Physiotherapy pulse currents. Electrotherapy – treatment of diseases with electric current or magnetic fields

In recent years, physiotherapy has increasingly used impulse currents low frequency, characterized not by continuous, but by periodic flow of current to the electrodes. Based on the shape of the pulses, several types of intermittent low frequency currents are distinguished.

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

2. Pulse current rectangular shape with a frequency from 5 to 100 Hz. Used to induce electrosleep.

3. Pulse current of exponential shape (smoothly increasing and more rapidly decreasing shape of the current curve) with a frequency from 8 to 80 Hz. Used for electrodiagnostics and electrogymnastics.

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

• 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 single-phase current alternates with the supply of two-phase current to the electrodes;
• e) single-phase current in a “syncopation 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), electrogymnastics (currents in the “syncope rhythm”) and electrophoresis of certain medicinal substances (fixed biphasic current).

5. Adjacent to the same group of physical agents are sinusoidal modulated currents proposed by Professor V.G. Yasnogorodsky: alternating current of medium frequency (5000 Hz) of a sinusoidal shape, modulated by low-frequency pulses (from 10 to 150 Hz). Thanks to the use of medium frequency, sinusoidal modulated currents do not encounter significant resistance from superficial tissues (unlike diadynamic currents) and are able to affect deep-lying tissues (muscles, nerve endings and fibers, blood vessels, etc.). The control knobs available on the devices allow you to arbitrarily adjust the basic parameters of low-frequency modulated current: modulation depth, frequency and duration of pulses, duration of intervals between them, current strength. There are 4 types of sinusoidal modulated currents:

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

Treatment with sinusoidal modulated currents is called amplipulstherapy (we consider another term legitimate - synmodular therapy). Amplipulse therapy is used to combat pain, improve blood supply, eliminate trophic disorders, electrical stimulation of muscles, and in lately- and for electrophoresis of drugs (amplipulsophoresis).

Low frequency pulse currents in the neurological department are used to perform the following tasks:

1. electrical stimulation of muscles;
2. reducing sleep disorders and enhancing inhibitory processes in the cerebral cortex through electrosleep treatment;
3. combating pain, eliminating circulatory and trophic disorders;
4. administration of medicinal substances using pulsed current (electrophoresis).

Demidenko T. D., Goldblat Yu. V.

"Physiotherapy with pulsed currents for neurological diseases" and others

Recently, for diagnostic and therapeutic purposes, intermittent direct current has been used in the form of individual shocks (impulses) with pauses between them, the so-called pulsed current.

Each pulse is characterized by a certain duration t and a pause t 0 following it, which together make up the period T.

Pulse currents are distinguished by:

• a) the shape of the impulses;
• b) pulse repetition rate per second (expressed in hertz - Hz);
• c) the duration of each pulse (expressed in milliseconds - ms).

During galvanization, a slow increase in current strength, causing a gradual change in the concentration of ions in cells, under conditions of tissue adaptation, leads to mild irritation of nerve endings. There is no muscle contraction; if the current is turned on and off quickly, muscle contraction is observed. This can be explained by some displacement of ions and a lag in diffusion processes during short-term current pulses. The degree of change in ion concentration is determined by the strength of the current and the duration of its exposure.

Some forms of current pulses have been used previously under different names. For example, intermittent galvanic current was widespread, which was obtained by connecting various types of interrupters to a direct current circuit (hand-held electrode-interrupter, metronome-interrupter, etc.). The Leduc current was known with a number of interruptions of 100 per second (with a ratio of the duration of the circuit to the duration of the opening of 1: 9), which caused the phenomena of electronic anesthesia.

Faradic current received from an induction coil was widely used, with a pulse frequency of 60-80 per second and a breaking pulse duration of 1-2 ms. (The use of faradic current for therapeutic purposes is called faradization.) Since faradic current is capable of causing long-term (“tetanic”) contraction in skeletal muscles, leading to muscle fatigue and ultimately to its atrophy, for electrical stimulation of muscles it was proposed to use periodic interruptions of the current, the so-called rhythmic faradization, which causes alternate contraction and muscle relaxation.

Currently, the following types of current pulses of different shapes, durations and frequencies are mainly used.

1. Current with rectangular pulses. The duration of each pulse is 0.1-1 ms at a frequency of 10-100 Hz. This type of current enhances inhibitory processes in the central nervous system and is used to produce a state similar to physiological sleep (electrosleep).

The device for electrosleep is a pulse generator based on a vacuum tube circuit. Electrodes are placed on the eye sockets and mastoid processes. This type of treatment with protective inhibition is used for some mental illnesses, as well as for diseases associated with dysfunction of the corticovisceral system (peptic ulcer, hypertension).

