Test 1 Flashcards
Current is measured in?
Amperes
Materials that impede free electron movement?
Air, wood, glass, rubber, etc.
Definition of Volt?
The difference in electron electrical potential between the two poles.
Disease’s that impede healing?
Diabetes, HIV, arthritis, endocrine disease, connective tissue disease, carcinoma, renal disease, hepatic disease, cardiovascular disease, and autoimmune disease.
Cryotherapy in adj. w/ Modalities help by?
Controls, swelling, reduces secondary hypoxic injury, and creates analgesia for pain control
What part of the healing phase should you start exercising the patient?
Proliferation Phase
Modalities to use during the remodeling phase?
Deep heat agent, electrical stimulation, and exercise.
Electricity displays
Magnetic, chemical, mechanical, and thermal effects
3 types of current
Monophasic, Biphasic, Polyphasic
Which electrical pole stimulates the skin better?
Negative pole
Resistance is measured in?
Ohms
Ohms Law is?
Voltage = Current * Resistance
Bigger curve =
Greater electricity
Amplitude definition
Highest point of each pulse phase and is referred to as voltage and current intensity measured in milliamps (mA)
Duration definition
The time of the pulse from beginning to end of all phases measured in microseconds
Frequency definition
number of pulses in one second
Pulse definition
An individual waveform with one or two phases
Pulse period definition
Sum of the pulse duration and the interpulse interval
Phase definition
Portion of the pulse which rises above or below the isoelectric line
Burst definition
An interrupted train of pulses
Burst or Low frequency waves are produced by?
High or medium frequency stimulators
What is the range of pps that humans can feel?
1-200 pps
Duty Cycle definition?
Sum of “on-time” or stimulation pulse delivery and the “off-time” or duration of recovery.
What is Modulation? and what does it include?
Alterations or variations in pulse amplitude or duration and includes continuous , interrupted burst and ramped.
Interrupted Modulation is commonly used for?
Muscle re-education, muscle strengthening, and range of motion techniques.
A pulsed current in a packet of 3 or more pulses are delivered and then shut off briefly are what type of electrical stimulation?
Russian
What size ramp is better for e-stim?
small ramp = better ramp (most are at 2)
The best conductors in the body?
nerve, muscle, blood
Series circuit works by?
allowing the electrical current to flow and at any point be the same at any point on the path. The resistance of current flow is the sum of all resistors in the circuit.
In a series circuit how is the energy dissipated?
The electrical energy used to direct current through the resistors is dissipated as heat and the voltage decreases as it passes through each resistor.
What is the physiological response to e-stim?
The cells should respond to the electrical energy in a manner similar to how the cell functions or grows.
The biological tissue response depends on?
length of the pulse, rate of rise and decay, length of time between pulses, modulation of pulses, and amplitude of the pulse.
What 4 things can e-stim accomplish in rehab?
1) Facilitate muscular contractions through nerve or muscle excitation. 2) Pain control through sensory nerve stimulation. 3) Tissue healing by creating an electrical field. 4)Use of electrical field on skin surface to drive ions, beneficial for healing, through the skin.
What are the 4 classifications of changes due to e-stim?
1) cellular level, 2) Tissue level, 3) Segmental level, and 4) systematic level.
What happens at the cellular level of change?
Excitation of nerves, changes in cell membrane permeability, protein synthesis, stimulation of fibroblast & osteoblast, and modification of microcirculation
What happens at the tissue level of change?
Skeletal muscle contraction, smooth muscle contraction and tissue regeneration.
What happens at the segmental level of change?
Modification of joint mobility, pumping to alter circulation and lymph flow, alteration of the micro-vascular system, and increased movement of charged proteins in the lymph system.
What happens at the systematic level of change?
Analgesic effect as endogenous pain suppressor are released, and analgesic effect from the stimulation’s of neurotransmitters to control pain stimuli (enkephlans)
What is resting potential?
The potential difference between the inside and outside of the cell which the cell maintains as its homeostatic environment.
Definition of Action Potential?
a recorded change in electrical potential between the inside and outside of a nerve cell resulting in muscular contraction.
Which electrode is deemed the dispersive electrode?
Anode electrode
Which electrode is the active electrode?
Cathode (negative)
What is the absolute refractory period?
The time after cell excitation and depolarization which nerve is unable to transmit a second impulse
What is tetany?
It is when intensity is great enough to have all muscle fibers contract synchronously
Explain the strength-duration curve?
Stimuli of short duration require greater current amplitude to reach nerve and muscle cell threshold. (Have a non-linear relationship)
What is Rheobase?
It is the minimum amount of intensity of the current needed for tissue excitation when given for maximum duration
What is Chronaxie?
