PART 2

LOW FREQUENCY CURRENT

 2.3 ELECTRIC SHOCK
DEFINITION:-
 Electric shock is a painful stimulation of sensory and motor nerves
caused by a sudden flow,cessation of flow or variation of intensity of
current passing through the body,resulting in mild discomfort and
fear to loss of consciousness and death in few cases.
 In order to receive a shock,the person must become a part of the
electrical circuit,by touching two terminals of a voltage source,so that
a shock current can flow.
TYPES OF ELECTRIC SHOCK
A.Depending on the nature and amount of current flow:-

1. Macroshock
• If the current flow is from the body surface through the skin into the
body,a relatively large amount of current is needed to produce a
harmful shock,called Macroshock.
2. Microshock
• If the current by passes the surface of the body and enters the heart
by way of myocardial electrodes or a transvenous catheter,a small
current is needed to produce a fatal shock without the patient
experiencing anything.
B. Depending on the severity of shock:-

1. Mild shock
• When the intensity of the current causing shock is upto 20mA,the
patient gets only a painful sensory stimulation,with laboured and
upset breathing with a lot of fear and distress,without any loss of
consciousness.
2. Severe shock
• If the current flow is more than 20mA,it results in difficulty in letting
go,muscular paralysis,Hypotension,loss of consciousness,cessation
of respiration,ventricular fibrillation and cardiac arrest in a few cases
resulting in death.
• Above 100mA- Death is usual
• Above 200mA- Death is must
C. Depending upon faulty wiring of houses and equipments:-

Earth Shock
• When the shock is due to a connection between the live wire of the
main and the earth,it is known as earth shock.
• If the current provided to the patient is not earth free or if there is no
connection between the outer case of the apparatus and earth or
when the building does not have a earth connection,the patient may
form the earth circuit and will get earth shock if the floor is not
insulated.
Causes of Electric Shock
 Sudden Alteration of current flow
 Improper Earth connection
 Leakage currents
 Two pin connections
 Faulty Electrical components
 Non-insulated floorings
 Faulty switch and Fuse connection
Treatment of Electric Shock
 1st Step- disconnect the victim from the contact with the source.
 Minor shock- Assurance and rest
Water to drink
Avoid hot water
 Severe Shock- Lay the victim flat and clear respiratory passage
Loosen the tight clothings
Circulate plenty of air to avoid warming and sweating
Do not feed anything if patient is unconscious
Cardiopulmonary Resuscitation(CPR)
Call for medical support
Prevention of Electric Shock
 The department floor should be insulated and water pipes should not
be wired close to the treatment area.
 The switches and fuses must break the live wire.
 The apparatus casing should be connected to earth.
 Always try to use 3 pin plugs for all apparatus.
 The patient should not touch the apparatus during treatment.
 During use of water for electrotherapy treatment,the container must
be made of insulated material and there should not be any water
leakage.
 The current used must be earth free.
 ELECTRICAL BURN
• It is a skin burn that happens when electricity comes in contact with body.
• Commonly damaged organs are- Heart,Kidney,Bones and muscles,Nervous system

TYPES OF ELECTRICAL BURN

1.Superficial burn- Affects only the top layer of the skin.Skin becomes red,dry and painful.
2.Partial thickness burn- It affects the top 2 layers of the skin.The skin becomes red,can
leak fluid or form blisters.
3.Full thickness burn- It affects all the layers of skin.Usually they are painless.The skin
becomes white/gray/black.

