ELECTROPHYSIOLOGY &

ELECTROTHERAPY FOR CLINICAL

PRACTICE PHYSIOTHERAPY
Aditya Johan .R, SST.FT, M.Fis
INTRODUCTION

• The basic functions of the nervous system is collect and

receives sensory input, integration, response (motor response)
• None of our perceptions, thoughts, or movements would be
possible without nerve conduction
• Nerve conduction is an electrochemical process
• The basis of this communication is the action potential
ACTION POTENTIAL

A rapid rise and subsequent fall in voltage or membrane potential across a cellular
membrane with a characteristic pattern
 EXTRACELLULER & INTRACELLULER
FLUIDS

• Most cells in the body make use of charged

particles, ions, to build up a charge across the cell
membrane
• Both of the cells make use of the cell membrane
to regulate ion movement between the
extracellular fluid & intracellular fluid
PROTEIN TRANSPORT

• Of special interest is the carrier protein referred to as the sodium/potassium

pump that moves sodium ions (Na+) out of a cell and potassium ions (K+) into
a cell, thus regulating ion concentration on both sides of the cell membrane
MECHANICAL GATED CHANNEL

A mechanically gated channel opens because of a physical distortion of the cell

membrane. Many channels associated with the sense of touch (somatosensation)
are mechanically gated
VOLATAGE GATED CHANNEL

A voltage-gated channel is a channel that responds to changes in the electrical

properties of the membrane
LEAKAGE CHANNEL

A leakage channel is randomly gated, meaning that it opens and closes

at random, hence the reference to leaking
RESTING MEMBRANE POTENTIAL
(RMP)

 When the cell is at rest, and the ion channels are closed (except for leakage
channels which randomly open)
 The concentration of Na+ outside the cell is 10 times greater than the
concentration inside
 The concentration of K+ inside the cell is greater than outside
RESTING MEMBRANE POTENTIAL

Resting membrane potentials for cells generally range: -20 mV to -200mV

ACTION POTENTIAL

To get an electrical signal started, the membrane potential has to change

The membrane potential will reach +30 mV by the time sodium has entered the cell
• The channels that start depolarizing the membrane because of a
stimulus help the cell to depolarize from -70 mV to -55 mV
• Once the membrane reaches that voltage, the voltage-gated Na+
channels open, this is what is known as the threshold
• Action potentials are “all or none.”
ACTION POTENTIAL REACH NMJ
IONIC FLOWS

• Positive ions (cations) are repelled from the positive electrode and migrate
toward the negative electrode (cathode)
• The negative ions (anions) migrate toward the positive electrode (anode)
SODIUM (NA+)
• Sodium ions (Na+), which are positively charged, migrate toward the
negative pole and combine with water, forming the base sodium
hydroxide (NaOh)
• This chemical reaction increases the alkalinity of the area and
promotes liquefaction of proteins and the softening of tissues
CHLORIDE ION (CL-)
• Chloride ions (Cl–), which are negatively charged, migrate to the
positive pole and combine with water, forming hydrochloric acid (HCl)
• This chemical reaction increases the acidity of the area, thus
promoting coagulation of proteins and the hardening of tissues
IONIC FLOWS UNDER ELECTRODES

Nerves will become hyperpolarized (less excitable) under the anode and more excitable
under the cathode
CURRENT CLASSIFICATION

• Direct current (DC)

