3.5. Polarity
3.3.5.1. Positive or negative
4. Muscle Re-education and Strength (NMES)
4.1. Effects
4.1.1. Peripheral nerve injuries
4.1.2. Tendon transplants
4.1.3. Muscle Inhibition
4.1.4. Upper motor neuron lesions
4.1.5. Disuse atrophy
4.1.6. Immobilization
4.1.7. Limited ROM (not structurally blocked)
4.1.8. Augment Functional activity
4.2. Indications
4.2.1. Improved muscle performance
4.2.2. Muscle re-education
4.2.3. Edema reduction
4.2.4. Joint movement
4.2.5. Augmentation of functional activities
4.3. Parameters based on treatment goal
4.3.1. Muscle strengthening
4.3.1.1. Frequency: 35-80 pps
4.3.1.2. Duration: 125-200 us (sm) 200-350 us (lg)
4.3.1.3. Amplitude: to >10% MVIC injured muscle, >50% MVIC in uninjured
4.3.1.4. On-Off Time: 6-10 s on, 50-120 s off, Ratio: 1:5 initially
4.3.1.5. Ramp time: at least 2 s
4.3.1.6. Treatment time: 10-20 min
4.3.1.7. Times/day: every 2-3 hr
4.3.2. Muscle re-education
4.3.2.1. Frequency: 35-50 pps
4.3.2.2. Duration: 125-200 us (sm) 200-350 us (lg)
4.3.2.3. Amplitude: sufficient for func. activity
4.3.2.4. On-Off Time: depends on func. activity
4.3.2.5. Ramp time: at least 2 s
4.3.2.6. Treatment time: depends on func. activity
4.3.3. Muscle spasm reduction
4.3.3.1. Frequency: 35-50 pps
4.3.3.2. Duration: 125-200 us (sm) 200-350 us (lg)
4.3.3.3. Amplitude: to visible contraction
4.3.3.4. On-Off Time: 2-5 s on, 1-5 s off; equal on-off times
4.3.3.5. Ramp time: at least 1 s
4.3.3.6. Treatment time: 10-30 min
4.3.3.7. Times/day: every 2-3 hr until spasm relieved
4.3.4. Edema reduction
4.3.4.1. Frequency: 35-50 pps
4.3.4.2. Duration: 125-200 us (sm) 200-350 us (lg)
4.3.4.3. Amplitude: to visible contraction
4.3.4.4. On-Off Time: 2-5 s on, 1-5 s off; equal on-off times
4.3.4.5. Ramp time: at least 1 s
4.3.4.6. Treatment time: 30 min
4.3.4.7. Times/day: 2
4.4. Waveform
4.4.1. Biphasic PC
4.4.2. Burst Modulated AC
4.4.3. Monophasic PC or DC
4.5. Polarity
4.5.1. Positive or negative
5. Soft Tissue Healing
5.1. Indications
5.1.1. Chronic wounds: pressure ulcers, diabetic ulcers, venous ulcers
5.1.2. Edema control
5.1.3. Transdermal drug delivery
5.2. Effects
5.2.1. Antimicrobial effects
5.2.2. Enhanced circulation
5.2.3. Cell activation
5.3. Parameters
5.3.1. Inflammatory phase/infected
5.3.1.1. Waveform: HVC
5.3.1.2. Polarity: Negative
5.3.1.3. Pulse frequency: 100-105 pps
5.3.1.4. Pulse duration: 100-105 pps
5.3.1.5. Pulse duration: -100 us
5.3.1.6. Amplitude: to produce comfortable tingling
5.3.1.7. Time: 45-60 min daily, 3-7 days/week
5.3.2. Proliferation phase/clean
5.3.2.1. Waveform: HVC
5.3.2.2. Polarity: Positive
5.3.2.3. Pulse frequency: 100-105 pps
5.3.2.4. Pulse duration: 100-105 pps
5.3.2.5. Pulse duration: -100 us
5.3.2.6. Amplitude: to produce comfortable tingling
5.3.2.7. Time: 45-60 min daily, 3-7 days/week
5.3.3. Waveform
5.3.3.1. Monophasic
5.3.4. Polarity
5.3.4.1. Negative- antibacterial effect
5.3.4.2. Positive- dermal wound healing
5.3.4.3. Switching polarity- if plateau in healing occurs