Electro Final review Flashcards
(396 cards)
1
Q
kinetic energy
A
thermal
mechanical
electrical
magnetic
2
Q
potential energy
A
chemical
elastic
nuclear
gravitational
3
Q
conduction
A
energy transferred when two objects touch
4
Q
example of conduction modality
A
heat pack
5
Q
convection
A
energy transferred by circulating medium
6
Q
convection modality example
A
whirlpool tub
7
Q
conversion
A
change in matter state, less heat transfer
8
Q
conversion modality example
A
ultrasound turning electrical energy from machine into sound waves
9
Q
what is an electrical charge?
A
subatomic particles experiencing force when placed in an electrical field
field made by electromagnetic intersections of particles’ electrons
approximating electrons generates force and generates movement of current
10
Q
electricity
A
type of energy that can be stored as potential energy and flow as current when turned into kinetic energy
11
Q
current
A
flow of electrons among particles in a circuit/material
12
Q
why are metals conductive?
A
they have free electrons that are not tightly bound to each atom so they are easily moved and influenced by current
13
Q
why is rubber an insulator?
A
it’s electrons are tightly bound and won’t allow electron movement to generate an electrical charge
14
Q
principles of electrical charge
A
opposite charges attract
like charges repel
charges can’t be created or destroyed, only transferred
charges can be transferred object to object
15
Q
cation
A
positive ion
16
Q
anion
A
negative ion
17
Q
coulombs law
A
The interaction between charged objects is a non-contact force that acts over some distance of separation
the forces exchanged by particles depends on how close or far away they are from each other as well as their respective charges and polarities
18
Q
voltage
A
difference in electrical potential energy that can be converted to current when particles are approximated
19
Q
Current
A
movement of charged particles like electrons moving through a conductor
20
Q
requirements for there to be a current
A
needs to be a driving force for particles like a voltage (difference in potential energy)
needs a conductive pathway
difference in electrical potential, meaning one side of the pathway has more electrons than the other side
21
Q
voltage measures:
A
how big the dam is (potential energy difference)
22
Q
ampere measures:
A
how fast electricity comes out (current/flow of electrons)
23
Q
ohm measures:
A
potential for energy to be generated
resistance to current flow
24
Q
ohm’s law (words)
A
the current (volume of electrical particles per s) flowing through two points of a conductor is proportional to the voltage (difference in electrical potential energy) between the two points
this flow is limited by resistance between the two points
25
ohm's law (equation)
I=V/R
I - current
V - voltage
R - resistance
current through a conductor is decided by the voltage between two points and limited by the amount of resistance between the two points
26
conductor
accepts electron exchange and allows electrical flow
27
examples of conductors in body
adipose: poor conductor
muscle and nerves: good conductor
28
resistance
current flowing through a medium that is opposing it
decreases voltage in a circuit
29
in series resistors
current goes through each one at a time
30
in parallel resistors
current goes through all at once
31
capacitance
ability of conductor or insulator to store electrical charge before an AP occurs
relevant for e stim to determine which fiber you're stimulating
32
impedance
opposition to alternating/bidirecctional currents
vs resistance is opposition to one way current
sum of resistive, capacitive, and inductive components of tissue determining current flow
33
alternating current
creates a sinusoidal wave that goes back and forth on same path
34
AP threshold in nerve fibers
resting membrane potential is -70, once it reaches -55 mV an AP will fire down the axon
repetitive stimulus will hyperpolarize and threshold is raised
35
rheobase
minimum amount of stimulus intensity over time needed to initiate a response or AP in a fiber
36
chronaxie
minimum amount of time or pulse duration needed to excite a fiber when the current is 2x the rheobase, or min stimulus intensity to get AP response
37
microcurrent
doesn't meet threshold of sensory nerves but may still have effect on ionic movement
38
Question
Answer
39
biophysical agents include:
modalities of:
electromagnetic energy
thermal energy
electrical
sound
mechanical
40
EM energy modalities
diathermy
infrared lamps
UV therapy
laser
LED
41
thermal energy modalities
heat and ice
42
electrical energy modalities
estim
biofeedback
iontophoresis
43
sound energy
ultrasound
extracorporal shockwave therapy
44
mechanical energy modalities
intermittent compression
traction
massage
vibration
45
IFC current uses
pain modulation
muscle re ed
pumping contractions
fracture healing
increase ROM
46
russian current uses
muscle strengthening
47
low volt estim currents usage
wound healing
fracture healing
iontophoresis
48
Question
Answer
49
components of naming current
balanced or unbalanced
symmetry/asymmetry
shape
alternating/mono/bi current
50
balanced current
area under each pulse on a graph is symmetrical
shape may be different but if area under each is the same it is still balanced
51
alternating current
current flows in both directions on a circuit
eg wall outlet, changing directions many times a second
52
direct current
current flows one direction in a circuit
eg: battery
53
phase
current flowing in one direction for a definite amount of time
eg: only positive part of biphasic pulse
54
phase duration
time from beginning of one phase of pulse/cycle of alternating current
55
pulse duration
time from beginning to end of one pulse
56
interphase interval
period of time of no electrical activity between two phases
57
what does lengthening duration of phase do to fiber recruitment?
