E-Stim Ultrasound Practical Flashcards
When using high volt for edema, what is the first thing you should do to set up the machine?
Move the black cables to the middle “Hi-Volt” port, and use the side that has a tag that says “Active” as the distal electrode
What is the correct electrode selection for using hi-volt for edema?
What is the patient position?
Small electrode at the site of the swelling (distal), large disperser electrode proximal
The limb should be elevated (Supine w/ leg elevated if reducing ankle swelling)
Case: Pt is 1wk s/p ACL reconstruction, assist w/ quad activation
Russian
Muscular Re-education
Case: Pt is 1 week s/p RTC repair and needs a way of managing pain
Conventional TENs (Because it’s for acute injuries)
Case: Pt has chronic Bilateral lumbar pain. Provide pain relief.
IFC (Because it has 4 electrodes and therefore can cover the entire lowerback)
Case: P has very tight achilles tendon and calf. Provide modality to assist w/ stretching.
Russian Increasing ROM
note: apply to OPPOSITE muscles to help stretch this muscle (Tib anterior)
or
Ultrasound vigorous thermal
Case: Pt has severe lateral arm pain 3 weeks after tearing middle delt. Provide modality for pain relief.
Conventional TENs or IFC
Pt has severe ankle swelling 4 days s/p sprain. Manage Edema.
Hi-volt
E-Stim Contraindications
✧ Pacemakers or auto defibrillator
✧ Stimulation of current through chest or near heart
✧ Stimulation over carotid sinus
✧ Area with venous thrombosis, occlusive vascular disease, or
arterial thrombosis
✧ Patients who are confused and/or disoriented
✧ Patients with an internal stimulator
✧ Seizure disorders
✧ Infection
✧ Over open wounds
✧ Malignancies
✧ Pregnancy
✧ Musculoskeletal problems where muscle contraction
would exacerbate the condition
✧ High level spinal cord injury
Ultrasound Contraindications
● Areas of active bleeding
● Areas of decreased temperature
sensation
● Areas of decreased circulation
● Deep vein thrombosis
● Infection
● Malignancy
● Over breast implants
● Over carotid sinus or cervical ganglia
● Over epiphyseal areas in young
children
● Over eyes, heart, and genitalia
● Over methylmethacrylate cement or
plastic
● Over pelvic, lumbar or abdominal
areas in pregnant women
● Over pacemaker
● Thrombophlebitis
● Vascular insufficiency
Settings for conventional TENs?
Frequency:
Duration:
Intensity:
What is it for?
Frequency: 100
Duration: 100
Intensity: Tolerable Sensory
Acute Pain/Post Surgery
What are the settings of acupuncture like TENs?
Frequency:
Duration:
Intensity:
What is it for?
Frequency: LOW, under 20
Duration: HIGH 100-600
Intensity: High enough to activate motor
(Place over motor point)
For Chronic pain
What kind of TENs do you use for a trigger point?
What are the settings?
Noxious Level
Frequency: LOW, 1-5
Duration: HIGH, 100-1000
Intensity: Muscle Contraction acceptable, high intensity sensory
What kind of TENs will you use for fast pain relief during debridement?
What are the settings?
Brief Intense
Frequency: HIGH, 100
Duration: HIGH 100-600
Intensity: Muscle Fasciculations to sustained contraction
How long is the treatment for Conventional TENs?
30+ minutes up to a few hours
How long is the treatment for acupuncture-like and Brief Intense TENs
15 mins
How long is the treatment for noxious level TENs?
“Until the pain is no longer perceived”
So I’ll say 30 mins i guess…
What kind of e-Stim do you use for muscle re-education?
What are the settings?
Frequency:
Duration:
Intensity:
Duty cycle:
Treatment time:
Where do you set it up?
Russian
Frequency: 35-55(Beginning of tetany range)
Duration: 200-600
Intensity: Comfortable muscle contraction:
Duty cycle: 1:5 -> 1:3 -> 1:1 depending on fatigue
Treatment time: 15 mins
MOTOR POINT
When using e-stim for increasing ROM what kind will we use?
What are the settings?
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
Where will we put it?
