umh1723 2012-13 Lec011 Corrientes de Estimulación Rusa - Kotz

Name: umh1723 2012-13 Lec011 Corrientes de Estimulación Rusa - Kotz
Uploaded: 2013-04-23T19:22:18.000Z
Duration: 1 h 52 min 20 s

Introduction to the Topic

The instructor introduces the topic of "Corrientes Variables de Media Frecuencia" (Medium Frequency Variable Currents) and specifically focuses on the Russian stimulation or COD currents.

Characteristics of Russian Stimulation

The study and application of medium frequency current for muscle strengthening is the main objective.

The topic will cover the physical characteristics, classification, treatment parameters, and main indications of Russian stimulation.

A more comprehensive study on muscle strengthening will be covered in a later unit.

Superficial Understanding of Russian Stimulation

The instructor explains that only a superficial understanding of Russian stimulation will be provided, focusing more on technical aspects rather than therapeutic or preventive aspects.

Physical Classification of Russian Stimulation

The graphical representation helps classify COD current from a physical perspective.

Following classification rules, conclusions can be drawn about how the current is delivered in trains or impulse packets separated by pauses.

Characteristics of Impulses in Russian Stimulation

Each train contains a proportional number of impulses based on its duration.

Impulses are characterized as alternating current with rectangular shape and no polarity due to continuous flow between positive and negative poles.

Intensity is variable over time, and the frequency carrier for these impulses is 2,500 Hz, falling within the range used for medium frequency currents.

Classification Levels: Impulses and Trains

Two levels of classification are discussed - one related to individual impulses and another related to trains or packets of impulses.

Impulse Level Classification

Concepts such as impulse duration, intensity, frequency, and period are important at the impulse level.

Train Level Classification

Impulses are grouped into trains or packets, introducing concepts such as train frequency and train period.

Understanding Russian Stimulation: Impulse Trains

The instructor explains the concept of impulse trains in Russian stimulation and introduces new concepts related to train frequencies and train periods.

Train Level Classification

Impulses are emitted as a succession of impulses grouped into trains.

Concepts such as train frequency (number of trains per second) and train period (time between the start of one train and the start of the next) are discussed.

Conclusion

Understanding Parameters of Russian Stimulation

In this section, the speaker discusses the importance of understanding parameters related to frequency of trains and duration in the context of Russian stimulation. These concepts will be further explored throughout the course.

Parameters of Russian Stimulation

The frequency of impulse in Russian stimulation is equivalent to 2,500 Hz, which is referred to as the mother frequency or base frequency.

Russian stimulation emits a total of 2,500 impulses of alternating current, biphasic, symmetrical rectangular shape interrupted at medium frequency.

Russian stimulation is emitted in the form of impulse packets, and one suitable parameter for treatment is a train frequency of 50 Hz.

The train frequency refers to the number of impulse packets emitted per second. The most commonly used train frequency with Russian stimulation is 50 Hz, but other parameters like 20 Hz and 80 Hz can also be utilized.

Differentiating Impulse Frequency and Train Frequency

This section explains the distinction between impulse frequency and train frequency in relation to Russian stimulation. It emphasizes that these are two different parameters that need to be understood separately.

Impulse Frequency vs Train Frequency

Impulse frequency always remains constant at 2,500 Hz in Russian stimulation.

Train frequency refers to the number of impulse packets emitted per second.

Understanding both parameters (impulse and train frequencies) is crucial for effectively utilizing Russian stimulation.

Calculating Impulses within a Train Duration

This section demonstrates how to calculate the number of impulses within a given duration using an example scenario.

Calculation Example

If we know that the duration of a train is 100 milliseconds (ms), we can calculate how many impulses can fit within that duration.

The impulse frequency is 2,500 Hz, so if the train duration is 1,000 ms (1 second), there would be 2,500 impulses.

Using a proportionate calculation, if the train duration is 100 ms (1/10th of a second), we would have 250 impulses within that train.

Factors Affecting Impulses in a Train

This section discusses the factors that influence the number of impulses within a train and how both the duration of the train and the filling frequency play a role.

Factors Affecting Impulses in a Train

The number of impulses in a train depends on two main factors: the duration of the train and the filling frequency.

