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BOARDS: Modalities > Electrical Stimulation, ionto, EMG biofeedback > Flashcards

Electrical Stimulation, ionto, EMG biofeedback Flashcards

1
Q

Which ion is the cell membrane most permeable to? (aka what leaks in and out all the time)

A

potassium

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2
Q

What is resting membrane potential for excitable cells?

A

-60 to -90mV

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3
Q

What causes an action potential?

A

influx of Na+ comes into the cell, depolarizing the cell and reaching threshold (about -55mV)
- voltage gated channels open and more Na+ and K+ come in

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4
Q

T/F: estim can be used to decrease muscle spasm.

A

true - done through either fatiguing it out through tetanic contraction for several minutes, muscle pump and relax to increase circulation, or combo of pump with US heat

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5
Q

T/F: Both low intensity, continues non-pulsed low volt direct current and high-volt pulsed current can be used for wound healing.

A

true - can do both pulsed and continuous

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6
Q

What are the contraindications to using estim?

A
  • no active infection or bleed
  • no demand pacemaker/electrical implant (insulin pump)
  • not over abdomen/low back if pregnant
  • superficial metal implants
  • DVT in area
  • epilepsy or arrhythmias
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7
Q

T/F: A patient with hyper or hypotension is a contraindication for estim.

A

false, just precaution

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8
Q

How can you mitigate the fatigue effects from estim?

A

use on:off ratio of 1:3 to minimize fatigue

- unless purpose is to fatigue a muscle spasm, then do 1:1

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9
Q

What can estim do for a patient?

A
  • reduce muscle spasm
  • neuromuscle re-ed
  • pain modulation
  • wound healing (via muscle pump)
  • improve disuse atrophy
  • edema reduction (via muscle pump)
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10
Q

What are examples of pulsed current??

A

monophasic
biphasic
polyphasic

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11
Q

What does pulsed current do?

A

improve circulation via muscle pump
- improves nutrition of tissue and hasten metabolic waste disposal

recall this is monophasic, biphasic, polyphasic current

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12
Q

What in a patient’s cardiac history would make them inappropriate for estim anywhere on their body?

A

unstable arrhythmias

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13
Q

What are the contraindications to estim use?

A
  • active bleed or infection
  • demand pacemaker or other electronic device inside body
  • unstable arrhythmias
  • seizure disorder or suspected epilepsy
  • abdomen or low back of a pregnant woman
  • cancer area
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14
Q

If a patient has CHF, is estim contraindicated?

A

no, heart disease is just a precaution for use of estim

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15
Q

For your patient who’s using estim for their subluxed shoulder, what would you instruct them about home use? (times to wear, times to not)

A
  • can wear all day except for driving, playing sports, operating heavy machinery, or in conjunction in other electronic monitoring equipment
  • must tell them about skin checking
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16
Q

How much space should their be between the active electrode and the dispersive electrode?

A

at least the size of the diameter of the active electrode

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17
Q

What ratio of duty cycle should be included to minimize fatigue effects of estim?

A

> or equal to 1:3

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18
Q

What should the ratio for on/off times be for treatment of muscle spasm with estim?

A

1:1

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19
Q

What is a cathode?Anode?

A 
cathode = negative
anode = positive
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20
Q

What’s the maximum intensity of ionto?

A

4-5mA

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21
Q

The amount of medication that gets into the skin is dependent on what during an ionto treatment? (3)

A

1) duration of treatment
2) current density
3) concentration of ions in the solution

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22
Q

What are the contraindications for ionto?

A

same as estim, plus allergy to medicine

  • no low back/abdomen on pregnant women
  • not with demand pacemakers or internal devices
  • not with active bleed or infection
  • not with seizure disorder or suspected epilepsy
  • DVT in area
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23
Q

Before administering ionto or estim with a patient, what questions should you ask?

A
  • no potential for pregnancy?
  • no pacemakers, heart arrhythmias?
  • no internal devices?
  • no history of seizures or epilepsy?
  • no current issues with blood clots?
  • no cancer?
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24
Q

What ion may be used to treat hyperhidrosis? What’s its polarity?

A

water can be used to treat hyperhidrosis

- can be positive or negative

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25
Q

What ion may be used to treat edema reduction? What’s is polarity?

A

hyaluronidase: positive

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26
Q

What ion may be used to treat muscle spasm? What’s is polarity?

A

calcium or magnesium: both positive

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27
Q

What is dexamethasone used to treat using ionto?

A

muscle inflammatory conditions

- polarity is negative

28
Q

What is hydrocortizone used to treat and what’s its polarity?

A

used for muscle inflammatory conditions
- positive

dexamethasone = negative
hydrocortizone = positive
29
Q

If you have to guess what a polarity of a medicine is, what should you guess?

A

positive

  • since most are positive
  • recall that dexamethazone is negative, so is salicylate, acetate, and water: that’s it
30
Q

What is TENS designed for?

A

to provide afferent stimulation for pain management

31
Q

What does afferent mean?

A

sensory information carried into the brain/body

32
Q

What fibers are key to activating inhibitory interneurons, inhibiting pain fibers?