2. Tetanizing current is characterized by a triangular shape of impulses. The duration of each pulse is 1-1 1/2 ms, frequency 100 Hz.

The source of this form of current is devices with vacuum tube circuits.

Tetanizing current causes prolonged contraction of striated muscles, and it is used for electro-gymnastics - exercise of muscles when their function is impaired.

3. Exponential current (Lapik current) has a gently increasing curve shape), reminiscent of the shape of the currents of the action of a nerve when it is irritated. Pulse duration from 1.6 to 60 ms. The pulse frequency can be changed. Depending on the degree of muscle damage, the appropriate exponential current is selected. To obtain a rhythm of muscle contraction and relaxation, a so-called modulator is used. The advantage of the exponential current waveform is that it can induce a motor response in more deeply affected muscles when tetanizing current does not. This form of current is used to stimulate muscles.

The source of pulsed currents is the AFM apparatus. It consists of a short-term pulse generator, a pulse modulator and a converter modulation stage. In addition to tetanizing and exponential forms of current, the device can be used for treatment with continuous direct current (galvanization) and rhythmic galvanization.

The ACM device is used for electrical stimulation (electro-gymnastics) of muscles when their contractility is impaired. Rhythmic electrical stimulation improves blood supply and trophism of the neuromuscular system, helps to increase the volume and efficiency of muscles, restore the conductivity of nerve elements, and has a beneficial effect on the regeneration of nerve fibers, thereby accelerating the restoration of the function of the affected muscle.

Electrical stimulation is used for lesions of the peripheral motor neuron (residual effects after polio, neuritis of the facial nerve, traumatic neuritis, secondary atrophies and paresis that developed due to prolonged muscle inactivity, functional paralysis). In order to enhance the function of smooth muscles, electrical stimulation is indicated, for example, for atony of the stomach, intestines, and bladder.

Pulse current is an electrical current entering the patient’s circuit in the form of separate “impacts” - impulses of various shapes, frequencies and durations. According to A.N. Obrosov, for the first time, such a current, obtained using an induction coil with a supply current interrupter, was used for medicinal purposes by the Russian physician I. Kabat in 1848. This current, which represents unequal pulses of negative and positive directions, was used until the recent past in the faradization method (see .). Later, in the 20th century, rectangular direct current pulses (S. Leduc), tetanizing and exponential (N.M. Liventsev), diadynamic (P. Bernard), interference (G. Nemec), sinusoidal modulated ( V.G. Yasnogorodsky), fluctuating (L.R. Rubin) currents.
The main physical characteristics of pulse currents are the following: shape, pulse repetition rate, duration of each pulse and pause, duty cycle, current strength, frequency and modulation depth. In addition, pulse currents are divided into rectified and alternating directions.
In medical practice, four main forms of pulsed currents are used.
1. Current with rectangular pulses (Leduc current). The pulse duration can vary from 0.1 to 4.0 m/s, and the frequency from 1 to 160 Hz. They are used in the techniques of electrosleep, electroanalgesia and electrical stimulation (including transcranial).
2. Current with pulses of a pointed (triangular) shape. Previously it was known as faradic, but now, used at a frequency of 100 Hz and with a pulse duration of 1-1.5 m/s, it is called tetanizing. Used in electrodiagnostics and electrical stimulation.
3. Current with exponential pulses (Lapik current). It is characterized by a gentle rise and fall, has a frequency from 8 to 80 Hz, and a pulse duration from 1.6 to 60 m/s. Used in electrodiagnostics and electrical stimulation.
4. Current with sinusoidal or half-sinusoidal pulses. It is characterized by a change in amplitude according to the sine law (along a sinusoid). Currents of this form can be either rectified or alternating with different physical parameters. Representatives of rectified sinusoidal currents are diadynamic currents, also called Bernard currents. Sinusoidal alternating currents include sinusoidal modulated currents, interference currents and fluctuating currents.
The pulse current frequency indicates the number of pulse repetitions in 1 s and is measured in Hertz (Hz). Depending on the frequency, pulse currents are divided into currents of low (1-1000 Hz), sound, or medium (1000-10000 Hz), and high (more than 10000 Hz) frequencies. The period (T) of the pulse current is closely related to frequency. It is the reciprocal of frequency (f): T = 1: f. Measured in seconds or milliseconds.
The pulse duration (t) is the time during which current is applied to the patient, and the pause duration (t0) is the time during which there is no current in the patient’s circuit. They are measured in seconds or milliseconds and add up to a period (T = t0 + t). The ratio of the period to the pulse duration is called the duty cycle (S). S = T: t.
When using pulsed currents, the average (Iav.) and amplitude (Im) value of the current is taken into account, the ratio between which depends on the duty cycle:
I with p = Im: S;
Im = I c p . · S.
Pulsed currents for therapeutic purposes are used modulated and unmodulated. Modulation is distinguished by frequency and depth. Frequency modulation characterizes the alternation of series of pulses with a pause, and the modulation frequency indicates the number of series (packs) of pulses per minute. The modulation depth characterizes the degree of change in pulse amplitude and is measured in% from 0 (unmodulated current) to 100 (full modulation).
The physiological effect of each pulse current on the body has its own characteristics, depending on their physical parameters. Most of them have a pronounced effect on the neuromuscular system. In addition to the irritating effect on the neuromuscular system of varying intensity, pulsed currents can have a pronounced antispastic, analgesic, ganglion blocking and vasodilator effect, and help increase the trophic function of the autonomic nervous system. Exposure to pulsed currents is used to: normalize the functional state of the central nervous system and its regulatory influence on various systems body; obtaining an analgesic effect when affecting the peripheral nervous system; stimulation of motor nerves, muscles and internal organs; enhancing blood circulation, tissue trophism, achieving an anti-inflammatory effect and normalizing the functions of various organs and systems.