Larger trains allow for more impulses to be filled, while smaller trains accommodate fewer impulses.

The filling frequency also affects the number of impulses. For example, with an impulse frequency of 2,500 Hz and a train duration of 100 ms, there would be 250 impulses in that train.

Understanding the Relationship Between Train Duration and Pause Duration

In this section, the instructor discusses the relationship between train duration and pause duration in electrical muscle stimulation.

Train Duration and Pause Duration

The number of impulses per second that can be accommodated in a train is affected by factors such as frequency of filling, size of the train, and number of impulses per train.

The concept of train duration refers to the combined duration of both the train and the pause between trains.

The ratio or duty cycle represents the relationship or percentage between the duration of the train and the duration of the pause. It can be expressed as a numerical ratio (e.g., 1:1, 1:2) or as a percentage (e.g., 50%, 33%).

Importance of Ratio in Electrical Muscle Stimulation

This section highlights the significance of ratio or duty cycle in electrical muscle stimulation protocols.

Importance of Ratio

The ratio indicates the proportion between train duration and pause duration in electrical muscle stimulation. It plays a crucial role in determining how muscles are stimulated.

Different ratios can result in distinct physiological responses. For example, stimulating with a shorter train duration and longer pause may have different effects compared to using a longer train duration and shorter pause.

Considerations for Muscle Strength Maintenance

This section emphasizes that while electrical muscle stimulation can increase muscle strength, voluntary active work by patients is essential for long-term maintenance.

Voluntary Active Work

Electrical muscle stimulation alone cannot sustain long-term muscle strength.

To maintain increased muscle strength over time, patients must actively engage in voluntary work during the neuromuscular training period.

The role of electrical current is to provide additional reinforcement to the patient's active and voluntary work. It should not be relied upon as the sole means of improving muscle contraction quality.

Historical Background of Russian Current

This section provides a brief historical background on Russian current and its origins.

Origins of Russian Current

Russian current was developed in Russia around 1970 with the aim of producing electrically-induced muscular strengthening while minimizing discomfort and secondary effects on patients.

These currents were studied by a physician named COD, who observed significant changes in muscular trophism (development) through their use. They were primarily used in the Soviet Union to counteract muscular atrophy in astronauts and enhance performance in athletes.

Factors Affecting Muscle Hypertrophy

This section mentions that muscle hypertrophy depends on various factors and that electrical stimulation alone is not sufficient for long-term increases in muscle strength.

Muscle Hypertrophy Factors

Muscle hypertrophy, or an increase in muscle size, depends on multiple factors beyond electrical stimulation alone.

While electrical stimulation can contribute to increased muscle strength and modify motor unit recruitment, it does not follow the physiological pattern naturally occurring within the body.

Long-term maintenance of increased muscle strength requires a combination of electrical stimulation and voluntary active work from patients during neuromuscular training periods.

[t=0:23:52s] Using Electrical Stimulation for Muscle Strengthening

In this section, the speaker discusses the use of electrical stimulation for muscle strengthening and its limitations.

The Role of Electrical Stimulation in Muscle Strengthening

Electrical stimulation can be used to strengthen muscles in specific cases where intense voluntary muscle activity is contraindicated due to a patient's condition.

It is important to understand that long-term muscle strength and hypertrophy cannot be solely achieved through electrical stimulation. Combining active exercise with electrical stimulation yields better results.

Electrical stimulation was designed specifically for electrically-induced muscle strengthening. It should be used in combination with voluntary exercise for optimal outcomes.

Automatic Program for Electrical Stimulation

There are two ways to utilize electrical stimulation in clinical practice. One method is using an automatic program where the intensity gradually increases to a predetermined maximum value, then maintains that intensity for a set duration before gradually decreasing back to resting levels.

The automatic program consists of four distinct parts:

Ramping up the intensity

Maintaining the intensity

Ramping down the intensity

Rest period before starting a new cycle

Parameters and Settings for Electrical Stimulation

The device screen displays parameters related to the automatic program. The frequency mentioned refers to the impulse trains, not the carrier or main frequency.

When selecting Russian current mode, the device automatically sets the impulse frequency at 2500 Hz and prompts users to choose their desired burst or train frequency (e.g., 50 Hz, 20 Hz, or 80 Hz).