Russian
Frequency: 35-55(Beginning of tetany range)
Duration: 200-600
Intensity: Comfortable muscle contraction:
Duty cycle: 1:5 -> 1:3 -> 1:1 depending on fatigue
Treatment time: 90 minutes or 3 sets of 30
Put it on antagonistic muscle
When using E-Stim for muscle strengthening, what will we use?
What are the settings?
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
Russian Current
Frequency: 50-85(Tetany range)
Duration: 200-600
Intensity: 60% of voluntary maximum isometric contraction
Duty Cycle: 1:5
Time: 3x10 reps
Note: add gradual ramp to peak intensity
When using E-Stim for prevention of muscle atrophy, what settings will we use?
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
Russian current
Frequency: 50-85 (tetany range)
Duration: 200-600
Intensity: 25% of Maximum voluntary muscle contraction
Duty Cycle: 1:5
Time: 3x10 reps
Note: almost the same as strenghtening
When using E-Stim to control edema, what will we use?
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
High Volt
Frequency: 35-55 (beginning of tetany range)
Duration: 200-600
Intensity: Comfortable Muscle Contraction
Duty Cycle: 1:1
Time: 20-30 mins
Elevate the body part, dont forget to use a large disperser electrode mixed with a smaller active electrode. Dont forget to change the wires to the high volt port (in the middle of the machine)
What e-stim would you use to control edema if they cant tolerate normal high volt
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
Edema control: sensory level
Still high volt
Frequency: 120 (high)
Duration: 2-10 LOW
Intensity: 10% less than what produces a muscle contraction
Duty Cycle: continuous
Time: 30 mins
What kind of e-stim is best for pain control?
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
Frequency: 4100-4000 = 100
Duration: 120
Intensity: Sensory level
Duty cycle: continious
Time: 10-20 minutes
Note: if you select IFC on the machine it will give you all the correct default settings, you just have to turn up the intensity.
Add in sweep if you want them to not accomadate to the frequency.
Use target mode if you want to target one area
Don’t forget the electrodes must be in a cross pattern with the channels diagonal
What kind of E-stim will we use for a denervated muscle?
Frequency:
Duration:
Intensity:
Duty Cycle:
Time:
NMES
Frequency: Under 10
Duration: As short as possible
Intensity: Moderately strong muscle contraction
Duty Cycle: 1:5
Time: 3x10 3 times a day
What settings would we use to do ultrasound on an acute injury?
Duty Cycle:
Intensity:
Time:
Non-Thermal
Duty Cycle: 20% AKA 1:5
Intensity: 1
Time: 8 minutes
What settings would we use for ultrasound on a sub-acute superficial injury or hematoma
Duty Cycle:
Intensity:
Time:
Mild Thermal
Duty Cycle: Continuous
Intensity: 0.5
Time: 3.3 mins
What settings would we use for ultrasound on a deep subacute injury or hematoma
Intensity:
Time:
Mild Thermal
Intensity: 1
Time: 5 minutes
What ultrasound settings would we use for a superficial chronic injury/ pain/ trigger point?
Intensity:
Time:
Moderate thermal
Intensity: 0.5
Time: 6.67 minutes
note:its double the superficial mild-thermal time
What ultrasound settings would we use for a deep Chronic injury/ inflammation/ pain/ triggerpoint?
Intensity:
Time:
Moderate thermal
Intensity: 1
Time: 10 minutes
Note: it’s twice the time of the mild-thermal
What ultrasound settings will we use for stretching superficial collagen or a contracture
Intensity:
Time:
Intensity: 1
Time : 6.67
Note: it’s just twice the intensity of the moderate thermal
What ultrasound settings will we use for stretching deep collagen or a contracture
Intensity:
Time:
Intensity: 2
Time: 10 minutes
Note: it’s just twice the intensity of the moderate thermal
Ask your e stim contraindications
Do you have a pace maker, internal stimulator, seizure disorder, blood clot, cancer, open wounds, or are you pregnant?
Ask your ultrasound contraindications
Do you have any bleeding, decreased sensation, blood clot, infection, cancer. Implants or cement, pacemaker, pregnancy, or vascular disease?
Premod parameters
Duty cycle 10:10
frequency 40-70
duraton: 200-400
time: 10-20 mins
