Modalities Quiz Flashcards
_______ agents apply energy in the form of electromagnetic radiation or electrical current
electromagnetic
Variation of the _______ and _______ of electromagnetic radiation changes it depth of penetration
frequency; intensity
Reasons we use E-Stim
_______ modulation
_________ re-education and strengthening
________ prevention/reduction
Decreasing __________
________/________ healing
Muscle _______ reduction
Drug delivery ( __________ )
Reinverting _________ muscle (EMS)
EMG ____________
pain
muscle
edema
tissue; wound
spasm
iontophoresis
denervated
biofeedback
________ is the use of electrical current to induce muscle contraction, changes in sensation, reduce edema, or accelerate tissue healing
E-stim
_______ ________ = flow of charged particles
current flow
Charged particles may be _______ or _______
electrons; ions
Current flow is considered to be from ______ to _______
anode; cathode
Cathode is when the ______ electrode attracts positively charged ions; anode is when the _________ charged electrode attracts negatively charged ions
negative; positively
TENS stands for what?
Transcutaneous Electrical Nerve Stimulation
NMES stands for?
Neuromuscular Electrical Stimulation
EMS stands for?
Electrical Muscle Stimulation
TES stands for?
Therapeutic Electrical Stimulation
FES stands for?
Functional Electrical Stimulation
If you want sensory stimulation, use a ______ machine?
TENS
If you want motor stimulation, use a ______ machine?
NMES
________ __________ are the messaging unit of the nervous system, and the basic unit of nerve communication
action potentials
To stimulate an AP in a nerve cell, the electrical current must have sufficient ______ and ______ to cause depolarization
amplitude; duration
__________ is the changing of flow of the ions across the cell membrane = AP “All or none” event
depolarization
___________ is the return to resting membrane potential which is generally more negatively charged
due to electron imbalance inside vs. outside the cell
repolarization
After depolrization and repolarization, then the AP will _________ (travel) from the stimulus along the nerves axon until it reaches its terminating point
propagate
__________ is the process by which a nerve gradually becomes less responsive to stimulation of normally sufficient amplitude and duration and no longer depolarizes
accommodation
__________ once an AP is generated it triggers an AP in the adjacent area of the nerve membrane
Propogation
Terminating point:
_______ nerve- muscle creates a contraction
________ nerve- spinal cord creates a tingling sensation
motor
sensory
_________ Fatty sheath that wraps around certain nerve axons
(increasing the diameter) that increase the speed in which nerves
propagate
myelin
______ ______ _______ small gaps between the Myelin sheath from
which AP jump from one node to the next a process called _______
_______ which accelerates AP propagation
nodes of ranvier
saltatory conduction
_______- dependent characteristics
* Phase
* Phase duration
* Pulse
* Pulse duration
* Interpulse interval
* Frequency
time
________- dependent characteristics
*Amplitude
* Peak amplitude
* Peak-to-peak amplitude
* Phase charge
* Pulse charge
amplitude
_______ ________ (NMES)
* On/Off Time
* Ramp up/down Time
Device Parameters
_______ : Period when electrical current flows in one direction
phase
_____ : Period when electrical current flows in any direction
May be made up of one or more phases
pulse
_____ _______: How long a phase lasts in microseconds (µs)
phase duration
_______ ________: How long a Pulse lasts, beginning of the first phase of the
pulse to end of last phase. in microseconds (µs)
pulse duration
________ ________ : the amount of time between pulses.
interpulse interval
Pulse duration (“Pulse width”, “Cycle”, “Period duration”)
NMES= should be between _____-_____ _µs small muscles
_______-_______ µs for large muscles
125; 200
200; 350
Most NMES units intended solely for stimulating muscle contractions
have a fixed pulse duration of approximately _____ to ______ µs
250; 300
With NMES, As the pulse duration is ________, the _________ amplitude current will be
required to achieve the same strength of muscle contraction
shortened; higher
With NMES, When ______ protocol is used, the cycle duration cannot be adjusted.
Russian
Pulse duration (“Pulse width”, “Cycle”, “wavelength”, “Period duration”)
Pulsed biphasic TENS
High rate: ____-_____ µs to depolarize only A-beta sensory nerves ( _____ _____ effects)
Low rate: ______-______ µs to also depolarize the motor nerves and possibly A-delta nerves ( _______ _______ effects)
50; 80; pain gaiting
200; 300; endongenous opioid
Which setting with the TENS machine is often adjusted for patient comfort?
pulse duration
With the TENS unit, if _______ ______ is used for pain control, one cannot change the pulse duration
inferential current
The NMES/TENS unit we use in lab will refer to this as ______ _____ and is preset to ______ µs
pulse width; 300
Frequency is also kown as _______
- number of _____ (pulses) per second
- inverse of cycle ________
Units are:
_______ for pulsed currents
_______ for alternating currents
cycles
duration
PPS
Hz
NMES Frequency determines the type of response
Low frequency- ____-_____ pps will produce a twitch contraction
Frequency _____-_______ pps the twitches occur closer together, eventually summating into a smooth contraction.