Other parameters requested by the device include the duration of the intensity ramp-up, maintenance time, intensity ramp-down time, and rest interval. Additionally, users can set the total treatment time.

Setting Intensity and Starting the Program

Once all parameters are set, including those mentioned earlier, users need to specify the maximum intensity level for the automatic program. This value will be memorized by the device.

After confirming the maximum intensity level, users can start the automatic program. The movement of a small dot on the screen indicates that electrical stimulation will begin when it reaches the "ramp-up" phase.

Purpose of Visual and Auditory Cues

In this section, the speaker discusses how visual or auditory cues can be used in electrical stimulation therapy to signal the start of muscle contraction. The purpose of these cues is to prompt the patient to perform voluntary contractions before the intensity of the stimulation increases. This allows the electrical current to reinforce the active and voluntary muscle work performed by the patient.

Visual and Auditory Cues for Muscle Contraction

Visual or auditory cues are incorporated into some electrical stimulation devices.

These cues indicate when the ramp-up phase of muscle contraction will begin.

The purpose is to encourage patients to engage in voluntary contractions before the intensity increases.

By reinforcing active and voluntary muscle work, electrical stimulation enhances muscular strength.

Automatic vs Manual Programs

This section explains two different modes of operation in electrical stimulation therapy: automatic and manual programs. The automatic program functions without any patient input, while the manual program allows for more control over parameters. The choice between these programs depends on factors such as desired levels of muscle recruitment and avoidance of neuromuscular accommodation.

Automatic Program

Suitable for cases where any muscular activity is contraindicated.

The program operates automatically, producing artificial depolarization with a ramp-up phase, contraction time, ramp-down phase, and rest period.

Accommodates patients who are unable to perform voluntary contractions.

Manual Program

Used when reaching maximum depolarization and neuromuscular recruitment is desired.

Provides more control over parameters compared to automatic programs.

Helps avoid neuromuscular accommodation that occurs with repeated stimuli at consistent intensities.

Justification for Manual Program Selection

This section explains why the manual program may be chosen over the automatic program in certain cases. The speaker highlights that the automatic program inherently leads to some degree of neuromuscular accommodation, which can affect muscle contraction quality over time.

Neuromuscular Accommodation and Manual Program

Automatic programs lead to a certain level of neuromuscular accommodation.

Neuromuscular accommodation refers to a decrease in muscle contraction quality over time with repeated electrical stimuli.

Manual programs offer more control and allow for adjustments to prevent accommodation.

In cases where maximum muscle recruitment is desired, the manual program is preferred.

Avoiding Neuromuscular Accommodation

This section discusses how increasing intensity can help avoid neuromuscular accommodation. By continuously adjusting the intensity, it is possible to maintain high-quality contractions throughout the session.

Intensity Adjustment for Preventing Accommodation

To prevent neuromuscular accommodation, intensity needs to be increased periodically.

Increasing intensity breaks through accommodation and ensures good contraction quality.

However, after a few minutes, accommodation may occur again, requiring constant intensity adjustments.

Manual Program for Maximum Demand

This section explains that when no degree of accommodation is desired, such as in high-level athletes or when maximum muscular work is required, a manual program should be used. The manual program allows for progressive intensity adjustment during each contraction cycle.

Manual Program for Maximum Demand

In cases where no degree of accommodation is acceptable:

A manual stimulation program should be used.

Intensity can be adjusted manually during each contraction cycle.

The goal is to reach maximum tetanic contraction within patient tolerance.

Each cycle includes periods of contraction, rest, and intensity adjustment.

Controlling Intensity in Manual Program

This section explains how the manual program allows for precise control over intensity adjustments during each contraction cycle. By manually adjusting the intensity, neuromuscular accommodation can be minimized, leading to more effective muscle work.

Precise Intensity Control in Manual Program

In a manual program, intensity is adjusted manually throughout each contraction cycle.

Manual adjustment prevents accommodation during each increase in intensity.

The desired intensity is maintained for the required duration (maintenance phase).

Afterward, intensity is gradually decreased (ramp-down phase).

A rest period follows before starting the next cycle.