TREATMENT
• Cooling the burn- cool cloth or cool water,don’t put ice on burn
• Protect the burn site with bandage with cream or ointment
• Medication for pain relief
• Surgical repair
CHEMICAL BURNS
• These are injuries to the skin,eyes,mouth or internal organs caused
by contact with a corrosive substance.
TYPES
1. Superficial or 1st degree burns
2. Partial thickness or 2nd degree burns
3. Full thickness or 3rd degree burns
CAUSES
Ammonia,Battery acid,Metal cleaners,Bleach,Acid
CLINICAL FEATURES
• Redness,Irritation,burning
• Pain and numbness
• Blisters and black dead skin
• Vision changes if eye is affected
• Cough or shortness of breath
 FIRST AID
• Remove any contaminated clothing
• Wash with water,remove if there is any solid material
MEDICAL TREATMENT
• IV fluids to normalize blood pressure and heart rate
• IV medications for pain relief and infection
• Decontamination
• Bandage with creams and ointments
• Breathing tube in case of breathing problem
• Medication for itching
• Surgical repair for grade 3 burn(cosmetic or reconstructive surgery)
• Physiotherapy and Occupational therapy
• Counselling and support
 DC FOR TREATMENT
RECTIFICATION OF AC
• Rectification is the conversion of an alternating current to a direct
current.
• This is achieved using a circuit with two diode valves or two
semiconductors.
DC FOR TREATMENT
• Constant direct current is used clinically for Iontophoresis,which is
the deposition of therapeutically beneficial ions through the skin
deeper into the tissue for therapeutic benefits.
• The interrupted DC is used clinically for muscle and nerve
stimulation.
• SDIDC or faradic type current is used for stimulation of nerves and
innervated muscles.
• LDIDC or Galvanic type current is used for stimulation of denervated
muscles.
 GALVANIC TYPE CURRENT/ LONG DURATION IDC
• Otherwise known as Interrupted Direct current(IDC) or Galvanic type
Current.

• It is the long duration,low frequency,interrupted direct current used

for the stimulation of denerveted muscles.

• Pulse duration is more than 1 ms and may be upto 300/600 ms.

• The Pulse Interval is always either of same or more duration than

the Pulse duration.
SURGING OF DC
• Surging is the modification of the shape of the pulse or type of
pulse by varying the measures like pulse duration,ramp-
up,constant current duration and ramp-down.
• Surging is done according to the requirement of the condition
and comfort of patient.
• DC pulses can be surged to various types of pulses like-
1. Rectangular pulse
2. Trapezoidal Pulse
3. Triangular Pulse
4. Saw-tooth pulse
5. Depolarized pulse
PRODUCTION OF MODIFIED DC:-
• Modified DC is produced using a device called Multivibrator Circuit.

SELECTIVE IMPULSES
• The impulses in which the current rises gradually,not suddenly are
called selective impulses.
• These types of impulses are used to prevent accomadation of tissues
to the applied current.
• Accomodation is the mechanism in which after certain amount of
time the tissues stop responding to the applied current if the same
intensity of current is passed through the tissues for a long duration
of time.
• Triangular,Trapezoidal and Saw-tooth impulses are the types of
selective impulses.
SELECTION OF IMPULSE TYPE
• If the muscle is showing better response to Rectangular
Impulses,then that should be preferred for the treatment.
• A denervated muscle often show good response to an impulse with
slow/gradual rising intensity instead of sudden rise impulses like
Rectangular Impulses.
• Selective impulses have less sensory stimulation effect than the
sudden rising impulses.
• With the selective impulses,a lower intensity of current is required to
stimulate a denervated muscle.But with a sudden rising impulse,
higher intensity of current is required to stimulate a denervated
muscle and that current may affect intact innervated muscles to
contract.
• To stimulate a denervated muscle,a rise time of longer than 100 ms is
used.So 300/500 ms triangular pulses are selected.
• For the stimulation of denervated muscles Rectangular wave pulses
of duration 30 ms or more / Triangular wave pulses of long
duration(rise time of 100-500 ms) are mainly used.
• As there is no motor point,the current is applied through the muscle
tissue by placing the electrodes on either sides of the muscle belly.
PHYSIOLOGICAL EFFECT OF IDC
1. Stimulation of Sensory nerve
• Stabbing or burning sensation
• Reflex dilatation of superficial blood vessels resulting in skin
Erythema

