Electrotherapy for Pain Control & Muscle Contraction

Question 1

Which Estim parameters leverage Gate Control Theory

Answer 1

• conventional TENS/high rate

Question 2

Which Estim parameters leverage Endogenous Opioid pain relief theory

Answer 2

• low rate/acupuncture TENS

Question 3

What fibers does high rate TENS stimulate and how does it work in Gate Control Theory

Answer 3

• 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

Question 4

How does low rate/acupuncture TENS use the Endogenous Opioid theory

Answer 4

• 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

Question 5

Describe electroacupuncture

Answer 5

• needles are stuck in the patient’s skin and Estim current is applied
• these points are targeted with high intensity, long duration, & low frequency

Question 6

When is conventional/high rate TENS recommended

Answer 6

• recommended when sensation, but not muscle contraction will be tolerated

Question 7

When is low rate/acupuncture TENS recommended

Answer 7

• recommended when a longer duration of pain control is desired (hours) & muscle contraction is likely to be tolerated

Question 8

Conventional/high rate TENS parameters

Answer 8

Frequency: 100-150
Duration: 50-80
Intensity: tingling sensation
Treatment time: no set time
Mechanism of action: Gate Control Theory

Question 9

Low rate/acupuncture TENS parameters

Answer 9

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

Question 10

Describe interferential current (IFC)

Answer 10

• uses two channels delivering alternating currents of different frequencies
• reduces impedance allowing for a deeper more sensory experience

Question 11

Describe premodulated alternating current (Premod)

Answer 11

• uses a single set of electrodes
• alternating current with a medium frequency & sequentially increased & decreased intensity
• lacks depth

Question 12

Define bipolar electrode set up

Answer 12

• 2 electrode set up

Question 13

Define quadripolar electrode set up

Answer 13

• 4 electrode set up

Question 14

Define modulation related to Estim

Answer 14

• irregular pattern of TENS stimulation in order to reduce or minimize the accommodation effects of regular patterned stimulation

Question 15

What variables can be modulated

Answer 15

• frequency
• intensity
• duration

Question 16

Define a scan modulation

Answer 16

• modulation of the intensity

Question 17

Define a sweep modulation

Answer 17

• modulation of the frequency

Question 18

Indications for Estim for muscle contraction

Answer 18

• strengthening
• decrease rate of atrophy
• spasticity management
• edema management
• increase local blood flow
• improve ROM
• muscle reeducation
• improve muscle endurance
• improve function

Question 19

Parameters for muscle strengthening

Answer 19

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

Question 20

Parameters for muscle reeducation

Answer 20

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

Question 21

Parameters for muscle spasm reduction

Answer 21

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

Question 22

Parameters for edema reduction using muscle pump

Answer 22

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

Question 23

How does Estim muscle contraction differ from normal muscle contraction

Answer 23

• Estim stimulates large fast twitch muscle fibers first which fatigue quickly
• Estim also fires all motor units at the same time (synchronous)

Question 24

What can the PT do to minimize fatigue during NMES application

Answer 24

• vary current intensity
• modify electrode placement
• modify muscle length

Question 25

How can you increase the amount of current

Answer 25

• increase duration
• increase intensity
• increase electrode size

Question 26

Russian has not been proved to be more or less effective than pulsed biphasic waveform (true/false)

Answer 26

• True

Question 27

With shorter durations, you will need ____ intensities (higher/lower)

Answer 27

• higher intensities

Question 28

Define temporal motor recruitment/summation of contractions

Answer 28

• as frequency increases the muscle twitches will occur more closely together resulting in increased comfort, but with worsening fatigue

Question 29

Define spatial motor unit activation

Answer 29

• the higher the intensity the more motor units activated

Question 30

What is a motor point

Answer 30

• it is where motor nerves enter the muscle and is generally over the middle portion of the muscle belly