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Modalities Test 1 > E Stim > Flashcards

E Stim Flashcards

1
Q

where are electrodes contraindicated? (9)

A
  1. eyes
  2. carotid bodies
  3. trunk/heart with pacemakers
  4. pelvis/abdomen in pregnant women
  5. phrenic nerve stimulators
  6. gonads
  7. PVD areas
  8. active osteomyelitis sites
  9. hemorrhage areas
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2
Q

is a pacemaker a contraindication or precaution for stim?

A

trick question, it depends on the cardiac doc’s input

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3
Q

what are 6 precautions for estim

A
  1. non intact sensation
  2. pt w difficulty communicating
  3. compromised mental ability
  4. cardiac dysfunction
  5. seizures
  6. active or hx cancer
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4
Q

what three effects are produced by estim

A

thermal, physical, and chemical

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5
Q

why is it common to see redness under an electrode pad

A

heat and vasodilation

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6
Q

what can you do to decrease resistance to current flow?

A

ensure proper pad attachment by cleaning the area with soap and water and avoiding callused areas of skin

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7
Q

what is the electrophysical effect of estim (3 steps)

A
  1. cell membranes become more permeable to Na
  2. resting membrane potential decreases
  3. nerves depolarize first
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8
Q

describe cell charge at rest

A

net negative intracellular controlled by Na and K exchange

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9
Q

why do most individuals feel estim before seeing or feeling a motor response

A

the most superficial Aalpha and beta fibers depolarize first

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10
Q

do large or small diameter fibers depolarize easier?

A

small

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11
Q

as you increase amplitude and duration of estim, what are the three levels of response?

A

sensory > motor > pain

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12
Q

what is the force frequency relationship

A

as frequency increases, force increases

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13
Q

what are the five indications for estim

A
  1. skeletal muscle activation
  2. pain
  3. tissue healing
  4. edema
  5. improve blood flow
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14
Q

what are the three skeletal muscle estim

A

nmes, ems, fes

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15
Q

what is nmes?

A

stimulation of the nerve to cause a muscle contraction

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16
Q

what is ems?

A

stimulation of a denervated muscle

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17
Q

what is fes?

A

stimulating muscle (either innervated or denervated) to enhance functional movement

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18
Q

when is nmes indicated? (3)

A
  1. post ACL/TKA for quads
  2. CP/SCI/MS/stroke to enhance strength
  3. to decrease spasticity
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19
Q

how can nmes decrease spasticity? (3)

A
  1. reciprocal inhibition via antagonist
  2. to fatigue spastic muscle group
  3. sensory stim leading to habituation
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20
Q

is spasticity velocity dependent or independent? what does this mean?

A

velocity dependent: ramp up the antagonist slowly to overcome spasticity

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21
Q

what kind of stim is NMES

A

burst modulated AC (Russian or Aussie)

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22
Q

where are electrodes placed for NMES

A

over functional motor points (which don’t have to be known for the exam)

23
Q

relatively, how do you set up NMES?

A
  • set intensity and pulse duration as high as possible
24
Q

is NMES different than a voluntary contraction?

A

yes, NMES is unorganized motor recruitment vs voluntary contractions which start with smaller units before bigger units

25
Q

do tv abdominal stimulators meet NMES parameters?

A

no, they dont have the pulse or duration to cause hypertrophy

26
Q

how does FES relate to NMES?

A

FES = NMES with functional activity

27
Q

what are the three most common uses for FES?

A

shoulder subluxation, UE function after stroke/TBI/SCI, and DF assistance

28
Q

what muscles would you target for FES indicated for shoulder subluxation?

A

supraspinatus to elevate the humeral head and post delt to posteriorly translate it

29
Q

remark upon the parameters for FES

A

set the minimum necessary to elicit the desired effect to prevent fatigue

30
Q

small or large pads for FES?

A

largest you can without stimulating antagonists

31
Q

how is stimulating a denervated muscle different than NMES or FES?

A

it takes a higher charge and a pulse duration >10ms to stimulate the sarcolemma; also, there is not strong evidence to support its use

32
Q

what are the nociceptors called

A

a-delta and c fibers

33
Q

what does the a-delta fiber do (3)

A

first pain sensation, withdrawal reflex, and precise location of stimulus

34
Q

what does the c-fiber do

A

second pain, prevents further tissue damage

35
Q

what is the gate theory

A

a-beta fibers block noxious afferents

36
Q

when is tens indicated

A

pain relief

37
Q

what kind of estim is tens

A

biphasic pulsed

38
Q

where are the top four places to place tens pads

A
  1. on/around painful area
  2. over dermatomes
  3. spinal cord segment innervating the area
  4. trigger points

any combination may also be used

39
Q

how high do you set tens?

A

strongest comfortable paresthesia below muscle contraction

40
Q

what is low frequency tens and how does it work

A

motor stimulation releases endogenous opioids

41
Q

what are two drawbacks to low frequency tens?

A
  1. 15-45min duration of tx

2. cannot be used during activity b/c of muscle contraction

42
Q

how does the stem pattern differ between tens, IFC, and NMES

A

IFC is crisscrossed

TENS and NMES is up and down

43
Q

what kind of stim is IFC

A

amplitude modulated AC

44
Q

how does IFC work

A

2 different sine waves interfere to create a beat frequency

45
Q

what is the difference between IFC and PreMod

A

Premod is IFC but the beat frequency is already created in the machine so you only need two electrodes

46
Q

what are the requirements for tissue healing stim?

A
  1. grade 3-4 pressure ulcer

2. no sign of healing for 30 days with standard care

47
Q

what kind of stim is tissue healing?

A

high volt twin peak monophasic

48
Q

how do you apply tissue healing stim?

A

direct to wound or region around it via saline moistened sterile gauze, inactive electrode 15-30 cm away

49
Q

how high do you set the intensity for tissue healing?

A

strong tingling just below muscle twitch. if insensate then turn up to muscle twitch and then down until the twitch disappears

50
Q

what type of stim is used for edema

A

high volt pulsed monophasic

51
Q

how can stim be used for edema

A

only during the acute phase and below the motor threshold for 30 min on and 30 off for 3-4 hours

52
Q

what kind of stim is iontophoresis

A

DC

53
Q

what is the significance of the ionto pads

A

the closer the pads, the more superficial the current

54
Q

how do you determine ionto dosage

A

dose = current x duration

Modalities Test 1 (5 decks)

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