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PT Modalities > Final - Queen > Flashcards

Final - Queen Flashcards

1
Q

Calc current density of given electrode size of the electrode (in milli-amps)

A

Applied current (mA) / electrode (cm^2) =

current density (mA/cm^2)

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2
Q

What is current density?

A

mA/cm^2

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3
Q

what motor fibers will be excited during motor response?

A

A-a fibers

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4
Q

Know when noxious response occurs When e-stim stimulate beyond therapeutic effect to a noxious response, what threshold is passed?

A

Supramaximal stimulus threshold

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5
Q

When ES amplitude or duration is increased beyond supramaximal stimulus threshold what fibers are stimulated?

A

A-d or C fibers

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6
Q

What is the uncomfortable surge of the e-stim intensity when the device is abruptly turned off called?

A

CAPACITANCE

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7
Q

What causes capacitance in e-stim?

A

Abrupt termination of treatment by unplugging or turning off the device before the current has decreased, allows stored current to freely flow through the electrodes

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8
Q

How is total phase duration of biphasic pulse cal.?

A

Pulse duration + interphase duration

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9
Q

What is phase duration?

A

Time elapsed from the beginning to the end of one phase

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10
Q

What is Pulse duration?

A

Time elapsed from beginning to the end of the two phases within a pulse, including the interphase interval, if present

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11
Q

If phase durations of a biphasic pulse are 150 μsec each & interphase interval is 50 μsec, what is the total pulse duration?

A

350 μsec

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12
Q

What is the carrier frequency for russian current, and what is it modulated to?
When it’s modulated, what is this called?

A

2500 Hz, burst (many Hz =burst)

CONTINUOUS CARRIER WAVE = Bursts of 50Hz

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13
Q

What does modulated russian currents CONTINUOUS CARRIER WAVE consist of?

A

Bursts of 50 bps

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14
Q

What frequency do nerves respond to,to depolarize?

A

50Hz

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15
Q

What is polarity?

A

Net charge of an object

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16
Q

What is the 1 use of continuous direct current?

A

Iontophoresis

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17
Q

How is biphasic current produced?

A

Intermittently interrupting an AC current source

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18
Q

What is the primary clinical indication for using a TENS device?

A

Chronic pain…in order to gait the pain and/or get opioid release

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19
Q

What is on and off cycle used for the rehab of Russian Stem?

A

10 on

50 off

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20
Q

Why is the R-stem on and off cycle only one for 10sec?

A

To prevent muscle fatigue, which occurs at 15sec

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21
Q

The 10/50/10 Russian Stem stem rehab cycle allows for muscle contraction to produce what?

A

To increase force and strength with the parameters

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22
Q

What is the designated/universal symbol of current?

A

I = intensity

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23
Q

I (intensity) is the universal symbol for current. What is I measured in?

A

amps (A)

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24
Q

What biphasic current waveform is clinically useful for Trigger Point Therapy?

A

Biphasic pulsed sinusoidal wave

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25
Q

What does a Biphasic pulsed sinusoidal wave consist of?

A

+ & - polar chard (anode & cathodal phases)

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26
Q

What are the 2 type of Biphasic pulsed wave currents?

A

Symmetrical & asymmetrical balanced

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27
Q

Which high frequency range for TENS application provides rapid pain gait analgesia of short duration
Conventional TENs?

A

80 - 125 Hz

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28
Q

In Iontophoresis, you have a drug with a Negative ion, which electrode is the drug attached to?

A

CATHODE / ( - ) / Black

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29
Q

In Iontophoresis, you have a drug with a positive ion charge, which electrode is the drug attached to?

A

ANODE ( + ) / red

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30
Q

What defining characteristic of Russian stem causes nerve degeneration?

A

Motor nerve depolarization

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31
Q

R-stem motor nerve depolarization results from what?

A

Independent, intrinsic number of pulses contained in each burst.

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32
Q

Why are all NMES currents effective at depolarizing motor nerves?

A

Independent pulse bursts summate to evoke action potential

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33
Q

common waveform to activate skeletal muscle?

