Ch. 10 Clinical Uses of Electrical Stimulation Flashcards
Define TENS and explain the parameters for SENSORY tens:
TENS - Transcutaneous electrical nerve stimulation
-Unknown if it’s effective in reducing pain
SENSORY TENS
- AKA: High-rate tens
- TARGET: A-Betas
- PAIN THEORY: Gate control theory (‘on’) since target is A-Betas
- PULSE RATE HIGH: 60-120 pps
- PHASE DURATION: less than 100 usec
- CONTINUOUS: no duty cycle
- Used mostly in acute phase of pain
“let me know when you feel it, it should be comfortable but not painful”
Define Motor TENS and explain its parameters:
Motor TENS:
-AKA: Low-rate tens
-TARGET: A-Deltas
-PHASE DURATION HIGH: 200-300 usec
-CONTINUOUS: no duty cycle
-FREQUENCY/PULSE RATE LOW: 2-7 pps
-PAIN THEORY: motor pain modulation theory
(Chemical release of endorphins from the pituitary gland)
*Treats subacute pain or trigger points, used in the repair phase NOT on acute injury as there will be muscle contractions
Define Noxious TENS and explain its parameters:
Noxious TENS: pain relief through central biasing mechanism, commonly used with point stimulators
1) PAG (midbrain) –> medulla –> substantia gelatinosa
2) Pons
-TARGET: C-Fibers
-PAD PLACEMENT: Dispersive pad and small probe to be more potent
***PHASE DURATION LONG: 10-20ms (milisec)
-FREQUENCY:
High (100-150pps), Low (2-7pps)
-Using probe, stimulate each motor point for 30 sec, have 8-10 points
*Not commonly practiced
Explain the different methods of pad placement:
1) Direct - place pads directly where it hurts
2) Spinal cord level - spinal nerve roots parallel to spine
3) Around the painful tissues
4) Dermatome placement (spinal nerve root, and distal end of dermatome) ex: one on back, one on leg
5) Contralateral (NOT SEEN MUCH) - pads placed on opposite side of pain
**Avoid bony areas, place pads around them instead
Define IFC and explain its parameters:
IFC - interferential stimulation
- Used for pain relief, increased circulation, and muscle stimulation
- *PRIMARILY used for pain control
- CARRIER FREQUENCY: 4,000-5,000 Hz
- PHASE DURATION: 100-125 usec (PRESET)
- “beat” frequency ranges from 1-1,000 beats/sec
- WEDENSKI’S INHIBITION: applied too fast, no refractory period of nerce
- QUADRIPOLAR SET UP (criss cross)
What does NMES mean?
NMES - Neuromuscular electrical stimulation
What is muscle reeducation neuromuscular e-stim used for?
- Used to overcome muscle inhibition after injury or surgery
- GOAL= see strong muscle contraction by stimulation the alpha motor neuron
EX: Trying to see quad contraction, pad placement (2) pads = one on VMO, one on midpoint of quad
List the two types of NMES and their parameters:
BIPHASIC NMES:
- Phase duration: 250-300 usec
- Pulse rate 35-50 pps
- Duty cycle 1:5 initially
- Have pt contract with stim
RUSSIAN NMES:
- Phase duration PRESET at 200 usec
- Pulse rate 35-50 pps
- Duty cycle 1:5 initially
- Have pt contract with stim
- *- stronger than biphasic, higher frequency, typically used more on younger pt’s than older
Explain the pad placement for neuromuscular e-stim?
For NMES, the electrodes are placed over the motor points which are usually located at the muscle belly.
OPTIONS:
- Reciprocal: stim quad 10 sec, hamstring 10 sec
- co-contraction: requires 2 channels
Describe High-Volt pulsed current stimulation?
High-Volt stim has a voltage of atleast 150V, and uses a twin-peaked monophasic current (does not cross line)
High-volt has deeper penetration, uses an active and dispersive lead, and does not cause skin irritation like direct current stim. High volt is more comfortable than direct current.
What is high-volt used for?
pain, edema (swelling), tissue healing, muscle spasms
Describe the parameters for high-volt stimulation?
- Waveform: monophasic
- Phase duration: 50-120 usec (CANNOT be adjusted)
- Monopolar set-up (unequal pad size)
- Frequency: 50-80 pps
- Nerve targeted: A-betas
- BEST FOR ACUTE PHASE
- Can be continuous or surge (on/off)
Explain what HVPC is?
HVPC - high volt pain modulation (high volt for pain control)
*Most treatments begin with the negative polarity then switch to positive
- Negative polarity: Encourages blood clots to dissolve
- Positive polarity: Encourages blood clot formation
Why is it so important to consider which polarity to select when using high-volt stim for wound healing?
Positive current = cellular migration, biosynthesis
Negative current = retard microorganism growth
**If wound is infected, MUST use (-) negative polarity until culture is free for 3-5 days; then switch to (+) positive
**If wound is not infected and is just having a hard time healing, use (+) positive to jumpstart, then switch to (-) negative
How do you place the electrodes when using high-volt for wound healing?
The electrodes are placed on the wound once the wound itself is packed with gauze or saline. Typically use the carbon electrodes as they will not tear skin.
The duration varies anywhere from 20 minutes to one hour, and the frequency is between 80-120 pps
