Chap 8 - E-STIM Flashcards
How can the application of electrical currents benefit the patient? What are the clinical uses.
- Pain control
- muscle strengthening and re-education
- decrease muscle spasm
- wound healing
explain the physiological effects of each physical agent #8
by depolarizing the nerve membranes and thereby producing action potentials, the message unit of the nervous system . Once that acton potential is propagated along eh axon, the human body responds to it in the same way as it does to action potentials that are initiated by physiological stimuli
what is action potential
The basic unit of nerve communication
what does IFC mean
interferential current
NMES
neuromuscular electrical stimulation
Inotophoresis
delivery of medication
What is gate control
stopping the pain at the spinal cord level. tricking the body to focus on the vibrations. Not treating the condition just blocking the pain.
Parameters for conventional TENS
- PPS (pulse frequency) 100 to 150
- PD (pulse width, duration) 50-80 us
- C-continuous
- produce tingling only -no muscle contraction
- can be worn 24hrs but not recommended
Acupuncture-like TENS
- uses the burst mode units of 10s
- PPS=2-10
- PD (pulse duration, width) 200-300
- visible contraction
- tx time 20-30 mins
- release endorphins
Typically TENS is used for what type of pain
Chronic (more than six months)
Note when you are doing IFC use always use the same pulse frequency (rate) of….
PPS (pulse rate or frequency)
low beat is 100pps (hz)
high beat is 150pps(hz)
What sensation testing would you use for Electrical stimulation
Light touch is sufficient
placement of electrodes TENS
- clean skin with alcohol pads
- around the painful area
- doesn’t matter crossed or parallel patterns
- make sure setting are correct
- explain the what they will be feeling (tingling)
If the patient accommodates to the continuous setting what can you do and why?
turn it to the modulation setting so it comes in waves and it will take them a longer time to accommodate to the tx.
Contra for ES
P- pace maker
C- Carotid sinus (don’t place over)
A- Arterial thrombosis or thrombophlebitis (blood clot cause embolism)
P- pregnant women’s abdomen or back
precaution for ES
O- open wounds M- malignant tumore 5-7 yrs (not benign) I- impaired mentation M I- impaired sensation C- Cardiac disease S- skin irritation
Longer pulses and high current amplitudes are used for what type of stimulation?
200-400 us
Motor stimulation
Short pulses and low current amplitudes are used for what type of sensory?
100-300 us
Sensory stimulation
Ramp up time /Ramp down time
time it takes stimulator to go from no current to its maximum intensity
Acetate (bone spurs)- for ionto
source - Acetic acid
plarity- Negative
indications- calcium deposits
concentration-2.5-5
Dexamethasone phosphate- for ionto
-source- DexNa, PO3
-polarity-negative
-indications- inflammation
concentration-.4
Lidocaine
- source- lidocaine with epinephrine
- polarity-positive
- indications- local anesthetic
- concentration- 5
Pulse current
the period when current is flowing in any direction
A waveform produced by the interference of two medium frequency sinusoidal alternate currents of slightly different frequencies.
Mrs T notes
2 channel wave form produced by 2 medium frequency alternating currents to produce eats
interferential current
the frequency modulation of an interferential current
sweep
the time from the beginning of the first phase of a pulse to the end of the last phase of a pulse
Pulse duration
A continuous unidirectional flow of charged particles
Direct current (DC)
a continuous flow of charged particles without interruptions or breaks
Continuous current
the positive electrode
Anode
Cathode
the negative electrode (way to remember C is for Cat and if you don’t like cats that is negative)
TENS with short durations, low amplitude pulses used to control pain; also called high rate TENS
Conventional TENS
TENS with long-duration, high-amplitude pulses used t control pain; also called low rate TENS
acupuncture-like TENS
The movement or flow of charged particles through a conductor in response to an applied electrical field.