• Alternating current (AC)
• Pulsatile/pulsed current
DIRECT CURRENT
• Direct current (DC) is a continuous unidirectional flow
• One electrode is always the anode (positive) and one electrode is
always the cathode (negative)
• Because one electrode is always positive and one is always negative,
there is an accumulation of charge
• This accumulation of charge is called chemical or polarity effect
ALTERNATING CURRENT
• Alternating current (AC) is an uninterrupted bidirectional flow of
charged particles changing direction at leas once a second
• Each electrode becomes positive for one phase of the cycle and then
negative as the current reverses
• Since the electrodes are continuously changing their polarity, charges
do not build up in the tissues / Zero Net Charge (ZNC)
PULSED CURRENT
• Pulsed or pulsatile current can take on the directionality
characteristics of AC or DC current
• Unidirectional (like DC) or bidirectional (like AC)
• It is a spatial drawing depicting the shape of the pulse, reflecting
amplitude (strength) and duration (length of time)
• There are monophasic, biphasic, and polyphasic waveforms
WAVEFORM
AMPLITUDE
• It is the magnitude or intensity of the stimulus and it is one factor
determining strength of stimulation
• The amplitude is read on either a milliamp meter or a volt meter
• The amplitude control on stimulator units is labeled intensity
• Peak amplitude is associated with depth of current penetration
THREE LEVELS OF EXCITATION
• Electrical stimulation produces three excitatory responses:
(1)Sensory
(2)Motor
(3)Pain
• Four clinical levels of stimulation are possible with electrical stimulation devices :
(1)subsensory,
(2)Sensory
(3)Motor
(4)noxious or uncomfortable levels of sensation
DURATION

F = Phase Duration
G = Pulse Duration

• Phase duration is the time period extending from the beginning to

the end of one phase of a pulse
• Pulse duration is the time interval between the beginning and end of
all the phases of the pulse, including the intrapulse interval
FREQUENCY

• The frequency, which often is referred to as pulses per second (pps) or pulse
rate
• the number of pulses delivered to the body in 1 second (Hz)
• The body responds to the number of pulses, not the number of phase
• A single monophasic, biphasic, or polyphasic pulse is counted as one pulse by
the body
CURRENT MODIFICATION

• Modification of :

A. Peak Amplitude
B. Pulse Frequency
C. Phase duration
LEVELS OF STIMULATION
ULTRASOUND
• Sound is defined as the periodic mechanical disturbance of an elastic
medium such as air
• Sound requires a medium for its transmission and cannot cross a
vacuum
• Ultrasound refers to mechanical vibrations, which are essentially the
same as sound waves but of a higher frequency
• Such waves are beyond the range of human hearing and can therefore
be called ultrasonic
• Sonic waves are series of mechanical compressions and rarefactions
in the direction of travel of the wave, hence they are called
longitudinal waves
• They can occur in solids, liquids, and gases and are due to regular
compression and separation of molecules
• The molecules of all matter are in constant random motion; the
amount of molecular agitation is what is measured as heat – the
greater the molecular movement, the greater the heat
• Sound waves will pass more rapidly through material in which the
molecules are close together, thus their velocity is higher in solids and
liquids than in gases
• Ultrasound (US) is a form of MECHANICAL energy, not electrical
energy
• Sound waves are longitudinal waves consisting of areas of compression
and rarefaction
• Piezo-electric effect: The production of a small electro motive force
across certain substances on being subjected to external pressure
• Reverse piezo-electric effect: Production of mechanical waves or
vibrations due to the application of electro motive force
• Piezoelectric effect generated by piezoelectric crystal
• Occurs when an electric current is passed through the crystal
• Crystal expands and contracts at frequencies that produce ultrasound
BEAM NON UNIFORMITY

• Spatial average intensity: Average intensity of

the US output over the area of the transducer
• Spatial peak intensity: Peak intensity of the
ultrasound output over the area of the
transducer. The intensity is usually great in the
centre of the beam and lowest at the edges of
the beam
• Spatial peak intensity is related to Spatial
avarege by the Beam Nonuniformity Ratio
(BNR)
• Beam non-uniformity ratio (BNR): Ratio
between peak intensity and average
intensity in the beam.
• The lower the BNR the more uniform the
beam
• With BNR 5:1, when the spatial average
intensity is 1W/cm2, the spatial peak
intensity would be 5W/cm2
• Continuous ultrasound: continuous delivery
of US through out the treatment period
• Pulsed ultrasound: delivering US only during
a portion of the treatment period.
• Pulsing reduces the thermal effects
• Duty cycle: proportion of the total
treatment time that the US is on.
• This can be expressed in percentage or a
ration
• 20% or 1:5 duty cycle, is on for 20% of the
time and off for the 80% of time
FREQUENCIES

