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Physical Agents > Week 5 and a little bit of week 6 > Flashcards

Week 5 and a little bit of week 6 Flashcards

1
Q

Treatment electrode has a negative ion medication and connects to the ____ (color) lead wire which has a ____ charge

A

black; negative

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2
Q

Treatment electrode has a positive ion medication and connects to the ____ (color) lead wire which has a ____ charge

A

red; positive

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3
Q

In iontophoresis using a negative ion medication the dispersive electrode connects to the ____ (color) lead wire which has a ____ charge

A

red; positive

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4
Q

In iontophoresis using a positive ion medication the dispersive electrode connects to the ____ (color) lead wire which has a ____ charge

A

black; negative

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5
Q

After set-up, consider if your patient can tolerate the following current amplitudes, calculate how long the treatment will take using an electrode manufactured at 40mA*min:

0.5 mA intensity = __ minutes
1 mA intensity = __ minutes
2 mA intensity = __ minutes
3mA intensity = __ minutes
4mA intensity = __ minutes

A

80
40
20
13.3
10

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6
Q

What are the indications for iontophoresis?

A

Soft tissue inflammatory conditions
Neuralgia
Edema
Ischemic skin ulcers
Hyperhidrosis
Plantar warts
Gouty arthritis
Calcific tendonitis
Scar tissue
Other connective tissue disorders

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7
Q

What are the contraindications for iontophoresis and NMES?

A

Allergy or sensitivity to the medication being used

Electrodes should not be placed over the following:
-The trunk or heart region of patients with demand-type pacemakers or implantable cardioverter defibrillators
-The pelvic, abdominal, lumbar or hip region in pregnant women
-Carotid bodies
-Patients with phrenic nerve or urinary bladder stimulators
-Areas of known peripheral vascular disease, including arterial or venous thrombosis or thrombophlebitis
-The phrenic nerve, eyes or gonads
-Areas of active osteomyelitis
-Areas of hemorrhage

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8
Q

What are the precautions for using iontophoresis and NMES?

A

-Over neoplasm (active or previous): recommended written documentation of patient and physician consent
-Do not use ES within 5 yards of diathermy units or other sources of electromagnetic radiation

ES should be used with caution in patients:
-Without intact sensation
-Unable to communicate or with compromised mental or cognitive ability
-With cardiac dysfunction

Electrodes should not be placed over:
-Compromised skin (except specific wound care applications)
-Tissues vulnerable to hemorrhage or hematoma
-Cervical or craniofacial regions in patients who have history of CVA or seizures

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9
Q

what related assessments are there for iontophoresis and NMES?

A

-Girth measurements
-Pain scale
-ROM
-MMTs
-Neurological/sensation testing

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10
Q

List the following for NMES for muscle strengthening.
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration

A

-Waveform: Biphasic PC or burst modulation AC (Russian or Aussie)
-Pulse Duration: 200-600µsec; Typical: 125-200µsec for smaller muscles; 200-350µsec for larger muscles
-Frequency: 20-80 pps or bursts per sec; Small muscles: 20-30+ pps; Large muscles: 50+ pps
-Amplitude: As high as tolerated with a goal of reaching >50% max voluntary contraction (MVC)
-On:Off Time: 1:3 to 1:5 with on-time up to 10 sec and off-time up to 50 sec
-Ramp on & off time: Ramp up: 1-5 sec; Ramp down: 1-2 sec
-Duration: 10-20 strong contractions or up to 1hr/day 3-5x/week 4-8/weeks

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11
Q

List the following for NMES for improved ROM/decrease spasm
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration

A

-Waveform: Biphasic PC or burst modulation AC (Russian or Aussie)
-Pulse Duration: Typical: 125-200µsec for smaller muscles; 200-350µsec for larger muscles
-Frequency: 35-50 pps
-Amplitude: To visible contraction
-On:off time:1:1 on time and off time equal and 2-5 sec
-Ramp on & off time:Ramp 1-5 sec up and down
-Duration: 10-30 min; 1-4x/day 2 weeks-6 months

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12
Q

List the following for NMES for reduction of subacute or chronic edema
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration

A

-Waveform: Biphasic PC or burst modulation AC (Russian or Aussie)
-Pulse Duration:100-600µsec
-Frequency: 20-80 pps or bursts per sec
-Amplitude: mA to tetanic contraction
-On:Off time: 1:1 ratio; On 2-5 sec, off 2-5 sec
-Ramp on & off time: Ramp up: 1+ sec; Ramp down 1+ sec
-Duration: 10-20 minutes of rhythmic contractions; 1-2x/day, monitor edema

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13
Q

List the following for FES - function electrical stimulation
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration

