Chronic refractory gastrointestinal (GI) motility disorders are a significant burden on the healthcare system, acting as a large public health issue with significant impact on the quality of life in both the pediatric and adult population. Control systems of gastrointestinal motility are complex and involve coordination of smooth muscle contraction and relaxation, which the autonomic nervous system is largely responsible for. Gaps in the diagnosis process, such as overlooking autonomic function, has left patients with diminished quality of life and limited treatment options. Many patients in the clinic have experienced injury within the spinal cord and we hypothesized that GI symptoms might be related to spinal injury causing disruption of sensory and/or motor nerves of the autonomic nervous system. Our objective became to better understand the specific location and nature of spinal injuries and GI symptoms, as completed through the development of a self-report questionnaire. Main findings suggest symptoms indicative of T3-T9 and T10-L2 spinal pathology. COVID-19 did not allow for in-clinic neuromodulation with autonomic assessments, resulting in experiments remotely assessing at-home neuromodulation treatment for GI symptoms with suspected spinal autonomic dysfunction. At-home neuromodulation was not suitable for many patients, but those who were able to manage it showed highly promising results. After years of suffering, transcutaneous electrical nerve stimulation alleviated symptoms, particularly postprandial abdominal pain, constipation, vomiting and nausea. I discuss what we learned to set us up for successful at-home treatment, and we will use all information to design randomized controlled trials to prove the benefit of TENS. The present work offers significant information on the relationship of thoracolumbar spinal pathology and complex GI symptoms, which is now used in the clinic in the diagnosis process of GI dysmotility. In addition, we have learned how to conduct at-home treatment using TENS, which allows us to execute future studies. / Thesis / Master of Science (MSc) / There are gaps in the diagnosis process of complex gastrointestinal (GI) dysmotility disorders, including lack of testing of autonomic function, leaving patients suffering with diminished quality of life with unsuccessful treatment attempts. As many patients also experience injury or conditions of the spine, I have hypothesized that GI symptoms may be related to spinal injury-induced dysfunction of the autonomic nervous system. Experimental models aim to understand the location and nature of spinal pathology with GI symptoms for future diagnoses, as well as potential treatment options such as neuromodulation. Findings of this thesis suggest symptoms indicative of particular thoracolumbar spinal pathology and promising results of transcutaneous electrical nerve stimulation (TENS) to alleviate GI symptoms, including T3-T9 and T10-L2 spinal pathology-related postprandial abdominal pain, constipation, nausea, and vomiting. This work offers information for the diagnostic process of GI dysmotility and the future design of clinical trials of neuromodulation therapies.

The problem of this study concerns the reduction of spasticity in physically handicapped persons with CP. The hypotheses tested were: that there would be no significant difference between the mechanical efficiency (ME) of persons with spastic CP following application of the TENS Unit and following application of the placebo unit; that there would be no significant difference between the ME of males with spastic CP, following application of the TENS Unit or the placebo unit, and the ME of females with spastic CP, following application of the TENS Unit or the placebo unit; and that there would be no significant interaction between the treatment factor and the gender category.

Thesis title: Stimulation of the zones used during reflex lokomotion by the TENS Name: Markéta Vodňanská The aim of the thesis: The aim of this thesis is to determine, whether is activated the appropriate locomotor pattern during Vojta reflex locomotion - reflexive crawling, when TENS is used for a stimulation of trigger zones, as it is during manual stimulation of trigger zones for reflexive crawling. Method: The essence of this study is the stimulation of trigger zones used in the reflex locomotion manually and by transcutaneous electrical nerve stimulation (TENS) at a frequency of 30 Hz and 182 Hz. Six probands participated in this experiment. During the manual and TENS stimulation was scanned electrical activity in selected muscles by surface electromyography. First, it was evaluated the order of activation of selected muscles, using "standard timing" analysis by MyoResearch XP Master program. Second, it was evaluated the crawling reflex locomotion pattern visually. Results: It was confirmed, that the crawling reflex locomotion pattern, which is provoked by manual stimulation of trigger zones, is provoked by TENS stimulation as well, using the same trigger zones. It follows that the vector of direction and pressure during manual stimulation of trigger zones is not necessary for recall of the...

