电刺激

2200 -- 4400 HHzz：： 兴兴奋奋迷迷走走神神经经 扩扩张张局局部部动动脉脉 正正常常骨骨骼骼肌肌不不完完全全性性强强直直收收缩缩
2255--5500 HHzz ：： 正正常常骨骨骼骼肌肌完完全全性性强强直直收收缩缩 促促进进局局部部血血液液循循环环
5500－－225500HHzz：：
physiological effect vasodilation, the inhibition of the sympathetic nervous system
Noble ,2000-The effect of interferential therapy upon cutaneous blood flow in humans
Pelvic floor contraction Muscle pumping
Pain management
Urinary incontinence management
Blood flow/edema management
3
• Electrode Placement:
• -painful area (86.4%)
电刺激疗法
中山大学附属第一医院 康复科 江沁
本教材与国内教材分类的 异同点
• 直流电疗法和直流电离子导入疗法 • 低频脉冲电疗法 • 中频电疗法 • 高频电（透热）疗法
低频脉冲电疗法特点
• 脉冲电流是一种按一定规律从零或某一 电位水平上瞬间出现或消失的电流．
• 应用每秒频率在1000Hz以下的脉冲电 流治疗疾病的方法
中频电疗法
• 等幅中频正弦电疗(undamped medium frequency electrotherapy )
• 干扰电疗（Interferential current,IFC Interferential therapy--IFT )
• 苏联波(Russian current,KOTS) • 调制中频电疗(modulated medium
• Beat frequency-1200Hz (depolarize Sensory and motor nerve fibers)
Bipolar
• 2 electrodes -a single channel • not penetrate tissues deeply • more accurate • one muscle or muscle group only one
• “4 leaf clover” shaped field
stereodynamic
C1 C3
C2
Physiological and therapeutic Effect
interferential current
Sensory fibers
Motor fibers
gate closing
Evoked muscle contraction
channel is used
quadripolar quadripolar-
• 4 electrodes, each
Vector scan
pair to separate
• sweep: enlarge field
:channel
• Interference at
level of
TREATMENT AREA
抑抑制制交交感感神神经经：：止止痛痛、、镇镇静静 促促局局部部循循环环、、促促渗渗出出吸吸收收 缓缓解解肌肌紧紧张张
中国康复医学诊疗规范-308
blood flow 125μs, 4 kHz , 6/6 sweep
IFT 1 0–100 Hz
placebo
laser Doppler flowmetry / skin temperature
one-hour pad test, Pelvic muscle strength a 28-itemed questionnaire
Both methods can be used effectively
Demirtürk,2008-Interferential current versus biofeedback results in urinary stress incontinence
• 血肿机化 • 胃肠平滑肌张力低下 • 尿潴留 • 周围神经麻痹（后期） • 扭伤
2
Interferential Current --IFC Interferential therapy--IFT
the popularity of interferential therapy (IFT) amongst physiotherapists
ischaemic pain
30 healthy volunteers
active IFC
sham IFC
no treatment
submaximal effort tourniquet test (SETT)
100 Hz , 4 kHz , 125 μs
[Pain Rating Index (PRI) Present Pain Intensity Index (PPI) VAS MPQ
1
适应症
• 皮肤瘢痕增生肥厚 • 外伤或术后浸润粘连 • 血肿机化 • 注射后浸润 • 静脉炎残留索条 • 声带肥厚 • 肠粘连 • 慢性盆腔炎
禁忌症
• 恶性肿瘤 • 急性化脓性炎症 • 活动性出血 • 局部金属异物 • 心区 • 孕妇腹部 • 颈前区 • 心脏起搏器
调制中频电疗法（modulated medium frequency electrotherapy
( Lindsay et al., 1990 ; Pope et al., 1995 ; Robertson & Spurritt, 1998),
Biophysical Characteristics
• Medium frequency 3000 and 5000 Hz (lower skin impedance)
in animal experiments (Laabs et al., 1980; Beer et al., 1990) the treatment of nonunion of tibial fractures in humans (Ganne,1988).
