Week 5 and a little bit of week 6 Flashcards
Treatment electrode has a negative ion medication and connects to the ____ (color) lead wire which has a ____ charge
black; negative
Treatment electrode has a positive ion medication and connects to the ____ (color) lead wire which has a ____ charge
red; positive
In iontophoresis using a negative ion medication the dispersive electrode connects to the ____ (color) lead wire which has a ____ charge
red; positive
In iontophoresis using a positive ion medication the dispersive electrode connects to the ____ (color) lead wire which has a ____ charge
black; negative
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
80
40
20
13.3
10
What are the indications for iontophoresis?
Soft tissue inflammatory conditions
Neuralgia
Edema
Ischemic skin ulcers
Hyperhidrosis
Plantar warts
Gouty arthritis
Calcific tendonitis
Scar tissue
Other connective tissue disorders
What are the contraindications for iontophoresis and NMES?
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
What are the precautions for using iontophoresis and NMES?
-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
what related assessments are there for iontophoresis and NMES?
-Girth measurements
-Pain scale
-ROM
-MMTs
-Neurological/sensation testing
List the following for NMES for muscle strengthening.
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration
-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
List the following for NMES for improved ROM/decrease spasm
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration
-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
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
-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
List the following for FES - function electrical stimulation
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration
-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
List the following for EMS - electrical muscle stimulation
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-On:Off Time
-Ramp on & off time
-Duration
-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
What are the 4 principles of electricity?
-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
what is the difference between an anode and cathode?
cathode: negatively charged pole
anode: positively charged pole
what is voltage?
force of attraction or repulsion created by an electrical field represents potential energy (the greater the force, the greater the potential energy)
what are the most common ions (charges) in the body?
Na+ (sodium), K+ (potassium), Cl- (chloride)
name the conductors and insulators inside the body
conductors: water/body fluids, nerve, and muscle tissue (help move ions)
insulators: fat (slows movement of ions)
what is Ohm’s law?
current (I) = voltage (V)/Resistance (R)
omh = standard unit of resistance
what is capacitance?
current flowing in an insulated area with high resistance will slow and charge will start to store in that area
what is impedance?
resistance to the flow of alternating current
(gels and adhesive conductive agents help decrease impedance)
Areas with high fat act as ____ and will ____ electrical stimulation transmission
insulators; impede
gels and adhesive on electrodes decrease ____ and ____ conductivity between the electrode and skin
impedance; improve
True/False: abruptly turning off an e-stim device may cause a brief and uncomfortable surge in the stimulation intensity - like a shock
true
what body tissues have higher resistance and will impede electrical stimulation transmission?
Skin, Hair, Fascia, Ligament, Callus, Fat, Bone, Tendon, Scar
what is direct current and what types?
continuous unidirectional flow of electrons for at least one second
-interrupted, reversed, and interrupted/reversed
what are some clinical used for direct current?
iontophoresis and wound care (used less frequently in rehab because it is more likely to cause problematic changes)
what is alternating current and its clinical uses?
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)
what is pulsed current?
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
what is a duty cycle?
on-time/total time (on+ off time) x 100%
(on time is the duration that a series of pulses or bursts is delivered)
when documenting what are the 3 most important thing needed when describing pulsed current?
-waveform type and shape
-pulse frequency
-pulse duration
what are the 3 levels of response to electrical stimulation?
-sensory: pins and needles
-motor: muscle twitch or fasciculation
-noxious: stimulates pain receptors
true/false: voltage and current directly proportional
true
what is constant voltage?
voltage force driving the current stays constant and current intensity changes
what is constant current?
maintains a constant flow of current by modulating voltage
what are the subjective signs to replace electrodes?
-pt reports change in how the stimulation feels
-decrease in tolerance to current
-more current is required to elicit the same response
what are the objective signs to replace electrodes?
-skin reddening more than previous
-decrease in physiological response more than previous
-changes in physical appearance of the electrode (pigtail connection, gel surface peeling)
what are the differences in size of electrode?
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
what is interelectrode distance?
the distance between electrodes
what does wider electrode spacing allow for?
-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)
what is a bipolar electrode configuration?
-both or all electrode of a single circuit placed over a target tissue
-both electrode are active treatment electrodes
-most common configuration
what are common uses for bipolar electrode configuration?
muscle activation and pain modulation
what is a monopolar electrode configuration?
-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
what is a quadripolar electrode configuration?
-4 electrodes of 2 separate circuits over target tissue
-placed in a crossed pattern
-most common using interferential current for pain modulation
what are the common uses of electrical stimulation?
-to active skeletal muscle (improve muscle performance and strength)
-decrease or alleviate pain
-improve blood flow
-decrease or control edema
-facilitate tissue healing
what are the contraindications for ES?
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
what are the precautions for ES?
- 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
what is iontophoresis?
-technique using current to dive ions of charged medication across the skin to a target tissue
-most units use direct current
what are the clinical uses of iontophoresis?
- 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
what is electromigration?
-using ES to move charge ions into the target tissue
-like charges repel, opposite charges attract
what is electroporation?
increase in porosity of superficial skin in response to ES allows medication to enter the target tissue more easily
what is electoosmotic flow?
-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
In what direction is electroosmotic flow?
-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
what are two important aspects of iontophoresis application?
-know the polarity of the ion or drug to be used
-have good conductivity so there is not a chemical burn under the electrode
what is the equation for current density?
current density = current amplitude (mA) / conductive surface area of the electrode (cm2)
electrodes made for iontophoresis have a conductive surface area that allows current density within an acceptable range with maximal current output of ___
4-5 mA
what is the correct electrode placement for iontophoresis?
-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)
-electrode too close together will cause ____ delivery of current and drug
-electrode spaced further apart will ____ of current and drug penetration
a more superficial; increase the depth
what is the dosage equation for iontophoresis?
dosage (mA min) = current (mA) x duration (min)
what is the typical dosage for iontophoresis?
20-80 mA min
(require a 5-20 min duration with peak amplitude of 4mA)
what are the adverse effects of iontophoresis current?
- 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
