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Physical Agent > Electrical Stimulation > Flashcards

Electrical Stimulation Flashcards

1
Q

What can electrically stimulated do to muscles?

A

Strengthen
Improve endurance
Prevent muscle atrophy
Reduce spasticity
Help Restore function
(Improve cardiovascular health (Bonus))

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2
Q

When using electrical stimulation which muscle fiber is recruited 1st?

A

Fast twitch type II

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3
Q

What is the order of recruitment in normal muscle contraction?

A

Slow twitch type I fibers activated 1st
Followed by larger sized, faster motor units

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4
Q

Describe the graduation of contraction when electrically stimulated

A

Rapid/jerky b/c all motor units under pad fire once stimulated

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5
Q

Describe gradation of normal contraction

A

Gradual increase of force in smooth manner

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6
Q

Which fibers are more resistant to fatigue and atrophy?

A

Type I

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7
Q

Which fibers fatigue rapidly & prone to weakening & atrophy w/ disuse?

A

Type II

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8
Q

What is the clinical importance that electrical stimulation will recruit type II fibers first?

A

Longer rest time should be provided (more fatiguing)

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9
Q

Why should patients perform physiological contractions w/ electrically stimulated contraction?

A

Optimize recruitment
Functional integration

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10
Q

What is the ratio stimulation to rest time that should be done?

A

1:5

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11
Q

When using electrical stimulation describe the order from A beta fibers to denervated muscle that will be stimulated

A

A beta
Motor
A delta sharp pain
C dull pain
Denervated muscle

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12
Q

What is the clinical implication of nerve disease or injury?

A

Denervated muscle can no longer contract (physiologically or electrically)

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13
Q

In cases of denervated muscles what can be done to cause contraction?

A

Direct current is applied directly to muscle belly, stimulating AP in muscle cells directly w/o input from motor nerve

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14
Q

What can be an issue of direct current to denervated muscles?

A

Slows down nerve regrowth drastically

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15
Q

What are some clinical application of electrical stimulation for muscle contraction?

A

Orthopedic conditions
Cardiorespiratory
Healthy adults & athletes
Muscle coordination & motor control for patient w/ neurological conditions

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16
Q

Is NMES added to functional program before surgery shown to increase post - operative strength & faster functional improvement

A

YES

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17
Q

True or False: Higher NMES training intensities were associated w/ greater quad muscle strength & activation after TKA

A

True

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18
Q

What effect can NMES have on patients with OA?

A

Decrease pain
Increase quad strength
improve walking & climbing

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19
Q

What effect can NMES have on patients with RA?

A

Improve strength & endurance

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20
Q

What did a study show to do when NMES was applied to quads in patients w/ heart failure?

A

Improved:
Peak O2 uptake
6 min walk test distance
Muscle strength
Depressive sxm
QoL

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21
Q

In patients with critical illness what kind of effect did NMES have on them?

A

Regains strength 4.5 times faster than patients in control group

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22
Q

What effect did NMES have on healthy adults & athletes?

A

Generally improved strength
Inconsistent impact on functional performance

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23
Q

Following a stroke what can NMES do?

A

Improve strength & activity
Prevent or reduce shoulder subluxation & improve function
Reduces spasticity & increased ROM

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24
Q

What Neurological disorders cam NMES be used for?

A

Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Dysphagia
Urinary Incontinence

25
Q

What are some contraindication of NMES?

A

When muscle contraction of the muscles may disrupt healing

26
Q

What is precaution of NMES?

A

May cause DOMS

27
Q

What are the parameters to Russian Electrical Stimulation?

A

Pulse Duration: 200-800 usec
Frequency: 30-100 Hz
Amplitude: To max contraction
Treatment Time: 10 sec on/ 50 sec off
Ramp on/off time: 1-2 sec

28
Q

What are the parameters for Waveform- Symmetric biphasic?

A

Pulse Duration: 200-800 usec
Frequency: 20-60Hz
Amplitude: To max contraction
Treatment Time: 10 sec on/ 50 sec off
Ramp on/off time: 1-2 sec

29
Q

How should the electrode be placed for NMES?