A

Sinusoidal waveform burst modulated at 50 Hz

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34
Q

What protocol uses Sinusoidal waveform burst modulated at 50 Hz?

A

RStim 10/50/10

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35
Q

Full tetanic skeletal muscle contraction occurs at a what fusion frequency?

A

50Hz

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36
Q

Why is Russian stem described as having a 50% duty cycle?

A

Burst / interburst duration

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37
Q

Why are electrodes placed in a three- dimensional manner for microcurrent?

A

To flow along nerves / meridians

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38
Q

What is correct electrode placement for microcurrent therapy for Tx back pain?

A

1 electrode next to spine @ the level of involved spinal nerve
Other electrode is placed anterolaterally; on the front and opposite side
To direct current along the spinal nerves in a Three- dimensional manner to “Frame the pain”

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39
Q

What does bilateral microcurrent therapy theoretically stimulates?

A

dermatomes
myotomes
sclerotome

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40
Q

Repeat applications of microcurrent therapy may place electrodes one spinal level above, and one below the involved spinal nerve to accommodate what?

A

Overlap in the dorsolateral fasciculus

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41
Q

When is biphasic pulse current not indicated for acute mgmt?

General ES contraindication

A

Phlebitis, thrombophlebitis

acute and subacute

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42
Q

Why is biphasic pulse current not indicated for acute mgmt?

A

Increase edema & vascular fragility

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43
Q

What mechanism is responsible for electric migration during iontophoresis?

A

Voltage force, transcutaneous delivers a therapeutic agent (drug) by electrical current

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44
Q

What does voltage force do in iontophoresis do?

A

Separates the electrode charges , but pushing the charge, creating electrical potential energy

45
Q

What happens with to little voltage force in electric migration during iontophoresis?

A

limit agent delivery

46
Q

What happens with to MUCH voltage force in electric migration during iontophoresis?

A

Could result in adverse effects

47
Q

What 6 tissues have a low resistance to current flow in the body?

A 
Muscle
Blood 
Nerve
ECF (Extracellular Fluid)
ICF (Intracellular Fluid)
Synovial fluids
48
Q

When using BIPHASIC PULSED CURRENT for MUSCLE STRENGTHENING, what is the most appropriate DUTY CYCLE for patients with neuropathic recruitment pattern or a decreased activation of their muscles?

A

10 on 50 off

49
Q

What is the PULSE DURATION for BIPHASIC PULSED CURRENT in muscle strengthening?

A

300-500msec

50
Q

Why is the pulse duration increased in biphasic pulsed current for muscle strengthening?

A

To get action potential in the damaged nerve

51
Q

What’s the therapeutic waveform in microcurrent?

A

Pulsed monophasic waveforms

52
Q

What is primary clinical use of combo therapy?

A

MFTPs

53
Q

What’s the maximum safe current density under cathode during iontophoresis?
(Without burning / destroying tissue?

A

The current density is based on electroconductive surface area

54
Q

Iontophoresis, electroconductive surface area is always _____, than the gross electrode size?

A

smaller

55
Q

What is the cathode maximal safe current density in iontophoresis?

A

0.5 mA/cm2

56
Q

What is the Anode maximal safe current density in iontophoresis?

A

1 mA/cm2

57
Q

What type of IFC is quadripolar?

A

Classic

58
Q

What type of IFC is bipolar?

A

Premodulation

59
Q

Classic ICF uses ____ pads, creating a ___ pattern.

A

4, cloverleaf

60
Q

Premod ICF uses ____ pads, creating a ___ pattern.

A

2, oval

61
Q

Classic ICF uses has 100% modulation effect in the ___.

A

Patient

62
Q

Premod ICF uses has 100% modulation effect in the ___.

A

Machine

63
Q

Where is the therapeutic effect felt in classic IFC?

A

The middle of the X pattern

64
Q

Where is the therapeutic effect felt in Premod IFC?

A

Under the pads

65
Q

What is the level of penetration in classic IFC?

A

Deep

66
Q

What is the level of penetration in Premod IFC?