2. Stimulation of Motor nerve

• Contraction of the muscle
THERAPEUTIC EFFECTS AND USES OF IDC
1. Stimulation of Denervated Muscles
2. Electrodiagnosis:- S-D curve,Faradic-IDC tests
TECHNIQUES OF APPLICATION OF IDC
• Preparation of Apparatus and testing
• Preparation of the patient
• Methods of application-
1. Labile Method- In this method the passive electrode is fixed over
the origin of the muscle groups and the active is stroked
longitudinally over the muscle belly in a up-down direction and vice-
versa.
Advantage- Many muscles in the group can be stimulated in one
session and when one muscle in the group is contracting the other
gets rest
2. Stabile Method- In this method,the passive electrode is fixed at
the origin of the muscle and the active electrode is fixed at the lower
part of the muscle belly of the selected muscle.
Advantage- It permits large no. of contractions of the selected muscle
Disadvantage- Less no. of muscles can be covered in one session
CONTRAINDICATIONS TO IDC APPLICATION:-
1. Cardiac pace maker or Arrhythmia
2. Unconscious Patients
3. Recent Radiotherapy
4. Carotid Sinus
5. Areas of arterial and venous Thrombosis and Thrombophlebitis
6. Pregnancy
7. Early tendon transfer/repair
8. Malignancy
9. Infected wounds and skin lesions
10. Hemorrhage
PRECAUTIONS:-
1. Cardiac Disease
2. Anaesthetic/hypoesthetic skin
3. Small children
4. Mentally unstable patients
5. Iontophoresis
FARADIC TYPE CURRENT/ SHORT DURATION IDC
• It is the short duration,interrupted direct current with pulse duration
of 0.1-1 ms and frequency of 30-100 Hz.
• This current stimulates the muscle by directly acting on the nerve.
• Normally used to stimulate a muscle with intact nerve supply.
• For therapeutic application,this current is surged/modified with a
frequency of 4-30 surges per minute called as Surge-faradic current.

PRODUCTION
• Original Faradic coil – Smart-bristow Faradic coil – Multivibrator
circuit
SURGING OF THE FARADIC TYPE CURRENT
• Actual Faradic type current produces tetanic type contraction which
is not like actual muscle contraction of voluntary movements,hence
surging is needed.
• Surgings are Trapezoidal,Triangular,Saw-tooth.
• Intensity of all surged pulses rises gradually and falls either gradually
or suddenly.
PHYSIOLOGICAL EFFECTS OF FARADIC TYPE CURRENT
• Stimulation of sensory nerve - Tingling or Prickling
sensation,Erythema due to reflex vasodilatation
• Stimulation of motor nerve – Muscle contraction
• Effects of muscle contraction – Increased tissue
metabolism,increased demand for oxygen and nutrition,increased
output of waste products including metabolites,metabolites causes
dilatation of capillaries and arterioles causing increased blood supply
to muscles,increased lymphatic and venous return to heart due to
continuous muscle contraction and relaxation.
• Chemical effects – As the body tissue contain electrolytes,chemical
changes take place at the electrodes and the formed chemicals may
cause chemical burn if come in contact with the body tissues.
INDICATIONS(THERAPEUTIC EFFECTS & USES)
• Facilitation of Muscle contraction
• Re-education of muscle action
• Training a new muscle action
• Nerve injury
• Movement re-education
• Strengthening of weak muscles
• Prevention and loosening of adhesions
• Deformity correction
• Improvement of venous and lymphatic drainage
• Spasticity reduction
• Functional electrical stimulation
 SINUSOIDAL CURRENT
• These are evenly alternating sine wave currents with a frequency of
50Hz.
• 100 phases in 1 second,each phase of 10 ms,50 in one direction and
50 in the other.
• This is produced by reducing the mains voltage to 60-80 V with a
step-down Transformer.
EFFECTS OF SINUSOIDAL CURRENT
• If applied continuously,it causes tetanic muscle contraction and a
tingling sensation due to stimulation of sensory and motor nerves.
• Usually it is surged to produce a rhythmic muscle contraction.
• The sensory stimulation helps in reduction of pain and the rhythmic
muscle contraction helps in relief of edema.
• It also helps in enhancing blood flow and intramuscular mechanism.
TECHNIQUES OF APPLICATION
• It is applied by pads and other electrodes just like NMES.
• Due to large sensory effects,it is mainly used over large body areas
not all local small muscles.
• It is generally applied directly through pad electrodes but can also be
applied through bath methods.
• Minimum duration of application is 5 mins.
• For reduction of edema and to enhance circulation,surged sinusoidal
current is recommended.
 DIADYNAMIC CURRENT
• These currents are monophasic rectified sinusoidal currents.

