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TherEx > Electrical Stimulation > Flashcards

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
Q

Pulse Rise

A

-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

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26
Q

Duty Cycle

A

-on off ratio
-stimulation: break for (ms or s)
-1:7= no fatigue
-1:5= less fatigue
-1:1= repid fatigue

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27
Q

Cathode

A

-negative
-site of depolarization
-most electrons
-usually black
-where muscle contraction happens

IONTO
-alkaline effects
-repels neg/attrac pos

28
Q

Anode

A

-positive
-least electrons
-usually red

IONTO:
-repel pos/ attract neg
-acidic effects

29
Q

Electrodes

A

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
Q

Alpha Beta Nerve

A

-sensory nerves
-100usec chronaxie
-tingling sensation
-TENS, IFC
-largest diameter

31
Q

Motor Nerve

A

-contraction and tingling
-200-250usec chronaxie
-TENS, Russian, NMES

32
Q

Alpha Delta Nerve

A

-sharp pain
-300-700usec chronaxie
-noxious paresthesias, strong muscle contraction
-TENS

33
Q

C FIbers

A

-dull pain
-noxious paresthesias, strong muscle contraction
-1.0msec

34
Q

Denervated Muscle

A

-thinnest
-minimizes atrophy and edema
-10msec

35
Q

Electrical Current Effects: Cellular Level

A

-excitation
-change in permeability
-protein syn.
-stimulation of fibroblasts and osteoblasts
-microcirculation

36
Q

Electrical Current Effects: Tissue Level

A

-contraction
-regeneration

37
Q

Electrical Current Effects: Segmental Level

A

-joint mobility
-circulation/lymphatics
-microvasculation circulattioon

38
Q

Electrical Current Effects: Systemic Effects

A

-analgestic effects as endogenous pain suppressors
-analgestic effects as stimulation of neurotransmitters

39
Q

Neuro Muscular Electrical Stimulation (functional electric stimulator)

A

-NMES/FES

40
Q

Russian Currents

A

-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
Q

Interferential Currents

A

-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
Q

High-Volt Pulsed Current

A

-HVPC
-reducing edema
-muscle pump 1:1
-wound healing

-twin peaked monophasic
-unequal electrodes, small over treatment

43
Q

Transcutaneous Electrical Nerve Stimulation: Conventional

A

-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
Q

Iontophoresis

A

-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
Q

Voluntary vs. Electrical Motor Stimulation

A

Voluntary:
-Type 1 fibers
-asynchronous
-GTO protection
-slow fatigue

Electric:
-type 2 fibers
-synchronous
-no GTO protection
-fast fatigue

46
Q

Motor Point

A

-part in muscle where lowest threshold is
-best for contraction
-mid muscle belly
-where nerve meets muscle

47
Q

Wound Care

A

HVPC:
-promotes faster healing
-Negative Polarity: inflammatory phase of healing
-Positive Polarity:
proliferattion phase of healing (bacterial)

48
Q

Transcutaneous Electrical Nerve Stimulation: Low-Frequency/Acupuncture/Motor-Level

A

-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
Q

Gate Control Theory

A

-increase A-Beta afferents triggers release of enkephalin to inhibit 2nd order neuron to block pain

50
Q

Descending Pain Control: Modulation

A

-activate opiate receptors in PNS of nociceptive afferent fibers

51
Q

Transcutaneous Electrical Nerve Stimulation: Noxious- Level

A

-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
Q

Endogenous Opiate Pain Control Theory

A

-peripheral blockage and extrasegmental analgesia
-stimulation of small afferents to release endorphins

53
Q

Transcutaneous Electrical Nerve Stimulation: Brief Intense

A

-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
Q

Descending Pain Control: Peripheral and Central Analgesia

A

-serotonergic efferents from thalamus to activate enkephalin interneurons

55
Q

Premodulated (Bipolar)

A

-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
Q

E-stim Indications

A

-pain
-contraction
-muscle reeducation
-slow atrophy
-strengthening
-increasing ROM
-decrease edema
-decrease spasms
-healing
-regenerate tissues
-stimulate PNS
-protein synthesis

57
Q

E-Stim Contraindications

A

-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
Q

Muscle Re-education

A

-Russian, NMES
-following surgery
-CNS inhibition of muscle
-improve motor control
-200-600 usec/ 35-55 pulse
-15min
-Duty 1:1

59
Q

Muscle Pump Contractions

A

-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
Q

Edema Control

A

-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
Q

Muscle Strengthening

A

-Russian, NMES
-200-600usec/ 50-85pps
-gradual ramp
-duty 1:5
-to muscle fatigue 60% MVIC
-pt working with estim

62
Q

Increasing ROM

A

-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
Q

Denervated Muscle

A

-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
Q

Slow Muscle Atrophy

A

-Russian, MNES, HVPC
-200-600usec/ 50-86pps
-15-20mins
-duty 1:5
-to muscle fatigue
-pt working with estim

65
Q

IONTO Indications

A

-analgesia
-bone spurs
-ulcers
-edema reduction
-fungal infections
-sweating
-muscle spasms
-tendonitis

66
Q

IONTO Contraindications

A

-estim rules
-impaired skin sensation
-allergy
-recent scar
-broken skin
-metal

TherEx (20 decks)

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