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practical Flashcards

1
Q

e-stim indications (5)

A
  1. pain
  2. muscle weakness
  3. edema
  4. wound healing
  5. diagnostic purposes
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2
Q

transcutaneous e-stim works by triggering action potential. to do this we need: (3)

A
  1. sufficient intensity (amplitude)
  2. duration (width of pulse)
  3. speed of rise
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3
Q

order of fibers e-stim works on and why (3)

A
  1. sensory (first tingle) -these have the widest diameter and most mylenated so they are excited quickest
  2. motor - this is what you see when u see affected when u see contractions; not actual muscle contractions
    skip over if you put on bony prominence
  3. pain (recruited painful nerve fibers)
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4
Q

pulse intensity duration curve (2)

A
  1. PW vs. PI

2. shows better discrimination the narrower the pulse width (makes it easer to just trigger sensory)

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5
Q

electricity definition

A
  1. electricity is flow of e-
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6
Q

amplitude basics (4)

A
  1. amplitude is the # of e-
  2. height of pulse
    factors that affect amplitude:
  3. voltage - increase in voltage increases potential difference btwn point A & B => driving force for current 4. proportional relationship
  4. resistance (ohms)- how well a particular environment conducts the flow (healthy tissue has less resistance than necrotic tissue) 6. inverse relationship
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7
Q

3 types of electrical current

A
  1. direct
  2. alternating
  3. pulsified
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8
Q

direct current (2)

A
  1. flows in long pulse (1s or greater) in 1 direction

2. can be very irritating be careful

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9
Q

alternating current (3)

A
  1. continous flow in 2 directions (switches polarities)
  2. short pulse width (ms)
  3. less irritating
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10
Q

pulsatile current (3)

A
  1. most common
  2. 1 or 2 directions, but not continous monophasic or biphasic (symmetrical or a-symmetrical)
  3. narrowest pulse width (microseconds)
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11
Q

4 setting on e-stim machine

A
  1. intensity
  2. frequency
  3. duration
  4. modulation
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12
Q

pulse intensity

A
  1. height of pulse = amplitude (can change from subsensory -> sensory -> motor)
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13
Q

pulse frequency (4- 1= low vs. high frequency)

A
  1. # pulses/ second
  2. increase frequency = decrease interpulse interval
  3. low frequency = twitching muscle vs. 50pps = tetanic contracion
  4. high for wound healing and electro-osmosis because you need polarity*
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14
Q

pulse duration (3)

A
  1. pulse width
  2. to keep at sensory want low pulse width/ duration
  3. for muscles higher b/c want to have as much intensity as possible
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15
Q

modulation

A
  1. continuous vs ramp
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16
Q

bipolar vs. unipolar

A
  1. bipolar= same size electrodes, used for muscle strengthening
  2. unipolar = one much larger than the other, used for wound healing
17
Q

anodes and cathodes (direct current) (4)

A 
1. anodes are (+) and attract (-)ions = cations
   cathodes are (-) and attract (+) ions = anions
2. they are always the same (monophasic) and can causing burning or be irritating because of HCl or NaOH that builds up under skin (NaOH is worse for you, under (+)
3. this doesn't happen with biphasic current b/c change direction
4. doesn't happen with monophasic b/c current is milliseconds
18
Q

gate theory of pain (4)

A
  1. non-noxious A fibers stimulate SG (substantial gelatinous)
  2. noxious C fibers don’t stimulate SG (=>SG is inhibited by pain)
  3. SG inhibits T cells, which cause pain (this is the “gate)
  4. we want to stimulate SG with non-painful stimulus to inhibit pain = comfortable sensory input
19
Q

conventional TENS (transcutaneous electrical neural stimulation)

A
  1. rationale = gate theory of pain
  2. PI= low intensity for comfortable sensory
    Waveform : asymmetric biphasic
  3. PR = increase frequency as high as possible
  4. PW= narrow (50us) to tap into sensory
  5. modulations= continuous
  6. electrode placement = on or bracket pain, or nerve root
  7. rx time= 20m- 24h
20
Q

low frequency TENS

A
  1. rationale= stimulating brain to release endogenous opiates (endorphins)
  2. PI= strong sensory, localized motor
  3. PR= low frequency
  4. PW= wide as possible (more stim at given intensity)
  5. modulations= burst to minimize fatigue
  6. electrode placement= electrical acupuncture points
  7. rx time= 15=45m
21
Q

rationale for NMES (3)

A
  1. better overall recruitment of muscles
  2. more selective recruitment of muscles - we volitionally recruit type I muscles, this increases recruitment of type II muscles (fast twitch)
  3. synchronous contraction which is more demanding stimulus than our asynchronous normal contractions
22
Q

NMES for muscle strengthening

A
  1. rationale= increase type 2 muscles and increase synchronous contractions
  2. PI= strong motor (75% max contraction)
  3. PR= tetanizing = 50pps
  4. PW= wide
  5. modulation= interrupted 1:3 w/ ramped
  6. electrode placement: motor point/ muscle belly or peripheral nerve trunk
  7. rx time = based on # contractions you want
23
Q

NMES for neuromusclar activation

A
  1. rationale: enhance cortical reorganization (post stroke)
  2. PI= motor (enough to start contraction)
    Waveform: VMS, Russian, symmetric biphasic
  3. PR= tetanizing = 50pps
  4. PW= wide
  5. mod: interrupted 1:3 with ramp
  6. electrode placement= motor point or nerve trunk
  7. rx time= based on # contractions
24
Q

e-stim for external muscle pump

A
  1. rationale: create mechanical forces to move edema
  2. PI= motor
    Waveform: Russian- reciprocal electrodes
  3. PR= tetanizing (50pps) or twitch (below 35pps)
  4. PW= wide
  5. mod: interrupt 1:3 (tet) or 1:1(twitch)
  6. electrode placement= motor point
  7. rx time = 5-10m
25
Q

e-stim for edema (electro-osmosis)

A
  1. rationale= edema is (-) so place (-) electrode on edema to repel it
  2. PI= sub-motor
  3. PR= high 120- need to get polarity
    monophasic pulsatile*
  4. PW= wide
  5. mod= continous
  6. electrode placement = (-) over edema, (+) 4in proximal
  7. rx time = 20m -1h
26
Q

testing nerve damage severity

r/d(4)

A
  1. reaction of degeneration (R/D) test is based on that nerve is more excitable than muscle so you can activate it in micro-mili seconds and not a muscle
  2. short duration current (ac or PC, usually use PC) with unipolar technique- if partial or full response, PNS is intact
  3. no response => DC
  4. DC if response = full RD (muscle intact, nerve gone)
  5. DC if no response = absolute R/D = have more fibrotic tissue than muscle
27
Q

e-stim for wound healing

A
  1. rationale= to mobilize cells to go from phase 1 (inflammatory response) -> phase 2 (proliferation phase)
  2. PI= sub motor
  3. PR = *high to increase polarity
  4. PW= wide
  5. mod= continous
  6. electrode placement = (+) over wound,(-) large dispersive pad
  7. rx time= 1-2hrs- 2x /day

physical modalities (3 decks)

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