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Pulse current used during electrical stimulation. Medical encyclopedia - impulse current

V modern physiotherapy further improvement of pulse rhythmic effects in the treatment of various pathological conditions, since the impulse action in a certain predetermined mode corresponds to the physiological rhythms of the functioning organs and systems.


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PLAN

  1. Types of impulse current.
  2. Electric sleep.
  3. Electrodiagnostics.
  4. Electrical stimulation.
  5. DDT and SMT.
  6. Methodology and technique.
  7. Apparatus.
  8. Indications and contraindications

Key points of the lecture

Impulse current - separate "portions" and current surges

CMT - amplipulse

DDT - diadynamic currents

Ledyuk current - pulse frequency 1-130 Hz,

pulse duration 0.2 - 2 ms

Tetanizing current - pulse frequency - 100 Hz

Lapik current - pulse frequency 8100 Hz,

duration 2-60 ms

Literature

L.M. Klyachkin Physiotherapy. - 1995 - 33-64 p.

LECTURE No. 2

Topic: Impulse currents of low frequency and low voltage

In modern physiotherapy, further improvement of pulse rhythmic effects in the treatment of various pathological conditions should be considered very promising, sinceimpulse action in a certain predetermined mode correspond to the physiological rhythms of functioning organs and systems.

Impulse current - represents separate "portions", "shocks" of current, which has one direction during the passage of DC pulses and changing direction during the passage of AC pulses.

The specificity of DC pulses is that each individual pulse is a more or less rapidly increasing and decreasing DC current with a pause following it. With the passage of each DC pulse in the interelectrode space, there is a movement of interstitial, intracellular ions. Under the action of a constant impulse current, the cells are excited. And during pauses, they return to a state of rest. Physiological reaction for the passage of each pulse, there will be a contraction of the muscles under the electrode.

The action of a pulsed direct current depends on the shape of the pulses, their duration, intensity (current) and the frequency of the pulses (the duration of the pauses between pulses).

Types of impulse currents

By type, there are 3 types of impulse currents.

  1. Impulse current rectangular

(Leduc current)

Pulse frequency 1-130 Hz

duration of each pulse

0.2-2 ms

This current enhances the braking process in the cortex. brain, and it is used to obtain a state similar to physiological sleep(ELECTROSON).

2. Impulse current of pointed shape

(tetanizing - tonic? - sleep)

Pulse frequency - 100 Hz

This current causes muscle contraction, and it is used to exercise muscles when their function is weakened (electrical stimulation, electrodiagnostics, electroanalgesia).

3. Impulse current of exponential form

(Lapin current)

Pulse frequency - 8-100 Hz

Duration - 2-60 ms

This current is used for electro-gymnastics, electrodiagnostics, electroanalgesia. Moreover, the frequency and duration of the impulses depends on the degree of muscle damage.

E L E K T R O S O N

Electrosleep is a method of influencing the central nervous system with impulse currents of low and low strength. This method was proposed in 1943 by Soviet scientists Liventsev, Gilyarovsky, Kirillov.

Mechanism of action

Mechanism therapeutic action electrosleep is a complex process involving the direct and reflex effect of a pulsed current as a weak rhythmic stimulation of the subcortical formations and the cerebral cortex.

The electrosleep method induces sleep that is close to natural, physiological sleep. However, recent studies indicate that electrosleep, in contrast to physiological, proceeds with an increase in the minute volume of respiration with increased blood oxygen saturation.

Electrosleep:

Reduces high blood pressure,

Promotes reduction emotional activity,

Promotes normalization functional state blood coagulation and anticoagulation systems,

Strengthens the vagal influence - as with normal sleep (with bronchial asthma),

Reduces intraocular pressure in patients with glaucoma

Acts as a pain reliever for pain syndromes associated with peptic ulcer disease, burns, cardialgia, etc.,

Improves vegetative functions,

Normalizes basal metabolism,

Reduces blood sugar levels,

Contributes to the normalization of the main processes of higher nervous activity,

Relieves fatigue

Increases the effectiveness of hypnotics in combination treatment,

Improves blood flow to the brain,

Strengthens the regulatory role of the central nervous system in relation to other organs and systems of the body.

Technique and technique for conducting electrical sleep

When dispensing electrosleep procedures, the orbital-occipital technique of positioning the electrodes is used. The set of electrodes includes two pairs of electrodes: the orbital and the occipital.

Before the procedure, cotton swabs moistened with water are placed in the metal cups of the electrodes. The orbital electrode is applied to the eyelid skin closed eyes, and the second - on the skin in the area of ​​the mastoid processes behind auricles... Both electrodes are fixed with straps to a rubber band, which is attached to the head: under the chin, on the back of the head and crown. The ends of a bifurcated soft wire are attached to the electrodes, with the help of which the occipital electrode is connected to the positive terminal of the apparatus, and the orbital electrode is connected to the negative (cathode).

The procedures are carried out in a separate, quiet, well-ventilated, semi-darkened room. The patient should undress and lie down in a calm, relaxed position. After applying the electrodes and connecting to the apparatus, turn on the current.

The frequency of impulses in the electrosleep method depends on: features of the functional state nervous system the patient, from the severity and phase of the disease, from age and other factors. Therefore, at various diseases the frequency response is selected individually, at which the patients experience a drowsy state, drowsiness, and sleep. The strength of the current is regulated depending on the patient's sensation (a feeling of creeping under the electrodes, slight vibration in the eyelids, weak rhythmic tremors).

At the end of the procedure, the m / s turns on the device, and the patient can sleep until he wakes up on his own.

The duration of the procedures ranges from 30 minutes to 1-2 hours, depending on the characteristics of the patient's nervous system and the nature of the disease. The procedures are carried out daily. The course of treatment - 10-15 procedures - depending on the nature of the disease, the tolerance of the procedures.

Apparatus: ES-1, ES-2, ES-3, ES-4T.

Indications for the appointment of electric sleep

Diseases of the nervous system:

Neuroses

Neurasthenia,

Hallucinatory form of schizophrenia,

Long-term consequences of a traumatic brain disease (post-traumatic encephalopathy),

Migraine,

Atherosclerosis of cerebral vessels (initial period),

Ischemic disease hearts.

Diseases from the outside internal organs:

Hypertonic disease I - II st.,

Hypotonic disease

Peptic ulcer and 12 duodenal ulcer,

Bronchial asthma (mild and middle period),

Eczema, dermatoses, neurodermatitis,

Obliterating endarteritis,

Rheumatic chorea

Toxicosis of pregnancy.

Contraindications

  1. Intolerance to current.
  2. Inflammatory eye diseases.
  3. Weeping dermatitis of the face.
  4. Hysteria.
  5. Arachnoiditis.
  6. Severe circulatory disorders.
  7. Feverish states.
  8. Acute period myocardial infarction.
  9. Acute period of cerebral stroke.
  10. Negative attitude the patient to an electric current.

ELECTRODIAGNOSTICS

ElectrodiagnosticsIs a study of the excitability of the neuromuscular apparatus by electrical stimulation. Depending on the functional state of the nerve and muscle, their reactions to electrical stimulation are different, therefore, they can be used to judge the nature and depth of damage to the neuromuscular apparatus.

The study is carried out on devices KED-5, ASM-3, UEI-1, Stimul-1 on the motor points of the nerves and muscles.Motor point of the nerve -this is the area where the nerve trunk is most superficially located and accessible for research.Muscle motor pointIs a projection of the zone of penetration and branching of the nerve in the muscle. The most typical arrangement of motor points is given in special Erb tables.

For a correct assessment of the data obtained during the study, it is necessary to proceed from normal reaction neuromuscular apparatus for electric current.