Introdução. O uso da Estimulação Elétrica Nervosa Transcutânea (TENS) para o tratamento da dor pós-operatória tem sido objeto de estudo há alguns anos. Todavia, em quase a totalidade dos trabalhos, a TENS foi aplicada somente após os procedimentos cirúrgicos, à exceção de uma única pesquisa em que foi empregada no período pré-operatório. Em ambas as situações, esse recurso foi eficiente para o tratamento da dor, seja por meio da redução da sua intensidade ou do consumo de analgésicos. Porém, ainda hoje, não se sabe qual o papel que o seu momento de aplicação (somente antes da cirurgia; apenas após a operação; ou antes e após) pode vir a exercer no grau de analgesia obtido. Objetivo. Analisar a influência do momento de aplicação da TENS, na modalidade de alta freqüência, como recurso analgésico em pacientes do sexo masculino submetidos a herniorrafias inguinais pela técnica de Bassini. Casuística e método. A pesquisa clínica, controlada, aleatória e duplamente encoberta foi realizada no Hospital São José, entre abril de 2007 e junho de 2008, com amostra de 125 pacientes, distribuídos em 5 grupos: TENS depois (n = 25), TENS antes (n = 25), TENS antes e depois (n = 25), Placebo (n = 25) e Controle (n = 25). Todas as anestesias foram realizadas via raquidiana, com cloridrato de bupivacaína (0,5%); e a medicação analgésica utilizada no pós-operatório foi: dipirona, como medicação de resgate; e cetoprofeno, em horário programado. A mensuração da dor foi feita com a escala numérica (0-10 cm) e com a versão brasileira do Questionário de Dor McGill (Br-MPQ). Foram considerados estatisticamente significantes os valores de p 0,05. Resultados. Os grupos que foram tratados com a TENS apresentaram redução significante da dor, sendo os resultados mais expressivos naqueles pacientes em que a TENS foi aplicada tanto no período pré, quanto pós-operatório (TENS antes e depois). Houve também redução significante da administração de dipirona no período pós-operatório. Conclusão. O uso pré e pós-operatório da modalidade de alta freqüência da TENS, em pacientes submetidos a herniorrafias inguinais com técnica de Bassini, proporcionou analgesia mais satisfatória do que aquela obtida somente com a aplicação em um desses momentos. / Introduction. The use of Transcutaneous Electrical Nerve Stimulation (TENS) to treat postoperative pain has been searched lately. However, in the most of studies, TENS has been applied only after surgeries, excepting one where TENS was utilized before. In the two situations, this resource has presented good benefits for pain treatment, observed not only by a reduction in its intensity but also in consumption of analgesics. Nevertheless, there is a doubt about the role that TENS applications moment can exert in analgesias level obtained in the postoperative period. Objective. To analyze the influence of applications moment of high frequency TENS as an analgesic resource in male patients submitted to inguinal herniorraphy (Bassini technique). Cases and method. It was a placebo-controlled, randomized and double-blinded trial, carried out at the Hospital São José (Aracaju, SE, Brazil), between April 2007 and June 2008, and had a sample of 125 patients, distributed in 5 groups: pre TENS (n = 25), post TENS (n = 25), pre- and post TENS (n = 25), Sham (n = 25) and Control (n = 25). There was the standardization of the bupivacaine (0,5 %) as an anesthetic drug, as well as postoperative analgesic prescription: dipyrone, only if the patient complained about pain; and ketoprofen, prescribed for every 8 h. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3, 3½, 4, 5, 6 and 7 h after inducing the anesthesia besides one last verification at the hospital discharge). Brazilian version of the McGill Pain Questionnaire (Br-MPQ) was used 4 h following the inducing of the anesthesia. P values .05 were considered significant. Results. Patients treated with TENS showed less pain intensity, and the most expressive results occurred in pre- and post TENS, moreover there was also significant reduction in dipyrone consumption. Conclusion. The pre- and postoperative use of high frequency TENS in inguinal herniorraphy provided major analgesia than the one obtained by TENS application only in the pre- or postoperative period.