PULSE CURRENTS- electric currents of different polarity, used for the purpose of treatment and diagnosis, arriving to the patient intermittently in the form of separate “jokes”, “portions” (pulses). Treatment I. t. is used independently or (more often) as part of complex therapy. The pulses have different shapes, recorded by an oscilloscope, the edges are determined by the different speed of voltage increase after a pause and decrease before the subsequent pause. They follow each other either evenly or in the form of periodically repeating series with intervals between them. The pulse frequency is expressed in hertz, the duration in milliseconds, the amplitude and average values ​​of their strength and voltage - in milliamps and volts.

The I. t. group includes: 1) I. t. constant polarity and low frequency - Leduc, Lapic, tetanizing and diadynamic currents; 2) I. t. variable polarity and medium frequency - interference, sinusoidal modulated, fluctuating; 3) I. t. alternating polarity and high frequency- see Darsonvalization.

Leduc current - I. t. with pulses that rise sharply and after some time quickly fall, rectangular in shape. In practice, a current with a frequency of 5-150 Hz is used. First proposed with treatment. the purpose of the French physicist and biologist S. Leduc. Lapika current - I. t. with pulses that gradually increase and decrease, i.e., exponential shape. French was first proposed. neurophysiologist L. Lapik. Tetanizing current is characterized by pulses close to a triangular shape, with a frequency of 100 Hz and a duration of 1-1.5 ms; is an improved version of the one proposed by Faraday (M. Faraday) AC unstable frequency.

Diadynamic currents - I. t. with half-sinusoidal pulses (Fig. 1) with a frequency of 50 and 100 Hz. First proposed by A. N. Obrosov and I. A. Abrikosov for treatment. use in 1937. In the 50s. 20th century these currents are introduced into the treatment. practice by P. Bernard. The treatment method is called diadynamic therapy.

Interference currents (syn. Nemeck currents) arise as a result of interference (superposition) in the tissues of the patient’s body of two alternating currents with pulses of unequal average frequencies (4000 and 3900 Hz); are offered for treatment. application of Austrian physicist H. Nemec in 1951

Sinusoidal modulated alternating currents with a frequency of 5000 Hz and arriving after modulation (low-frequency conversion) to the electrodes in the form of pulses from 10 to 150 Hz are proposed and introduced into treatment. practice by V. G. Yasnogorodsky in 1966 (Fig. 2). The method of treatment with currents is called amplipulse therapy after the name of the domestic device that generates these currents, Amplipulse. Fluctuating (aperiodic) currents with pulses randomly combining with each other with a frequency from 100 to 2000 Hz were proposed in 1964 by L. R. Rubin for therapeutic purposes in dentistry. The method of treatment with these currents is called fluctuarization.

Mechanism of action

The main action of I. t. is the analgesic effect. Currents with sinusoidal and half-sinusoidal pulse shapes (diadynamic, interference, sinusoidal modulated and fluctuating) have the greatest analgesic effect. In the mechanism of the analgesic effect of these currents, two points can be distinguished. The first is a direct inhibitory effect such as a nerve blockade in the area of ​​influence on the conductors of pain sensitivity. This leads to an increase in the pain threshold, a decrease or cessation of the flow of afferent pain impulses in the c. n. pp., i.e., to the occurrence of anesthesia of varying degrees. The second stage is the creation in the center. n. With. dominants of irritation (according to A. A. Ukhtomsky) in response to a powerful flow of rhythmically incoming impulses from intero- and proprioceptors from the zone of influence of I. t. The dominant of rhythmic irritation “overrides” the dominant of pain.

