Electrotherapy Flashcards

1
Q

What factor influences the area of the spine treated?

A

Angle of pull Lumbar in flex, neutral or ext Cervical in neutral up to 25 degree

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2
Q

Intermittent vs. static traction

A

Static: initial/acute phase Intermittent: jt distraction, decrease m. spasm, disc protrusion, stretch soft tissue. The chouce btwn the two is also based on pt tolerance. static may be used throughout whole tx.

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3
Q

Direct current (electrotherapy)

A

Current flows in one direction. Electrode are either + or - amd maintain polarity. Used for iontophoresis Hi-volt HV HVDC PDC

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4
Q

Alternating Current (electrotherapy)

A

Flow is continued in 2 directions. Moves in cycles and rhythmically changes directions Used for pain and m. strengthening

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5
Q

Pulsed Current (electrotherapy)

A

Alternating current that flows in either one or two directions with intervals no no electrical activity. Used for pain and m. strengthening

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6
Q

Anode

A

Positive electrode that attracts negatively charged ions and repels positively charged ions

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7
Q

Cathode

A

Negative electrode that attracts positivley charged ions and repels negativley charged ions.

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8
Q

Current density

A

The amount of current delivered per unit area.

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9
Q

Electrical current

A

the movement or flow or charged particles through a conductor in response to an applied electrical field.

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10
Q

Gate control theory

A

The theory that that there are gates at the spinal level that allow certain signals to pass or not.

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11
Q

Action potential

A

The basic unit of n. communication The depolarization and repolarization of a n. that occurs in response to a stimulus

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12
Q

Accommodation

A

When a n. gradually becomes less responsive to a stimulus. An increase in threshold.

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13
Q

Impedance

A

The opposition to current flow. Includes tissue resistance and ability to hold a charge

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14
Q

Motor Point

A

The point in a muscle that will prodice the greatest m. contraction with the application of e-stim. Generally located over the m. body Use: Muscle strengthening

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15
Q

Acupuncture Point

A

Specific points mapped along meridians. Effects may be local or referred. Use: Pain

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16
Q

Trigger Point

A

Points that are hypersensitive to pressure or electrical stim. Effects can be local or referred Use: Pain

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17
Q

Ohm’s law

A

Current = Voltage/Resistance When the tissue resistance increases, the flow of current decreases

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18
Q

Tissue Impedance is affected by?

A

Water content of the tissue Temperature Quality of integument Factors influencing fluid balance Prescence of injury or disease

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19
Q

Resistance

A

A materials resistance to current flow. Acupuncture and motor points are known to have less resistance.

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20
Q

Ramp

A

Up/Down The time it takes to go from 0 to its max amp The time to go from max amp to 0 Allows pt to become accustomed to the stim

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21
Q

Amplitude

A

Current strength M. nerve - Higher amps to stim Sensory nerve - Lower amps to stim

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22
Q

Adaptation

A

Decreased frequency of action potentials, and decreased sensation of stim that occurs because of unchanging characteristics

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23
Q

Opiod release theory

A

The stimulation of the A delta fibers (acupuncture like) causes the release of an endogenous opiate in the spinal cord. This blocks noxious stimulus pathways.

Repetetive m contractions, brief sharp pain. Acupuncture like

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24
Q

Interferential Current

A

2 high frequency currents crossed to control pain

No m. contraction elicited

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25
Q

Premodulated Current

A

Interferential current for a smaller treatment area. The crossing of electrical current happens within the machine.

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26
Q

Nerve Depolarization

A

When a stimulus is applied the sodium channels open rapidly allowing sodium to rush into the cell making the cell more positively charged.

Electrical currents depolarize nerves causing an action potential. Can effect m contraction, pain, tissue healing

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27
Q

A-beta fibers

A

Large myelinated axons.

Located in skin, bones and joints

Normal transmission of stretching, vibration of the skin

Short duration pulse (50-80us), comfy amp current = best for isolating these fibers

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28
Q

A-delta Fibers

A

Small myelinated fibers

Most sensitive to high-intensity mechanical stim. Sharp stabbing or pricking pain, not controlled by opiates

Repetitive stim can stim endongenous opiod production.

29
Q

Motor (alpha) Fibers

A

When stimulated, cause a m contraction

When stim by e-stim, the larger fast-twitch fibers are activated first. The contraction is rapid, with poor grading, and fatiguing.

