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becky: THER EX > Lecture 3: E-STIM > Flashcards

Lecture 3: E-STIM Flashcards

1
Q

electricity is….

A

set of physical phenomena associated with the presence and flow of electric charge

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2
Q

electrical current is

A

current of electricity or flow of electrons

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3
Q

rate at which electrical current flows

A

ampere (unit of measure! NOT PULSE WIDTH OR FREQ)

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4
Q

We measure electrical currents in

A

milliamperes and microamperes
(net movement of e from higher to lower potential)

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5
Q

what is volt?

A

electromotive force

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6
Q

what is voltage?

A

volt is measured in voltage:
force resulting from an
accumulation of electrons at one
point in an electrical circuit,
usually corresponding to a deficit
of electrons at another point in
the circuit

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7
Q

conductance is

A

the ease with which current flows along a conducting medium
metals!

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8
Q

insulators are…

A

resist current flow; fewer free electrons and greater resistance to electron flow
-air, wood, gas

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9
Q

resistance or electrical impedance

A

unit: ohm (R)
opposition to electron flow in conducting material

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10
Q

Ohm’s law is….

A

Electrical circuit with high resistance (ohms) = less flow (amperes) than a circuit with less resistance and the same voltage

✧ Ohm’s Law – the current in a circuit is directly proportional to the voltage and inversely proportional to the resistance

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11
Q

current flow through SKIN

A

INSULATOR
greater the impedance of skin, the higher the voltage needed to stimulate
underlying nerve and muscle

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12
Q

What are good conductors?

A

JUICY THINGS
nerve
blood
muscle

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13
Q

what are good insulators/poor conductors?

A

tendon: poor conductor
fat is great cond, skin, bone is poorest cond

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14
Q

impedance and frequency have a

A

inverse relationship!
as frequency goes up, electrical skin impedance goes DOWN

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15
Q

closed circuit means

A

electrons are flowing

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16
Q

AC CURRENT

A

alternating/biphasic, TENS, IFC
continuous flow, bidirectional, constantly changing direction

negative to positive electron moving!
BALANCED!

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17
Q

direct current (DC)

A

galvanic current, monophasic
DIRECTIONAL, UNIDIRECTIONAL! towards anode (+)
-chemicals accumulated at each electrode (electrolysis)

example: iontophoresis! may be UNCOMFY

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18
Q

pulsatile current (PC)

A

current can be broken up into parts
2 or more pulses grouped together
-unidirectional or bidirectional

HI VOLT AND RUSSIAN CURRENTS (HVPG)
***most nerve/muscle stimulating currents
-discontinuous current

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19
Q

HVPG and Russian current

A

directional
*MOST NERVE/MUSCLE STIMULATING CURRENTS

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20
Q

accommodation phenomenon

A

fiber has been subjected to constant level of depolarization will become UNEXCITABLE at that same intensity (amplitude)

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21
Q

With continuous direct current a muscle contraction would occur only when the

A

current intensity rose to a stimulus threshold

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22
Q

Chemical effects from using direct current usually occur only when stimulus is

A

continuous and is applied over a period of time (> 1 minute)

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23
Q

electrical circuits series

A

resistors have

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24
Q

skin and fat have e-circuits in

A

series

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25
Q

nerve, blood, muscle, connective tissue, bone electrical circuits occur in

A

parallel

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26
Q

FREQUENCY IS

A

cycles per second (Hz) or pulses per second PPS

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27
Q

INTENSITY IS

A

VOLUME KNOB! turn up music
increasing stimulation or amplitude

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28
Q

PULSE DURATION IS

A

changing current pulse length to target specific structures

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29
Q

capacitance

A

ability of tissue to store electricity
higher capacitance=longer before a response

30
Q

ramping modulation

A

aka surging modulation; amplitude will increase or ramp up gradually to a preset maximum
*ramp up time: 1/3 of the time

31
Q

TETANY OCCURS AT APPROX

A

50 PPS/Hz
function of frequency!NOT INTENSITY
-complete tetanus: once the number of twitch contractions per second increases, single twitch responses cannot be distinguished

32
Q

pain relieving Estem

A

IFC
tenz

33
Q

higher intensity means current reaches

A

deeper into tissue!!!!

34
Q

current density must be

A

HIGH ENOUGH to facilitate depolarization
*amount of current flow per cubic volume!

35
Q

strength duration curve

A

threshold for depolarization of particular nerve fiber
*PULSE WIDTH
NONLINEAR RELATIONSHIP BETWEEN CURRENT DURATION AND CURRENT INTENSITY

36
Q

rheobase

A

– intensity of current necessary to cause
observable tissue response given a long duration

37
Q

chronaxie

A

duration required for a current of twice
the intensity of rheobase to produce tissue excitation

38
Q

A-beta fibers

A

sensory! first, wide

39
Q

A-delta fibers

A

sharp pain

40
Q

C fibers

A

dull pain/crude touch

41
Q

order of nerves

A

A-beta, motor, A delta, C, denervated muscle

42
Q

what happens at cellular level with electrical current?

A

Excitation of nerve cells
* Changes in cell membrane permeability
* Protein synthesis
Stimulation of fibroblasts
and osteoblasts
* Modification of microcirculation

43
Q

what happens at tissue level with electrical current?

A

Skeletal muscle contraction
* Smooth muscle contraction
* Tissue regeneration

44
Q

types of e-sim

A

NMES
Russian
IFC
HVPC
TENS
DC

45
Q

electrical stimulation (NMES, FES)

A

Pulsed waveform (1-500 Hz)
✧ Single or multiple-channel electrical stimulators programmed in a synergistic sequence
*MUSCLE STIMULATION FOR STRENGTHENING

46
Q

IF PATIENT COMES IN WITH PAIN, WHAT DO YOU DO FIRST E-STIM WISE

A

IFC
interfered biphasic continuous waveform (1k-10k Hz)
*pre-mod is little brother

47
Q

RUSSIAN current

A

Pulsatile biphasic waveform (2k-10k Hz)

48
Q

where do you put electrodes to shock?

