Unit

IV
Therapeutic Currents

UNIT OUTLINE

Chapter 10 Faradic and Galvanic Currents

Chapter 11 Iontophoresis, Russian, and Dydyanamic Currents
Chapter 12 Transcutaneous Electrical Nerve Stimulation
Chapter 13 Functional Electrical Stimulation
Chapter 14 Interferential Therapy
 Faradic and
Galvanic Currents 10
LEARNING OBJECTIVES
On completion of the chapter, the student will be able to:
• Obtain sound knowledge and deep understanding of faradic and galvanic currents.
• Explain physiological and therapeutic effects of faradic and galvanic currents.
• Explain the polar reactions.
• Describe the application of different types of low frequency currents used in the physical therapy practice.
• Discuss the motor point determination and strength-duration curve.

CHAPTER OUTLINE
• Faradic Current • Contraindications
• Interrupted Galvanic Current • Application Procedure
• Physiological Effects of Faradic and Galvanic Currents • Faradic Foot Bath
• Polarity • Faradism Under Pressure
• Therapeutic Uses • Strength-Duration Curve
• Indications • Reaction of Degeneration Test

KEY TERMS
Accommodation: Phenomenon in which the threshold of a membrane excitability automatically rises or ceases with a
stimulus of slowly increasing intensity.
Active electrode: It is the negative or cathode electrode used to stimulate the motor points on the muscle belly.
Alternating current: Alternating current is a biphasic current which flows in both the directions. The current may have
symmetrical and asymmetrical waveforms. No accommodation of the nerve occurs as the current changes its direction.
Chronaxie: It is the minimal pulse duration of the stimulus required to stimulate the muscle for minimally visible
contraction. It is measured in millisecond. The chronaxie for the normally innervated muscles is 1ms or less for partially
denervated muscle is between 1 and 10ms and for complete denervated muscle it is more than 10ms.
Direct current: Direct current flows in a single direction. It is also known as monophasic current. The current flows in a
single direction either toward the positive or negative poles.
Faradic current (FC): It is an alternating short pulse duration current with a frequency of 50 to 100 Hz. It is also called short
pulse duration current.
Faradic foot bath: It is the technique of application of surged faradic current to stimulate and strengthen muscles of foot
in the water.
Faradic type current: Faradic type current is a direct current modified from original faradic current with different
waveforms. It is also called short pulse duration current.
Contd…
 Electrotherapy: Principles and Practice

Faradism under pressure: It is the technique of applying surged faradic current under the pressure of elastic crepe
Unit IV ▶ Therapeutic Currents

bandage.
Interpulse duration: It is the time between two pulses, also called pulse interval.
Interrupted direct current: A direct long pulse duration current with a frequency of 1Hz to 6Hz used to stimulate
denervated and innervated muscles.
Low frequency currents: Currents having frequency between 1Hz and 1000 Hz are termed low frequency currents,
however, for the therapeutic purposes, we use 1 Hz to 150 – 200 Hz with the pulse duration of 0.1 millisecond to 300
millisecond.
Motor point: There is a point on the muscle belly where maximum contraction can be achieved. Physiologically it
is identified as a specific location on the skin that requires the lowest amplitude of electrical stimulation to produce
excitation of an underlying innervated muscle.
Nerve depolarization: The abrupt change in the resting membrane potential, leading to the development of an action
potential or excitation of cell. The transmission of ions from sodium (outside) to potassium (inside the nerve) and
potassium to sodium causes nerve depolarization.
Passive electrode: It is the positive or anode electrode, usually requires more current to stimulate the muscle than the
active electrode at the same intensity, hence, it is placed on the origin or nerve trunk of the muscle rather than on the
motor point.
Phase duration: It is the duration of one phase of a pulse. Phase duration is generally expressed in microseconds.
Polarity: It is the charge of an electrode that will be positive or negative with a direct or monophasic pulse current.
There is constantly changing of charges of the electrodes in case of an alternating or biphasic current. Or simply it is the
representation of the negative and positive charges by the electrodes. The cathode electrode is represented as negative
and anode as positive.
Polar reactions: The electrochemical reactions under the cathode and anode electrodes are referred to as polar reactions.
Polar reactions under the electrodes cause pain and discomfort, hence, to get rid of this, a polarity switch is used to
change the anode to cathode and cathode to anode.
Pulse duration: Time from the beginning of the first phase of a pulse to the end of the last phase. It is generally expressed
in microseconds.
Reaction degeneration test: It is the test done to determine the integrity of the nerve, whether the muscle is receiving its
nerve supply or not. The concerned muscle is stimulated first with the faradic current, if there is no reaction to the current,
then it is stimulated with the interrupted galvanic current. If there is a slow or sluggish response, it indicates partial or
complete denervation.
Rheobase: Rheobase is the minimal amplitude or intensity of a current that is required to elicit a minimal visually
perceptible muscle contraction. It is measured in millivolt.
Strength duration curve: It is the technique of plotting the threshold current versus duration required to stimulate an
excitable tissue. To plot SD curve, interrupted direct current is used.
Waveform: Waveform is usually a graphic representation of the shape of a wave that indicates characteristics of a current.
The most common waveforms are the saw tooth, triangular, and trapezoidal.

INTRODUCTION
Electrical muscle stimulation is the method of stimulating nerves and producing involuntary contraction
of the muscles. Luigi Galvani (1791) provided the first scientific evidence that current can activate muscles.
He stimulated frog nerves and muscles with electrical charges from lightning and recorded that the animal
spontaneously developed electricity. However, Alessandro Volta in 1976, proved that the electrical changes
in Galvani’s experiment were the result between dissimilar metals that were in contact with each other and
not spontaneously produced by the animals. During the 19th and 20th centuries, researchers studied and
documented the exact electrical properties that generate muscle movement.1,2 It was discovered that the body
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Chapter 10 ▶ Faradic and Galvanic Currents

functions induced by electrical stimulation caused long term changes in the muscles.3,4 Currents used for

Unit IV ▶ Therapeutic Currents

stimulation of the muscles are described in this chapter.

FARADIC CURRENT
Faradic current is an alternating current named after
inventor Michel Faraday. In 1930, Faraday discovered
that bidirectional electrical current could be induced
by moving a magnet. He called this faradic current.
Faradic current is a short pulse duration current, i.e.,
0.1ms to 01 ms with the frequency between 50 and
100 Hz. The faradic current was initially produced
by the induction coil also known as faradic coil.
The current produced by faradic coil consists of two
unequal phases, first of low intensity, long duration
and second phase of high intensity and short Figure 10.1: Original Faradic current consisting two
duration (Fig. 10.1). unequal phases first of long duration, low intensity and
second phase of short duration and high intensity
In the original faradic coil, current was surged
manually but now it happens automatically by the modern electronic stimulators.

Faradic Type Current

The original unmodified (plane) faradic current cannot
be used for the treatment as there is a continuous
current which could result in fatigue of the muscles after
a short period of application (Fig. 10.2). Therefore, the
faradic type currents modified from the original faradic
current are the direct currents with different waveforms.
The original faradic current produced by the faradic
coil has been superseded by the modern electronic Figure 10.2: Unmodified plane faradic current;
stimulators. The faradic type current produced by the a continuous current with no interval between the pulses
modern electronic stimulators with the Smart-Bristow
coil has similar physiological effects on the tissues; however, it differs from the original faradic coil in terms of
waveforms. The Smart Bristow faradic coil has a retractable iron core which is moved in and out of the coil to
change the strength of the pulses. Recent types of Smart Bristow coil can be worked with all sorts of currents
such as AC, DC or battery.