2 types-
1. Half-wave rectified sinusoidal current (Monophase fixed/MF)-
10 ms half sine wave shaped pulses with 10 ms pulse interval

2. Full wave rectified sinusoidal current (Diphase fixed/DF)-

Continuous series of 10 ms sinusoidal pulses resulting in a frequency
of 100 Hz
• COURTES PERIOD
When MF and DF are applied alternatively for 1 second each,the
resulting current is called Courtes period module.

• LONGUES PERIOD
When two MF currents are applied so that one series of pulses
occupies the pulse interval of the other and one is constant intensity
while the other one is surged,the resulting current is called Longues
period module.
PHYSIOLOGICAL EFFECTS
• Sensory stimulation
• Motor stimulation and muscle contraction
• Some chemical changes under skin

THERAPEUTIC EFFECTS
• Pain relief- Pain gate,removal of noxious metabolic wastes,placebo
effect
• Reduce Inflammation- due to changes in cell membrane
• Muscle re-education and strengthening
• Enhances the local circulation
• Facilitation of tissue healing

METHOD OF APPLICATION
Same as Faradic Stimulation
 CONSTANT DC
IONTOPHORESIS:-
• It is the introduction of drug substances into the body for therapeutic
purposes by means of a low voltage constant direct current.
• Also known as Ion Transfer or Cathodal & Anodal galvanism
(application of galvanic current through cathode and anode).
• In this Transdermal drug delivery method,each substance is
separated into ionic components by the action of the current and
deposited subcutaneously,according to the imposed polarity on the
electrodes.
• Iontophoresis promotes transdermal drug delivery by increasing the
permeability of the stratum corneum,which is the main barrier of
transdermal drug uptake.
MECHANISM
• Application of a voltage to an electrolyte results in Electrolysis and
movement of positive ion towards the negative pole and negative
ions towards the positive pole.
• The drugs introduced to the superficial layer of skin sre further driven
deeper into the tissues by the blood stream.
• The amount of substance to be introduced- I T ECE
I= Intensity of current in amperes
T= time in hours
ECE= Electrochemical equivalence of the substance
• Ionic Polarity- The basis of successful ion transfer is the physical
principle,i.e like poles repel and unlike poles attract.
• Low level Amperage- The lower the intensity of current,greater is the
amount of penetration of the ions through the skin.
• Larger negative electrode- To reduce the skin irritation by reducing
current density under it.
PHYSIOLOGICAL EFFECTS
• Ion Penetration
• Acid/Alkaline Reaction- Anode produces an acid reaction and cathode
produces an alkaline reaction.
• Hyperemia- due to vasodilatation as a result of heat production.
• Dissociation- Electrolysis
INDICATIONS(THERAPEUTIC USES)
• Local Anaesthesia:- agents like Lignocaine or Procaine can be used in
conditions like Trigeminal neuralgia,herpes zoster infection.
• Idiopathic Hyperhydrosis:- substances like Glycopyrronium bromide
and Poldine methylsulfate are used to treat excessive sweating
conditions in palm,sole and axilla.
• Application of Antibiotics:- Metallic silver is used to treat chronic
infected wounds.Xanthinol nicotinate and Histamine diphosphate
are used to treat chronic nonhealing ulcers.
• Application of Anti-inflammatory drugs:- conditions like Tendinitis
and Bursitis are treated with agents like Sodium salicyclate and
Sodium diclofenac.
Contd..
• Neurogenic Pain:- agents like Vinca alkaloids( vincristine &
vinblastine) are used for conditions like Postherpetic
neuralgia,Trigeminal neuralgia and pain due to Carcinoma.
• Edema relief:- substance like Hyaluronidase are used for edema
relief.
• Ischemic Ulcers:- Iontophoresis of Zinc is used for wound healing in
conditions like Pressure Ulcer.
• Scar Mobilization:- Iontophoresis of Iodine and Chlorine is used for
this.
• Fungal Infection:- Iontophoresis of Copper is done for conditions like
Tinea Pedis.
• Allergic Rhinitis:- Iontophoresis of Copper and Zinc is used for this
condition.
PRINCIPLES OF APPLICATION
• Preparation of Apparatus
• Preparation of the Patient
• Application of Treatment
• Dosimetry of Iontophoresis:- 5-20 mA of current for 10-30 mins.
CONTRAINDICATIONS AND PRECAUTIONS
• Same as Interrupted Galvanic current.

