Microcurrent therapy (MCT) involves the application of sub-sensory electric current and can promote tissue repair, possibly by mimicking endogenous electrical cues for healing. It has been used successfully to treat recalcitrant bone fractures and skin ulcers, but its effects on other forms of tissue have received little attention. This study aimed to investigate the potential of MCT to promote healing and alleviate symptoms in a selected soft connective tissue disorder. A systematic review of human studies involving MCT for soft connective tissue damage was conducted. A survey of 93 musculoskeletal physiotherapists was used to help select a common, recalcitrant disorder to treat with microcurrent in a clinical trial. Novel sonographic scales to quantify tendon structural abnormality and tissue healing were developed, and their measurement properties evaluated along with several clinical and patient-rated outcome measures. Two preliminary clinical trials, involving 62 people with the selected disorder – chronic tennis elbow - were conducted, comparing four different types of microcurrent applied daily for 3 weeks. The review found fair quality evidence that certain forms of MCT can relieve symptoms, and low quality evidence that they can promote healing, in several soft connective tissue disorders, including those affecting tendons. Optimal treatment parameters are unknown. In the survey, clinicians identified frozen shoulder, plantar fasciitis and tennis elbow as particularly problematic, and tennis elbow was selected for treatment in the trials. The sonographic scales of hyperaemia had fair-to-good inter-rater and test-retest reliability. Minimum Detectable Change values are calculated for the sonographic scales and for pain-free grip strength measurements. The trials suggest that monophasic microcurrent of peak amplitude 50 µA applied for 35 hours was most effective in symptom alleviation, with a 93% treatment success rate three months after treatment. By final assessment, pain-free grip strength increased by 31% (95%CI:5,57%), pain measured on a multiple-item questionnaire reduced by 27% (95%CI:16,38%) and patient-rated functional disability by 26% (95%CI:14,28%). MCT with a current amplitude of 500 µA was significantly less effective, and varying the waveform appeared less important in determining outcomes. Differences between groups were non-significant on several measurs, though there was a risk of type II error in the tests used. No significant differences between any groups were seen in sonographic assessments, although consistent patterns in bloodflow chage suggested that MCT may modulate hyperaemia levels. Higher baseline hyperaemia was associated with sustained falls in hyperaemia levels after treatment, and with improved clinical outcome. MCT’s analgesic effect does not rely on sensory stimulation, and further investigation of its influence on tendinous blood flow and vascularity, or on the local biochemical milieu, may help elucidate its mechanism of action. On the basis of this investigation, a fully-powered controlled clinical trial is justified. A protocol, combining MCT with an exercise programme, is proposed.

No description available.

Uma investigação experimental sobre a influência da estimulação elétrica direta na regeneração do nervo usando uma lesão por esmagamento do nervo ciático de ratos como modelo foi realizada. Quarenta e dois ratos foram utilizados e divididos em quatro grupos, de acordo com o procedimento: 1) Sem lesão e sem estimulação; 2) lesão por esmagamento, sem estimulação; 3) sem lesão, com estimulação; 4) lesão por esmagamento, com estimulação. O nervo ciático foi exposto através de uma incisão lateral na coxa direita e submetido à lesão por esmagamento numa máquina universal de testes com uma carga de 15.000 g concentrada em um segmento de 5 mm por 10 minutos, nos grupos 2 e 4. Um estimulador elétrico foi desenvolvido para liberar uma corrente elétrica contínua de baixa intensidade (1 &#956A). O mesmo foi implantado no espaço subcutâneo próximo a coluna lombar, o ânodo foi colocado proximalmente e o catôdo distalmente ao esmagamento. A recuperação funcional foi avaliada em intervalos semanais até o 21º dia pós-operatório, através do Índice Funcional do Ciático (IFC) e calculada por um programa específico, apresentando melhora progressiva em ambos os grupos com lesão por esmagamento, porém mais acentuada naqueles com estimulação elétrica. Os animais foram sacrificados no 21º dia pós-operatório para análise histológica e morfométrica dos nervos, onde os resultados mostraram aumento da densidade das fibras nervosas mas decréscimo do diâmetro das fibras nervosas, assim como um aumento no número e diâmetro dos vasos sangüíneos intra e extra~fasciculares no grupo estimulado. Similar, mas um menos evidente fenômeno foi observado no grupo sem lesão por esmagamento mas com estimulação elétrica. Concluiu-se que a estimulação elétrica direta de baixa intensidade provoca a regeneração nervosa após lesão por esmagamento em condições controladas e que o IFC é um método confiável para avaliar a recuperação nervosa uma vez que seus resultados aproximam-se do estudo morfométrico. / An experimental investigation of the influence of direct electrical stimulation on nerve regeneration using a crush injury of the sciatic nerve of rats as model was undertaken. Forty two rats were used and divided into four groups according to the procedure carried out: 1) no injury, no stimulation; 2) crush injury, no stimulation; 3) no injury, stimulation; 4) crush injury, stimulation. The sciatic nerve was exposed through a lateral incision on the Iight thigh and submitted to a crush injury in an universal testing machine with a 15000 g load concentrated on a 5 mm-long segment for 10 minutes, in groups 2 and 4. An electrical stimulator was developed to deliver a continuous direct low intensity electrical current (1 &#956A). The device was implanted into the subcutaneous space near the lumbar spine, the anode placed proximally and the cathode distally to the crush injury. Functional recovery was checked at weekly intervals up to the 21st postoperative day, by means of the Sciatic Functional Index (SFI) as calculated by a specific software and showed progressive improvement in both groups with crush injury but more marked in that with electrical stimulation (4). The animals were killed on the 21st post operative day for morphometric and histological examination of the nerves, whose results showed an increased nerve fiber density but decreased nerve fíber diameter, as well as increased number and diameter of intra and extrafascicular blood vessels in the stimulated group. Similar but less marked phenomena were observed in the group without crush injury but with electrical stimulation. It was concluded that low intensity direct electrical stimulation enhances nerve regeneration followíng a crush injury in controlled conditions and that the SFI is a reliable method to evaluate the nerve recovery since its results closely matched those of the morphometric study.

