tangular wave form, indirect application, maximally
tolerated intensity) as the only mode of
treatment is a useful tool in the treatment of
chondromalacia patellae, where significant
quadriceps atrophy exists. The degree of
strength improvement ranged from 25-200%
and was observed to be directly dependent on
the intensity of the electrical stimulation tolerated
and the severity of the patient's condition. Furthermore,
thigh girth increased slightly (5.1%)
and the majority of patients reported a decrease
in pain. This study did not utilize other exercise
or treatment groups, or a control group for comparison,
so generalization must be made with
caution.
Williams and Streetz5 reported that electrical
stimulation in combination with active exercises
was the most successful technique in restoring
the function of the quadriceps muscles. However,
this clinical report utilized electrical stimulation
primarily as a kinesthetic reeducation
technique for the vastus medialis muscle in patients
who lacked normal voluntary control. Electrical
stimulation alone was said not to be as
effective as when combined with exercises. Description
of the exercises used in conjunction
with the electrical stimulation was not provided.
The specific current format and application technique
were described as follows: faradic, 2.8-
3.8-second rest between pulses, and surged
current intensity as tolerated by the patient. The
duration of contractions and current frequency
were unspecified. Quadriceps strength scores
were not reported; however, a mean thigh girth
increase of 0.4 inch was observed after a mean
of 12 treatments.
Millardqg found electrical stimulation to be of
little value in the restoration of quadriceps
strength and thigh girth, and in the reduction of
knee effusion following immobilization postknee
trauma. Although the electrical stimulation only
group (faradic, 30-50 cycles per second, rectangular
wave form, 1 -millisecond duration
pulses) demonstrated slightly greater thigh girth
than did the voluntary exercise group, no differences
in strength or effusion remission were
observed between the two groups. However, in
this study the electrical stimulation delivered was
only of sufficient intensity to raise the heel during
knee extension. The low strength training stimulus
may have accounted for the low strength
scores.
Curwin et reported that 1 year's clinical
use of an electrical stimulator, which claims to
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JOSPT Fall 1982 ELECTRICAL STIMULATION: A REVIEW 9 7
duplicate the Russian current format, has not
demonstrated results similar to those reported
by Kots in either abnormal or normal muscle.
Although skin sensory discomfort was minimal,
considerable muscle discomfort, similar to muscle
cramp, was reported. Furthermore, maximally
tolerated electrical stimulation contractions
did not produce as much force as did
voluntary isometric contractions of the same
muscle group, which is again contrary to informatior!
reported by Kots.I4 Although strength
scores were not reported, Curwin et al.4 concll~ded
that electrical stimulation is of value in
limiting the extent of biochemical changes associated
with atrophy accompanying immobilization,
but it is not as effective or as pain-free as
claimed.
The rehabilitation electrical stimulation studies
cited have utilized different treatment technlques,
different current formats, and different
patient populations, due to having different levels
of severity in different conditions. Generalization
in these multivariate situations must be made
with caution. That electrical stimulation can be
utilized as an effective means of improving
strength of weakened muscle is generally agreed
upon. However, disagreement is apparent as to
how effective electrical stimulation is in relation
to voluntary exercise programs and in relation to
total strength gain. Whether electrical stimulation
should be utilized until normal strength levels
have been achieved has not been examined.
Furthermore, the question of whether the ultimate
benefit is great enough to warrant use of
electrical stimulation, in place of, or in combination
with, traditional exercise, has not been
answered.
CONCLUSIONS
At the present time, sufficient detail is not
available to permit duplication and scientific evaluation
of the Russian technique of electrical
stimulation. It is not known if exact duplication of
the current format and application technique wilf",'
achieve similar results to those claimed in normal
or in injured muscle. Only two studies which
specifically sought to duplicate the Russian technique
of electrical stimulation current format and
application technique could be located.438 Neither
study found electrical stimulation to be superior
to traditional voluntary exercise techniques.
Several other studies have reported similar
conclusions using a variety of electrical stimulation
program^.^. 57 77 lo, l6
Frequently, researchers working in the area of
electrical stimulation have not made it clear exactly
what they have done or how. The specifics
of current format and its application technique
are often missing in published articles. Recognition
has not been given to the fact that the
possible combinations of electrical stimulation
current format and application techniques for
each are very numerous. Whether similar
strength improvements would be observed with
different combinations has not been a consideration
in the available literature.
In view of the implications associated with the
potential use of electrical stimulation as a
strength improvement technique and the publicity
being given this procedure, it is imperative
that sound scientific evaluation be undertaken.
Unless studies possess a sound scientific basis,
normal and injured individuals may undergo uncomfortable
and unnecessary electrical stimulation
treatments, which may be no more effective
than traditional simple voluntary exercise programs.
