Mod. 4-7: NMES, HVPC, Ionto, US Flashcards
purpose of NMES
assist muscle contraction facilitation
NMES: Indications
muscle strengthening
muscle re-education
mm spasm
edema
NMES physio effects
stimulate APs along motor nerves
overload principle (combo of e-stim contraction and mm contraction)
SAID principle (stimulate type 2 first)
NMES waveform (mm strengthen or edema)
pulsed biphasic/Russian
NMES pulse duration (& for mm types)
150-350 us
(150-200 us for small mm; 200-350 us for large mm)
NMES: frequency,
duty cycle (mm strengthen vs. edema)
freq: 35-50 pps
duty cycle (on/off time): 1:5 ratio- mm strengthen
1: 1 ratio- edema
NMES amplitude
& tx time (mm strengthen vs. edema)
amplitude: smooth mm contraction
mm strengthen tx time: 10-20 min
edema tx time :20-30 min
NMES (dec. mm spasm or edema) ramp time
1-4 sec
when to not use NMES for edema
acute inflammation
organ failure
NMES electrode placement
1 over motor point (mid mm belly)
1 over stimulated mm, parallel to mm fibers
What is EMG? acronym & function
electromyography
measure electrical activity in muscle tissue
What type of stimuli does biofeedback utilize? (3)
auditory, visual, haptic (tactile)
EMG Indications
bowel/urinary incontinence
cerebral palsy
hemiplegia
impaired motor control
mm spasm
mm weakness
pain
SCI
EMG physio effects
neuromusc. facilitation to inc. strength
neuromusc. inhibition
neuromusc. coordination
improve motor planning w/ feedback
EMG for mm facilitation:
gain
amplitude
isometric holds
tx duration
gain: low sensitivity
amplitude: 66% MVIC
holds: 5-10 sec w/ rest between
tx duration: 5-10 min per mm group
EMG for mm inhibition:
gain
amplitude
tx duration
gain: high sensitivity
amplitude: lower than baseline
tx duration: max 30 min
EMG contraindications
acute inflammatory conditions (avoid mm contraction)
skin irritation
pregnancy, vaginal or bladder infection
HVPC Indications
chronic wounds (ulcers)
edema (d/t inflammation)
HVPC Physio Effects
galvanotaxis (cell movement)
activate cell function
enhance antimicrobial activity
enhance circulation
Anode: charge, when used, attracted cells
positive
in proliferative phase of healing (no inflammation)
macrophage, neutrophil, epidermal cells
Cathode: charge, when used, attracted cells
negative
in inflammatory phase of healing
lymphocyte, platelet, mast cells, fibroblasts, keratinocytes
HVPC Wound Healing:
waveform
electrode placement
amplitude
pulsed monophasic
elec. placement: in wound or surrounding
sensory tingling
HVPC Wound Healing:
pulse duration
frequency
tx time
pulse duration: 40-200 us
frequency: 60-125 pps
tx time: 45-60 min (5 days/wk)
HVPC Edema (Inflamm)
waveform
elec. placement (cathode & anode)
amplitude
pulsed monophasic
cathode- area of edema; anode- proximally
visible mm twitch (mm pump)
HVPC Edema (Inflamm)
pulse duration
frequency
tx time
pulse duration: 40-100 us
frequency: 100-120 pps
tx time: 20-30 min
Iontophoresis: waveform & common drug
direct current
dexamethasone
Iontophoresis: Indications
Pain* & inflammation*
also, fungal infection, ischemia, mm spasm, plantar warts, scar tissue, wounds etc.
Ionto: contraindications beyond standard e-stim
no application after other phys. agent (ice, heat, US)
drug allergy
skin sensitivity to specific ion reactions
Ionto: Physio Effects
elec. current pushes medication with same charge into skin (repels medicine)
ion penetration less than 1mm
absorbs deeper via capillary circulation
Ionto: amplitude & usual dosage
less than 1-4 mA
~ 40-120 mA-min
Ways to decrease Ionto Burns
increase cathode size
dec. amplitude
inc. distance between electrodes
skin prep
use appropriate med. dosage
medication in correct electrode (ex: neg. charge med in cathode)
Ionto dosage calculation
dosage = amplitude x tx time
Ultrasound Indications
pain
acute, subacute conditions
scar tissue
chronic inflammation
joint contracture
ST shortening
mm spasm
tissue regeneration
etc
US Contraindications
epiphyseal area of bones in kids
acute conditions (for thermal)
malignancy
DVT, blood clot, thrombophlebitis
joint cement/plastic in replacement
active bleeding
etc
Thermal US- Physio Effects
inc. metabolic rate & circulation
pain modulation
dec. mm spasm & joint stiffness
inc. ST extensibility
alter nerve conduction velocity
Nonthermal US- Physio Effects
inc. intracellular calcium levels
inc. cell membrane permeability
stimulate cell function
facilitate tissue repair
Cavitation (gas bubbles)
Microstreaming & Acoustic Streaming (circular flow of fluids)
US: tx area size & transducer speed
treat area twice the size of transducer head
move transducer 4cm/sec
US: ST shortening (MM) parameters @ 1MHz & 3 MHz
thermal or nonthermal?
1MHz (freq)- 100% duty cycle - 1.5W/cm2 - 14 min
3MHz (freq) 100% duty cycle - 1 W/cm2 - 7 min
thermal
US: ST shortening (tendon) parameters @ 1 MHz & 3 MHz
thermal or nonthermal?
1 MHz (freq) - 100% duty cycle - 1.5W/cm2 - 10 min
3 MHz (freq) - 100% duty cycle - .8-1.0W/cm2 - 5 min
thermal
US: pain modulation parameters (freq, duty cycle, intensity, time) @ both 1& 3 MHz range
1 or 3 MHz- 100% duty cycle - .5-3.0 W/cm2 - 3-10 min
US: ST healing (wounds & mm) Parameters @3 MHz
3 MHz (freq) - 20% duty cycle - 1 W/cm2 - 10 min
US: bone fracture healing Parameters @ 1 MHz
1 MHz (freq) - 20% duty cycle - 0.15 W/cm2 - 20 min
US: tendon/ligament injury Parameters @ 1 MHz
1 MHz (freq) - 20% duty cycle - 1-2 W/cm2 - 5-10 min
1 MHz frequency: tissue depth (and reaches what), temp. inc. rate
max 5 cm depth
reaches bone (and some cartilage & tendon)
low & slow temp increase
3 MHz frequency: tissue depth (and reaches what), temp inc. rate
1-2 cm depth
reaches mm and skin (not bone)
high & fast temp increase
Phonophoresis Parameters: duty cycle, intensity range, frequency & tx duration
20% duty cycle - 0.5-1.0W/cm2 - 3 MHz - 5-10 min
Combo: US transducer & e-stim electrode
Which one is positive vs. negative?
US transducer- positive
Electrode- negative
