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Integumentary Mid Term > E-Stim > Flashcards

E-Stim Flashcards

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1
Q

What is electricity?

A

is the force created by an imbalance in the # of electrons at 2 points, aka poles

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2
Q

what is polarity?

A

refers to net charge of an object

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3
Q

How does a charge travel?

A

by the path of least resistance

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4
Q

What is voltage?

A

the force of attraction or repulsion created by an electric field, greater the force the greater potential energy

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5
Q

What are the ions in our body?

A

sodium, potassium and chloride. the more ions present the greater electric potential

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6
Q

What are good conductors of electricity in the body?

A

water, nerves, muscle, body fluids

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7
Q

What are not good conductors?

A

adipose tissue

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8
Q

What is current?

A

rate of flow of electricity in response to voltage

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9
Q

What us Ohm’s Law?

A

Current (I)= voltage/ resistance

more resistance to current the less current or flow there will be

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10
Q

How can we decrease resistance of skin?

A

clean area with alcohol swab, heat area if cold, optimal electrode placement

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11
Q

Does a smaller or larger electrode have greater current density?

A

smaller area, higher the current density the more intense the effects

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12
Q

What are three types of e-stim currents?

A
  1. Direct Current (ionto)
  2. Alternating Current (IFC and Russian)
  3. Pulsatile Current (mono or biphasic)- can either be direct or alternating
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13
Q

Which type of current is most commonly used for modalities?

A

pulsed

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14
Q

What is direct current?

A

continuous unidirectional flow of charged ions for atleast one second

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15
Q

What are important things to remember with DC?

A

it has a known polarity like with ionto

the body is given no break so the pt is at risk for a burn

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16
Q

What is AC?

A

continuous bi directional flow of ions and must change direction at least one time per second

no polarity as electrons are constantly moving

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17
Q

What is a monophasic pulsed current?

A

interrupted uni directional flow of ions, even though there is a known polarity this setting is usually more comfortable

used a lot for wound care

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18
Q

What is a biphasic current?

A

interrupted bi directional flow of current, alternating btwn positive and negative

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19
Q

What are three components or biphasic

A
  1. Symmetrical vs Asymmetrical
  2. Balanced vs Unbalanced
  3. Shape of phase
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20
Q

Why is PC preferred to DC for muscle strengthening?

A

bc of the pulses the muscle is able to contract and relax due to depolarization

DC will only contract muscle once and not repolarize it

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21
Q

What is pulse duration?

A

time from start to end of all phases of a pulse

stimulus must be long enough for depolarization for ions to change

longer duration tends to decrease comfort

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22
Q

What are three time dependent characteristics?

A

phase and pulse duration and interpulse interval

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23
Q

What are the 3 excitatory phases produced by estim?

A

sensory, motor and pain

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24
Q

In order to reach motor reaction more comfortably what should PT do?

