Test 1 Flashcards
Electro physical agents
Electrophysical and biophysical energies for the purpose of treatment and prevention of impairments, activity limitations and participation restrictions
Examples of mechanical energy
Massage
Traction
Continuous passive motion
Top reasons people go to chiropractors
Low back/pelvis
Neck
ADLs
Overuse/repetitive injuries
What are the 4 stages of healing
He most asks
Inflammatory
Proliferation
Remodeling/maturation
3 stages of healing
Inflammation
Repair
Remodel
Inflammatory phase
Aka Acute phase
Immediate to a few days after
Defending against foreign intruders and remove damaged tissue
How is the inflammation stages characterized
Vasodilation
Increased capillary permeability
Phagocytosis by neutrophils and macrophages
What inflamamatory chemicals cause pain
Bradyokinin, prostaglandins, and serotonin
Secondary enzymatic injury
Lysosomal enzymes released
Non-specific
Healthy tissue damaged
Secondary hypoxic injury
Hemorrhage, clotting, edema, spasms, hematoma
Deceased o2 and nutrition
Damage surrounding uninsured tissue
PRICE and what’s its goal
Protect Rest Ice Compress Elevate
Preserve ROM
Proliferative phase
Aka repair phase
Angiogenesis
Fibroblasts, chondroblasts and osteoblasts
Goals in the proliferation/repair phase
Decrease swelling, pain
Increased pain free ROM
Provide protective support
Encourage proliferation
Remodeling phase
Aka maturation phase
Scar contraction and loss of ROM
Decrease BV
Type III collagen replaced by Type I
Goals in remodeling phase
Regain full strength
Normal biomechanics
Protect and strengthen
Tension on CT causes
Increased collagen diameter, # fibrils, # cross-linking and density
Organized in parallel fashion
Care done during remodeling/maturation phase
Stretching
Strengthening
Proprioceptive training
Task specific skills
What are some things electrical stimulation can do
Decrease pain Decrease spasm Reduce edema Simulate contraction Healing
What does electricity require
Source of electrons
Driving force (imbalance)
Path (conductor)
Voltage is like a what?
Waterfall
As height increases potential energy increases
What are the two types of currents
Monophonic and biphasic
Monophonic current
One direction
Aka DC current/Galvanic current
Aka galvanic current
Monophonic current
Biphasic current
Flow of electrons changes directions regularly
Aka AC current
What shape is Monophysite current wave
Square
What shape is biphasic current
Sinusoidal, square, rectangular, triangular
Phase duration
Time it takes current to leave isoelectric line to when it returns
Phase duration for monophasic current
Phase duration and pulse are the same
Phase duration for biphasic (AC)
Two phase durations for each pulse
What do tissues respond to? Phase or pulse?
Phase duration
What are A-B fibers?
Light touch sensation
“Tingly” feeling
Close to skin and has lower threshold so stimulated first
Does tissue pay more attention to average current or to peak current?
Average
Strength duration curve
Relationship between amplitude and duration
Why is the strength-duration curve important?
Charge must overcome the capacitance of a nerve fiber to depolarize just like if amplitude is too low, no depolarization will occur no matter the duration
Pt reports tingling but no muscle twitch
Alpha-beta fibers are exceeded
Patient reports muscle contraction
Alpha motor neurons exceeded
Burning, meddling sensation
Exceeded alpha-delta fiber capacitance
Rheobase
Minimum amplitude needed to depolarize a nerve fiber when phase duration is infinite
Corona is
Time or phase duration required to depolarize a nerve fiber when the peak current is twice rheobase
Aka twice the amplitude needed to depolarize a nerve fiber
What is the rate limiting factor of the number of impulses that can be generated by a nerve
Absolute refractory period
Summation
Force from two twitches with no relaxation after 1st twitch
What frequency do you get fused tetanus
50pps
What frequency do you target slow twitch fibers
35pps
Frequency that there is no pain in nerves and stops depolarizing
> 1000pps
What frequency does IF generate
4000-5000hz
What frequency does Russian current generate
2500hz
Unequal size electrodes will concentrate current in which electrode>
The smaller electrode
Gives an “intenser” feeling
When pads are placed close together current is most concentrated where?
Superficial tissues
When pads are placed further away from each other where is current concentrated?
Deeper tissues
Types of interferential current
True interferential
Premodulated
Vector scan
Sterodynamic
How many electrodes for IF?
4 electrodes
Heterdyne
Combo of constructive and destructive that leads to a wave with a “beat” effect
Determine frequency of heterodyne?
Difference between the two waves
Compare and contrast IF vs premod as far as interference
Interference occurs in machine in pre-mod
What is pre-mod good for?
Pain relief of small area
Ex: one muscle/group
Indications for IFC
Pain reduction
Muscle strengthening/re-education (pelvic floor)
Slow bowel transit*
Frequency/beat for IFC for acute
80-150
Beat frequency for chronic for IFC
1-15
Amplitude for IFC
“Patient comfort”
What fibers are targeted in acute pain with IFC
AB fibers
80-150hz
No muscle contraction
What fibers are targeted in chronic IFC
A-delta fibers
1-15hz
Some muscle twitch
Frequency for sub-acute IFC
1-150hz
Time for IFC
15-20 min
What fibers are targeting in sub-acute pain for IFC
Ab and alpha-delta fibers
How does Russian current work?