Modified Faradic Current

In simple terms, faradic type of currents are surged for the purpose of treatment. The surges are the series
of pulses of different waveforms which increase gradually with the strength and fall suddenly or gradually.
The main purpose of the faradic current to modify into surges is to avoid accommodation and fatigue of the
muscles. The surges can be modified into various durations, frequencies and waveforms (Figs 10.3A to D).
The surges of modified faradic current are interrupted at regular intervals to provide sufficient time to the
muscle to get ready for the next contraction.

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 Electrotherapy: Principles and Practice
Unit IV ▶ Therapeutic Currents

Figure 10.3A: Modified faradic current with surges. Each surge has series of contractions which may increase gradually
and fall suddenly after reaching to the peak. There is a distance between two surges which is known as relaxation
period, that can be increased or decreased.

Figure 10.3B: Modified Faradic Current — surges varying in duration

Figure 10.3C: Modified Faradic Current — varying interval between the surges. The duration between the two surges
can be increased or decreased as per the requirement.

Figure 10.3D: Modified faradic current with various waveforms of surges

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Chapter 10 ▶ Faradic and Galvanic Currents

• Saw tooth waveform: The current increases gradually and reaches to the peak, then after falls suddenly.

Unit IV ▶ Therapeutic Currents

• Triangular surge waveform: The current increases gradually, reaches to the peak and then after falls
gradually.
• Trapezoidal surge waveform: The current rises gradually reaches to the peak and maintains at the peak
then after falls gradually

INTERRUPTED GALVANIC CURRENT

Interrupted galvanic or direct current is a long duration current, i.e., 01ms to 300ms or 600ms with a frequency
of 1Hz to 6Hz. The long duration direct current is modulated by interrupting the flow at regular intervals.
Interruption is the most useful modification of the direct current. The interruption in the flow of current
makes the current commencing and ceasing at regular intervals. Therefore, the current rises and falls followed
by relaxation or rest period. This arrangement of the rise and fall of the impulses with brief period of rest do
not allow accommodation of the nerve.5 Such type of impulses are called selective impulses as they cause
contraction of the denervated muscles (the muscles which are deprived of nerve supply), however, fail to
stimulate the motor nerve as accommodation occurs.5 Interrupted direct current with various waveforms –
rectangular, saw tooth, triangular, trapezoidal and depolarized are shown in Figure 10.4.

Figure 10.4: Interrupted direct current with various waveforms – rectangular, saw tooth, triangular, trapezoidal and
depolarized

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 Electrotherapy: Principles and Practice

Practical Tip
Unit IV ▶ Therapeutic Currents

To stimulate the denervated muscles, the pulses of long duration of 300ms are selected initially and reduced to
100ms as the muscles show improvement in the strength. An impulse of 100ms with a frequency of 30 per minute is
commonly practiced to stimulate the denervated muscles. If the duration of the current is increased from 100ms, the
frequency must be reduced, and if the duration is reduced from the 100ms, the frequency must be increased. Such
modifications are made to avoid fatigue of the muscles. The ratio of contraction and relaxation of the muscles with
the interrupted direct current should be 1:1 or preferably 1:2.

The monophasic unidirectional direct current causes electrochemical reactions under the cathode and anode
electrodes as it passes into the electrolytes. The chances of chemical reactions under the electrodes are much
reduced if the interrupted direct current (IDC) is used. This risk is further reduced by the use of depolarized
impulses. Depolarized impulses are the low intensity reversed current between the impulses.

Must Know
Interrupted direct current produces similar physiological and therapeutic effects to the faradic type current. IDC is
used to stimulate the denervated muscles. Faradic current, due to its short pulse duration, is unable to stimulate the
denervated muscles. Therefore, to determine the location of motor point of the muscle, IDC should always be used
in place of faradic current. Hence, whenever, the patient reports to the department with the history of weakness
following nerve injury or pathology, IDC must be used to determine the motor point as well as rheobase for the
strength duration curve. The placement of electrodes for stimulation of the muscles remain same for both the faradic
type current and interrupted direct current.

PHYSIOLOGICAL EFFECTS OF FARADIC AND GALVANIC CURRENTS

The stimulus with an adequate strength and enough duration can produce following physiological effects in
the tissues:

Nerve Depolarization
In the resting state, there are positive ions outside and negative ions inside of the nerve membrane. If there is
no transmission of ions across the membrane, then it can be said that the nerve is in the state of polarization.
This is also known as resting membrane potential.

Must Know
Nerve at rest has a membrane potential of -60 millivolt secondary to the selective permeability of the membrane to
potassium and sodium ions (a higher concentration of sodium ions results extracellularly, leaving intracellular space
more electrically negative).

When a stimulus of sufficient strength is applied over a sufficient length of time, sodium channels in the cell
membrane open rapidly, while potassium channels open slowly. The sodium ions rush into the cell through
the membrane. This makes the cell more positive inside the membrane and as soon as membrane potential
reaches to +30 millivolt, the permeability to sodium ions decreases. Now the potassium channels open
rapidly. The membrane permits potassium ions outside of it. The reduction of negative charges, which also
represents a reduction of the membrane potential of the cell, is known as depolarization phase. The abrupt
change of the resting potential leads to the development of an action potential or excitation of cell (Fig. 10.5).
The transmission of ions from sodium (outside) to potassium (inside) and potassium to sodium causes nerve
depolarization.
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Chapter 10 ▶ Faradic and Galvanic Currents

Unit IV ▶ Therapeutic Currents

Figure 10.5: Resting membrane potential

As soon as the depolarization or excitation of the membrane reaches to its peak, i.e., between 60 and 90
millivolt, the permeability of sodium ions decreases and it is followed by repolarization phase. Immediately
after this activity, the sodium ions are pumped out and potassium ions are pumped in again. The membrane
returns to its resting state. The difference of potential between the active and resting parts of the nerve causes
local electron flow. Electrons travel from a region of high concentration (the cathode/negative electrode)
to one of lower concentration (the anode/positive electrode) (Fig. 10.6). This sequential depolarization and
repolarization of the cell membrane (Fig. 10.7) caused by the change of flow of ions across the cell membrane
is called action potential (AP).
When the nerve is at the stage of depolarization and there is no fall in the action potential, nerve cannot be
stimulated further. This period is known as absolute refractory and relative refractory period. If the nerve
axon fails to respond to the subsequent stimulus, this is known as absolute refractory period. Therefore, to
get the nerve stimulated, a stronger stimulus than the previous one is required, which is known as refractory
period. After depolarization just before returning to the resting potential, there is a brief period of membrane
hyperpolarization (Fig. 10.8).

Figure 10.6: Electron flow

Figure 10.7: Direction of flow of impulse

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 Electrotherapy: Principles and Practice
Unit IV ▶ Therapeutic Currents

Figure 10.8: Nerve depolarization, action potential and refractory period

Sensory Nerve Stimulation

The flow of current to the superficial structures on the skin is perceived by the superficial nerve ending, which
leads to prickling sensation. The sensory stimulation causes a reflex vasodilatation of the superficial blood
vessels which produces slight erythema on the skin (local area).

Motor Nerve Stimulation

A stimulus of sufficient strength (intensity) can stimulate the motor nerve which in turn can cause tetanic
contraction of the muscles. Tetanic is the surge which includes series of contractions or pulses of short period.
Approximately, 50-100 contractions or pulses are produced in 0.1 to 1 millisecond.

