Parameter Settings for Electrically Stimulated Muscle ContractionParameterSetting/goal treatment goal

PulseFrequency

Pulse durations

Amplitude On/offTime and ratio

Ramptime

Treatment time

Times perday

MuscleStrengthening

35- 80 pps 150 -200μsfor small muscles, 200-350 for large muscles

To > 10% of MVIC in injured, >50% MVIC in uninjured

6-10 sec on, 50-120 sec off, ratio of 1:5, initially.Can reduce w/ repeated treatment

At least 2 sec

10-20 min to produce 10-20 repetitions

Every 2-3 hours when awake

Muscle reeducation

35-50 pps 150-200μsforsmall muscles, 200-350μs for large muscles

Sufficient for functional activity

Depends on functional activity

At least 2sec

Depends on functional activity

NA

Muscle spasm reduction

35-50 pps 150-200μs for small muscles, 200-350μs for large muscles

To visible contraction

2-5 sec on: 2-5 sec off. Equal on/off times

1sec 10-30 min Every 2-3hrs until spasm relieved

Edema reduction using muscle pump

35-50 pps 150-200μs for small muscles, 200-305μs for large muscles

To visible contraction

2-5 sec on: 2-5 sec off.Equal on/off times

At least 1sec

30 min Twice a day

Recommended Parameter Settings for Electrical Stimulation for Pain Control (TENS)Parameter settings/goal of treatment

Pulse frequency (beat frequency for interferential)

Pulse duration

Amplitude Modulation(frequency, duration, or Amplitude)

Treatment time

Possible mechanism of action

Conventional (high rate)

100-150 pps 50-80μs To produce tingling

Use if available

May be worn for 24 hours, as needed for pain control

Gating at the spinal cord

Acupuncture-like (low rate)

2-10 pps 200-300μs To visible contraction

None 20-30 min Endorphin release

Burst mode Generally preset in unit at 10 bursts

Generally preset and may have max of 100-300μs

To visible contraction

Is generally not possible in burst mode

20-30 min Endorphin release

Recommended Parameter Setting for Electrical Stimulation for Tissue HealingParameter settings/goal of treatment

Waveform Polarity Pulse frequency

Pulse duration

Amplitude Treatment time

Tissue healing: inflammatory phase/infected

HVPC Negative 60-125 pps Usually preset for HVPC at 40-100μs

To produce comfortable tingling

45-60 min

Tissue healing: proliferation phase/clean

HVPC Positive 60-125 pps Usually preset for HVPC at 40-100μs

To produce comfortable tingling

45-60 min

Recommended parameter setting for electrical stimulation for edema controlParameter settings/goal of treatment

Waveform Polarity Pulse frequency

Pulse duration

Amplitude Treatment time

Edema control with inflammation

HVPC Negative 100-120 pps Usually preset for HVPC at 40-100μs

To produce comfortable tingling

20-30 min

Edema control associated with lack of mobility

Biphasic (can use interferential if on/off time available)

NA 30-50 pps, 2-5 sec equal on/off time

150-350μs To visible contraction

20-30 min

Current Amplitude and Treatment Duration for Iontophoresis TreatmentCurrent amplitude (mA) Treatment time (min) Dose (mA-min)1 40 402 20 403 13.3 404 10 40

Contraindications for the Use of Electrical Currents

Precautions for the Use of Electrical Currents

Demand cardiac pacemaker or unstable arrhythmias Cardiac diseasePlacement of electrodes over carotid Patients with impaired mentation/sensationAreas where venous or arterial thrombosis or thrombophlebitis is present

Malignant tumors or areas of skin irritation or open wounds

Pregnancy-over or around the abdomen or low back Iontophoresis after other physical agents

Ask the Patient*Do you have a cardiac pacemaker?*Do you have a history of heart problems or have you been treated for heart problems?*What type of heart problems?*How recently has your doctor checked you heart?

Ask the Patient*Do you have a known history of cardiac disease?*Have you had a previous myocardial infarction?*Have you ever had rheumatic fever as a child or an adult?*Are you aware of having any cardiac problems at this time?

Assess1. Check for surgical incisions in the thoracic area, both anteriorly and posteriorly.2. Check the patient’s resting pulse and respiratory rate before initiating treatment and check for changes in these values during and after applying electrical stimulation.