Electrotherapy Flashcards
What factor influences the area of the spine treated?
Angle of pull Lumbar in flex, neutral or ext Cervical in neutral up to 25 degree
Intermittent vs. static traction
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.
Direct current (electrotherapy)
Current flows in one direction. Electrode are either + or - amd maintain polarity. Used for iontophoresis Hi-volt HV HVDC PDC
Alternating Current (electrotherapy)
Flow is continued in 2 directions. Moves in cycles and rhythmically changes directions Used for pain and m. strengthening
Pulsed Current (electrotherapy)
Alternating current that flows in either one or two directions with intervals no no electrical activity. Used for pain and m. strengthening
Anode
Positive electrode that attracts negatively charged ions and repels positively charged ions
Cathode
Negative electrode that attracts positivley charged ions and repels negativley charged ions.
Current density
The amount of current delivered per unit area.
Electrical current
the movement or flow or charged particles through a conductor in response to an applied electrical field.
Gate control theory
The theory that that there are gates at the spinal level that allow certain signals to pass or not.
Action potential
The basic unit of n. communication The depolarization and repolarization of a n. that occurs in response to a stimulus
Accommodation
When a n. gradually becomes less responsive to a stimulus. An increase in threshold.
Impedance
The opposition to current flow. Includes tissue resistance and ability to hold a charge
Motor Point
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
Acupuncture Point
Specific points mapped along meridians. Effects may be local or referred. Use: Pain
Trigger Point
Points that are hypersensitive to pressure or electrical stim. Effects can be local or referred Use: Pain
Ohm’s law
Current = Voltage/Resistance When the tissue resistance increases, the flow of current decreases
Tissue Impedance is affected by?
Water content of the tissue Temperature Quality of integument Factors influencing fluid balance Prescence of injury or disease
Resistance
A materials resistance to current flow. Acupuncture and motor points are known to have less resistance.
Ramp
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
Amplitude
Current strength M. nerve - Higher amps to stim Sensory nerve - Lower amps to stim
Adaptation
Decreased frequency of action potentials, and decreased sensation of stim that occurs because of unchanging characteristics
Opiod release theory
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
Interferential Current
2 high frequency currents crossed to control pain
No m. contraction elicited
Premodulated Current
Interferential current for a smaller treatment area. The crossing of electrical current happens within the machine.
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
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
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.
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.
Clinical Application of Electrical Stim
Pain Management
Neuromuscualr Dysfunction
Joint Mobility
Tissue Repair
Acute Chronic Edema
Urine.Fecal incontinence
Medcication Delivery
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
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
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
TENS indications
Pain:
Acute/sub acute/ chronic
Myofascial
Phantom limb
Musculoskeletal
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)
TENS/ IFC Precautions
Cardiac Disease
Over open wound
Pregnancy distal extremities
Patients with terminal cancer
Electrical current Adverse Reactions
Skin irritation
Burns
Pain
Conventional TENS effect
Sensation is strong but comfortable.
Rapid onset analgesia while the unit is on
Acupuncture-like TENS effect
Less comfortable, slow onset of analgesia (hours), long lasting once unit is removed, m. contraction elicited
Burst TENS effects
Less comfortable, rapid onset of analgesia, long lasting
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
IFC Indications
Pain relief
Low back pain
Osteoarthritis
Post-op ortho surgery
Stim myofascial trigger points
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
Iontophoresis Indications
Bursitis
Tendonitits
Carpal Tunnel Syndrome
Arthritis
Trigger point pain
Need for analgesia
TMJ
Plantar fasciitis
Epicondylitis
Iontophoresis Adverse reactions
Skin irritation from DC
Histamine Release (stim of mast cells) = small red bumps
Itching
Common medications for Iontophoresis
Dexamethasone - Negative (reduces inflammation)
Acetate - Negative (dissolve calcium buildup and scar tissue)
Hydrocortisone - Positive (reduce inflammation)
Lidocaine - Positive (decrease pain)
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
SCI Patients and NMES
can cause autonomic dysreflexia
Loss of sympathetic control
excessive inrease in BP
increased spasticity
Profuce sweating
Bradycardia
HA
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
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
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
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
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)
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
High volt
Wound healing: Stim dissolving of blood clots, increase vascularity. Antibacterial effects. Stim healing cells. Promote epithelial growth
Edema control
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
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
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
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
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
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
Laser Contraindications
Over pregnant uterus
Malignancy
Active hemorrhage
Over boney growth plates
Over endocrine gland (thyroid)
Within 4-6 months of radiation
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
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
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
Sweeping technique
Laser
Can be direct contact or held over the tissue.
Applicator moved over an area
LED
Light emission Diod
Lower intensity
More spread (multiple diods)
multiple wavelengths
longer treatment (because of decreased energy)
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