As a result, the response impulse from the c is normalized. n. p., which contributes to breaking the vicious circle “center of pain - c. n. s. - source of pain.” The irritation of autonomic nerve fibers that occurs under the influence of current and the rhythmic contractions of muscle fibers in the affected area contribute to the stimulation of collateral circulation, normalization of peripheral vascular tone, which improves blood supply and trophism in the patol, focus.

According to general biol. According to the law of adaptation, the “irritation-reaction” ratio under the influence of I. t. treatment changes significantly over time: the threshold for the perception of currents increases, and the analgesic effect decreases (addiction reaction). To reduce this phenomenon, electrical currents are usually used not only at one frequency, but also in the form of various and sequentially applied modulations—alternations of electrical currents of unequal frequencies in different time ratios (short and long period currents, etc.).

I. t. constant polarity and low frequency cause significant sensory and motor irritation due to the rapid increase and decrease in voltage in the impulse; this irritation manifests itself even with a low current strength as a burning or tingling sensation under the electrodes and intensifies with increasing current, accompanied by a tetanic contraction of the affected muscles. In connection with the above features of action, Leduc, Lapic, tetanizing currents are used primarily for electrodiagnostics (see) and for electrical stimulation (see).

I. t. variable and constant polarity, in particular sinusoidal and half-sinusoidal shapes and medium frequencies, cause less sensory irritation while maintaining motor excitation. This allows them to be used for both pain relief and electrical stimulation.

Diadynamic currents have not only an analgesic effect; their use for trophic disorders and skin damage accelerates regeneration and promotes the replacement of coarse scar tissue with looser connective tissue. The effect of diadynamic currents on the area of ​​the sympathetic nodes helps to normalize blood circulation in the extremities; in case of cerebral atherosclerosis with the syndrome of regional cerebral hypertension, it reduces the tone of intracerebral vessels and improves blood flow in them; in case of migraine, it stops an attack. Sinusoidal modulated currents have the widest spectrum of action, causing positive responses from both the sensory and motor spheres and the trophic function of the nervous system. In this regard, they have found application in a number of functional disorders; Thus, the use of sinusoidal modulated currents in patients with the initial stage of lymphostasis of the extremities helps to improve the drainage function of the lymphatic system. In patients with arterial hypertension of renal origin of stages I - IIA, the use of these currents on the area of ​​projection of the kidneys helps to reduce blood pressure due to changes in glomerular filtration and increased renal blood flow, etc.

Fluctuating currents have not only analgesic, but also anti-inflammatory effects. Their use in purulent inflammation helps to enhance phagocytosis in the lesion, delineate it from “healthy” tissue and improve the course of the wound process.

Indications, contraindications

The main indications for the therapeutic use of diadynamic, interference, sinusoidal modulated currents: diseases and injuries of soft tissues of the torso and limbs (bruise, sprained ligaments and muscles, myositis, ligamentitis, etc.), diseases and consequences of injuries of the spine and joints (osteochondrosis, deforming spondylosis, osteoarthritis, spondyloarthrosis, etc.); peripheral nerves (radiculitis, plexitis, neuritis, neuralgia, herpes zoster), spinal cord and its membranes (arachnoiditis, myelitis), occurring with pain or paresis and paralysis of the limbs; damage to the blood vessels of the brain and peripheral vessels of the extremities or disturbances in their tone (atherosclerosis of the cerebral vessels in the initial period, Raynaud's disease, obliterating endarteritis stages I-III, atherosclerotic occlusion of the vessels of the extremities I-II stages, various forms of migraine); hron, diseases of the abdominal organs and conditions after operations on them, occurring with atony of smooth muscles; a number of diseases of the female and male genital organs (chron, inflammation of the uterine appendages and prostate gland), accompanied by severe pain. Diadynamic currents, in addition, are used for vasomotor rhinitis, chronic, adhesive otitis media, sinusitis. Diadynamic and sinusoidal modulated currents are used to expel stones from the ureter (with appropriate Urol, indications and special techniques). Interference currents are used, in addition to the indications listed above, for electronic anesthesia (see). Sinusoidal modulated currents are also used to treat patients with chronic. lymph, edema of the lower extremities.

