Electrotherapy Flashcards
Goals of electrotherapy
- pain reduction
- muscle strengthening
- reduction of spasticity
- increase ROM
- muscle re-education
- decrease swelling/ edema
- wound care
- stimulate denervated muscle
Phases of healing
within 48 hours= acute
up to 4 hours= subacute
past 6 weeks= chronic
Types of Waveforms
- direct current (DC)
- alternating current (AC)
- pulsed current
Examples of alternating current waveforms:
- Interferential current (IFC)
- pre-modulated
- Russian
Examples of pulsed current waveforms:
- monophasic–high volt (HVS)
- biphasic–symmetrical, asymmetrical (balanced and unbalanced)
Electrotherapy Setting options:
- High Rate
- Low Rate
- Neuromuscular Electrical Stimulation (NMES)
High Rate setting parameters
- Frequency= 50-150 pps
- pulse duration= <200 us
- intensity: comfortable tingling
- sensory
- acute
- gate control theory
- modulated
Low Rate setting parameters
- Frequency= 0-10 pps
- pulse duration= >200 us
- intensity: sensory/slight motor
- motor
- chronic
- opiate production
- burst mode
Brief Intense Noxious setting parameters–Central Biasing
- Frequency= 100-500 pps
- pulse duration= 250-500 us
- intensity: noxious
- central biasing/opiate production
- modulated
Modulated vs. Burst modes
- modulated modes: HRT & Brief intense noxious
- burst modes: LRT (can stimulate both pain gate and opiate release mechanisms simultaneously)
Neuromuscular Electrical Stimulation (NMES) parameters
-Frequency= 35-50 pps (up to 80 for muscle strengthening)
-pulse duration= 150-200 us - small muscle
200-350 us- large muscles
-intensity: no contraction
-motor
-on/off: limit fatigue
-ramp time (for comfort)
Contraindications for Electrical Current Use
- pregnancy (primarily over or around abdomen or lower back)
- pacemaker or other implanted electronic device
- unstable arrhythmias
- areas with DVT
Precautions for Electrical Current Use
- cardiac disease
- impaired mentation or sensation
- malignant tumors
- skin irritation or open wounds
Electrotherapy options for Analgesia
- HRT (sensory- acute, subacute, chronic)
- LRT (motor- subacute or chronic)
- HVS (better for edema/wound care)
- IFC
- Pre-modulated
- Biphasic VMS (used for reeducation of muscle, when only small contraction–most versatile, all parameters can be changed)
- microcurrent
When to use Neuromuscular Electrical Stimulation (NMES)?
- muscle re-education
- muscle pump contractions (edema)
- muscle strengthening
- increase ROM
- muscle spasm reduction
Type of NMES waveforms and primarily when to use
- Russian=muscle strengthening (synchronous motor contraction)
- VMS (biphasic) = muscle re-education
- HVS= swelling–small muscles
Changing NMES parameters to prevent fatigue:
- frequency lowered to 20-35
- longer off time (less fatique–> ability to generate greater next contraction
- decrease number of repetitions
Options for Edema control (edema associated with inflammation)
***HVS: negative polarity, 100-125 pps, preset duration 40-100 us, 20-30 minutes
other options: pre-mod or NMES
Options for Edema (muscle pumps–immobility)
***biphasic: 35-50 pps, 150- 300 (>200 us), visible contraction, 2-5 on/2-5 off, 20-30 min
other options: HVS or Russian
HVS Tissue Healing Continuum
- inflammatory phase/ infected: HVS negative, 60- 125 pps, preset duration (40-100 us), 45-60 minutes
- proliferation phase/ clean: HVS positive, 60-225 pps, preset duration (40-100 us), 45- 60 minutes
–important to switch to positive to prevent a plateau in healing, continue to alternate every 3-5 days
goals of Iontophoresis
- reduce inflammation
- reduce pain
- initiate exercise earlier
benefits of iontophoresis
- virtually painless (can cause burns–observe skin carefully)
- noninvasive- less risk for infection
- localized
- less drug delivered
Common iontophoresis drugs used:
- Acetate (negative)
- **Dexamethasone (negative)
- Chlorine (negative)
- Calcium (positive)
- Tap water- hyperhydrosis (positive/negative)
- Lidocaine (positive)
Iontophoresis Parameters
- 40-80 mA/min (recommend starting at 40)
- amplitude 1-4 mA
- amplitude determines your treatment time based on the dosage that you chose (40 mA/min at 4mA= 10 minutes)
