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Physical Agents > Week 7 > Flashcards

Week 7 Flashcards

1
Q

List the following for high-rate TENS
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-Duration

A

-Waveform: monophasic pulsed (hi-volt) or biphasic pulsed
-Pulse Duration: < or equal to 100usec
-Frequency: 100-150 pps
-Amplitude: sensory level
-Duration: 30 min or less in clinic; 1 hour at home with 30 min off

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2
Q

List the following for low-rate TENS
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-Duration

A

-Waveform: monophasic pulsed (hi-volt) or biphasic pulsed
-Pulse Duration: 150-200usec
-Frequency: < or equal to 10pps
-Amplitude: motor level; visible contraction
-Duration: 30 min or less

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3
Q

List the following for IFC
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-Duration

A

-Waveform: amplitude modulated AC
-Pulse Duration: 2kHz = 250usec; 4kHz = 125usec
-Frequency: 2kHz = muscle contraction; 4kHz = reduced pain
-Amplitude: will rise and fall at frequency equal to beat frequency; 50Hz for muscle contraction; 100 Hz for high rate pain modulation; 1-10Hz for low rate pain modulation
-Duration: 10-20 min most common (up to 30)

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4
Q

List the following for ES for acute tissue healing
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-Duration

A

-Waveform: HVPC negative polarity
-Pulse Duration: 40-100us
-Frequency: 60-125 pps
-Amplitude: to produce comfortable tingling
-Duration: 45-60 min

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5
Q

List the following for ES for chronic tissue healing
-Waveform
-Pulse Duration
-Frequency
-Amplitude
-Duration

A

-Waveform: HVPC positive polarity
-Pulse Duration: 40-100us
-Frequency: 60-125 pps
-Amplitude: to produce comfortable tingling
-Duration: 45-60 min

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6
Q

what are the contraindications/precautions for TENS and ES

A

-Over pregnant uterus, abdomen or lower back in pregnancy (may be used for pain control during labor and delivery)
-Electrical implants
-Carotid sinus, eyes, internally or on reproductive organs
-Over damaged skin
-Thrombosis
-Thrombophlebitis
-Hemorrhage
-Over malignant tumors
-Undiagnosed pain
-Patients with impaired sensation or cognitive ability, and others
-Do not use stimulated muscle contractions for pain control, as with low-rate TENS, when muscle contractions may disrupt healing (ex. Muscle or tendon tear, overuse, or acute injury)

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7
Q

what are the two types of second order neurons?

A

-high threshold neurons: nociceptive-specific receiving input from peripheral nociceptors only
-wide-dynamic range neurons: receive input from nociceptive and non-nociceptive primary afferent fibers

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8
Q

what does central sensitization result in?

A

-increased responsiveness to noxious and non-noxious stimuli
-increase receptive field
-decreased activation thresholds

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9
Q

why is treating pain of an unknown or unidentifiable origin considered a contraindication of TENS?

A

masking undiagnosed pain with TENS can postpone proper treatment and lead to worsening of underlying condition

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10
Q

what is the gate control theory?

A

-selective stimulation of large-diameter A-beta sensory nerve fibers block noxious afferent input from smaller-diameter unmyelinated nociceptive C fibers and small myelinated A-delta fibers

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11
Q

what are the main mechanisms of action for TENS

A

-activation of peripheral opioid receptors
-activation of central opioid receptors

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12
Q

what is burst mode tens?

A

-uses same mechanism as low-rate TEN but may produce a more comfortable muscle contraction
-combination of high rate and low rate TENS stimulation delivered in bursts (high freq. pulses (100hz) delivered at low freq. (1-4hz) and long duration (150-200usec) at motor level

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13
Q

what are the two main theories for TENS?

A

-gate control theory: Activation of A-beta afferents to induce inhibitory circuits in dorsal horn to block A-delta and C-fiber input
-central inhibition and release of endogenous opioids: Activation of descending inhibitory pathways projecting to spinal cord; Selective activation of opioid receptors: Low-frequency TENS: µ-opioid receptors; High-frequency TENS: δ-opioid receptors

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14
Q

what is the correct placement for TENS?

A

-around or over painful area
-lead wire color is irrelevant
-over the peripheral nerve that innervates the painful area
-parallel to spine to stimulate nerve roots of spinal nerves innervating painful area
-over acupuncture points, motor points, or trigger points

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15
Q

what is IFC?

