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Phys Agents > Electrotherapy and Pain Modulation > Flashcards

Electrotherapy and Pain Modulation Flashcards

1
Q

What are the levels of physiologic response (4)

A
  1. Cellular
  2. Tissue
  3. Segmental
  4. Systemic
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2
Q

What are the cellular level responses to electrotherapy (5)

A
  1. Excitation of excitable cell membranes
  2. Changes in cell membrane permeability
  3. Protein synthesis
  4. Stimulation of fibroblasts and osteoblasts
  5. Modification of microcirculation
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3
Q

What cell membranes are excited by electrotherapy (2)

A
  1. Nerve

2. Muscle

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4
Q

What are the tissue level responses to electrotherapy (3)

A
  1. Skeletal muscle contraction
  2. Smooth muscle contraction
  3. Tissue regeneration
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5
Q

True or False:

Tissue level responses to electrotherapy require multiple cellular events

A

True

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6
Q

What are the segmental level responses to electrotherapy (5)

A
  1. Modification of joint mobility
  2. Modification of muscle contractility
  3. Muscle pumping action to change circulation and lymphatic drainage
  4. An alteration of microvasculature not associated with muscle pumping
  5. Increased movement of charged proteins into lymphatics resulting in fluid moving centrally
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7
Q

What are the systemic response to electrotherapy (3)

A
  1. Analgesic effects as endogenous pain suppressors are released
  2. Analgesic effects from the stimulation of certain neurotransmitters
  3. Stimulate spinal gate
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8
Q

What are the effects of electrical stimulation (3)

A
  1. Nerve depolarization
  2. Muscle depolarization
  3. Ionic effects
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9
Q

What has a slightly higher resting membrane potential nerves or muscles

A

Muscles

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10
Q

True or False:

The membrane of cells has differential permeability to different electrically charged ions

A

True

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11
Q

Is K+ easily or slightly permeable to the membrane

A

Easily permeable

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12
Q

Is Na+ easily or slightly permeable to the membrane

A

Slightly permeable

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13
Q

True or False:

The membrane is impermeable to large negatively charged protein and phosphates (anions)

A

True

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14
Q

True or False:

There are a large number of anions trapped inside the cell

A

True

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15
Q

True or False:

Depolarizing something in the middle will cause depolarization on both directions

A

True

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16
Q

Which way does the Na+/K+ pump move Na+ and K+ in relation to the cell

A

Na+ out

K+ in

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17
Q

Where is Na+ in higher concentration

A

Fluid surrounding the cell

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18
Q

Where is K+ and anions in higher concentration

A

Inside the cells

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19
Q

What is the resting membrane potential for muscle

A

-90 mV

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20
Q

What is the resting membrane potential for peripheral nerves

A

-70 mV

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21
Q

What maintains the negative resting membrane potential

A

The Na+/K+ pump moving 3 Na+ out and 2 K+ in resulting in a negative charge

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22
Q

True or False:

Larger diameter nerve fibers conduct the action potential faster

A

True

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23
Q

How fast do A alpha motor nerves carry APs

A

60-120 m/sec

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24
Q

How fast do A gamma and A delta nerves carry APs

A

12-30 m/sec

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25
Q

True or False:

Myelin makes the AP conduct faster

A

True

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26
Q

What is the AP jumping from node to node called

A

Saltatory conduction

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27
Q

True or False:

Most nerves in humans are mixed nerves leading to different nerve fibers firing at different rates

A

True

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28
Q

Where is the cell body and axon located in motor nerves

A

Cell body: Ventral horn or brainstem motor nuclei

Axon: Terminate on muscle

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29
Q

Where is the cell body and axon located in sensory nerves

A

Cell body: Dorsal root ganglion or cranial nerves sensory nuclei
Axon: 50% end as free nerve endings and 50% are specialized sensory receptors

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30
Q

What are the A alpha nerve diameter, conduction velocity, and type of nerve fiber (3)

A
  1. 12-20, 72-120, Muscle spindle primary afferent
  2. 12-20, 72-120, Golgi tendon organ afferent
  3. 12-20, 72-120, Skeletal muscle efferent
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31
Q

What are the A beta nerve diameter, conduction velocity, and type of nerve fiber (2)

A
  1. 6-12, 36-72, Touch pressure receptor afferent

2. 5-12, 20-72, Muscle spindle secondary afferent

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32
Q

What are the A gamma nerve diameter, conduction velocity, and type of nerve fiber (1)

A
  1. 2-8, 12-48, Muscle spindle efferent
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33
Q