Em vista ao alto índice de cesárea no Brasil e ao projeto de humanização do ciclo gravídico-puerperal, observa-se a importância de pesquisar e utilizar recursos nãofarmacológicos que auxiliem na recuperação de mulheres no puerpério imediato da cesárea. A dor e o desconforto estão presentes em razão da cirurgia e dos movimentos necessários para o autocuidado e os cuidados com o recém-nascido. A Eletroestimulação Nervosa Transcutânea (Transcutaneous Electrical Nerve Stimulation - TENS) é uma modalidade terapêutica comumente utilizada para alívio de dor, inclusive dor aguda pós-operatória. O objetivo deste trabalho é analisar a efetividade da TENS no alívio de dor após cesárea. Para isto, foi realizado estudo clínico controlado, randomizado e simples-cego. Participaram do estudo 20 puérperas no grupo experimental que receberam a TENS e 20 no grupo controle, em que apenas a dor era avaliada. As puérperas foram avaliadas quanto às limitações de atividades decorrentes da dor pós-operatória. Para avaliar a dor foi usada a Escala de Categoria Numérica (Numeric Rating Scale - NRS) e o Questionário de Dor McGill. Foi feita uma primeira avaliação seguida da aplicação da TENS para o grupo experimental, por 45 minutos, e o acompanhamento do grupo controle pelo mesmo tempo. Após este período foi realizada uma segunda avaliação e, uma hora após, uma terceira avaliação. As puérperas apresentaram limitação nos movimentos de sentar e levantar e caminhar. A dor caracterizava-se, principalmente como ritmada e localizada. Os descritores mais comumente citados para descrevê-la foram \"dolorido\", \"que prende\", \"cólica\" e \"que repuxa\". Os maiores escores de dor foram relacionados aos movimentos de sentar e levantar e caminhar. Por meio de teste não paramétrico de Mann-Whitney, foi possível observar que o grupo experimental apresentou redução da dor estatisticamente significante maior que o grupo controle na segunda e na terceira avaliação pela NRS (p<0,001) e pelo McGill (p<0,001). Conclui-se que a TENS foi eficaz no alívio da dor, que permaneceu por, pelo menos, uma hora após a aplicação. Há a necessidade de mais pesquisas, possibilitando a utilização da TENS na prática clínica e como recurso não-farmacológico de humanização no puerpério de cesárea. / On the strengh of the large number of cesareans in Brazil and concerning the humanizing project of the pregnancy-puerperal cycle, it can be observed the importance of researching and prescribing non-pharmacological resources that can help by the recovery of puerperal women from the cesarean section. The pain and the discomfort by reason of the surgery and of those necessary movements for the self-help and to take care of the baby. The Transcutanous Electrical Nerve Stimulation (TENS) is a therapeutic technique commonly used for easing the pain, including the post-operating acute pain. The objective of this research is to analyze the effectiveness of the TENS in the pain relief after cesarean. Hence a simple-blind and a random clinical-controlled study was done. Twenty puerperal women composed the experimental group in which TENS technique was applied and 20 others puerperal women composed the control group in which the pain was only evaluated. The puerperal was evaluated the pain the Numeric Rating Scale (NRS) and the McGill Pain Questionnaire were chosen a first assessment was followed by a 45 minutes session of TENS technique with the experimental group, while the control group was only followed at the same time. After this period happened a second assessment and, an hour later, a third assessment. The puerperal presented limitations in sitting down, stand up and walking movements. The pain was characterized chiefly as rhythmic and located. The words more commonly used to describe pain were \"painful\", \"that holds\", \"colic\" and \"that pulls\". The highest scores of pain were related to the movements of sitting down, stand up and walking. By this Mann-Whitney non-parametric test, it was possible to observe that the experimental group presented a pain reduction more statistically significant than that of the control group in the second and third NRS (p<0,001) and McGill (p<0,001) assessment. The conclusion is that TENS is an efficient technique to promote pain reduction and resulting relief remains at least an hour after its use. More researches should be developed in order to make possible the use of TENS technique in the clinical practice and as a non-pharmacological humanizing resource in the puerperal condition of cesarean section.