Diagnostic technique

The most commonly used 1-pole technique is with a button electrode with a push button breaker and a conventional hydrophysical pad plate electrode.

ElectrostimulationIs a method based on the use of a pulsed or intermittent galvanic current to induce rhythmic muscle contractions (that is, the effect on the neuromuscular apparatus).

Currently, electrical stimulation can be performed on commercially available devices UEI-1, SNIM-1, Amplipulse-3, Amplipulse-3T.

The mechanism of action of electrical stimulation

Electrostimulation regulates muscle tone, improves blood circulation and metabolism in the affected muscles, maintains their contractility and slows down atrophy.

Indications for electrical stimulation

  1. Flaccid paralysis and paresis of the muscles of the face, trunk, limbs.
  2. Atony of smooth muscles of internal organs.
  3. Paresis and paralysis of the muscles of the larynx.
  4. Some forms of hearing loss.
  5. Sexual neuroses.
  6. Violations heart rate and breathing.
  7. Bowel paresis (fecal incontinence).
  8. Urinary incontinence (to stimulate the sphincter of the bladder).

Contraindications

  1. Impact on the muscles of internal organs in cholelithiasis and kidney stones.
  2. Bleeding tendency
  3. Acute purulent processes of the abdominal organs.
  4. Impact on muscles in case of bone fractures until the moment of their consolidation.
  5. Dislocations.
  6. Trophic long-term non-healing ulcers of the extremities.
  7. Thrombophlebitis.
  8. The first month after a nerve suture operation (for a nerve injury).

Types of DDT

1. One-act continuous: OH - tingling sensation

under the electrodes,

causes muscle contraction,

has an irritating, stimulating effect.

2. Two-act continuous: DN - slight tingling, at

Gain - a sense of vibration,

analgesic effect,

brake.

3. Syncope rhythm - causes muscle contraction with

subsequent relaxation

during a pause (therefore

used for electrical stimulation).

4. Current modulated by short periods:

K.P. - the patient feels a strong, painful contraction, a kind of vibration, muscle massage, - increased blood circulation,

blood vessels expand

the temperature rises,

at the site of exposure,

absorbing action,

metabolism is activated.

5. Current, modulated long periods:

the patient feels a strong

prolonged contraction

muscles (3.5), and it is replaced

gentle vibration (6.5).

Reduces the effect of arousal by changing inhibitory pain relievers.

6. One-shot wave - enhances the analgesic effect.

7. Two-beat wave

Devices: SNIM-1, Tonus-1, Model - 717, Diadynamic-1

Diadynamophoresis.

Amplipulse therapy (SMT)

The impact of SM-currents, due to which their good permeability through the skin is ensured, their irritating effect on the skin and its receptors is excluded.

Devices: Amplipulse-3T, A-4.

Distinguish the following types CMT:

  1. Source unmodulated current.
  2. Current "constant modulation" PM (1p. R.)

(annoying)

  1. "Send-pause" current "P-P" (2 r.r.)

(stimulating)

  1. Current of modulated and unmodulated PN oscillations (3 r. P.)

(pain reliever)

  1. Intermittent frequency current of the inverter (4 r.r.)

(pain reliever).

CMT have the following effect:

  1. pain reliever;
  2. contribute to the improvement of peripheral blood circulation and the functional state of the neuromuscular apparatus.

The technique and methodology for dispensing procedures is the same as for DD therapy.

Indications for the appointment of DDT and SMT:

  1. Muscle bruises.
  2. Sprain.
  3. Periarthritis.
  4. Diseases of the peripheral nervous system with the presence of pain syndrome (radiculitis, neuritis), especially in the acute period.
  5. Obliterating endarteritis.
  6. Paresis and paralysis of the muscles of the limbs, trunk, face.
  7. Colon dyskinesia with a predominance of the atonic component.

Contraindications

  1. General physiotherapy.
  2. Sharp inflammatory diseases in the cavities.
  3. Infectious febrile conditions.
  4. Active tuberculosis in the intoxication phase.
  5. Insufficiency of blood circulation of 2-3 degrees.
  6. Pregnancy (abdomen and lower back).
  7. Psychosis.

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Page 1 of 2

Impulse currents are widely used for the treatment of various pathological conditions, since impulse influences in a certain predetermined rhythm correspond to the physiological rhythms of functioning organs and systems.

Impulse current is a separate "portion, jerk" of the current. If this current is constant, then impulse current will have one direction; and if this current is alternating, the impulse current will also change its direction.

Each individual DC pulse is a rapidly increasing and rapidly decreasing DC current followed by a pause.

With the passage of each DC pulse in the interelectrode space ( fabrics patient) occurs movement of interstitial, intracellular ions... This movement of ions is faster than when exposed to continuous direct current. Faster movement of ions leads to their rapid accumulation on the intercellular membranes. During the pause, the ions move away from the membranes, and with the subsequent pulse, they are quickly directed again to the membranes. Thus, when exposed to a constant current in a pulsed mode, the cells will be excited during the passage of the pulse, and during the pause, they will return to rest. The physiological response to the passage of each impulse will be muscle contraction under the electrodes.

The action of a pulsed direct current depends on the shape of the pulses (Fig. 2.10), the duration and intensity of the pulses, and the frequency of the pulses.


Rice. 2.10. Graphic image pulsed direct current

Electrosleep- a method of influencing the central nervous system with a pulsed current of low frequency and low strength - was proposed in 1948 by Liventsov, Gilyarovsky, Kirillova and Segal.

In the procedure of electrosleep, sleep itself is not important, but it is important to achieve the normalization of the processes of excitation and inhibition, to improve the influence of the brain on all processes in the body.

Equipment: Electrosleep-2, Electrosleep-3, Electrosleep-4 T, Electrosleep ES-10-5 and etc.

To obtain a weak rhythmic stimulus causing inhibition in the cerebral cortex, turning into drowsiness and sleep, the authors of the method used a pulsed direct current with rectangular pulses, low frequency, low strength, constant polarity. Pulse duration 0.2-2 milliseconds (ms). Pulse frequency 1-130 Hertz (Hz).

The first electrode (bifurcated) is applied to the skin of the eyelids of closed eyes, and the second, also bifurcated, to the skin in the area of ​​the mastoid processes behind the auricles. The orbital electrode is connected to the cathode and the occipital electrode to the anode.

Pulse frequency from 1 to 130 Hz ( low frequencies), the current strength is individual: until the appearance of vibration in the eyelids (but not more than 0.5 mA). The pulse duration is 0.2-0.5 ms. Exposure: first procedure - 10 minutes, subsequent - up to 60 minutes. The course of treatment is 15-20 times, daily or every other day.

The mechanism of action of electrosleep associated with the reflex action of alternating current through the skin receptors of the eyelids on the cerebral cortex.

Electrosleep contributes to: normalization of higher nervous activity, increasing the threshold of pain sensitivity, improving brain functions, improves vascular reactivity, blood supply to the brain, helps to restore the functional state of the brain. With electric sleep, the blood saturation with O 2 improves up to 98%, the work of the coagulating and anti-coagulating blood systems with oxygen is normalized, respiration and pressure are normalized.

Indications: neuroses, neurasthenia, schizophrenia, long-term consequences brain trauma, cerebral vascular sclerosis (initial period), hypertonic disease Stage I - II, hypotonic disease, peptic ulcer stomach and duodenum, bronchial asthma, eczema, dermatoses, neurodermatitis, phantom pain, obliterating diseases of the vessels of the extremities, toxicosis of pregnancy, rheumatic chorea, rheumatoid arthritis, periodontal disease.

Contraindications: individual current intolerance, inflammatory eye diseases, weeping dermatitis of the face, hysteria, severe circulatory disorders, arachnoiditis, myopia.