Differentiating Automatic and Manual Programs

This section highlights the similarities and differences between automatic and manual programs in electrical stimulation therapy. Both programs consist of ramp-up, maintenance, ramp-down phases, and rest periods. However, the key distinction lies in how intensity adjustments are made.

Similarities and Differences between Automatic and Manual Programs

Both programs have four phases: ramp-up, maintenance, ramp-down, and rest.

In automatic programs:

Intensity increases automatically to a predetermined level.

Accommodation may occur due to consistent stimulation at a fixed intensity.

In manual programs:

Intensity is manually adjusted by the therapist or patient.

Accommodation can be minimized by adjusting intensity during each contraction cycle.

Individualized Approach for Manual Program

This section emphasizes that manual programs are tailored to specific patients who lead active or athletic lifestyles. The speaker mentions that not everyone requires this type of program but rather those who engage in intense physical activities or are at a medium-to-high athletic level.

Individualized Approach for Manual Program

Manual programs are not necessary for all patients.

Reserved for individuals with active or athletic lifestyles.

Used when maximum muscle work is desired.

Adjustments are made to achieve maximum tetanic contraction within patient tolerance.

Suitable for medium-to-high-level athletes or those engaged in intense physical activities.

Visual Demonstration of Parameter Programming

In this section, the speaker provides a visual demonstration of parameter programming using an electrical stimulation device. The video shows how different parameters can be adjusted to customize the treatment according to the patient's needs.

Parameter Programming Demonstration

A video demonstration showcases parameter programming on an electrical stimulation device.

The frequency parameter is set based on specific requirements (e.g., 50, 20, or 80).

The ratio concept and various options are explained (e.g., 1:1, 1:2, 1:4).

Parameters such as ramp-up time, maintenance time, and treatment duration can be customized.

Setting Parameters for Contraction and Rest Cycles

This section focuses on setting parameters related to contraction and rest cycles during electrical stimulation therapy. The speaker explains how ramp-up time, maintenance time, and treatment duration can be adjusted based on individual patient needs.

Customizing Contraction and Rest Cycles

Understanding Intensity Settings

In this section, the speaker explains how to adjust the intensity settings on the device and memorize them for future use.

Adjusting Intensity and Memorizing Values

When adjusting the intensity, a blank box appears asking for the maximum intensity value to be entered.

Once the maximum intensity is set, the automatic program starts functioning visually and acoustically.

The intensity automatically increases to the programmed maximum value and remains for a cycle of 12 seconds.

If muscle contraction quality decreases during a cycle, the intensity can be increased manually while current is passing through to maintain higher quality contractions.

If muscle fatigue or accommodation occurs after multiple cycles, the intensity can be further increased in subsequent cycles.

Manual Program vs Automatic Program

This section discusses the differences between manual and automatic programs in terms of adjusting intensity and achieving maximum muscle contraction.

Manual Program

In manual mode, there are no automatic programs. The user manually adjusts the intensity using a button and keeps track of time using a stopwatch or timer.

The user determines their desired duration for each phase (ramp-up, maintenance, ramp-down, rest).

The user can choose a specific maximum intensity based on their desired level of muscle contraction quality.

Automatic Program

In automatic mode, there are preset programs that follow similar criteria as the manual mode.

The intensity is adjusted progressively to prevent muscle accommodation, but not as frequently as in the manual program.

Understanding Ratio Parameter

This section explains the concept of the ratio parameter and its significance in stimulation with Russian current.

Definition and Units of Ratio Parameter

The ratio parameter, also known as duty cycle, represents the relationship between train duration and pause duration in Russian current stimulation.

The ratio can be expressed as a percentage or a numerical relationship (e.g., 1:1, 1:2).

A higher ratio value indicates that train duration is equal to or longer than pause duration.

Period and Frequency Calculation

This section discusses how to calculate period and frequency for both individual pulses and trains of electrical stimulation.

Calculating Pulse Frequency

Pulse frequency can be calculated by dividing 1000 milliseconds by the pulse period.

Train frequency can be calculated by dividing 1000 milliseconds by the train period, which is equal to the sum of train duration and pause duration.