Dor é sintoma comum a diversos quadros clínicos. É provavelmente a razão mais freqüente de auxílio médico. Estima-se que 10 a 20% da população adulta apresentam dor crônica, sendo que, destes, cerca de 5% apresentam pouca resposta a tratamento. A abordagem terapêutica da dor crônica de origem muscular deve ser multidisciplinar, com interrupção do ciclo de dor. Para tal, são utilizadas várias técnicas, entre elas, alongamento muscular e estimulação elétrica nervosa transcutânea (TENS). O presente trabalho de pesquisa teve como objetivo avaliar a resposta analgésica de cinco sessões de fisioterapia com alongamento e/ou TENS, em dores crônicas com origem na musculatura da coluna vertebral. Foi realizado ensaio clínico randomizado, duplo-cego, em paralelo, controlado por alongamento muscular, no Centro Corpo em Porto Alegre, RS, Brasil. Foram estudados pacientes portadores de dor crônica de origem muscular, com localização na coluna vertebral. Tratava-se de pacientes adultos, com diagnóstico de dor há mais de 6 meses, feito por médico ortopedista, e que estavam iniciando tratamento fisioterapêutico entre janeiro e dezembro de 2005. Os pacientes foram alocados randomicamente em três grupos: um considerado controle e dois grupos de intervenção. O primeiro (ALONG; n=33) realizou 20 min de alongamentos musculares e 20 min de TENS-sham. O grupo intervenção 1 (TENS; n=31) realizou 20 min de falsos alongamentos musculares e 20 min de TENS acupuntural. O grupo intervenção 2 (ALONG/TENS; n=31) realizou 20 min de alongamentos musculares e 20 min de TENS acupuntural. Dos 95 pacientes estudados, 57,9% eram mulheres e 42,1%, homens, com similar distribuição nos 03 grupos (Teste qui-quadrado, P=0,622). Quanto à localização, 32,6% apresentavam dor na região cervical, 2,1% na região torácica, 49,5% em região lombar e 15,8% na região cérvico-lombar (Teste qui-quadrado, P=0,120, para comparação dos 3 grupos). A idade variou dos 19 aos 76 anos, sem diferença entre os grupos (ANOVA, P=0,456). Observou-se que, ao longo das 05 sessões, houve redução significativa dos escores de dor. Porém não foi detectada diferenças entre os regimes terapêuticos estudados. Na avaliação inicial em escala analógica visual, os grupos ALONG, TENS e ALONG/TENS apresentaram, respectivamente, escores (média + desvio padrão) de 53,85+24,18, 57,39+23,47 e 47,74+24,95 (ANOVA, P=0,288). Após 05 sessões, os valores foram, respectivamente, de 25,88+22,62, 27,48+21,47 e 20,39+20,98 (ANOVA, P<0,000 diferença significativa entre os tempos e P= 0,535 diferença não significativa entre os grupos). Na avaliação inicial em escala verbal, os grupos ALONG, TENS e ALONG/TENS apresentaram, respectivamente, escores (mediana, percentis 25% e 75%) de 4(3/4), 4(4/5) e 4(3/4) (Teste de Kruskal-Wallis, P=0,217). Após 05 sessões, os valores foram, respectivamente, de 3(1/3), 3(2/3) e 3(0/3) (Teste de Friedman P=0,000 diferença significativa ao longo do tempo). Concluiu-se que as técnicas de alongamento e TENS são capazes de reduzir significativamente dores musculares com origem na coluna vertebral. Seus efeitos são similares, sugerindo igual eficácia analgésica. / Pain is a common symptom in several situations. It is probably the most frequent reason for the search of medical care. It is estimated that ten to twenty percent of the adult population suffer from chronic pain and that five percent show little response to treatment. The clinical approach to chronic muscular pain must be multidisciplinary, trying to interrupt the pain cycle. With that in mind, many techniques are used, such as muscular stretching, and transcutaneous electrical nerve stimulation (TENS). This research project aimed to evaluate analgesic response to stretching and/or TENS in five physiotherapy sessions for chronic pain in muscles of the spinal cord. A randomized, double-blind, parallel-group, stretching-controlled clinical trial was conducted at Centro Corpo in Porto Alegre, RS, Brazil. Patients with muscular pain in the spinal cord were studied. All of them were adults, with diagnosis of pain lasting for more than six months. The diagnosis was made by an orthopedist and the patients were beginning physiotherapeutic treatment between January and December, 2005. The patients were