estem Flashcards
what are the indications for e stem?
pain
edema
loss of function
ROM
tissue healing (of skin)
augmentation of blood flow
what are the contraindications of stem
*Cardiac arrythmia
*Pacemakers
*Pregnancy
*Menstruation *
Cancer
*Open wounds (except when treating the wound)
*Hardware (exposed)
*Carotid Sinus
*Eplilepsy
*Across spine
what are the one indications in the CPG to perform ESTEM because it has grade A level evidence
knee stability and movement coordination impairments: knee ligament sprain revision
6-8 weeks to do muscle strengthening after ACL reconstruction to increase quadriceps.
what are the three types of currents?
direct current
alternating current
pulsed current
what are the types of direct current E-stem?
conventional DC
reversed DC
Reversed-interruption DC
what are the parameters for direct current?
polarity
intensity
what are the parameters for E-stem?
Monophasic and biphasic
what are the parameters for monophonic?
polarity
frequency
pulse duration
intensity
ramps
what are the two types of biphasic currents?
symmetrical and asymmetrical
what is are the parameters for asymmetrical biphasic?
balanced and unbalanced
what are the parameters for unbalanced alternating currents?
polarity
frequency
intensity
Describe what a DC current is?
continuous unidirectional flow of electrons or ions for 1 second. flows between a + and - or - to +.
Describe what a interrupted DC current flow looks like?
After flowing in one direction for a sec the current will stop and kick back in to flow for another sec in the same direction.
describe a reverse DC current flow?
The current will flow in one direction for a sec and flip to flow int he opposite direction for a sec.
describe what a interrupted reversed current will look like?
combination of both interrupted pausing pattern and the flipping of directions seen in reverse flows.
From the book:
what is the most common use of DC current in the clinic?
most commonly used for iontophoresis or wound care.
How does iontophoresis work?
The process in which ions are transferred through intact skin via electrical potential
Via negatively charged ions being placed under the cathode (-) which are replied or pushed into the tissue away from them negative cathode.
what is iontophoresis used for and what are the precautions?
administer aqueous solutions of FDA approved medications prescribed by physician
used as alternative to injections
Precautions: Skin irritation (erythema, pruritis, increased temperature), burns (especially at cathode)
Residual skin break down (long term treatments)
What is a AC current and how does the flow of current work?
uninterrupted bidirectional flow off currents.
ions must flow and change directions at least one time per second.
Sinusoidal wave form.
from the book: What is the most common use of AC currents clinically?
most commonly modulated AC currents are used in Russian or IFC.
AC must change direction at least one time per second. If it does not, then what type of current would it be?
DC
what does pulsed currents flow look like?
pulsatile current, is the unior
bidirectional flow of ions or electrons that periodically
ceases for a period of time before the next electrical event.
Describe the difference between monophonic and biphasic currents?
monophonic: pulse deviates in one direction from baseline. Pulse phase is followed by a interpulse interval.
Biphasic: current flow switches between directions with a interpulse interval.
what are the three things you will primarily modulate?
frequency
phase duration
amplitude and intensity
Do you want a short, fat wave, a tall
skinny wave, or something in between?
Describe the strength duration curve theory?
For a A α nerve fiber what is the size/ myleination? what is the diameter? what is the conduction velocity? what receptor does it use? what stimulus does it use?
size/ myleination: large/high
diameter: 12-20um
conduction velocity: 70-120m/s
Receptor: Proprioceptive mechanoreceptor
Stimulus: Muscle veocity & length changes, reflex?
For a A β nerve fiber what is the size/ myleination? what is the diameter? what is the conduction velocity? what receptor does it use? what stimulus does it use?
size/ myleination: medium/high
diameter: 6-12 um
conduction velocity: 36-72 m/s
Receptor: Proprioceptive mechanoreceptor
Stimulus: Muscle length, SENSORY, TOUCH, Hair receptors
For a A δ nerve fiber what is the size/ myleination? what is the diameter? what is the conduction velocity? what receptor does it use? what stimulus does it use?
size/ myleination: Smaller/Less
diameter: 1-4 μm
conduction velocity: 5-15 m/s
Receptor: Pain, crude touch, pressure, temperature
Stimulus: Thermal change
For a C nerve fiber what is the size/ myleination? what is the diameter? what is the conduction velocity? what receptor does it use? what stimulus does it use?
size/ myleination: Smallest/Un-myelinated
diameter: 0.1-1 μm
conduction velocity: 0.2-2 m/s
Receptor:Pain, pressure, touch, SLOW
Stimulus: Noxious, mechanicalTemp
what are the settings for gate control theory application?
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Target nerve: A Beta
*
Frequency: 80-150 Hz
*
Phase Duration: 50-100 μs
*
Intensity: Strong, sub motor tingle
*
Pain relief: Gate theory
*
Duration of effect: As long as current is on
what are the levels for motor level pain modulation
Motor Level Pain Modulation (Beta Endorphin)
*
Target nerve: A Delta (alpha motor too)
*
Frequency: 1-10 Hz (usually 2-4)
*
Phase Duration: >150 μs
*
Intensity: Strong, visible contractions
*
Pain relief: Beta endorphins
*
Duration of effect: possibly hours
what are the settings for descending pain modulation?
Hyperstimulation Analgesia or Noxious Level Pain Mod)
◦
Target nerve: C Fiber
◦
Frequency: 100-150 Hz OR 2-7pps*
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Phase Duration: >1 millisecond
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Intensity: As high as tolerable (PAIN!)
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Pain relief: Descending serotonergic path
Beta Endorphins, Dynorphins
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Duration of effect: Several hours