What are the A delta nerve diameter, conduction velocity, and type of nerve fiber (1)

A
  1. 1-5, 6-30, Pain temperature afferent
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34
Q

What are the B nerve diameter, conduction velocity, and type of nerve fiber (1)

A
  1. Less than 3, 2-18, Preganglionic autonomic efferent
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35
Q

What are the C nerve diameter, conduction velocity, and type of nerve fiber (2)

A
  1. Less than 1, Less than 2, Pain temperature afferent

2. Less than 1, Less than 2, Postganglionic efferent

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36
Q

What are Ia nerve diameter, conduction velocity, and type of nerve fiber (1)

A
  1. 12-20, 72-120, Muscle spindle primary afferent
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37
Q

What are Ib nerve diameter, conduction velocity, and type of nerve fiber (2)

A
  1. 12-20, 72-120, Golgi tendon organ afferent

2. 12-20, 72-120, Skeletal muscle efferent

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38
Q

What are II nerve diameter, conduction velocity, and type of nerve fiber (3)

A
  1. 6-12, 36-72, Touch pressure receptor afferent
  2. 5-12, 20-72, Muscle spindle secondary afferent
  3. 2-8, 12-48, Muscle spindle efferent
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39
Q

What are III nerve diameter, conduction velocity, and type of nerve fiber (2)

A
  1. 1-5, 6-30, Pain temperature afferent

2. Less than 3, 2-18, Preganglionic autonomic efferent

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40
Q

What are IV nerve diameter, conduction velocity, and type of nerve fiber (2)

A
  1. Less than 1, Less than 2, Pain temperature afferent

2. Less than 1, Less than 2, Postganglionic efferent

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41
Q

What does the Gasser scheme name

A

Peripheral nerve fibers

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42
Q

What does Lloyd scheme name

A

Sensory fibers only

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43
Q

What is the strength duration curve

A

Graphic representation of minimum combination of current strength and pulse duration needed to depolarize that nerve

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44
Q

What do lower current amplitudes and shorter pulse durations depolarize

A

Sensory nerves (A beta and A delta)

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45
Q

What do higher current amplitudes and longer pulse durations depolarize

A

Motor nerves (A alpah and A gamma)

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46
Q

What do higher yet current amplitudes and longer pulse durations depolarize

A

Pain transmitting C fibers

47
Q

True or False:

You feel the electrical current before you see movement

A

True

48
Q

What is sub-threshold

A

Amplitude duration below curve for particular nerve

49
Q

What is threshold stimulation

A

Amplitude and duration on the curve

50
Q

What is supra-threshold

A

Amplitude and duration above the curve

51
Q

True or False:

The peripheral nerve membrane is more excitable than the muscle membrane

A

True

52
Q

What is the minimum current amplitude with a very long pulse duration required to produce an action potential called

A

Rheobase

53
Q

What is the minimum duration it takes to stimulate that tissue twice the rheobase amplitude called

A

Chronaxie

54
Q

What is rheobase dependent on

A

Current amplitude

55
Q

What is chronaxie dependent on

A

Time/duration

56
Q

What is all or none response

A

Once threshold is achieved nerve fiber fires

57
Q

What is accommodation

A

If stimulus is too slow nerve can adjust threshold level

58
Q

What are the 2 types of AP propagation

A
  1. Orthodromic

2. Antidromic

59
Q

What is orthodromic propagation

A

Normal physiological stimulation where the AP propagates one way only

60
Q

What is antidromic propagation

A

AP propagated both ways

61
Q

What controls peripheral nerve axon recruitment

A

Intensity

62
Q

What does a current that is applied at an intensity and duration just strong enough to reach threshold stimulate in a mixed nerve

A

Large superficial fibers

63
Q

What does an increased current intensity now stimulate in a mixed nerve

A

Medium sized superficial and deeper large sized fibers

64
Q

What does further increasing current amplitude now stimulate in a mixed nerve

A

Small superficial, medium deeper, and large deepest fibers

65
Q

What is TENS used for

A

Pain modulation

66
Q

What can selective stimulation of A beta fibers do

A

Block pain transmission in the spinal cord via the gate control theory

67
Q

What are the parameters for E-stim trancutaneously (conventional)

A

Short pulse duration (50-80), pulse frequencies 100-150, and low current amplitude (cause tingling)

68
Q

How long will conventional TENS block pain

A

Only as long as the stimulation is on

69
Q

True or False:

Conventional TENS can be used 24 hours a day

A

True

70
Q

How do you control for adaption (2)