randomly divided in three groups: one of them was the control group and the other two were the intervention groups. The first group (STRETCH, n=33) did twenty minutes of muscular stretching and twenty minutes of sham TENS. Intervention group one (TENS, n=31) did twenty minutes of ineffective stretching exercises and twenty minutes of Acupuncture TENS. Intervention group two (STRETCH/TENS, n=31) did twenty minutes of effective stretching exercises and twenty minutes of Acupuncture TENS. From the 95 patients analyzed, 57.9% were women and 42.1% were men. They were similarly distributed along the three groups (Chi-square test, P=0.622). As to the region the pain was located, 32.6% presented cervical pain, 2.1% presented thoracic pain, 49.5% had lumbar pain, and 15.8% had cervical/lumbar pain (Chi-square test, P=0.120, to compare the three groups). Age ranged from 19 to 76, with no difference among the groups (ANOVA, P=0.456). It was observed that, throughout the five sessions, there was significant reduction of pain scores. No difference was detected, though, among the therapeutic methods which were studied. In the first evaluation using the Visual Analogical Scale, the groups showed the following scores (mean ± standard deviation): STRETCH: 53.85±24.18, TENS: 57.39±23.47, and STRETCH/TENS: 47.74 ±24.95 (ANOVA, P=0.288). After five sessions, the scores were: STRETCH: 25.88±22.62, TENS: 27.48±21.47, and STRETCH/TENS: 20.39±20.98 (ANOVA, P<0.000; significant difference among the times and P=0.535; no significant difference among the groups). In the first evaluation using the Verbal Scale the groups showed the following scores (median, 25 and 75 percentiles): STRETCH: 4 (3/4), TENS: 4 (4/5), and STRETCH/TENS: 4 (3/4) (Kruskal-Wallis test, P=0.217). After five sessions, the scores were: STRETCH: 3 (1/3), TENS: 3 (2/3), and STRETCH/TENS: 3 (0/3) (Friedman test, P=0.000 significant difference over time). It is concluded that the stretching and the TENS techniques can significantly reduce muscular pain originated in the spinal cord. Their effects are similar, which suggests equal analgesic efficacy.

Dor é sintoma comum a diversos quadros clínicos. É provavelmente a razão mais freqüente de auxílio médico. Estima-se que 10 a 20% da população adulta apresentam dor crônica, sendo que, destes, cerca de 5% apresentam pouca resposta a tratamento. A abordagem terapêutica da dor crônica de origem muscular deve ser multidisciplinar, com interrupção do ciclo de dor. Para tal, são utilizadas várias técnicas, entre elas, alongamento muscular e estimulação elétrica nervosa transcutânea (TENS). O presente trabalho de pesquisa teve como objetivo avaliar a resposta analgésica de cinco sessões de fisioterapia com alongamento e/ou TENS, em dores crônicas com origem na musculatura da coluna vertebral. Foi realizado ensaio clínico randomizado, duplo-cego, em paralelo, controlado por alongamento muscular, no Centro Corpo em Porto Alegre, RS, Brasil. Foram estudados pacientes portadores de dor crônica de origem muscular, com localização na coluna vertebral. Tratava-se de pacientes adultos, com diagnóstico de dor há mais de 6 meses, feito por médico ortopedista, e que estavam iniciando tratamento fisioterapêutico entre janeiro e dezembro de 2005. Os pacientes foram alocados randomicamente em três grupos: um considerado controle e dois grupos de intervenção. O primeiro (ALONG; n=33) realizou 20 min de alongamentos musculares e 20 min de TENS-sham. O grupo intervenção 1 (TENS; n=31) realizou 20 min de falsos alongamentos musculares e 20 min de TENS acupuntural. O grupo intervenção 2 (ALONG/TENS; n=31) realizou 20 min de alongamentos musculares e 20 min de TENS acupuntural. Dos 95 pacientes estudados, 57,9% eram mulheres e 42,1%, homens, com similar distribuição nos 03 grupos (Teste qui-quadrado, P=0,622). Quanto à localização, 32,6% apresentavam dor na região cervical, 2,1% na região torácica, 49,5% em região lombar e 15,8% na região cérvico-lombar (Teste qui-quadrado, P=0,120, para comparação dos 3 grupos). A idade variou dos 19 aos 76 anos, sem diferença entre os grupos (ANOVA, P=0,456). Observou-se que, ao longo das 05 sessões, houve redução significativa dos escores de dor. Porém não foi detectada diferenças