A

large A-beta fibers inhibit the small A-delta and C-fibers that are pain fibers

33
Q

What are the two big physiological effects to why TENS decreases pain?

A

1) activates central inhibition of pain transmission via gait theory
2) descending pathways generate endogenous opiates (noxious stimuli activate areas of brain to produce opiates)

34
Q

What type of current is used for TENS?

A

continuous pulsatile or burst current

35
Q

What is frequency measured in?

A

Hz

36
Q

What are the three types of current?

A

direct
alternating
pulsed

37
Q

What is direct current used for?

A

ionto, trigger point stim, wound healing

- unidirectional current flow of negative or positive

38
Q

T/F: Direct current is able to provide a sensory and motor response.

A

false -> there’s no frequency, just one long pulse

- so this doesn’t activate the sensory or motor fibers

39
Q

What is pulse duration?

A

aka pulse width
- determines if we get large sensory fibers, pain fibers, etc

so if you reduce pulse width, you reduce pain

40
Q

T/F: Large, superficial fibers are recruited first with estim.

A

true
- as you increase strength/duration, you recruit more deeper, smaller fibers

THIS IS UNLIKE NORMAL PHYSIOLOGY
- normal physiology: small fibers are recruited first, incrimental recruitment

41
Q

What is the critical fusion frequency that allows for tetanic contraction?

A

usually 20-30 pps

- aka 20-30 APs per second

42
Q

T/F: When you increase frequency, you increase muscle recruitment.

A

false, you’re just making the current fibers that are recuited work HARDER
- because you’re increasing how many times an AP goes through them per second with frequency

43
Q

Why would we want to increase frequency, if when you do that you’re just fatiguing out the recruited muscles more?

A

we WANT muscle fatigue to get the muscle stronger in cases of strengthening or neuro re ed

44
Q

What is pulse duration used for in estim?

A

use it to recruit different muscle fibers

- can decrease for pt comfort, but don’t want to reduce muscle recruitment if possible

45
Q

What is the range for frequency that involves a muscle working at moderate to high intensity?

A

50-80pps

46
Q

T/F: Alternating current can be used for polarity effects.

A

false - no polarity effects with alternating

- that’s just direct current

47
Q

What pulse width do we need for a motor response?

A

300ms

48
Q

T/F: The shorter the pulse width, the better the patient tolerance.

A

true

- longer pulse widths activate pain fibers

49
Q

What is interferential current?

A

medium-frequency alternating current that’s either interfered with or burst
- Russian stim is interferential burst current (50-80pps)

50
Q

What are the three parameters of estim that you absolutely need to get a response? (either sensory or motor)

A

pulse duration
frequency
amplitude

51
Q

How is amplitude set for a patient undergoing estim?

A

increase amplitude to desired response

- this is the last thing that’s set after frequency and pulse duration

52
Q

What would you set frequency at for a neuro re-ed session with estim? How would that differ from a strengthening session?

A

we don’t want fatigue with neuro re-ed as much, so frequency should be lower: .3ms
- .1-.3ms is what provides a motor response

frequency for strengthening after ACL: .5-.8ms b/c we want moderate to high intensity there

53
Q

What might your duty cycle be for strengthening and how might that differ from neuro re-ed?

A
  • need 1:5-ish ratio for duty cycle (want to minimize fatigue)
  • for neuro re-ed or orthotic substitution: 1:3 really is fine
54
Q

What is the pulse duration for TENS?

A

50-100micro seconds

  • recall that 100-300 is the range for motor contraction
  • with tens, we just want the sensory fibers stimulated
  • put in continuous mode
55
Q

Contraindications to TENS?

A

epilepsy
eyes
laryngeal muscles
head/neck of a patient post CVA

56
Q

For orthotic substitution for a subluxed GH joint, where would you place the electrodes?

A

supraspinatus and posterior delt

57
Q

What is the duty cycle for FES for a shoulder subluxation?

A

start at 1:3 (2sec, 6sec) so as to prevent fatigue, increasing to 12:1 (24sec, 2 sec)

58
Q

How long should you use FES for a subluxed shoulder? (treatment time)

A

15-30min, 3-7 times daily. (up to 6-7hours)

59
Q

What kind of current is used for FES to subluxed shoulder?

A

interrupted pulsatile current

60
Q

What is pulse rate also known as?

A

frequency

61
Q

What pulse rate provides tetanic contraction?

A

20-30

62
Q

What does EMG look at?

A

measures motor unit action potentials generated by active muscles

63
Q

T/F: When working on a weak muscle with EMG biofeedback, you need to start with electrodes placed closely together with high sensitivity.

A

false

To increase muscle activity: begin with…
- widely spread apart, high sensitivity to maximize detection

64
Q

To decrease muscle sensitivity, how should EMG biofeedback electrodes be placed? High or low sensitivity?

A

to decrease muscle activity: begin with…

- electrodes close together, low sensitivity to reduce cross talk

65
Q

What estim characteristics are appropriate to be used for wound healing?

A

hold volt pulsed current

low-intensity continuous low-volt direct current

BOARDS: Modalities (3 decks)

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