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Final Exam Flashcards

1
Q

Russian stim ramp time for strength? For speed?

A

Strength: 1-2 seconds allows for time for muscle fiber recruitment

Speed: 0.5-1 second for quicker recruitment of mm fibers

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2
Q

What is Russian stim ramp time?

A

Attempts to mimic as closely as possible the natural voluntary muscle contraction

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3
Q

What is the on/off cycle for Russian stim? What is optimal? Why?

A

Ratio of time measured during which there is stimulation to the time during which there is no stim

10:50 (10 sec on:50 sec off) is optimal because it allows for enough rest time between contractions to prevent mm fatigue

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4
Q

Which tissue has lowest resistance to current flow?

A

Muscle

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5
Q

What does TENS do?

A

Afferent nerve stimulation based on the “gate control” theory of pain modulation

Designed to relieve pain as well as the reflexogenic and autonomic physiologic responses to nociception

Remember: TENS only controls pain, there is NO tissue healing benefit. Pain relief can be expected to last for a few hours after stopping the treatment

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6
Q

When do you use HI TENS? How long is Tx?

A

For acute pain - sensory only (NO MM contraction). Usually begin therapy with HI TENS

Offers comfortable paresthesia

Tx = 20 minutes to several hours

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7
Q

When do you use LOW TENS? How long is Tx?

A

Chronic pain - motor involvement. You add motor involvement to patient comfort.

20-45 minutes, no longer d/t risk of mm soreness

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8
Q

Compare HI and LOW TENS: Frequency

A

HI 75-100 pps

LOW 1-5 pps

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9
Q

Compare HI and LOW TENS: pulse width

A

HI: short 50-100 usec
LOW: long 200-300 usec

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10
Q

What is gate control used for (e-stim)?

A

Gate control is sensory level and used for acute conditions to block pain

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11
Q

What is opiate release used for (e-stim)?

A

To mild motor level used for more chronic conditions

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12
Q

Compare e-stim frequencies for gate control vs opiate release

A

80-120 bps gate control (acute)

1-10 bps opiate release (chronic)

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13
Q

Contraindications for all modalities talked about since the midterm

A

Contraindications: General electro stim (except light therapy):

  • Cancer / malignancy
  • Acute bacterial or systemic infection
  • Broken skin (exception = IFC for germicide)
  • Areas of reduced circulation / sensation
  • Anticoagulant therapy / bleeding disorders
  • Hemorrhage
  • Near areas of subsurface bleeding / menstruation
  • Thrombosis
  • Over active epiphysis in children
  • Over the cervical ganglion, vagus or phrenic nerves, carotid sinus, or heart
  • Cardiac rhythm disturbances
  • Pacemakers
  • Other implanted electrical devices
  • Near surgical implants (US = no plastic, others = no metal)
  • Any patient who cannot understand instructions or communicate clearly
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14
Q

Indications for TENS

A

Controls P ONLY

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15
Q

Indications for Russian stim

A

Muscle strengthening ONLY

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16
Q

Indications for US

A

Used for combo therapy with IFC

Tissue healing
Reduce p
Increase circulation
Deep healing effect for phonophoresis

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17
Q

Indications for high voltage pulsed current

A

Muscle strengthening

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18
Q

Indications fo rIFC

A

Reduce pain and nerve block for acute or chronic pain

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19
Q

Indications for microcurrent

A

Reduce pain
Swelling/edema
Promote tissue healing

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20
Q

What effect does the distance between electrode pads have during IFC

A

Pads close together: superficial tissue

Pads further apart: deeper tissue

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21
Q

What is peak amplitude?

A

The maximum current amplitude of one or more phases from zero baseline to peak

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22
Q

How do you perform russian stim?

A
  • Place both pads on the muscle belly
  • During the ON cycle: patient contract mm against doctor’s resistance
  • Intensity should be to tolerance with a ramp time of 1-2 second depending on goal (1-2 sec for mm fiber recruitment; 0.5-1 sec for quicker mm fiber recruitment)
  • Do 10-20 reps with a 10 sec isometric hold
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23
Q

Frequency for Russian stim?

