What Is Cranial Electrotherapy Stimulation?

The method of applying a current below 1000Hz to treat diseases is called low-frequency electrotherapy, which can be used to treat acute and chronic pain.

Pan Yu	(Deputy Chief Physician)	Beijing Rehabilitation Center Rehabilitation Department
She Shuyan	(Deputy Chief Physician)	Beijing Rehabilitation Center Rehabilitation Department
Wang Luyi	(Resident)	Beijing Rehabilitation Center Rehabilitation Department

The method of applying a current below 1000Hz to treat diseases is called low-frequency electrotherapy, which can be used to treat acute and chronic pain.

Characteristics of low frequency electrotherapy

(1) Both are low-voltage, low-frequency, and adjustable;

(2) No obvious electrolytic effect;

(3) It has a strong stimulating effect on sensory and motor nerves;

(4) It has analgesic but no fever effect.

At present, the commonly used low-frequency electrical therapies are: neuromuscular electrical stimulation therapy, transcutaneous electrical nerve stimulation therapy, interkinetic electrical therapy, low-frequency high-voltage electrical therapy, etc. ^[1] .

Low-frequency electrical therapy neuromuscular electrical stimulation therapy

It is a method of applying low-frequency pulse current to stimulate nerves or muscles to contract to restore their motor function. This method is mainly used to stimulate denervated muscles, spastic muscles and smooth muscles, and can also be used to treat disused muscle atrophy. Neuromuscular electrical stimulation therapy (NMES) is a treatment technique used to improve central nervous system dysfunction and reshape peripheral nerve function.

Principle of low frequency electrotherapy electrical stimulation

Therapeutic effects of electrical stimulation on denervated muscles

After the inferior motor neurons are paralyzed, the muscles lose their innervation and atrophy. In order to slow down this change, according to different conditions, different pulse currents are selected to stimulate muscles or muscle groups to cause passive rhythmic contractions. Through exercise, muscle functions are retained, and the development of atrophy and degeneration is delayed.

Therapeutic effect on spastic muscle

The principle of this treatment method is still in a hypothetical stage. Spastic electromyography is mainly used to stimulate the reflex inhibition of the Golgi apparatus in the spastic muscle tendons and stimulate the interaction inhibition of the muscle abdomen to achieve relaxation of the spasm.

Low-frequency electric therapy electric stimulation treatment technology and method

Electrode technology

The bipolar method is generally proposed, because the bipolar method can focus the current on the diseased muscle without affecting the treatment due to the stimulation of adjacent muscles. But when the muscles are too small (such as the hand muscles) or need to stimulate the entire muscle group, the bipolar method is not suitable. Place another larger electrode between the lumbosacral or scapular.

The timing of electrical stimulation treatment

1. In the first month after denervation, muscle atrophy is the fastest, so early electrical stimulation should be performed. This treatment should also be carried out as early as possible when uncertain but suspected of denervation of the muscles.

2. After several months of denervation, it is still necessary to apply electrical stimulation, but the effect is not certain. Although the process of atrophy may not be delayed at this time, it is still effective for preventing fibrosis. However, before the electrical stimulation, it is necessary to determine whether the muscle has the potential to restore innervation.

Selection of current waveform

Conditions for ideal current:

1. It can selectively stimulate only the diseased muscles without affecting the adjacent normal muscles.

2, can only stimulate the diseased muscle without causing sensory reactions.

Selection of current polarity

The cathode is generally used in the unipolar method. If the bipolar method is used, the cathode is usually placed at the far end.

Number of muscle contractions per treatment

During the initial treatment, each diseased muscle should be contracted 10-15 times and rested for ten minutes. If unconditional, you can rest for 3-5 minutes and then contract it the same number of times. Each diseased muscle contracted at least about 80-120 times throughout the treatment period. However, it cannot be determined solely by number. The appropriate stimulation should meet the following requirements:

1. The contraction of the diseased muscle must be strong enough, otherwise it is difficult to delay the appearance of atrophy

2. It does not hurt or is very light when contracted.

3, the response of adjacent muscles is small

4. The shrinkage is similar each time

Number of treatments per day

Experiments have shown that 4-6 times daily treatment is better than 1-3 times. If there is no condition, treatment should be at least once a day, the condition improves, and treatment should be 3 times a week.

Estimation of the duration of electrical stimulation

1. Nerve apraxia is a condition in which muscle function is temporarily lost but the nerve has no organic lesions. There is no denervation in electrical diagnosis. It is estimated that it can be recovered in 3-4 weeks or a little longer. At this time, electrical stimulation should be continued for more than 6 weeks until the nerve function is restored.

2. When the peripheral nerve is injured due to trauma, compression, surgery, etc., if the location is clear, limited, and it is possible to regenerate, it can be estimated based on the peripheral nerve regeneration rate.

3. If the damage site is uncertain and cannot be calculated according to the above formula, it can only be estimated in general. That is: partial degeneration or partial denervation takes about 6-12 weeks to recover; complete degeneration or complete denervation takes about 6-12 months to recover.

Low frequency electrotherapy indications and contraindications

Indications: Mild hemiplegia after cerebrovascular accident (neuromuscular electrical stimulation can improve upper limb function in patients with stroke, especially in training wrists and fingers for extensor function), children with cerebral palsy, birth trauma Spastic paralysis due to sporadic paralysis, multiple sclerosis paralysis, spastic paralysis due to traumatic cerebrospinal injury, Parkinson's disease

Contraindications: Atrophic lateral sclerosis, multiple sclerosis, disease progression and deterioration ^[2] .