(recommended)
Frequency- _____-______ pps may produce stronger contractions, but it also causes more rapid fatigue.
20; 30
35; 50
50; 80
TENS “rate” frequency- depends on your goal for treatment and pain relief mechanism
High-rate TENS: Pulse frequency = _____-______ pps ( sensory with _____ ______ effects)
Low-rate TENS: Pilse frequency = < ____ pps (motor with ______ _______ effects)
_______: Preset frequency combining both High Rates and Low Rates in intermittent bursts
100; 150; pain gating
10; endogenous opioid
burst
________ is a known property of sensory receptors caused by decreased
excitability of the nerve membrane with repeated stimulation
adaptation
Frequency Modulations (Bursts)
TENS
- rate can be _________ (varied over time) to limit adaptation/accommodation/habituation to stimulus and thus a tolerance as in high-rate
TENS
modulated
_________
magnitude of the current flow
measured in amps/volts
strength/________
denoted by a range ___-_____
weak to ______ intensity
adjusted according to _______ response
amplitude
intensity
1; 10
strong
patient’s
______ amplitude
Max Intensity (Highest
Magnitude)
* Measured in amps/volts
* “Strength” “Intensity”
peak
____-_____-_____ amplitude
Peak Amp= Peak-to-peak
for monophasic waveforms
* Biphasic property
peak; to; peak
Amplitude or intensity
Often relative to patient ________
tolerance
Amplitude
NMES
- current amplitude is adjusted to __________________ depending on goal of the intervention
- hypertrophy of a muscle requires _______, whereas functional external cueing may desire less amplitude
produce a contractionof desired strength
overload
Amplitude
TENS
- To control _____ with electrical stimulation, the treatment should be comfortable
- High-rate TENS: Recommended that the amplitude be set to produce a ______ ______ sensation
- Low-rate and burst TENS: Amplitude should be sufficient to produce a ______ ________ that can be seen or palpated by the clinician
pain
strong tingling
muscle contraction
Device parameters (NMES)
On Time vs. OFF Time (sec) used to stimulate ________ contraction and ______ phases of physiological exercise
To prevent muscle _________
voluntary
relax
fatigue
On/Off time usually expressed in a ratio of ___ to _____
___:____ ratio would indicate an on stimulation time of 10 sec and off “rest” time of _____ seconds between current
on; off
1; 5
50
_____ _____ _____ (sec)
Number of seconds it takes for the current to
increase from zero to maximum amplitude during
“On time”
ramp up time
______ _____ _____ (sec)
Number of seconds it takes for the current to
decrease from its max to zero during “Off time”
ramp down time
Ramp up vs down time
This is to minimize the _______ that can occur
when the electrical current turns on and off
discomfort
_______ is the continuous flow of electrons/ions in one direction
direct
Which current should not be used for rehab due to being uncomfortable?
direct
________ current is a continuous, sinusoidal, bidirectional flow of charged particles, where the current is always flowing back and forth
alternating
Which current comes from a wall outlet?
alternating
Clinical uses of AC:
______ control
muscle ________
pain
contraction
________ current is the interrupted current flow of electrons where the current flow in a series of
pulses separated by periods when no
current flows
pulsed
A pulsed may flow in one directiononly aka _______ or flow back and forth between polarities during each pulse ________
monophasic
biphasic
Pulsed _______ current is the most commonly used waveform in electrotherapy
These promote muscle _______ and control _______
biphasic
contractions
pain
Pulsed _______ current is used clinically to promote ______ healing
- manage acute _______
- ________- most common
monophasic
tissue
edema
HVPC (high-volt pulsed current)
Alternating currents are ALWAYS _______
- alternating _______ between + and -
- Frequency for AC is measured in _____
biphasic
polarity
Hertz (Hz)
AC waveforms are sometimes referred to as “ ________ frequency” and are used clinically following these treatment protocols:
_________ current
_________ current
________ protocol
medium
inferential
premodulated
Russian
__________ current uses 2 pairs of 2 independent circuits (Quadripolar
electrode placement) carrying slightly different
frequencies which cause “Interference” at their
intersecting point
inferential
2 pairs of 2 independent circuits = ________ electrode placement
quadripolar
With quadripolar electrode placement, the electrodes are placed this way so that the ______ of the current permeates the tissues at a target
intersection
With IFC and quadripolar placement, it produces envelopes of pulses called “______” within these tissues is where the ACs intersect
beats
IFC is thought to be more comfortable and penetrate deeper ______ ________ waveforms
pulsed biphasic
______ _________ (IFC current)
The interference pattern produces a
beat frequency equal to the
difference in frequency between the
2 alternating current frequencies.
