Chpt. 6 Foundations Flashcards by Jenny Wambold

What are 3 types of electro Therapy (E-Stimulation)?

1) Electrotherapy
2) Electrodiagnosis – interpreting the response of nerves and mm to stim
3) EMG – electromyography

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What is NMES?

Neuromuscular electrical stim

– stimulating innervated mm (muscles) to restore function. Includes strengthening and muscle re-ed

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What is TENS?

Transcutaneous electrical nerve stim.

– pain management through skin electrodes

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What is IFC?

*most liked by patients

Interferential Current –

4 electrodes. Used for pain. 2 currents – interfering.

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What is EMS?

Electrical Muscle Stimulation

– done to maintain muscle viability

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Positive charge of the proton in the nucleus is balanced by the ____ electrons outside

negative

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Movement is caused by losing electrons, and is therefore called:

electricity

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**What are 3 UNSTABLE ions , that are used in axon (nerve) movement for example?

sodium
potassium
calcium

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What is the difference between atom and ion?

an ion is lacking an electron

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What is all matter composed of ?

atoms and ions

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**What are 8 different atoms in your BODY?

carbon 
nitrogen
hydrogen
calcium 
phosphorus
*sodium
potassium 
magnesium

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What ion is Highly reactive ion because it is so unstable (one extra electron) ?

sodium

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*What is a conductor ?

made of material that are composed of reactive atoms

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*What is an Insulator?

materials with atoms that have stable outer shells

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What is a really good conductor ?

- therefore it is used as gel for electrical stimulation (ex. TENS)

water

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What is a really good insulator?

skin (fat)

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Where the nerve enters the muscle is the ____ ?

motor point

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***Electrons flowing continuously in 1 direction is called what?

Direct Current (DC)

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What is an electric current?

he actual flow of electrons in a conductor

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What is a current (I) measured in?

***What is a Therapeutic current flow measured in?

(A) ampere

mA ( milli amperes)

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The more Voltage (V) the more what ?

power

ex. the more you open up the water tao, the more comes out

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What is Resistance (r) ?

What is it measured in?

ease or difficulty of current moving through substances

(Ohm)
All materials offer some resistance to current flow

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What is Impedence?

What is both resistance and impedence measured in?

opposition of electrical circuits to flow of AC

-Ohm

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What is the formula for Ohm’s Law?

V=I x R

Voltage=Current x Resistance

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Current and Resistance are ____ related ?

inversely

What is directly proportional to Current flow ?

Voltage

What are the 2 types of "flows" or electrical current in the body ?

- electron flow | - ionic flow

How is an acidic (HCL=hydrochloric acid) environment created which isn't very good for you?

Negative ions are driven towards the positive pole (anode)

***How does TENS work ?

stimulates sensory sodium and potassium crosses the membranes

What is Saltitory conduction (happens on mylenated nerve) ?

happens in TENS | *positive and negative current switch directions the whole time= flipping back and forth

Where does the TENS need to be located on your body when in use?

peripheral nerve

** What is Biphasic pulse and why is it important?

One direction of current flow in (+), stops, flips, other direction (-) etc. *Has a Gap between switching directions to prevent HCL (hydrochloric acid)

Assymetrical Byphasic used in TENS and NMES and is what?

- similar to biphasic but it FEELS good for patients because it it NOT symmetrical (first a square then a a triangle etc.)

What is monophasic pulse?

has one phase; always unidirectional (+ ve or -ve)

*3 important things to know how to use a TENS machine?

1. Amplitude- Adjust current (like turning up volume) 2. Pulse Width 3. Frequency

What is Peak amplitude? Higher peak is deeper ___ ?

maximum current delivered in one phase deeper penetration in to tissue

What 4 levels stimulation, is E-stim capable of generating?