• Frequency: number of compression

rarefraction cycles per unit of time, usually
expressed in cycles per second (Hertz)
• Increasing the frequency of US causes a
decrease in its depth of penetration and
concentration of the US energy in the
superficial tissues
• Frequency - the number of times a particle experiences a complete
compression/rarefaction cycle in 1 second.
• 1 MHz equal to 1000000 Hz
PROPAGATION SPEED

• Propagation speed/velocity is the maximum speed which an acoustic wave

can move through a medium (depens on mediums), unit (m/s)
• Propagation speed is greater in solids > liquids > gases
• the propagation speed is constant for a given medium, if the frequency
increases, the wavelength will decrease, viceversa
• Wavelength is the distance between two equivalent points on the
waveform in the particular medium
• With a velocity or propagation speed (c) of 1,540 m/s, the wavelength
of 1 MHz is 1.54 mm, of 2 MHz is 0.77 mm, and of 3 MHz is 0.51 mm
ACCOUSTIC IMPEDANCE

• Accoustic Impedance describe how much resistance an ultrasound

beam encounters as it posses through a tissue
• Attenuation is the reduction of the sound beam’s amplitude and intensity as it travels through a
medium
• Attenuation coefficient is the attenuation per unit length of sound wave travel
• For soft tissue, it is approximately one-half of the operating frequency of the transduce
• for every centimeter per MHz, there is approximately 0.5 dB of attenuation coefficient
• How much Intensity left for soundwave 3 MHz frequency with 1.5
W/cm2 at 4 cm?
Att = 0.5 x 4 cm x 3 MHz
Attenuation = - 6 dB
Value of dB = 10-6/10 = 0.251
Final Intensity = Incident Intensity x 0.251
= 1.5 W/cm2 x 0.251
= 0.38 W/cm2
SPATIAL AVERAGE TEMPORAL PEAK
AND AVERAGE

• Spatial Average Temporal peak (SATP) is

maximum intensity in the pulse
(measured when the pulse is on)
• Spatial Average Temporal average
(SATA) is intensity averaged over one on-
off beam cycle (takes into account the
intensity from the beginning of one pulse
to the beginning of next)
• SATP x duty cycle = SATA
ULTRASOUND DOSAGE

FREQUENCY
• Taking into account that the most frequently available treatment
frequencies are 1 and 3MHz
• 3MHz ultrasound is absorbed more rapidly in the tissues, and
therefore is considered to be most appropriate for superficial lesions,
whilst the 1MHz energy is absorbed less rapidly with progression
through the tissues, and can therefore be more effective at greater
depth
INTENSITY
• The intensity shown on the meter is usually the Space Average
Temporal Peak (ISATP)
• For continues the SATP and SATA are the same
• For pulsed the SATP x Duty Factor = SATA
• Pulsed : SATP intensity of 2 W/cm2 at 1:4 pulse ratio is equivalent to
SATA intensity (continues) of 0.4 W/cm2
• For acute intensities in the range 0.1 – 0.25 W/cm2
• For chronic intensities in the region of 0.25 – 1 W/cm2
DURATION TIME

• CONTINUES MODE : TREATMENT AREA / ERA

• PULSED MODE : TREATMENT AREA / ERA X PULSE RATIO (to total
period)
• Convinient guide is to give1-2 minutes of treatment for every 10 cm2
• Minimum treatment times are considered to be 1-2 minutes,
maximum 10-15 minutes and an everage would be 5 minutes
INCIDENT INTENSITY
• Final Intensity = Incident Intensity x Value of db (Continues Mode)
• Final Intensity = Incident Intensity (SATP x dc) x Value of db (Pulsed Mode)

• Continues Mode
• Ultrasound 1 MHz at 4 cm depth require 0.3 W/cm 2, incident?
• Attenuation = 0.5 x 4 x 1 = 2
• Value of db = 10(-2/10) = 0.63 = 63%
• Incident = Final Intensity : Vodb
• 0.3 : 0.63 = 0.48 W/cm2

• Pulsed Mode
• If duty cycle at 50% = 0.48 / 50% = 0.96 W/cm 2
• If duty cycle at 20% = 0.48 /20% = 2.4 W/cm 2