S2_L3: Electrical Currents for Muscle Contraction Flashcards
TRUE OR FALSE:
There’s an acute response to injury once a nerve is cut, there’re certain cellular changes that will happen like the retraction of ends of the nerve, swollen cellular body, & the nucleus will go to the periphery. There is also some changes in the interior contents of the neurons/cells
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
The following statements are true of Physiology of Denervation, EXCEPT:
A. Partial Depolarization of the Sacrolemma as early as 3 hrs following nerve transection, RMP of the sacrolemma decreases
B. Atrophy to a greater extent of type II muscle fibers
C. Muscle Degeneration due to Intramuscular Venous Stasis & Superimposed Trauma
D.None of the above
D
Match the following injury to its classification.
- M + Axon (A)
- M + A + Endoneurium (E)
- Myelin sheath (M)
- M + A + E + Perineurium (P)
- M + A + E + P + Epineurium
Seddon-Sunderland
A. Neuropraxia - 1st degree
B. Axonotmesis - 2nd degree
C. Neurotmesis - 3rd degree
D. Neurotmesis - 4th degree
E. Neurotmesis - 5th degree
- B
- C
- A
- D
- E
Match the following degeneration & regeneration to its classification.
* there can be multiple answers
- Conduction block
- Walerian degeneration
- Complete recovery
- incomplete recovery
Seddon-Sunderland
A. Neuropraxia - 1st degree
B. Axonotmesis - 2nd degree
C. Neurotmesis - 3rd degree
D. Neurotmesis - 4th degree
E. Neurotmesis - 5th degree
- A
- B, C, D, E
- A, B
- C, D, E
TRUE OR FALSE
Other changes of denervation include:
▪ Hypersensitivity of Ach
▪ Fibrillations
▪ Membrane Changes
▪ Mechanical Changes
T
modified TRUE OR FALSE:
re-innervation/regeneration is when the peripheral nerve will try to meet again using the sprouting/nodal effect.
We need to stabilize the area since too much movement might affect the growth of the nerve resulting to disconnection of nerve to its point of attachment.
TT
The following statements are true on Controversies for use of ES, EXCEPT:
A. Can cause denervated muscle to contract
B. Help limit edema and venous stasis, therefore delay muscle fibrosis & leads to shortened recovery time
C. May disrupt regenerating neuromuscular junctions that further traumatize the denervated muscles
D. Not worth the financial and time costs
E. None of the above
E
TRUE OR FALSE:
For Total Denervation, rate of nerve growth: 1-2 mm/day
For Partial Denervation, re-innervation is done thru, Collateral Sprouting, Nodal & Terminal growth
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
The following statements are the type of waveform/Current type, EXCEPT:
A. Slowly rising exponentially progressive current (EPC)
B. Saw Tooth Pulse
C. Triangular
D. Trapezoidal Pulse
E. Monophasic PC
F. None of the above
F
Saw Tooth Pulse is commonly used
modified TRUE OR FALSE about Treatment Parameters:
▪ Pulse Frequency =1-500 pps/Hz
▪ Pulse Duration = Greater than or equal to chronaxie, 1-450 msec (less accurate)
TT
TRUE OR FALSE on Determination of Pulse Duration:
▪ Rheobase is the least amount of time needed to elicit visible
muscle contraction for an indefinite duration (5-35volts/ 2-18mA)
▪ Chronaxie minimum intensity required to produce a muscle contraction with an intensity set at twice the rheobase which is determined by plotting the strength-duration curve (0.05 - 0.5ms or <1ms)
FF
Rheobase is the least amount of intensity
Chronaxie minimum time
The following statements are true on treatment parameters of ES, EXCEPT:
A. Current Amplitude is the maximum tolerated contraction
B. Treatment Duration is less than or equal to 20-30 mins for 2-3 x/day; 5-7 days per week
C. For Electrode Configuration, anode over most excitable part of muscle
and, ideally smaller than cathode
D. None of the above
C
cathode over most excitable part of muscle and, ideally smaller than anode
identify the wrong parameter on ES for denervated muscles at motor level:
Pulse duration: ≥ Chronaxie (moreaccurate) 1-400 msec
Amplitude: Visible twitches up to maximum tolerated contraction
Ramp up/down: N/A
Frequency: 1-500 pps/Hz^A,B
Treatment Duration: 10-20 min
On Time : Off Time Ratio - 1:1
Treatment Duration: 20-30 min
TRUE OR FALSE the ff is written in the correct documentation format
ES using < ES machine> on <affected> x <pulse> x <pulse> x <treatment> to</treatment></pulse></pulse></affected>
<rationale>
</rationale>
T, can add position of patient
T/F adverse effects of ES for denervated muscles include burns due to increased current density & skin irritation
T
Match the following
- Demand-type cardiac pacemaker or unstable arrhythmias
- Over carotid sinus / phrenic nerve/ abdomen / pelvis of pregnant woman
- Deep venous thrombosis / PVDs / Areas of active hemorrhage
- Impaired mentation & sensation
- Malignant tumors / cancer /Within 3-5 meters from diathermy
- Cardiac disease
- Skin irritation or open wounds
- With epilepsy or seizure disorders
A. Contraindication
B. Precaution
- A
- A
- A
- B
- A
- B
- B
- B
Match the following terms to its definition
- Due to peripheral nerve injury & usually manifests as denervation atrophy
- Intact peripheral nerves, including the motor unit and neuromuscular junction & usually manifests as disuse atrophy
- Examples are post-operative weakness, orthopedic conditions, CNS affectation, etc.
