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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
what should be the pulse diration for NMES
when using a pulsed biphasic waveform the pulse duration should be between: small muscles = 125-200 microsec large muscles = 200-350 microsec
26
if you shorten the pulse duration, what factor needs to be changed in order to achieve the same strength of muscle contraction
higher amplitude required
27
chatanooga continuum (LMU DPT TENS unit) has a fixed pulse width of
300 microseconds
28
high rate vs low rate TENS
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
what cant you change when using interferential current with TENS
cant change pulse diration
30
what setting is often adjusted for pt comfort
pulse duration usually adjustable on most portable units
31
what is frequency
number of cylces or pulses per sec aka rate inverse of cycle duration
32
units of frequency
PPS (pulse per sec) for pulsed currents Hz (Hertz) for alternating currents
33
different frequencies and types of response for NMES
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
pulse frequencies associated with high and low rate tens and their clinical uses
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
why might you modulate rate of TENS
to limit adaptation/habituation and thus tolerance to tens modulation doesnt change overall analgesic effects of stimulation if pt never adapts
36
what is amplitude
magnitude of current flow amps/volts aka strength/intensity usually denoted by range 1-10 (weak to strong)
37
what is peak amplitude and peak to peak amplitude
peak = max intensoty peak to peak = biphasic property (from top of + wave to bottom of - wave)
38
what setting is related to pt tolerance
amplitude
39
what do you want when adjusting the amplitude for high and low rate TENS
high = want strong tingling sensation low = want to produce a muscle contraction
40
what is on/off time and why might it be useful
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
what is ramp up/down and why is it useful
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
3 types of waveforms
direct current (DC) alternating current (AC) pulsed current (PC)
43
describe direct current
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
describe alternating current
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
describe pulsed current
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
what is biphasic
most commonly used waveform used in all TENS and NMES units promote muscle contraction control pain
47
what is monophasic
used clinically to promote tissue healing manage acute edema high volt pulsed curretn (HVPC) is most common
48
parameters for alternating current
always biphasic alternating polarity between + and - frequency for AC is measured in Hz
49
alternating currents sometimes referred to as what? how are they used clincally?
medium frequency used clinically in the following protocols: -interferential current -premodulated current -russian protocol
50
compare treatment protocols of medium frequency vs high rate vs low rate
medium = AC between 1000 and 10000 Hz high rate = PC above 100 pps low rate = PC below 10 pps
51
what is interferential current
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
benefit of IFC
thought to be more comfortable and penetrate deeper than pulsed biphasic waveforms
53
explain beat modulation
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
what is Russian protocol
originally intended for LE quad muscle strengthening for Russian olympic athletes only need 1 channel cant modify preset protocol
55
parameters for russian protocol
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
rationale for russian protocol
skin impedance decreases with decreased pulse or cylce duration thus claimed to be more comfortable limited data
57
types of modulation
continuous modulaiton burst modulation (burst modulated pulsed current or alternating current) beat modulation
58
2 physiological mechanisms of pain control
gate control endogenous opiod release
59
how is the gate control theory activated with tens
high rate tens produces sensation without contracton to stimulate A Beta nerves high frequency 100-150 pps
60
how is the endogenous opiod release activated with tens
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
when is high rate tens recommended
when senstaion but not muscle contraction would be tolerated post injury inflammation present tissues may be damaged by repeated contraction
62
when is low rate tens recommended
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
when is burst mode TENS recommended
to apply more intensity in shorter bursts for those with higher tolerance decreases likelihood of acommodation equally effective as high and low rate
64
when might it be more comfortable to use IFC
to penetrate a larger and deeper area

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