it increases recruitment due to longer time for the electricity to meet capacitance of tissue
58
current density and electrode size
smaller electrodes will deliver greater current density and higher stimulation intensity due to the same amount of voltage being spread over a smaller area
too small electrode can lead to harmful densities and damage tissue
59
rise time
time for leading edge of phase to increase from zero to peak amplitude
decay time is opposite
60
amplitude modulation
variation in peak amplitude among pulses (mA)
61
phase/pulse duration modulation
vary phase or pulse duration in a series of pulses (ms)
62
frequency modulation
vary frequency among pulses
63
duty cycle
ratio of on time to the total time of stimulation, expressed as percentage
64
burst
series of pulses or cycles of aAC delivered during the ON period of the stimulator
65
burst duration
length of time of burst in ms bc many combined pulses
66
burst frequeny
bursts per second
67
direct current
current running for one second or greater in one direction
68
alternating current
continuous bidirectional flow
symmetrical (most are this)
asymmetrical (creates polarity, uncommon)
IFC and russian are AC
69
IFC actual current name
medium frequency beat/ampltiude modulated alternating current
70
russian actual current name
medium frequency burst/time alternating current
71
how does IFC work?
two sinusoidal AC currents differing in frequency
where the frequencies intersect they summate, resulting in higher or lower amplitudes
creates beats of varying amplitudes
72
rms of current
root mean squared
area under the curve is how much current pt is getting
need to be able to metabolize and disperse heat from current transferring energy to tissue
73
uses of IFC
as TENS: pain management, other applications liek joint mobs/ROM
decrease chronic edema
74
what is IFC not good for?
not good for use with small electrodes due to high RMS, however if machine is constant voltage generator is better
not good for generating polarity like acute edema or wound healing
75
uses of russian current
regain muscle strengtgh with strong enough force
regain ROM if strong enough contraction
decrease chronic edema
76
russian current is not good for:
not good for use with small electrodes due to high RMS, however if machine is constant voltage generator is better
not good for generating polarity like acute edema or wound healing
77
pulsative current
noncontinuous flow of direct alternating current
types: HVPC or monophasic, biphasic, polyphasic
78
HVPC
twin peak pulses with monophasic PC current
pulse duration: 5-20 usec, very short
amplitude: 2000-2500, very high
RMS is low due to short duration with high amplitude
79
uses of HVPC
create weak polarity due to monophasic wave
can excite sensory, motor, and pain fibers due
+ disuse atrophy, chronic edema
80
HVPC should not be used for:
large muscle groups
denervated muscle
iontophoresis, which requires a stronger polarity
81
calculate current density
current / area of electrode
82
high RMS currents
russian
IFC
must be used with larger electrodes
83
low RMS currents
monophasic pulsed current
HVPC
biphasic symmetrical pulsed current
84
Question
Answer
85
orthodromic
normal movement down a nerve, AP firing from cell body down axon to terminal
86
antidromic
electrical stimulation causes APs to propagate along peripheral nerve in both directions from stimulus
this creates non physiological loops
87
size principle of motor neurons, physiologic
smaller motor neurons require less synaptic current to produce an AP and will be activated first
in a muscle contraction, the small, 1A fibers will be activated first, then 2A, then the largest 2X
SMALL to LARGE
88
size principle in estim
because estim is activating nerve fibers antidromically, it will activate those with the least resistance first
the largest nerves have the lowest internal resistance and will be activated before smaller ones
LARGE to SMALL
89
using the size principle, why does NMES have a rest time?