Types of rehabilitation: physiotherapy, exercise therapy, massage: textbook. manual / T.Yu. Bykovskaya [and others]; under total. ed. B.V. Kabarukhina. - Rostov n / a: Phoenix, 2010 .-- 557, p .: ill. - (Medicine). S. 47-48.

MOTIVATION

The most promising direction of modern physiotherapy should be considered the further improvement of impulse rhythmic effects in the treatment of various pathological conditions, since impulse effects in a certain predetermined mode correspond to the physiological rhythms of functioning organs and their systems.

PURPOSE OF THE LESSON

Learn to use the following methods to treat diseases:

Electrosleep;

Transcranial electroanalgesia;

Short-pulse electroanalgesia;

Diadynamic therapy;

Electrodiagnostics;

Electrostimulation and electropuncture.

TARGETED ACTIVITIES

To understand the essence of the physiological action of impulse currents of low frequency. Be able to:

Determine indications and contraindications for the use of impulse currents of low frequency;

Choose an adequate type of therapeutic effect;

Independently appoint procedures;

Evaluate the effect of impulse currents on the patient's body.

To study the principles of operation of the devices "Electroson-5", "LENAR", "Tonus-3", "Mioritm".

INFORMATION BLOCK

Impulse methods of exposure physical factors- the most adequate stimuli for the body, and in case of impaired functions, their therapeutic effect is most effective. The main advantages of impulse physiotherapy techniques:

Selectivity of action;

The possibility of a deeper impact;

Specificity;

Lack of quick adaptation of tissues to a physical factor;

Therapeutic effect with the least stress on the body.

Impulse currents consist of rhythmically repetitive short-term changes in electrical voltage or current. Possibility of using a pulsed current for a stimulating effect on various bodies, tissues and systems of the body is based on the nature of electrical impulses that mimic the physiological effect of nerve impulses and cause a response similar to natural excitement. At the heart of the action electric current lies the movement of charged particles (ions of tissue electrolytes), as a result of which the usual composition of ions on both sides of the cell membrane changes and physiological processes that cause excitation develop in the cell.

Excitability can be judged by the least strength of the stimulus required for the occurrence of a reflex reaction, or by the threshold current strength, or by the threshold potential shift sufficient for the emergence of an action potential. Speaking of excitability, they use concepts such as rheobase and chronaxia. These concepts were introduced into physiology in 1909 by L. Lapik, who studied the smallest (threshold) effect of excitable tissues and determined the relationship between the current strength and the duration of its action. Rheobase (from the Greek "rheos" - flow, flow and "basis" - course, movement; base) is the smallest DC electric current that causes excitation in living tissues with a sufficient duration of action. Rheobase, like chronaxia, makes it possible to assess the excitability of tissues and organ-

new in terms of the threshold strength of irritation and the duration of its action. Rheobase corresponds to the threshold of irritation and is expressed in volts or milliamperes.

The reobase value can be calculated using the formula:

where I is the strength of the current, t is the duration of its action, and, b are constants determined by the properties of the tissue.

Chronaxia (from the Greek "chronos" - time and "axia" - price, measure) - the shortest time of action of a direct electric current of double the threshold force (double rheobase), causing tissue excitation. As established experimentally, the magnitude of the stimulus causing excitation in the tissues is inversely proportional to the duration of its action, which is graphically expressed by hyperbole (Fig. 6).

Changes in the functional state of cells, tissues and organs under the influence of an external electrical stimulus are called electrostimulation. Within the limits of electrostimulation, electrodiagnostics and electrotherapy are distinguished. In electrodiagnostics, the body's response to electrical stimulation by impulse currents is examined. Determined that irritating effect a single current pulse depends on the steepness of the rise of its leading edge, the duration and amplitude of the pulse. The steepness of the rise of the front of a single pulse determines the acceleration of ions as they move. In addition, the effect of alternating electric current on the body depends significantly on its frequency. At a low pulse frequency (of the order of 50-100 Hz), the displacement of ions is sufficient to irritate the cell. At medium frequencies, the irritating effect of the current decreases. At a sufficiently high frequency (of the order of hundreds of kilohertz), the magnitude of the displacement of ions becomes commensurate with the magnitude of their displacement during thermal motion, which no longer causes a noticeable change in their concentration and does not have an irritating effect.

The value of the threshold amplitude determines the maximum instantaneous displacement of ions and depends on the duration of the pulses. This relationship is described by the Weiss-Lapik equation (see Fig. 6).

Each point of the curve in Fig. 6 and the points above the curve correspond to impulses that cause tissue irritation. Extremely short-term impulses do not have an irritating effect (the displacement of ions is commensurate with the amplitude

Rice. 6. Muscle electrical excitability curve (Weiss-Lapik).

vibrations during thermal motion). With rather long impulses, the irritating effect of the current becomes independent of the duration. Pulse parameters that provide an optimal response to irritation are used for therapeutic electrical stimulation. Modern development electronics provides the ability to obtain pulse currents with any required parameters. In modern devices, pulses of various shapes are used, with a duration from tens of milliseconds to several seconds, with a repetition rate from fractions of a Hertz to ten thousand Hertz.

Electrosleep

Electrosleep is a method of neurotropic non-pharmacological action on the central nervous system with a constant impulse current of a rectangular configuration, low frequency (1-160 Hz) and low strength (10 mA). The method is notable for its harmlessness, absence of toxic effect, allergic reactions, addiction and cumulation.

It is believed that the mechanism of action of electrosleep is based on the direct effect of current on the structures of the brain. The impulse current, penetrating into the brain through the openings of the orbits, spreads through the vascular and cerebrospinal fluid spaces and reaches the sensitive nuclei of the cranial nerves, pituitary gland, hypothalamus, reticular formation and other structures. The reflex mechanism of action of electrosleep is associated with the effect of low-strength direct current pulses on the receptors of the reflexogenic zone: the skin of the eye sockets and upper eyelid... In a reflex arc, irritation is transmitted to the subcortical formations, the cerebral cortex, causing the effect of protective inhibition. In the mechanism of the therapeutic effect of electric sleep, an essential role is played by the ability of the nerve cells of the brain to assimilate a certain rhythm of the impulse current.

Acting on the structures of the limbic system, electrosleep restores disturbances in the emotional, vegetative and humoral balance in the body. Thus, the mechanism of action consists of the direct and reflex influence of current impulses on the cerebral cortex and subcortical formations.

Impulse current is a weak stimulus that has a monotonous rhythmic effect on such structures of the brain as the hypothalamus and reticular formation. Synchronization of impulses with biorhythms of the central nervous system causes inhibition of the latter and leads to the onset of sleep. Electrosleep has an analgesic, hypotensive effect, has a sedative and trophic effect.

The electrosleep procedure has two phases. The first is inhibitory, associated with stimulation of subcortical formations by impulse current and manifested by drowsiness, drowsiness, sleep, decreased pulse, breathing, decreased blood pressure and bioelectrical activity of the brain. This is followed by the disinhibition phase associated with an increase in the functional activity of the brain, self-regulation systems and manifested by increased efficiency and improved mood.

Electrosleep has a calming effect on the body, induces sleep that is close to physiological. Under the influence of electrosleep, conditioned reflex activity decreases, respiration and pulse decrease, small arteries expand, blood pressure; the analgesic effect is manifested. In patients with neuroses, emotional stress and neurotic reactions weaken. Electrosleep is widely used in psychiatric practice; at the same time, the disappearance of the feeling of anxiety and the sedative effect are noted. Indications for the appointment of electrosleep in patients with chronic ischemic heart disease (IHD) and postinfarction cardiosclerosis:

Cardialgia;

Feeling of fear of death;

Insufficient effectiveness of sedatives and hypnotics.