A

Superficial

67
Q

How is IFC beat frequency calculated

A

big number minus the smaller number

difference in frequencies

68
Q

How is the IFC beat frequency range calculated?

A

0 thru the max beat frequency

69
Q

What is the pH needed for a sclerotic effect?

A

<7.4pH

70
Q

The anode produces an acidic reaction (anode attracts acid) creating what type of effect?

A

Sclerotic

71
Q

How is a localize area of acidic pH formed, results in a decrease in local water content & increased protein density what will harden tissues & imparting the sclerotic effect?

A

Cl- anions combine with water at the anode to form hydrochloric acid: HCL.
Creating an accumulation of Cl- at the anode

72
Q

During e-stem what is the motor recruitment pattern for voluntary motor recruitment?

A

Slow progressive recruitment is slow

73
Q

Smaller motor units move _____ than larger motor units.

A

Faster

74
Q

Asynchronous recruitment pattern allows for what, when muscle fibers become fatigued.

A

activation of additional motor units

75
Q

How do voluntary contraction continues with little decrease in force?

A

modulating firing frequency of motor units

76
Q

ow does ES over the muscle belly recruits motor units?

A

nonselective, random order regardless of fiber type

77
Q

What is indiscriminate activation in regards to ES over the muscle belly?

A

There are no alterations in recruitment between repeated contractions
regardless if the unit is slow or fast
Contributing to muscle fatigue, decreasing the contraction force

78
Q

What is the goal of pulse direct stimulation?

A

promote granulation tissue at a wound

79
Q

Where does the cathode go during pulse direct stimulation, & why?

A

goes over the wound to promote granulation

80
Q

With quadripolar method of IFC, where is the modulation depth at 0%?

A

At the pads

81
Q

In the COX protocol for nucleus pulposus herniation & radiculopathy, where are the electrodes placed?

A

HIGH VOLT PULSED PARAMETERS
Positive electrode directly over disc lesion, companion negative pad next to it
Other positive electrode placed in popliteal fossa (Acupuncture spots: BL40, Weizhong; some texts UB54), companion negative electrode opposite to it

82
Q

What mechanism causes nerves to stop firing during median electrical stimulation?

A

Wendinski’s inhibition

83
Q

Wendinski’s inhibition

A

when the nerve stops firing bc we have gotten use to the stem

84
Q

What are the 3 physiological mechanisms related to the wound effects for High-Volt pulsed current?

A

*Short pulse durations & low amperage overcome skin impedance providing comfortable stimulation

Average current flow through tissues in MICROCURRENT RANGE, possibly similariting TISSUE HEALING effects

PULSE DURATION (peak to peak) is fixed at 25 usec

85
Q

12 things that description of premodulation (Premod) IFC?

A

2 electrodes
oval shaped pattern
superimposition of carrier waves in device
composite waveform current delivery
4000 Hz frequency & 4000- 4150 Hz frequency
fully modulated AC from device
100% modulation depth
Premodulated Tx w/ lower intensity vs. IFC
Current dispersed
Smaller total coverage area
greater current density @ Tx site
No evidence Premod is clinically more effective than true IFC

86
Q

What is the pain control mechanism in the COX protocol, for a herniated nucleus pulposus and radiculopathy?

A

Sensory & motor mechanisms

87
Q

How Biphasic current wave form are described as?

A

Balanced

88
Q

How are classic IFC wave forms described?

A

Amplitude modulated sinusoidal waves

89
Q

How are classic IFC wave forms described?

A

sinusoidal

90
Q

How is Beat Frequency described?

A

Amplitude modulated current created by superimposed MFACs

91
Q

How Russian Stem waves described?

A

burst modulated monophasic AC

Basically alternating current

92
Q

What is burst frequency for russian?

A

50 bups

93
Q

What wave type used current is the delivery of repeated pulses separated by an interpulse interval (A).

A

Biphasic

94
Q

What wave form is amplitude modulated alternating current, using a medium frequency alternating current?

A

Interferential current (IFC)

95
Q

IFC is ________waves.

A

amplitude modulated sinusoidal

96
Q

RStim is waveform burst modulated.