30
Q

Clinical Application of Electrical Stim

A

Pain Management

Neuromuscualr Dysfunction

Joint Mobility

Tissue Repair

Acute Chronic Edema

Urine.Fecal incontinence

Medcication Delivery

31
Q

TENS Conventional Parameters

A

High frequency Short/wide pulse duration

Frequency - 100-150pps

Pulse Duration - 50 - 80 us

Amplitude - Tingling, no m. contraction

Duration - Up to 24 hrs PRN

Pain control - gating at the spinal cord

32
Q

TENS Acupuncture-like Parameters

A

Low frequency, High/long pulse duration

Frequency - 2-10 us

Pulse duration - 200-300 us

Amplitude - Produce visible contraction

Duration - 20-30 mins

Pain control - endorphine release

33
Q

TENS Burst mode Parameter

A

High frequency, high duration

Frequency - preset to 10 bursts

Pulse duration - max or 100-300 us

Amplitude - visible contraction

Duration - 20-30 mins

Pain control - endorphine release

34
Q

TENS indications

A

Pain:

Acute/sub acute/ chronic

Myofascial

Phantom limb

Musculoskeletal

35
Q

Electrotherapy Contraindications

A

Undiagnosed pain

Pacemaker (demand type)

Seizure disorder

Pregnancy

Over carotid sinus

Broken skin

Anesthetic skin

Directly over eyes

Malignancy

Children

Where unable to allow for adequate distance btwn electrodes. (IFC)

Allergy (Ion)

Abn sensation (ion)

New/ denuded scar (ion)

36
Q

TENS/ IFC Precautions

A

Cardiac Disease

Over open wound

Pregnancy distal extremities

Patients with terminal cancer

37
Q

Electrical current Adverse Reactions

A

Skin irritation

Burns

Pain

38
Q

Conventional TENS effect

A

Sensation is strong but comfortable.

Rapid onset analgesia while the unit is on

39
Q

Acupuncture-like TENS effect

A

Less comfortable, slow onset of analgesia (hours), long lasting once unit is removed, m. contraction elicited

40
Q

Burst TENS effects

A

Less comfortable, rapid onset of analgesia, long lasting

41
Q

Interferential current Parameters

A

Frequency - increase on at a time. Sensation felt where m. cross

Amplitude - Stong sensory level

Pulse duration - not changable

Duration - 20-30 mins

42
Q

IFC Indications

A

Pain relief

Low back pain

Osteoarthritis

Post-op ortho surgery

Stim myofascial trigger points

43
Q

Iontophoresis Parameters

A

Polarity - Drug delivery electrode should be the same polarity as the medication being used

Amplitude - Determined by pt, but not more than 4 mA. Strong but comfortable sensation

Duration - determined by amplitude

Placement - drug electrode is place over the pathology, return is over a lrg m. belly

44
Q

Iontophoresis Indications

A

Bursitis

Tendonitits

Carpal Tunnel Syndrome

Arthritis

Trigger point pain

Need for analgesia

TMJ

Plantar fasciitis

Epicondylitis

45
Q

Iontophoresis Adverse reactions

A

Skin irritation from DC

Histamine Release (stim of mast cells) = small red bumps

Itching

46
Q

Common medications for Iontophoresis

A

Dexamethasone - Negative (reduces inflammation)

Acetate - Negative (dissolve calcium buildup and scar tissue)

Hydrocortisone - Positive (reduce inflammation)

Lidocaine - Positive (decrease pain)

47
Q

NMES Precautions

A

Areas of excessive adipose or scar tissue

Over areas without sensation

Open wound within the treatment area

Extreme edema

Laryngeal, pharyngeal muscle, or carotid sinus

Stim uncomfortable

SCI patients

48
Q

SCI Patients and NMES

A

can cause autonomic dysreflexia

Loss of sympathetic control

excessive inrease in BP

increased spasticity

Profuce sweating

Bradycardia

HA

49
Q

NMES Contraindications

A

Over thoracic region (may effect heart)

Over implanted stim (phrenic n., bladder stim)

Prescence of DVT

Area of neoplasm of infection

Trunk of pregnant woman

Disoriented, mentally impaired

Over the eyes

Injured, frail skin

In the presence of superficial implants

Area of active bleeding

When motion is contraindicated

50
Q

NMES Indications

A

Stroke Patients: prevent shld subluxation, Facilitate active contraction

Chronic stroke - Improve ROM, Improve sensation

Improve function in patients with permanent CNS deficits

Improve function in children with CP (combined with bracing)

Improve m. and resp function in COPD patients

Improve bladder control in patients with stress or urge incontinence

Increase strength and endurance of select m.

Restore force generation in a m. following surgery

Bell’s palsy

Maintain m. health in peripheral n. injuries

Decrease spasticity

Maintain/ improve ROM

Decrease edema, promote circulation

51
Q

NMES M. Strengthening

Parameters

A

Frequency - 35-80 pps

Pulse Duration - 150-200us (sm m.) 200-350us(lrg m.)