Electrosleep effects:

In the first phase:

❖ anti-stress;

❖ sedative;

❖ tranquilizing;

In the second phase:

❖ stimulating;

❖ relieves mental and physical fatigue.

Electrosleep procedures are performed using voltage pulse generators of constant polarity and rectangular configuration with a certain duration and adjustable frequency: "Electroson-4T" and "Electroson-5".

The procedures are carried out in a quiet, darkened room with comfortable temperature... The patient lies on a couch in comfortable position... The technique is retromastoidal. Eye electrodes with wetted hydrophilic pads 1 cm thick are placed on closed eyelids and connected to the cathode; occipital electrodes are fixed on the mastoid processes temporal bones and attached to the anode. The strength of the current is dosed according to a slight tingling sensation or painless vibration felt by the patient. If unpleasant sensations appear in the area of ​​application of the electrodes, the strength of the supplied current should be reduced, usually not exceeding 8-10 mA. The pulse frequency is selected depending on the functional state of the patient. In diseases caused by the development of organic, degenerative processes in the vessels and nervous tissue of the brain, the effect occurs if an impulse frequency of 5-20 Hz is used, and in case of functional disorders of the central nervous system - 60-100 Hz. Simultaneously with electrophoresis, electrophoresis can be performed medicinal substances... Procedures lasting from 30-40 to 60-90 minutes, depending on the nature pathological process, carried out daily or every other day; the course of treatment includes 10-20 exposures.

Indications for treatment:

Neuroses;

Hypertonic disease;

Ischemic heart disease (coronary insufficiency of the 1st degree);

Obliterating vascular diseases of the extremities;

Atherosclerosis of cerebral vessels in the initial period;

Bronchial asthma;

Rheumatoid arthritis in the presence of neurasthenia or psychasthenia;

Pain syndrome;

Phantom pain;

Post-traumatic encephalopathy (in the absence of arachnoiditis);

Schizophrenia during asthenization after active drug treatment;

Diencephalic syndrome;

Neurodermatitis;

Toxicosis of pregnancy;

Preparing pregnant women for childbirth;

Menstrual dysfunction;

Premenstrual and climacteric syndrome;

Meteotropic reactions;

Logoneurosis;

Stressful states and prolonged emotional stress. Contraindications:

Current intolerance;

Inflammatory and dystrophic eye diseases;

Retinal disinsertion;

High degree of myopia;

Dermatitis of the facial skin;

Hysteria;

Post-traumatic arachnoiditis;

The presence of metal objects in the tissues of the brain and eyeball.

Transcranial electroanalgesia

Transcranial electroanalgesia is a method of neurotropic therapy based on the impact on the central nervous system of pulsed currents of a rectangular configuration with a frequency of 60-2000 Hz with variable and constant duty cycle.

The therapeutic effect is based on selective excitation of the endogenous opioid system of the brain stem by impulse currents of low frequency. Impulse currents change the bioelectric activity of the brain, which leads to a change in the activity of the vasomotor center and is manifested by the normalization of systemic hemodynamics. In addition, the release of endogenous opioid peptides into the bloodstream activates regenerative-reparative processes in the focus of inflammation.

Transcranial electroanalgesia is a method with pronounced sedative (at a frequency of up to 200-300 Hz), tranquilizing (at 800-900 Hz) and analgesic (above 1000 Hz) effects.

Apparatus and general instructions for performing procedures

For transcranial electroanalgesia procedures, devices are used that generate rectangular pulses with voltage up to 10 V with a frequency of 60-100 Hz, duration 3.5-4 ms: "TRANSAIR", "Etrans-1, -2, -3" - and voltage up to 20 V with a frequency of 150-2000 Hz ("LENAR", "Bi-LENAR"). The strength of the analgesic effect increases with the inclusion of an additional constant component of the electric current. The optimal ratio of direct and impulse current is 5: 1-2: 1.

During the procedure, the patient lies on the couch in a comfortable position. The fronto-mastoid technique is used: a bifurcated cathode with pads soaked in warm water or 2% sodium bicarbonate solution, set in the region of the eyebrows, and the bifurcated anode - under the mastoid processes. After choosing the parameters of transcranial electroanalgesia (frequency, duration, duty cycle and amplitude of the constant component), the amplitude of the output voltage is gradually increased until the patient develops a tingling sensation and light heat under the electrodes. The duration of exposure is 20-40 minutes. The course of treatment includes 10-12 procedures.

For transcerebral electroanalgesia, sinusoidally modulated currents are also used with the following parameters:

The duration of half periods is 1: 1.5;

Variable mode;

Modulation depth 75%;

Frequency 30 Hz.

The duration of the procedure is 15 minutes. The procedures are carried out daily, the course of treatment includes 10-12 manipulations. During the procedure, an electronic rubber half mask from the electric sleep apparatus is used, replacing the plug with a plug device for the "Amplipulse" series apparatus.

Indications for treatment:

Neuralgia of the cranial nerves;

Pain due to vertebral pathology;

Phantom pain;

Vegetodystonia;

Exertional angina pectoris I and II functional class;

Peptic ulcer and duodenum;

Neurasthenia;

Neurodermatitis;

Overwork;

Alcohol withdrawal syndrome;

Sleep disturbance;

Meteopathic reactions. Contraindications:

General contraindications to physiotherapy;

Current intolerance;

Acute pains of visceral origin (angina attack, myocardial infarction, renal colic, childbirth);

Closed brain injury;

Diencephalic syndrome;

Thalamic syndrome;

Violation of the rhythm of the heart;

Damage to the skin at the places where the electrodes are applied.

Healing techniques

At hypertension I and II stages and ischemic heart disease for electric sleep, an orbital-retromastoidal technique is used using a rectangular pulse current with a frequency of 5-20 Hz, lasting from 30 minutes to 1 hour, daily. The course of treatment consists of 12-15 procedures.

Transcranial electrotranquilization is performed according to the lobnoretromastoidal technique using a rectangular pulse current with a frequency of 1000 Hz, lasting 30-45 minutes daily. The course of treatment consists of 12-15 procedures.

With stable hypertension apply electrosleep using a rectangular pulse current with a frequency of 100 Hz (the first 5-6 procedures); then they switch to 10 Hz. The duration of the procedures is 30-45 minutes. The course of treatment includes 10-12 daily procedures.

With diencephalic syndrome and neuroses apply electrosleep using a rectangular pulse current with a frequency of 10 Hz for a duration of 30 minutes to 1 hour, every other day. The course of treatment consists of 10-12 procedures.

Transcranial electrotranquilization is carried out according to the lobnoretromastoidal technique using a rectangular pulse current with a frequency of 1000 Hz and a duration of 30-40 minutes. The course of treatment includes 12-15 daily procedures.

With traumatic encephalopathy electrosleep is applied according to the ocular-retromastoidal technique using a rectangular pulse current with a frequency of 10 Hz for a duration from 30 minutes to 1 hour, every other day. The course of treatment includes 10-12 procedures.

Short-pulse electroanalgesia

Short-pulse electroanalgesia (percutaneous electroneurostimulation) is an effect on a painful focus with very short (20-500 μs) current pulses, followed by bursts of 20-100 pulses with a frequency of 2 to 400 Hz.

The duration and repetition rate of current pulses used in short-pulse electroanalgesia are very similar to the corresponding parameters of pulses of thick myelinated Ap fibers. In this regard, the flow of rhythmic ordered afferentation created during the procedure excites the neurons of the gelatinous substance of the posterior horns spinal cord and blocks the conduct of nocigenic information at their level. Excitation of the interneurons of the dorsal horns of the spinal cord leads to the release of opioid peptides in them. The analgesic effect is enhanced by the electrical impulse effect on the paravertebral zones and areas of reflected pain.

