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PHTY2240 MSE > L9: Introduction to Electrical stimulation > Flashcards

L9: Introduction to Electrical stimulation Flashcards

1
Q

Our body is an ______ circuit

A

electrical

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2
Q

Nerves conduct _____.

A

electricity

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3
Q

Nerves depolarise by generating an _______.”All or none” threshold in order to send a _______.

A

action potential; signal (motor or sensory)

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4
Q

Electrical stimulation devices operate by ______ nerves from externally placed electrodes

A

depolarising

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5
Q

What are the 2 therapeutic uses of electrical stimulation?

A
  1. Pain relief
  2. Motor stimulation
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6
Q

What is the pain inhibitory system?

A
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7
Q

What is segmental inhibition (pain gate theory)?

A
  • A beta (β) fibrestimulation
  • high frequency, intensity just to sensory threshold
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8
Q

What is descending inhibition (endogenous analgesia)?

A
  • Stimulation of A delta (δ)fibres activates interneuronesin posterior horn ⇒encephalin release -endorphin type effect on C fibres
  • Via higher centres(encephalin + mid brain serotonin)
  • low frequency, intensity to 2-3 x sensory threshold
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9
Q

What is the purpose of the descending inhibition (endogenous analgesia)?

A
  • Apply slightly painful stimulus
  • After 20mins –> can have pain relief for 2 hrs
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10
Q

What are 5 things that sensory response to low frequency stimulation depend on?

A
  1. Intensity
  2. Duration
  3. Frequency
  4. Shape of stimulus
  5. Polarity
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11
Q

Higher intensity equal higher _____.

A

current

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12
Q

Chronic injuries require _____ (longer/shorter) electrical stimulation.

A

longer

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13
Q

Acute injuries require _____ (longer/shorter) electrical stimulation.

A

shorter

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14
Q

A lower frequency goes _____ (shallower/deeper).

A

shallowed

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15
Q

A higher frequency goes _____ (shallower/deeper).

A

deeper

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16
Q

How to apply therapeutic electrical currents?

A

Usually involves a stimulator leads and electrodes

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17
Q

In order to depolarise nerves we can _______ various characteristics (parameters) of the electrical current to overcome skin impedance and affect different types of nerves

A

manipulate

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18
Q

What are 5 basic characteristic of therapeutic electric current which can be manipulated to produce desired effect?

A
  1. Frequency (Hz)-no. pulses or bursts /sec
  2. Amplitude (mA) –intensity of current –total no. nerve fibres recruited
  3. Pulse duration (ms)
  4. Pulse interval (ms)
  5. Pulse shape
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19
Q

Most clinical effects of electrical currents are the result of ______ stimulating an action potential (nerve impulse) in sensory and/or motor nerves

A

current

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20
Q

Nerves have resting membrane potential of _____ mV

A

-70

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21
Q

Stimulus must be more than mV (ie. down to -55mV) to overcome threshold. Remember its an ‘_______’ phenomena

A

15; all or none

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22
Q

Increasing current amplitude or pulse duration does not make _____ greater

A

AP

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23
Q

What are 2 factors that ease with which nerve membrane?

A
  1. Strength (amplitude) of the stimulus
  2. Duration for which it is applied
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24
Q

What are 3 different nerves?

A
  1. Sensory
  2. Motor
  3. ‘Nociceptors’
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25
Q

Each nerve is shown by ______curve

A

strength duration

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26
Q

What is a rheobase?

A

Minimum nerve impulse required to elicit a response from a tissue

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27
Q

What is a chronaxie?

A

minimum time must flow at twice the rheobaseto produce a threshold response

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28
Q

Rheobase determined by _____, ______ and proximity to stimulus

A

size; myelination

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29
Q

What are 2 advantages of rheobase?

A
  1. Short pulse duration, high intensity, therefore recruit more nerves (motor stimulation)
  2. Longer pulse duration, low intensity
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30
Q

What are A-beta cells?

A

Mechanoreceptors

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31
Q

What are C fibres?

A

Don’t transmit very quickly –> take a while

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32
Q

What are strength duration curve?

A
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33
Q

What are 4 things that the strength duration curve tells you?