Makes use of duty cycles to cause muscle contraction for muscle strengthening
Indications for Russian stimulation
Muscle re-education
Retard atrophy
Muscle strengthening
Decrease spams via fatigue
Burst frequency for Russian current
50hz—temporal summation
Means wave is interrupted 50 times per second
Burst frequency for muscle strengthening
10sec on/50 sec off
Burst frequency for muscle fatigue
10:10
16.7% duty cycle for what>
Russian current for
Reduce atrophy
Re-educate muscle
Muscle strengthening
Ramp time for Russian current
0.5-2 seconds
Electrode placement for Russian current
Along fibers of same muscle/group
Describe co-contract in regards to Russian current use
2 channels, 4 electrodes
For muscles that contract together ex: paraspinals
Describe reciprocal contraction in regards to Russian current
2 channels, 4 elcectrodes
Agonist/antagonist muscles
1 channel on one muscle group, another on the other
What is the duration of Russian current for strengthening muscle
10 minutes
What is the duration for Russian current for fatiguing muscle
20 minutes
What is the intensity for Russian or biphasic pulsed current?
Patient TOLERANCE
NMES goal
Stimulate alpha motor neurons causing strong contraction to retrain lost muscle function, decrease atrophy, or decrease spasm
Physiological vs electrical muscle fiber contractions
Physiological: slow twitch are contracted first with asynchronous firing to produce a continuous contraction. Slow to fatigue
Electrical: large diameter fast twitch fibers recruited first because of their lower capacitance. Recruited synchronously. Fast to fatigue
What currents are used for NMES
Russian current and biphasic pulsed current and interferential (pelvic floor muscles only)
What is the waveform with Russian current
Sine wave
What is the waveform with biphasic pulsed current
Square wave
What does TENS stand for
Transcutaneous electrical nerve stimulation
What is TENS
Stimulation of nerves through the skin
What is TENS used for
Modification of neurological aspects of pain
Sensory level TENS
Targets AB fibers (acute)
Tingling
Pain
Duty cycle for TENS sensory
None
Motor level TENS
Depolarization of alpha-motor neurons
For subacute and CHRONIC
No duty cycle
Noxious level TENS
Stimulates C-fibers
Elicits pain relief through endogenous opiates
Often used on trigger points in brief-intense mode
Phase duration: 10-20ms
Thx time: 30 seconds per point to maximum tolerable
8-10 points per session
Indication for ESTHR (electrical stimulation for tissue healing and repair)
Stimulate healing
Indications for hi volt
Stimulate healing
Reduce edema
Decrease spasm/guarding
Galvanotaxis effect
Induce cell migration
What cells are attracted in the galvantotaxis effect/cell migration
Fibroblasts Epidermal cells Keratinocytes Macrophages Neutrophils
What polarity do you want during proliferative phase/repair phase?
Negative (cathode)
What cells does a negative/cathode attract?
Fibroblasts
Epidermal cells
Keratinocytes
What polarity do you want during acute/inflammatory phase?
Positive (anode)
What cells are attracted to a positive polarity (anode)
Neutrophils
Macrophages
What can you use for edema reduction?
HiVolt
What is the polarity in HiVolt for edema reduction
Negative
How do you set up electrodes for edema reduction on HiVolt
2electrodes
Around edema with dispersal pad proximal
What is the preferred treatment for muscle spasm reduction
Russian current
What is preferred for pain reduction
Interferential
What is the frequency for HiVolt
1-200hz
Does the dispersive pad attract cells?
No
Mono polar electrodes in HiVolt
Active pad and dispersal pad
Bipolar electrode placement for Hivolt/Microcurrent
2 electrodes that each attract cells
What is a unique contraindication for HiVolt/ESTHR
Osteomyelitis
In monophasic current for ESTHR, does positive polarity attract acids or bases?
Acids
Cl-/HCl
Negative polarity attracts acids/bases?
Bases (Na+/NaOH)
Low volt current polar and vasomotor responses
Acids attracted to positive pole
Bases attracted to negative pole
Iontophoresis
Local transfer of ionized substances such as drugs across the skin
Relationship of charge of active electrode and dissolved substance for iontophpresis
Polarity of active electrode should be the same as that of the dissolved substance
Dosage in iontophoresis
Amplitude x treatment time
Phase
Current flow in one direction
Pulse duration
Equal to phase duration for DC current and 2x phase duration for AC current
Burst
Series of successive pulses of cycles over a period of time
Burst duration
Time between beginning of 1st and end of last cycle or pulse
Beat
The resulting current waveform when 2 or more sinusoidal waves intersect with each other
Train
Continuous series of pulses, cycles, or bursts or beats over time
Modulation
Changes in amplitude, pulse duration, pulse frequency or a combination of these for prevent nerve accommodation to stimulation
