Some of the advanced low-frequency currents like Diadynamic currents, Träbert Current, High Voltage Galvanic Stimulation, Microcurrent are discussed here.

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Low Frequency Stimulation
Advanced Applications

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Diadynamic currents

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Introduction
• Introduced by Pierre Bernard nearly 60
years ago
• rectified alternating current, with a
frequency which is derived directly from
the mains supply, resulting in
• monophasic sinusoidal pulses with a
duration of 10 ms.

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Types
• four classic diadynamic current types:
1.Diphasé Fixe (DF)
2.Monophasé Fixe (MF)
3.Courtes Périodes (CP)
4.Longues Périodes (LP)
5.Rhythm Syncopal (RS)

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Diphasé Fixe (DF)
• Fixed di-phase
• full wave rectified
AC.,
• Frequency 100Hz
• muscle contraction at
high intensities
• Used for circulatory
disorders

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Monophasé Fixe (MF)
• Fixed mono-phase
• Half wave rectified
AC.
• Frequency 50Hz
• Strong penetrating
vibration sensation,
• muscle contraction at
lower intensities
than DF
• Used for pain without
muscle spasm,

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Courtes Périodes (CP)
• Short periods
• equal phases of
DF & MF
• Used for traumatic
pain
1 sec DF 1 sec MF 1 sec DF

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Longues Périodes (LP)
• Long periods
• 10 sec phase of MF,
followed by 5 sec
phase of DF
• peak intensity is
varied
• Tx of myalgia. &
neuralgia
• long lasting analgesic
effect
10 sec MF 5 sec DF 10 sec MF

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Rhythm Syncopal (RS)
• Syncopal Rhythm
• It comprises 1sec
phase of MF, followed
by a 1sec rest phase.
• Used for muscle
stimulation,
• test excitability of the
nerve.

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Physiological Effects
• Pain masking
• Vasodilatation and hyperemia
• Muscle fibers stimulation
• Stimulation of vibration sense

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Indications
• Soft tissue injury
• Joint disorders
• Circulatory disorders
• Peripheral nerve disorders

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Contraindications
• Open skin: The current tends to concentrate at
this point; small broken areas can be insulated
by Vaseline.
• Bony areas: It may produce burn.
• Loss of sensation: It can produce burn.
• Skin lesions: Eczema fungi can be irritated and
made worse.
• Infections: It may cause spreading of infection.
• Thrombosis.
• Cardiac pace makers.
• Superficial metal.

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Dosage
• Intensity: It should be increased gradually
until definite vibration or prickling
sensation occurs.
• Duration: Not more than 12 minutes; each
type for 3 minutes.
• Frequency: Daily or every other day for
12 sessions.

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Träbert Current

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• Also known as '2-5
Current' or 'Ultra-
Reiz Current'
• direct current with a
rectangular pulse
• phase duration of 2
ms and a
• phase interval of 5
ms.
• frequency of the
current is
approximately 143
Hz.
Träbert Current

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Träbert Current, Application
• Used for pain relief
• Examples of application:
– EL I is used to treat both
headaches and neck
pain.
– EL IV is particularly
suitable for the treatment
of intermittent
claudication

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Träbert Current, Application
• accommodation will occur fairly quickly, due to the
absence of frequency changes or interruptions.
• amplitude is increased in steps, up to the limit of
tolerance.
• The muscle contractions must be palpable or just
visible.
• As soon as the contractions start to reduce, the
current amplitude should be increased again.
• i.e. at intervals of one minute
• use thick sponges (minimum thickness 1 cm) that
are thoroughly wet to electrodes

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High Voltage Galvanic Stimulation

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HVPGS
• originally developed in 1945 by Haslip in
the USA and called ‘Dyna-wave
neuromuscular stimulation’.
• High voltage galvanic stimulation (HVGS)
• High Voltage Pulsed Galvanic
Stimulation (HVPGS).
• high voltage pulsed current stimulation
(HVPCS)
• Twin Peak Monophasic current

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A. direct current
B. monophasic pulsed DC
C.symmetric biphasic pulsed
D.twin peak monophasic
basic stimulating current forms