Fluctuating currents are primarily used in dentistry: for neuralgia of the trigeminal, glossopharyngeal and other nerves, for arthritis of the temporomandibular joint, alveolitis (alveolitis), periodontal disease, for inflammatory diseases (acute, chronic, aggravated) and acute purulent processes of the maxillofacial and submandibular areas (phlegmon, abscess in the postoperative period).

The main contraindications to the use of diadynamic, interference, sinusoidal modulated, fluctuating currents: individual intolerance to currents, bone fractures and dislocations (until consolidation or reduction), extensive hemorrhages or a tendency to them, thrombophlebitis, acute purulent infection (the use of fluctuating currents is possible in the postoperative period ), neoplasms, hypertension stages II B and III, hron, circulatory failure stages II-III; hron, coronary heart disease with symptoms of angina pectoris and severe sinus bradycardia, pregnancy of all stages.

Indications, contraindications and treatment. techniques for pulsed current Lapic, Leduc and tetanizing (rectangular, triangular and exponential shape) - see Electrodiagnostics, Electrosleep, Electrical stimulation.

Devices for treatment with pulsed currents. For treatment with diadynamic currents, there are domestic devices SNIM-1, Model-717, Tonus-1 and Tonus-2. Current pulses with a frequency of 50 and 100 Hz in the devices are obtained by one- and two-half-wave rectification of the AC mains current.

In addition to rectifiers, the device circuit includes a rectangular pulse generator with a multivibrator ( electronic device, with the help of which one obtains electrical energy with a wide range of frequencies and with a shape close to rectangular). This current is then used in the apparatus to produce electrical current of a half-sinusoidal shape with a gradual decay of the pulse. The SNIM-1 device (Fig. 3) generates seven types of currents: single-cycle and two-cycle continuous and wave currents, currents in the rhythm of syncope (alternating single-cycle continuous with a pause), currents “short and long period” (alternating single- and two-cycle continuous currents in different time relationships).

All currents, except continuous ones, can be used in two forms of sending - “constant” and “variable”. In the “constant” form, the currents are constant given parameters. With “variable” - some current parameters (duration of the sending period, increasing and decreasing the amplitude of pulses) can be changed within certain limits. This allows you to significantly expand the treatment. the use of diadynamic currents, in particular to use them for pain relief in patients with intolerance to continuous currents and for electrical stimulation of muscles in diseases of internal organs and lesions of peripheral nerves. The power consumed by the device from the network is 60 W, weight is 12 kg. Model-717 is a portable device that generates the same types of currents as SNIM-1, in a “permanent” form of bursts. The power consumption of the device is 35 W, weight is 4 kg. The Tonus-1 device is used in hospital settings and at home; generates all types of currents as the devices described above, as well as single-cycle and push-pull currents in new and varied combinations. The form of the parcels is “permanent”. The power consumption of the device is 25 W, weight is 7 kg. Foreign devices for treatment with diadynamic currents - D padinam i k (PNR), Bipulsator (NRB), etc. - generate diadynamic and galvanic currents, which can be used separately and in combination with each other. The form of the parcels is “permanent”.

For amplipulse therapy, domestic devices Amplipuls-3T and Amplipuls-4 are used (Fig. 4). The device circuit includes a carrier generator sinusoidal oscillations medium frequency (5000 Hz), low frequency modulating oscillation generator (10-150 Hz), parcel generator and power supply. Amplipulse-3T generates sinusoidal modulated oscillations, continuous ("constant modulation") and alternating with a pause ("send - pause") with pulses of other frequencies ("alternating frequencies") or with modulated oscillations ("send - carrier frequency"). The duration of the messages can be adjusted from 1 to 5 seconds. Currents are used in AC and DC modes. The depth of modulation (the degree of its expression) can be changed. With increasing modulation depth, the exciting effect of currents increases. This is taken into account when using the method to lay down. use of the device. The power consumption of the device is no more than 170 W, weight is 17 kg. Amplipulse-4 - portable model of the device (weight 7.5 kg); generates the same types of currents as Amplipulse-3, but with less modifications.

In the domestic apparatus for fluctuarization ASB-2, the source of alternating current voltage of audio frequency (from 100 to 2000 Hz) is a germanium diode. The voltage in the device is supplied in three versions: alternating, partially “rectified” and constant polarity (current No. 1, 2, 3, respectively). For use in dentistry, a set of intraoral electrodes is attached to the device. The weight of the device is 6.5 kg, power consumption is 50 watts.

All described devices, with the exception of Tonus-1 and Amplipulse-4, require grounding when used.