entre os regimes terapêuticos estudados. Na avaliação inicial em escala analógica visual, os grupos ALONG, TENS e ALONG/TENS apresentaram, respectivamente, escores (média + desvio padrão) de 53,85+24,18, 57,39+23,47 e 47,74+24,95 (ANOVA, P=0,288). Após 05 sessões, os valores foram, respectivamente, de 25,88+22,62, 27,48+21,47 e 20,39+20,98 (ANOVA, P<0,000 diferença significativa entre os tempos e P= 0,535 diferença não significativa entre os grupos). Na avaliação inicial em escala verbal, os grupos ALONG, TENS e ALONG/TENS apresentaram, respectivamente, escores (mediana, percentis 25% e 75%) de 4(3/4), 4(4/5) e 4(3/4) (Teste de Kruskal-Wallis, P=0,217). Após 05 sessões, os valores foram, respectivamente, de 3(1/3), 3(2/3) e 3(0/3) (Teste de Friedman P=0,000 diferença significativa ao longo do tempo). Concluiu-se que as técnicas de alongamento e TENS são capazes de reduzir significativamente dores musculares com origem na coluna vertebral. Seus efeitos são similares, sugerindo igual eficácia analgésica. / Pain is a common symptom in several situations. It is probably the most frequent reason for the search of medical care. It is estimated that ten to twenty percent of the adult population suffer from chronic pain and that five percent show little response to treatment. The clinical approach to chronic muscular pain must be multidisciplinary, trying to interrupt the pain cycle. With that in mind, many techniques are used, such as muscular stretching, and transcutaneous electrical nerve stimulation (TENS). This research project aimed to evaluate analgesic response to stretching and/or TENS in five physiotherapy sessions for chronic pain in muscles of the spinal cord. A randomized, double-blind, parallel-group, stretching-controlled clinical trial was conducted at Centro Corpo in Porto Alegre, RS, Brazil. Patients with muscular pain in the spinal cord were studied. All of them were adults, with diagnosis of pain lasting for more than six months. The diagnosis was made by an orthopedist and the patients were beginning physiotherapeutic treatment between January and December, 2005. The patients were randomly divided in three groups: one of them was the control group and the other two were the intervention groups. The first group (STRETCH, n=33) did twenty minutes of muscular stretching and twenty minutes of sham TENS. Intervention group one (TENS, n=31) did twenty minutes of ineffective stretching exercises and twenty minutes of Acupuncture TENS. Intervention group two (STRETCH/TENS, n=31) did twenty minutes of effective stretching exercises and twenty minutes of Acupuncture TENS. From the 95 patients analyzed, 57.9% were women and 42.1% were men. They were similarly distributed along the three groups (Chi-square test, P=0.622). As to the region the pain was located, 32.6% presented cervical pain, 2.1% presented thoracic pain, 49.5% had lumbar pain, and 15.8% had cervical/lumbar pain (Chi-square test, P=0.120, to compare the three groups). Age ranged from 19 to 76, with no difference among the groups (ANOVA, P=0.456). It was observed that, throughout the five sessions, there was significant reduction of pain scores. No difference was detected, though, among the therapeutic methods which were studied. In the first evaluation using the Visual Analogical Scale, the groups showed the following scores (mean ± standard deviation): STRETCH: 53.85±24.18, TENS: 57.39±23.47, and STRETCH/TENS: 47.74 ±24.95 (ANOVA, P=0.288). After five sessions, the scores were: STRETCH: 25.88±22.62, TENS: 27.48±21.47, and STRETCH/TENS: 20.39±20.98 (ANOVA, P<0.000; significant difference among the times and P=0.535; no significant difference among the groups). In the first evaluation using the Verbal Scale the groups showed the following scores (median, 25 and 75 percentiles): STRETCH: 4 (3/4), TENS: 4 (4/5), and STRETCH/TENS: 4 (3/4) (Kruskal-Wallis test, P=0.217). After five sessions, the scores were: STRETCH: 3 (1/3), TENS: 3 (2/3), and STRETCH/TENS: 3 (0/3) (Friedman test, P=0.000 significant difference over time). It is concluded that the stretching and the TENS techniques can significantly reduce muscular pain originated in the spinal cord. Their effects are similar, which suggests equal analgesic efficacy.