Fibrillation of smooth muscles of arterioles and superficial muscles of the skin, caused by electrical impulses, activates the processes of utilization of algogenic substances (bradykinin) and mediators (acetylcholine, histamine) released during the development of pain syndrome. Strengthening local blood flow activates local metabolic processes and local protective properties fabrics. Along with this, perineural edema decreases and depressed tactile sensitivity in areas of local pain is restored.

Apparatus and general instructions for performing procedures

For the procedures, the devices "Delta-101 (-102, -103)", "Eliman-401", "Bion", "Neuron", "Impulse-4", etc. are used. During the procedures, electrodes are applied and fixed

in the area of ​​the projection of the painful focus. According to the principle of their placement, peripheral electroanalgesia is distinguished, when the electrodes are placed in areas of pain, points of exit of the corresponding nerves or their projection, as well as in reflexogenic zones, and segmental electroanalgesia, in which the electrodes are placed in the region of paravertebral points at the level of the corresponding spinal segment. Most often, two types of short-pulse electroanalgesia are used. In the first case, current pulses with a frequency of 40-400 Hz with a force of up to 5-10 mA are used, causing rapid (2-5 minutes) analgesia of the corresponding metamer, which lasts for at least 1-1.5 hours. When exposed to biologically active points (BAP) use current pulses up to 15-30 mA, supplied with a frequency of 2-12 Hz. Hypoalgesia develops in 15-20 minutes and captures, in addition to the area of ​​impact, and neighboring metameres.

The parameters of the impulse currents are dosed in terms of amplitude, repetition rate and duty cycle, taking into account the stage of pain syndrome development. Along with this, the appearance of a feeling of hypoalgesia in the patient is taken into account. During the procedure, the patient should not have pronounced muscle fibrillation in the area where the electrodes are located. Exposure time - 20-30 minutes; procedures are carried out up to 3-4 times a day. The duration of the course depends on the effectiveness of pain relief.

Indications for treatment are pain syndromes in patients with diseases of the nervous system (sciatica, neuritis, neuralgia, phantom pain) and musculoskeletal system (epicondylitis, arthritis, bursitis, sprains, sports injury, bone fractures).

Contraindications:

Current intolerance;

General contraindications to physiotherapy;

Acute pains of visceral origin (angina pectoris attack, myocardial infarction, renal colic, labor pains);

Diseases of the membranes of the brain (encephalitis and arachnoiditis);

Neuroses;

Psychogenic and ischemic pain;

Acute purulent inflammatory process;

Thrombophlebitis;

Acute dermatoses;

The presence of metal fragments in the affected area.

Diadynamic therapy

Diadynamic therapy (DDT) is an electrotherapy method based on exposure to a low-frequency pulsed current of a constant direction of a half-sinusoidal shape with an exponential trailing edge of 50 and 100 Hz in various combinations.

DDT has an analgesic effect. The analgesic effect of DDT is due to processes developing at the level of the spinal cord and brain. Irritation by rhythmic impulse current a large number nerve endings leads to the appearance of a rhythmically ordered flow of afferent impulses. This flow blocks the passage of pain impulses at the level of the gelatinous substance of the spinal cord. The analgesic effect of DDT is also facilitated by reflex excitation of the endorphin systems of the spinal cord, resorption of edema and reduction of compression of the nerve trunks, normalization of trophic processes and blood circulation, elimination of tissue hypoxia.

The direct effect of DDT on body tissues differs little from the effect of galvanic current. The reaction of individual organs, their systems and the body as a whole is due to the impulsive nature of the supplied current, which changes the ratio of ion concentrations at the surface of cell membranes, inside cells and in intercellular spaces. As a result of changing ionic composition and electrical polarization, the dispersion of colloidal solutions of the cell and the permeability of cell membranes change, the intensity of metabolic processes and the excitability of tissues increase. These changes are more pronounced at the cathode. Local changes in tissues, as well as the direct action of the current on receptors, cause the development of segmental reactions. In the foreground is hyperemia under the electrodes, due to vasodilation and an increase in blood flow. In addition, when exposed to DDT, reactions caused by current pulses develop.

Due to the changing concentration of ions at the surface of cell membranes, the dispersion of cytoplasmic proteins and the functional state of the cell and tissue change. At rapid changes the concentration of ions, the muscle fiber is reduced (at a low current strength, it is strained). This is accompanied by an increase in blood flow to the excited fibers (and to any other working organ) and an intensification of metabolic processes.

Blood circulation also increases in areas of the body innervated from the same segment of the spinal cord, including the symmetrical region. At the same time, the blood flow to the affected area, as well as the venous outflow, increases, the resorption capacity of the mucous membranes of the cavities (pleural, synovial, peritoneal) improves.

Under the influence of DDT, the tone of the great vessels is normalized and the collateral circulation is improved. DDT affects the functions of the stomach (secretory, excretory and motor), improves the secretory function of the pancreas, stimulates the production of glucocorticoids by the adrenal cortex.

Diadynamic currents are obtained by one- and two-half-wave rectification of alternating mains current with a frequency of 50 Hz. In order to reduce adaptation to influences and increase the effectiveness of treatment, several types of current have been proposed, representing a sequential alternation of currents with a frequency of 50 and 100 Hz or an alternation of the latter with pauses.

Half-wave continuous (OH) half-sinusoidal current with a frequency of 50 Hz has a pronounced irritating and myostimulating properties, up to tetanic muscle contraction; causes a large, unpleasant vibration.

Full-wave continuous (DN) half-sinusoidal current with a frequency of 100 Hz has a pronounced analgesic and vasoactive properties, causes fibrillar muscle twitching, small diffuse vibration.

One-half rhythmic (RR) current, the transmissions of which alternate with pauses of equal duration (1.5 s), has the most pronounced myostimulating effect during the transmission of current, combined with a period of complete muscle relaxation during the pause.

A short-period modulated current (CP) is a sequential combination of OH and DN currents following equal bursts (1.5 s). The alternation significantly reduces the adaptation to the impact. This current first has a neuromyostimulating effect, and after 1-2 minutes - an analgesic effect; makes the patient feel the alternation of a large and soft gentle vibration.

Long-period modulated current (LP) is a simultaneous combination of OH current pulses with a duration of 4 s and

current DN with a duration of 8 s. The neuromyostimulating effect of such currents decreases, but the analgesic, vasodilating and trophic effects gradually increase. The patient's sensations are similar to those in the previous exposure regime.

One-half-wave wave (OF) current is a series of half-wave current pulses with an amplitude that increases from zero to a maximum value for 2 s, remains at this level for 4 s, and then decreases to zero for 2 s. Total duration sending an impulse 8 s, the duration of the entire period - 12 s.

Full-wave wave (DW) current is a series of full-wave current pulses with an amplitude that changes in the same way as the OF current. The total duration of the period is also 12 s.

Diadynamic current has an injecting ability, which determines its use in techniques drug electrophoresis(diadynamophoresis). Yielding to the galvanic current in terms of the amount of the administered drug, it contributes to its deeper penetration, often potentiating its action. It is best to prescribe diadynamophoresis when pain prevails.

Apparatus and general instructions for performing procedures

For DDT procedures, devices are used that generate pulses of different duration, frequency and shape with different duration of pauses between messages, such as "Tonus-1 (-2, -3)", "SNIM-1", "Diadynamic DD-5A" and etc.