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Characteristics of HVPGS
Waveform : Monophasic twin-peak wave
E
BA
D
9900 μs100μs500
V
A. Pulse Duration : 100 μs (Very Short)
B. Interpulse Interval : 9900 μs (Very Long)
C. Duty Cycle : A + B = 10000 μs (10 ms)
D. Peak Amplitude : 500 V
E. Average Current : 1.5 - 2 mA (Very Low)

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• The skin resistence to HVPGS is less
because of high frequency (upto 140 Hz)
and high voltage.
• Produces a comfortable tingling sensation
and parasthesia similar to high TENS
• The intensity must be gradually increased
to comfortable level
• Treatment duration is 30 - 60 minutes

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Indications
• Wound Healing
• Pain Management
• Edema
• Muscle Strengthening

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Contraindications
1.Do not use on
a.Patient with pacemaker
b.Heart or brain
c.Lumbar and abdominal area of pregnant
women
d.Potential malignancies
e.Anterior cervical area

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HVPGS for Wound Healing
• Position patient
• Clean and debride wound
• Cover the wound with several layers of
sterile gauze soaked in saline
• Place active electrode over the gauze
• For infected wound active electrode
should have negative polarity
• Positive polarity to promote healing

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Micro current

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• Microcurrent Electrical Neuromuscular
Stimulation (MENS)
• Microcurrent Electrical Stimulation (MES)
• Microcurrent therapy (MCT)
• Microamperage stimulation
• Pulsed low intensity direct current
• low-intensity direct current that delivers
monophasic or biphasic pulsed microamperage
currents across the intact surface of the skin

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MCT
• low-intensity direct current that delivers
monophasic or biphasic pulsed
microamperage currents across the
intact surface of the skin
• the current is so small that there is no
tissue resistance
• MCT uses currents that are smaller than
those delivered by standard TENS devices
(milliamperes)

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Arnold-Shulz Law
Weak stimuli increase physiologic activity
and very strong stimuli inhibit or abolish
activity.

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• Tissue health is maintained by a
direct current electrical system in the
human body
• a shift in this‘normal current flow’
occurs when tissue is damaged
• This shift described as the ‘current of
injury’, with a magnitude in the
microampere range
• MET simulates this current of injury
to assist tissue growth and healing,
and that milliampere currents
delivered by standard TENS devices
are detrimental to this process of
repair
Becker’s theory

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Parameter Recommendations
• Exact amplitude, freq, polarity, time & method of
application are varied and debated
• Amplitude: 0 - 900 microamps
• Frequency: 0.1 - 100 Hz
• Polarity: alternating
• Time: 15 - 90 minutes
• Application: probes or silver electrodes

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Effects
• restoring metabolic processes that are
responsible for healing.
• promoting ATP (adenosine triphosphate)
production
• remove metabolic wastes is enhanced
• preventing accumulation of toxic
substances
• enhancing nutrient distribution and
improving blood circulation

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INDICATIONS
• Pain
• Inflammation
• Spasm
• Wound

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References
1. Adel den RV, Luykx RHJ. Low and medium Frequency Electrotherapy. Enraf-Nonius B.V; 2005:
pp 12-13
2. Low J, Reed A. Electrotherapy Explained Principles and practice. 2 edition. Butterworth
Heinemann. pp 13,
3. www.kau.edu.sa/Files/0053044/Files/73334_7_Didynamic.doc
4. lib.pt.cu.edu.eg/Diadynamic%20currents%20-%20Copy.ppt
5. www.electrotherapy.org/modality/diadynamic-therapy-
6. http://www.holisticphysicaltherapy.org/Micro_current_therapy.html
7. Watson T. Electrical stimulation for wound healing: a review of current knowledge. In: Kitchen S
ed.Electrotherapy: evidence based practice, 11 edition. Edinburgh: Churchill Livingstone,
2002:313–34
8. Cheng N, Hoof HV, Bockx E. The effects of electric current on ATP generation, protein synthesis,
and membrane transport in rat skin. Clin Orthop Rel Res 1982; 171: 264–72.
9. Seegers JC, Engelbrecht CA, van Papendorp DH.Activation of signal-transduction mechanisms
may underlie the therapeutic effects of an appliedelectric field. Med Hypotheses 2001; 57: 224–30

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