Amplitude - Submax contraction

On/off time - 6-10 s on, 1-2 min off

Ramp - at min 2 s

Duration - 2-3 hrs when awake

10-20 contractions

52
Q

NMES M. Re-education

Parameters

A

Frequency - 35-50 pps

Pulse Duration - 150-200us (sm m.) 200-350us (lrg m.)

Amplitude - Sufficient for functional activity

On/Off time - Depends on activity

Ramp - at min 2s

Duration - depends on functional activity

53
Q

NMES M. spasm reduction

Parameter

A

Frequency - 35-50 pps

Pulse duration - 150-200us (sm m.) 200-350 (lrg m.)

Amplitude - visible contraction

On/Off time - 2-5s on/off

Ramp - min 1s

Duration - 30 min 2-3hrs (until relief)

54
Q

Russian

A

Muscle strengthening burst modulated to deliver 50 burst per sec

Indications: post knee surgery, during immobilization after anterior collateral ligament sprain

Frequency: 2500 Hz

Reciprocal - stim agonist then antagonist to encourage alt mvmnts

Co-contraction - stim agonist and antagonist to encourage stability

Continuous

55
Q

High volt

A

Wound healing: Stim dissolving of blood clots, increase vascularity. Antibacterial effects. Stim healing cells. Promote epithelial growth

Edema control

56
Q

HIgh volt wound healing parameters

A

Alt polarity

50% of time negative, 50% positive

or

start with negatieve until plateau is reched and switch to positive

Pulse: 30-130 pps

Pulse duration: 100 us

Continuous mode

Voltage: comfortable (100-200 V)

30-60 min, 2 hrs BID, 5-7 x a wk

Active electrode is place near or on wound

57
Q

Hi volt edema parameters

A

Muscle pumping action:

  • Pulse Freq 30-60 pps (produce contraction)
  • Pulse duration 150-350 us
  • On/Off 1-2 sec
  • 20-30 min

* Acute inflammation control:

  • Pulse freq 100-120 pps
  • Pulse duration 40-100 us
  • Negative electrode placed over area of edema
  • continuous
  • Voltage comfortable
  • 20-30 min
58
Q

Laser

A

Light amplification by simulated emission of radiation

Increases metabolic rate -> biochemical responses

Low level

wave length 600-1000nm Larger wavelength go deeper (2-4cm)

classification 3B

59
Q

Biochemical changes

Laser

A

Increase synthesis of endorphines

Decreases “C” pain fiber activity

Decrease inflammatory response

May increase nerve growth

Influences cellular messangers taht regulate blood flow, m contraction and nerve activation

60
Q

Benefits of laser

A

Increase cellular energy by increasing ATP production

improve cellular membrane stabilization

Increase immune response

Improve healgin by increasing cell proliferation

Increased local blood circulation

reduces pain

increases endorphine release

muscle relaxation

anti-inflammatory response

61
Q

Laser indications

A

postherpetic neuralgia

Carpal tunnel

Wound healing

Fibromyalgia

Arthritis (OA, RA) short term (4 wk)

Pain management

Achillies tendonitis

ankle sprains

Medial/lateral epicondylitis

Myofascial syndrome

Neuropathic pain

Post traumatic nerve regeneration

Reduce post mastectomy lyphedema

62
Q

Laser Contraindications

A

Over pregnant uterus

Malignancy

Active hemorrhage

Over boney growth plates

Over endocrine gland (thyroid)

Within 4-6 months of radiation

63
Q

Laser Precautions

A

Direct irradiation over eyes

Over tattoo of skin of dark pigmentation

Impaired sensation/mentation

Increased sensitivity to light

Over epiphyseal plates in children

64
Q

Laser

Direct contact

A

Stationary direct contact

held in place with moderate amount of pressure (decreases scattering with changes in interface)

Imagine a grid. Hold in one spot, then move and hold

65
Q

Stationary Direct contact

Laser

A

4-9mm over tissue surface (not in contact with the skin)

  • Wound
  • hpersensitiivy
  • Inability to tolerate pressure

more scattering occurs

less penetration

66
Q

Sweeping technique

Laser

A

Can be direct contact or held over the tissue.

Applicator moved over an area

67
Q

LED

A

Light emission Diod

Lower intensity

More spread (multiple diods)

multiple wavelengths

longer treatment (because of decreased energy)

68
Q

LED indications

A

Wound care

Increase vascularity

Thermal effects

Specific infections

Trigger points

Accupunture points

Dermatologic dx

Myofacial pain

Joint pain

Diabetic peripheral neuropathy

  • Improve sensation
  • Decrease pain
  • used along with exercise
  • Short term effects
69
Q
A