DANGERS
• Burn
• Electric Shock
• Skin Irritation
• Systemic effects:- headache,abdominal pain,dryness of mouth
 ELECTRICAL REACTIONS/ELECTRO-DIAGNOSIS
• It is the study of electrical activity in motor units and sensory nerves
when stimulated by electrical pulses.
• It studies the behaviour of motor units and sensory pathways
whether they are normal or abnormal when stimulated.
• Interpretation of results helps in diagnosis and prognosis of the
condition.

PHYSIOLOGICAL BASIS OF ELECTRO-DIAGNOSIS

• It is the mechanism of normal electrical activity of muscle and nerve
when stimulated by electrical impulses.
• Resting membrane potential of Nerve: -70 mV
• Resting membrane potential of Muscle: -90 mV
 STRENGTH-DURATION(S-D) CURVE
• This curve indicates the strength of impulses of various duration
required to produce muscle contraction in a muscle.
• It is obtained by joining points on a graph representing the current
intensities on X-axis and various duration of stimulus on Y-axis.
• In normal innervated muscle,the curve is parabolic or C-shaped.
• In denervated muscles the graph shifts to right.
• In partially denervated muscles,the curve shows a KINK.
ADVANTAGES OF SD CURVE
• It is simple and reliable.
• It indicates the proportion of denervation.
DISADVANTAGES OF SD CURVE
• In a large muscle,only a proportion of fibres may respond to the
current stimulus,therefore obtaining a full picture of the whole
muscle is not possible.
• It does not tell about the site of lesion/injury.
OPTIMUM TIMING FOR S-D CURVE
• Following injury to a pheripheral nerve,it takes 10-14 days for
WALLERIAN DEGENERATION to be completed.
• So it is always appropriate to plot S-D curve after this degeneration is
completed otherwise there will be chances of great errors in
diagnosis.
METHODS OF PLOTTING S-D CURVE
• A Neuromuscular stimulator machine providing various pulse
durations like 0.01 ms,0.03 ms,0.1 ms,0.3 ms,1 ms,3 ms,10 ms,30
ms,100 ms,300 ms, is selected for the plotting.
• Preparation of patient is similar to IG current application.The muscle
to be tested should be well exposed and relaxed.
• Put the passive electrode over the nerve root or the muscle origin.
• Put the active electrode over the fleshy part of muscle or muscle
belly.
• First apply the current using the stimulus having the longest duration
and look for minimal perceptible/visible contraction.Note the
magnitude of the current required for the contraction.
• Gradually shorten the pulse duration and note the corresponding
current intensity requirements to get the same type of contraction.
• Keep the active electrode on the same point through out the test.
• Put the points on graph having the current intensities on Y-axis and
pulse durations on X-axis and plot the curve.
CHARACTERISTICS OF THE CURVES
1. For normal/ Innervated muscles
2. For paralysed/denervated muscles
3. For partial denervated muscles
FACTORS AFFECTING ACCURACY OF S-D CURVE
• Skin Temperature
• Humidity
• Location of muscles
• Edema
• Ischemia
• Superficial fat
• Electrode position
• Pressure variations
PRACTICAL USES OF S-D CURVE
• To detect the presence of excitable nerve fibers in the
muscle
• To assess the extent of denervation
• It detects the sign of re-innervation
• It monitors the progress of injury and detects whether the
lesion is recovering/deteriorating.
• It identifies the utilization time from the curve which will be
used for the treatment purpose.