Devices that generate electrical current with rectangular, triangular and exponential pulse shapes - see Electrosleep, Electrodiagnostics, Electrical stimulation. Serial production There are no domestic devices for treatment with interference currents, since Amplipulse type devices are more effective. Devices for electronarcosis using interference currents - see Electronarcosis.

Treatment methods

Therapeutic techniques (explained in relation to the treatment of pain syndrome - the most common cases of use of I. t.). The effect of I. t. is carried out through electrodes (with wetted hydrophilic pads), which are connected to the output terminals of the device and fixed on the patient’s body. The magnitude of the current “in the patient’s circuit” is determined by his sensations (to a clear but painless vibration of the tissues under the electrodes) and by the readings of a measuring device - a milliammeter. The procedures are carried out daily, and in case of acute pain, 2 times a day with an interval of 3-4 hours. When sequentially affecting several zones, the duration of the entire procedure should not exceed 20 minutes. The course of treatment, depending on the analgesic effect, is prescribed from 1 - 5 to 12-15 procedures. When treating with currents of constant polarity, the cathode on the limb is placed on the area of ​​pain, the anode is often transverse to the cathode; when affecting the spine area - paravertebral.

During diadynamic therapy, the patient is first sequentially exposed to a push-pull continuous or push-pull wave current (in “constant” or “variable” form of bursts) for 10 seconds - 2 minutes. (depending on the area of ​​influence), then with currents for “short and long” periods (each for 1 - 3 minutes), depending on the severity of pain.

During the procedure, it is possible to switch the polarity (if there are several pain points) in compliance with safety regulations (all switching of the device handles is carried out with the “patient current” turned off).

With amplipulse therapy, the effect is sequential for 3-5 minutes. modulations “package - carrier frequency” and “alternating frequencies”. The mode of exposure, frequency and depth of modulation are prescribed depending on the severity of pain. For acute pain - alternating current mode, frequency 90-150 Hz, modulation depth 25-50-75%, for non-acute pain - alternating or direct current mode, frequency 50-20 Hz, modulation depth 75-100%. In cases where a sharp stimulating effect of currents is undesirable, they are used with a modulation depth of 25 to 75% (depending on the area of ​​influence and the severity of pain).

Exposure to interference currents is carried out by two pairs of electrodes from two separate current circuits, positioning them so that the intersection of the power lines is in the projection zone of the pathol, focus. The rhythm and frequency of modulation are prescribed depending on the severity of pain in the range from 50 to 100 Hz.

The effects of fluctuating currents on the oral mucosa are carried out with intraoral electrodes, and on the skin - with plate electrodes. In acute and aggravated inflammatory processes in the maxillofacial area, a current of alternating polarity is used; in chronic, inflammatory processes and periodontal disease, a current of partially rectified or constant polarity is used.

Repeated courses of treatment for I. t. for wedge indications can be prescribed after 2-3 weeks. Children are prescribed variable I. t. of medium frequencies (sinusoidal modulated) from the age of 1 year; other types of I. t. - more often for children over 5 years old for the same indications and using the same methodological techniques as in adults.

In complex treatment, I. t. is widely combined not only with drug treatment, but also with other physio- and balneological procedures - medicinal electrophoresis (see), galvanization (see), general warm fresh and mineral baths and warm showers, local thermal procedures , massage and treatment. gymnastics. When I. t. procedures are carried out correctly, no complications are observed. It is not recommended to expose the same area to I. t. and ultraviolet rays in an erythemal dosage.

Bibliography: Bernard P. D. Diadynamic therapy, trans. from French, M., 1961; Liventsev N.M. and Livenson A.R. Electromedical equipment, M., 1974; Practical guide to physiotherapeutic procedures, ed. A. N. Obrosova, p. 40, M., 1970; Handbook of physical therapy, ed. A. N. Obrosova, p. 37, M., 1976; Physical factors in the complex treatment and prevention of internal and nervous diseases, ed. A. N. Obrosova, M., 1971.

M. I. Antropova.

Electrotherapy (or electrotherapy) is the use of various types of electricity for therapeutic purposes. Based on the property of certain types of electrical energy at therapeutic doses to change the functional state of organs and systems.

