- source- lidocaine with epinephrine - polarity-positive - indications- local anesthetic - concentration- 5

Chap 8 - E-STIM Flashcards by Meg Rowan

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

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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

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what is action potential

The basic unit of nerve communication

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what does IFC mean

interferential current

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NMES

neuromuscular electrical stimulation

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Inotophoresis

delivery of medication

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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.

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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

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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

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Typically TENS is used for what type of pain

Chronic (more than six months)

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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)

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What sensation testing would you use for Electrical stimulation

Light touch is sufficient

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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)

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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.

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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

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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

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Longer pulses and high current amplitudes are used for what type of stimulation?
200-400 us

Motor stimulation

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Short pulses and low current amplitudes are used for what type of sensory?
100-300 us

Sensory stimulation

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Ramp up time /Ramp down time

time it takes stimulator to go from no current to its maximum intensity

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Acetate (bone spurs)- for ionto

source - Acetic acid
plarity- Negative
indications- calcium deposits
concentration-2.5-5

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Dexamethasone phosphate- for ionto

-source- DexNa, PO3
-polarity-negative
-indications- inflammation
concentration-.4

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Lidocaine

source- lidocaine with epinephrine
polarity-positive
indications- local anesthetic
concentration- 5

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Pulse current

the period when current is flowing in any direction

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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

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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

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.