Increased Metabolism
The tetanic like contraction of the muscles or group of muscles increases metabolic rate, with consequent
increase in the demand for oxygen, and nutrients. There is increased output of the waste products including
metabolites.

Increased Vasodilatation
Increased metabolism and demand for oxygen increases dilatation of the blood vessels (arterioles and
capillaries). A tetanic contraction followed by relaxation exerts a pumping action within and around the
vessels. The pumping action helps in increasing venous and lymphatic return.

Denervated Muscle Contraction

Faradic current has limited use in the stimulation of the denervated muscles as the current is of short duration.
The denervated muscles require more time to get stimulated, therefore, galvanic current, a long duration
current can stimulate the denervated muscles, prevent disuse atrophy, and help in regeneration of the nerve.
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Chapter 10 ▶ Faradic and Galvanic Currents

POLARITY

Unit IV ▶ Therapeutic Currents

Under normal physiological conditions, less current is required from a cathodal stimulus to evoke a muscle
contraction of given strength than from an anode stimulus.

Must Know
The negative electrode is used to evoke the muscle contraction and is termed the active electrode, because
depolarization of the biologically excitable tissue is most easily accomplished at the cathode. Excitable tissue under
the positive electrode is less prone to depolarization and thus, the anode is often termed the inactive, reference, or
dispersive electrode.6 The strength of a muscle contraction produced by the inactive electrode (anode) is about 70%
of the contraction produced by the active electrode (cathode) at a given current amplitude.7

Polar Reactions
Direct current can induce chemical reactions in body tissues. There is oxidation of the anions at the anode
that results in acidic reactions, whereas, at the cathode, reduction of the cations results in alkaline reactions.
These electrochemical reactions under the cathode and anode electrodes are referred to as polar reactions.
The polar reaction under the anode electrode can cause formation of hydrochloride (Hcl), solidification of
protein, hardening of the tissues, hyperpolarization and increased nerve excitability. The polar reaction under
cathode electrode includes formation of sodium hydroxide (NaOH), liquefaction of protein, softening of
tissues, hyperpolarization and increased excitability. To avoid such chemical reactions under the electrodes,
their positions are changed intermittently.
Alternating current is a biphasic current, which flows in two directions or bidirection. The electrodes used
to deliver the current to the tissues change their polarity as the current changes its direction. Therefore, the
chemical reactions formed under the electrodes during one half cycle of the output phase is neutralized by the
next half cycle of the output which is opposite in direction and similar in magnitude. The change of direction
in every half cycle changes the polarity of the electrodes and thus avoids formation of any chemical reactions
under the electrodes.

THERAPEUTIC USES
Therapeutic electrical currents have been in use for many years to successfully stimulate and contract
paralyzed muscles.8,9 They have received increasing attention in the last few years because of their potential
to serve as a strength training tool for healthy subjects and athletes, a rehabilitation and preventive tool for
partially or totally immobilized patients, a testing tool for evaluating the neural and/or muscular function in
vivo, and a postexercise recovery tool for athletes.10

Disuse Atrophy: Prevention and Reduction

Disuse atrophy refers to the decrease in muscle cross sectional area or reduction of muscle mass (there is no
change in the number of muscle fibers, but rather a decrease in the mean fiber cross sectional area). It may
occur as a result of prolonged immobilization of the joint (after fracture), or as a result of central nervous
system trauma (stroke or spinal cord injury).

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 Electrotherapy: Principles and Practice

Must Know
Unit IV ▶ Therapeutic Currents

Both the type I and type II muscle fibers show atrophy following immobilization. The atrophy of the type I (slow-
twitch muscle fibers) begins soon after the immobilization whereas atrophy in the type II (fast-twitch) muscle fibers
begins after months of the immobilization. Therefore, atrophy of the type II muscle fibers is a more gradual process
and only observed after months of immobilization.

Electrical stimulation promotes early active range of motion in postsurgical and cast immobilized limbs.11 Use
of electrical stimulation in preventing the muscle atrophy or decreasing the effect of the atrophy is a common
practice in physiotherapy, however; its effectiveness depends upon the parameters of current. The atrophy of
the muscle may range from minimal to severe. To treat the muscles with severe atrophy, the frequency and
contraction time (on time) should be as low as possible usually 3-10pps (pulses per second), and 5 seconds
respectively. The relaxation period between two contractions should be at least 25-50 seconds. To treat the
muscles with minimal atrophy, the frequency of the pulses per second and contraction period (on time) can
be increased to 30-50 pps, and 10-15 seconds. The session length should be 15 minutes irrespective of the
severity of the atrophy. If patient achieves voluntary contraction, electrical stimulation can be discontinued,
and should be encouraged to perform resisted exercises. However, if endurance is the concern, the electrical
stimulation may be continued until the functional goal previously established is achieved or modified.

Pain Control
A stimulus of sufficient strength can stimulate sensory as well as motor nerve. The impulses are carried out
by the large-diameter afferent neurons to the spinal cord, where they may travel to the higher centers in the
central nervous system and eventually be perceived as a pain sensation. While traveling to the higher centers,
the large diameter afferent neurons block the small diameter nociceptive impulses at the level of spinal canal,
resulting in analgesia.

Increase, Maintain and Restore Range of Motion

Loss of range of motion following prolonged immobilization, injuries, surgery, pain, stroke and spinal cord
insult is a common problem. Maintenance and restoration of the range of motion is one of the challenges
in the clinical practice. For example, (a) pain in the knee joint due to chronic osteoarthritis limits range of
motion of the joint. Stimulation of the quadriceps muscles with low level of intensity for long periods can
increase range of motion of the knee joint.12 (b) Spasticity in the flexor group of the wrist limits extension
range. In a study reported by Baker et al and expanded by Waters and Bowman, a nerve and muscle electrical
stimulation program was effective in maintaining wrist and finger range of motion into extension in nearly 80
patients with spastic hemiparesis without joint limitations.13,14 Munsat et al, reported first time that stimulation
of the femoral nerve provided activation of the quadriceps femoris muscle group which improved range of
motion of the knee joint.15 To be optimal, stimulation programs should be done daily, which is often most
effectively managed at home.17

Decrease Spasticity
Spasticity resulting from trauma, lesion or dysfunction of the central nervous system is a major concern for
the physical therapist. The spastic muscles inhibit the weak agonist, prohibiting the patient from using the
extremity appropriately. Moderate to severe spasticity not only interferes with the functions but also disturbs
the posture, making coordinated movements impossible. Electric stimulation of the antagonists to a spastic

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Chapter 10 ▶ Faradic and Galvanic Currents

muscle, followed by vigorous range of motion exercises can dramatically decrease the muscle tone. When

Unit IV ▶ Therapeutic Currents

spasticity impedes volitional control, addition of the electrical stimulation provides significant increase in
the management of abnormal muscle tone.18 The neurophysiologic rationale for the effectiveness of electrical
stimulation to the antagonist of the spastic muscle deems to rest on the principle of reciprocal inhibition.
However, the effect of the reciprocal inhibition is very short, measurable in milliseconds. The phenomenon
known as post-tetanic potentiation (PTT) may account for some of the therapeutic effects that exceed the
length of the treatment program.19
Electrical stimulation of the spastic muscles to reduce spasticity and increase voluntary contraction has
also been reported in many literatures.31 However, some authors believe that the electrical stimulation of the
spastic muscles may result in no effect or slight increase in spasticity.20

Must Know
There are two possible rationale for the decrease in tone fatigue following the barrage of electrical stimulation
(i) Same motor neuron stimulation and
(ii) Antidromic activation of the axon of an alpha motor neuron. The antidromic stimulation of the alpha motor
neuron activates the motor unit and, through recurrent collaterals, excites a pool of Renshaw cells. In turn, the
Renshaw cells inhibit the alpha motor neuron of the activated pool and the motor neurons of the synergistic
muscles.

