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CP2 > Estim (wk 2) > Flashcards

Estim (wk 2) Flashcards

1
Q

What are goals/indications for estim?

A

a. Pain modulation
b. Decrease muscle spasm
c. Improve ROM
d. Muscle re-education
e. Improve muscle strength/reduce atrophy
f. Wound healing
g. Edema reduction
h. Stimulate denervated muscle

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2
Q

Contraindication or precaution of estim:

Cardiac disease

A

precaution

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3
Q

Contraindication or precaution of estim:

over superficial metal implants

A

Contraindications

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4
Q

Contraindication or precaution of estim:

Motor-level stimulation in conditions that prohibit motion

A

Contraindications

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5
Q

Contraindication or precaution of estim:

Impaired mentation

A

precaution

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6
Q

Contraindication or precaution of estim:

Anywhere in the body for someone with a pacemaker or other electronic medical device (insulin pump)

A

Contraindications

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7
Q

Contraindication or precaution of estim:

impaired sensation

A

precaution

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8
Q

Contraindication or precaution of estim:

Transcerebrally

A

Contraindications

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9
Q

Contraindication or precaution of estim:

over malignant tumors

A

Contraindications

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10
Q

Contraindication or precaution of estim:

areas of skin irritation or open wounds

A

precaution

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11
Q

Contraindication or precaution of estim:

over pharyngeal/laryngeal muscles

A

Contraindications

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12
Q

Contraindication or precaution of estim:

over carotid artery, thrombosis, eyes, phrenic nerve, pelvis and/or low back in pregnant women

A

Contraindications

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13
Q

Contraindication or precaution of estim:

patient with uncontrolled hypotension or hypertension

A

precaution

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14
Q

Contraindication or precaution of estim:

In presence of active bleeding or infection

A

Contraindications

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15
Q

Contraindication or precaution of estim:

bleeding disorder

A

precaution

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16
Q

What is polarity of cathode?

A

net negative

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17
Q

What is polarity of anode?

A

net positive

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18
Q

What is the amplitude/force of attraction or repulsion?

A

Voltage

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19
Q

What is rate of flow of electrons?

A

Amperage/current

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20
Q

Ohms law =

A

Current (I) = Voltage (V)/resistance (R)

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21
Q

Current is directly proportional to what?

A

Voltage

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22
Q

Current is indirectly proportional to what?

A

Resistance

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23
Q

What can act as resistance to flow on skin?

A
  1. skin
  2. hair
  3. fascia
  4. ligament
  5. fat
  6. bone
  7. tendon
  8. scar
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24
Q

What is a unidirectional flow of charged particles? (one pad to another)

A

monophasic

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25
Q

What is a bidirectional flow of charged particles?

A

biphasic

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26
Q

What is a uninterrupted unidirectional flow?

A

direct current

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27
Q

What is a uninterrupted bidirectional flow?

A

alternating current

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28
Q

What is a current that can either be unidirectional (monophasic) or bidirectional (biphasic) that periodically ceases for short time period?

A

Pulsed current

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29
Q

A pulsed current will have what 3 chracteristics?

A
  1. frequency
  2. pulse duration (width)
  3. amplitude
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30
Q

RMP for neuronal cells?

A

-70

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31
Q

RMP for skeletal muscle cells?

A

-90

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32
Q

How does electrical stimulation change Na and effect the membrane?

A

influx of Na+, causing reduction of RMP leading to DEPOLARIZATION of the membrane

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33
Q

Amplitude/intensity needs to be _____ enough and duration must be ____ enough to produce depolarization

A

Great enough

Long enough

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34
Q

T/F Duration of < 1ms is sufficient to stimulate nerve and muscle cells.

A

False, < 1 ms is sufficient to stimulate a nerve cell, but is too short to stimulate a muscle cell

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35
Q

Strength duration curve:

A
  1. Ab sensory
  2. motor
  3. Ad sharp pain
  4. C dull pain
  5. denervated muscle
36
Q

Why does normal redness occur during estim?