A

Frequency= 50bps

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24
Q

What is the ideal on/off ratio for Russian stim?

A

10:50 On:Off

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25
What is the ideal duration for Russian stim?
10-20 min every other day for 2 weeks
26
What modalities are used in combo therapy?
US and IFC
27
How do you perform combo therapy (US and IFC)?
Pads placed in adjacent area to area of Tx Sound head becomes second electrode and closes the circuit Start with US and then add IFC to patient tolerance
28
Know the different ways micro current can be applied
1) 2-4 pads on either side of the lesion 2) 2 probes 3) 1 probe and 1 pad Home units can be applied 23 hrs/day
29
Effects of microcurrent?
- DECREASE INFLAMMATION - Wound healing theorized mechanism (Skin battery, Current of injury, Tissue repair, Polar attraction of cells) - Cell wall permeability changes - Increased ATP production and protein synthesis - Increased fibroblastic activity - Pain relief - Cell differentiation - Increased tissue healing
30
What are the 2 US frequencies and what depth of tissue do they penetrate?
3 MHz = 0.4-0.8 inches | 1 MHz = 1-2 inches
31
Which US frequency is high frequency and what does that mean?
3 MHz has 3-4Xfaster thermal effects than 1 MHz
32
Which US frequency has greater depth of penetration?
1 MHz (low frequency) has higher rate of absorption by deep tissues 1-2 inches
33
What is the waveform for Russian stim?
Burst modulation stimulates pulsed low frequency AC during russian stim
34
What is polarity?
Net charge of an object
35
What is net negative polarity? | What is net positive polarity?
Net (-) is cathode | Net (+) is anode
36
What is universal symbol for current ?
I
37
Know the characteristics that allow russian stim to depolarize motor nerves
Kits theorized that during a maximal voluntary contraction (MVC) a healthy athlete could recruit a substantial number of large type II fast-twitch motor units and fire them at a frequency rapid enough to maximally develop muscular force. To test this hypothesis, Kots suggested the use of... 2500 Hz AC that acted like low-frequency (50Hz) stimulation, at high stimulating amplitudes that, Kots believed, would selectively depolarize large fast-twitch motor fibers. (Lecture 9, Pg 7)
38
Duty cycle for russian stim?
10:50
39
Duty cycle for US (acute vs chronic)?
Acute or phonophoresis 20%/pulsed Chronic 100%/continuous
40
Duty cycle for TENS (HI vs LOW)?
HI burst or modulate | LOW burst or modulate
41
What are clinical effects of combo therapy?
1˚ for location and Tx active and/or latent MFTPs, fibro, piriformis syndrome and spasm
42
What does US do in combo therapy?
Reduces resting membrane potential of peripheral nerve by increasing permeability to sodium and calcium so it is easier for ES to depolarize the nerve
43
IFC uses 2 medium frequency alternating currents called ________, that are a slightly difference frequency to each other.
Carrier waves — they intersect each other.
44
What is the pattern of intersections of IFC’s carrier waves?
Cloverleaf pattern of stimulation
45
Due to the slight differences in the IFC frequencies, the carrier waves are in and out of phase with each other and that creates a new waveform called
Polyphasic amplitude modulated current or BEAT FREQUENCY
46
What is beat frequency?
Number of times the 2 different currents peak simultaneously
47
What can the IFC current do?
Stimulate mm contractions w/o promoting motor end plate fatigue
48
How do you increase current in a circuit? (2)
1. Increase voltage force | 2. Decrease resistance (shave yo’ hair off)
49
How does electrical motor recruitment differ from voluntary
- ES activation of motor nerves tends to promote the physiological (voluntary) motor recruitment pattern - ES activation of myocytes (over muscle belly) recruits motor units in a nonselective, random order. More likely to contribute to muscle fatigue and decreased contraction force.
50
How does micro (MES) increase tissue healing?
1- increased blood flow, skin temperature, vasodilation, tissue oxygenation 2- Upregulation of cellular metabolism 3- Stimulation of reparative cell migration to the cathode or anode 4- Bactericidal and bacteriostatic effects 5- Stimulation of collagen matrix organization and wound contraction 6- Stimulation of fibroblast activity, epidermal cell proliferation, advanced scar remodeling, and epithelialization