A

One over motor point & other on muscle to be stimulated
Electodes should be placed at least 2 inches apart

30
Q

What kind of pulse duration are more comfortable for smaller muscles?

A

Shorter

31
Q

What kind of pulse duration are more comfortable for larger muscles?

A

Longer

32
Q

What needs to be increased as pulse duration is shortened?

A

Amplitude

33
Q

What is the first thing you change if the stimulation is uncomfortable?

A

Pulse duration

34
Q

What will a low frequency cause?

A

each pulse will produce a separate twtitch contraction

35
Q

What can accrue as frequency increases to about 30-50 pps?

A

Twitches occur closer together eventually summating into smooth titanic contraction

36
Q

What can frequency of 50-80 pps cause?

A

Stronger muscle contraction but results in faster fatigue

37
Q

When can electrical stimulation be used to control edema & improve circulation?

A

When caused from lack of muscle activity

38
Q

What is TENS?

A

Method of nerve stimulation

39
Q

What does TENS do?

A

Activate:
Gate control theory
Descending pain control theory
Endogenous Opiate Theory

40
Q

What does Conventional TENS (high rate or high frequency) use?

A

Short duration, high frequency biphasic pulses at a current amplitude sufficient to produce comfortable sensation w/o muscle contraction to selectively stimulate nociceptor A beta nerves & activate gating mechanisms

41
Q

How does TENS activate the descending pain control theory?

A
  1. Intense electrical stimulation of A delta & C fibers cause stimulation midbrain, pons & medulla
  2. Release enkephalin through depending neurons which blocks pain impulses at spinal cord level
  3. Cognitive input from cortex relative to past pain experience contributes as well
42
Q

What does Low Rate or Low Frequency TENS use?

A

Low frequency pulses at rate high enough to produce motor contraction using repetitive stimulation of motor nerves to produce brief repetitive muscle contraction (twitches) to stimulate endogenous opioid production & release & increase opioid binding receptor potential

43
Q

Why is high rate TENS more effective than low rate TEN in pts taking opioids?

A

Low rate TENS stimulate same receptors as opiods

44
Q

Why may a patient that consumes a lot of caffeine not feel analgesic effect of high frequency TENS?

A

Caffeine (200 mg) can block effect b/c is it a competitive adenosine receptor antagonist

45
Q

How long can low rate TENS control pain?

A

4-5 hrs after 20-30 minute treatment

46
Q

What can happen if you apply the same parameter of TENS over and over again?

A

Pts may develop tolerance

47
Q

When is high rate TENS recommended to use?

A

When sedation but not muscle contraction will be tolerated
Acute injury w/ inflammation or tissue may be damaged by contraction

48
Q

When is Low rate TENS recommended to use?

A

When longer duration of pain control is desired & muscle contraction is likely to be tolerated
More analgesia at 5 & 15 min post application

49
Q

Is TENS recommended for neck pain?

A

Might not be best option

50
Q

Is TENS found to be effective in the knee?

A

No

51
Q

What is the effect of TENS on acute pain?

A

Produced clinically significant reduction in pain severity for patients w/ moderate to sever acute pain
Reduced anxiety secondary to pain

52
Q

What is the effect of TENS on chronic pain?

A

No clue b/c so many factors

53
Q

What is IFC?

A

TENS application of 2 medium frequency that alternate
Cross 4 pads

54
Q

How should a patient be positioned when TENS is applied for acute pain?

A

Positioned for comfort

55
Q

How should electrode pads be placed for TENS?

A

Around painful area
Prox along sensory nerve when can’t be applied to painful area
1 inch apart

56
Q

What should the current amplitude cause with High Rate TENS?

A

Strong tingling or vibration sensation

57
Q

What should the current amplitude cause with Low Rate & burst TENS?

A

Muscle contraction that can be seen or palpated

58
Q

What all should be documented with electrical stimulation?

A

Electrical Stimulation Type
Area of Body treated
Patient position
Electrode Placement
Specific Parameters
Treatment duration
Patients Response
Rational for treatment

Physical Agent (10 decks)

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