It is the duration necessary for a current twice the intensity of rheobase to cause tissue excitation (use so we can get treatments to stimulate faster and higher intensity)
Do greater intensities beyond threshold improve excitation?
False, it will not improve it.
T or F: Stim can help provide a better environment for mitochondria to produce to make ATP.
True
Compression causes what type of potential?
Negative
Distraction causes what type of potential?
Positive
The bio-electrical field of the CNS is?
positive
The bio-electrical field of the PNS is?
negative
T or F: Epidermis is negative compared to a more positive dermis
True
T or F: Having a larger anode electrode will have a higher density in the anode.
False: Having a larger cathode will allow for higher density in the anode electrode
T or F: Small amplitude DC currents are intrinsic to the ways the body works to grow and repair.
True
When the electrodes are different sizes, which electrode will have the greater current intensity?
The smaller, active, electrode
T or F: A large, dispersive, electrode disperses the current over a larger area decreasing the current density
True (combo)
T or F: When trying to accomplish muscle contraction the active electrode should be positive
False: should be negative
What level of frequency should you use to gain a stronger contraction? pumping effect?
Higher frequency for a stronger contraction
Lower frequency for a pumping effect
Do low voltage simulators usually have a preset pulse duration?
No, they usually have an adjustable duration. Whereas High Volt stimulators have a preset pulse.
Monophasic (DC, Galvanic) Currents are said to enhance?
Enhance the movement of charged proteins into the lymph channels
What are the parameters for e-stim on edema?
Current: LV monophasic Intensity: High but w/o muscle contraction Frequency: 120 pps Pulse Duration: As short as possible Tx Time: 30 min - continuous Negative electrode must be distal
Does e-stim do anything when there is already swelling?
No, when edema is present, it cannot be effectively treated with e-stim.
During the Gate system which fibers are evoked?
Peripheral large-diameter A beta sensory fibers
What do A-beta sensory fibers activate in the gate system?
They activate inhibitory interneurons in the substantia gelatinosa of the dorsal horn.
When a-beta sensory fibers are inhibiting interneurons, what cells does it effect?
The effect occurs on the T-cells to close to the gate and nociceptive input is able to send signals to the brain.
What should the intensity feel like to open the gate system?
The intensity should produce tingling w/o a muscular contraction
What are stronger pain relievers than endorphin’s?
Dekephalines
How does the Opiate system work?
When the negative feedback loop is activated through the T-cells and the descending endogenous opiate system.
Parameters for the Opiate System?
Current: HVP currents best but LVP works also to stimulate A-delta and C fibers.
Intensity: High, somewhat uncomfortable, muscle contraction
Frequency: Low
Pulse duration: High
going to need current and lots of it
What is the current for central biasing?
Low frequency, high intensity is best
What should the intensity be for central biasing?
High; muscle contraction is not desired and small areas for point stimulators
What should frequency and pulse duration be for central biasing>
Frequency: Low
Pulse duration: Moderate
3 methods the TENS unit can be used for
Sensory, Motor, and Brief Intense
What can the sensory method on a TENS unit be used for?
acute (sub-acute) pain relief
What are the parameters of sensory method on a TENS unit?
Placement: on painful area Intensity: Pleasant tingling Frequency: 80-200 pps Pulse duration: 80-100 microsec. Rate: N Tx Time: 30 mins - 2 hours
What fibers does the TENS unit activate in sensory method?
A-beta fibers gate system
What is the motor method on a TENS unit used for?
Chronic pain- trying to fatigue the muscle
What are the parameters of the motor input on a TENS Unit?
Placement: Over trigger points Intensity: To tolerance, slight muscle twitch Frequency: 1-5 pps Pulse duration: 150-250 microsecs. Rate: B Tx Time: 15-30 mins
What fibers does the TENS unit activate during the motor input?
A-delta and C fibers, activating the central biasing and Opiate systems (last 6+ hours)
What is the brief intense input used for on a TENS unit?
Pain prior to exercise
What are the parameters for the brief intense input for a TENS unit?
Placement: Over motor points/trigger points Intensity: Intense; want muscle tetany Frequency: Variable Pulse Duration: >250 microsecs Rate: M Tx Time: 10-20 mins
What fibers does the brief intense input on a TENS unit activate?
A-beta, A-delta, and C-fibers (lasts <30 mins)
Contraindications for the TENS unit?
1) over lower abdominal & pelvic area during pregnancy
2) Over anterior transcervical area and 3) over heart transthoracic area
Precautions for the TENS unit?
Pacemaker, electronic implants or mental confusion
What is interferential current?
It is two medium frequencies (3000-5000 Hz) sinusoidal currents in which are generated by independent oscillatory circuits
If two currents interfere with each other but are in phase with one another are said to be__________ and ________?
