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Electro & Bio Physiological Agents > Physiology of Electrical Stimulation & ES Application for Pain > Flashcards

Physiology of Electrical Stimulation & ES Application for Pain Flashcards

1
Q

artificial area of depolarization

A

an electrode placed in the periphery bypasses the CNS to stimulate muscle

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2
Q

orthodromic

A

traveling in the normal direction in a nerve fiber.

activate nerves and muscles

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3
Q

Antidromic

A

traveling in the opposite direction to that normal in a nerve fiber

pain relief

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4
Q

force generation via ES: volitional contraction

A

small diameter alpha motor neurons recruited first, then larger ones as more force is needed

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5
Q

rate coding

A

increase tension

-CNS increases firing rate of motor units contracting

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6
Q

Asynchronous

A

swapping motor units in & out to reduce fatigue

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7
Q

Natural recruitment order

A

slow twitch type 1

  • -> fast twitch , fatigue resistant, type IIA
  • -> fast twitch fatiqguable type II B
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8
Q

force generation via ES: Stimulated Contraction

A

larger diameter alpha motor neurons recruited first and then smaller ones last

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9
Q

which type of muscles are recruited first in stimulated contraction

A

fatigable

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10
Q

recruitment order for stimulated contraction

A

fast twitch, fatigable type IIB

–> fast twitch, fatigue resistance, type IIA

–> slow twitch type I

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11
Q

factors influencing muscle force production via ES

A
  • frequency of activation
  • amplitude of activation
  • pulse duration
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12
Q

Frequency

A

increases firing rate, force, & increases fatigue

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13
Q

Twitch

A

initial pulse creates AP

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14
Q

Unfuse tetany

A

another pulse occurs before Ca+ reuptake occurs

oscillations (3-20 pps)

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15
Q

Fused Tetany

A

summative effect

greater than 20 pps

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16
Q

critical fusion frequency

A

can differ among muscles

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17
Q

amplitude

A

stimulated deeper and smaller fibers

increases force production

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18
Q

pulse duration

A

stimulate smaller fibers
increases force production

pain over 400 usec

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19
Q

clinical respones

A

sensory
motor
noxious

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20
Q

sensory

A

first response as stim is turned on “tingling”

21
Q

motor

A

alpha motor neurons threshold is reached

-recruitment increases as stim increases

22
Q

noxious

A

pain fibers are being stimulated

PD> 400 u sec activates all fibers

23
Q

motor point

A

the point on skin which smallest amount of current activates the muscle

located near the point that peripheral nerve enters muscles

24
Q

innervated muscle

A

muscle has intact peripheral nerve

25
Q

denervated muscle

A

peripheral nerve is damaged

26
Q

denervated & fibrotic

A

nerve is damaged plus muscle has undergone changes preventing contraction

27
Q

anode (+) effects

A
  • acid produces
  • coagulates protein
  • hardens tissue
  • accelerates tissue growth
28
Q

cathode (-) effects

A
  • base produces
  • liquifies protein
  • softens tissue
  • bacteriostatic effect (get rid of ecoli)
29
Q

current density

A

size of the electrode influences the excitability of the tissue under it

(charge delivered over the area of the electrode)

30
Q

ES for pain control relies upon two mechanism

A

Gate-theory (short lasting)

Central mechanisms (long lasting)

31
Q

First order neurons

A

A-beta
A-delta
C afferents

32
Q

A-betta (II)

A

joint, touch, muscle spindle receptors

33
Q

A-delta (III)

A

free ending

fast pain

34
Q

C afferents (IV)

A

free ending

slow pain

35
Q

substantia gelatinosa

A
  • act as a modulator
  • when active, there is a decrease in sensory input to the 2nd order neuron

-A-beta first activate the 2nd order and then decrease through SG

36
Q

Inhibitory interneuron

A

A-delta and C’s activate the 2nd order neurons

-also activate an inhibitory interneuron which inhibits the SG, causing increased activity

37
Q

Pre-synpatic inhibition of 2nd order neuron

A

the SC acts pre-synaptically to alter the signal to the 2nd order neurons that affects the pain signals sent to higher centers for perception

WDR

38
Q

central mechanism : 2nd order neurons to higher centers

1st path

A

axons 1 & V cross midline to ascend uninterrupted via the lateral spinothalamic tract which ascends on the contralateral side of the spinal cord

39
Q

central mechanism : 2nd order neurons to higher centers

2nd path

A

spino-reticulo-thalamic tract requires multiple synapses as pain information ascends

40
Q

medulla and pons are responsible for

A

autonomic responses to intense noxious stimuli

important in the affective components of pain

41
Q

Thalamus

A
  • recognition of location and type of pain occurs here
  • initiating the behavioral reactions to pain
  • sends projections to the cortex
42
Q

endorphins

A

endogenous morphine

43
Q

Endogenous Opioid System

A

Beta-endorphins are released by the pituitary and can have long lasting effect on pain (6-8 hours)

44
Q

The medulla and pons role in Endogenous Opioid System

A

release neurotransmitters that are either inhibitory or excitatory on the SG

45
Q

medulla

A

serotonin - inhibitory

46
Q

pons

A

norepinephrine exciting

47
Q

Counter Irritation Analgesia

A

idea that acute painful stimulus can alleviate ongoing pain

(acupunture )

works on endorphin system

48
Q

Contraindications

A 
Implanted Devices
Carotid Sinus 
Damaged Skin
Reproductive Organs 
Transcranial application 
Eyes
Cancer 
Pregnancy
Epilepsy
Thrombosis 
Hemorrhage 
Radiated tissues 
Infection/Tuberculosis
49
Q

Pre-Cautions

A 
Undiagnosed pain 
Cancer
Pregnancy 
Cognitive Impairment
Cardiovascular disease
Extreme edema 
Extreme adipose 
Adverse TENS experience 
Visual impairment 
Trans thoracic applications 
Impaired sensation/scar tissue

Electro & Bio Physiological Agents (3 decks)

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