A
  1. 1st response usually sensory
  2. Larger fibre, more easily stimulated
    • sensory (Aα)and motor (Aβ)
  3. short duration pulses-sensory and motor thresholds can be exceeded without reaching pain tolerance limit
  4. Sensory stimulation for pain control and no motor response, need shorter duration pulse
    • Have a lot of leeway with short duration pulses because can turn up intensity quite high before causing pain
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34
Q

What are 3 characteristics of refractory period?

A
  1. Once nerve has depolarized, it cannot send another signal until after refractory period
  2. So to increase the signal, need to recruit more nerves instead of stimulating the same one again
  3. In practice this means as you turn up the intensity/amplitude you recruit more nerves so can have a greater effect
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35
Q

What are 4 characteristics of intensity?

A
  1. Due to all or none phenomenon, no matter what the current intensity, the same nerve impulse is triggered
  2. If turn up the intensity of current …..
  3. Patient will feel increased sensory effects or stronger muscle contraction
  4. Due to larger number of nerve fibres being stimulated not the increase in current or a greater effect on the nerve
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36
Q

What are 3 characteristics of accommodation?

A
  1. Ability of the nerve or muscle to adapt to slowly increasing current intensities
  2. Muscle -low accommodation
  3. Nerve-high accommodation –do not respond to long slow rising pulses
    • Respond to short or long pulses with sharp leading edge
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37
Q

What are 4 types of electrical current used in electrotherapy?

A
  1. Direct Currents (DC)
  2. Alternating Currents (AC)
  3. Continuous
  4. Pulsed
  5. Pulsed Currents
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38
Q

What is frequency?

A

number of pulses per second (pps) (Hertz) (1 sec=1000ms)

Nb. 1 ms= 1000 microseconds (μs)

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39
Q

What is amplitude?

A

Intensity= no. of nerves recruited

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40
Q

What are 3 characteristics of pulse duration, pulse interval?

A
  1. Pulse and phase characteristics
  2. Pulse rate
  3. Duty cycle (on-off time for a pulsed current)
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41
Q

What are 4 characteristics of pulse shape?

A
  1. Rectangular
  2. Triangular
  3. Saw tooth
  4. Sinusoidal
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42
Q

What are 5 shapes of pulse?

A
  1. Phase
    • Monophasic / Biphasic
  2. Waveform
    • Symmetrical / Asymmetrical
  3. Ramping
  4. Pulsed current
  5. Balanced/unbalanced
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43
Q

What are 2 characteristics of monophasic waveform?

A
  1. Current moves in one direction, dangers of charge building up on electrodes which can cause skin irritation/burns and deterioration of electrodes
  2. More excitation possible under –veactive electrode
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44
Q

What are 2 characteristics of biphasic waveform?

A
  1. Current moves in both directions, so no charge accumulation
  2. Lose some of advantages of excitation
    • Compromise –asymmetrical current (small ms)
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45
Q

What are effects of different waveforms?

A
  1. Monophasic
  2. Biphasic
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46
Q

What are 3 different types of wave?

A
  1. Ramping –relates to intensity (important in motor stimulation)
    • More gradual to mimic normal
  2. Modulation
    • Can vary (increase and decrease)
  3. Sweep Eg. Interferential
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47
Q

What are 3 types of electrical current?

A
  1. Direct current (DC)
  2. Alternating current (AC)
  3. Pulsed currents (AC or DC)
    • Low frequency ( < 1,000 Hz)
    • Medium frequency ( 1,000-10,000 Hz)
    • High Frequency (> 10 000 Hz)
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48
Q

The higher the frequency –> ____ (more/less) able to penetrate the body (________ (deeper/shallower))

A

more; deeper

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49
Q

Be aware there are variations as to how currents are described which can lead to confusion eg • Pulse duration for ______is in μs, for HVS • Frequency can be measured in _____ or pps

A

TENs; Hz

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50
Q

1 second = ______ milliseconds (ms)

A

1000

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51
Q

1 ms= _____ microseconds (μs)

A

1000

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52
Q

What are 2 different naming systems for defining ES currents?

A
  1. Descriptive
  2. Named system
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53
Q

What are 3 descriptive currents?

A
  1. Direct current
  2. Alternating current
  3. Pulsed current
    • Low (< 1,000 Hz)
    • Medium (1,000-10,000Hz)
    • High (>10,000Hz)
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54
Q

What are 5 descriptive currents?