However, electrical stimulation could revolutionize
the approach to muscular strength
development in patients, normal individuals, and
athletes.
Despite the fact that the technique of high
intensity electrical stimulation may not be a viable
technique for all rehabilitation patients, it is
the responsibility of rehabilitation personnel to
know what the most effective techniques are and
to make such treatment available. Such knowledge
can only be gained through scientific and
comparative investigation.
At the present time, the available literature
does not support claims made for the Russian
technique of electrical stimulation. However, insufficient
scientific evidence currently exists to
warrant either the acceptance or the rejection of
electrical stimulation as a strength improvement
technique. Without scientific comparative studies,
treatment decisions will continue to be based
on clinical observation and anecdotal evidence,
both of which are unsatisfactory when the means
for conducting the necessary research is available
to most practitioners
คลื่น tangular แบบฟอร์ม สมัครทางอ้อม maximallyสมความเข้ม) เป็นโหมดเท่านั้นรักษาเป็นเครื่องมือที่มีประโยชน์ในการบำบัดรักษาchondromalacia patellae สำคัญquadriceps ฝ่อแล้ว ระดับของการปรับปรุงความแข็งแรงที่อยู่ในช่วงตั้งแต่ 25-200%และถูกตรวจสอบจะขึ้นอยู่โดยตรงกับความรุนแรงของการกระตุ้นไฟฟ้าที่เกิดขึ้นโดยเด็ดขาดและความรุนแรงของสภาพของผู้ป่วย นอกจากนี้อื่น ๆ รอบต้นขาเพิ่มขึ้นเล็กน้อยพรม (5.1%)และส่วนใหญ่ผู้ป่วยรายงานลดลงอาการเจ็บปวด การศึกษานี้ไม่ได้ใช้ออกกำลังกายอื่น ๆหรือกลุ่มการรักษา หรือกลุ่มควบคุมเปรียบเทียบดังนั้น ต้องทำ generalization ด้วยข้อควรระวังวิลเลียมส์และ Streetz5 รายงานว่า ไฟฟ้ากระตุ้นร่วมกับการออกกำลังกายที่ใช้งานอยู่เป็นเทคนิคประสบความสำเร็จมากที่สุดในการฟื้นฟูสภาพการทำงานของกล้ามเนื้อ quadriceps อย่างไรก็ตามรายงานนี้ทางคลินิกใช้ไฟฟ้ากระตุ้นเป็น kinesthetic reeducation หลักเทคนิคสำหรับการ vastus medialis ฟื้นฟูกล้ามเนื้อในผู้ป่วยที่ขาดการควบคุมปกติความสมัครใจ ไฟฟ้ากระตุ้นคนเดียวก็บอกไม่ต้องเป็นมีประสิทธิภาพเป็นเมื่อรวมกับการออกกำลังกาย คำอธิบายของการออกกำลังกายที่ใช้ร่วมด้วยการกระตุ้นไฟฟ้าไม่ได้ระบุในปัจจุบันรูปแบบและการประยุกต์ใช้เทคนิคเฉพาะอธิบายได้ดังนี้: faradic, 2.8 -เหลือ 3.8 วินาทีระหว่างกะพริบ และจากเพิ่มขึ้นความเข้มที่ปัจจุบันเป็นเผื่อไว้โดยให้ผู้ป่วย ที่ระยะเวลาของการหดและความถี่ในปัจจุบันไม่สามารถระบุได้ คะแนนแรง quadricepsไม่ถูกรายงาน อย่างไรก็ตาม อื่น ๆ หมายถึงต้นขาเพิ่มขึ้น 0.4 นิ้วถูกตรวจสอบหลังจากหมายความว่าการรักษา 12Millardqg พบกระตุ้นไฟฟ้าเป็นค่าเล็กน้อยในการคืนค่าของ quadricepsความแข็งแรงและต้นขาอื่น ๆ และการลดลงของeffusion เข่าต่อตรึงโป postkneeบาดเจ็บ แม้ว่าการกระตุ้นไฟฟ้าเท่านั้นกลุ่ม (faradic, 30-50 รอบต่อสอง สี่เหลี่ยมรูปคลื่น ระยะเวลา 1 - มิลลิวินาทีกะพริบ) สาธิตมากกว่าเล็กน้อยสะโพกอื่น ๆมากกว่ากลุ่มสมัครใจออกกำลังกาย ความแตกต่างไม่ได้ในความแข็งแรงหรือ effusion ปลดสังเกตระหว่างสองกลุ่ม อย่างไรก็ตาม ในศึกษานี้กระตุ้นไฟฟ้าส่งถูกเท่าของความเข้มที่พอยกส้นระหว่างเบอร์ต่อภายในข้อเข่า กระตุ้นการฝึกความแข็งแรงต่ำอาจมีการลงบัญชีสำหรับความแข็งแรงต่ำคะแนนCurwin ร้อยเอ็ดรายงานว่า 1 ปีของทางคลินิกใช้ของการไฟฟ้าเครื่องกระตุ้น ซึ่งอ้างว่าสมุดรายวันของกระดูกและกีฬากายภาพบำบัด ดาวน์โหลดจากที่ www.jospt.org เมื่อ 23 กันยายน 2015 สำหรับใช้ส่วนบุคคลเท่านั้น ไม่ใช้งานอื่น ๆ ไม่ได้รับอนุญาต สงวนลิขสิทธิ์ © 1982 สมุดของกระดูกและกีฬากายภาพบำบัด สงวนลิขสิทธิ์ทั้งหมดJOSPT ตก 1982 กระตุ้นไฟฟ้า: ความเห็น 9 7ซ้ำรูปแบบรัสเซียปัจจุบัน ยังไม่แสดงให้เห็นถึงผลลัพธ์ที่คล้ายกับรายงานโดย Kots ในกล้ามเนื้อผิดปกติ หรือปกติถึงแม้ว่าผิวหนังรับความรู้สึกสบายมีต้นไม้เยอะconsiderable muscle discomfort, similar to musclecramp, was reported. Furthermore, maximallytolerated electrical stimulation contractionsdid not produce as much force as didvoluntary isometric contractions of the samemuscle group, which is again contrary to informatior!reported by Kots.I4 Although strengthscores were not reported, Curwin et al.4 concll~dedthat electrical stimulation is