Types of Stim Flashcards
Conventional TENS use
temporary pain relief while stimulator is running
AKA high frequency TENS
Uses gate theory to control pain short term
Conventional TENS parameters
Wave: symmetric biphasic
Frequency: 50-100 Hz
Duration: 50-100 (<200 usec) to stimulate sensory but not motor
Intensity: pt comfort, tingling sensation
Continuous current
Used 10-20 min at a time
Strong Low rate TENS uses
slightly longer term pain relief after stimulator is removed, a few hours post
AKA low frequency TENS
Uses endogenous opioid release
Strong Low rate TENS parameters
Wave: symmetric biphasic
Frequency: 2-4 Hz, to get twitch and not held contraction
Duration: 150 usec +, get motor response at lower intensity
Intensity: generates muscle contraction, less comfortable for patient, around 40 mA
Used 10-15 min
Brief-Intense TENS uses
used during painful therapeutic procedures
Type of high frequency TENS
Brief-Intense TENS parameters
Wave: symmetric biphasic
Frequency: 60-150 Hz
Duration: 50-250 usec
Intensity: about 40 mA, may get fasciculations and should create paresthesia
Pulse burst TENS use
pain relief along with muscle contractions, more comfortable way to get the muscle contraction vs strong low rate
Type of high frequency TENS
Pulse burst TENS parameters
Wave: symmetric biphasic, bursts
Frequency: 60-100 Hz
Burst frequency: .5-4 pps (low)
Duration: 50-200
Intensity: low or high
high for tetanic m contraction and paresthesia - for chronic, deep pain
Low for pulsating paresthesia - for acute superficial pain
Modulated TENS uses
TENS will automatically change output characteristics (duration, amplitude, or frequency) by given percentage from initial level
Conventional TENS with modulation setting
Noxious TENS uses
hyperstimulation like electro acupuncture
Uses endogenous opioid theory
Noxious TENS parameters
Wave: direct or monophasic pulsed current
High current density though probe stimulator (1-3 mm)
Frequency: 1-4 Hz
Duration: 500 ms
FES NMES uses
functional e stim, used as a dynamic bracing/orthotic support for a hemi, scoliosis, shoulder subluxation, AFO
Decrease frequency and duration if using on smaller muscles like deltoid and supraspinatus
FES NMES parameters
Frequency: 20-30 Hz?
Duration: 30 usec
Intensity: get m contraction
Ramp: slow, 2-3 seconds to avoid triggering spasticity
on/off: 10-15 sec on
Duty cycle: 1:3, longer rest periods to reduce fatigue
ROM NMES uses
placed on reciprocal muscle groups to range a joint
Complete 200 reps of ROM daily to gain new range, 50-100 to maintain
1-4x day for 3 wks-6 mo
ROM NMES paramters
Wave: symmetric biphasic pulsatile current
Frequency:
Duration: 200-300 usec
Intensity: enough to generate full ROM (3+) in joint
Ramp: 1-2 sec
Duty cycle: 1:1 (% time it is active, rest and active times are equal)
Spasticity NMES uses
reduce acute spasm or UMN lesion spasticity, used as a contract relax/hold relax PNF
Use on antagonist, agonist, or both in alternating form
Spasticty NMES paramters
Wave: biphasic pulsatile current
Frequency: 20-30 Hz
Duration: 250-300 usec
Intensity: induce at least grade 1 muscle twitch
Duty cycle: 1:1, 2:1
Ramp: 2-10 seconds for on/off
Edema reduction NMES uses
reduce edema in joint in combination with elevation, especially useful when pt does not have active control of the joint to range it such as a hemiparesis
edema reduction NMES parameters
Acute: 2-3 days post
Wave: monophasic pulsed HVPC
Frequency: 100-125 Hz
Duration 2-100 usec
Intensity: just below motor activation
20-45 min
Chronic
Wave: biphasic or burst
Frequency: 20-80 Hz
Duration: 100-600 usec
Intensity: tetanic contraction
Duty cycle: 1:1, 3 sec on 3 sec off for 10-20 rhythmic contractions
strengthening NMES parameters
aka russian
Wave: biphasic
Frequency: 30 pps or 50 bursts per sec
Duration: 100-500, often 300 usec
Intensity: contraction at 60-70 MVIC
Ramp: 1-5 sec up and down
Duty cycle: 1:3 to 1:5, more rest than active
motor re-ed NMES parameters from google
frequency between 20-50 Hz, pulse width of 200-400 microseconds, a ramp time of a few seconds, and an on:off time ratio of 1:3 or similar