A
  1. Galvanic (DC)
  2. Russian (Alternating)
  3. IFT (Crosses over –> Cancels it out –> small and low frequency (oscillates))
  4. TENS, Faradic, FES, HVS
  5. SWD, Microwave
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55
Q

What are 2 main effects of a pulsed current?

A
  1. Stimulation of excitable tissue
    • sensory nerves
    • motor nerves
    • pain nerves
    • muscle tissue directly (when no nerve supply)
  2. Stimulation of non excitable tissue
    • Local tissue effects
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56
Q

What are 4 characteristics of stimulation of excitable tissue?

A
  1. sensory nerves
  2. motor nerves
  3. pain nerves
  4. muscle tissue directly (when no nerve supply)
57
Q

What is a characteristics of stimulation of non excitable tissue?

A

Local tissue effects

58
Q

What are 3 effects of electrical stimulation of sensory/pain nerves?

A
  1. Increasing afferent input at spinal cord level or to supraspinallevels
  2. Main reasons for using sensory stimulation:
    1. to alter pain perception or
    2. to alter cortical activity
  3. Mainly used for pain relief but can be used to reduce spasticity (increased tone in neurological conditions)
59
Q

What are 2 main reasons for using sensory stimulation?

A
  1. to alter pain perception or
  2. to alter cortical activity
60
Q

What are 3 characteristics of transcutaneous electrical nerve stimulation (TENS)?

A
  1. Small portable battery operated units
  2. Can also be found on larger machines
    • Short pulses (microseconds) –e.g. 50-400 μs
    • Medium frequency 2-200 Hz
  3. Motor and sensory nerves
61
Q

TENS is a ________ or _______ pulse shape.

A

Biphasic symmetrical or asymmetrical pulse shape

62
Q

What are 2 types of pain relief for TENS?

A
  1. Using pain gating
  2. endogenous analgesia
63
Q

What does TENS look like?

A

Pain modulator that is mobile –> can use to be more active Uses microsecs

64
Q

With a longer pulses is ____ (faster/slower) rate.

A

slower

65
Q

What are 3 modes of TENS?

A
  1. Conventional TENS=pain gating
  2. Acupuncture type = endogenous analgesia
  3. Burst type= probably uses both systems (pain gating and endogenous analgesia)
66
Q

What is conventional TENS used for?

A

Pain gating

67
Q

What is an accupunture type of TENS?

A

endogenous analgesia

Not as comfortable but more effective for pain relief

68
Q

What is a burst type of TENS?

A

probably uses both systems (pain gating and endogenous analgesia)

69
Q

What are 8 current parameters for conventional TENS?

EXAM QUESTION

A
  1. Short pulse duration -50μs
  2. Frequency -40-200Hz (most often 100 or 150Hz)
  3. High frequency/low intensity
  4. Stimulates Aβfibres –fast onset pain relief
  5. Not painful and does not cause muscle contraction
  6. Duration 30-60 mins
  7. Can also be used continuously
  8. Pain relief only while on and for short time afterwards
70
Q

What are 7 current parameters for acupuncture TENS?

EXAM QUESTION

A
  1. Pulse width 200μs
  2. 2Hz
  3. Low frequency/high intensity
  4. Stimulates Aδor C fibres
  5. Applied acupuncture or motor points
  6. Latent effect, lasts several hours
  7. Need to apply for 20-30mins to gain effect
71
Q

What are 4 current parameters for burst TENS?

EXAM QUESTION

A
  1. series of pulses repeated 1-5 times/sec
  2. each burst contains a number of pulses at the conventional TENS frequency 4-150Hz
  3. delivered at higher frequency
  4. ?combines the effects of conventional and acupuncture
72
Q

What are 2 other parameters of TENS?

A
  1. Brief intense
    • Long pulse width –high intensity
    • Apply for 15 mins
  2. Modulated
    • Some units have modulation facility
    • Allows pulse width, frequency and/or intensity to be varied
    • Prevents accommodation of nerve when used over a long time
73
Q

What are 3 characteristics of brief intensity for TENS?

A
  1. Chronic use
  2. Long pulse width –high intensity
  3. Apply for 15 mins
74
Q

What are 3 characteristics of modulated TENS?

A
  1. Some units have modulation facility
  2. Allows pulse width, frequency and/or intensity to be varied
  3. Prevents accommodation of nerve when used over a long time
75
Q

What are 6 characteristics of the position of electrodes in TENS?