Beat modulation
Beat modulation (IFC current)
creates a beat frequency of _____ beats per second in this case
100
_______ current
- “Medium frequency” AC
* has __ elctrodes ( __ channel)
* Produces same resulting waveform as IFC
which uses 2 circuits and 4 electrodes but only
uses a single circuit and 2 electrodes
premodulated
2; 1
With Russian protocol, there is only ___ channel needed
1
______ protocol is a part of NMES protocol
this is usually intended for LE quad muscle strengthening
Russian
______ protocol is preset and cannot be modified by a therapist
Russian
Russian protocol
“Medium frequency” AC
- ______ Hz
- Pulse duration: __ burst per sec
- Burst duration: ____ms long bursts
- Burst modulation: ___ms interburst interval
2500
50
10
10
TYPES OF TIMING MODULATION: AC CURRENT
ONLY
- Designed for _____ (Tens) only
- To prevent ________
pain
accommodation
What are the two physiologic mechanisms of pain control?
Gate control
Endogeneous Opoid release
__________ of TENS can affect the physiologic mechanism managing the pain
Parameters
Gate control theory with TENS
Noxious (painful) ____- fibers are gated by non-noxious ____- Beta fibers from being perceived by the CNS
C
A
High-Rate (Conventional) TENS: produces comfortable ______ without muscle ______ to stimulate A-beta nerves
High frequency: ____-_____ pps
Short pulse duration ___-___ µs
_____ _______ waveform
sensation; contraction
100; 150
50; 80
pulsed biphasic
________ _________ release with TENS
The internal stimulation of the production and
release of endorphins (opiopeptins) which bind to
opiate receptors in the CNS to decrease pain
perception
Endongenous opiod
Low-Rate TENS
- High intensity motor-level electrical stimulation to produce _____,______, ______ contractions (twitches) to stimulate _______ _______ production
brief
repetitive
muscle
endongenous opioid
Low-Rate TENS
Low frequency- ____-____pps
Pulse duration- _____-_______ µs
Pain controlled 4-5 hours after a ___-____ minute session
DO NOT EXCEED past ______ minutes
2; 10
150; 300
20; 30
45
______- rate TENS is recommended when sensation, but not muscle contraction
would be tolerated
* Post injury
* Inflammation present
* Tissues may be damaged by repeated muscle contractions
High
_____ rate TENS is recommended when a longer duration of pain control is
desired and muscle contraction is going to be tired
* More chronic conditions
* Will have effects during and following treatment
Low
______ _______ TENS is recommended for some individuals to apply more
intensity in shorter bursts for those with higher tolerance
* Equally effective as High-rate or Low-rate, more for comfort and patient
preference
* Decreases likelihood of accommodation.
Burst Mode
IFC uses AC waveform
do not need to adjust _______ (pulse duration or frequency)
still adjust _______ for desired effects
parameters
amplitude
IFC may be more comfortable and _______ to a larger, deeper area
penetrate
Premodulated (Mod) is a variation of _____ current that only uses two electrodes
IFC
Contraindications for electrotherapy
Implantable ______ electronic devices (pacemaker)
________ electrode placement
________ arrthymias
______ _______ thrombosis
Pregnancy
cardiac
transcerberal
unstable
deep vein (DVT)
Precautions
______ disease
Epilepsy
________ due to acute trauma or fracture
Impaired ________
Impaired _______
_______ tumors
Areas of skin ______ or open ______
cardiac
hemorrhages
sensation
mentations
malignant
irritation
wounds
If a muscle is denervated, it requires _____ current or _____current with pulse duration of _____ msec or longer
DC; pulsed
Denervated muscle requires NMES or EMS?
EMS
With tretament for denervated nerve, it stimulates the ______ _______ in muscle cells directly through depolarization of the sarcolemma
action potential
Do Type I OR Type II fibers contract first with NMES and which atrophy quicker?
II
Prolonged impairment in neural recruitment results in ______ _____ and _____ loss
muscle atrophy
fiber
Galvanotaxis is _______ _________ of cells
directional movement
_________ is using current to promote transdermal drug delivery
Uses low amplitude _____ current
Most common drug used in PT is __________
iontophoresis
DC
dexamethasone