A
  1. Modulate rate

2. Modulate width

71
Q

What are the parameters for low rate or acupuncture like TENS

A

Frequencies of 2-10, long pulse duration (100-200), and higher current amplitude (visible contraction)

72
Q

How long will acupuncture like TENS control pain after 20-30 minutes of treatment

A

4-5 hours

73
Q

How does acupuncture like TENS control pain for 4-5 hours

A

By stimulating the endogenous opioid system

74
Q

What is the half life of endogenous opiates

A

4.5 hours

75
Q

What fibers does acupuncture like TENS stimulate (3)

A
  1. A delta nociceptive
  2. A alpha
  3. A beta
76
Q

What are the parameters of noxious intensity TENS

A

Short duration stimulation (less than a minute), can use low (1-5) or high frequencies (80-110), pulse duration up to 1 sec, and amplitude 2 times motor threshold

77
Q

What is the intent of noxious intensity TENS

A

Stimulate C-fibers

78
Q

What is the motor threshold

A

When you see the muscle twitch

79
Q

What fibers does noxious intensity TENS stimulate

A

A delta, C fibers, A alpha, and A beta

80
Q

True or False:

Noxious intensity TENS uses opioid mediated and nonopioid mediated analgesia

A

True

81
Q

What does noxious intensity TENS mediate in the cord

A

Serotonin and noradrenaline

82
Q

Where does noxious intensity TENS mediate muscarinic

A

Supraspinally

83
Q

What does burst mode TENS work like

A

Low frequency TENS

84
Q

How is the stimulation delivered in burst mode TENS

A

Bursts or packages of 10 pulses

85
Q

What is the pulse duration of burst mode TENS

A

100-300 pps

86
Q

What types of nerves does interferential current depolarize

A

Sensory and motor nerve

87
Q

What are the therapeutic effects of IFC (3)

A
  1. Increase pain threshold
  2. Muscle contraction
  3. Muscle pumping
88
Q

How does IFC work

A

Stimulator imparts 2 different currents into the body and the currents interfer giving you a beat current which is the difference between frequencies.

89
Q

True or False:

The beat frequency can be changed to get pretty much any effect you want

A

True

90
Q

What is the pulse frequency of IFC for pain management

A

50-120 pps

91
Q

What neurons do you want to stimulate to modulate pain with IFC

A

Large diameter afferent neurons

92
Q

What is the pulse frequency of IFC for muscle contraction

A

20-50 pps

93
Q

What is the pulse frequency of IFC for acutism pain relief

A

1 pps

94
Q

True or False:

30 pps gives a smooth tetanic contraction when using IFC

A

True

95
Q

What are the indications for IFC (2)

A
  1. Pain of known origin

2. Possibly for muscle exercise to increase blood flow, muscle relaxation, and edema reduction

96
Q

What are the therapeutic purposes for high voltage pulsed current (3)

A
  1. Sensory TENS pain management
  2. Muscle contraction
  3. Motor TENS pain relief
97
Q

What is the pulse frequency for HVPC sensory TENS pain management

A

80-120 pps

98
Q

What is the pulse frequency for HVPC muscle contraction

A

30-60 pps

99
Q

What is the pulse frequency for HVPC motor TENS pain relief

A

2-4 pps

100
Q

What does HVPC sensory TENS pain management stimulate

A
  1. Large diameter afferent neurons

2. Activate spinal gate

101
Q

What does HVPC motor TENS pain relief stimulate

A

Endorphin descending loop

102
Q

True or False:

E-stim can activate the spinal gate to decrease pain

A

True

103
Q

How does E-stim activate the spinal gate to decrease pain

A

Stimulate A-beta fibers which closes the spinal gate by competing with A-delta and C-fibers

104
Q

What is AC current

A

An alternating sinusoidal curve

105
Q

What is DC current

A

Current that stays on the same side of the line

106
Q

How does AC current cause muscle contraction

A

Stimulates the alpha motor neuron

107
Q

How does DC current cause muscle contraction

A

Stimulates the muscle its self

108
Q

What type of contraction does AC current produce

A

Smooth tetanic contraction

109
Q

What type of contraction does DC current produce

A

A twitch

110
Q

Why are A-beta fibers the first fibers stimulated

A

The are small diameter myelinated fibers

111
Q

Why is a shorter phase duration more comfortable

A

The electric current is flowing in one direction for a longer time

112
Q

How do you stimulate the ascending and descending endorphin loops

A

By stimulating the A-delta and C-fibers

113
Q

Does E-stim directly stimulate receptors

A

No it stimulates the nerve attached to the receptor

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