1. subsensory 2. sensory 3. motor 4. noxious

*The longer you have a Pulse Width on, the more you stimulate what neuron? Longer Pulse width= Short Pulse width=

Stimulate Motor neurons Longer Pulse width= motor Short Pulse width= sensory

***What is High Rate TENS? Feelings? And what conditions is it used for usually?

High frequency + Low width pulse; - stimulates A-Beta fibers * tingling/buzzing* -ACUTE

***What is Low Rate TENS? Feelings? And what conditions is it used for usually?

Low frequency + High width Pulse -stimulates A-Beta and A-Alpha * twitching= release of endogenous opiates=pain relief) - CHRONIC

Why do we need adjustments of frequency? (2)

- Switch response | - Depth of penetration

What is Rise/ramp time?

the time it take for the amplitude to increase from zero to peak amplitude

What is Decay time ?

– time it takes for peak amp to decrease back down to zero

What is the relationship between pulse width and frequency?

inverse relationship

What is Pulse width?

Duration of a pulse wave

What is the Most therapeutic frequencies range?

1-120 Hz

Why is Duty cycle important?

for rest time | *ratio of on to off time (1:4)

**Why do we change pulse width for TENS?

Sensory to motor stimulation

What is Modulation in TENS?

* to vary one or more of the electrical parameters | * to prevent accomodation (your body getting used to it)

What are the 3 different types of modes in TENS?

- burst - modulated - continuous

**Why do we use TENS?

pain relief

What are 6 indications for Electrical Stimulation?

- Pain mgmt - muscle strengthening - stimulation of denervated muscle - wound care - fracture healing - circulation and edema management

** What are 5 CONTRAINDICATIONS for E. Stim?

- Pregnancy – over the uterus. - Pacemaker – not over pacemaker - Cancer- not over cancer site. - On or near DVT - Over the carotid sinus

***What are 4 SAFETY considerations for E. Stim?

- Electrical “shock” is first felt as tingling at 1mA - Motor response occurs at 5mA - An inability to let go occurs around 20 mA - Ventricular fibrillation – 80 mA. (Ventricular defibrillation=electric shock given, to start heart again) – 6A. Burns at 12 A

**What are 4 Pre-treatment guidelines?

- **Ask history of ES (experience with electrical stimulation) - Ask about CI’s (Contraindications) - Inspect skin (ex. if medal staples) - Sensation check

**During Treatment Guidelines?

- give patient instructions on what to expect (ex. TENS= comfortably strong NMES=need contraction) -give patient call BELL

What are the 2 types of EXCITABLE CELLS?

- nerve cells | - muscle cells

What does EXCITABLE mean?

the cells have the ability to have their cell membranes altered to allow ionic changes in potential across the membrane (forcing the movement of sodium/potassium across membrane

What is the RMP (Resting Membrane Potential)?

-60 - 90 mv

**What is Action Potential?

-reaching THRESHOLD (which causes a rapid reversals of polarity)

**What do Nodes of Ranvier do?

-speed up transmission (because myelin sheath jumps from space to space to speed it up)

(What are T tubules and the sarcoplamic reticulum?)

- transverse tubule: a deep hole - plasma membrane of muscle (-allow depolarization of membrane to quickly penetrate to the interior of the cell)

What is neurotransmitter?

a chemical substance that transfers the impulse to another nerve fiber (by crossing a synapse)

What is the function of calcium?

calcium channnels open and calcium rushes into the neutron terminal during an action potential - "calcium influx"

What is Tetany? | How does strength of contraction increase?

a sum of twitches | -more motor units recruit/contract

When we VOLUNTARILY stimulate mm (muscle) we recruit which motor units (large or small)?

small=Type 1 first

When we stimulate with ELECTRICAL stimulation, we recruit which motor units (large or small)?

Large=it's reversed from voluntarily contracting muscle * your muscles fatigue!

What are the 2 excitable cell properties that effect how much of a stimulus is required for depolarization ?

- Resistance | - Capacitance

What does A-Alpha respond to

- Short duration and | - Low Intensity

Positive pole is: | Negative pole is:

- anode | - cathode

What kind of relationship is there for Current Density and SIZE (of electrode)?

inverse relationship

Smaller electrodes permit deeper...

penetration

Where is calcium stored?

- sarcoplasmic reticulum | of the muscle cell