Week 3 E Stim Lecture Pt 2 (Clinical Application) Flashcards by Alexander Lee

Cellular effects of electrical current

Excitation of nerve cells

Change in membrane permiability

Protein Synthesis

Stimulation of fibroblasts and osteobalsts

modification of microcirculation

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Tissue level effects of Electrical current:

Muscle fiber (skeletal and smooth) contraction

Tissue regeneration

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Segmental effects of E-Stim

Modification of joint mobility

muscle pumping action (lymphatics)

Alteration of microvascular system

increase in movement of charged proteins into lymphatic channels

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Systemic effects of E- Stim

Analgesic effects

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What kind of E-Stim is our first choice for pain?

IFC

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What are the 4 clinical stimulation levels?

Subsensory

Sensory- tingling/prickling feeling

Motor- Strong paresthesias, muscle contraction

Noxious- Strong uncomfortable paresthesias, strong muscle contraction, burning sensation

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What is a “motor point”

Point located above the skin where you can place the electrode to get the most muscle twitch with the least current

AKA area with least resistance

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What are uses of High Voltage Currents (HVPC)

Muscle contraction

reducing Edema

Wound healing

Pain control (but IFC and TENs are preferred over this)

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What do the waves look like for HVPC?

Twin peak monophasic pulsed wave forms

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How do you apply HVPC?

2 unequal sized electrodes

Active electrode: smaller one placed over treatment site

Dispersive electrode : Large electrode placed somewhere away from treatment site

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Negative polarity HVPC is most effective in what phase of healing?

Inflammatory phase

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Positive polarity HVPC is most effective in what phase of healing?

Proliferation phase

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When using HVPC for edema, what settings should you use?

Frequency: 120pps

Intensity: 30-50V (10% less than what’s needed to produce a muscle contraction)

Duration: 30 minutes

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What kind of E-Stim uses gate control theory/descending control theory?

TENS (Transcutaneous Electrical Nerve Stimulation)

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Where can you put the electrodes for a TENs unit?

Almost anywhere that there is pain

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Conventional TENS vs

Acupuncture-like TENS

Conventional: High rate, low intensity (best for acute pain)
Uses gate control theory

Acupuncture - Low rate, high intensity (best for chronic pain)
Uses descending control theory

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What are the 4 types of TENS

Conventional

Acupuncture

Noxious Level

Brief Intense

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What kind of TENS is best for wound debridement?

Brief Intense (high rate and high intensity)

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What should the settings be for conventional TENS?

Frequency 80-125 (100)

Duration 75-150 (100)

Intensity: Tolerable SENSORY stimulation (no muscle contraction)

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How long can you use conventional TENS?

30 mins to a couple hours

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What is gate control theory?

Increasing activity of A-Beta fibers triggers release of enkephalin from interneurons whcih inhibit second order neurons of pain

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What are the settings for acupuncture-like TENS

Frequency : LOW 1-20 pps

Duration : 100-600 (Remember we set it to 250 which is the max the machine in lab can do)

Intensity: Enough to ilicit sensory and muscle contraction

How long should you use acupuncture-like tens?

15 mins

How does descending pain control theory work?

Opiate receptors in central or peripheral terminals of nociceptive afferent fibers

“basically pain is tricked into not crossing into spinal cord” - Dr G

What are the settings of Noxious level TENS?

LOW frequency 1-5 Duration 100-1000 Intensity: set to noxious level w/ possible muscle contraction FOR trigger points/acupuncture points

What kind of TENS uses endogenous opiate pain control theory

Noxious level TENS

Settings for brief intense TENS?

frequency 100pps Duration 100-600 intensity: Muscle fasciculation to sustained muscle contraction

What are 2 uses of russian current?

Muscle Strengthening Muscle re-education

Should russian E-Stim be a substitute for therapeutic exercise?

What is the normal frequency of Modern Russian Current?

2000-10000 hz (waves look like solid blocks of smaller waves)

What are the advantages of russian current? Why is the frequency so high?

Higher frequency reduces resistance making the waveform **tolerable** enough **at high intensities** As soon as nerve repolarizes its already stimulated again, leading to **maximal summated muscle contractions**

What are 2 uses of IFC?

Pain Control Muscle stimulation (reduce spasm)

How are the electrodes placed for IFC?

In a cross pattern, each channel is diagonal

How does IFC work?

2 different current paths interfere with eachother and the frequency is actually the difference between the 2 diagonal frequencies Example: 4100 one way and 4000 the other way = 100hz in the middle

What is IFC sweep mode?

Allows frequencies to be modulated to avoid accomodation

What is interferential current scan mode?

Scan mode allows the AMPs to be modulated, increases the area of interference Example: if patient has poorly localized pain this allows it to cover more area

What is IFC target mode?

You can select what area between the 4 pads you want to focus on, reduces accomodation by changing the location of the current

What is the "little brother" of IFC called?

Pre-MOD

How does pre-mod work?

2 currents interfere with each other inside the device before being delivered to the patient basically IFC with only 2 electrodes

E-Stim contraindications: Pace makers Stimulation near heart Area over carotid sinus Area with DVT or thrombsis Patients who are confused Patients w/ internal stimulator **Name more?**

seizure disorders Infection Wounds,scars,lesions Malignancies pregnancy MSK problems where it would exacerbate the condition high level spinal cord injury

E-Stim Contraindication: seizure disorders Infection Wounds,scars,lesions Malignancies pregnancy MSK problems where it would exacerbate the condition high level spinal cord injury **Name more?**

Pace makers Stimulation near heart Area over carotid sinus Area with DVT or thrombsis Patients who are confused Patients w/ internal stimulator

What is the normal rule for electrode placement (distance)?

Electrodes must be atleast 1.5x the electrode diameter apart

How should electrodes be oriented on a muscle?

Parallel to the muscle fibers

Small vs large electrodes

Small: increase current density increased impedance decrease flow Large: Decrease current density decrease impedance increase flow

Muscle fibers are ____________ ______ conductive when the electrodes are placed parallel to the fibers vs perpendicular to them

x4 more

Conventional TENs works on what fibers?

A-Beta fibers

Motor level/low rate TENs works on what fibers?

A-Beta Motor and possibly A-Delta

What is the "Hot finger" technique?

1. Set pulse rate between 80 - 150 Set pulse duration (width) between 50 - 150 (Basically 100 100) 2. Apply 1 electrode on yourself and the other on your patient 3. Using your fingertip, contact on your patient (aim for the motor point) 4. Turn the unit on and raise the amplitude until you feel a mild tingling. Slowly move your finger over the skin. 5. When you come on to a low impedance point, you will feed a greater current flow through your finger

What technique helps you find a **low impedence point** for placing an electrode?

hot finger technique

What is carrier frequency of IFC? What is beat frequency?

Carrier- the lesser frequency current of the 2. Example: you've got 4000 and 4100, so 4000 is the carrier frequency Beat- The difference of the frequencies (example: 4100-4000 = 100)

When using NMES, what frequencies do small muscles get, what about big muscles?

small muscles 200-300; large muscles 300-600

When using NMES, the higher the pulse frequency the ___________ the fatigue

faster

When using NMES, the longer the pulse duration the __________ frequency needed for tetany, and the patient experiences an ______ discomfort

Lower Increased