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License Prep > Modalities > Flashcards

Modalities Flashcards

1
Q

resting membrane potential

A

negative inside cell, positive outside the cell

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2
Q

refractrory period

A

absolute: cannot fire.
relative: can fire, but requires stronger stimulus

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3
Q

Contraindications for ESTIM

A

trunk of pregnant woman
areas of PVD/thrombophlebitis
pacemaker/other implanted electrode
close proximity to diathermy

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4
Q

Precautions for ESTIM

A 
Carotid sinus
High intensity estim around heart
excess adipose
insensate skin
seizures
open wound (unless treating wound)
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5
Q

Galvanic current

A

continuous, direct current. Used only for ionto

Has polarity

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6
Q

Cathode

A

negative electrode

attracts cations

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7
Q

Anode

A

positive electrode

attracts anions

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8
Q

Effects of Cathode

A

Base reaction
increase in nerve irritability
softening of tissue

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9
Q

Effects of anode

A

acid reaction
decrease in nerve irritability
hardening of tissue

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10
Q

Current

A

Flow of charged particle
Measured in Amperes
Current=voltage/resistance

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11
Q

Which is more important, average or peak current?

A

Average

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12
Q

Average total current limits

A

Do not go over 4 (most patients uncomfortable at over 2)

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13
Q

Fused/tetanic contractions occur around ____ Hz

A

15-20

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14
Q

What common applications are there for polyphasic current?

A

IFC and Russian

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15
Q

What current is “jack of all trades”

A

Hi volt pulsed DC

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16
Q

Rise and decay

A

Rise: time from baseline to peak
Decay: time from peak to baseline

Both apply to a single phase

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17
Q

Ramp

A

Ramp up: time from zero to maximum amplitude (seconds)

Ramp Down: time from max to zero

Increases comfort

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18
Q

Rheobase

A

magnitude of current just strong enough to cause tissue excitation with long pulse duration

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19
Q

Chronaxie

A

minimal pulse duration for activation at twice rheobase intensity

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20
Q

Pulse Duration

A

100-400 us.
300-400 most used
over 800 will stimulate pain receptors

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21
Q

Increased pulse duration will increase recruitment of:

A

smaller fibers at same depth

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22
Q

Increased amplitude will increase recruitment of:

A

smaller fibers at same depth, AND

larger fibers further away

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23
Q

What is the desired pulses per second for strengthening

A

30-50pps

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24
Q

Monopolar electrodes

A

1 active pad, 1 dispersive:

dispersive is larger and away from treatment area

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25
Q

cycle time

A

on/off time

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26
Q

modulation

A

varying 1 or more parameters

increases comfort and prevents accomodation

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27
Q

Burst

A

finite series of pulses

Time interval=burst duration

often seen in TENS and Russian

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28
Q

Train

A

a continuous, repetitive series of pulses at a fixed frequency

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29
Q

Normal vs Evoked firing pattern

A

Normal: asynchronous, fine gradiations in tension, small units first

Evoked: synchronous, max tension at tetany, large units recruited first

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30
Q

Classification of Estim by frequency

A

Low (1-1000Hz): most pulsed units

Medium (1k-100k) Russian (2500Hz), IFC (4-5k)

High frequency: 100k+ diathermy: 27MHz

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31
Q

Use of continuous DC

A

ionto

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32
Q

Use of Interrupted DC

A

Denervated muscle (pulse width of over 10ms)

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33
Q

Use of monophasic pulsed DC with twin spikes

A

Hi volt pulsed DC:

Pain control
edema reduction
tissue healing
muscle stimulation (small muscles)

34
Q

Use of polyphasic sine wave

A

Russian (motor)

IFC: analgesia, edema/spasm reduction

35
Q

Low volt pulsed current

A

Common
less than 150v
symmetrical/asymmetrical

Portable NMES/TENS

36
Q

High-Volt Pulsed

A

0-500V
Monophasic twin spike

Management of pain, edema, wounds.

muscle contraction in small muscle groups

fixed pulse duration at 100-150 usec

37
Q

IFC

A

two channels with different frequencies- beats per second is difference in frequencies.

Less than 150V, but high average current

Used for pain, edema, muscle spasm

38
Q

Russian current

A

Interrupted sine wave-medium frequency

carrier frequency typically 2500 Hz, 50 bursts per second

50% duty cycle

39
Q

NMES pulse duration

A

May be fixed

100-600 (300)

keep as low as possible to minimize chance of stimulating A deltas.

