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Electrical Stimulation Flashcards

1
Q

Ampere

A

-rate of current flow

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2
Q

Current

A

-net mmt of electrons
-high to low
-can be increased by increasing pulse duration and frequency

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3
Q

Voltage

A

-force of current flow

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4
Q

Good Conductors

A

-nerve
-muscle
-blood**

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5
Q

Resistance/Impedance

A

-opposition to electron flow
-skin and fat are highest

-increases as electrode disease increases
-decreases as frequency increases

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6
Q

Ohm’s Law

A

I= V/R

-more resistance=less current

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7
Q

Good Insulators

A

-skin
-fat
-bone
-nerve sheath
-tendon

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8
Q

Current Flow: Skin

A

-insulator
-need more voltage to penetrate skin and layers

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9
Q

Current Flow: Fat

A

-insulator
-most resistance

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10
Q

Current Flow: Nerve

A

-conductor
-6x better than muscle, but surrunded by fat and sheath (insulator)

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11
Q

Current Flow: Blood

A

-best electrical conductor

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12
Q

Current Flow: Tendon

A

-poor conductor
-most resistance

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13
Q

Current Flow: Muscle

A

-good conductor

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14
Q

Current Flow: Bone

A

-Poorest conductor
-most resistance

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15
Q

Frequency vs Impedence

A

-increased frequencies decreases impedence

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16
Q

Biphasic/Alternating

A

-goes positive and negative
-pain relieving
-continous flow, changing directions
-no chemical reactions

ex: TENS, IFC

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17
Q

Monophasic/Direct Current

A

-uninterupted flow of electrons toward positive pole
-can be reversed
-chemical changes: electrolysis
-muscle contraction when meeting threshold

Ex: ionto

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18
Q

Pulsatile

A

-2+ pulses grouped together
-discontinuous
-most nerve/muscle stimulation

ex: Russian and High Volt

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19
Q

Accommodation Phenomenon

A

-a fiber subjected to constant depolarization will become unexcitable at the same intensity

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20
Q

Frequency

A

-cycles per second Hz
-can determine the type of muscle contraction elicited
-Tetany: 50Hz

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21
Q

Intensity

A

-amplitude/volatge/intensity
-increasing the stimulation or amplitude to reach deeper tissues, more nerves, stronger contraction
-knob on top

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22
Q

Pulse Duration

A

-pulse width
-targets specific structures

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23
Q

Capacitance

A

-ability of a tissue to store electricity
-higher capacitance= more time before a response
-capacitance can be reduced by increasing frequency
-larger diameter= smaller capacitance

