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Modalities > Lecture 7: ESTIM (Start of Final) > Flashcards

Lecture 7: ESTIM (Start of Final) Flashcards

1
Q

clinical applications for ESTIM

A

pain
muscle re-education
reduce/prevent edema
decrease inflammation
tissue healing
reduce muscle spasm
drug delivery
reinverting denervated muscle
EMG biofeedback

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2
Q

definition of electrotherapy or electrical stimulation

A

use of electrical current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing

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3
Q

what is electrical current

A

flow of charged particles (can be electrons or ions)

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4
Q

what is cathode and anode

A

cathode is negative electrode that attracts positively charged ions

anode is the positive charged electrode that attracts negatively charged ions

with ESTIM current flows from anode to cathode

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5
Q

what does TENS stand for

A

transcutaneous (non invasive) electrical nerve stimulaiton

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6
Q

what does NMES stand for

A

Neuromuscular electrical stimulation

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7
Q

what does EMS stand for

A

electrical muscle stimulaiton

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8
Q

what does TES stand for

A

therapeutic electrical stimulaiton

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9
Q

what does FES stand for

A

functional electrical stimulation

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10
Q

what is an action potential

A

messaging unit of nervous system/basic unit of nerve communication

propagates down nerve’s axon until it reaches a termination point

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11
Q

nerve cell must have sufficient what to stimulate an action potential

A

amplitude and duration

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12
Q

what is depolarization

A

change in flow of ions across cell membrane

all or nothing even t

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13
Q

what is repolarization

A

return to resting membrane potential

resting is generally more neg

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14
Q

what is accommodation

A

process by which a nerve gradually becomes less responsive to stimulation of normally sufficient amplitude and duration and no longer depolarizes

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15
Q

what are terminating points for motor and sensory nerves

A

motor = muscle
sensory = spinal cord

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16
Q

what are nodes of ranvier

A

small gaps between myelin sheath from which AP jumps from one node to the next in a process called slatory conduction

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17
Q

time dependent characteristics of waveforms

A

phase
phse duration
pulse
pulse duration
interpulse
frequency

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18
Q

amplitude dependent characteristics of waveforms

A

amplitude
peak amplitude
peak to peak amplitude
phase charge
pulse charge

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19
Q

what are teh adjustable parameters on NMES/TENS

A

pulse duration (pulse width, cycle, period, duration)

frequency (rate)

burst midulation (pulse waveforms)

amplitude (intensity)

on/off time

ramp up/down time

duration

electrode size/placement

wave form (depends on unit)

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20
Q

what is phase

A

period when electrical current flows in one direction

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21
Q

what is pulse

A

period when electrical current flows in any direction

may be made up of one or more phases

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22
Q

what is phase duration

A

how long phase lasts

microseconds

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23
Q

what is pulse duration

A

aka pulse width, cycle, and period duration

how long a pulse lasts

begins at first phase of pulse and ends at last

microseconds

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24
Q

what is interpulse interval

A

amount of time between pulse

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25
Q

what should be the pulse diration for NMES

A

when using a pulsed biphasic waveform the pulse duration should be between:

small muscles = 125-200 microsec

large muscles = 200-350 microsec

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26
Q

if you shorten the pulse duration, what factor needs to be changed in order to achieve the same strength of muscle contraction

A

higher amplitude required

27
Q

chatanooga continuum (LMU DPT TENS unit) has a fixed pulse width of

A

300 microseconds

28
Q

high rate vs low rate TENS

A

high = 50-80 microsec to depolarize only the A beta sensory nerves

low = 200-300 microsec to depolarize motor nerves and possibly A beta

29
Q

what cant you change when using interferential current with TENS

A

cant change pulse diration

30
Q

what setting is often adjusted for pt comfort

A

pulse duration

usually adjustable on most portable units

31
Q

what is frequency

A

number of cylces or pulses per sec

aka rate

inverse of cycle duration

32
Q

units of frequency

A

PPS (pulse per sec) for pulsed currents

Hz (Hertz) for alternating currents

33
Q

different frequencies and types of response for NMES

A

low frequency (20-30 pps) = will produce a seperate muscle twitch contraction

35-50 pps = smooth contraction

50-80 pps = stronger contractions but rapid fatigue

34
Q

pulse frequencies associated with high and low rate tens and their clinical uses

A

high rate tens = 100-150 pps (sensory with pain gating effects)

low rate tens = <10pps with motor and endogenous effects

burst = combines high and low intermittently

35
Q

why might you modulate rate of TENS

A

to limit adaptation/habituation and thus tolerance to tens

modulation doesnt change overall analgesic effects of stimulation if pt never adapts

36
Q

what is amplitude

A

magnitude of current flow

amps/volts

aka strength/intensity

usually denoted by range 1-10 (weak to strong)