A. Innervated Muscles
B. Denervated Muscles
- B
- A
- A
modified TRUE OR FALSE:
Neuromuscular Electrical Stimulation
(NMES) is the use of ES to produce muscle contractions in innervated muscles.
Functional Electrical Stimulation (FES),Aka Orthotic Substitution
is a type of NMES that specifically enhances the control of movement and posture
TT
NMES should be integrated to functional activities
modified TRUE OR FALSE:
Overload principle states that inc. current, inc. frequency, inc. pulse duration leads to increase externally-applied resistance
Specificity theory, targets type II muscle fibers which are reduced after surgery, immobilization or any pathology
TT
Match the following terms to its definition
- Due to command from upper motor neurons
- Recruits smaller to larger motor units & activates first type I muscle fibers
- Due to applied electricity stimuli
- Recruits larger to smaller motor units & activates first type II muscle fibers
- Asynchronous recruitment of motor units with slow onset of muscle fatigue
- Synchronous recruitment of motor units with rapid onset of muscle fatigue
A. Volitional
B. Electrically-induced
- A
- A
- B
- B
- A
- B
The following statements are true on therapeutic effects of ES, EXCEPT:
A. Increased muscle size, increased muscle mass usually takes several weeks to occur
B. Improved motor unit recruitment which occurs more rapidly & synchronized recruitment of more motor units
C. Promotes Muscle Re-education & improvement of motor control which stimulates brain plasticity
D. Prevents Disuse Atrophy which provides externally-induced muscle
contraction to prevent muscle wasting & with adequate muscle strength, it serves as a biofeedback to promote muscle contraction
E. None of the above
E
The following statements are true on therapeutic effects of ES, EXCEPT:
A. It reduces Muscle Spasm over both agonist by making the muscles fatigue & induce relaxation
B. It reduces Muscle Spasticity over the antagonist by the reciprocal inhibition of agonist muscle
C. It reduces Muscle Spasticity over both agonist and antagonist by sequential stimulation of agonist then followed by
antagonist which closely mimics normal motor activity or typical behavior of individuals without CNS dysfunction
D. It reduces edema through the muscle pumping effect
E. None of the above
E
TRUE OR FALSE:
Functional Electrical Stimulation (FES) must be used during Gait Training, over tibialis anterior during initial contact while over gastrocsoleus during push-off
For Idiopathic Scoliosis FES are placed over lateral flexors on concave side
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C
For Idiopathic Scoliosis FES are placed over lateral flexors on CONVEX side
TRUE OR FALSE on electrode placement:
Active electrode over the motor point and Dispersive electrode about 2-inch away on the same muscle following the orientation of the muscle fiber.