Improve Voluntary Control

The inability to contract the muscles adequately as per demand of the activities of daily living may be due to:
• Peripheral inhibition of the central nervous system such as pain in the knee joint, or
• Due to decreased descending activation from the cortical and subcortical centers onto the alpha motor
neuron pool such as immediately following stroke. Inadequate contraction of the muscle is mainly due to
inadequate motor neuron drive on voluntary command. Peripheral inhibition of the motor neuron pool,
that decreases voluntary contraction of the muscles can be enhanced by decreasing the patient’s pain and
increasing the sensory drive by applying the electrical stimulation to the nerve which will excite the motor
neuron of the targeted muscles.

Control and Decrease Edema

Voluntary contraction of the muscles produces pumping action which aids in venous return. Loss of pumping
action of the muscles does not adequately help in venous return that may lead to accumulation of the fluid
in the local area or in the limb. Congestion of the body fluid may also occur due to compromised peripheral
vascular function such as venous insufficiency. Loss of pumping action of the muscles may occur as a result of
injury, prolonged bed rest, weakness due to pain, or dysfunction of the central or peripheral nervous system.
Application of the electrical stimulation to the weak muscles can cause contraction that improves the pumping
action and thus improve circulation to the area. Bipolar electrodes of one or more channels are placed over
the agonist and antagonist muscles for reciprocal contraction and relaxation. The ratio of contraction and
relaxation of the muscles should be 1:2 respectively to allow weak muscles to relax. The repetition should also
be slow to allow the vessels to refill. Treatment session should be approximately 20-30 minutes, however, time
may be increased or decreased as per the patient’s tolerance. The technique used to reduce edema is known as
faradism under pressure which is described later in this chapter.

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 AQ- please add indications
Electrotherapy: Principles and Practice

Muscle Re-education and Facilitation

Unit IV ▶ Therapeutic Currents

Prolonged immobilization following fracture or injury, weakness due to dysfunction of central nervous
system or peripheral nervous system, enable the patients to contract the muscles by voluntary demand. In
other words, simply the muscle forgets its own action. For example, (a) in patients with long standing flat foot,
the intrinsic muscles become unaware of their own action, (b) spasticity in the flexor group of the muscles due
to dysfunction of central nervous system does not allow active extension of the wrist in response to voluntary
demand, (c) paralysis of one side of the face muscles due to dysfunction of the peripheral nervous system
(Bell’s palsy) remain stretched to the sound side and (d) following tendon transfer muscle does not contract
voluntarily as it is not aware of the new action. Electrical stimulation not only helps in re-educating the muscle
action but also facilitates the action of the muscles by providing proprioceptive, kinesthetic, and sensory
input. The electrical stimulation facilitates muscle action during functional training involving gait training.21

Tissue Repair
The human body has a mechanism that is engaged in the repairing of the damaged tissues due to injury
or trauma. Electrical stimulation at a wound site has been claimed to accelerate and enhance healing by
retarding bacterial growth, increasing local circulation, or enhancing the natural process of tissue repair.22 The
electrical stimulation around the wound site can increase the permeability to macromolecules, and marked
extravasation of white blood cells occurrs from the capillaries. There is migration of epidural cells, fibroblasts,
leukocytes, and macrophages by electrical fields. Lateral fields at the edge of wound conceivably could directly
promote the inflammatory response, epithelialization, and fibrogenesis associated with wound healing.23

INDICATIONS
************

CONTRAINDICATIONS
• Cardiac Pacemaker: Electrical stimulation should not be given over the pacemaker directly as this can
interfere with the function of the pacemaker.
• Over the carotid sinus: Application of electrical stimulation on the carotid sinus may reduce the blood
pressure of the patient.
• Areas of the venous or arterial thrombosis or thrombophlebitis: Application of electrical stimulation
on the area of venous or arterial thrombosis or thrombophlebitis may increase circulation, and the risk of
releasing emboli.
• Over the abdomen during pregnancy: The application of electrical stimulation directly or nearby to the
fetus area can cause current to pass to the fetus.
• Impaired sensation: Areas of sensory deficit should well be avoided for electrical stimulation. Application
of electrical current directly over the area of impaired sensation can cause electrical burn.
• Malignant tumor: Application of electrical stimulation on the tumor can enhance the growth of the tissues
as the current increases blood circulation and metabolism rate necessary for tissue growth.
• Open wounds: Electrical stimulation is used to enhance the healing and growth of the tissues, but the
sensation of the areas (peripheral to the open area) should be tested and the intensity may be kept low to
avoid any adverse effects.
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Chapter 10 ▶ Faradic and Galvanic Currents

APPLICATION PROCEDURE

Unit IV ▶ Therapeutic Currents

Motor Point
A motor point can physiologically be identified
as a specific location on the skin that requires the
lowest amplitude of electrical stimulation to produce
excitation of an underlying innervated muscle.
Anatomically, this area of skin has been found to
transversely overlie a muscle’s neurovascular hilus,
which contains sensory, motor, and autonomic
axons, and the zone of innervations, where branches
of motor axons terminate on individual muscle
fibers.24, 25 This is the point where maximum muscle
contraction is achieved, more than any other area of
the muscle with the same amplitude of the current Figure 10.9: Motor point
(Fig. 10.9).
Motor points are frequently located at the junction of the upper and middle one thirds of the fleshy belly
of the muscle. There are some exceptions:
• The motor points of the vastus medialis, whose nerve enters at the lower part of the muscle, is situated a
short distance above the knee joint.26
• The motor point of the extensor hallucis longus can only be elicited at the distal anterior part of the ankle
joint as the upper and middle one third of the muscle is deep to the peroneal muscles.
• In denervated muscles, normal motor point is no longer present as these muscles are deprived of the nerve
supply. The contraction is present due to stimulation of the muscle itself, rather than the motor nerve.
Hence, the motor point is usually found distal to the normal motor point. However, no contraction is
achieved with the short pulse durations.

Technique
Determination of the motor point is essential either to strengthen the weak muscle or to draw strength
duration curve for the diagnosis. The individual or specific muscles can be strengthened by stimulating the
muscles at the motor points.

Preparation of Equipment
The equipment of electronic muscle and nerve stimulator should be free from any electric shock. It should
have faradic, surged faradic, plane galvanic and interrupted galvanic currents (Fig. 10.10). The parameters of
the currents such as frequency, waveforms, contraction and relaxation periods should be designed very well
on the equipment.
The equipment should have black and red colored marked points for active and passive electrodes. The
electrodes may be made up of carbon and stainless steel (plate). If plate electrodes are used to stimulate
nerve and muscles, these should be covered with lint (cloth). The lint is made of cotton, which is folded in
such a way that eight layers can be made. The plate electrode is inserted into the folded lint that seven layers
out of eight remain on one side of it. The seven-layer part of the electrode is placed over the skin, whereas
last layer of the lint remains out. However, many therapists cover the plate electrodes with the lint as per the
convenience of patient and therapist. The carbon electrodes do not require lint and are placed on the patient’s
skin with the gel. 15
 Electrotherapy: Principles and Practice
Unit IV ▶ Therapeutic Currents

Figure 10.10: Electrical muscle and nerve stimulator

Selection of Parameters
Select the current, pulse duration, and frequency. To elicit the motor points, interrupted (galvanic) direct
current should be selected, this is because it is a long duration current and can stimulate both the innervated
and denervated muscles. On the other hand, faradic current is a short duration current which cannot
stimulate the denervated muscles, therefore, if surge faradic current is selected, it would not elicit the motor
points of the denervated or partially denervated muscles.