A

motor point
*sweet spot-mid belly of muscle

49
Q

HIGH VOLT CURRENTS ARE FOR

A

***reducing edema!!!!
wound healing
(kinda muscle contraction but not feeling good, will not usually let u get to that point)
pain control ish…

50
Q

muscle contraction

A

MES/russian

51
Q

pain

A

IFC
TENS

52
Q

negative polarity HVPC is most effective for

A

inflammatory phase of healing

53
Q

positive polarity HVPC is most effective for

A

proliferation phase of healing

54
Q

edema control

A

HVPC with negative polarity!!!!!

55
Q

CONVENTIONAL TENS

A

High Rate & Low intensity (sensory level) * Best for acute pain
* Gate Control Theory – stimulate A-beta fibers

56
Q

ACUPUNCTURE LIKE tens

A

Low Rate & High Intensity (motor level) * Usually for chronic pain
* Descending Pain control Theory – release of enkephalin

57
Q

noxious level tens

A

hyperstimulation analgesia * Endogenous opiate pain control theory

58
Q

brief intensity tens

A

High Rate & High Intensity
* For fast pain relief during a procedure/wound debridement
* Peripheral and central analgesia

59
Q

conventional TENS

A

asymmetrical biphasic is most common
frequency 80-125 pps
duration 75-150 microsec
intensity: tolerable sensory stimulation
treatment time: until pain is no longer perceived (30 min up to few hrs)
theory: gate control

60
Q

Gate Control Theory

A

Increased activity of A-beta afferents triggers the release of enkephalin from interneurons in Substantia Gelatinosa (SG), which inhibit synaptic transmission to 2nd order neurons (transmission (T) cells) and block pain message ascending to the brain

61
Q

low frequency TENS
acupuncture
motor level TENS

A

freq: LOW below 20 pps
duration: 100-600 microsec
intensity: high enough to elicit both sensory (tingling) and motor (mm contraction)

TO MOTOR POINT
duty: 30 s-60s on, off
treat time: 15-60 min
theory: descending pain control theory

62
Q

descending pain control theory

A
  • Opiate receptors in central or peripheral terminals of nociceptive afferent fibers
  • Central:
  • Pituitary gland
  • Hypothalamus
  • Periaqueductal gray (PAG) * Raphe nucleus
  • Dorsal horn
  • Peripheral: * A-delta
  • C fibers
63
Q

noxious level TENS

A

hyperstim analgesia
Asymmetrical biphasic is the most common
* Hyperstimulation analgesia
* Frequency: 1-5 pps
* Duration: 100 - 1000 microseconds
* Intensity: High intensity to a noxious level (muscle contraction is acceptable)
* Applied over trigger or acupuncture points
* Duty: 30-45s, off time as needed to be tolerable
* Treatment time: until pain no longer perceived
* Theory: Endogenous opiate pain control theory

64
Q

endogenous opiate pain control theory

A
  • Peripheral blockage and extra-segmental analgesia
  • Stimulation of the small afferents (A-delta and C) can stimulate the release of endorphins, beta-endorphin and dynorphin
  • Beta-endorphin is released by anterior pituitary gland and hypothalamus
  • Prolonged electrical stimulation on acupuncture points triggers the release of beta-endorphin and dynorphin
65
Q

brief intense TENS

A

Asymmetrical biphasic is the most common
* Frequency: 100 pps
* Duration: 100 - 600 microseconds
* Intensity: Muscle fasciculation to sustained
muscle contraction
* Treatment time: ~ 15 minutes
* Theory: Peripheral and central analgesia

WOUND DEBRIDEMENT

66
Q

IFC IS THE GO TO FOR WHAT

A

Pain control!
does stimulate mm but not the best…reduces mm SPASM

67
Q

IFC techniques to reduce accomodation

A

scan mode
target mode
sweep mode

67
Q

premod is how many electrodes?

A

two! IFC: four
Two currents are interfered within the device before delivering the current to the patient

68
Q

NMES OR FES

A

Combining waveform characteristics makes possible to stimulate both sensory and motor nerves

✧ Muscle reeducation and strengthening (adequate intensity), pulse rate (35-55 pps), and duration (200-600 μs)
✧ Nerve stimulation
✧ Edema reduction (muscle pump contraction)
✧ Pain control
✧ Retardation of atrophy
✧ Increasing range of motion
✧ Restoring muscle tone

69
Q

CONTRAINDICATIONS FOR E-STIM

A
  1. pacemakers/auto defib
  2. stim of current through chest, near heart, over carotid
  3. pts with internal stim in area
  4. seizure disorders, confused/disoriented
  5. area of venous thrombosis, occlusive vasc disease, arterial thrombosis
  6. infection
  7. Over open wounds*, osteomyelitis, scars, skin lesions, areas receiving radiation therapy, protruding metal implants EXCEPT HIGH VOLT/TENS FOR TREATING WOUNDS
  8. malignancies
  9. pregnancy
  10. MSK probs where contraction is bad
  11. high level SCI
70
Q

electrode placement

A

Placed on or around a painful area
Over specific dermatomes, myotomes, or sclerotomes of the painful area
Close to the spinal cord segment that innervates a painful area
Peripheral nerves that innervate the painful area Electrodes placed near the superficial nerve
Vascular structures contain neural tissue and ionic fluid Trigger points or acupuncture points
Motor points of muscles or muscle belly
Combination of previously listed systems

71
Q
A

becky: THER EX (11 decks)

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