During electrotherapy, energy is supplied to the body in the form of electric current, magnetic or electric fields and their combinations. The type of energy determines the place of its absorption in tissues and the nature of the primary physical and biological processes underlying the reactions of the whole organism. General, local and segmental effects are used. In all cases, the body reacts to the impact as a whole, but depending on the area where the energy is applied, its reactions can be both general and predominantly local in nature. With segmental techniques, the effect on superficially located reflexogenic zones causes reactions in deeply located organs that receive innervation from the same segment as these zones. With all methods, so-called nonspecific reactions common to many physical factors appear in the form of increased blood circulation, metabolism, and tissues. At the same time, the action of each factor is characterized by specific reactions unique to it. Thus, galvanic current causes a redistribution of ions and changes in biochemical processes in tissues. Acting as a biological stimulant, it promotes the processes of restoration of impaired nerve conduction. The use of this current with the simultaneous administration of small quantities of medications through intact skin (see) ensures their active effect for a long time.

Direct and alternating pulse currents (see) can cause, depending on the frequency, intensity and other parameters, an increase in inhibitory processes in the central nervous system, an analgesic and improving effect, and muscle contraction. High-frequency pulse currents (see Darsonvalization, local), stimulating the skin and deep-lying organs with high-frequency discharges, help reduce the excitability of the nervous system and eliminate blood vessels. When exposed to a high-frequency pulsed magnetic field (see Darsonvalization, general), weak eddy currents are induced in the tissues, under the influence of which metabolism is enhanced and functional disorders of the nervous system can be eliminated. An alternating continuous magnetic field of significantly higher frequency and intensity (see Inductothermy) induces intense eddy currents in the body, as a result of which significant heat is generated in the tissues and conditions are created for the reverse development of subacute and chronic inflammatory processes.

Under the influence of a constant electric field high voltage(see) the ratio of charges of tissues of the whole body changes and the functional state of the nervous system, the processes of hematopoiesis and metabolism improve. In addition, air ions, ozone and nitrogen oxides formed during a “silent” discharge also have an effect. An ultra-high frequency electric field (see), causing rotation and vibration of dipole protein molecules of tissues, acts mainly on tissues similar in physical properties to dielectrics (nerves, fatty, bone, brain tissue), and has a therapeutic effect not only in chronic, but also in acute, including purulent, inflammatory processes.

Electromagnetic oscillations of ultra-high frequency (see Microwave therapy), absorbed, cause local heat generation at a depth of 4-5 cm. Electromagnetic oscillations in the decimeter range, with the same mechanism of energy absorption and action on body tissues, provide deeper and more uniform heating and have a therapeutic effect in various subacute and chronic inflammatory processes.

Indications - see articles on individual types of electrotherapy (Darsonvalization, Pulse current, Inductothermy, etc.).

Contraindications for electrotherapy are malignant neoplasms, a tendency to bleed, recent significant hemorrhages in the cavity or tissue, severe cardiac failure, and pregnancy.

Electrotherapy (electrotherapy) is the use of electrical energy for therapeutic purposes.

Depending on the structure of the electric current, direction, intensity, frequency, duration of exposure, place of application, combination with other therapeutic factors, as well as depending on the stage of the disease, individual reaction to certain types of electrical energy, treatment electric shock causes various reactions of tissues, organs and body systems. Neurohumoral and neuroreflex pathway various types electrotherapy regulates the functions of the nervous system, metabolism, endocrine organs, blood and lymph circulation, etc. The most lasting effect is achieved when treating patients in the subacute, and in some cases, in the acute period of the disease. Some types of electrotherapy are contraindicated in some cases, for example, the use of tetanizing current for spastic paralysis, diathermy (long- and medium-wave) for purulent processes that do not have outlets for pus, etc. Electrotherapy should not be used in patients with stage III circulatory insufficiency or hypertension Stage III, for acute bleeding, malignant diseases, etc. Some patients cannot tolerate certain types of electrotherapy.

Electric current is applied in continuous and pulsed mode. The types of electric current used for medicinal purposes are listed in the table.

Continuous low voltage constant current. Galvanization (see) improves the permeability of cell membranes, enhances lymph circulation, promotes the resorption of decay products, improves trophism and tissue regeneration processes, and accelerates the restoration of impaired nerve conduction. These changes depend on the reactivity of the body, the course of the pathological process, and the reaction of the central nervous system. Dry skin resists direct current; The electrical conductivity of the skin and different tissues is different, the current lines of force in different tissues are distributed unevenly. Medicinal substances are introduced into the body through galvanic current through the skin and mucous membranes (see Medicinal electrophoresis). Previously, this effect was called iontophoresis, ionogalvanization, etc. A.E. Shcherbak developed the doctrine of “ion reflexes,” in which, along with the local skin reflex, a general response of the body occurs.

Medicinal substances administered by galvanic current, even in small quantities, are retained in tissues longer, adverse reactions are significantly reduced, and the inactivation of certain substances (for example, antibiotics) is slowed down. In these processes, in addition to changes in tissue reactivity (under the influence of galvanic current), the influence of current on the structure of the drug substance may also play a role.