Self-testing of the Equipment

If all the parameters are set and electrodes
are prepared for eliciting the motor points,
it is important to test the equipment before
applying the current to the patient to
know whether the equipment is working
satisfactorily or not. For self-testing, the
therapist places both the electrodes under
the palmar aspect of hand and the intensity is
increased gradually. A fine visible contraction
with comfortable current can be elicited. If the
examiner feels discomfort with the current
Figure 10.11: Self-testing of the equipment
with increasing intensity and the current is
unable to elicit the visible contraction, it may probably be due to the malfunctioning of the equipment. It
should not be tried on the patient (Fig. 10.11).

16
Chapter 10 ▶ Faradic and Galvanic Currents

Preparation of Patient

Unit IV ▶ Therapeutic Currents

The patient is placed in a comfortable position. Muscle which is being stimulated must be exposed adequately
from origin to the insertion. The skin must be cleaned with warm water and soap or alcohol to remove any
dirt to decrease the skin resistance. If the muscles of the extremity are to be stimulated, place joint at neutral
position to see the visible contraction (for motor points) or place the extremity with appropriate support in a
semiflexed position for the desired movement (for strengthening).

Placement of the Electrodes

To elicit the motor points of the muscles, pen electrodes and plate or pad (carbon) electrodes are used. The
pen and pad electrodes are called active and passive electrodes respectively. The knob of the active electrode
is a metal piece which is placed over the muscle belly. The metal knob of the electrode must be completely
covered by lint or cloth. The knob of the electrode with lint or cloth is soaked repeatedly into the water to
conduct the current to the tissues through the lint. An active electrode is placed directly on the muscle belly
to find out the motor point.

Practical Tip
There are three criteria for placement of the passive electrodes:
• On the origin of the muscle,
• On the respective nerve trunk, and
• On the spinal cord (spine).
Efforts should be made to place the electrode over the origin of the muscle, but if it is difficult especially when the
motor points of the small muscles (facial) are elicited or there is difficulty in exposing the origin of the muscles for
privacy such as quadriceps and hamstrings. For these reasons, the passive electrode is placed over the trunk or spinal
cord. The advantage of the placement of the electrode over the nerve trunk is that all the muscles supplied by the
respective nerve can be stimulated without changing the passive electrode.

Elicitation of Motor Point

After preparing the patient and selecting the parameters
of the current, explain the procedure to the patient. The
passive electrode is placed over the desired position as
mentioned above and active electrode is placed randomly
on the upper and middle one-thirds of the fleshy belly
of the muscle. Ensure that the intensity knob is at zero
before switching the equipment on. The intensity is
increased gradually. The examiner must keep the eyes on
the muscle which is being stimulated to see the visible Figure 10.12: Elicitation of motor point
contraction. As soon as a visible contraction is observed, the intensity is stopped from being increased further.
The examiner now moves the active electrode over the upper and middle one-thirds of the fleshy belly of the
muscle to find out maximum contraction. The point where maximum contraction is achieved is termed the
motor point of the said muscle. The examiner must ensure that the electrode is kept perpendicular to the
muscle and pressure should also be same throughout the procedure. The electrode must not be lifted off the
muscle belly while searching the motor point and intensity if on (Figs 10.12 and 10.13A to E).

17
 Electrotherapy: Principles and Practice
Unit IV ▶ Therapeutic Currents

Figure 10.13A: Illustration of motor points of upper extremity (palmar view)

Figure 10.13B: Illustration of motor points of upper extremity (dorsal view)

18
Chapter 10 ▶ Faradic and Galvanic Currents

Unit IV ▶ Therapeutic Currents

Figures 10.13C: Illustration of motor points of back

Figure 10.13D: Illustration of motor points of lower extremity (anterior view)

Figure 10.13E: Illustration of motor points of lower extremity (posterior view) 19

 Electrotherapy: Principles and Practice

Motor Points of Facial Muscles

Unit IV ▶ Therapeutic Currents

The facial muscles are supplied by the seventh cranial nerve. Bell’s palsy and upper motor neuron lesion can
affect the contraction of the facial muscles. Bell’s palsy is a lower motor neuron lesion in which paralysis of
same side of facial muscles occurs following pain in the ear (Herpes Zoster infection) whereas in upper motor
neuron lesion, paralysis of the muscles of opposite side of the face occurs, the later may affect both the sides
of muscles.

Must Know
Accommodation
When adequate amplitude of current is transmitted into the nerve, it can cause potential difference which results in
excitation of the nerve. The rise and fall of the current produce the nerve excitation. The accommodation is described
as a phenomenon in which the threshold of membrane excitability automatically rises or ceases with a stimulus of
slowly increasing intensity. If the variation of the current is gradual, there is time for accommodation to take place,
and the muscle (s) fails to respond to the stimulus, therefore, a greater current is needed to be effective than if the
variation is sudden. A current that changes very slowly does not initiate a nerve impulse at all. It is, therefore, to avoid
accommodation to take place in the nerve, a current of square waveform pulse, which rises or falls suddenly is used
as it is more effective in initiating an impulse than one which changes slowly.

FARADIC FOOT BATH

Faradic foot bath is the technique of application of faradic current to
stimulate and strengthen muscles of foot in the water. The foot ailments
such as flat foot, Hallux valgus and metatarsalgia can be treated with the
faradic currents. It is difficult to stimulate the foot muscles by using the
motor point technique as there are four layers of the muscles in the foot.
The water makes perfect contact with the foot tissues and also reduces
skin resistance. Position the patient in high sitting with back support.
Place the foot in the bath. The level of water should be till the web of toes
as shown in the image. If the water level is above the web of toes, this
would unnecessarily stimulate the dorsal muscles (foot) (Fig. 10.14).
• For Lumbrical Muscles: Place each pad electrode under the heel and
metatarsal head transversely.
• For Plantar Interossei Muscles: Place one electrode on each side of Figure 10.14: Faradic foot bath
the foot at the level of the metatarsal shafts.
• For Abductor Hallucis: Place the pad electrode under the heel and pencil (active) electrode on the muscle
belly of the abductor hallucis.
Select the surged faradic current with an appropriate contraction and relaxation periods. The relaxation
period should be larger than the contraction period to allow the muscles to relax and to avoid fatigue. Increase
the intensity gradually till a strong contraction is achieved. Several contractions for 3-5 minutes are repeated
for improving the strength. The patient is encouraged to contract the muscles voluntarily with the electrical
stimulation. Once the patient achieves voluntary contraction, the stimulation is discontinued.

20
Chapter 10 ▶ Faradic and Galvanic Currents

FARADISM UNDER PRESSURE

Unit IV ▶ Therapeutic Currents

Faradism under pressure is the application of surged faradic current combined with the elastic crepe bandage
to reduce swelling and edema of the distal part of the extremities. The elastic crepe bandage increases the
pressure on the vessels when the muscles contract in response to electric stimulation and exerts a further
pumping effect as the muscle relaxes during the relaxation phase of the current.