4
urinary stress incontinence
• 脉冲方向不变为单脉冲电流,方向变换者 为双脉冲电流.
• 兴奋神经肌肉组织（？）
低频脉冲电疗法的分类（70页）
• 感应电刺激(法拉第电流)(Faradic current,FC) • 经皮神经电刺激(Transcutaneous Electrical Nerve
stimulation,TENS) • 低周波电刺激(Silver Spike Point,SSP) • 高伏特间歇直流电(High voltage pulsed Galvinic
调 制 方式：
连调：镇痛作用明显 断调：锻炼骨骼肌、提高平滑肌张力 间调：促血循环、淋巴回流 变调：加速渗出水肿的吸收
调 幅 度：
深浅幅度表示低频成分的大小 深→振幅大→强度变率大→刺激作用强 浅→振幅小→强度变率小→刺激作用弱
调制中频电疗法的应用
• 颈椎病 • 肩周炎 • 骨性关节炎 • 肌筋膜炎 • 腱鞘炎 • 术后瘢痕粘连
IFC produced significantly greater analgesia than sohnson ,2002-A single-blind placebo-controlled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects
• 应用中频电流被低频电流调制后，其幅度和频 率随着低频电流的幅度和频率的变化而变化的 电流治疗疾病的方法。
• 调制中频电流含有1～150Hz低频电流与2～ 10KHz中频电流，兼有低频电与中频电两种电 流各自的特点和治疗作用，作用较深，不产生 电解刺激作用，人体易于接受而不易产生适应 性。
调调制制方方式式与与治治疗疗作作用用
frequency electrotherapy )
等幅中频电疗法(undamped medium frequency electrotherapy
• 频率1,000～2,000Hz的等幅正弦以治疗 疾病的方法。由于这种电流处于音频 段，因此又称音频电疗。
• 临床作用是镇痛、促进局部血液循环、 消炎(非特异性)、软化瘢痕、松解粘连 等。
fractures
IFC placebo
control
4.0 kHz ,10 – 25 Hz, 6 S 6,25~50mA,30min/day,10day
a monthly basis. Radiological union
IFC can not reduce the healing time for new fractures of the tibia or prevent nonunion.
forty women
IFC
pelvic floor exercises via biofeedback
15 minutes per session three times a week a total of 15 sessions. a frequency of 0– 100 Hz
vacuum electrodes suprapubic region medial side of the ischial tuberosity,
• -spinal nerve root (53%)
• -peripheral nerve (26%)
• -trigger point (10%)
• -acupuncture point (5%)
• Duration of Treatment
10~30min
• Intensity of Treatment
current ,HVPG) • 微电流(Microcurrent) • 间动电流(双动态波)(Diadynamic current) • 失神经肌肉电刺激(NMES for Dennervated Muscles) • 功能性电刺激(Functional electrical stimulation，FES ) • 痉挛肌电刺激(Hufschmidt electrical stimulation )
Fourie,1997-Stimulation of bone healing in new fractures of the tibial shaft using interferential currents
Interferential currents have been shown to be effective for bone healing of new fractures
Knee surgery
87,anterior cruciate ligament (ACL)reconstruction, menisectomy, or knee chondroplasty
ICF
placebo
pain, pain medication
three times daily, 28 min, 7 to 9 weeks 14min 5-10 Hz, 14min80-150Hz.
IFT 2 80–100 Hz
50 healthy volunteers
10–20 Hz via suction electrodes increase in cutaneous blood flow increase in skin temperature.
IFT 3 10–20 Hz
control
10~60mA
Anecdotal Evidence
Johnson ,1999- The mystique of interferential currents when used to manage pain
11..22.. 差差 频频 的的 治治 疗疗 作作 用用
11 －－1100 HHzz ：： 兴兴奋奋交交感感神神经经 正正常常骨骨骼骼肌肌单单收收缩缩 平平滑滑肌肌收收缩缩（（11－－22HHzz））