A

-Waveform: Biphasic PC or burst modulation AC (Russian or Aussie)
-Pulse Duration: 200-600µsec
-Frequency: 20-60 pps or bursts per sec
-Amplitude: To level commensurate with functional activity
-On:Off time and Ramp on & off time: Depends on function activity
-Duration: Task specific

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14
Q

List the following for EMS - electrical muscle stimulation
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration

A

-Waveform: Monophasic or DC
-Pulse duration: 1-450 msec (long)
-Frequency: 1-500 pps
-Amplitude: High enough to obtain contractions but low enough to prevent burns
-On:Off time: Highly variable; On time 3-10 sec and off time 30-50 sec
-Ramp on & off time: Not specified
-Duration: 30min/8 hours per day; 5-7day/week; 4 days to 4 years

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15
Q

What are the 4 principles of electricity?

A

-two types of charges: positive and negative
-like charges repel while opposite charges attract
-charge is neither created nor destroyed
-charge can be transferred from one object to another

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16
Q

what is the difference between an anode and cathode?

A

cathode: negatively charged pole
anode: positively charged pole

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17
Q

what is voltage?

A

force of attraction or repulsion created by an electrical field represents potential energy (the greater the force, the greater the potential energy)

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18
Q

what are the most common ions (charges) in the body?

A

Na+ (sodium), K+ (potassium), Cl- (chloride)

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19
Q

name the conductors and insulators inside the body

A

conductors: water/body fluids, nerve, and muscle tissue (help move ions)
insulators: fat (slows movement of ions)

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20
Q

what is Ohm’s law?

A

current (I) = voltage (V)/Resistance (R)
omh = standard unit of resistance

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21
Q

what is capacitance?

A

current flowing in an insulated area with high resistance will slow and charge will start to store in that area

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22
Q

what is impedance?

A

resistance to the flow of alternating current
(gels and adhesive conductive agents help decrease impedance)

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23
Q

Areas with high fat act as ____ and will ____ electrical stimulation transmission

A

insulators; impede

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24
Q

gels and adhesive on electrodes decrease ____ and ____ conductivity between the electrode and skin

A

impedance; improve

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25
Q

True/False: abruptly turning off an e-stim device may cause a brief and uncomfortable surge in the stimulation intensity - like a shock

A

true

26
Q

what body tissues have higher resistance and will impede electrical stimulation transmission?

A

Skin, Hair, Fascia, Ligament, Callus, Fat, Bone, Tendon, Scar

27
Q

what is direct current and what types?

A

continuous unidirectional flow of electrons for at least one second
-interrupted, reversed, and interrupted/reversed

28
Q

what are some clinical used for direct current?

A

iontophoresis and wound care (used less frequently in rehab because it is more likely to cause problematic changes)

29
Q

what is alternating current and its clinical uses?

A

uninterrupted bidirectional flow of electrons, must change direction at least once per second
-Russian current (burst modulated AC current) and interferential current (amplitude modulated AC current)

30
Q

what is pulsed current?

A

unidirectional or bidirectional flow of electrons that periodically ceases for a short period of time, the interphase/interpulse interval, before the next event or pulse

31
Q

what is a duty cycle?

A

on-time/total time (on+ off time) x 100%
(on time is the duration that a series of pulses or bursts is delivered)

32
Q

when documenting what are the 3 most important thing needed when describing pulsed current?

A

-waveform type and shape
-pulse frequency
-pulse duration

33
Q

what are the 3 levels of response to electrical stimulation?

A

-sensory: pins and needles
-motor: muscle twitch or fasciculation
-noxious: stimulates pain receptors

34
Q

true/false: voltage and current directly proportional

A

true

35
Q

what is constant voltage?

A

voltage force driving the current stays constant and current intensity changes

36
Q

what is constant current?

A

maintains a constant flow of current by modulating voltage

37
Q

what are the subjective signs to replace electrodes?

A

-pt reports change in how the stimulation feels
-decrease in tolerance to current
-more current is required to elicit the same response

38
Q

what are the objective signs to replace electrodes?

A

-skin reddening more than previous
-decrease in physiological response more than previous
-changes in physical appearance of the electrode (pigtail connection, gel surface peeling)

39
Q

what are the differences in size of electrode?

A

large: lower current density = more comfortable, appropriate for larger muscles and treatment areas

smaller: higher current density, may cause uncomfortable burning sensation, appropriate for smaller muscles and treatment areas

40
Q

what is interelectrode distance?

A

the distance between electrodes

41
Q

what does wider electrode spacing allow for?