For Upper Extremity

Place the patient in supine position with the arm
elevated above the heart level to enhance venous
return. Remove all the jewelry and clothing to
expose the extremity. Privacy of the patient must
be the concern. Clean the flexor aspect of the
arm and forearm with the soap and warm water
to reduce skin resistance. Place pad electrodes
each over the flexor aspect of the arm and
forearm. Apply an elastic crepe bandage from
distal to proximal (hand to the proximal arm).
The bandage is applied with maximum pressure
at the hand and decreasing gradually toward the
Figure 10.15: Faradism under pressure
arm. There should not be any gaps between the
turns of the bandage (Fig. 10.15).

For Lower Extremity

Place the patient in supine position with the concerned leg elevated above the heart level to enhance venous
return. Remove all the jewelry and clothing to expose the extremity. Privacy of the patient must be the concern.
Clean the posterior leg and the plantar surface with the soap and warm water to reduce the skin resistance.
Place one pad electrode over the mid-calf muscles and other pad electrode over the plantar aspect of the foot.
Apply elastic crepe bandage with maximum pressure at the toes of the foot and decreasing gradually toward
the proximal calf muscles. There should not be any gaps between the turns of the bandage.
Select the surged faradic current with appropriate pulse contraction and relaxation periods. Ensure that
the intensity knob is at zero before turning the stimulator on. Increase the intensity gradually till a strong but
tolerable contraction is achieved. Total treatment time for reducing edema should be thirty minutes.

STRENGTH-DURATION CURVE
The strength-duration curve is a technique of plotting the threshold current (I) versus pulse duration (d)
required to stimulate excitable tissue.36 Plotting Strength-duration curve is one of the techniques of testing
of electrical reaction in peripheral lesions. It was the technique most widely used in the clinics till 1960s, and
after that it declined sharply with the development of nerve conduction velocity test and electromyography.
The muscle is contracted to see the strength of impulses of various durations.

21
 Electrotherapy: Principles and Practice

Must Know
Unit IV ▶ Therapeutic Currents

Normal muscle responds to the electrical stimulation of pulse duration ranging from 0.01millisecond to 600
millisecond. The longer the duration, the lesser the strength (in intensity) required to stimulate the muscle; and vice
versa. The muscle deprived of nerve innervations do not respond to the electrical current of short pulse duration
usually 0.01, 0.03, 0.1, 0.3 and 1 millisecond, but may respond to the longer pulse duration usually 100ms and above.

Application of electrical stimulation with appropriate parameters and proper positioning of the electrodes
on motor points can provide reliable and accurate information on the status of the peripheral nerve
innervations and denervation to the muscles. The results of the strength curve can be as objective as nerve
conduction testing and electromyography. The disadvantage of the technique is that in large muscles only a
proportion of the fibers of the muscle responds to the current, so that the full picture is not clearly shown and
also an SD curve does not indicate the site of the lesion. These limitations can only be overcome by testing
several muscles, innervated by that particular nerve.
To plot an SD curve, an electrical stimulator
capable of producing square-wave monophasic pulse
stimuli at various precise pulse durations ranging
from 0.1 to 300 millisecond is required (Fig. 10.16).
The stimulus must have a meter preferably digital
for an accurate reading of intensity (strength) at
various precise pulse durations. Most of stimulators
are designed with the constant voltage and constant
current. Wynn Parry discussed the strength curve
properties using a constant voltage stimulator
rather than constant current stimulator and related
that although the output of the constant current is
more stable (because it compensates for changes in
tissue impedance), both types of stimulators give Figure 10.16: Strength-duration curve for normal muscle
equally accurate results and the constant voltage is (constant voltage)
more preferred in interest of the patient’s comfort and tolerance.27
The part which is being tested for strength-duration curve is exposed adequately and the skin is cleaned
with warm water and soap. Passive electrode (pad) is either placed on the nerve trunk or origin of the muscle
which is being tested, if both locations are not convenient the third choice of placement of passive electrode is
on the lumbar spine for the lower extremities, and cervical spine for the upper extremity and facial muscles.
Active (pencil) electrode is placed directly on the muscle belly. Interrupted direct galvanic current with
constant voltage or constant current is selected. The frequency of the pulses should ideally be 30 pulses per
minute.

Practical Tip
Strength-duration curve plotting should be started from the longer durations, for example, 300 millisecond pulse
duration is selected first and the intensity is increased till a visible or palpable contraction is achieved.

The point where muscle starts showing visible contraction is the strength of the stimulus at the 300
millisecond pulse duration. This amplitude (intensity) shown by the meter is recorded. The intensity is
reduced to zero and next shorter pulse duration is selected, i.e., 100 millisecond. The intensity is increased

22
Chapter 10 ▶ Faradic and Galvanic Currents

gradually till a visible contraction is achieved. The

Unit IV ▶ Therapeutic Currents

point where muscle starts showing visible contraction
is the strength of the stimulus at the 100 millisecond
pulse duration. This same procedure is repeated for
each length of the stimulus. The minimum visible
contraction should be same for all the pulse durations
to get the accurate results. The examiner should ensure
that the location of the active electrode must be in
the same position with the same pressure throughout
the session. Change in the location of electrodes and
pressure can distort the findings.

Significance of Strength-Duration Curve

The strength-duration curve helps in detecting
whether the concerned muscle is deprived of the
nerve innervation partially or completely. The special
characteristic features can identify the innervation of
the nerve to the muscle (Figs 10.17A to C). Figures 10.17A to C: Strength-duration curve,
A. Normal muscle; B. Partially denervated muscle, and
Complete Denervation C. Complete denervated muscle
The muscles with complete nerve denervation do not respond to the short pulse duration impulses. As
the pulse duration is decreased, the stimulus strength is increased rapidly to elicit the muscle contraction,
therefore, curve rises steeply. Muscles do not respond to the stimulus strength to shorter impulses usually less
than 1 millisecond.

Partial Denervation
The innervation to the muscle is not completely cut, nerve fibers are still intact to supply the muscle. There are
some muscle fibers, deprived of the nerve supply whereas, remaining muscle fibers are innervated. Initially,
the stimulus strength (intensity) stimulates the innervated and denervated muscle fibers. But the curve rises
steeply as the denervated muscles respond less readily to the shorter impulses (Fig. 10.17D).

Must Know
With decreasing pulse duration, the innervated muscle fibers start contracting with the less amplitude, therefore,
the curve falls steeply and forms an angle which is known as kink. Kink is actually a point between the stimulating of
denervated and innervated muscle fibers. It is a feature of partially denervated muscles.

Wallerian Degeneration
In Wallerian degeneration, alterations in the myelin sheath and axon distal to the lesion occur in 2-3 weeks;
therefore, a strength-duration curve test will not reveal an accurate picture of denervation if it is performed
earlier than fourteen days after an injury. The follow-up of the strength-duration curve should not be
scheduled frequently as an average axonal regeneration is 1 millimeter per day. To see the prognosis, several
strength-duration curves must be plotted over several weeks. The two important points on the curve are
rheobase (b) and chronaxie (c), which correlates to twice the rheobase (2b).
23
 Electrotherapy: Principles and Practice
Unit IV ▶ Therapeutic Currents

Figure 10.17D: Strength duration curve, for partial denervated muscle

Rheobase
Rheobase is the minimal amplitude or intensity of
a current that is required to elicit a minimal visually
perceptible muscle contraction31 at infinite pulse
duration, usually 100ms for the clinical practice.26 It
is represented as “b”. In neuroscience, rheobase is the
minimal current amplitude of infinite duration (in a
practical sense, about 300 milliseconds) that results
in the depolarization threshold of the cell membranes
being reached, such as an action potential or the
contraction of a muscle.29 When the strength-duration
curve is plotted, the contraction of the muscle depends
on the two variables, the strength of the stimulus and the
duration of the stimulus.30 The strength and duration
of the stimulus are inversely related to each other. As
the duration of the stimulus required to stimulate Figure 10.18: Rheobase (constant voltage)
is reduced, the required strength of the stimulus is
increased. The two important points on the curve are rheobase (b) and chronaxie (c), which correlate to twice
the rheobase (b). The rheobase of same muscle of different patients varies due to skin resistance (Fig. 10.18).

