Final Flashcards
NMES- low rate vs. high rate
Low rate – twitch – used over motor pts, low rate, high width, endogenous opiates, good for chronic pain, tx time – 30-45 min
High rate – sensory analgesia – multiple electrode placements, high rate, low width, gating, more comfortable for long applications, best for acute pain
NMES- what is modulated vs. burst used for?
to prevent accomadation
with nmes then do we use it? with or without muscles contracting?
with
NMES- what is ramp modulation?
the rise time
NMES- definition of frequency
low=twitch, high=tetany
the purpose of nodes of ranvier
The action potential travels from one location in the cell to another, but ion flow across the membrane occurs only at the nodes of Ranvier. As a result, the action potential signal jumps along the axon, from node to node, rather than propagating smoothly, as they do in axons that lack a myelin sheath.
calcium is stored where?
in non- muscle cells.
difference between muscle and trigger points
motor points: area of muscle
trigger: area of muscle that is more sensitive and more excitable/ and tender
stages of tissue healing
- Acute (inflammatory) 3 days 2. repair and regeneration (proliferative stage) collagen being laid down 3. remodeling (adding forces to the collagen)
what is Galvanotaxis
A process by which negative ions are attracted to a positive pole and positive ions to a negative pole (helps with healing)
Final exam written:
has a table and have to tell indications (what it does) contraindications (why you wouldn’t use it) and also how it works and some conditions you would use it for***
uses of IFC
1- Relief and management of acute and chronic pain.
2- Muscle stimulation
3- Increased blood flow
4- Reduction of edema
5- Stimulating of soft tissues healing and repair.
laser has?
photons (particles of light) which stim tissue healing by effecting tissue healing
laser definition
Light Amplification by the Stimulated Emission of Radiation
laser indications
Tissue healing
Acute and chronic pain
laser contrindications
Pregnancy
Fontanels of children
Cancer
Near eyes or genitals
wave length and particle
wave length carries the energy, has ability to be measured with frequency and amplitude (bigger wave = more energy)
traction- angle of pull for cervical spine
flat= upper cervical, the more we flex= more lower cervical
hydrotherapy- specific water heat temperature
Ms-colder water
Oa- warmer water
hydrotherapy- deep water excdercise
Patient’s feet cannot touch the bottom
Open chain exs
Depth at least 5’6”
Patient must use buoyancy assist devices
Water should be tepid, since treatment times approach 45 min
Great medium for pregnancy
Water immersion – lowers resting heart rate. This is good for pregnant women with back pain as land based exercise has been shown to raise the heart rate of the fetus.
hydrotherapy- Mid-level to shallow-level exercise
T12 –chin = mid
Knee – T-12
Permits the body to move over fixed distal extremity
Some WB
May allow faster rehab for pts with total jt replacements
Can progress from mid to shallow
Significant training effects noted – esp VO2 max
hydrotherapy-Bad Ragaz techs
a buoyant ring to assist the patient floating in the water.
The ring may be placed around the trunk or around the extremities or it may support the head and neck
PNF patterns often added
ROM, Stretching and strengthening can also be done (isometric and isotonic)
Patient can be supine, prone or sidelying
what CAN taping do?
Support areas subject to excessive stress
Support joints with a history of an injury
Secure dressings in place
Minimize chance of further damage
Provide some compression to control swelling
Enable athlete to return to activity which assists in regaining strength and flexibility
what taping CANNOT do?
Because tape is applied to skin (moves), total control is not possible
Cannot be used in isolation for injury management
common taping mistakes
Windows – opening in the tape
Shadows – area of less overlap of tape
Wrinkles
Tape too tight or too loose
comomon acid formed
salt, HCl, citric
electrical stim monophsic or asymetrical
monophasic (good current for necrotic tissue)
disorders for why traction could be used
Disc protrusions
Lateral stenosis (pinched nerves)
DDD
And subluxations
traction- intermittent vs. static hold
Intermittent (the rest period)
Static hold is better for chronic holds
facet issues benefit from long intermittent
lumbar traction-angles of pull
45-60 deg of flexion will cause laxity at the L5-S1 level
60-75 deg – laxity at L4-5
And 75-90 deg at the L3-4 (traction boulster)
contraindications for traction
Spinal infections – meningitis RA Osteoporosis Spinal CA (cancer) Spinal cord pressure Recent fracture Harrington rods? (very rare)
define TENS
transcutaneous electrical nerve stim – pain management through skin electrodes
define IFC
Interferential Current – 4 electrodes. Used for pain. 2 currents – interfering. (most liked by patients)
define NMES
neuromuscular electrical stim – stimulating innervated mm to restore function. Includes strengthening and muscle re-ed
define EMS
electrical muscle stimulation – done to maintain muscle viability
define Direct Current (DC)
Electrons flowing continuously in 1 direction
define Alternating current (AC)
Periodic reversal of electron flow
define current (I)
How fast electrons flow
OHM is the measure of what
resistance
define impedence
opposition of electrical circuits to flow of AC. Ohm is used for impedance and resistance. (like fat and skin)
most tens and nmes are what type of wave?
biphasic
why is biphasic better than monophasic?
prevents ion build-up and abnormal pH
contraindications for estim
Pregnancy – over the uterus. Pacemaker – not over pacemaker Cancer- not over cancer site. On or near DVT Over the carotid sinus-side of the neck
estim motor resposne occurs at
5mA**
3 categories of peripheral nerves
: A (biggest, afferent and efferent and myelinated); B (same as A but smaller); C – unmyelinated and small – these are pain (visceral) and cutaneous sensation. (don’t move quickly) some sensations don’t want to relay quickly
what is tetany?
Tetany is a summation of twitches
what happens when u increase amplitude?
u are recruiting more muscle motors
motor point for
twitch
What is the formula for ohn’s law
Voltage=currentxR (V=IxR
The description of how fast electrons move is called
current
The current resistance are ( ) related. High skin resistance therefore required more voltage to produce necessary current
inverse relationship
The( )the pulse width, the more likely you are to stimulate( )nerves
Longer, motor nerves OR
shorter, sensory
The type of wave most common for tens and nmes is
Asymmetrical biphasic
accomidation can be prevented by
Turn up amps or turn onto modulated or burst
By turning up intesnsity one moves from
Sub sensory to sensory to motor to pain
What is the rmp (resting membrane potential)
-70 to -90 mV
Normally these muscles fibers are recruited first
types 1 (exception is estim because large motor units are recruited first)
Sources of ELF are from
household applicance at 60 Hz
frequencies for tissues
Nerve‐2 Hz
Bone‐75 Hz
Ligament‐10 Hz
Capillaries and skin‐15 Hz
US laser and PEMF can effect cell membranes which can..?
affect healing
contraindications for PMEF
Pacemakers
Pregnancy
Epilepsy
PEMF therapeutic frequency
extremely low (frequency range)
traction- how much weight do u use
half body weight for lumbar traction
US-indications: why use it?
Tissue healing, for heating up deep layers of tissue
mechanisms: 2 answers
- acoustic streaming: movement of gas bubble across cell membranes, 2. Friction: vibrating of cells
intensity, frequency, duty cycle (10, 15% of continuous
bigger wave=
more energy
parameters of IFC
Do not cross electrodes over the thorax Same CI and precautions as TNS and NMES Caution that electrodes do not dry out!! MUST wet sponges!!!! Some IFC use vacuum suction and some require sponges to be held in place with velcro straps
Causes of Itching or Prickling sensations
Patient moved and electrodes not making good contact
Gel or water dried out
Electrode worn out
which current is best for tissue healing?
can have both monophasic or asymmetrical biphasic as answer