A

increase phase duration before intensity

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25
What are desired duration levels for each response?
20-100 usec- sensory 200-400 motor 400-1000 noxious
26
What is a sensory level response to estim?
pins and needles feeling due to stimulation of A beta fibers
27
What is a motor level response to estim?
muscle tetany to twitch to full muscle contraction A alpha nerve fibers
28
What is a noxious level response to estim?
elicits perception of pain, A delta and C fibers
29
What is the main amplitude characteristic?
intensity- measure of magnitude of current or voltage
30
Which type of wave form is reported as most comfortable?
symmetrical biphasic
31
Which waveform is preferred to stimulate large muscle groups?
symmetrical biphasic, most like an AP
32
T/F: All wave forms are capable of reaching peripheral nerves?
True
33
Which waveform poses least risk for skin reaction?
symmetrical biphasic
34
Which wave form is best for wound healing?
monophasic
35
What is pulse frequency?
number of pulses in a second, defines the quality of muscle response
36
What is desired frequency for Sensory TENS?
80-120 pps
37
What is desired frequency for motor tens ?
2-4 PPS
38
What is desired frequency for noxious tens?
2-4 or 50-150 pps
39
What is desired frequency for muscle re-ed?
30-75 pps
40
What are two ways to prevent accommodation?
vary frequency- sweep | vary intensity- scan
41
Under cathode or anode will depolarization happen more easily?
cathode, this is bc nerve is positively charged on outside and neg. on inside so nerve will be more excitable with cathode and less with anode
42
In what order do nerves depolarize?
sensory, motor, pain and muscle fiber
43
What are the three types of pain nerve fibers?
A, B, C
44
What are A fibers?
large, myelinated, fast condutcing
45
What are a-alpha fibers?
for proprioception and somatic (voluntary) motor
46
What are a beta fibers?
touch and pressure
47
What are a gamma fibers?
motor to muscle spindles
48
What are a delta fibers?
pain, temp and touch
49
What are B fibers?
small, myleinated, conduct less rapidly
50
What are c fibers?
smallest, unmyleinated and slowest 1. dorsal root- pain, reflex response 2. sympathetic- post ganglionic sympathetic
51
What type of fiber type is myleinated pain receptors?
a delta, felt most with ionto
52
What type of fiber type is unmyleinated pain receptors?
c fibers, need hogher intensity and duration
53
What is the pain transmission path?
some type of stimulus activates nociceptor 1. neuron - spinal cord 2. dorsal horn of spinal cord-ascending spinal thalamic tract 3. tract to thalamus/sensory cortex
54
What is gait control theory?
brain can only receive so many pains signals, therefore to control nerve impulses to brain the worst pain wins
55
What is descending pain control?
opiate mediated, natural pain control endorphins are released to help control pain prob wont work w/ someone with opioid addiction
56
What are different types of endorphins?
short acting- enkephlans | long acting- serotonin, dopamine
57
Why is cardiac pacemaker/ arrhytmias a contraindication for estim?
effects ions for cardiac muscle
58
How does placement of pads effect deepness of penetration?
further away the two electrodes the farther deeper it goes but will also require greater intensity
59
What are the main uses for estim?
1. muscle strength/activation 2. muscle retraining (motor control) 3. pain control 4. increase circulation 5. decrease edema 6. increase tissue healing
60
What is TENS?
transcutaneous electrical nerve stimulation usually biphasic symmetrical- more comfortable biphasic asymmetrical- better for accomodation no polarity
61
What are three types of TENS?
sensory, motor, noxious
62
What is sensory tens mostly used for?
acute pain management using gait control theory, short acting enkephalins
63
What is motor level tens mostly used for?
chronic pain or long lasting relief, produces muscle twitch to help relieve muscle spasms
64
What is noxious tens mostly used for?
rarely used but for severe pain, wound debridement and trigger points short cuts pain loop and brain can only feel this pain
65
What is monophasic pulsed estim used for?
pain control, wound healing (great option), edema reduction (muscle pump), muscle facilitation known polarity, quick so not as much is felt
66
What is BMAC?
burst modulated alternating current or russian burst provides great depolarization
67
What is important for pt to do after russian tx session?
do volitional contractions to enhance neuromuscular affect
68
How many reps should pt perform with russian?
10? not too many as all muscle fibers fire causing muscle to fatigue faster
69
What is IFC?
interferential current, alternating currents of different frequencies that interfere with eachother
70
What is IFC used for?
used for pain modulation, acute chronic and muscle spasms greater depth of penetration and covers large area
71
What are two different types of frequencies with IFC?
1. Carrier- usually at 4000 hz | 2. beat- diff of two frequencies
72
What is unique about electrode set up?
always use 4 electrodes so 2 currents intersect each other quadpolar
73
What is a FES?
functional estim used for muscle re ed for functional and purposeful movement
74
What frequency used with FES?
20-60 pps to induce contraction but not too hard to decrease fatigue
75
What is NMES?
neuromuscular education, used for muscle strengthening through improvement of motor recruitment
76
What are advantages on NMES?
symmetrical biphasic so less skin irritation phase duration, pulse frequency, amplitude and duty cycle can all be manipulated
77
What else is NMES used for?
ROM, prevention of joint contracture, prevention of disuse atrophy can be used when limb immobilized to slow onset of atrophy might be better than russian for elderly as less intense
78
What are precautions when using NMES?
intense or prolonged session can produce soreness avoid placement over tendon injury as it can pull tendon off bone, avoid where bony attachment is not secure
79
What is important to remember for monopolar set up?
there is only one single active electrode, smaller pad is active and has higher current density
80
Why is estim good for wound managment?
bc the estim attracts neutrophils, macrophages. lymphocytes
81
For debridement what cells are recruited and what is polarity?
macrophages and neutrophils, anode
82
infection?
active neutrophils, anode or cathode to attract active neutrophils
83
Granulation?
fibroblasts, cathode
84
wound contraction?
myofibroblasts, cathode
85
epitheliazation?
keritinocytes and epidermal cells, cathode
86
What should we document with estim?
1. type of waveform 2. waveform parameters 3. electrode placement, size etc. 4. patient position 5. dosage 6. treatment duration 7. pain pre and post?

Integumentary Mid Term (11 decks)

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