A faísca eletrocirúrgica é o fenômeno que rege os principais efeitos da eletrocirurgia, o corte e a fulguração. Trabalhos anteriores forneceram evidências de que o processo da faiscância gera assimetrias importantes em corrente e tensão, a despeito da presença de capacitores nos circuitos do paciente. Tais assimetrias podem causar queimaduras eletrolíticas ou eletroestimulações indesejadas. Este trabalho investiga as características da deflagração da faísca, a quebra de rigidez dielétrica neste tipo de descarga elétrica, em espaços submilimétricos e em relação às geometrias, materiais e meio envolvidos na eletrocirurgia. Foi possível associar qualitativamente os valores dc aos valores ac de trabalhos anteriores. Esta associação e as peculiaridades da faísca eletrocirúrgica são discutidas aqui. Também são apresentadas as alterações que podem surgir nos processos de faiscância devido a alterações do tecido orgânico quando dessecado. / Electrosurgical spark is the phenomenon that rules the main effects of electrosurgery, cut and fulguration. Previous studies have shown evidences that electrosurgical sparkling generates important voltages and currents asymmetries, despite the presence of the dc protection capacitance at the patient circuit. Those asymmetries can lead to undesirable electrostimulation and dc burns. The present study has investigated the characteristics of the beginning of the spark, or the very moment of its breakdown, according to electrodes geometries, submilimetric gap distances, atmosphere temperature, pressure and humidity conditions, and electrodes materials. It was possible to notice a qualitative resemblance between the dc breakdown and the ac characteristics from previous studies. This association and peculiarities of the electrosurgical sparks and organic electrodes material influence are analyzed. Furthermore, characteristics such as alterations that can take place during sparkling processes due to changes in organic tissue when it gets dried are also presented and analyzed.

