Electrotherapy for Pain Control & Muscle Contraction Flashcards
Which Estim parameters leverage Gate Control Theory
- conventional TENS/high rate
Which Estim parameters leverage Endogenous Opioid pain relief theory
- low rate/acupuncture TENS
What fibers does high rate TENS stimulate and how does it work in Gate Control Theory
- stimulates A-beta nerves
- pain perception is determined by the activity of A-delta & C nerves so an increase in A-beta activity decreases pain perception
How does low rate/acupuncture TENS use the Endogenous Opioid theory
- parameters stimulate motor nerves & a-delta nerves which when activated produce brief sharp pain resulting in the release of endogenous opioids & activation of inhibitory pathways
Describe electroacupuncture
- needles are stuck in the patient’s skin and Estim current is applied
- these points are targeted with high intensity, long duration, & low frequency
When is conventional/high rate TENS recommended
- recommended when sensation, but not muscle contraction will be tolerated
When is low rate/acupuncture TENS recommended
- recommended when a longer duration of pain control is desired (hours) & muscle contraction is likely to be tolerated
Conventional/high rate TENS parameters
Frequency: 100-150
Duration: 50-80
Intensity: tingling sensation
Treatment time: no set time
Mechanism of action: Gate Control Theory
Low rate/acupuncture TENS parameters
Frequency: 2-10
Duration: 200-300
Intensity: visible twitch contraction
Treatment time: 20-30 minutes every 2-4.5 hours
Mechanism of action: Endorphin release
Describe interferential current (IFC)
- uses two channels delivering alternating currents of different frequencies
- reduces impedance allowing for a deeper more sensory experience
Describe premodulated alternating current (Premod)
- uses a single set of electrodes
- alternating current with a medium frequency & sequentially increased & decreased intensity
- lacks depth
Define bipolar electrode set up
- 2 electrode set up
Define quadripolar electrode set up
- 4 electrode set up
Define modulation related to Estim
- irregular pattern of TENS stimulation in order to reduce or minimize the accommodation effects of regular patterned stimulation
What variables can be modulated
- frequency
- intensity
- duration
Define a scan modulation
- modulation of the intensity
Define a sweep modulation
- modulation of the frequency
Indications for Estim for muscle contraction
- strengthening
- decrease rate of atrophy
- spasticity management
- edema management
- increase local blood flow
- improve ROM
- muscle reeducation
- improve muscle endurance
- improve function
Parameters for muscle strengthening
Frequency: 80
Duration: 125-200 for small muscle & 200-350 for large muscle
Intensity: 10% max injured contraction & 50% max non injured contraction
On:Off time: 1:5 ratio
Ramp: at least 2 sec
Treatment time: 10-20 minutes or 10-20 reps every 2-3 hours
Parameters for muscle reeducation
Frequency: 35-50
Duration: 125-300 depending on muscle size
Intensity: depends on functional activity
On:Off time: depends on functional activity
Ramp: at least 2 sec
Treatment time: depends on functional activity
Parameters for muscle spasm reduction
Frequency: 35-50
Duration 125-350 depending on muscle size
Intensity: visible contraction
On:Off time: 2-5 sec equal on/off times
Ramp: at least 1 sec
Treatment time: 10-30 minutes every 2-3 hours until relief
Parameters for edema reduction using muscle pump
Frequency: 35-50
Duration 125-350 depending on muscle size
Intensity: visible contraction
On:Off time: 2-5 sec equal on/off times
Ramp: at least 1 sec
Treatment time: 30 minutes 2 times per day
How does Estim muscle contraction differ from normal muscle contraction
- Estim stimulates large fast twitch muscle fibers first which fatigue quickly
- Estim also fires all motor units at the same time (synchronous)
What can the PT do to minimize fatigue during NMES application
- vary current intensity
- modify electrode placement
- modify muscle length
How can you increase the amount of current
- increase duration
- increase intensity
- increase electrode size
Russian has not been proved to be more or less effective than pulsed biphasic waveform (true/false)
- True
With shorter durations, you will need ____ intensities (higher/lower)
- higher intensities
Define temporal motor recruitment/summation of contractions
- as frequency increases the muscle twitches will occur more closely together resulting in increased comfort, but with worsening fatigue
Define spatial motor unit activation
- the higher the intensity the more motor units activated
What is a motor point
- it is where motor nerves enter the muscle and is generally over the middle portion of the muscle belly