Percutaneous electrical stimulation neurotherapy

Low frequency pulse current with certain technical parameters is input into the human body through the skin for the treatment of acute and chronic pain.

Principles of Low Frequency Electrotherapy for Transcutaneous Electrical Stimulation and Neurotherapy

(1) Analgesic mechanism

The main role of percutaneous electrical stimulation neurotherapy is analgesia. The intensity of percutaneous electrical stimulation neurotherapy that produces analgesic effects often excites only glial cells in the posterior horn of the spinal cord.

(B) the treatment of acute pain

Commonly used for soft tissue injury, neuralgia and postoperative pain relief.

(Three) treatment of chronic pain

Low back pain, arthritis, neurogenic pain, headache

Low frequency electric therapy

(I) Treatment

1. Electrode placement The electrode placement location is more flexible. The commonly used methods are:

(1) The electrode is placed on the pain area, exercise point, trigger point, and acupuncture point

(2) The electrodes are placed beside the spine at the same stage of the lesion, along the direction of the peripheral nerve, the segment above the lesion, and the same segment on the opposite side of the lesion. The two electrodes or two groups of electrodes are placed side by side, opposite, and near End-to-end juxtaposition, cross-shaped, etc.

(3) Eye-occipital transcranial method

(4) The electrodes are placed on both sides of the postoperative incision

2.Parameter selection

There are currently three types of treatment: conventional, acupuncture-like, and transient stimulation.

3. Treatment time

The most commonly used is the conventional type, which can take a long time, ranging from 30-60 minutes to 36-48 hours per day. The acupuncture-like type can excite both the sensory nerve and the motor nerve at the same time, and the treatment time is generally 45 minutes, which is determined according to the muscle fatigue of the stimulus. The transient strong stimulus current is very large, and the muscles are prone to fatigue. Generally, it takes a few minutes after each 15 minutes of stimulation. Generally, 30-60 minutes for each treatment, 1-2 times a day. 3-6 times a week.

Low frequency electrotherapy indications and contraindications

Indications: acute and chronic pain, short-term pain, peripheral circulation disorders, long-term pain, used to enhance the analgesic effect during minor surgery and painful procedures.

Contraindications: Those with a cardiac pacemaker, the stimulation of carotid sinus, pregnant women's abdomen and lumbosacral region, eye parts, patients with cerebrovascular accidents, electrodes placed in the body cavity, etc.

Electrokinetic therapy

A kind of pulse current formed by superimposing 50HZ alternating current on direct current.

Principle of dynamic current between low-frequency electrotherapy

(I) Physical characteristics

1.Types of intermittent current: dense wave, sparse wave, sparse wave, intermittent rising wave, intermittent wave, undulating wave

2.Interactive current characteristics

(1) Intermittent current The waveform, frequency, pulse duration and interval of each group of current are fixed, and only the current intensity can be adjusted during treatment.

(2) The intermittent current is a half-wave sinusoidal current.

(3) Intermediate current has the nature of direct current and has the function of electrolysis. It is necessary to clearly define the anode and cathode during treatment and use pads.

(4) The carrier frequency of the intermittent current is low, so the effect is not deep.

(B) the therapeutic effect of intermittent current

1. Analgesic effect

2, has a more obvious role in promoting local blood circulation.

Exciting neuromuscular tissue

Therapeutic technology and method of dynamic current between low-frequency electrotherapy

(A) the mode of action of the electrode

1. The pain point is connected to the cathode with a small round electrode, and the anode is placed on the pain point, and the anode is placed 2-3CM away from the cathode near the pain point.

2. The lateral juxtaposition of the corresponding segments next to the nerve root and spine.

3. Juxtapose the neural stem and walk along the nerve.

4. The electrodes around the upper limbs act on the diseased cervical sympathetic ganglia with electrodes.

5. Bilateral lesions of the blood vessels around the lower limbs are energized from the spinal plane, the anode is placed on the neck, and the cathode is placed on the palate; in unilateral lesions, electrodes are placed side by side at the corresponding segment of the waist, and the cathode is on the diseased side.

6, muscle muscle starting and ending points

7.Local electrode opposition

(Two) the amount of current

Direct current: 1-2mA when the electrode area is small, 2-3mA when the area is large.

Pulse current: The pulse current is added to the current, and its current is increased to the maximum that the patient can tolerate.

(Three) power-on time

Usually only 3-6 minutes per site.

(Four) frequency and course of treatment

The acute phase is once a day, and 5-6 times is a course of treatment.

Chronic diseases occur once a day or every other day, and 10-12 times are a course of treatment.

Low frequency electrotherapy indications and contraindications

1.Indications Major occipital neuralgia, trigeminal neuralgia, intercostal neuralgia, great auricular neuralgia, radiculitis, sciatica, sympathetic nerve syndrome, contusion, sprain sequelae, tennis elbow, etc.

2. Contraindications: Acute purulent inflammation, acute eczema, bleeding tendency, severe heart disease, pacemaker installation, allergic to current ^[3] .

Low frequency electrotherapy

Physiological and therapeutic effects of low-frequency electrotherapy

1.Promote skin wound healing

2. Pain relief

3. Promote peripheral blood circulation

4.Antibacterial and anti-inflammatory effect

Low frequency electrotherapy indications and contraindications

1.Indication

Various acute and chronic pains, reflex muscle spasms caused by pain, disuse muscle atrophy, and poor blood circulation

2. Contraindications

High-voltage stimulation can induce muscle contraction, but it cannot be used to excite large muscle groups or excite denervated muscles.