A
  1. Over site of pain Try not to cross the spine
  2. Same dermatome/myotome
  3. Trigger or acupuncture points
  4. Along length of peripheral nerve
  5. Over spinal nerve roots
  6. 1 or 2 channels 4 electrodes for a larger area
76
Q

What is the range of the pulse width for TENS?

A

30 –260 μs

77
Q

What is the range of the pulse rate for TENS?

A

2 –150 pps

78
Q

What are 3 modes of TENS?

A
  1. Conventional
  2. Modulated
  3. Burst
79
Q

What is the range of the pulse width for TENS for acute pain?

A

Narrow pulse width (60-100 μs)

80
Q

What is the range of the pulse width for TENS for chronic pain?

A

Wide pulse width (150-200 μs)

81
Q

What is the range of the pulse rate for TENS for acute pain?

A

High pulse rate (80-200 pps)

82
Q

What is the range of the pulse rate for TENS for chronic pain?

A

Low pulse rate (1-5 pps)

83
Q

What is the intensity for TENS for acute pain?

A

Pleasant tingling

Comfortable but patient is aware

84
Q

What is the intensity for TENS for chronic pain?

A

To tolerance

Uncomfortable but tolerable

85
Q

Where can you change the intensity controls

A

top: dial for each channel

86
Q

What are 7 clinical applications of TENS?

A
  1. Musculoskeletal pain
    • Low back and neck pain
    • Knee and shoulder pain
  2. Primary dysmenorrhea
  3. Chronic pain
    • Helps to take less pain killers (reduce medication intake)
  4. Intractable angina
  5. During painful procedures or postoperative pain
  6. During labour (but unable to be submerged in water eg. water birth)
  7. Help with period pain
87
Q

When is interferential therapy (IFT) over TENS?

A

For more deeper structures

88
Q

In IFT, as increase frequency ______ (increase/decrease) depolarisation of nerves (easier to get APs)

A

increase

89
Q

In IFT, higher frequency currents overcome skin resistance ____ (more/less) easily, but require very high current intensities to stimulate nerve.

A

more

90
Q

Why is IFT better for deeper structures?

A
  • Need to cross the electrodes
  • Cancel each other out
  • Small current that goes deep (eg. ACL or hip structures)
91
Q

What are 2 aims of ITF?

A
  1. To produce low frequency effects at sufficient intensity at depth, most patients experience considerable discomfort in the superficial tissues (ie. the skin)
  2. Resistance (impedance) of skin is inversely proportional to the frequency of the stimulation
92
Q

What are 2 characteristics of skin impedance for IFT?

A
  1. Skin impedance at 50 Hz is 3200Ωwhilst at 4000Hz it is reduced to approximately 40Ω
  2. Higher frequencies require less electrical energy to reach the deeper tissues and giving rise to less discomfort
93
Q

What are 4 characteristics of “true” IFT?

A
  1. Two out of phase medium frequency currents of slightly differing frequencies that interfere with each other
    • 4000-4250 Hz
  2. Where 2 currents intersect , a new resultant current is formed. Resultant amplitude is the sum of the 2 original currents
  3. Where a peak and a trough coincide they augment each other , but
  4. where a peak meets a trough they cancel each other out
94
Q

What are 5 characteristics of amplitude modulation?

A
  1. This resultant current varies in amplitude
  2. The frequency by which the new current varies is called the beat frequency
  3. The beat frequency is equal to the difference between two original frequencies
  4. So example, if current A is 4000Hz and current B is 4100Hz, the resultant beat frequency is 100Hz
    • Low frequency but high amplitude
  5. It is this modulation pulse deep in the tissues that triggers the nerve impulse (AP)
95
Q

What is the beat frequency?

A

The frequency by which the new current varies

96
Q

What does the beat frequency equal to?

A

the difference between two original frequencies

97
Q

The ______ which is deep in the tissues that triggers the nerve impulse (AP)

A

modulation pulse

98
Q

What are 3 characteristics of the frequency of IFT?

A
  1. Most IF machines allow a constant beat frequency 10, 50, 100Hz
  2. Usually use a sweep mode between pre-set frequencies over a specifed time eg0-150Hz, 80-120Hz, 0-100Hz
  3. Sweeping is helpful for swelling and to limit nerve accommodation (larger sweep for swelling)
99
Q

What is sweeping important for?