When carrying out the DDT procedure, hydrophilic gaskets of electrodes of the required size are moistened with warm tap water, squeezed, metal plates are placed in the pockets of the gaskets or on top of them. Cup electrodes are placed in the area of ​​the most pronounced pain and during the procedure, hold the handle of the electric holder by hand. An electrode is placed on the painful point, connected to the negative pole of the apparatus - the cathode; another electrode of the same area is placed next to the first at a distance equal to its diameter or more. With electrodes of different areas, a smaller electrode (active) is placed on the painful point, a larger (indifferent) electrode is placed on a significant

distance (in the proximal part of the nerve trunk or limb). With DDT, water can be used as an active electrode on the area of ​​small joints of the hand or foot: it is filled in a glass or ebonite bath and the bath is connected to the negative pole of the apparatus through a carbon electrode.

Depending on the severity of the pathological process, the stage of the disease, the patient's reactivity (the property of the tissue to respond differentially to the action of an external stimulus; in this case, the action of a physiotherapeutic factor or changes in the internal environment of the body), individual characteristics the organism and the therapeutic tasks to be solved, one or another type of DDT is used, as well as their combination. To reduce addiction and gradually increase the intensity of exposure, 2-3 types of DDT current are used on the same part of the body.

The current strength is selected individually, taking into account subjective sensations patient (slight tingling, burning, feeling of electrode slipping, vibration, intermittent contraction or contraction of muscles in the area of ​​exposure). With DDT of pain syndrome, the current strength is selected so that the patient feels a pronounced painless vibration (from 2-5 to 15-30 mA). During the procedure, addiction to the action of DDT is noted; this must be taken into account and, if necessary, the intensity of the impact must be increased. The duration of the procedure is 4-6 minutes in one area, the total exposure time is 15-20 minutes. The course of treatment includes 5-10 daily procedures.

Indications for treatment:

Neurological manifestations of osteochondrosis of the spine with pain syndromes (lumbago, radiculitis, radicular syndrome), motor and vascular-trophic disorders;

Neuralgia, migraine;

Diseases and injuries of the musculoskeletal system, myositis, arthrosis, periarthritis;

Diseases of the digestive system (peptic ulcer and duodenal ulcer, pancreatitis);

Chronic inflammatory diseases of the uterine appendages;

Hypertension in initial stages... Contraindications:

Current intolerance;

General contraindications to physiotherapy;

Sharp inflammatory processes(purulent);

Thrombophlebitis;

Non-fixed fractures;

Hemorrhage in the cavity and tissue;

Tears of muscles and ligaments.

Healing techniques

Diadynamic therapy in the treatment of trigeminal neuralgia

Small round electrodes are used. One electrode (cathode) is placed at the exit site of one of the branches of the trigeminal nerve, the second - in the area of ​​pain irradiation. Impact with current DN 20-30 s, and then with current KP for 1-2 minutes. The current strength is gradually increased until the patient feels a pronounced painless vibration; the course of treatment includes up to six daily procedures.

Diadynamic therapy in the treatment of migraine

The position of the patient is lying on the side. They act with round electrodes on a hand holder. The cathode is installed 2 cm behind the corner. lower jaw on the area of ​​the upper cervical sympathetic node, the anode - 2 cm higher. The electrodes are placed perpendicular to the surface of the neck. Apply the DN current for 3 min; the current strength is gradually increased until the patient feels a pronounced vibration. The impact is carried out from two sides. The course consists of 4-6 daily procedures.

Diadynamic therapy for headaches associated with a hypotensive state, atherosclerosis of the cerebral vessels (according to V.V. Sinitsin)

The position of the patient is lying on the side. Use small double electrodes on a hand-held holder. The electrodes are placed in the temporal region (at the level of the eyebrow) so that the temporal artery is in the interelectrode space. The KP current is applied for 1-3 minutes, followed by a change in polarity for 1-2 minutes. During one procedure, the right and left temporal arteries are acted upon alternately. The procedures are carried out daily or every other day, the course of treatment consists of 10-12 procedures.

Diadynamic therapy for the area gallbladder

The plate electrodes are positioned as follows: an active electrode (cathode) with an area of ​​40-50 cm 2 is placed on the projection area of ​​the gallbladder in front, the second electrode (anode) with a size of 100-120 cm 2 is placed transversely on the back.

OV is used in a constant or variable mode of operation (in the latter, the duration of the period is 10-12 s, the rise time of the leading edge and the fall of the trailing edge is 2-3 s each). The current strength is increased until pronounced contractions of the muscles of the anterior abdominal wall begin under the electrodes. The duration of the procedure is 10-15 minutes daily or every other day, the course of treatment consists of 10-12 procedures.

Diadynamic therapy for the anterior muscles abdominal wall Electrodes with an area of ​​200-300 cm 2 are placed on the abdominal wall (cathode) and in the lumbosacral region (anode). DDT parameters: OV-current in constant operation mode; the current strength is increased until the appearance of pronounced contractions of the abdominal wall, the exposure time is 10-12 minutes. The course of treatment includes up to 15 procedures.

Diadynamic therapy for the perineal region

Electrodes with an area of ​​40-70 cm 2 are positioned as follows:

Above the pubic joint (anode) and on the perineum (cathode);

Above the pubic articulation and on the perineal area under the scrotum (polarity depends on the purpose of exposure);

Above the symphysis pubis (cathode) and on the lumbosacral spine (anode).

DDT parameters: half-wave current in alternating operating mode, period duration 4-6 s. Syncope rhythm can be used with alternating operation. With good tolerance, the current strength is increased until the patient feels a pronounced vibration. The duration of the procedure is up to 10 minutes daily or every other day, the course of treatment includes up to 12-15 procedures.

The effect of diadynamic therapy on the genitals of a woman

Electrodes with an area of ​​120-150 cm 2 are placed transversely above the pubic articulation and in the sacral region. DDT parameters: DN with polarity reversal - 1 min; CP - 2-3 minutes, DP - 2-3 minutes. The procedures are carried out daily or every other day. The course of treatment consists of 8-10 procedures.

Diadynamic therapy for diseases of the shoulder joint

Plate electrodes are placed transversely on the anterior and posterior surfaces of the joint (the cathode is at the site of the projection of pain).

DDT parameters: DV (or DN) - 2-3 min, CP - 2-3 min, DP -

3 min. For pain under both electrodes in the middle of exposure

with each type of current, the polarity is reversed. The current strength is increased until the patient feels a pronounced painless vibration. The course is prescribed 8-10 procedures, carried out daily or every other day.

Diadynamic therapy for bruised or sprained joint ligaments

Round electrodes are placed on both sides of the joint at the most painful points. Impact with a current of the DN for 1 min, and then - KP for 2 min in the forward and reverse directions. The strength of the current is increased until the patient feels the most pronounced vibration. The procedures are carried out daily. The course of treatment consists of 5-7 procedures.

Electrostimulation

Electrical stimulation is a method of treatment with impulse currents of low and increased frequency, used to restore the activity of organs and tissues that have lost their normal function, as well as to change the functional state of muscles and nerves. Separate impulses are applied; series, consisting of several impulses, as well as rhythmic impulses alternating with a certain frequency. The nature of the reaction caused depends on:

Intensity, configuration and duration of electrical impulses;

The functional state of the neuromuscular apparatus. These factors, closely related to each other, lie in

based on electrodiagnostics, allowing you to select the optimal parameters of the impulse current for electrical stimulation.

Electrical stimulation supports muscle contractility, enhances blood circulation and metabolic processes in tissues, and prevents the development of atrophy and contractures. Procedures carried out in the correct rhythm and with an appropriate current strength create a stream of nerve impulses that enter the central nervous system, which in turn helps to restore motor functions.

