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Boards: Modalities > Electrical Stimulation > Flashcards

Electrical Stimulation Flashcards

1
Q

ES: General Characteristics Nerve/Muscle Cells

A

Duration of 1 ms is enough to depolarize a nerve cell, too short to stimulate a muscle cell 10 ms with high intensities needed for denervated muscle Rate of rise must be rapid enough to prevent accomodation (square wave = instantaneous rise)

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2
Q

ES: Rheobase

A

Intensity of the current (have a long duration) required to produce a minimum muscle contraction

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3
Q

ES: Chronaxie

A

Pulse duration of stimulus at twice rheobase intensity.

Chronaxie of a denervated muscle is greater than 1 ms

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4
Q

ES: Motor Point

A

Area of greatest excitability on skin Small currenct generates a muscle response

  • innervated muscle located at/near where motor nerve enters muscle, usually over belly
  • denervated muscle - located over muscle distally towards insertion
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5
Q

ES: Types of MS Contraction

A

Low freq pulse (1-10/sec) produces brief twitch with each stim

Increasing number of stim progressively fuses twitches to tetanic contraction

Asynchronous/worm-like (vermicular) muscle response is noted in denervated muscle

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6
Q

ES: Amperage

A

Rate of flow of electrons

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7
Q

ES: Voltage

A

Force driving electrons

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8
Q

ES: Ohm’s Law

A

Current is directly proportional to voltage and inversely proportional to resistance.

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9
Q

ES: Monophasic Waveform

A

Direct/galvanic Unidirectional flow Has either positive or negative charge

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10
Q

ES: Biphasic Waveform

A

Alternating current Bidirectional flow Half cycle above baseline, half below Two phases = one cycle Zero net charge if symmetrical

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11
Q

ES: Polyphasic Waveform

A

Russian current or interferential current Biphasic current modified to produce three or more phases in a single pulse

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12
Q

ES: Surge Mode

A

Gradual increase in decrease in intensity over finite period of time

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13
Q

ES: Ramped Mode

A

Gradual rise in intensity with maintenence of intensity at a selected lever for a given period of time. Then gradual or abrupt decline.

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14
Q

ES: Indications

A
  • Pain modulation
  • Decrease muscle spasm
  • Increase/Maintain ROM
  • Muscle re-education
  • Disuse atrophy
  • Soft tissue repair
  • Edema Reduction
  • Spasticity
  • Denervated muscle
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15
Q

ES: Contraindications

A
  • Anywhere in body w/ demand type pacemaker
  • Unstable arrhythmia
  • Suspected epilepsy or seizure disorder
  • Over area of carotid sinus
  • Thrombosis
  • Eyes
  • Thoracic region
  • Phrenic nerve
  • Urinary bladder stimulators
  • Abdomen Low back during pregnancy
  • Transcerebrally or thoracic
  • Active bleeding or infection
  • Superficial metal implants
  • Pharyngeal or laryngeal ms
  • Motor level stim should not be applied in conditions that prohibit motion.
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16
Q

ES: Precautions

A
  • Cardiac dx
  • Impaired mentation
  • Areas of impaired sensation
  • Malignant tumors
  • skin irritation
  • open wound
  • Iontophoresis after other agent
  • Hyper or hypotension
  • Excessive adipose tissue/edema
  • Bleeding disorders
  • Menstruating uterus
  • Pregnancy: during labor or delivery
17
Q

ES: Electrodes

A
  • Two required - one active (stimulating), one dispersive
    • Active placed on motor point
    • Dispersive placed on treatment site or at a remote site
  • Current density is relative to electrode size (small size, high density, strong stim)
  • Electrode size should be relative to size of treatment site
18
Q

ES: Electrode Placement

A
  • Unipolar/monopolar:
    • Single or bifurcated active electrodes placed over treatment area.
    • Usually larger size dispersive electrode placed ipsilaterally away from treatment area.
  • Bipolar:
    • Equal sized active and dispersive electrodes in same treatment area.
    • Space between A and D electrodes should be at least the diameter of the active electrode and as far as practically possible.
    • Greater space = less current density in intervening tissue - less risk of burns and skin irritation.
19
Q

ES: Ms Strength/spasm/edema (ms pump)

A
  • Slowly increase intensity until muscle response observed 10-25 contractions may be sufficient depending on goal
  • Muscle re-education sessions may last 10-30 mins
  • Interrupted/ramped allows muscles to recover Ratio of 1:3 or more minimizes fatigue
  • Use continuous to enduce fatigue for spasm
20
Q

ES: Methods to decrease muscle spasm

A
  • Muscle fatigue - tetanic contraction
  • Muscle pump - interraupted/surge modulation, increase circulation
  • Muscle pump and heat - Combination of elec stim and US to increase tissue temp and produce muscle pump at same time
21
Q

ES: Methods to increase ROM

A

mechanical stretching - used when muscle strength in deficient of dysfunction (e.g. spasticity) prevents adequate joint movement

22
Q

ES: Wound Healing - Pulsed Currents

A

Interrupted modulations Improved circulation (muscle pump) - improved tissue nutrition and waste metabolism

23
Q

ES: Wound Healing - Monophasic

A
  • Low volt continuous, high volt pulsed Low amp for 30-60 mins
    • -Restores electrical charges at wound -
    • Disruption of bacerial DNA, RNA synthesis, cell transport
    • Increased ATP concentration, amino acid uptake, protein and DNA synthesis
  • Inflammation -
    • Macrophages (+ve), mast cells (-ve), neutrophils (+ve/-ve)
  • Proliferation
    • Fibroblasts (+ve) Wound contraction - Alternating (+ve/-ve)
  • Epithelialization - Epithelial cells (+ve)
24
Q

ES: Edema Reduction

A
  • Muscle pump - increase lymph and venous flow
  • Electrical field phenomenon - Effect of electrical charge in interstitial proteins increase lymph and venous flow.
25
Q

ES: Spasticity

A

Fatigue of agonist Reciprocal inhibition - stimulate antagonist, inhibit agonist

26
Q

ES: Stimulate Denervated Ms

A
  • Controversal Goal is to decrease effects of disuse and shorten recovery time
  • May be deleterious to denervated muscle by:
    • Interfering with regeneration of NMJ and subsequent reinnervation
    • Traumatizing hypersensitive denervated muscle
    • Financial cost and prolonged treatment time required until reinnervation are additional factors to consider.

Boards: Modalities (18 decks)

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