PT Flashcards
Change in muscle length and spindle tension
GTO’s
Deep sensory proprioceptors
GTO’s, pacinian, ruffini
change in jt. position and vibration
pacinian
joint end range, possible heat(as deep proprioceptor), skin stretch/pressure(superficial sensory receptor)
ruffini
superficial sensory pressure and touch
meissners & pacinian
superficial sking stretch/pressure
ruffini, merkle
4 stages of healing
hemostasis, inflammatory, proliferation, remodeling
3 stages of healing
inflammation, repair, remodel
AKA: Repair Phase• Angiogenesis - new capillaries• Fibroblasts, chondroblasts, osteoblasts• Extracellular matrix
proliferation phase of healing
AKA: Maturation Phase• Scar contraction– Can lead to joint adhesion and loss of motion• Decrease of blood vessels• Type III collagen replaced by Type I• Collagen aligns along stress lines• Cross-linking continues
remodeling phase
ability of a material to store a charge
capacitence
ohm’s law-
voltage=current x resistance V=IxR
Direct Current (DC)• AKA: Galvanic• Net charge– Positive and negative electrode– Charge builds up in the tissue
monophasic current
Alternating Current (AC)– Flow of electrons changes direction regularly• Changes polarity
biphasic current
Minimum amplitude needed to depolarize a nerve fiber when phase duration is infinite
rheobase
the time (or phase duration) required to depolarize a nerve fiber when the peak current is twice rheobase
chronaxie
Stimulation at high frequency near refractory period of the sensory nerve causes inhibition
Wedenski’s inhibition
high frequency generators(>100,000hz)=
diathermy
med frequency generators(1,000-100,000hz)=
russian stim
Combination of constructive and destructive wave interference resulting in a wave with a beat effect
heterodyne
What electric stim uses heterodyne?
interferential
4 types of interferential?
True Interferential Current, Premod, Vector Scan, Stereodynamic
Same as IF but interference occurs in machine, not body• Pain relief• Good for small treatment areas– use 2 electrodes on either side of the pain• Allows for effective pain control with 2 electrodes
premod
Quadripolar electrode placement• Uses true interferential current• Varies the amplitude between the channels• Cloverleaf pattern rotates• Larger treatment area
vector scan
3 channels• 6 electrodes• 3D Interference pattern = 6-petal flower shape
stereodynamic
Pain reduction– Acute and chronic• Muscle strengthening / re-education– Especially pelvic floor– Secondary consideration– Russian Stim. is better (traditionally)• Increased circulation– Only with suction electrode systems– Due to suction not IFC• Slow bowel transit (not much evidence
indications for IFC
Anterior cervical area• Through the chest• Through the head• Pacemakers and Implantable Cardioverter-Defibrilator(ICD)• Abdomen, pelvis, lumbar areas of pregnant women in their first trimester• Metal implants• Epilepsy• Areas of hemorrhage• Cancer• Confused and unreliable patients• Damaged skin• Unknown etiology
contraindications IFC
- Makes use of duty cycles (on/off cycles) to cause muscle contraction for muscle strengthening
- indications= Muscle re-education – Retard atrophy– Muscle strengthening – Decrease muscle spasm through fatigue
russian stim
• Anterior cervical area• Through the chest• Through the head• Pacemakers and Implantable Cardioverter-Defibrilator(ICD)• Abdomen, pelvis, lumbar areas of pregnant women in their first trimester• Metal implants• Epilepsy• Areas of hemorrhage• Cancer• Confused and unreliable patients• Damaged skin• Unknown etiology
contraindications for russian stim
Primary Indications:– Retrain lost muscle function from inhibition following injury or surgery – Decrease muscle atrophy from periods of immobilization• Secondary Indication:– Decrease muscle spasm
-Goal is to stimulate alpha motor neurons causing a strong muscle contraction
NMES, neuromuscular electric stimulation
Stimulation of nerves through the skin
TENS: Transcutaneous Electrical Nerve Stimulation
types of TENS stimulation
Sensory level stimulation• Conventional TENS mode– Motor level stimulation• Acupuncture-like TENS mode• Burst TENS mode– Noxious level stimulation• Brief-Intense TENS mode– Modulation mode
TENS stim type: Target tissue– Large-diameter A-beta fibers• Submotor stimulation • Comfortable level – tingling sensation• Acute pain • Post surgically• Used in Conventional TENS mode
- Pain relief is through pain gating– Lasts only as long as the stimulation• Often combined with ice or heat– Reduce muscle spasm– Relaxation– Analgesia
Sensory level stim
Causes depolarization of Alpha motor neurons• More vigorous than sensory TENS• Not for acute conditions!– Subacute and chronic• Theorized to release endogenous opiates • Longer pain relief but may be delayed onset (hours)• Used in Acupuncture-like Mode– Target is A-Beta and Alpha motor neurons• Used in Burst Mode– Target is Alpha motor neurons and Delta fibers
motor level stim
Stimulates C-fibers• Elicits pain relief through endogenous opiates• Commonly used with point stimulators– High density of current in small space– Often used on trigger points• Used in Brief-Intense mode
noxious level stim
Electro Galvanic Stimulation, voltage > 150V (up to 500)• Must have twin peak monophasic (DC) current,
-allows deeper penetration – Twin peaks does not allow small sensory fibers (A-delta and C) to be stimulated (increased comfort)• Average current remains low due to short phase duration resulting in a safe current• Duration of both peaks usually is between 100 and 200 microseconds– Phase duration can not be adjusted
high voltage stimulation
Stimulate healing • wound healing, germicidal
highvolt and microcurrent
Decrease edema– Decrease spasm / guarding(Pelvic floor)
highvolt