RHEOBASE
• It is the intensity of current required to produce a minimal visible
muscle contraction when the pulse duration is maximum.
• Unit- mA
• Normal value:- 2-10 mA
• For Denervated muscle,Rheobase is less (means the value is more) as
there is no nerve supply,the intensity of current required will be
more.
• As re-innervation occurs,Rheobase becomes more (means the value
is less) as some nerve fibers are intact,lesser intensity of current will
be required.
FACTORS AFFECTING RHEOBASE
• SKIN RESISTANCE
• EDEMA and INFLAMMATION
• ISCHAEMIA and PAIN
• TEMPERATURE
• SUBCUTANEOUS FAT
• DENERVATION
CHRONAXIE
• It is the duration of the shortest impulse that will produce a response
with a current double of the rheobase.
• Normal value:- <1 ms (0.05-0.5 ms)
• In denervated muscle,value of Chronaxie is more than the Innervated
muscle.
FACTORS AFFECTING CHRONAXIE VALUE
• TEXTURE OF SKIN
• ISCHEMIA
• EDEMA
• FATIGUE
• POSITION OF ACTIVE ELECTRODE
• DENERVATION
• RE-INNERVATION
• NERVE ROOT LESION
 FG TEST(FARADIC-GALVANIC TEST)
• FG test is a qualitative analysis which helps to find out whether the
muscle is innervated or denervated.
• If the muscle is responding to short duration (<1 ms) current i.e,
Faradic type(surge faradic) current,then it is INNERVATED.
• If the muscle is not responding to short duration current and only
responding/not responding at all to long duration(IG/Galvanic type)
current,then the muscle is denervated
INDICATIONS
• Neuro-muscular disorders
 Myasthenia gravis
 Multiple sclerosis
 Myopathy(Muscular dystrophy)
 Spinal muscular atrophy
 Amyotrophic lateral sclerosis

• To test whether the muscle is innervated or denervated

NERVE INJURY AND RESPONSE TO DIFFERENT CURRENTS:-

NERVE INJURY FARADIC CURRENT GALVANIC CURRENT

NEUROPRAXIA Decreased strength Brisk

AXONOTMESIS Decreased strength/No Brisk/Sluggish

response

NEUROTMESIS No response Sluggish

TESTING PROCEDURE
1. FARADIC CURRENT
• Passive electrode:- Nerve root
• Active electrode:- Motor point
• First,place the active electrode on normal side muscle
• Increase the intensity till minimal visible contraction is obtained
• Note the intensity
• Shift the active electrode to the same muscle on the affected side
• Increase the intensity upto the minimal visible msucle contraction
• Note the intensity
• If intensity required is same on both side,then faradic reaction is of normal
strength - INNERVATED MUSCLE
• If intensity required is more on the affected side,then faradic reaction is of
reduced strength- PARTIALLY DENERVATED MUSCLE
• If no response is obtained on affected side till maximum intensity,then faradic
reaction is absent- COMPLETE DENERVATION
2. GALVANIC CURRENT
• Applied only on the affected side
• Active electrode:- over the motor point
• Passive electrode:- muscle origin
• Intensity is increased to obtain muscle contraction
• Type of contraction is noted
• Brisk contraction and immediate relaxation- INNERVATED MUSCLE
• Sluggish contraction:- COMPLETE DENERVATION
• Sluggish/brisk contraction and sluggish relaxation:- PARTIAL
DENERVATION
• No response:- COMPLETE DEGENERATION OF MUSCLE/FIBROSED
MUSCLE
DISADVANTAGES OF FG TEST
• Less accurate
• Result depends much more on the judgement ability of the operator
• Its very difficult to differentiate between Neuropraxia and
Axonotmesis by just seeing the type of contraction.
• Sometimes it shows abnormal responses
 NCV(Nerve Conduction Velocity) TEST