Chronaxie
Chronaxie refers to the minimal pulse duration of the stimulus required to stimulate the muscle for minimally
visible contraction. It is double of the rheobase. The chronaxie value for the normal muscle is found less
than 1 millisecond, usually a pulse duration of millisecond, while the chronaxie for the fully denervated
muscle is detected much longer, usually 20 to 50 millisecond. Therefore, the muscles deprived of their nerve

24
Chapter 10 ▶ Faradic and Galvanic Currents

supply require higher rheobase (amplitude), whereas muscles with intact nerve supply require less rheobase

Unit IV ▶ Therapeutic Currents

(amplitude) at the same pulse duration. This is the reason that the muscles deprived of their nerve supply do
not respond to the current at the lower pulse duration usually less than 1 millisecond.
Determination of Rheobase and Chronaxie in the strength-duration curve is shown in Table 10.1 and
Figure 10.19.

TABLE 10.1: Determination of Rheobase and Chronaxie in the strength-duration curve

Pulse duration Amplitude of right Amplitude of right Tibialis Amplitude of right Tibialis Anterior
(in millisecond) Tibialis Anterior Anterior (denervated) (partially denervated)
(in mA) (in mA) (in mA)
100 2 4 3
30 2 6 3
10 2 11 6
3 2 17 7
1 3 No response 9
.3 4 10
.1 5 No response
.03 11
.01 19

Figure 10.19: Determination of Rheobase and Chronaxie in the strength-duration curve

25
 Electrotherapy: Principles and Practice

• The rheobase (b) and chronaxie (c) can be determined from the SD curve as under (Fig. 10.19):
Unit IV ▶ Therapeutic Currents

ƒ For the right normal tibialis anterior (curve A), rheobase (b) is 2 milliamperes whereas the chronaxie
(double of the rheobase) is 0.3 millisecond.
ƒ For the left complete denervated tibialis anterior, the rheobase is 4 milliamperes whereas the chronaxie
is 20 milliseconds.
ƒ For the left partially denervated peroneus longus, the rheobase is 3 milliamperes and chronaxie is 10
milliseconds.
From the curve A, B, and C, it can be inferred that the normal muscle has chronaxie less than 1 millisecond,
whereas, the partially denervated and complete denervated muscles have chronaxie 10 milliseconds and 20
milliseconds respectively.

REACTION OF DEGENERATION TEST

Reaction of degeneration test is the screening procedure for assessment of paralytic muscles following lower
motor neuron injuries. It is used as a quick screening test for differentiating a muscle with normal peripheral
innervations from a muscle with peripheral denervation. The reaction of degeneration test is also referred to
as faradic and galvanic test as both the currents are used in the procedure. A motor point is searched with the
help of small, hand-held electrode or pencil electrode.
First, faradic current of more than 20Hz repetitions at less than 1 millisecond pulse duration is applied to
the motor point. This would produce a tetanic or sustained contraction of the muscle of interest. It is called no
reaction of degeneration. If no response or sluggish response is seen, peripheral denervation is likely to occur.
Now, the muscle of interest is stimulated with the galvanic, a long pulse duration current (monophasic), at
100 millisecond pulse duration or longer. A slow, or sluggish response to the current is due to either partial or
complete denervation of the nerve.

Disadvantages
The reaction of degeneration test is very inaccurate. The sluggish response of the innervated muscles may also
be recorded if their temperature is below normal or in certain conditions such as myxedema, on the other
hand, the contraction of denervated muscles may be brisk if their temperature rises.

Summary
• Faradic current, an alternating short duration, i.e., 0.1 to 1 millisecond current with a frequency of 50 to 100 Hz
initially produced by a faradic coil is now produced by the electronic stimulator.
• The original faradic current could not be used for the purpose of the treatment as there was no rest between
the pulses. Hence, the original faradic current has been modified into the faradic type current, a modified direct
current. However, the original and modified faradic type currents produce similar physiological effects.
• The faradic type currents are further modified into the surges and different waveforms.
• Faradic type currents are primarily used for prevention of disuse atrophy, pain control, to improve volitional
control, decrease edema, restoration of range of motion and decrease spasticity.
• Interrupted galvanic current is a long duration, i.e., 0.1ms to 300ms direct current with a frequency of 1Hz to
6Hz. The rise and fall of impulses of interrupted direct current with brief period of rest between them prevents
accommodation to occur in the nerve.

Contd…

26
Chapter 10 ▶ Faradic and Galvanic Currents

Unit IV ▶ Therapeutic Currents

• The current produces similar physiological effects of faradic type current such as stimulation of motor, sensory,
increased metabolism, and vasodilatation.
• Interrupted direct current can be used to stimulate both the innervated and denervated muscles as it has long
duration pulses, whereas faradic current cannot be used to stimulate the denervated muscles due to its short
pulse duration. To detect the motor points of the muscles, only interrupted direct galvanic current is used.
• Interrupted direct current is also used for plotting the strength-duration curve, required to determine the integrity
of the nerve. This helps in identifying the partial or complete denervation of the nerve.

References
1. Ranvier, Louis-Antoine (1874). “De quelques faits relatifs à l’histologie et à la physiologie des muscles striés”.
Archives de physiologie normale et pathologique (in French) 6: 1–15.
2. Denny-Brown, D. (1929). “On the Nature of Postural Reflexes”. Proceedings of the Royal Society B 104 (730):
252–301.
3. Buller, AJ; Eccles, JC; Eccles, RM (1960). “Interactions between motoneurones and muscles in respect of the
characteristic speeds of their responses”. The Journal of physiology 150: 417–39.
4. Pette, Dirk; Smith, Margaret E.; Staudte, Hans W.; Vrbová, Gerta (1973). “Effects of long-term electrical
stimulation on some contractile and metabolic characteristics of fast rabbit muscles”. Pflügers Archiv European
Journal of Physiology 338(3): 257.
5. Angela Forster, Nigel Palastanga. Clayton’s Electrotherapy, theory and practice ninth edition, pp 80.
6. Pfleuger, EFW: Uberdie tetanisierende Wirkungdes constantent Stromes und dass Allgemeingeesetz der
Reizung. Virchow’s Arch 3:13, 1858.
7. McNeal, DR and Baker, LL: Effects of joint angle, electrodes and waveform on electrical stimulation of the
quadriceps and hamstrings. Ann Biomed Engg16:299, 1998.)
8. Geddes LA. A short history of the electrical stimulation of excitable tissue including electrotherapeutic
applications. Physiotherapist 27 (suppl): S-2, 1984,
rd
9. Speilholz NI. Electrical stimulation of denervated muscles. In clinical electrotherapy; 3 Lange, 1999, 411-
446..ed. Stamford, CT: Appleton and Maffiuletti, Nicola A.; Minetto, Marco A.; Farina, Dario; Bottinelli,
Roberto (2011). “Electrical stimulation for neuromuscular testing and training: State-of-the art and unresolved
issues”. European Journal of Applied Physiology111 (10): 2391–7.
10. Knight KL: Electrical stimulation during immobilization. Phys Sport ed. 1980;8:147 Eriksson E, Haggmark
T:Comparison of isometric training in the recovery after major knee ligament surgery. Am J Sports Med.
1979;7:169-171)
11. Zizic TM, Hoffman KC, Holt Pa et al. the treatment of osteoarthritis of the knee with pulsed electrical
stimulation. J Rheum 22:1757-1761, 1995).
12. Baker LL, Yeh C, Wilson D, Waters RL,. Electrical stimulation of wrist and fingers for hemiparesis patients. Phys
Therapy Association 1979.
13. Waters RL, BowmanBR, Multicenter functional electrical stimulation evaluation for contracture prevention
and correction. Final report to veteran Administration, No. V790, p1441, Washington DC, 1981.
14. Munsat TL, McNeal D, Waters R: effects of nerve stimulation on human muscle, Arch Neurol, 33:608-617,
1976).
15. Baker LL, McNEAL dr, Benton LA, Bowman BR, Waters RL,. Neuromuscular electrical stimulation – A
Practical Guide (third edition) Downey, CA, Los Amigos Research and education institute, 1993.
16. Roger M. Nelson, Karen W. Hayes, Dean P Currier, Clinical Electrotherapy third edition, p361).
17. Levine MG, Knott M, Kabat H. Relaxation of spasticity by electrical stimulation of antagonist muscles. Arch
Phys Med, 33:668-673, 1952).
18. Roger M. Nelson, Karen W. Hayes, Dean P Currier Clinical Electrotherapy, third edition, pp382).