A
  • swelling
  • to limit nerve accommodation
    • (larger sweep for swelling)
100
Q

Do you want a large or small sweep for swelling?

A

Large

101
Q

What can the beat frequency for IFT be set at?

A

constant beat frequency can be set between 1-250Hz

102
Q

What can the frequency modulation for IFT be set at?

A

can be set to sweep between for eg. 20-80Hz over 6 secs, then back 6 secs

103
Q

What are 3 reasons for using sweeping?

A
  1. To prevent nerve habituation/accommodation
  2. Effects on cell membrane-useful for swelling due to local increased fluid flow and fluid exchange, larger sweep is better
  3. Stimulation of autonomic nerve endings-may help to remove chemical irritants affecting nociceptive nerve endings –reduce tissue pressure
104
Q

What are 9 characteristics of electrodes?

A
  1. Carbon/rubber with damp pads or adhesive
  2. Equal sized and as large as body part can accommodate
  3. 4 electrodes (2 each channel)
  4. Positioning relative to target tissue Make sure don’t cross heart –> has electrical currents (eg. not front and back)
    • Contra-planar (on opposite sides of a limb- Across limb )
    • Co-planar (on same side e.g. for low back pain)
  5. Avoid trans-thoracic applications (effects on heart)
  6. As large as feasible
  7. Wet pads if not adhesive
  8. Wash skin to reduce impedance
  9. Make sure you have full contact with skin Risk of burns if not fully contacted
105
Q

Why can electrodes be applied with suction cups and sponges?

A
  • Ease of application
  • Need good skin condition
  • Increase circulation
  • Use with extreme care with haematoma or acute swelling
106
Q

What are examples of electrode placement in the back, elbow, knee and shoulder

A

Channels must cross each other with target tissue in the middle

107
Q

Channels must cross each other with target tissue in the _______.

A

middle

108
Q

What are the 5 effects of frequency on sympathetic parasympathetic, motor, sensory nerve and smooth muscle

A
  1. Sympathetic nerve 1-5Hz
  2. Parasympathetic nerve 10-150Hz
  3. Motor nerve 10-50Hz
  4. Sensory nerve 90-100Hz
  5. Smooth muscle 0-10Hz
109
Q

What are 3 characteristics of the Pre-modulated medium frequency current (MMF)?

A
  1. Waveform produced by one channel (2 electrodes) that is the same as the interference produced by 2 channel IFT machines
  2. Interference produced in the machine
  3. ‘IFT” can be applied using just 2 electrodes
    • Useful for smaller parts
    • Considered less effective than ‘true’ IFT because currents don’t cross deep in the target tissue
110
Q

What are 4 main clinical applications for IFT/MMF? What another clinical application

A
  1. Pain relief
  2. Muscle stimulation
  3. Increased local blood flow
  4. Reduction of oedema egstress incontinence
111
Q

Short duration in order to get patient to do ______ or so you can do some other treatment eg joint mobilisation

A

exercise

112
Q

What is the general rule for clinical dosage for acute injuries?

A

lower intensity, short treatment time

113
Q

What is the general rule for clinical dosage for chronic injuries?

A

high intensity, longer treatment time

Endogenous effects

114
Q

What is the frequency of treatment for acute injuries?

A

low intensity-more regular treatment

115
Q

What is the frequency of treatment for chronic injuries?

A

less frequent

116
Q

If sweep is available, what is the clinical dosage for acute injuries?

A

slow rate 6/6

117
Q

If sweep is available, what is the clinical dosage for chronic injuries?

A

fast rate 1/1

118
Q

With acute injuries, they generally require _____ (higher/lower) frequency.

A

higher (80-150Hz)

119
Q

With chronic injuries, they generally require _____ (higher/lower) frequency.

A

lower (<10Hz)

120
Q

What is the commonly used IFT/MMF treatment frequencies to activate pain gate mechanism (stimulation of large diameter fibres -Aβ)?

A

(stimulation of large diameter fibres -Aβ)

High beat frequencies, sweep between 80-200Hz ( eg80-120Hz, 100-150Hz, 100-199Hz)

121
Q

What is the commonly used IFT/MMF treatment frequencies to activate A delta (δ) and C-fibres to release endorphins/ encephalins (Endogenous analgesia)?