NERVE CONDUCTIVITY
• Here,an impulse with pulse duration 0.1-0.3 ms is applied at the point
where the nerve is superficial.
• If there is any contraction in the muscles supplied by that nerve
below the point of application,then we can say that atleast the
muscle is not denervated.
• Comparison of the strength of contraction on the affected side with
the non-affected side gives some extra information regarding the
severity of injury.
• In case of Neuropraxia,where there occurs conduction block,it is
possible to find the site of block by testing the nerve at different
points along its course.
NERVE CONDUCTION VELOCITY
• It indicates the speed at which the impulse is propagated along the
peripheral nerves to detect any lesion/injury.
• The stimulus is applied to the nerve by two small electrodes fixed to
the skin about 2 cm apart.
• Normal pulse duration used:- 0.05-2 ms
• Recording is done by different set of electrodes which are placed over
the stimulated muscle or sensory nerve.
• The recorded response is displayed on Oscilloscope.
• 2 types:-
1. MOTOR NCV TEST
2. SENSORY NCV TEST
1. MOTOR NCV TEST
• Here,the nerve is stimulated at two different points.
• Firstly,the nerve is stimulated at a distal point to produce muscle
contraction.
• The complete action potential of the stimulation can be seen on the
oscilloscope.
• The duration between the beginning of the stimulus and initiation
of muscle contraction is called LATENCY which is calculated from
the display on the Oscilloscope.
• LATENCY is the time gap between STIMULUS ARTIFACT and the
ONSET OF M-WAVE and is measured in millisecond.
• To compare with the distal values,the nerve is again stimulated at a
more proximal point.
• LATENCY is again calculated by noting the time gap between
STIMULUS ARTIFACT and ONSET OF M-WAVE.

CONDUCTION VELOCITY= CONDUCTION DISTANCE

PROXIMAL LATENCY - DISTAL LATENCY
• UNIT:- meter/second
• Avg. value for U/L:- 60 m/s
• Avg. value for L/L:- 50 m/s
• Case example:- CARPAL TUNNEL SYNDROME
2. SENSORY NCV TEST
• Sensory NCV test can be done in two directions:-
1. ORTHODROMIC CONDUCTION (physiological direction)
2. ANTIDROMIC CONDUCTION (opposite to normal conduction)
• Electrodes used:- Surface electrode
Needle electrode
Digital ring electrode
• Measurement of sensory NCV is similar to motor NCV.Latencies are
measured at two different sites and NCV is calculated by the formula
same as motor NCV.
 ELECTROMYOGRAPHY(EMG)
• EMG is the study of the MOTOR UNIT activity.
• It involves detecting,amplifying and displaying the electrical changes
that occur when a muscle contracts.
• EMG examination assesses the integrity of the Neuro-muscular
system including the UMNs and LMNs,the NMJs and muscle fibers.
• Basically this test studies the muscle action potentials (MOTOR UNIT
ACTION POTENTIAL-MUAP) at different stages of muscle contraction.
• The signals read by EMG are very tiny.So,they are amplified to a
thousand times to get a larger value which can be displayed on the
Oscilloscope or heard by the Loudspeaker.
PROCEDURE
• It is a 3 phase system-
1. Input phase:- picking up electrical reactions from the contracting
muscle by the electrodes