A

sinusoidal

97
Q

What is clinical application for Russian stem?

A

Muscle strengthening

98
Q

What 5 things are primary clinical applications of IFC?

A

Modulates effusion & edema
Activates spinal gate & central pain modulatory mechanisms
Reduces spasm, local tonus & relieves MFTPs
Possible mechanisms for relaxation effect
Similar effects for muscle strengthening, low-frequency ES

99
Q

4 things that make IFC therapeutically desirable over other therapeutic modalities?

A

Pain modulation
NO contraindications
Comfortable bc of medium frequency
Penetrates easy w/o resistance

100
Q

7 primary clinical applications for biphasic current?

A

Cell recovery effects, tissue repair
Muscle strengthening
Reduction of effusion & edema
Relaxation of spasm
Pain modulation via the pain gate & central opioid system
Purpose of TENS therapy is to selectively activate nerve fibers to relieve a range of painful conditions
TENS activates a complex neuronal network to result in a reduction in pain

101
Q

What is the primary clinical application of TENS?

A

TENS therapy (ES) is the application of BIPHASIC waveforms for pain modulation

102
Q

What are primary clinical applications for high-volt pulse current and what the application is for micro-current and know the PAD setups for each? (NOT FINISHED!!!) Tissue and dermal wound healing for HV (ALSO EDEMA) and Microcurrent

11 things

A

Promotes restoration of skin integrity in superficial / deep wounds
restart / accelerate wound healing by imitating the natural electrical current occurring in injured skin
bacteriostatic & bactericidal effects may lower bioburden in the wound bed & facilitate wound closure
Increases local tissue metabolism & perfusion(blood & oxygen)
Promotes ATP levels
Increases cell MB transport 40%- 50%
Increases protein synthesis 50%
Increase proline uptake 91%
Increase hydroxyproline uptake 255%
Promotes bone healing
MES waveforms activate central pain modulatory mechanisms
Promotes restoration of skin integrity in superficial & deep wounds

103
Q

What is primary clinical application for iontophoresis?..Is it sclerotic effect or sclerolytic?

A

ONLY 1 to use continuous direct current (Continuous DC)

Electrical energy is used to “push” drug molecules through the skin
Continuous monophasic current induces transcutaneous movement of ions across the skin & into the target tissues

drug under negative cathode
Pushes meds into tissue

104
Q

What fibers stimulated with Low TENS?

A

Motor: Type Aa fibers

activation causes muscle twitch or contraction and strong paresthesia under electrodes

105
Q

What fibers simulated with High TENS

A

Sensory: Type AB fiber

activation causes tingling, prickling or pins and needles sensation under electrodes

106
Q

What fibers stimulated with Intense TENS?

A

Noxious: Type AD and Type C fiber

activation causes strong muscle contraction, strong uncomfortable paresthesia and sharp or burning pain under electrodes

107
Q

Know general contraindications for e-stem…(10 categories)

A

Benign tumors and malignancy
Bleeding, menstruation
Epilepsy, seizure disorder and status post CVA, TIA; in the cranial and upper cervical regions

Implanted or transcutaneous electrical devices, e.g. neurostimulator, pacemaker
Local infection, unless the goal is germicidal effects in a dermal wound
Metal implants

Osteomyelitis
Over the carotid sinus, cervical sympathetic ganglion, phrenic nerve, vagus nerve
Over the pharyngeal and laryngeal muscles; potentially causing spasm and airway constriction

Patients with sensory, mental impairment or who are confused or unreliable
Phlebitis, thrombophlebitis; in the acute and subacute stages
Scar tissue
Through specialized tissue: brain, eyes, gravid uterus, heart, sex organs
Tuberculosis

108
Q

Know what are NOT contraindications for e-stem…

A

DOMS (delayed onset muscle soreness)

109
Q

What are 2 adverse effects & there resolution time for continuous monophonic DC (iontophoresis)

A 
Electrode burns (1st degree skin burns 1- 2days, Severe, non healing burns possible derm referral)
Skin irritation (resolve 1- 3 h post Tx)

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