Chapter 10 - Therapeutic Modalities Flashcards
Describe the galvanotaxic effect of electrical stimulation
Attraction of tissue repair cells via electrode polarity
- Inflammation phase: macrophages (+), mast cells (-), neutrophils (+ or -)
- Proliferation phase: fibroblasts (+)
- Wound contraction phase: alternating +/-
- Epithelialization phase: epithelial cells (+)
Absolute contraindications for electrical stimulation
- anywhere in the body for demand-type pacemakers or other electronic devices such as insulin pumps, unstable arrhythmias, suspected epilepsy, or seizure disorder
- over or in the area of the carotid sinus, thrombophlebitis, eyes, thoracic region, phrenic nerve, urinary bladder stimulators, and abdomen or low back during pregnancy
What is the recommended duty cycle for electrical stimulation when the goal is muscle strengthening or muscle re-education?
≥3:1
Conventional TENS
- Amplitude: comfortable tingling sensation, paresthesia. No muscle response.
- Pulse rate: 50-80 pps
- Pulse duration: 50-100 µsec
- Mode: continuouse
Acupuncture-like TENS
- Amplitude: strong, but comfortable rhythmic muscle twitches
- Pulse rate: 1-5 pps
- Pulse duration: 150-300 µsec
- Mode: continuous
High-voltage pulsed current
- Waveform: paired monophasic, with an instantaneous rise and exponential fall of current
- Current: continuous, surged or interrupted pulsatile current
Wound healing parameters of HVPC
- Amplitude: comfortable, but tingling sensation, paresthesia, no muscle response
- Pulse rate: 50-200 pps
- Pulse duration: 20-100 µsec
- Mode: continuous
*For bactericidal effect, the active electrode should have a negative polarity. For a culture-free wound, the active electrode should be positive.
Functional electrical stimulation (FES)/Neuromuscular electrical stimulation (NMES) for shoulder subluxation
- Amplitude: tetanic muscle contraction to patient’s tolerance
- Pulse rate: 12-25 pps
- Duration of treatment: 15-30 minutes; 3x/day up to 6-7 hours. On/off ratio: 1:3 (2 sec: 6 sec) progressing to 12:1 (24 sec: 2 sec)
Functional electrical stimulation (FES)/Neuromuscular electrical stimulation (NMES) for foot drop
- Amplitude: tetanic muscle contraction sufficient to decrease plantarflexion
- Pulse rate: 30-300 pps
- Treatment mode: heel switch contains pressure-sensitive contact that stops stimulation during stance phase and activates stimulation during swing phase. Hand switch also allows the therapist to control stimulation during gait.
Lidocaine, Xylocaine
- Positive
- Analgesia
Salicylate
- Negative
- Analgesia
Acetate (acetic acid)
- Negative
- Calcium deposits
Zinc (zinc oxide)
- Positive
- Dermal ulcers
Hyaluronidase (wydase)
- Positive
- Edema reduction
Copper (copper sulfate)
- Positive
- Fungal infections