A

-consists of two interfering medium-frequency alternating currents intersecting to yield a single treatment
-reduces skin impedance and reaches deeper tissues with less discomfort
-requires 2 channels/4 electrodes set up is x pattern

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16
Q

what is constructive interference?

A

amplitudes of the 2 currents are in sync and will sum together

17
Q

what is destructive interference?

A

amplitudes of the 2 currents are out of sync and will cancel each other out

18
Q

what is amplitude modulation?

A

amplitude of the current increases and decreased as the 2 waves are in and out of sync creating

19
Q

what is sweep (in reference to IFC)?

A

-modulation of the beat frequency
-to allow low and high freq. stimulation within the same treatment

20
Q

what is swing (in reference to IFC)?

A

-characteristic of sweep
-can set the beat freq. to just go from min to max or move continuously through the range of min to max

21
Q

what is vector scan in relation to IFC?

A

-amplitude modulation of the input currents
-increases the area of the interference pattern
-provides simulation to a larger tissue area

22
Q

what is premodulated IFC current?

A

-bipolar IFC
-applied using 2 electrodes
-current is created by the interference of two alternating currents within the stimulator device, not by interference within the pt’s tissues

23
Q

what is the sequence for the application of TENS?

A

-position patient and drape as needed
-clean skin
-connect wires to electrodes
-place electrodes
-set parameters
-slowly increase amplitude until mild tingling, continue to increase to strong, comfortable sensation and muscle twitch
-when treatment time completes, reduce the amplitude back to the minimum and turn off machine
-remove electrodes and inspect the skin

24
Q

what are the contraindications and precautions for TENS?

A
  • Over pregnant uterus, abdomen or lower back in pregnancy (May be used for pain control during labor and delivery)
  • Electrical implants
  • Carotid sinus, eyes, internally or on reproductive organs
  • Over damaged skin
  • Thrombosis
  • Thrombophlebitis
  • Hemorrhage
  • Over malignant tumors
  • Undiagnosed pain
  • Patients with impaired sensation or cognitive ability, and others
  • Do not use stimulated muscle contractions for pain control, as with low-rate TENS, when
    muscle contractions may disrupt healing (e.g. muscle or tendon tear, overuse, or acute
    injury).
25
Q

ES increases the following in wound healing

A

-DNA
-Protein
-ATP
-Thymidine synthesis
-Intracellular calcium
-Vascular endothelial growth factor production
-Decreased wound area

26
Q

what are the mechanisms of ES for wound healing?

A

-attracting appropriate cell types - galvanotaxis
-Activating cells by altering cell membrane function
-Modifying endogenous tissue electrical potential
-Reducing edema
-Enhancing antimicrobial activity
-Increasing protein synthesis
-Promoting circulation/oxygenation

27
Q

what is the difference in parameters for tissue healing inflammation phase/infection and proliferation phase?

A

-inflamed: negative polarity
-proliferation: positive polarity

28
Q

why do we not treat edema with systemic cause with ES?

A

-may drive fluid from extremities into central circulation further overwhelming the system
-heart, liver, or kidney failure

29
Q

what does ES do for edema due to inflammation?

A

negative polarity HVPC retards formation of acute edema (50% reduction)

30
Q

what does ES do for edema due to lack of muscle contraction?

A

-healthy tissues contract to promote fluid return from periphery
-treat with motor level ES and elevation followed by compression garment

31
Q

You are using a 6.5 cm2 electrode; what is the highest current
you should use if the active electrode is the cathode?

A

0.5mA/cm2 = X/6.5cm2
x = 3.25 mA

32
Q

what are the guidelines for iontophoresis?

A

-clean and inspect skin
-position pt and support treatment area
-place correct size active electrode on treatment area (active electrode same polarity as the medicinal ion)
-dispersive electrode place at either proximal or distal distant to side about 4-6” away
-determine dose
-turn intensity up slowly to selected level of pt comfort
-after treatment inspect skin integrity for signs of adverse effect to current

33
Q

what needs to be documented for iontophoresis?

A

-the area of the body treated
-patient positioning
-specific stimulation parameters
-electrode placement
-treatment duration
-pt’s response including the condition of the skin and surrounding areas

Physical Agents (14 decks)

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