Original Research Sensory and Motor Thresholds of Transcutaneous Electrical Stimulation Are Influenced by Gender and Age Rinaldo Roberto de Jesus Guirro, PhD, Elaine Caldeira de Oliveira Guirro, PhD, Natanael Teixeira Alves de Sousa, PT Background: Transcutaneous electrical stimulation (ES) is a therapeutic procedure used in rehabilitation. However, the effectiveness of it depends on sensory responses to pain and motor control in neuromuscular recruitment, considering the differences related to gender and age of the subjects treated, as well as the intensity and frequency of ES. Objective: To determine the threshold of sensory perception (TSP) and the threshold of motor response (TMR) in young and elderly individuals of both genders. Design: Randomized controlled clinical trial. Setting: General community. Participants: Eighty volunteers with no history of systemic diseases were selected to participate in the study: 40 men and 40 women were subdivided by convenience sampling and age group into young male and female (age 21.6  2.4 years) groups as well as into elderly female and male groups (age 72.6  6.1 years). Interventions: The participants received electrical stimulation (ES) at 5 and 50 Hz, with pulse durations of 20, 100, 400, 1000, and 3000 ms applied on the flexor muscle bellies of the wrist and fingers. Main Outcome Measures: TSP was identified as the first sensation of increased current intensity and TMR as the minimum muscle contraction detected. The results were submitted to analysis of variance, followed by the Tukey’s test, with a significance level of 5%. Results: TSP was lower than TMR for all pulse durations, regardless of gender and age. In women, TSP was lower than that in young and elderly men at both frequencies. However, TSP was higher in elderly subjects than in younger subjects at 50 Hz for both genders. Age also affected the TMR, presenting higher thresholds in elderly subjects of both genders at 50 Hz; however the same occurred only in male subjects at 5 Hz. Conclusion: Age and gender interfere directly with ES. These variables should be considered during rehabilitation because they indicate that electrical stimulation in elderly women should be carefully performed, as they have lower thresholds than elderly men when polarized currents are used, and there is a risk of skin lesion because of their high thresholds. PM R 2014;-:1-6 INTRODUCTION Electrical stimulation, when applied with percutaneous electrodes, is a noninvasive therapeutic procedure useful in clinical practice. It has been often used in rehabilitation in several areas of health care, such as analgesia, tissue repair, circulation, and neuro- muscular stimulation, especially at the sensory [1] and motor [2] levels. The term threshold is applied to denote the energy required to promote presynaptic excitation of the neuronal membrane, which produces sensory (sensory threshold) or motor response (motor threshold) [3]. The combination of physical parameters (ie, pulse duration, intensity, frequency) characterize the different types of electrical currents, thus producing several therapeutic R.R.d.J.G. Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; and Post- Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medi- cal School, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil. Address corre- spondence to: R.R.J.G.; e-mail: rguirro@fmrp. usp.br Disclosure: nothing to disclose E.C.d.O.G. Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; and Post- Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medi- cal School, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil Disclosure: nothing to disclose N.T.A.d.S. Department of Biomechanics, Medicine and Rehabilitation and post-grad- uate program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil Disclosure: nothing to disclose The present study received financial assis- tance in the form of a grant from the Coordi- nation for Improvement of Higher Education Personnel (CAPES) Foundation; and National Council for Scientific and Technological Development (CNPq - N  :487767/2013-6). Clinical trial registration number: NCT01876160. Submitted for publication August 9, 2013; accepted July 6, 2014. PM&R 1934-1482/14/$36.00 Printed in U.S.A. ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. -, 1-6, Month 2014 http://dx.doi.org/10.1016/j.pmrj.2014.07.004 1 FLA 5.2.0 DTD  PMRJ1294_proof  30 August 2014  1:16 pm  ce