Chpt. 6 Foundations Flashcards
What are 3 types of electro Therapy (E-Stimulation)?
1) Electrotherapy
2) Electrodiagnosis – interpreting the response of nerves and mm to stim
3) EMG – electromyography
What is NMES?
Neuromuscular electrical stim
– stimulating innervated mm (muscles) to restore function. Includes strengthening and muscle re-ed
What is TENS?
Transcutaneous electrical nerve stim.
– pain management through skin electrodes
What is IFC?
*most liked by patients
Interferential Current –
4 electrodes. Used for pain. 2 currents – interfering.
What is EMS?
Electrical Muscle Stimulation
– done to maintain muscle viability
Positive charge of the proton in the nucleus is balanced by the ____ electrons outside
negative
Movement is caused by losing electrons, and is therefore called:
electricity
**What are 3 UNSTABLE ions , that are used in axon (nerve) movement for example?
sodium
potassium
calcium
What is the difference between atom and ion?
an ion is lacking an electron
What is all matter composed of ?
atoms and ions
**What are 8 different atoms in your BODY?
carbon nitrogen hydrogen calcium phosphorus *sodium potassium magnesium
What ion is Highly reactive ion because it is so unstable (one extra electron) ?
sodium
*What is a conductor ?
made of material that are composed of reactive atoms
*What is an Insulator?
materials with atoms that have stable outer shells
What is a really good conductor ?
- therefore it is used as gel for electrical stimulation (ex. TENS)
water
What is a really good insulator?
skin (fat)
Where the nerve enters the muscle is the ____ ?
motor point
***Electrons flowing continuously in 1 direction is called what?
Direct Current (DC)
What is an electric current?
he actual flow of electrons in a conductor
What is a current (I) measured in?
***What is a Therapeutic current flow measured in?
(A) ampere
mA ( milli amperes)
The more Voltage (V) the more what ?
power
ex. the more you open up the water tao, the more comes out
What is Resistance (r) ?
What is it measured in?
ease or difficulty of current moving through substances
- (Ohm)
- All materials offer some resistance to current flow
What is Impedence?
What is both resistance and impedence measured in?
opposition of electrical circuits to flow of AC
-Ohm
What is the formula for Ohm’s Law?
V=I x R
Voltage=Current x Resistance
Current and Resistance are ____ related ?
inversely
What is directly proportional to Current flow ?
Voltage
What are the 2 types of “flows” or electrical current in the body ?
- electron flow
- ionic flow
How is an acidic (HCL=hydrochloric acid) environment created which isn’t very good for you?
Negative ions are driven towards the positive pole (anode)
***How does TENS work ?
stimulates sensory
sodium and potassium crosses the membranes
What is Saltitory conduction (happens on mylenated nerve) ?
happens in TENS
*positive and negative current switch directions the whole time= flipping back and forth
Where does the TENS need to be located on your body when in use?
peripheral nerve
** What is Biphasic pulse and why is it important?
One direction of current flow in (+), stops, flips, other direction (-) etc.
*Has a Gap between switching directions
to prevent HCL (hydrochloric acid)
Assymetrical Byphasic used in TENS and NMES and is what?
- similar to biphasic but it FEELS good for patients because it it NOT symmetrical (first a square then a a triangle etc.)
What is monophasic pulse?
has one phase; always unidirectional (+ ve or -ve)
*3 important things to know how to use a TENS machine?
- Amplitude- Adjust current (like turning up volume)
- Pulse Width
- Frequency
What is Peak amplitude?
Higher peak is deeper ___ ?
maximum current delivered in one phase
deeper penetration in to tissue
What 4 levels stimulation, is E-stim capable of generating?
- subsensory
- sensory
- motor
- noxious
*The longer you have a Pulse Width on, the more you stimulate what neuron?
Longer Pulse width=
Short Pulse width=
Stimulate Motor neurons
Longer Pulse width= motor
Short Pulse width= sensory
***What is High Rate TENS?
Feelings?
And what conditions is it used for usually?