Electrical current
a continuous bidirectional flow of charged particles
Alternating current
the application of electrical current through the skin to modulate pain
Transcutaneous electrical nerve stimulation
what are the types of electrical currents
- Direct current
- alternating current
- pulsed current
- interferential current
- premodulated current
- Russian Protocol
An interrupted flow of charged particles where the current flows in a series of pulses separated by periods when no current flows
- Mrs T notes Discontinued flow of current
- monophasic
- biphasic
pulsed current
an alternating current with a medium frequency and sequentially increasing and decreasing current amplitude, produced with a single circuit and only two electrodes
Mrs. T notes
-1 channel wave form producing inferential effect.
premodulated current
a waveform with specific parameters intended for quadriceps muscle strengthening.
Mrs Ts notes
Polyphasic alternating current waveform delivered at 50 bursts per second.
Russian protocol
Effects of electrical currents
- circulatory
- metabolic
- musculoskeletal
mrs Ts notes
What does electrical currents do for the circulation?
It increase local cellular circulation
mrs Ts notes
What does electrical currents do for metabolism?
- promotes galvanotaxis
- increases antimicrobial activity
mrs Ts notes
What does electrical currents do for musculoskeletal ?
- Increases muscle contraction via creating action potentials
- promotes pain modulation
Mrs Ts notes (pg 216 tbl 8-1)
the change in the nerve membrane potential (via the electrical current) must be great enough to cause an action potential
Strength duration curve
MVIC
Maximum voluntary isometric contraction
This type of ES stimulates large diameter axons first then smaller diameter
-consider this for tx time and also for functional ES
NMES
NMES -type I muscle fibers are
slow twitch muscle fibers
NMES - type II muscle fibers are
fast twitch muscle fibers
higher force contraction; more muscle strength gain
overload principal
The place in a muscle where electrical stimulation will produce the greatest contraction with the least amount of electricity, generally located over the middle of the muscle belly
pg 419-421
Motor points
- Pulses per second (pps)
- Hz
Frequency
a current that is made up of two phases; the first phase begins when current starts to flow in one direction and ends when the current starts to flow in the other direction, which is also the beginning of the second phase
biphasic pulse
number of cycles per sec/ alternating current
Hz
us
microsecond
on/off cycle for sensory
constant
on/off cycle for motor
not constant
Why would you use IFC?
decrease pain
decrease inflammation
increase ROM
for the acute stage
FYI- Large unit (vectra Genisys) and small unit
both can be set at low beat or high beat
the process of a nerve gradually becoming less responsive to stimulation
-a transient increase in threshold to nerve excitation
Mrs T - increase in intensity
accommodation
Any pattern of variation in one or more of the stimulation parameters.
Mrs T - to vary the current
modulation
A series of pulses where the charged particles move only in one direction is known as?
monophasic
what adjustments can be made to for a patient that begins to accommodate the tx?
- Beat
- Intensity
- Electrodes
These serve as interface between stimulator and patient and connects the leads to wires
Electrodes
FYI
larger electrodes tend to feel more comfortable than smaller ones
FYI
the smaller electrodes are better at targeting smaller muscle groups.
What happens when you increase the distance between the electrodes
it increases the depth of penetration and decreases specificity
Where should you not place electrodes .
Over bony prominences
carotid artery
Adverse reactions to ES
burns
skin irritation
pain
what is the recommended on and off time for an initial Russian E-Stim treatment if the goal is to improve muscle strength?
1:5 ratio initially
What is the recommended on:off ratio to utilize when decreasing muscle spasm is the goal?
2:5 ratio
What is the recommended on:off ratio when utilizing e-stim if the goal is to decrease edema?
2:5 ratio
When utilizing e-stim with the goal of muscle strengthening (Russian), what are the recommended treatment parameters?
same as re-education
PPS 35-80
PD 150-200 small muscles
PD 200-350 large muscles
When utilizing NMES (muscle re-education), what are the recommended treatment parameters?
same as strengthening
PPS 35-80
PD 150-200 small muscles
PD 200-350 large muscles
What is important about electrode placement when utilizing IFC?
criss cross
centering around the point of pain
1 to 2 inches apart
What is the purpose of Iontophoresis?
to use a low-amplitude direct current to facilitate transdermal drug delivery.
FYI
“Ideal electrode placement should be documented, noting distance or approximation to bony landmarks or anatomical structures, so that follow up sessions can replicate the same placement. Diagrams are often helpful.
