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Ther-ex > Week 3 E Stim Lecture Pt 2 (Clinical Application) > Flashcards

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

1
Q

Cellular effects of electrical current

A

Excitation of nerve cells

Change in membrane permiability

Protein Synthesis

Stimulation of fibroblasts and osteobalsts

modification of microcirculation

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2
Q

Tissue level effects of Electrical current:

A

Muscle fiber (skeletal and smooth) contraction

Tissue regeneration

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3
Q

Segmental effects of E-Stim

A

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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4
Q

Systemic effects of E- Stim

A

Analgesic effects

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5
Q

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

A

IFC

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6
Q

What are the 4 clinical stimulation levels?

A

Subsensory

Sensory- tingling/prickling feeling

Motor- Strong paresthesias, muscle contraction

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

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7
Q

What is a “motor point”

A

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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8
Q

What are uses of High Voltage Currents (HVPC)

A

Muscle contraction

reducing Edema

Wound healing

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

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9
Q

What do the waves look like for HVPC?

A

Twin peak monophasic pulsed wave forms

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10
Q

How do you apply HVPC?

A

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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11
Q

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

A

Inflammatory phase

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12
Q

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

A

Proliferation phase

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13
Q

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

A

Frequency: 120pps

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

Duration: 30 minutes

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14
Q

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

A

TENS (Transcutaneous Electrical Nerve Stimulation)

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15
Q

Where can you put the electrodes for a TENs unit?

A

Almost anywhere that there is pain

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16
Q

Conventional TENS vs

Acupuncture-like TENS

A

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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17
Q

What are the 4 types of TENS

A

Conventional

Acupuncture

Noxious Level

Brief Intense

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18
Q

What kind of TENS is best for wound debridement?

A

Brief Intense (high rate and high intensity)

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19
Q

What should the settings be for conventional TENS?

A

Frequency 80-125 (100)

Duration 75-150 (100)

Intensity: Tolerable SENSORY stimulation (no muscle contraction)

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20
Q

How long can you use conventional TENS?

A

30 mins to a couple hours

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21
Q

What is gate control theory?

A

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

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22
Q

What are the settings for acupuncture-like TENS

A

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

23
Q

How long should you use acupuncture-like tens?

A

15 mins

24
Q

How does descending pain control theory work?

A

Opiate receptors in central or peripheral terminals of nociceptive afferent fibers

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

25
Q

What are the settings of Noxious level TENS?

A

LOW frequency 1-5

Duration 100-1000

Intensity: set to noxious level w/ possible muscle contraction

FOR trigger points/acupuncture points

26
Q

What kind of TENS uses endogenous opiate pain control theory

A

Noxious level TENS

27
Q

Settings for brief intense TENS?

A

frequency 100pps

Duration 100-600

intensity: Muscle fasciculation to sustained muscle contraction

28
Q

What are 2 uses of russian current?

A

Muscle Strengthening

Muscle re-education

29
Q

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

A

no

30
Q

What is the normal frequency of Modern Russian Current?

A

2000-10000 hz

(waves look like solid blocks of smaller waves)

31
Q

What are the advantages of russian current?

Why is the frequency so high?

A

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

32
Q

What are 2 uses of IFC?

A

Pain Control

Muscle stimulation (reduce spasm)

33
Q

How are the electrodes placed for IFC?

A

In a cross pattern, each channel is diagonal

34
Q

How does IFC work?

A

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

35
Q

What is IFC sweep mode?

A

Allows frequencies to be modulated to avoid accomodation

36
Q

What is interferential current scan mode?

A

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

37
Q

What is IFC target mode?

A

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

38
Q

What is the “little brother” of IFC called?

A

Pre-MOD

39
Q

How does pre-mod work?

A

2 currents interfere with each other inside the device before being delivered to the patient

basically IFC with only 2 electrodes

40
Q

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?

A

seizure disorders

Infection

Wounds,scars,lesions

Malignancies

pregnancy

MSK problems where it would exacerbate the condition

high level spinal cord injury

41
Q

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?

A

Pace makers

Stimulation near heart

Area over carotid sinus

Area with DVT or thrombsis

Patients who are confused

Patients w/ internal stimulator

42
Q

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

A

Electrodes must be atleast 1.5x the electrode diameter apart

43
Q

How should electrodes be oriented on a muscle?

A

Parallel to the muscle fibers

44
Q

Small vs large electrodes

A

Small: increase current density
increased impedance
decrease flow

Large: Decrease current density
decrease impedance
increase flow

45
Q

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

A

x4 more

46
Q

Conventional TENs works on what fibers?

A

A-Beta fibers

47
Q

Motor level/low rate TENs works on what fibers?

A

A-Beta

Motor

and possibly A-Delta

48
Q

What is the “Hot finger” technique?

A
  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
49
Q

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

A

hot finger technique

50
Q

What is carrier frequency of IFC?

What is beat frequency?

A

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)

51
Q

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

A

small muscles 200-300; large muscles 300-600

52
Q

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

A

faster

53
Q

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

A

Lower

Increased

Ther-ex (11 decks)

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