Summative and constructively interfering
If two currents have phases opposing one another the waves will cancel each other out and are considered _________________________?
Destructively interfering
What can IFC be used for?
Acute pain control, chronic pain control, muscle spasm, bone healing, and edema control
Parameters for acute pain control in using IFC?
Rate: 80-150 pps
Intensity: Pleasant tingling
Carrier frequency: 4000-5000 Hz
Placement: Criss-cross painful area 10-30 mins
Parameters for chronic pain using IFC?
Rate: 1-10 pps
Intensity: Pleasant/ moderate tingling
Carrier Frequency: 2500 Hz
Placement: Criss-cross painful area 10-30 mins
Parameters for muscle spasm using IFC?
Rate: 4 pps
Intensity: Visible muscle contraction
Carrier frequency: 2500 Hz
Placement: Criss-cross trigger points 10-30 mins
Parameters for edema control using IFC?
Rate: 50 pps
Intensity: To tolerance/strong contraction
Carrier Frequency: 4000-5000 Hz
Placement: Criss-cross swelling 10- 30 mins
What is stereodynamic interferential method?
A 3rd sinusoidal current is added and a star-shaped 3-D electrical field is developed w/ 6 different electrodes
IFC and Pre-Mod contraindications?
Arterial and Venous Thrombus, Malignancy and Hemorrhagic area.
Low Intensity Stimulators are also called what?
Microcrurrent electrical neuromuscular stimulators
What is the pad placement for the Low intensity stimulators?
Active negative over wound or fx, and 2nd disperssive is place farther away depending on the depth of the desired tissue penetration
What is iontophoresis?
It is the transporting of ions through tissues by using a continuous monophasic current.
What is a therapeutic window?
The plasma concentrations of a drug which falls between a inimum concentration to be effective and a maximum concentration which adverse reactions occur above
What is dexamethasone?
an animal-based anti-inflammatory medicine
What is the primary mode of ion transport in the skin?
Sweat glands
What is the Tx penetration of Ionto?
1-3mm
T or F: In Ionto Tx, the electrode with the medication is considered the active electrode
True
T or F: In Ionto, the second electroe is referred to as the dispersive or return electrode?
True
T or F: To help avoid burns during Ionto Tx, you want to try and keep the cathode (-) smaller than the anode (+)
False, you want the cathode (-) to be larger than the anode (+)
Is A.C. or D.C. current better tolerated during Ionto?
A.C. shows better promise. D.C. has more alkaline and acidic reactions
Ionto indications?
Inflammation, analgesia, muscle spasm, ischemia, edema, calcium deposits, and scar tissue
Contraindications of Ionto?
Skin lesions, sensitivity or allergy to drug, Impaired sensation
Precautions of Ionto?
Diabetes mellitus and softening of the skin
What population could benefit from biofeedback?
Anyone who has suffered a neuromuscular injury
What is Electromyography (EMG)?
It is the recording of electrical activity generated in the muscle for diagnostic purposes. (uses needles)
What do Biofeedback units measure?
Peripheral skin temp., finger phototransmission, skin conductance activity, and electromyographic activity
T or F: During Biofeedback, only difference between the active electrodes will be monitored, common mode rejection ratio (CMRR) since the middle electrode is the reference electrode to absorb the “noise”
True
While using Biofeedback, what are some considerations regarding the electrodes?
prepare skin by removing lotions and oils, place electrodes parallel to muscle fibers, keep on specific muscle so it doesn’t pick up “noise” from other muscles.
T or F: Biofeedback has to be isometric
False, it does not have to be
Contraindications of Biofeedback
Any reason the pt should not contract a muscle, i.e. DVT, acute injury, muscle tear, joint instability, pain from unknown source, and Fx.
Precautions of Biofeedback
Stress Fx, hypertension, anxiety disorder, mental confusion
Radiating pain is similar to referred pain except it ?
Travels along a nerve
What does cutaneous pain feel like?
It is sharp, bright and burning with fast and slow onset
Where does deep somatic pain originate?
Originates in tendons, muscles, joints, peritoneum and blood vessels
Where does visceral pain begin?
It begins in organs and is diffused at first and may become localized
Where is psychogenic pain felt?
It is felt by the individual but it is more emotional rather than physical
What are some potential causes of chronic pain?
Changes in sympathetic nervous system, changes in adrenal activity, reduced production of endogenous opioids and sensitization of primary afferent and spinal cord neurons
The structures most sensitive to damaging (noxious) stimuli are?
Periosteum, joint capsule, subchondral bone, tendon, ligments, muscle, cortical bone and synovium, articular cartilage