A

Heat is created by friction and vibration of particles moving through the material

  1. Normal redness dissipate after just a few hours
  2. Should not blister or result in broken skin
37
Q

T/F Patients may be at risk for burns if intensity of estim is too high

A

True

38
Q

A larger electrode means what size current density? More/less tolerant?

A

large electrode = current dispersed over a large area = small current density = more tolerated by patient

39
Q

A small electrode means what size current density? More/less tolerant?

A

small electrode = current dispersed over a small area = greater current density = less tolerated by patient

40
Q

increasing current density can cause skin burn. To avoid this:

A

i. Remove resistance: clean the skin
ii. Listen to patient’s perception
iii. Use larger electrodes when possible
iv. Always maintain good contact
v. Use an appropriate coupling agent if appropriate

41
Q

Describe electrode configuration of monopolar estim:

A

one small electrode over target area, and a large electrode placed over remote area (to complete the current).

42
Q

When would you use monopolar estim?

A

method choice when polarity is a concern (wound healing - attract to area, edema control, iontophoresis - drive into body).

43
Q

Describe bipolar electrode configuration:

A

both electrodes are of similar size and are placed over the target area. Current bounces between two pads.

44
Q

Preferred uses of bipolar:

A
  1. Disuse atrophy
  2. Neuromuscular facilitation
  3. ROM
  4. Spasms
  5. Circulatory disorders
45
Q

Describe quadripolar electrode configuration:

A

2 electrodes from two separate stimulating circuits are positioned so that the individual currents intersect with each other (IFC).

46
Q

What happens to depth of current when electrodes are placed further a part?

A

Increase depth of current

47
Q

recommended that the distance between electrodes be what?

A

at least one half the diameter of each electrode

48
Q

If motor stimulation is the goal, where place the electrodes?

A

Over the muscle belly

49
Q

2 common mistakes of estim placement:

A
  1. one electrode over muscle belly with the other over not much muscle
  2. too close together when trying to stimulate deep muscle
50
Q

What are the goals of NMES?

A

i. Atrophy treatment/ prevention
ii. Strengthening
iii. Achieve synchronous firing/ recruitment of motor units

51
Q

WHen using NMES, describe recruitment of motor units and the number recruited:

A

i. More random recruitment, large and small together (voluntary is small to large motor units)
ii. Cannot alter # of motor units recruited (voluntary can alter # recruited)

52
Q 
NMES:
Pulse width=
Pulse frequency = 
ON/OFF time = 
Ramp= 
Amplitude=
A 
Pulse width= 200-800
Pulse frequency = 30-100
ON/OFF time = 10s on 50s off 10 min
Ramp= 1-5 s
Amplitude= max contraction/tolerance
53
Q

What is burst modulation (russion) NMES?

A

Variation of alternating current that is interrupted and delivered in short bursts (AKA medium frequency burst alternating current)

54
Q

T/F Amplitude can stay the same in NMES during treatment and between treatments

A

False, decrease a chance of adaptation and optimize strengthening with ES current amplitude should be increased as often and as much as tolerated

55
Q

shorter the off time and the longer the on time of nmes =

A

greater chance for fatigue

56
Q

longer the on time of nmes =

A

a decrease in force output over time

57
Q

Align the electrodes ____ to the direction of the m fibers

A

parallel

58
Q

T/F Despite widespread use of Russian Current in clinical practice NMES pulsed current has been found to produce similar neuromuscular adaptations with less perceived discomfort.

A

True

59
Q

NMES shown to improve strength and function in patient ____

A

post surgery

60
Q

Functional estim (FES), a type of NMES in which the electrical stimulation is utilized as an alternative or supplement to orthotic devices or braces, is commonly used on what body parts?

A

shoulder subluxation and foot drop (swing phase foot clearance)

61
Q

What are the goals of interferential current (quad setup)?

