NMES, TENS, Hi-Volt, Microcurrent Flashcards
What is the overall goal of NMES?
Stimulation of alpha motor NEURONS to cause strong muscle contraction
What are the indications for NMES?
1 retrain lost muscle function following surgery or injury
2 decrease muscle atrophy
3 decrease muscle spasm
Are slow or fast muscle fibers contracted first with normal physiologic muscle contractions?
Slow (fast when needed for greater exertion)
What does minimal fatigue occur with normal physiologic muscle contractions?
1 slow twitch fibers contracting first
2 asynchrony of firing motor units
Are slow or fast muscle fibers contracted first with NMES?
Fast (due to lower capacitance)
Why does fatigue happen easier with NMES?
1 fast twitch fiber recruitment
2 synchronous firing of motor units
Which exhibits faster fatigue: NMES or normal physiologic muscle contraction?
NMES
What currents can be used for NMES?
Russian, biphasic pulsed, interferential
What type of current is the stimulation of NERVES through the skin?
TENS
What is a common error with the names of TENS and NMES?
EMS (electrical muscle stimulation) - muscles aren’t being directly stimulated….NERVES ARE
What is the most common wave form seen with TENS?
Biphasic, symmetrical, square/rectangular
What fibers are targeted by TENS sensory level stimulation?
A-beta (large diameter)
What fibers are targeted by TENS motor level stimulation?
A-delta (in general)
What fibers are targeted by TENS noxious level stimulation?
C fibers
What TENS mode is used for sensory-level stimulation?
Conventional
What type of pain would be an indication to use sensory level stimulation?
Acute
Sensory-level TENS stimulation is often combined with what other treatments?
Ice or heat
What is the duty cycle for sensory level TENS stimulation?
None
What is the treatment time for sensory level TENS stimulation?
20-30 minutes (but could theoretically be 24 hours)
Motor-level TENS stimulation is for what kinds of pain conditions?
Subacute and chronic (NOT ACUTE)
Motor-level TENS stimulation is theorized to release what substance to decrease pain?
Endogenous opiates
What specific fibers are targeted by motor-level TENS stimulation in acupuncture like mode?
A-beta and alpha motor neurons
What specific fibers are targeted by motor-level TENS stimulation in burst mode?
Alpha motor neurons and delta fibers
How does noxious-level TENS stimulation elicit pain relief?
Endogenous opiates
What is the treatment time for noxious-level TENS stimulation?
30 seconds per point (8-10 points per session)
What is unique about noxious-level TENS stimulation while a patient is using narcotic analgesics?
Results will be diminished (natural opiates then have to compete)
What is the purpose of high-voltage pulsed current?
Enhancing soft tissue repair and healing (especially slow healing cutaneous wounds)
What are other names for high volt stimulation?
Electro-Galvanic Stimulation, High Volt Galvanic Stimulation, or High Volt Pulsed Stimulation
High volt indicates what level of voltage?
Greater than 150V (up to 500)
What is the purpose for a high voltage with high volt stimulation?
Deeper penetration
High volt stimulation must have twin peaks of what type of current?
Monophasic
What are the benefits of high volt stimulation?
1 deeper penetration
2 twin peaks doesn’t allow small sensory fibers (A-delta and C) to be stimulated therefore increasing comfort
What is unique about the peak amplitude of micro current?
Below rheobase of A-beta fibers (no depolarization, sub-sensory and sub-motor)
What is the term for polarized cells being attracted to the opposite polarity thus enhancing healing during micro current?
Galvanotaxis
What type of polarity is associated with the inflammatory phase of healing, and what cells does it attract?
Positive: neutrophils and macrophages
What type of polarity is associated with the proliferation phase of healing, and what cells does it attract?
Negative: fibroblasts and promotes collagen formation
What type of polarity is associated with the remodeling/maturation phase of healing, and what cells does it attract?
Negative: keratinocytes and epidermal cells
What is the germicidal effect associated with micro current?
Increase of bacterial growth inhibition (not a lot of research)
What type of current is associated with reducing edema?
HiVolt
How does negative polarity work to reduce edema through HiVolt?
Repels negatively charged proteins
What type of electrode placement is used with HiVolt to reduce edema?
Monophasic with treatment electrode over area of swelling and dispersal one proximal
Why is Russian stimulation preferred for muscle spasm reduction even though HiVolt could possibly help?
Lack of polarity effect
What is recommended for pain relief instead of HiVolt?
Interferential (lack of polarity effect)
Although both HiVolt and micro current are used for healing stimulation, what are two things that are ONLY accomplished through HiVolt, not micro?
Decrease of edema and spasm/guarding
Which polarity attracts acids and repels bases?
Positive
Which polarity attracts bases and repels acids?
Negative