Pulse direct currents low voltage(see Pulse current) enhance inhibitory processes in the brain, used for electrosleep therapy (see); tetanizing (formerly called faradic) current contracts skeletal muscles, used for electro-gymnastics and classical electrodiagnostics; Exponential current (Lapika) in structure resembles the current of a nerve, causes a motor reaction in deep-lying muscles, and is used mainly for electro-gymnastics.

Diadynamic current (Bernard)- constant pulsating, rectified sinusoidal current, used in various modifications (single- or two-phase, with short or long periods, etc.); one of the most effective analgesic agents for acute, subacute and chronic lesions of the peripheral nervous system, muscles, joints, etc.

Constant high voltage electric field(see Franklinization). There is an electric field and charged air particles - ozone air ions and nitrogen oxides. The entire body is affected, peripheral blood circulation expands, the trophic function of the nervous system is enhanced, and the processes of hematopoiesis and metabolism are stimulated.

Low voltage alternating current- interfering (ionomodulation). The current is formed by adding two alternating current circuits with a frequency of 3900-4000 Hz and 3990-4000 Hz; interference is created in the frequency range 10-100 Hz; ionomodulation acts directly on deeply located tissues and organs, causing a blockade of the path between the lesion and the central nervous system. It is used to treat non-purulent inflammatory diseases, some lesions of the muscles and nervous system with severe pain.

Sinusoidal modulated current, received from the Amplipulse-3 apparatus, is characterized by a carrier frequency of 5000 Hz and modulations in frequency from 10 to 150 Hz and amplitude from 0 to the maximum value; has a pronounced analgesic effect and an effect on nervous trophism.

High frequency currents. Pulsed current of high frequency and high voltage - local darsonvalization (see) - with a frequency of 300-400 kHz and a voltage of up to 10-15 kV causes reflex reactions of all systems (and internal organs), reduces the excitability of the neuromuscular system, has a pronounced analgesic, antipruritic, antispastic effect, improves trophism, promotes the growth of granulations and epithelium. Diathermy (see) - frequency 500-1500 kHz, voltage 100-150 V, current up to 1-2 A; endogenous heat is formed in the tissues, biochemical processes and trophism are activated, metabolism and phagocytosis increase, an analgesic and especially antispastic effect is expressed. It is used for subacute and chronic processes, and in some cases for acute ones. It is advisable to combine diathermy with other physical factors - galvanodiathermy (see), diathermoelectrophoresis, diathermomud therapy.

High frequency electromagnetic field. With general darsonvalization (autoinduction), weak high-frequency currents arise that the patient does not feel; inhibitory processes in the central nervous system increase, arterial blood pressure decreases slightly blood pressure in patients with stage I B, II A hypertension, metabolic processes are enhanced and functional disorders of the nervous system are corrected. Inductothermy (see) - short-wave diathermy, frequency 13.56 MHz; the electromagnetic high-frequency field induces eddy currents. With the same indications, inductothermy has significant advantages over diathermy (long- and medium-wave) due to a more uniform distribution of current and uniform development of heat in the tissues, it is better tolerated by patients and provides a more lasting therapeutic effect. Continuous electromagnetic field UHF (see UHF therapy), frequency 40.68 MHz, generator power from 10 to 350 W. Mostly athermic and oligothermic doses are used. It is advisable to treat not only subacute, but also acute inflammatory and purulent processes (boils, carbuncles, etc.). Pronounced anti-inflammatory, absorbable, analgesic, hypotensive, bacteriostatic and other effects have made it possible to establish an extremely wide range of applications of UHF therapy. Pulsed electromagnetic field UHF: frequency 39 MHz, average power 15 W, 15 kW per pulse. The oscillatory effect is greater than with a continuous UHF electromagnetic field; is prescribed for approximately the same indications (stage I B hypertension, stage II A, endarteritis, inflammatory diseases of the liver and biliary tract, joint diseases of various etiologies, etc.). Microwaves (see Microwave therapy) - electromagnetic vibrations ultra-high frequency (2375 MHz), maximum power output circuit 150 W. With this method of electrotherapy, even more uniform distribution of current and heat distribution in tissues, and an even greater oscillatory effect are achieved than with the described treatment methods. A bacteriostatic effect, an increase in phagocytic activity, an increase in the activity of the reticuloendothelial system, etc. have been established. The treatment of acute purulent-inflammatory processes, metabolic disorders, trophic disorders, diseases of the joints, peripheral nervous system, etc. is effective.