Muscle: most
Nerve: least

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24
Q

Pulses

A

-individual waveforms
-monophasic current

Symmetric, asymmetric, balanced, unbalanced

Cycle: biphasic

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25
Pulse Rise
-how quickly the pulse reaches max -can be adjucted by ramp-up time Slow: more comfortable, wont decrease impedance, more voltge needed High: lowers skin impedence, less voltage needed
26
Duty Cycle
-on off ratio -stimulation: break for (ms or s) -1:7= no fatigue -1:5= less fatigue -1:1= repid fatigue
27
Cathode
-negative -site of depolarization -most electrons -usually black -where muscle contraction happens IONTO -alkaline effects -repels neg/attrac pos
28
Anode
-positive -least electrons -usually red IONTO: -repel pos/ attract neg -acidic effects
29
Electrodes
Spaced together: superficial Spaced far: deeper Larger: decreased current, dispersive Smaller: higher current, motor point Placement: -1.5 away from each other -parallel to fibers Monopolar: different sizes Bipolar: same size electrodes Quadripolar: 2 sets of bipolarr
30
Alpha Beta Nerve
-sensory nerves -100usec chronaxie -tingling sensation -TENS, IFC -largest diameter
31
Motor Nerve
-contraction and tingling -200-250usec chronaxie -TENS, Russian, NMES
32
Alpha Delta Nerve
-sharp pain -300-700usec chronaxie -noxious paresthesias, strong muscle contraction -TENS
33
C FIbers
-dull pain -noxious paresthesias, strong muscle contraction -1.0msec
34
Denervated Muscle
-thinnest -minimizes atrophy and edema -10msec
35
Electrical Current Effects: Cellular Level
-excitation -change in permeability -protein syn. -stimulation of fibroblasts and osteoblasts -microcirculation
36
Electrical Current Effects: Tissue Level
-contraction -regeneration
37
Electrical Current Effects: Segmental Level
-joint mobility -circulation/lymphatics -microvasculation circulattioon
38
Electrical Current Effects: Systemic Effects
-analgestic effects as endogenous pain suppressors -analgestic effects as stimulation of neurotransmitters
39
Neuro Muscular Electrical Stimulation (functional electric stimulator)
-NMES/FES
40
Russian Currents
-muscle strengthening* -muscle re-education* -increasing ROM -Slow atrophy -Edema control (via muscle) -2,000-10,00z frequency -burst mode -fast oscillating AC current, burst
41
Interferential Currents
-IFC -pain control* -muscle stimulation -2 bipolar configurations (relief where they cross) -4000-4100Hz frequencies -120usec pulse width Sweep Mode: frequencies modulated to avoid accommodation Scan Mode: amplitude can be modulated -for poorly localized pain Target Mode: move with finger
42
High-Volt Pulsed Current
-HVPC -reducing edema -muscle pump 1:1 -wound healing -twin peaked monophasic -unequal electrodes, small over treatment
43
Transcutaneous Electrical Nerve Stimulation: Conventional
-TENS -acute pain relief; surgical, labor* -gate control theory; A-Beta* -asymmetric biphasic -tingle with no contraction* Settings: -75-150msec Duration/Width -80-125pps Frequency -continuous* - Starting: 100p/100f* -30mins, til pain is gone*
44
Iontophoresis
-low volt, continuous direct current -drive ions into body -medicine -less than 30min on big machines -longer with home devices Doses: -40mA-min= 4.0 current x 10min -40mA-min= 2.0 current x 20min Meds: -Acetate, -, calcium depositis -Dexamethasone, -, tendonitis/bursitis -Lidocaine, +, trigeminal neuralgia
45
Voluntary vs. Electrical Motor Stimulation
Voluntary: -Type 1 fibers -asynchronous -GTO protection -slow fatigue Electric: -type 2 fibers -synchronous -no GTO protection -fast fatigue
46
Motor Point
-part in muscle where lowest threshold is -best for contraction -mid muscle belly -where nerve meets muscle
47
Wound Care
HVPC: -promotes faster healing -Negative Polarity: inflammatory phase of healing -Positive Polarity: proliferattion phase of healing (bacterial)
48
Transcutaneous Electrical Nerve Stimulation: Low-Frequency/Acupuncture/Motor-Level
-TENS -chronic pain relief* -Descending Pain control theory: modulation; enkephalin* -asymmetric biphasic -tingle AND contraction* Settings: -100-600msec Duration/Width -<20pps Frequency -Duty cycle: 30-60s* - Starting: 180p/18f* -15-60min* -over motor point
49
Gate Control Theory
-increase A-Beta afferents triggers release of enkephalin to inhibit 2nd order neuron to block pain
50
Descending Pain Control: Modulation
-activate opiate receptors in PNS of nociceptive afferent fibers
51
Transcutaneous Electrical Nerve Stimulation: Noxious- Level
-TENS -hyperstimulation analgesia -chronic pain relief* -Endogenous opiate pain control theory* -asymmetric biphasic -high intensity to noxious level; muscle contraction acceptable* Settings: -100-1000msec Duration/Width -1-5pps Frequency -Duty cycle: 30-45s - Starting: 250p/2f* -15-60min* -over trigger point, until pain is no longer percieved
52
Endogenous Opiate Pain Control Theory
-peripheral blockage and extrasegmental analgesia -stimulation of small afferents to release endorphins
53
Transcutaneous Electrical Nerve Stimulation: Brief Intense
-TENS -fast pain relief during procedure* -Descending: peripheral and central anagelsia theory* -asymmetric biphasic -muscle fasciculation to sustain contraction* Settings: -100-600msec Duration/Width -100 pps Frequency -Duty cycle: 30-45s - Starting: 250p/100f* -15min* -around wound
54
Descending Pain Control: Peripheral and Central Analgesia
-serotonergic efferents from thalamus to activate enkephalin interneurons
55
Premodulated (Bipolar)
-2 currents switch within the device -only 2 electrodes -pain control -muscle stimulation/reeducation -slow atrophy -2 bipolar configurations (relief where they cross) -duty 10:10, ramp 1-2s, 10-20min -200-400usec pulse width
56
E-stim Indications
-pain -contraction -muscle reeducation -slow atrophy -strengthening -increasing ROM -decrease edema -decrease spasms -healing -regenerate tissues -stimulate PNS -protein synthesis
57
E-Stim Contraindications
-pacemaker/defib -internal stimulators -chest or heart area -carotid -thrombosis/vascular or arterial disease -confusion -seizure -infection -open wounds (unless treatin) -cancer -pregnancy -high level SCI
58
Muscle Re-education
-Russian, NMES -following surgery -CNS inhibition of muscle -improve motor control -200-600 usec/ 35-55 pulse -15min -Duty 1:1
59
Muscle Pump Contractions
-HVPC, Russian, NMES -increase circulation -mimic normal contractions -200-600usec/ 35-55 pulse -comfortable muscle contraction -20-30min -duty 1:1 -elevatte the body part (can use AROM)
60
Edema Control
-HVPC -elevate extremity* -space electrodes far apart* -negative polarity distal to swelling* -driving forve to move plasma away -30min -best results immediately after injury -80-120Hz/ low frequency* -intensity as needed >60*
61
Muscle Strengthening
-Russian, NMES -200-600usec/ 50-85pps -gradual ramp -duty 1:5 -to muscle fatigue 60% MVIC -pt working with estim
62
Increasing ROM
-Russian, NMES -200-600usec/ 35-55pps -strong contraction -interrupted current with gradual ramp -antagonist muscles to joint contracture -90min -duty 1:1 -pt passive
63
Denervated Muscle
-lost peripheral nerve supply -if reinnervation doesnt occur in 2 years connective tive replaces contractile elements so recovery not possible -1st week <1ms duration -2 weeks >10ms duration -NMES
64
Slow Muscle Atrophy
-Russian, MNES, HVPC -200-600usec/ 50-86pps -15-20mins -duty 1:5 -to muscle fatigue -pt working with estim
65
IONTO Indications
-analgesia -bone spurs -ulcers -edema reduction -fungal infections -sweating -muscle spasms -tendonitis
66
IONTO Contraindications
-estim rules -impaired skin sensation -allergy -recent scar -broken skin -metal

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