High frequency + Low width pulse;
- stimulates A-Beta fibers
- tingling/buzzing*
-ACUTE
***What is Low Rate TENS?
Feelings?
And what conditions is it used for usually?
Low frequency + High width Pulse
-stimulates A-Beta and A-Alpha
- twitching= release of endogenous opiates=pain relief)
- CHRONIC
Why do we need adjustments of frequency? (2)
- Switch response
- Depth of penetration
What is Rise/ramp time?
the time it take for the amplitude to increase from zero to peak amplitude
What is Decay time ?
– time it takes for peak amp to decrease back down to zero
What is the relationship between pulse width and frequency?
inverse relationship
What is Pulse width?
Duration of a pulse wave
What is the Most therapeutic frequencies range?
1-120 Hz
Why is Duty cycle important?
for rest time
*ratio of on to off time (1:4)
**Why do we change pulse width for TENS?
Sensory to motor stimulation
What is Modulation in TENS?
- to vary one or more of the electrical parameters
* to prevent accomodation (your body getting used to it)
What are the 3 different types of modes in TENS?
- burst
- modulated
- continuous
**Why do we use TENS?
pain relief
What are 6 indications for Electrical Stimulation?
- Pain mgmt
- muscle strengthening
- stimulation of denervated muscle
- wound care
- fracture healing
- circulation and edema management
** What are 5 CONTRAINDICATIONS for E. Stim?
- Pregnancy – over the uterus.
- Pacemaker – not over pacemaker
- Cancer- not over cancer site.
- On or near DVT
- Over the carotid sinus
***What are 4 SAFETY considerations for E. Stim?
- Electrical “shock” is first felt as tingling at 1mA
- Motor response occurs at 5mA
- An inability to let go occurs around 20 mA
- Ventricular fibrillation – 80 mA.
(Ventricular defibrillation=electric shock given, to start heart again) – 6A. Burns at 12 A
**What are 4 Pre-treatment guidelines?
- **Ask history of ES (experience with electrical stimulation)
- Ask about CI’s (Contraindications)
- Inspect skin (ex. if medal staples)
- Sensation check
**During Treatment Guidelines?
- give patient instructions on what to expect
(ex. TENS= comfortably strong
NMES=need contraction)
-give patient call BELL
What are the 2 types of EXCITABLE CELLS?
- nerve cells
- muscle cells
What does EXCITABLE mean?
the cells have the ability to have their cell membranes altered to allow ionic changes in potential across the membrane (forcing the movement of sodium/potassium across membrane
What is the RMP (Resting Membrane Potential)?
-60 - 90 mv
**What is Action Potential?
-reaching THRESHOLD (which causes a rapid reversals of polarity)
**What do Nodes of Ranvier do?
-speed up transmission (because myelin sheath jumps from space to space to speed it up)
(What are T tubules and the sarcoplamic reticulum?)
- transverse tubule: a deep hole
- plasma membrane of muscle
(-allow depolarization of membrane to quickly penetrate to the interior of the cell)
What is neurotransmitter?
a chemical substance that transfers the impulse to another nerve fiber (by crossing a synapse)
What is the function of calcium?
calcium channnels open and calcium rushes into the neutron terminal during an action potential
- “calcium influx”
What is Tetany?
How does strength of contraction increase?
a sum of twitches
-more motor units recruit/contract
When we VOLUNTARILY stimulate mm (muscle) we recruit which motor units (large or small)?
small=Type 1 first
When we stimulate with ELECTRICAL stimulation, we recruit which motor units (large or small)?
Large=it’s reversed from voluntarily contracting muscle
- your muscles fatigue!
What are the 2 excitable cell properties that effect how much of a stimulus is required for depolarization ?
- Resistance
- Capacitance
What does A-Alpha respond to
- Short duration and
- Low Intensity
Positive pole is:
Negative pole is:
- anode
- cathode
What kind of relationship is there for Current Density and SIZE (of electrode)?
inverse relationship
Smaller electrodes permit deeper…
penetration
Where is calcium stored?
- sarcoplasmic reticulum
of the muscle cell