40
Q

NMES frequency

A

30-50 pps (true russian is 50)

41
Q

Ramp down is usually ___ of ramp up

A

1/2

42
Q

Gate Control

A

Stimulate A-Beta. “closes pain gate” so C and A delta cannot reach cerebral cortex)

43
Q

Enkepahlins vs Endorphins

A

Enkephalins: depress receptive ability of pain receptors in SC

  • short half life (2 min)
  • high frequency, low pulse stim

Endorphins: released from pituitary

  • long half life (4 hours)
  • low frequency, high pulse duration stim
44
Q

Sensory TENS settings for acute pain

A

*2-50 usec pulse duration
*50-100 pps
20-30 min
residual relief variable

High rate TENS, Conventional TENS

45
Q

Motor level stimulation TENS for chronic

A

150 usec pulse duration
2-4 pps
30-45 min in research, 20 min in practice
Residual relief for hours

46
Q

ESTIM noxious stimulation protocol

A

-For chronic pain
-Pulse duration as high as possible
1-5 pps, or greater than 100 pps

47
Q

Advantages of IFC

A

has vector scan (amplitude modulation) built in

Preferred by many pts

Frequency modulation (sweep)

Has a high average current (can be advantage or disadvantage)

48
Q

Should the anode or cathode be put over inflammation for edema management

A

cathode

49
Q

What stages of pressure ulcers are most appropriate for estim use

A

stage 3/4. (2 can be used, but may not be necessary).

infected or edematous wounds most appropriate

50
Q

Is Estim appropriate over osteomyelitis?

A

no

51
Q

Effects of negative polarity on wound healing

A 
epidermal proliferation
increased blood flow
fibroblast proliferation
neutrophil attraction
edema reduction

bacteriocidal

52
Q

Effects of positive polarity on wound healing

A

attracts macrophages
epithelial growth
new capillarization
bacteriocidal for STAPH

53
Q

Ionto

A

uses continuous DC.

Pole used is determined by drug

Dosed in “mA*min”

54
Q

Dexamethasone for ionto

A

for inflammation

negative polarity

55
Q

lidocaine for ionto

A

sodium channel blocker

positive polarity

56
Q

Inverse Square law

A

intensity of radiation is inversely proportional to the square of the distance

57
Q

Cosine law

A

Absorption of rays is optimal when they are perpendicular. As angle increases from perpendicular, efficiency is decreased proportional to cosine of the angle

58
Q

Levels of heating effects

A

0-1C: mild (subacute injuries)
1-2C: moderate (chronic inflammation, pain, trigger pt
2-3*C: vigorous: stretching collagen

59
Q

Heating effect on muscle firing

A

increased GTO firing and decreased secondary afferent firing

combine to decrease motorneuron firing

60
Q

How deep can superficial heating therapeutically reach?

A

3 cm (most effects up to 1 cm)

61
Q

What temperature should hydrocollator packs be kept at?

A

165-175 (76-80* C)

62
Q

What temperature should parafin be kept at?

A

125-135 (52-53C)levels

63
Q

Buoyancy

A

at ASIS 50% WB,

at C7 10% WB

64
Q

Cold Urticaria

A

Release of histamine in response to cold.

causes: wheals, erythema, swelling, systemic effects (syncope, GI, respiratory)

65
Q

Cryoglobinemia

A

pt has substances in blood that precipitate in cold

66
Q

Raynauds

A

vasoconstriction of distal vessels in response to cold. most common in 18-30 yo females, usually bilateral

67
Q

Hunting reaction

A

Prolonged cold leading to vasodilation in the area

68
Q

Biophysical effects of cold on spasm, spasticity, and flaccidity

A

decreased spasm d/t decreased muscle spindle activity

decreased spasticity d/t decreased gamma motor neuron activity

Facilitation of contraction in flaccidity

69
Q

Temperature for cold baths

A

55-65* F

70
Q

Vapocoolant Sprays

A

hold 18-24” from pt

spray at 30* at rate of 4”/s

71
Q

Contrast bath temps

A

100-110, 55-65

72
Q

depth of US

A

1 MHz: 2-5 cm

3 MHz: 0-3

73
Q

Biological effects of US

A

increased metabolism
increased blood flow
increased collagen extensability
decreased neural sensitivity

74
Q

Acoustic Streaming

A

unidirectional movement of fluid in US field.

“micromassage”

increase diffusion, permeability

promotes tissue repair

75
Q

Cavitation

A

alternate compression and expansion of gas

Some is desired, so is undesired

76
Q

Phonophoresis

A

uses nonthermal effects to enhance diffusion

pulsed US

77
Q

Diathermy

A

Microwave: 2450 MHz (gets superficial)
Shortwave: 27.12 MHz

78
Q

Capacitance diathermy field

A

places pt in circuit: need both heads

more heat in areas of fat/skin (superficial)

79
Q

Inductance diathermy field

A

places patient in field: only need one head

muscle, synovial fluid (deeper)

80
Q

Contraindications to diathermy

A 
metal in area,
metal or plastic implants
eyes
CA
pregnant
carotid sinus, heart, stellate ganglion
pacemaker
81
Q

Biofeedback on weak muscles pad placement and sensitivity

A

Placement far apart with high sensitivity in order to increase detection.

As pt gets stronger, decrease sensitivity

82
Q

Biofeedback to decrease muscle activity

A

Place pads close together with low sensitivity (in order to isolate muscle.

Progress to higher sensitivities

License Prep (22 decks)

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