A
  1. Most commonly used for pain modulation

2. production of muscle contraction and reduction of edema

62
Q

Describe interferential current (quad setup) setup:

A

Characterized by crossing of two sinusoidal waves that interfere with one another to generate an amplitude-modulated beat frequency

63
Q

What is constructive interference?

A

when the two waves are in phase, the sum of the superimposed wave is large

64
Q

What is destructive interference?

A

sum of the two waves is zero when the waves are 180 degrees out of phase

65
Q

What is beat frequency ((amplitude-modulated)?

A

resultant frequency produced by the two frequencies going into and out of phase

66
Q 
interferential current (quad setup)
Pulse width=
Pulse frequency = 
ON/OFF time = 
Amplitude=
A

Pulse width=200-400
Pulse frequency = 10-150
ON/OFF time = 10-30 min
Amplitude= strong but tolerable sensation

67
Q

T/F IFC is said to be more comfortable than equal amplitudes delivered by conventional means

A

True

68
Q

T/F IFC is effective alone

A

False, alone not effective, but when combined with other physical therapy treatments leads to above outcomes

69
Q

What is the goal of High Rate tens? Theory?

A

Pain modulation through activation of central inhibition of pain transmission (gate control theory)

70
Q

At what phases can high rate tens be used to decrease pain?

A

Acute or chronic

71
Q 
High Rate tens
Pulse width=
Pulse frequency = 
duration
Amplitude=
A

Pulse width= 50-80
Pulse frequency = 50-100
duration = 10 - several hours
Amplitude= comfortable tingling sensation; no muscle response

72
Q

High rate tens onset of pain relief and duration of pain relief?

A

Onset of pain relief: relatively fast

Duration of pain relief: temporary

73
Q

Low rate TENS goal? Theory?

A

Pain modulation through descending pathways generating endogenous opiates

74
Q

Low rate TENS used at what phase for decreasing pain?

A

chronic

75
Q 
Low rate tens:
Pulse width= 
Pulse frequency = 
duration = 
Amplitude=
A

Pulse width=150-300
Pulse frequency = 1-5
duration = 20-40 min
Amplitude= strong, but comfortable rhythmic muscle twitch

76
Q

Brief intense TENs is used when?

A

Used to provide rapid-onset, short term pain relief during painful procedures (wound debridement, passive stretching, joint mobilizations)

77
Q

Burst mode TENs is what?

A

Combines characteristics of both high and low rate TENS. Stimulation of endogenous opiates, but current is more tolerable to patient than low rate TENS

78
Q

What is hyperstimulation (point stimulation) TENS?

A

noxiously stimulate trigger point or local area of pain such as tendonitis

79
Q

What is modulation mode TENs?

A

a method of modulating parameters of any of above TENS to prevent adaptation due to constant ES; alters frequency, intensity, or pulse durations by > 10% (body does not get used to high intensity)

80
Q

Low intensity DC (micro-current) is used for what?

A

Wound healing

81
Q

Describe theory behind Low intensity DC (micro-current)>

A

b. Does not stimulate sensory/motor nerves

c. Used for tissue repair, wound healing

82
Q

What is the wound healing concept?

A

a. Intact skin surface negative with respect to deeper epidermal layers
b. Injury to skin develops positive potentials initially and negative potentials during healing process

83
Q

What is the goal of iontophoresis?

A

i. Application of a continuous direct current to transport medicinal agents through the skin or mucous membranes for therapeutic purposes; Need prescription to apply medication
ii. Like charges repel like charges
iii. Unlike charges attract unlike charges
(ex: dexamethasone is negative - place cathode to repel)

84
Q

How does NMES help with edema reduction?

A

Muscle pump: interrupted mode produces rhythmic contraction and relaxation of muscle to replicate muscle pump and improve circulation

85
Q

T/F recent animal study suggest Estim for denervated muscle has positive effect

A

False, negative effect

CP2 (20 decks)

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