Electrical stimulation is an important tool in medicine with applications like muscle rehabilitation, pain management and pacemakers. Portable stimulation devices for home use are divided mainly in two domains: low and middle frequency therapies. Due to the lack, in Germany, of a system to provide both therapies at the same equipment, the main objective of this project is the development of a current source not only capable of that, but also able to generate arbitrary stimulation patterns controlled by an external microcontroller. Moreover, the system should make possible the use of interferential current therapy. The result of the project is an electronic device that triggers current stimulation patterns based on three control signals, which could be easily generated by a microcontroller. The system provides LF stimulation with balanced current pulses up to 80mA through 1k? load impedance, pulse widths between 50 and 1000µs, and frequencies up to 150Hz. It also provides MF stimulation outputs up to 100mApp, with a modulation frequency up to 4kHz and a simple interface to control the envelope waveform. It presents also two galvanic isolated channels to allow interferential current therapy and, when no output current is intended, it is able to provide a short circuit on the load to remove possible net charges introduced by the system to the patient’s body. Additionally, a MATLAB application and a SPICE simulation were developed to assist the creation of control signals. As the system is able to deliver stimulation currents with an arbitrary pattern, it can be used to find the best pulse waveforms for a series of different applications involving electrical therapy, like TENS and MES. / Elektrostimulation ist ein wichiges Hilfsmittel in der Medizin mit Anwendungen im Bereich der Muskelrehabilitation, der Schmerztherapie und in Herzschrittmachrn. Tragbare Stimulatoren zum hauslichen Gebrauch warden hauptsachlich in zwei Gruppen unterteit: Niederfrequenz- und Mittelfrequenztherapiegerate. Bisher gibt es in Deutschland kein Great das beide Therapieformen durchfuhren kann, sodas das Hauptziel dieses Projekts die Entwicklung einer Stromquelle ist, die in der Lage ist, beide Therapieformen anzuwender. Das Great ist zusatzlich in der Lage beiebige, einstellbare Stimulationsmuster zu erzeugen, welche durch einen externen Mikrocontroller gesteuent warden. Auberdem soll disses System Interferenzstromtherapie ermoglichen. Das Ergebnis dieses Projekts ist ein elektronisches Great, das auf drei Steuersignalen basierende Reizstrommuster erzeugt. Diese Steuersignale konnen von einem Mikrocontroller einfach generiert warden. Das System ermoglicht NF-Stimulation mit ausbalancierten Stromimpulsen bis zu 80mA bei 1K? Lastimpedanz, Pulsbreiten zwischen 50 und 1000us und Frequezen bis 150Hz. Es beinhaltet MF-Stimulationsausgange fur bis zu 100mApp Ausgangsstrom, mit Modulationsfrequenzen bis zu 4k Hz und einem einfachen Interface zur Steuerung der Wellenform der Hullkurve. Es bietet zwei galvanische getrennte Kanale zur Interferenzstromtherapie. Falls Kein Ausgangsstrom benotgt wind, konnen die Ausgange Kurzeschlossen warden, um den korper des Patienten vo einer moglichen elektrischen Aufladung das Gerate zu schutzen. Daruber hinaus wurden eine MATLAB application und eine SPICE Simulation entwickelt, um die Erstellung von Steuersignalen zu unterstutzen. Das System Kann beliebige Reiztrommuster erzengen, dadurch eignet es zur Erforschung der optimalen Impulswellenformen vieler verschiedener Elektrotherapien. / 5000

A faísca eletrocirúrgica é o fenômeno que rege os principais efeitos da eletrocirurgia, o corte e a fulguração. Trabalhos anteriores forneceram evidências de que o processo da faiscância gera assimetrias importantes em corrente e tensão, a despeito da presença de capacitores nos circuitos do paciente. Tais assimetrias podem causar queimaduras eletrolíticas ou eletroestimulações indesejadas. Este trabalho investiga as características da deflagração da faísca, a quebra de rigidez dielétrica neste tipo de descarga elétrica, em espaços submilimétricos e em relação às geometrias, materiais e meio envolvidos na eletrocirurgia. Foi possível associar qualitativamente os valores dc aos valores ac de trabalhos anteriores. Esta associação e as peculiaridades da faísca eletrocirúrgica são discutidas aqui. Também são apresentadas as alterações que podem surgir nos processos de faiscância devido a alterações do tecido orgânico quando dessecado. / Electrosurgical spark is the phenomenon that rules the main effects of electrosurgery, cut and fulguration. Previous studies have shown evidences that electrosurgical sparkling generates important voltages and currents asymmetries, despite the presence of the dc protection capacitance at the patient circuit. Those asymmetries can lead to undesirable electrostimulation and dc burns. The present study has investigated the characteristics of the beginning of the spark, or the very moment of its breakdown, according to electrodes geometries, submilimetric gap distances, atmosphere temperature, pressure and humidity conditions, and electrodes materials. It was possible to notice a qualitative resemblance between the dc breakdown and the ac characteristics from previous studies. This association and peculiarities of the electrosurgical sparks and organic electrodes material influence are analyzed. Furthermore, characteristics such as alterations that can take place during sparkling processes due to changes in organic tissue when it gets dried are also presented and analyzed.