Indications

Electrostimulation is most widely used in the treatment of diseases of the nerves and muscles. These diseases include various paresis and paralysis of skeletal muscles, such as flaccidity, caused by disorders of the peripheral nervous system.

we and the spinal cord (neuritis, the consequences of poliomyelitis and spinal injuries with damage to the spinal cord), and spastic, post-stroke. Electrical stimulation is indicated for aphonia due to paresis of the muscles of the larynx, paretic state of the respiratory muscles and diaphragm. It is also used for muscle atrophy, both primary, which developed as a result of injuries to the peripheral nerves and spinal cord, and secondary, which arose as a result of prolonged immobilization of the limbs in connection with fractures and osteoplastic operations. Electrical stimulation is indicated for atonic states of smooth muscles of internal organs (stomach, intestines, bladder). The method is used for atonic bleeding, to prevent postoperative phlebothrombosis, to prevent complications during prolonged physical inactivity, to improve the fitness of athletes.

Electrical stimulation is widely used in cardiology. A single high-voltage electrical discharge (up to 6 kV), the so-called defibrillation, is able to restore the functioning of a stopped heart and bring a patient with myocardial infarction out of a state of clinical death. An implantable miniature device (pacemaker), which supplies rhythmic impulses to the patient's heart muscle, ensures long-term effective heart function when its pathways are blocked.

Contraindications

Contraindications include:

Gallstone and kidney stone disease;

Acute purulent processes in the abdominal organs;

Muscle spasticity.

Electrical stimulation of facial muscles is contraindicated with an increase in their excitability, as well as with early signs contractures. Electrical stimulation of the muscles of the extremities is contraindicated in case of ankylosis of the joints, dislocations until the moment of their reduction, fractures of bones before their consolidation.

General instructions for performing procedures

Electrostimulation procedures are dosed individually according to the strength of the irritating current. During the procedure, the patient should experience intense, visible, but painless muscle contractions. The patient should not experience any discomfort. Absence of muscle contractions or painful sensations indicate wrong location electrodes or the inadequacy of the applied current. The duration of the procedure

ry is individual and depends on the severity of the pathological process, the number of affected muscles and the method of treatment.

In physiotherapy, electrical stimulation is used mainly to act on damaged nerves and muscles, as well as on the smooth muscles of the walls of internal organs.

Electrodiagnostics

Electrodiagnostics is a method that allows you to determine the functional state of the peripheral neuromuscular apparatus using some forms of current.

When a nerve or muscle is irritated by a current, their bioelectric activity changes and spike responses are formed. By changing the rhythm of stimulation, one can detect a gradual transition from single contractions to dentate tetanus (when the muscle has time to partially relax and contract again under the influence of the next current impulse), and then to full tetanus (when the muscle does not relax at all due to the frequent repetition of current impulses). These reactions of the neuromuscular apparatus when irritated by constant and impulse currents formed the basis of classical electrodiagnostics and electrical stimulation.

The main task of electrodiagnostics is to determine the quantitative and qualitative changes reactions of muscles and nerves to irritation with tetanizing and intermittent direct current. Repeated electrodiagnostic studies allow to establish the dynamics of the pathological process (restoration or deepening of the lesion), evaluate the effectiveness of treatment and obtain the necessary information for prognosis. In addition, a correct assessment of the state of electrical excitability of the neuromuscular apparatus allows you to select the optimal parameters of the current for electrical stimulation.

Electrical stimulation maintains contractility and muscle tone, improves blood circulation and metabolism in the affected muscles, slows down their atrophy, and restores high lability of the neuromuscular apparatus. During electrical stimulation, on the basis of electrodiagnostic data, the shape of the pulse current, the pulse repetition rate are selected and their amplitude is adjusted. At the same time, they achieve pronounced painless rhythmic muscle contractions. The duration of the impulses used is 1-1000 ms. The strength of the current for the muscles of the hand and face composition -

It is 3-5 mA, and for the muscles of the shoulder, lower leg and thigh - 10-15 mA. The main criterion of adequacy is obtaining an isolated painless muscle contraction of the maximum size when exposed to a current of minimum force.

Apparatus and general instructions for performing procedures

For carrying out electrodiagnostics, the "Neuropulse" apparatus is used. When electrodiagnostics are used:

Intermittent direct current with a rectangular pulse duration of 0.1-0.2 s (with manual interruption);

Tetanizing current with triangular pulses, frequency 100 Hz and pulse duration 1-2 ms;

Pulse current of rectangular shape and pulse current of exponential shape with pulse frequency adjustable in the range of 0.5-1200 Hz and pulse duration adjustable in the range of 0.02-300 ms.

The study of electrical excitability is carried out in a warm, well-lit room. The muscles of the study area and the healthy (symmetrical) side should be as relaxed as possible. When conducting electrodiagnostics, one of the electrodes (guide, with an area of ​​100-150 cm 2) with a wetted hydrophilic pad is placed on the sternum or spine and connected to the anode of the apparatus. The second electrode, previously covered with a hydrophilic cloth, is periodically moistened with water. In the process of electrodiagnostics, the reference electrode is placed on the motor point of the nerve or muscle under investigation. These points correspond to the projection of the nerves in the place of their most superficial location or the places of entry of the motor nerve into the muscles. Based special studies R. Erb in late XIX v. compiled tables showing the typical location of motor points, where muscles contract at the lowest amperage.

For myoneurostimulation, the devices "Miorhythm", "Stimul-1" are used. For insignificantly expressed lesions of nerves and muscles, devices for DDT and amplipulse therapy (in a straightened mode) are also used for electrical stimulation. Internal organs are stimulated using the Endoton-1 apparatus.

The Stimul-1 device generates three types of impulse currents. For electrical stimulation with this device, plate electrodes with hydrophilic pads of various areas are used,

as well as strip electrodes of a special design. In addition, electrodes on a handle with a push-button breaker are used. The location of the points is noted by the doctor during the electrodiagnostics.

For electrical stimulation of nerves and muscles with severe pathological changes a bipolar technique is used, in which two equal-sized electrodes with an area of ​​6 cm 2 are positioned as follows: one electrode (cathode) - at the motor point, the other (anode) - in the area of ​​the muscle-tendon transition, in the distal section. In the bipolar technique, both electrodes are placed along the stimulated muscle and fixed with a bandage so that muscle contraction is unobstructed and visible. During electrical stimulation, the patient should not experience unpleasant pain sensations; after muscle contraction, its rest is necessary. The greater the degree of muscle damage, the less frequently the contractions are caused (from 1 to 12 contractions per minute), the longer the rest after each contraction. As muscle movement is restored, the frequency of contractions gradually increases. With active stimulation, when the current is turned on simultaneously with the patient's attempt to make a volitional muscle contraction, the number and duration of impulses are regulated by a manual modulator.

The strength of the current is regulated during the procedure, achieving pronounced painless muscle contractions. The current strength varies depending on the muscle group - from 3-5 mA to 10-15 mA. The duration of the procedure and the course of electrical muscle stimulation depends on the nature of the muscle damage and its severity. The procedures are carried out 1-2 times a day or every other day. The course of treatment is 10-15 procedures.

Indications for electrical stimulation:

Flaccid paresis and paralysis associated with nerve injury, specific or non-specific inflammation of the nerve, toxic damage nerve, degenerative-dystrophic diseases of the spine;

Central paresis and paralysis associated with impairment cerebral circulation;

Muscle atrophy with prolonged physical inactivity, immobilization dressings;

Hysterical paresis and paralysis;

Postoperative intestinal paresis, various dyskinesias of the stomach, intestines, biliary and urinary tract, ureteral stones;

Muscle stimulation to improve peripheral arterial and venous circulation and lymph drainage;

Increase and strengthen muscle mass athletes. Contraindications:

Current intolerance;

General contraindications to physiotherapy;

Acute inflammatory processes;

Contracture of facial muscles;

Bleeding (other than dysfunctional uterine);

Bone fractures before immobilization;

Dislocation of joints before reduction;

Ankylosis of the joints;

Fractures of bones before their consolidation;

Cholelithiasis;

Thrombophlebitis;

Condition after acute disturbance cerebral circulation (first 5-15 days);

Suture of a nerve, a vessel during the first month after surgery;

Spastic paresis and paralysis;

Heart rhythm disturbances (atrial fibrillation, polytopic extrasystole).

