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Electrotherapy Flashcards

1
Q

What factor influences the area of the spine treated?

A

Angle of pull Lumbar in flex, neutral or ext Cervical in neutral up to 25 degree

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2
Q

Intermittent vs. static traction

A

Static: initial/acute phase Intermittent: jt distraction, decrease m. spasm, disc protrusion, stretch soft tissue. The chouce btwn the two is also based on pt tolerance. static may be used throughout whole tx.

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3
Q

Direct current (electrotherapy)

A

Current flows in one direction. Electrode are either + or - amd maintain polarity. Used for iontophoresis Hi-volt HV HVDC PDC

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4
Q

Alternating Current (electrotherapy)

A

Flow is continued in 2 directions. Moves in cycles and rhythmically changes directions Used for pain and m. strengthening

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5
Q

Pulsed Current (electrotherapy)

A

Alternating current that flows in either one or two directions with intervals no no electrical activity. Used for pain and m. strengthening

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6
Q

Anode

A

Positive electrode that attracts negatively charged ions and repels positively charged ions

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7
Q

Cathode

A

Negative electrode that attracts positivley charged ions and repels negativley charged ions.

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8
Q

Current density

A

The amount of current delivered per unit area.

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9
Q

Electrical current

A

the movement or flow or charged particles through a conductor in response to an applied electrical field.

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10
Q

Gate control theory

A

The theory that that there are gates at the spinal level that allow certain signals to pass or not.

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11
Q

Action potential

A

The basic unit of n. communication The depolarization and repolarization of a n. that occurs in response to a stimulus

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12
Q

Accommodation

A

When a n. gradually becomes less responsive to a stimulus. An increase in threshold.

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13
Q

Impedance

A

The opposition to current flow. Includes tissue resistance and ability to hold a charge

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14
Q

Motor Point

A

The point in a muscle that will prodice the greatest m. contraction with the application of e-stim. Generally located over the m. body Use: Muscle strengthening

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15
Q

Acupuncture Point

A

Specific points mapped along meridians. Effects may be local or referred. Use: Pain

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16
Q

Trigger Point

A

Points that are hypersensitive to pressure or electrical stim. Effects can be local or referred Use: Pain

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17
Q

Ohm’s law

A

Current = Voltage/Resistance When the tissue resistance increases, the flow of current decreases

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18
Q

Tissue Impedance is affected by?

A

Water content of the tissue Temperature Quality of integument Factors influencing fluid balance Prescence of injury or disease

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19
Q

Resistance

A

A materials resistance to current flow. Acupuncture and motor points are known to have less resistance.

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20
Q

Ramp

A

Up/Down The time it takes to go from 0 to its max amp The time to go from max amp to 0 Allows pt to become accustomed to the stim

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21
Q

Amplitude

A

Current strength M. nerve - Higher amps to stim Sensory nerve - Lower amps to stim

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22
Q

Adaptation

A

Decreased frequency of action potentials, and decreased sensation of stim that occurs because of unchanging characteristics

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23
Q

Opiod release theory

A

The stimulation of the A delta fibers (acupuncture like) causes the release of an endogenous opiate in the spinal cord. This blocks noxious stimulus pathways.