27
 Electrotherapy: Principles and Practice

19. Bowmam BBajd T. influence of electrical stimulation on skeletal muscle spasticity. Proc Intern Symp External
Unit IV ▶ Therapeutic Currents

ControlHuman Extremities. Belgrade, Yugoslavia, committee for electronics and Automation, pp561-576,
1981).
20. Uros Bogatal, Nusa Gros, et al: restoration of gait during two to three weeks of therapy with multi-channel
electrical stimulation. Phys Ther. 1989;69:319-327).
21. Bernadette Hecox, Tesega Andemicael Mehreteab and Joseph Weisberg Physical agents, a comprehensive
textbook for physical therapists, page 290.
22. Roger M. Nelson, Karen W. Hayes, Dean P Currier, Clinical Electrotherapy third edition, p209).
23. Roger M. Nelson, Karen W. Hayes, Dean P Currier, Clinical Electrotherapy third edition, p313. Gunn CC,
Motor points and motor lines. Am J A cupunct, 6:55-58, 1978.
24. Walthard KM, Tchicaloff M. Motor points. In Licht S(ed), electrodiagnosis and electromyography, Vol 3.
Baltimore, MD, Waverly Press, pp153-170, 1971).
25. Clayton’s Electrotherapy, theory and practice ninth edition p68. Angela Forster, Nigel [Link]
Currents Wynn Parry, CB; Strength duration curves. In Licht, S(ed): electrodiagnosis and electrophysiology,
ed 3, Elizabeth Licht, New Havens, 1971, pp141 .
26. Meryl Roth Gersh, Electrotherapy in Rehabilitation, first Indian edition, pp338.
27. Ashley, et al. “Determination of the Chronaxie and Rheobase of Denervated Limb Muscles in Conscious
Rabbits”. Artificial Organs, Volume 29 Issue 3 Page 212 - March 2005.
28. Geddes, L. A. (2004). “Accuracy limitations of chronaxie values”. IEEE Transactions on Biomedical Engineering,
51(1).
29. Lee WJ, McGovern JP, Duvall EN. Cutaneous tetanizing (low voltage) current for relief of spasm. Arch Phys Med
Rehabil, 31;766-771, 1950).

ASSESS YOURSELF
Long Answer Questions
1. What are the low frequency currents? Explain in detail the Faradic and Galvanic currents and their physiological
effects.
2. Explain in detail the physiological effects, therapeutic uses, indications, contraindications and procedure of
application of Faradic and Galvanic current.
3. What is a motor point? Explain the technique of locating or determining the motor point.
4. Define strength-duration curve, chronaxie and rheobase. Describe the procedure of plotting strength-duration
curve and its clinical significance.

Short Answer Questions

1. Define therapeutic currents.
2. Classify therapeutic currents.
a. On the basis of direction of flow
b. On the basis of frequency
c. On the basis of voltage
3. Define direct current.
4. What are the different modified waveforms of the direct current?

28
Chapter 10 ▶ Faradic and Galvanic Currents

Unit IV ▶ Therapeutic Currents

5. Why unmodified direct current is not used for the therapeutic purposes?
6. Define alternating current.
7. What are the different modulated forms of alternating current?
8. Explain low frequency currents.
9. What is the difference between original faradic current and faradic type of current?
10. What is the difference between faradic type current and interrupted direct (galvanic) current?
11. Which type of low frequency current is used to find the motor point and why?
12. What are the selective impulses?
13. Which pulse duration of interrupted direct current is commonly used to stimulate the denervated muscles?
14. What are depolarized impulses?
15. What are the physiological effects of faradic and galvanic current?
16. What are the therapeutic uses of faradic and interrupted direct current?
17. What is the motor point?
18. Where are the motor points frequently located?
19. Name the muscles whose motor points are not located at the junctions of the upper and middle one thirds of the
fleshy belly of the muscle.
20. What is the self-testing of muscle stimulator and why it is required?
21. What are different types of electrodes used for the stimulation of muscles with the faradic type and interrupted
direct current?
22. What is a pen electrode and how it is prepared?
23. What are the criteria for the placement of passive electrode?
24. What is accommodation?
25. How accommodation of nerve can be avoided?
26. What is the polarity?
27. What are the polar reactions?
28. How the polar reactions can be avoided?
29. How low frequency currents help in reducing the spasticity?
30. What should be the position of the passive and active electrodes for the stimulation of facial muscles?
31. What is faradic foot bath?
32. Which current is used in the faradic foot bath?
33. What should be the level of water in faradic foot bath?
34. What should be the position of electrodes for the strengthening of lumbricals?
35. What should be the position of electrodes for the plantar interossei muscles?
36. What should be the position of the electrodes for the abductor hallucis?
37. What should be the ratio of relaxation and contraction period?
38. What should be the time of treatment session for faradic foot bath?
39. What is faradism under pressure?
40. Explain the mechanism of faradism under pressure.
41. Explain the procedure of faradism under pressure for the upper extremity.
42. Explain the procedure of faradism under pressure for the lower extremity.

29
 Electrotherapy: Principles and Practice
Unit IV ▶ Therapeutic Currents

43. What is the strength-duration curve?

44. What is the significance of strength-duration curve?
45. What is complete denervation?
46. What is partial denervation of the muscle?
47. What is the difference between normal innervated and denervated muscles?
48. What should be the pulse duration of the current from which strength duration curve plotting should be started?
49. What is the Rheobase?
50. What is the relationship between strength of the stimulus and duration of the stimulus?
51. What is the Chronaxie?
52. What is the value of the chronaxie for the normal muscles, partially denervated muscles and completely denervated
muscles?

Short Notes
a. Faradic current
b. Faradic type current
c. Galvanic or interrupted direct current
d. Polarity or Polar reaction
e. Motor point
f. Accommodation of Nerve
g. Faradism foot bath
h. Faradism under pressure
i. Strength-duration curve
j. Chronaxie
k. Rheobase

30