Intermittent (impulse) currents also have healing properties. In contrast to galvanization, impulse currents are delivered to the patient in the form of separate impulses, ie, "shocks" (or "portions"), alternating with pauses.

Diadynamic therapy - exposure to constant impulse electric current with a frequency of 50 and 100 Hz. The method was proposed by the French physician P. Bernard, who called this current diadynamic (sometimes these currents are also called Bernard's currents).

Diadynamic currents, meeting great resistance of the epidermis and stimulating exteroceptors (skin receptors that perceive irritation), cause a burning sensation and hyperemia under the electrodes. The characteristic clinical effect of diadynamic therapy is pain relieving.

Electrical stimulation is based on the use of electric current to excite or enhance the activity of motor nerves and to contract skeletal and smooth muscles. The use of impulse currents is due to the fact that the sensitivity of the nerve fibers of the skin and skeletal muscles, assessed by the threshold strength of the exciting current, is approximately 3 times higher for impulse currents compared to constant currents.

In cosmetology, electrical stimulation is of limited use, since at high frequencies there is often a prolonged muscle contraction - tetanus, which is quite painful for the patient. Much more wide application found microcurrent therapy in cosmetology, devoid of this drawback.

Microcurrent therapy is a complex method of influence with therapeutic and cosmetic purpose on the body by modulated impulse currents of low strength (microamperes) and low voltage with different frequency characteristics. Acting on the skin, muscle tissue and lymphatic pathways, microcurrent therapy stimulates muscles and creates a lasting lifting effect.

The method is intended for non-surgical correction age-related changes oval face, smoothing wrinkles, treating cellulite, carrying out lymphatic drainage, increasing metabolic processes in the skin and muscles. Less commonly, microcurrent therapy is used to treat pain, depression, and insomnia.

The main difference between microcurrent therapy and electromyostimulation is that the methods of the former are more effective when acting directly on cells, while the latter is more preferable for stimulating muscles. Unlike classic massage, microcurrent therapy methods are applicable even with serious injuries skin, being almost the only method of dealing with edema in such cases.

The alternate compression and relaxation of muscle fibers under the action of microcurrents acts like a pump - when compressed, the blood and lymphatic capillaries between the muscle fibers close, when relaxed, on the contrary, the lumen of the capillaries opens and they fill up again. The aftereffect of such lymphatic drainage lasts about a day.

Microcurrents are effective in combating wrinkles. They do not cause subsequent skin sagging and aggravation mimic wrinkles in the absence of repeated exposure. However, for the final elimination of the problem, it is necessary enough microcurrent therapy procedures. The simplicity of the method, a small number of contraindications, high efficiency determined the widespread use and great popularity of this method in aesthetic medicine.

Electrolipolysis is one of the options for the impact of a pulsed or low-frequency current on adipose tissue.

In the case of using impulse currents on problem areas apply cutaneous electrodes. If low-frequency currents are used, then in the subcutaneous adipose tissue thin long disposable needle electrodes are inserted. 8 to 14 needles are used, the injection is sometimes imperceptible, sometimes a little unpleasant. Feelings during the procedure itself are approximately the same as during myostimulation. The results of electrolipolysis are:

  • an increase in metabolic activity and a decrease in the fat mass of cells;
  • temperature rise in the treated area;
  • improvement of circulatory processes in tissues, i.e. stimulation of capillary blood circulation and subsequent restoration normal conditions tissue nutrition, stimulation of lymph flow and the final removal of all decay products as a result of increased diuresis;
  • increasing muscle tone and strengthening the skin.

V last years In physiotherapy, pulsed currents of low frequency are increasingly used, characterized not by a continuous, but by a periodic supply of current to the electrodes. According to the shape of the pulses, several types of intermittent low-frequency currents are distinguished.

1. Pulse current of a pointed form (tetanizing current) with a frequency of 100 Hz. Used for electrodiagnostics and electrical stimulation.

2. Pulse current of rectangular shape with a frequency of 5 to 100 Hz. It is used to induce electrical sleep.

3. Pulse current of exponential form (smoothly increasing and more rapidly decreasing form of the current curve) with a frequency from 8 to 80 Hz. It is used for electrodiagnostics and electro-gymnastics.

4. Diadynamic currents (rectified sinusoidal impulse currents, or Bernard currents) with a frequency of 50 and 100 Hz. There are the following main types of diadynamic currents:

  • a) single-phase (single-cycle in the SNIM-1 apparatus) fixed current with a frequency of 50 Hz;
  • b) two-phase (push-pull) fixed current with a frequency of 100 Hz;
  • c) current, modulated by short periods: rhythmic alternation of one- and two-phase current every second;
  • d) current modulated by long periods: the supply of a single-phase current alternates with the supply of a two-phase current to the electrodes;
  • e) single-phase current in "syncope rhythm": current is supplied for 1 s, alternating with a pause of the same duration.

Diadynamic currents are used to combat pain, enhance blood circulation and metabolic processes in tissues (mainly currents modulated by short and long periods), electro-gymnastics (currents in the "syncope rhythm") and electrophoresis of certain medicinal substances (fixed two-phase current).

5. Sinusoidal modulated currents, proposed by Professor V.G. Yasnogorodsky, also adjoin this group of physical agents: alternating current medium frequency (5000 Hz) sinusoidal, modulated by low frequency pulses (from 10 to 150 Hz). Due to the use of a medium frequency, sinusoidal modulated currents do not encounter significant resistance from surface tissues (in contrast to diadynamic currents) and are capable of acting on deep tissues (muscles, nerve endings and fibers, vessels, etc.). The control knobs available on the devices allow you to arbitrarily adjust the basic parameters of the low-frequency modulated current: modulation depth, frequency and duration of pulses, duration of intervals between them, current strength. There are 4 types of modulated sinusoidal currents:

  1. constant modulation current (PM) - continuous supply of modulated pulses of the same type with a selected modulation frequency (from 10 to 150 Hz);
  2. alternation of modulated oscillations with a selected modulation frequency with pauses (the ratio of the pulse duration to the pause duration is also set arbitrarily) - the type of work of the PP (sending - pause);
  3. alternation of modulated oscillations with an arbitrary frequency and unmodulated ones with average frequency 5000 Hz (type of work PN: sending modulated oscillations and carrier frequency);
  4. alternation of modulated oscillations with an arbitrary frequency (from 10 to 150 Hz) and modulated oscillations with a set frequency of 150 Hz (IF - moving frequencies).

Treatment with sinusoidal modulated currents is called amplipulse therapy (we consider another term, synmodular therapy, also legitimate). Amplipulse therapy is used to combat pain, improve blood supply, eliminate trophic disorders, electrostimulation of muscles, and recent times- and for electrophoresis of drugs (amplipulsophoresis).

Pulse currents of low frequency in the neurological department are used to perform the following tasks:

  1. electrical muscle stimulation;
  2. reducing sleep disorders and enhancing inhibitory processes in the cerebral cortex by treating electrosleep;
  3. fight against pain syndrome, elimination of circulatory disorders and trophism;
  4. introduction with the help of a pulsed current of medicinal substances (electrophoresis).

Demidenko T. D., Goldblat Yu. V.

"Physiotherapy with impulse currents for neurological diseases" and others