Repetetive m contractions, brief sharp pain. Acupuncture like

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24
Q

Interferential Current

A

2 high frequency currents crossed to control pain

No m. contraction elicited

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25
Premodulated Current
Interferential current for a smaller treatment area. The crossing of electrical current happens within the machine.
26
Nerve Depolarization
When a stimulus is applied the sodium channels open rapidly allowing sodium to rush into the cell making the cell more positively charged. Electrical currents depolarize nerves causing an action potential. Can effect m contraction, pain, tissue healing
27
A-beta fibers
Large myelinated axons. Located in skin, bones and joints Normal transmission of stretching, vibration of the skin Short duration pulse (50-80us), comfy amp current = best for isolating these fibers
28
A-delta Fibers
Small myelinated fibers Most sensitive to high-intensity mechanical stim. Sharp stabbing or pricking pain, not controlled by opiates Repetitive stim can stim endongenous opiod production.
29
Motor (alpha) Fibers
When stimulated, cause a m contraction When stim by e-stim, the larger fast-twitch fibers are activated first. The contraction is rapid, with poor grading, and fatiguing.
30
Clinical Application of Electrical Stim
Pain Management Neuromuscualr Dysfunction Joint Mobility Tissue Repair Acute Chronic Edema Urine.Fecal incontinence Medcication Delivery
31
TENS Conventional Parameters
High frequency Short/wide pulse duration Frequency - 100-150pps Pulse Duration - 50 - 80 us Amplitude - Tingling, no m. contraction Duration - Up to 24 hrs PRN Pain control - gating at the spinal cord
32
TENS Acupuncture-like Parameters
Low frequency, High/long pulse duration Frequency - 2-10 us Pulse duration - 200-300 us Amplitude - Produce visible contraction Duration - 20-30 mins Pain control - endorphine release
33
TENS Burst mode Parameter
High frequency, high duration Frequency - preset to 10 bursts Pulse duration - max or 100-300 us Amplitude - visible contraction Duration - 20-30 mins Pain control - endorphine release
34
TENS indications
Pain: Acute/sub acute/ chronic Myofascial Phantom limb Musculoskeletal
35
Electrotherapy Contraindications
Undiagnosed pain Pacemaker (demand type) Seizure disorder Pregnancy Over carotid sinus Broken skin Anesthetic skin Directly over eyes Malignancy Children Where unable to allow for adequate distance btwn electrodes. (IFC) Allergy (Ion) Abn sensation (ion) New/ denuded scar (ion)
36
TENS/ IFC Precautions
Cardiac Disease Over open wound Pregnancy distal extremities Patients with terminal cancer
37
Electrical current Adverse Reactions
Skin irritation Burns Pain
38
Conventional TENS effect
Sensation is strong but comfortable. Rapid onset analgesia while the unit is on
39
Acupuncture-like TENS effect
Less comfortable, slow onset of analgesia (hours), long lasting once unit is removed, m. contraction elicited
40
Burst TENS effects
Less comfortable, rapid onset of analgesia, long lasting
41
Interferential current Parameters
Frequency - increase on at a time. Sensation felt where m. cross Amplitude - Stong sensory level Pulse duration - not changable Duration - 20-30 mins
42
IFC Indications
Pain relief Low back pain Osteoarthritis Post-op ortho surgery Stim myofascial trigger points
43
Iontophoresis Parameters
Polarity - Drug delivery electrode should be the same polarity as the medication being used Amplitude - Determined by pt, but not more than 4 mA. Strong but comfortable sensation Duration - determined by amplitude Placement - drug electrode is place over the pathology, return is over a lrg m. belly
44
Iontophoresis Indications
Bursitis Tendonitits Carpal Tunnel Syndrome Arthritis Trigger point pain Need for analgesia TMJ Plantar fasciitis Epicondylitis
45
Iontophoresis Adverse reactions
Skin irritation from DC Histamine Release (stim of mast cells) = small red bumps Itching
46
Common medications for Iontophoresis
Dexamethasone - Negative (reduces inflammation) Acetate - Negative (dissolve calcium buildup and scar tissue) Hydrocortisone - Positive (reduce inflammation) Lidocaine - Positive (decrease pain)
47
NMES Precautions
Areas of excessive adipose or scar tissue Over areas without sensation Open wound within the treatment area Extreme edema Laryngeal, pharyngeal muscle, or carotid sinus Stim uncomfortable SCI patients
48
SCI Patients and NMES
can cause autonomic dysreflexia Loss of sympathetic control excessive inrease in BP increased spasticity Profuce sweating Bradycardia HA
49
NMES Contraindications
Over thoracic region (may effect heart) Over implanted stim (phrenic n., bladder stim) Prescence of DVT Area of neoplasm of infection Trunk of pregnant woman Disoriented, mentally impaired Over the eyes Injured, frail skin In the presence of superficial implants Area of active bleeding When motion is contraindicated