Relationship with Train Frequency

A specific example mentions a train frequency of 50 Hz, indicating that 50 packets of rectangular biphasic metric current impulses will be emitted.

The relationship between pulse frequency, train frequency, period, and duration helps understand how different parameters affect electrical stimulation.

Despejando el periodo de trenes

In this section, the speaker explains how to calculate the duration of trains and pauses between trains by using the concept of ratio.

Understanding Train Periods and Durations

The period of trains can be calculated by dividing the total time (in milliseconds) by the number of impulse trains.

The period of trains represents the combined duration of a train and its pause.

Different combinations of train and pause durations can result in the same total period.

However, there can be significant differences in stimulation between different combinations.

To calculate train and pause durations separately, a parameter called "ratio" is needed.

Calculating Train and Pause Durations

Knowing the ratio allows for calculating train and pause durations separately.

The frequency indicates the number of impulses or trains emitted per second, while the period measures the time between emissions.

It's important not to confuse concepts like period (measured in milliseconds or seconds) with frequency (measured in hertz).

The duration of a train includes both its impulse and pause, depending on whether we refer to periods or impulses.

Understanding Ratios

Ratios determine how much of the total period corresponds to train duration versus pause duration.

Frequency is measured in hertz, indicating how many waves or trains are emitted per second.

Train and pause durations are expressed in milliseconds.

Examples with Different Ratios

In this section, the speaker provides examples with different ratios to illustrate how train and pause durations can vary.

Ratio of 1:1 (50%)

For a frequency of 50 hertz, the period of trains is 20 milliseconds.

With a ratio of 1:1, the train duration and pause duration are both 10 milliseconds.

Understanding Different Ratios

Changing the ratio to 1:2 (33%) means that one-third of the period corresponds to train duration, while two-thirds correspond to pause duration.

For example, with a frequency of 50 hertz and a ratio of 1:2, the train duration would be 7 milliseconds and the pause duration would be 14 milliseconds.

Ratio of 1:4 (25%)

With a ratio of 1:4, one-fifth of the period corresponds to train duration, while four-fifths correspond to pause duration.

For example, if the train lasts for 4 milliseconds, then the pause would last for 16 milliseconds.

Conclusion

Understanding Period and Frequency of Trains

In this section, the speaker explains the concept of period and frequency of trains in relation to stimulation with Russian current. The examples provided are calculated based on a train frequency of 50 hertz.

Calculation of Period for Different Train Frequencies

The duration of the train and the pause between trains is expressed as a percentage or ratio.

For example, if 25% of the period refers to the duration of the train, then the remaining percentage represents the duration of the pause between trains.

It is important to note that changing the train frequency will result in different parameters for period calculation.

Activity - Calculating Train Periods

The speaker introduces an activity related to calculating train periods for different frequencies in Russian current stimulation.

Calculation of Train Periods for Various Frequencies

The activity involves calculating train periods for frequencies such as 20 hertz and 80 hertz.

It is essential to be able to calculate train periods for all possible frequencies used in Russian current stimulation.

Calculation Results for Train Periods

The speaker provides specific calculations for train periods at different frequencies used in Russian current stimulation.

Train Periods at Different Frequencies

For a frequency of 20 hertz, the train period is calculated as 50 milliseconds.

For a frequency of 80 hertz, the train period is calculated as 12.5 milliseconds.

Calculation of Train Durations and Pauses

The speaker discusses how to calculate durations and pauses between trains based on previously calculated train periods using a ratio or percentage.

Calculation of Durations and Pauses

To calculate durations and pauses, a ratio of 1:1 or 50% is used.

For example, if the train period for 20 hertz is 50 milliseconds, with a 50% ratio, the duration of the train would be 25 milliseconds and the pause between trains would also be 25 milliseconds.

Similarly, for a frequency of 80 hertz with a train period of 12.5 milliseconds, the duration of the train and pause between trains would both be 6.25 milliseconds.

General Application of Concepts

The speaker emphasizes that understanding these concepts is important not only in Russian current stimulation but also in other topics such as ultrasound.

Importance of Understanding Concepts

The concepts discussed in this section are applicable to various types of currents.

These concepts will reappear in other topics like ultrasound, so it is crucial to grasp them.