Combination US & E-stim

Question 1

Ultrasound is most often combined with which e-stim?

Answer 1

pre-modulation Interferential Current Therapy (aka bipolar IFC)

Question 2

By combining US with IF, the advantages/effects of each treatment modality can be achieved at (lower/higher) intensities than usual.

Answer 2

lower

Question 3

By using US with e-stim what happens to the accommodation effects?

Answer 3

reduced or even eliminated

Question 4

What are the 3 main advantages of combination?

Answer 4

1. localizing lesions (especially chronic) which is diagnostic use
2. In ensuring accurate localization of US treatment to provide increased accuracy/effectiveness in treating deeper lesions
3. in treating trigger points

Question 5

What does US of combination do to the peripheral nerve?

Answer 5

reduces the resting membrane potential by increasing its permeability to various ions especially Na+ and Ca2+; this brings the membrane closer to threshold but not to the point of the nerve firing

Question 6

The simultaneous application of the interferential current does what to the depolarization potential?

Answer 6

it will take a smaller current than usual to achieve this due to the potentiation effect of the ultrasound

Question 7

By combining the 2 treatment modalities none of the individual effects of the treatments are lost, but the benefit is that…?

Answer 7

lower treatment intensities can be used to achieve potential benefits in terms of diagnosis & treatment times

Question 8

What is the suggested US output and frequency?

Answer 8

continuous 0.5W/cm2

Question 9

What is the preferable output?

Answer 9

1MHz; gives more effective penetration into the tissues

Question 10

What is the most common IFC output? With or without sweep?

Answer 10

100Hz using pre-mod (bipolar IFC) with no sweep

Question 11

The electrode is placed on the _____ aspect of the limb for superficial lesions or on the _____ aspect of the limb for deeper lesions.

Answer 11

same, opposite

Question 12

Start with the US head ___ from the lesion, gradually increase the pre-mod output intensity until ______ is encountered by the patient.

Answer 12

distant, normal tingling

Question 13

When moving towards the lesion site it is important to note what?

Answer 13

note any areas of increased sensitivity, local or referred pain

Question 14

The point of maximal sensitivity is assumed to be what?

Answer 14

the focal point of the lesion, this position is usually consistent and reproducible

Question 15

The point of maximal sensitivity will not provide what information?

Answer 15

will not provide information as to the precise tissue in question nor to depth

Question 16

What are the safe & effective US treatment techniques used during combined treatment?

Answer 16

• always using a moving treatment head
• maintain effective contact
• maintain the perpendicular relationship between the treatment head & the patients skin whenever possible

Question 17

Why is US and interferential justified with a patient who has an acute lesion/tear of the lateral ligament of the ankle? What is the dose? What is the electrode & US placement?

Answer 17

• US will promote the inflammatory/repair process
• interferential is used for its effects in reducing acute pain
• US dose based on normal dose calculations (3MHz, 0.2W/cm2, pulse 1:4, 10min)
• Pre-mod interferential pad electrode placed medially over the torn components of the lateral ligament

Question 18

What are the contraindications of combined therapy?

Answer 18

there does not appear to be any specific contraindications for combined therapy other than those for the individual modalities