51
How does premodulated IFC work?
Premodulate carrier waves inside the device emits the beat frequency through 2 electrodes in a bipolar configuration
52
How is premodulated IFC different from true IFC?
Delivers low freq amplitude modulated current to the skin so current is concentrated under the electrode and doesn’t penetrate as deep as true IFC
53
How long can acute patients wear HI TENS?
23 hours/day Sensory only means comfortable paresthesia that controls pain via pain gate stimulation
54
How long can acute patients wear LOW TENS?
20-45 minutes Motor means there is motor involvement to patients comfort, the longer and harder = more mm soreness
55
Which modalities modulate edema using muscle pump in acute patients?
Cryotherapy stimulates local contraction High volt pulsed current Russian stim BPC (biphasic pulsed current) IFC (interferential current)
56
Which modalities are good choices for muscle strengthening
``` MES: ancillary effect IFC: less effective outcome US pulsed: ancillary effect Moist heat: with therapeutic exercise (TE) Cold: to facilitate TE Laser: ancillary effect PSWT: ancillary effect Traction: ancillary effect MT, MOB: ancillary effect MFR, STM: ancillary effect ```
57
When do you need to use dispersive pad with HVPC?
When there are dermal wounds Place dispersive pad over healthy tissues 5-15 cm away
58
Where do you place the black cathode and red anode?
Black placed over motor point or mm belly of target muscle Red placed nearby on the same muscle group
59
Black cathode is the site of __________________ because it has a greater concentration of ____________ ions that will reduce _________________?
Black cathode is the site of motor nerve depolarization b/c it has greater concentration of negative ions that will reduce the motor nerve RMP
60
The red anode has lesser concentration of ___________ ions which does what?
negative ions, which hyperpolarize the nerve and results in decreased responsiveness of the muscle to the stim
61
What fiber type does TENS activate to close the pain gate at the spinal level?
Type A beta fibers
62
When russian stim is combined with voluntary contractions, the torque is less than produced by the voluntary contraction alone. What is this effect called, why does it happen and what is the result?
Wedenski inhibition It happens when two high-intensity stimuli occur simultaneously. Motor end plate fatigue is the result.
63
What is a purpose of direct current?
Iontophoresis = the movement of ions through the skin for pain relief and tissue healing. This happens via: - Vasodilation: promotes blood flow / tissue oxygenation, may increase or decrease edema and effusion - Calcium channel activation: stimulates fibroblasts and collagen synthesis - Upregulation: increases DNA / RNA activity, stimulates intracellular protein production - Anode: attracts leukocytes and epidermal cells - Cathode: attracts platelets, leukocytes, fibroblasts, keratinocytes
64
3 benefits of microcurrent
Reduce pain Reduce swelling, edema Tissue healing
65
Why would you use 0.5-1 second ramp speed for russian stim?
Quicker recruitment of muscle fibers
66
Why would you use 1-2 seconds ramp speed for russian stim?
To allow more time for all muscle fiber recruitment — so strength
67
What is frequency?
Frequency is the number of electrical energy pulses emitted per second.
68
What is frequency measured in?
Hertz 90 Hz=80 pulses per second
69
Know the clinical levels of electrical stim.
Sensory, motor, nociceptive | What is not part of clinical level?
70
What happens when you increase the distance between electrodes?
Tx affects deeper tissues the further the electrodes are away from each other
71
How long can you apply TENS?
23 hours/day
72
What does CBAN stand for?
Cooling Burning Aching Numbness
73
What is CBAN?
Stages of numbness in response to cryotherapy You gotta check in with the patient to see what stage they are at
74
What is the therapeutic temp range for heat? (In F˚ obvs)
104-113˚
75
How do you hold the sound head?
Parallel to Tx surface
76
When do you use pulsed US?
For mechanical effects
77
Benefits of pulsed US?
Soft tissue repair Stimulation of blood flow Bone fracture repair Tendon repair
78
T/F. Sound head should be moving at all times to avoid burns
True
79
T/F. Keep the sound head off boney prominences to avoid irritating periosteum
True

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