A

-increased current intensity
-current to travel deeper and reach deeper tissues (reach motor nerves and muscle, activate more motor units in NMES, activate more sensory fibers in TENS)

42
Q

what is a bipolar electrode configuration?

A

-both or all electrode of a single circuit placed over a target tissue
-both electrode are active treatment electrodes
-most common configuration

43
Q

what are common uses for bipolar electrode configuration?

A

muscle activation and pain modulation

44
Q

what is a monopolar electrode configuration?

A

-single circuit with one electrode place at the treatment area and the other place away from the treatment area (inactive)
-commonly used in wound care

45
Q

what is a quadripolar electrode configuration?

A

-4 electrodes of 2 separate circuits over target tissue
-placed in a crossed pattern
-most common using interferential current for pain modulation

46
Q

what are the common uses of electrical stimulation?

A

-to active skeletal muscle (improve muscle performance and strength)
-decrease or alleviate pain
-improve blood flow
-decrease or control edema
-facilitate tissue healing

47
Q

what are the contraindications for ES?

A

Electrodes should not be placed over the following:
§ The trunk or heart region of patients with demand-type pacemakers or implantable
cardioverter defibrillators
§ The pelvic, abdominal, lumbar or hip region in pregnant women
§ Carotid bodies
§ Patients with phrenic nerve or urinary bladder stimulators
§ Areas of known peripheral vascular disease, including arterial or venous thrombosis or thrombophlebitis
§ The phrenic nerves, eyes or gonads
§ Areas of active osteomyelitis
§ Areas of hemorrhage

48
Q

what are the precautions for ES?

A
  • ES should be used with caution in patients:
    § without intact sensation
    § unable to communicate or with compromised mental or cognitive ability
    § with cardiac dysfunction
  • Over neoplasms (active or previous)
    § Recommended written documentation of patient and physician consent
  • Electrodes should not be placed over:
    § Compromised skin (except specific wound care applications)
    § Tissues vulnerable to hemorrhage or hematoma
    § Cervical or craniofacial regions in patients who have history of CVA or seizures
  • Do not use ES within 5 yards of diathermy units or other sources of electromagnetic
    radiation
49
Q

what is iontophoresis?

A

-technique using current to dive ions of charged medication across the skin to a target tissue
-most units use direct current

50
Q

what are the clinical uses of iontophoresis?

A
  • Soft tissue inflammatory conditions (Dexamethasone (corticosteroid)
    most studied use)
  • Neuralgia
  • Edema
  • Ischemic skin ulcers
  • Hyperhidrosis
  • Plantar warts
  • Gouty arthritis
  • Calcific tendonitis
  • Scar tissue
  • Other connective tissue disorders
51
Q

what is electromigration?

A

-using ES to move charge ions into the target tissue
-like charges repel, opposite charges attract

52
Q

what is electroporation?

A

increase in porosity of superficial skin in response to ES allows medication to enter the target tissue more easily

53
Q

what is electoosmotic flow?

A

-when positive and negative electrodes applied to skin, ions of positive charge in the extracellular fluid attracted to the cathode and ions of the negative charge attracted to the anode
-creates a bulk movement of solute in response to the electrical field and helps move ions into the tissue

54
Q

In what direction is electroosmotic flow?

A

-since skin contains a net negative charge, the direction of flow is from the anode to the cathode
-assists the delivery of positive medication
-hinders the delivery of negative medications

55
Q

what are two important aspects of iontophoresis application?

A

-know the polarity of the ion or drug to be used
-have good conductivity so there is not a chemical burn under the electrode

56
Q

what is the equation for current density?

A

current density = current amplitude (mA) / conductive surface area of the electrode (cm2)

57
Q

electrodes made for iontophoresis have a conductive surface area that allows current density within an acceptable range with maximal current output of ___

A

4-5 mA

58
Q

what is the correct electrode placement for iontophoresis?

A

-active/treatment electrode goes directly over the treatment area
-inactive electrode distant from the treatment electrode (at least a few inches at a site of convenience over a large muscle/muscle belly)

59
Q

-electrode too close together will cause ____ delivery of current and drug
-electrode spaced further apart will ____ of current and drug penetration

A

a more superficial; increase the depth

60
Q

what is the dosage equation for iontophoresis?

A

dosage (mA min) = current (mA) x duration (min)

61
Q

what is the typical dosage for iontophoresis?

A

20-80 mA min
(require a 5-20 min duration with peak amplitude of 4mA)

62
Q

what are the adverse effects of iontophoresis current?

A
  • Greater risk of skin irritation and redness
    with DC current
  • Critical to inspect skin and document
    before and after
  • Changes at the cathode and anode in
    response to direct current

Physical Agents (14 decks)

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