Face and smaller muscles of the hand should use motor point stimulation using a probe/motor pen
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
*[bipolar if on same muscle; monopolar if on other area]
The following statements are true on FES placement, EXCEPT:
A. Over wrist extensors during Gripping
Activity
B. Over supraspinatus for Shoulder
Subluxation and posterior deltoids
C. Over quadriceps femoris and hamstrings during Cycling for LE
D. Over biceps brachii and triceps brachii during Cycling for UE
E. None of the above
E
Match the following current to its definition
- Uses medium frequency AC with a frequency of 2500 Hz delivered in 50 bursts per second
- Alternating medium-frequency currents, which are slightly out of phase and amplitude-modulated at low frequency
- Commonly uses square, balanced, symmetrical, biphasic PC; some use asymmetrical biphasic PC
A. Biphasic Pulsed Current
B. Russian Current
C. Interferential Current
- B
- C
- A
Match the following terms to its parameters (can have multiple answers)
- Overload principle & Selected recruitment
- inc. contraction time & rest intervals
- Pulse duration:
150-200 μsec (smaller muscles)
200-350 μsec (larger muscles)[Cameron] 200-600 μsec [Michlovitz]
100-600μsec [Belanger]
Amplitude:
4. ≥50% Maximum Voluntary Isometric Contraction (MVIC); maximum tolerated muscle contraction
- 25-50% MVIC
- Ramp up / down:
At least 2s [Cameron]
1-5s (up), 1-2s (down) [Michlovitz]
0.5-2s [Belanger]
A. strengthening
B. muscle endurance
- A
- B
- A,B
- A
- B
- A,B
Match the following terms to its parameters (can have multiple answers)
- Frequency:
20 pps (smaller mms), 30 pps (larger mms), 35-50 pps (smooth tetanic), 50-80 pps (greater strengthening) [Cameron]
20-100pps [Michlovitz]
30-60 pps [Belanger] - 30-50 pps
Treatment Duration:
3. More repetitions
- 10-20min (10-20 reps) [Cameron]
At least 10 contractions or up to 1 hr/day [Michlovitz]
On Time : Off Time Ratio
- 1:5 initially → 1:3 → 1:1
10-sec on:50-sec off - 1:1
A. strengthening
B. muscle endurance
- A
- B
- B
- A
- A
- B
Match the following level of spasticity to its parameters (can have multiple answers)
- Pulse duration
150-200 μsec (smaller muscles) [Cameron]
200-350 μsec (larger muscles) [Cameron]
250-500 μsec [Michlovitz] - 20-100 μsec
Amplitude
3. Below motor threshold
4. At motor threshold; to
visible contraction
- Ramp up/down: 0.5-3 sec [Cameron]
- Frequency
35-50 pps [Cameron]
20-60 pps [Michlovitz] - 80-100 pps
- Treatment Duration 10-60 min
- On Time : Off Time Ratio - 1:1, 3:4
A. motor level
B. sensory level
- A
- B
- B
- A
- A
- A
- B
- A,B
- A
modified TRUE OR FALSE:
Bipolar is the motor point between the 2 electrodes while quadripolar is using 4 electrodes over targeted muscle.
Wider spacing will result in deeper stimulation.
TT
identify the wrong parameter on motor level of muscle spasm:
Pulse duration:
150-200 μsec (smaller muscles [Cameron]
200-350 μsec (larger muscles)[Cameron]
100-600 μsec [Michlovitz]
Amplitude: At motor threshold; to visible contraction
Ramp up/down:
At least 1 sec [Cameron]
1-5 sec [Michlovitz]
Frequency: 35-50 pps
[Cameron] ,[Michlovitz]
Treatment Duration 30 min
On Time : Off Time Ratio 1:1
(2-5 sec on; 2-5 sec off)
Treatment Duration 10-30 min
- Treatment Duration of 30 mins is for motor level edema reduction (muscle pump)
The following statements are true about motor level edema reduction (muscle pump) , EXCEPT:
A. Pulse duration:
150-200 μsec (smaller muscles [Cameron]
200-350 μsec (larger muscles)[Cameron]
100-600 μsec [Michlovitz]
B. Amplitude: At motor threshold; to visible contraction
C. Ramp up/down:
At least 1 sec [Cameron]
1-5 sec [Michlovitz]
D. Frequency: 35-50 pps
[Cameron] ,[Michlovitz]
E. Treatment Duration 10-30 min
F. On Time : Off Time Ratio 1:1
(2-5 sec on; 2-5 sec off)
E, Treatment Duration 30 min
- Treatment Duration 10-30 min is for motor level of muscle spasm
TRUE OR FALSE:
- Formula of Duty Cycle = [ON / (ON + OFF)] x 100
- Example:
▪ Ratio = 1:3
▪ On time = 1 sec
▪ Off time = 3 sec
▪ Duty cycle = [1 / (1 + 3)] x 100
= 25%
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
TRUE OR FALSE on stimulation modes:
In Synchronous (co-contraction), channels 1 & 2 produces ON and OFF times together.
In Reciprocal, while channel 1 is ON, channel 2 is OFF.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
T/F the ff are in proper documentation format.
NMES/FES using <machine> on <affected> x <pulse> x <pulse> x <duty cycle or On & Off time> x <treatment> to</treatment></pulse></pulse></affected></machine>
<rationale>
</rationale>
T
Match the following terms to its definition
- Muscle contraction solely relies on electricity
- Electricity only serves as feedback for
contraction - Contraction produced by both the electrical stimulator and the patient
A. NMES
B. NMES plus volition
C. NMES as biofeedback for motion
- A
- C
- B