50
NMES Indications
Stroke Patients: prevent shld subluxation, Facilitate active contraction Chronic stroke - Improve ROM, Improve sensation Improve function in patients with permanent CNS deficits Improve function in children with CP (combined with bracing) Improve m. and resp function in COPD patients Improve bladder control in patients with stress or urge incontinence Increase strength and endurance of select m. Restore force generation in a m. following surgery Bell's palsy Maintain m. health in peripheral n. injuries Decrease spasticity Maintain/ improve ROM Decrease edema, promote circulation
51
NMES M. Strengthening Parameters
Frequency - 35-80 pps Pulse Duration - 150-200us (sm m.) 200-350us(lrg m.) Amplitude - Submax contraction On/off time - 6-10 s on, 1-2 min off Ramp - at min 2 s Duration - 2-3 hrs when awake 10-20 contractions
52
NMES M. Re-education Parameters
Frequency - 35-50 pps Pulse Duration - 150-200us (sm m.) 200-350us (lrg m.) Amplitude - Sufficient for functional activity On/Off time - Depends on activity Ramp - at min 2s Duration - depends on functional activity
53
NMES M. spasm reduction Parameter
Frequency - 35-50 pps Pulse duration - 150-200us (sm m.) 200-350 (lrg m.) Amplitude - visible contraction On/Off time - 2-5s on/off Ramp - min 1s Duration - 30 min 2-3hrs (until relief)
54
Russian
Muscle strengthening burst modulated to deliver 50 burst per sec Indications: post knee surgery, during immobilization after anterior collateral ligament sprain Frequency: 2500 Hz Reciprocal - stim agonist then antagonist to encourage alt mvmnts Co-contraction - stim agonist and antagonist to encourage stability Continuous
55
High volt
Wound healing: Stim dissolving of blood clots, increase vascularity. Antibacterial effects. Stim healing cells. Promote epithelial growth Edema control
56
HIgh volt wound healing parameters
Alt polarity 50% of time negative, 50% positive or start with negatieve until plateau is reched and switch to positive Pulse: 30-130 pps Pulse duration: 100 us Continuous mode Voltage: comfortable (100-200 V) 30-60 min, 2 hrs BID, 5-7 x a wk Active electrode is place near or on wound
57
Hi volt edema parameters
**Muscle pumping action:** * Pulse Freq 30-60 pps (produce contraction) * Pulse duration 150-350 us * On/Off 1-2 sec * 20-30 min **\* Acute inflammation control:** * Pulse freq 100-120 pps * Pulse duration 40-100 us * Negative electrode placed over area of edema * continuous * Voltage comfortable * 20-30 min
58
Laser
Light amplification by simulated emission of radiation Increases metabolic rate -\> biochemical responses Low level wave length 600-1000nm Larger wavelength go deeper (2-4cm) classification 3B
59
Biochemical changes Laser
Increase synthesis of endorphines Decreases "C" pain fiber activity Decrease inflammatory response May increase nerve growth Influences cellular messangers taht regulate blood flow, m contraction and nerve activation
60
Benefits of laser
Increase cellular energy by increasing ATP production improve cellular membrane stabilization Increase immune response Improve healgin by increasing cell proliferation Increased local blood circulation reduces pain increases endorphine release muscle relaxation anti-inflammatory response
61
Laser indications
postherpetic neuralgia Carpal tunnel Wound healing Fibromyalgia Arthritis (OA, RA) short term (4 wk) Pain management Achillies tendonitis ankle sprains Medial/lateral epicondylitis Myofascial syndrome Neuropathic pain Post traumatic nerve regeneration Reduce post mastectomy lyphedema
62
Laser Contraindications
Over pregnant uterus Malignancy Active hemorrhage Over boney growth plates Over endocrine gland (thyroid) Within 4-6 months of radiation
63
Laser Precautions
Direct irradiation over eyes Over tattoo of skin of dark pigmentation Impaired sensation/mentation Increased sensitivity to light Over epiphyseal plates in children
64
Laser Direct contact
Stationary direct contact held in place with moderate amount of pressure (decreases scattering with changes in interface) Imagine a grid. Hold in one spot, then move and hold
65
Stationary Direct contact Laser
4-9mm over tissue surface (not in contact with the skin) * Wound * hpersensitiivy * Inability to tolerate pressure more scattering occurs less penetration
66
Sweeping technique Laser
Can be direct contact or held over the tissue. Applicator moved over an area
67
LED
Light emission Diod Lower intensity More spread (multiple diods) multiple wavelengths longer treatment (because of decreased energy)
68
LED indications
Wound care Increase vascularity Thermal effects Specific infections Trigger points Accupunture points Dermatologic dx Myofacial pain Joint pain Diabetic peripheral neuropathy * Improve sensation * Decrease pain * used along with exercise * Short term effects
69

PTA Modalities (5 decks)

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