of value inlimiting the extent of biochemical changes associatedwith atrophy accompanying immobilization,but it is not as effective or as pain-free asclaimed.The rehabilitation electrical stimulation studiescited have utilized different treatment technlques,different current formats, and differentpatient populations, due to having different levelsof severity in different conditions. Generalizationin these multivariate situations must be madewith caution. That electrical stimulation can beutilized as an effective means of improvingstrength of weakened muscle is generally agreedupon. However, disagreement is apparent as tohow effective electrical stimulation is in relationto voluntary exercise programs and in relation tototal strength gain. Whether electrical stimulationshould be utilized until normal strength levelshave been achieved has not been examined.Furthermore, the question of whether the ultimatebenefit is great enough to warrant use ofelectrical stimulation, in place of, or in combinationwith, traditional exercise, has not beenanswered.CONCLUSIONSAt the present time, sufficient detail is notavailable to permit duplication and scientific evaluationof the Russian technique of electricalstimulation. It is not known if exact duplication ofthe current format and application technique wilf",'achieve similar results to those claimed in normalor in injured muscle. Only two studies whichspecifically sought to duplicate the Russian techniqueof electrical stimulation current format andapplication technique could be located.438 Neitherstudy found electrical stimulation to be superiorto traditional voluntary exercise techniques.Several other studies have reported similarconclusions using a variety of electrical stimulationprogram^.^. 57 77 lo, l6Frequently, researchers working in the area ofelectrical stimulation have not made it clear exactlywhat they have done or how. The specificsof current format and its application techniqueare often missing in published articles. Recognitionhas not been given to the fact that thepossible combinations of electrical stimulationcurrent format and application techniques foreach are very numerous. Whether similarstrength improvements would be observed withdifferent combinations has not been a considerationin the available literature.In view of the implications associated with thepotential use of electrical stimulation as astrength improvement technique and the publicitybeing given this procedure, it is imperativethat sound scientific evaluation be undertaken.Unless studies possess a sound scientific basis,normal and injured individuals may undergo uncomfortableand unnecessary electrical stimulationtreatments, which may be no more effectivethan traditional simple voluntary exercise programs.However, electrical stimulation could revolutionizethe approach to muscular strengthdevelopment in patients, normal individuals, andathletes.Despite the fact that the technique of highintensity electrical stimulation may not be a viabletechnique for all rehabilitation patients, it isthe responsibility of rehabilitation personnel toknow what the most effective techniques are andto make such treatment available. Such knowledgecan only be gained through scientific andcomparative investigation.At the present time, the available literaturedoes not support claims made for the Russiantechnique of electrical stimulation. However, insufficientscientific evidence currently exists towarrant either the acceptance or the rejection ofelectrical stimulation as a strength improvementtechnique. Without scientific comparative studies,treatment decisions will continue to be basedon clinical observation and anecdotal evidence,both of which are unsatisfactory when the meansfor conducting the necessary research is availableto most practitioners
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