37
Q

what is peak amplitude and peak to peak amplitude

A

peak = max intensoty

peak to peak = biphasic property (from top of + wave to bottom of - wave)

38
Q

what setting is related to pt tolerance

A

amplitude

39
Q

what do you want when adjusting the amplitude for high and low rate TENS

A

high = want strong tingling sensation

low = want to produce a muscle contraction

40
Q

what is on/off time and why might it be useful

A

current terminated and resumed throughout treatment

stimulates voluntary contract relax phases and prevents muscle fatigue

expresses as ratio of on to off (10:50 would indicate 10 s of current and 50 s of rest)

41
Q

what is ramp up/down and why is it useful

A

allow current to slowly reach max intensity and slowly terminate intensity

minimizes pt discomfort

ramp up = sec it takes for current to go from start to max amplitude

ramp down = from max to zero

42
Q

3 types of waveforms

A

direct current (DC)

alternating current (AC)

pulsed current (PC)

43
Q

describe direct current

A

continuous flow of electrons/ions in one direction

comes from battery (but not all battery powered currents are DC!)

can reverse polarity (pos to neg or neg to pos)

not used for rehab b/c of discomfort

used at low levels for iontophoresis

44
Q

describe alternating current

A

continuous, sinusoidal, bidirectional flow of charged particles

current always flowing back and forth

type or current found in wall outlet

used clinically for pain control and muscle contraction

45
Q

describe pulsed current

A

interrupted current flow of electrons where current flow in a series of pulses is seperated by periods when no current flows

may flow in one direction only (monophasic) or flow back and forth between polarities during each pulse (biphasic)

46
Q

what is biphasic

A

most commonly used waveform

used in all TENS and NMES units

promote muscle contraction

control pain

47
Q

what is monophasic

A

used clinically to promote tissue healing

manage acute edema

high volt pulsed curretn (HVPC) is most common

48
Q

parameters for alternating current

A

always biphasic

alternating polarity between + and -

frequency for AC is measured in Hz

49
Q

alternating currents sometimes referred to as what? how are they used clincally?

A

medium frequency

used clinically in the following protocols:
-interferential current
-premodulated current
-russian protocol

50
Q

compare treatment protocols of medium frequency vs high rate vs low rate

A

medium = AC between 1000 and 10000 Hz

high rate = PC above 100 pps

low rate = PC below 10 pps

51
Q

what is interferential current

A

uses 2 pairs of 2 independent circuits (quadripolar electrode placement)

they carry slightly different frequencies which cause interference at their intersecting point

electrodes are places so interference permeates the tissue at target

produces envelopes of pulses or “beats” at intersection

52
Q

benefit of IFC

A

thought to be more comfortable and penetrate deeper than pulsed biphasic waveforms

53
Q

explain beat modulation

A

when 2 different frequencies intersect interference pattern produces a beat frequency equal to the difference in frequency between 2 alternating current frequencies

i.e. if the 2 frequencies are 5000 Hz and 5100 Hz then beat frequency is 100 beats

54
Q

what is Russian protocol

A

originally intended for LE quad muscle strengthening for Russian olympic athletes

only need 1 channel

cant modify preset protocol

55
Q

parameters for russian protocol

A

medium frequency AC

2500 Hz

pulse duration of 50 bursts per sec

burst duration is 10 ms long

burst modualiton is 10 ms interburst interval

56
Q

rationale for russian protocol

A

skin impedance decreases with decreased pulse or cylce duration thus claimed to be more comfortable

limited data

57
Q

types of modulation

A

continuous modulaiton

burst modulation (burst modulated pulsed current or alternating current)

beat modulation

58
Q

2 physiological mechanisms of pain control

A

gate control

endogenous opiod release

59
Q

how is the gate control theory activated with tens

A

high rate tens

produces sensation without contracton to stimulate A Beta nerves

high frequency 100-150 pps

60
Q

how is the endogenous opiod release activated with tens

A

low rate tens

produce brief repetitive muscle contractions to stimulate endogenous opiod production

low frequency = 2-10pps

pulse duration = 150-300 microsec

treatment time for only 20-30 min can control pain for 4-5 hours

treatmetn should not exceed 45 min to prevent DOMS

61
Q

when is high rate tens recommended

A

when senstaion but not muscle contraction would be tolerated

post injury

inflammation present

tissues may be damaged by repeated contraction

62
Q

when is low rate tens recommended

A

when longer duration of pain control is desired and muscle contraction is going to be tired

more chronic conditions

will have effects during an following treatment

63
Q

when is burst mode TENS recommended

A

to apply more intensity in shorter bursts for those with higher tolerance

decreases likelihood of acommodation

equally effective as high and low rate

64
Q

when might it be more comfortable to use IFC

A

to penetrate a larger and deeper area

Modalities (7 decks)

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