A
  • Low frequencies, sweep between 0-25Hz (eg2-5, 10-25Hz)
  • Needs to be on for at least 20 mins
122
Q

What are the 18 steps in the procedure for applying electrical stimulation?

A
  1. Introduce yourself, explain the treatment you propose and why you think it may be beneficial as part of the multimodal treatment
  2. Gain initial consent
  3. Position patient appropriately
  4. Check contraindications/precautions
  5. Is there any cause for extra concern?
  6. Skin check
  7. Test sensation
  8. Clean skin
  9. Turn machine on
  10. Set up machine parameters (dosage)
  11. Machine check on self/demonstration to patient
  12. Apply electrodes to patient
  13. Warnings
  14. Turn up intensity slowly, ask patient when they first feel tingling
  15. Turn up intensity to desired level
  16. Give patient a bell
  17. Check after a few minutes that feeling ok
  18. At end of treatment-turn intensity to zero, remove electrodes, check skin, turn off machine
123
Q

What are 5 contraindications of electrical stimulation?

A
  1. Over pacemakers or inbuilt stimulator
  2. Over carotid sinus (in the neck)
  3. Trans-thoracic applications
  4. Venous thrombosis or thrombophlebitis
  5. Pregnancy-pelvic region ie. over uterus or low back (but can be used for pain relief in labour) (As the baby is already developed)
124
Q

What are 7 precautions of electrical stimulation?

A
  1. Metal in the area Watches, jewellery
  2. Impaired sensation
  3. Cognitive impairment/communication
  4. Malignant tumours/risk of dissemination
  5. Circulatory insufficiency
  6. Skin irritation or open wounds
  7. Self-adhesive electrodes Can come unstuck
125
Q

What is important about patient positioning?

A
126
Q

What are 4 characteristics to help overcome impedance in order to target desired tissues?

A
  1. Type of current and characteristics of current
  2. Need to examine skin for areas of high and low resistance
  3. Skin preparation
  4. Coupling
127
Q

What is the 3 purposes of the skin examination in preparation?

A
  1. Check for areas of low resistance e.g. cuts, abrasions –avoid positioning electrodes here and cover with petroleum jelly & cotton wool -reduces current focusing there
  2. Check for areas of high resistance e.g. warts or scars-avoid positioning electrodes over these
  3. Remove any grease from skin
128
Q

What are 3 ways to lower skin resistance?

A
  1. Reduce resistance of skin by washing to remove keratin and sebum
  2. Leave skin wet
  3. Warm skin
129
Q

What are 2 features of the size and shape of electrode?

A
  1. appropriate to body part
  2. Aim to use largest electrode possible for the area
130
Q

What are 2 features of the type of electrode?

A
  1. Depending on machine used
  2. Good quality for HVS and IFT
131
Q

What one thing to check in the integrity of electrode?

A

No cracks, well adhered to body part

132
Q

When small electrodes are close together, there is a ______ (deeper/superficial) flow of current.

A

superficial

133
Q

When large electrodes are close together, there is a ______ (deeper/superficial) flow of current.

A

deeper

134
Q

If using rubber electrodes need damp sponge or pads which are the ____ size as the electrode.

A

same

135
Q

What are 2 characteristics of current density?

A
  1. Total current at each electrode is the same but current density ie. current/unit area will be different
  2. If using 2 electrodes of different sides current density will be greater under smaller electrode
136
Q

What are 6 safety checks for electrical stimulation?

A
  1. Check contraindications
  2. Test patients sensation (sharp/blunt)
  3. Wash skin
  4. Test machine
  5. Turn machine ‘on’, intensity at zero
  6. Turn machine power on and off with patient not attached
137
Q

What are 6 characteristics in patient care for ES?

A
  1. Always give patient an explanation of what they should feel
  2. Give warning
  3. Supply with a bell
  4. Ask (what they are feeling)
  5. Look (can you see any unwanted effects egmuscle contraction)
  6. Feel –after treatment for change in tissues
138
Q

What are 6 characteristics of patient/equipment care for ES?

A
  1. Always turn up intensity SLOWLY
  2. Observe patient
  3. Check for any causes of uneven resistance
  4. Breaks in skin –cover with Vaseline
  5. Skin condition
  6. Wash off liniments, creams, oils etc

PHTY2240 MSE (17 decks)

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