2. Processor phase:- amplification of tiny electrical signals

3. Output phase:- conversion of amplified signal to visual or auditory

signals for display/analysis.
INSTRUMENTATION
A. RECORDING ELECTRODES
• 2 types of electrodes are used:-
1. Surface electrode
2. Needle electrode

• 3 electrodes are required for an EMG testing:-

 Recording electrode
 Reference electrode
 Ground electrode

• 2 Techniques of electrode placement:-

 Monopolar electrode placement
 Bi-polar electrode placement
B. AMPLIFIERS
• The main principle of using an amplifier is to amplify the received
signal and to reject the undesired signals(noises) keeping only the
desired signal from the motor unit.

C. DISPLAY DEVICES
• The amplified signal can be analyzed on output devises which can be
a computer monitor or Cathode ray Oscilloscope for visual display,a
speaker or tape recorder for auditory signals.
NORMAL MOTOR UNIT CHARACTERISTICS
• Amplitude:- 300 μV-5 mV
• Duration:- 3-16 ms
• Frequency:- 3-30 /sec
• May be diphasic/triphasic/Polyphasic
ABNORMAL MOTOR UNIT CHARACTERISTICS
A. SPONTANEOUS ACTIVITY:-

1. FIBRILATION POTENTIALS
• Spontaneous depolarization of a single fiber.
• Amplitude:- 20-300 μV
• Duration:- 2 ms
• Frequency:- 30/sec
• Produce high pitched click sound
• Indications:- LMN disorders like Peripheral nerve injuries,anterior
horn cell disease,Radiculopathy,Polyneuropathy,Muscular
dystrophy,Polymyositis,Myasthenia gravis and in some UMN lesions.
2. POSITIVE SHARP WAVES
• They appear with an initial sharp positive deflection.
• Usually Monophasic but can be diphasic.
• The negative phase is of much lower amplitude and longer duration
than the positive phase.
• Duration:- 2-100 ms
• Frequency:- 10/sec
• Amplitude:- upto 1 mV
• Indications:- Muscle denervation,Muscular dystrophy,Polymyositis
and in some UMN lesions
3. FASCICULATION POTENTIALS
• This is characterized by spontaneously occuring muscle contractions
in a group of muscle fibers.
• They may be diphasic,triphasic or polyphasic.
• Amplitude:- 5-1200 μV
• Duration:- 5-25 ms
• Frequency:- 50/sec
• Indications:- Degeneration of anterior horn cells,nerve root
compression,muscle spasms and
cramps,Myelopathies,Myopathy,Motor neuron
disease,Syringomyelia,poliomyelitis,spinal muscular atrophy.
B. REPETITIVE DISCHARGES
• High frequency discharges
• Amplitude:- 50 μV-1 Mv
• Duration:- 100 ms
• Frequency:- 5-100/sec
• Indications:- Anterior horn cell lesion,Peripheral nerve
injuries,Myopathies
CLINICAL IMPLICATIONS OF EMG
 No spontaneous activity,di-, tri- or polyphasic potentials,amplitude
300 μV-5 mV,duration 3-16 ms,frequency 3-30/ sec,sharp thumping
sound – NORMAL MOTOR UNIT
 No spontaneous activity,reduction in recruitment pattern or
abnormal recruitment pattern- SEVERE DENERVATION
 Spontaneous activity,no recruitment pattern on contraction-
COMPLETE DENERVATION
 Increased NCV latency across the blocked area,normal NCV above
and below the compression with normal EMG at rest but decreased
recruitment pattern in chronic cases- NEUROPRAXIA
 Normal/decreased/absent NCV,appearance of fibrillation potential
and positive sharp waves- AXONOTMESIS
 NCV absent,presence of spontaneous potentials,no EMG activity on
contraction- NEUROTMESIS
 Presence of small polyphasic potentials on contraction- NERVE
DEGENERATION