Uma investigação experimental sobre a influência da estimulação elétrica direta na regeneração do nervo usando uma lesão por esmagamento do nervo ciático de ratos como modelo foi realizada. Quarenta e dois ratos foram utilizados e divididos em quatro grupos, de acordo com o procedimento: 1) Sem lesão e sem estimulação; 2) lesão por esmagamento, sem estimulação; 3) sem lesão, com estimulação; 4) lesão por esmagamento, com estimulação. O nervo ciático foi exposto através de uma incisão lateral na coxa direita e submetido à lesão por esmagamento numa máquina universal de testes com uma carga de 15.000 g concentrada em um segmento de 5 mm por 10 minutos, nos grupos 2 e 4. Um estimulador elétrico foi desenvolvido para liberar uma corrente elétrica contínua de baixa intensidade (1 &#956A). O mesmo foi implantado no espaço subcutâneo próximo a coluna lombar, o ânodo foi colocado proximalmente e o catôdo distalmente ao esmagamento. A recuperação funcional foi avaliada em intervalos semanais até o 21º dia pós-operatório, através do Índice Funcional do Ciático (IFC) e calculada por um programa específico, apresentando melhora progressiva em ambos os grupos com lesão por esmagamento, porém mais acentuada naqueles com estimulação elétrica. Os animais foram sacrificados no 21º dia pós-operatório para análise histológica e morfométrica dos nervos, onde os resultados mostraram aumento da densidade das fibras nervosas mas decréscimo do diâmetro das fibras nervosas, assim como um aumento no número e diâmetro dos vasos sangüíneos intra e extra~fasciculares no grupo estimulado. Similar, mas um menos evidente fenômeno foi observado no grupo sem lesão por esmagamento mas com estimulação elétrica. Concluiu-se que a estimulação elétrica direta de baixa intensidade provoca a regeneração nervosa após lesão por esmagamento em condições controladas e que o IFC é um método confiável para avaliar a recuperação nervosa uma vez que seus resultados aproximam-se do estudo morfométrico. / An experimental investigation of the influence of direct electrical stimulation on nerve regeneration using a crush injury of the sciatic nerve of rats as model was undertaken. Forty two rats were used and divided into four groups according to the procedure carried out: 1) no injury, no stimulation; 2) crush injury, no stimulation; 3) no injury, stimulation; 4) crush injury, stimulation. The sciatic nerve was exposed through a lateral incision on the Iight thigh and submitted to a crush injury in an universal testing machine with a 15000 g load concentrated on a 5 mm-long segment for 10 minutes, in groups 2 and 4. An electrical stimulator was developed to deliver a continuous direct low intensity electrical current (1 &#956A). The device was implanted into the subcutaneous space near the lumbar spine, the anode placed proximally and the cathode distally to the crush injury. Functional recovery was checked at weekly intervals up to the 21st postoperative day, by means of the Sciatic Functional Index (SFI) as calculated by a specific software and showed progressive improvement in both groups with crush injury but more marked in that with electrical stimulation (4). The animals were killed on the 21st post operative day for morphometric and histological examination of the nerves, whose results showed an increased nerve fiber density but decreased nerve fíber diameter, as well as increased number and diameter of intra and extrafascicular blood vessels in the stimulated group. Similar but less marked phenomena were observed in the group without crush injury but with electrical stimulation. It was concluded that low intensity direct electrical stimulation enhances nerve regeneration followíng a crush injury in controlled conditions and that the SFI is a reliable method to evaluate the nerve recovery since its results closely matched those of the morphometric study.

The theoretical part of the thesis deals with the explanation of the actions that occur during the stimulation of tissues with the electric current. A significant analogy with electrical circuits is used to describe the phenomena at the molecular and cellular level. The models of membrane and cell are necessary for understanding the behaviour of more complex structures, such as tissues and organs. A considerable attention is paid to the conditions of electrical stimulation which bring about response in the stimulated area. Next, the cumulative effect of the subthreshold stimulation is analysed. The mechanisms of common treatment effects of the electrotherapeutic methods are outlined. The research results in the practical part of the thesis – the design for a microstimulator. Properties of the microstimulator and compliance with standard requirements are verified by testing the electromagnetic compatibility and electrical safety, conducted by the Institute for testing and certification, JSC. The effects of microstimulation on living organisms are experimentally investigated on horses, in collaboration with the Veterinary and Pharmaceutical University. For the first time, thermodynamic sensors are used for the objective assessment of the microstimulation therapeutic effect. These miniature sensors are placed on the horse´s front legs and monitor the changes in thermal activity while only one limb is really stimulated and the other is just considered as a reference. Comparison and statistical evaluation of the measured signals could provide a more detailed view of the thermal changes within the stimulated area, which is significantly related to blood circulation in limbs, and with the support of the reduction of edema. The course of the experiment which deals with the effect of microstimulation on edema of the horse´s legs caused by minor injuries (tendinitis, sprains, etc.), is documented in photographs or videos that are significant for possible evaluation of the effectiveness of the stimulation in this application.