estim recruits hast fatiguable fibers first, so they need a rest time to repolarize
90
rate coding
increased rate of motor unit discharge will increase muscle tension and fiber recruitment
91
physiologic discharge rate
30 pps
this is the critical fusion rate to get organized muscle contraction
under this level you will get fasciculations
going over this rate will increase fatigue
92
asynchronous recruitments
smooth switching between active and inactive units to avoid fatigue in fibers
this means discharge frequencies are not the same in all motor units to create functional movement
93
synchronous recruitment
the same motor units are continually activated based on level of current and fibers' resistance levels
estim does this and activates fatiguable fibers first, increasing fatigue levels
94
how does electrode placement affect recruitment?
size principle is often overridden by electrode placement, as it is easier for current to activate fibers that are closest
smaller fibers that are in closer proximity will be activated before larger fibers that are farther away
95
how to get smooth contraction with estim
ramping: offset lack of rate coding
frequency: 30 pps or greater for tetanic contraction
on/off: allow rest for recruited fibers to offset synchronous activation effect
electrode placement: allow specificity of recruitment
96
optimal contraction with estim
combine estim with voluntary contraction
voluntary contraction recruits slow fibers and estim recruits fast fibers
97
Question
Answer
98
Conventional TENS use
temporary pain relief while stimulator is running
AKA high frequency TENS
Uses gate theory to control pain short term
99
Conventional TENS parameters
Wave: symmetric biphasic
Frequency: 50-100 Hz
Duration: 50-100 (<200 usec) to stimulate sensory but not motor
Intensity: pt comfort, tingling sensation
Continuous current
Used 10-20 min at a time
100
Strong Low rate TENS uses
slightly longer term pain relief after stimulator is removed, a few hours post
AKA low frequency TENS
Uses endogenous opioid release
101
Strong Low rate TENS parameters
Wave: symmetric biphasic
Frequency: 2-4 Hz, to get twitch and not held contraction
Duration: 150 usec +, get motor response at lower intensity
Intensity: generates muscle contraction, less comfortable for patient, around 40 mA
Used 10-15 min
102
Brief-Intense TENS uses
used during painful therapeutic procedures
Type of high frequency TENS
103
Brief-Intense TENS parameters
Wave: symmetric biphasic
Frequency: 60-150 Hz
Duration: 50-250 usec
Intensity: about 40 mA, may get fasciculations and should create paresthesia
104
Pulse burst TENS use
pain relief along with muscle contractions, more comfortable way to get the muscle contraction vs strong low rate
Type of high frequency TENS
105
Pulse burst TENS parameters
Wave: symmetric biphasic, bursts
Frequency: 60-100 Hz
Burst frequency: .5-4 pps (low)
Duration: 50-200
Intensity: low or high
high for tetanic m contraction and paresthesia - for chronic, deep pain
Low for pulsating paresthesia - for acute superficial pain
106
Modulated TENS uses
TENS will automatically change output characteristics (duration, amplitude, or frequency) by given percentage from initial level
Conventional TENS with modulation setting
107
Noxious TENS uses
hyperstimulation like electro acupuncture
Uses endogenous opioid theory
108
Noxious TENS parameters
Wave: direct or monophasic pulsed current
High current density though probe stimulator (1-3 mm)
Frequency: 1-4 Hz
Duration: 500 ms
109
FES NMES uses
functional e stim, used as a dynamic bracing/orthotic support for a hemi, scoliosis, shoulder subluxation, AFO
Decrease frequency and duration if using on smaller muscles like deltoid and supraspinatus
110
FES NMES parameters
Frequency: 20-30 Hz?
Duration: 30 usec
Intensity: get m contraction
Ramp: slow, 2-3 seconds to avoid triggering spasticity
on/off: 10-15 sec on
Duty cycle: 1:3, longer rest periods to reduce fatigue
111
ROM NMES uses
placed on reciprocal muscle groups to range a joint
Complete 200 reps of ROM daily to gain new range, 50-100 to maintain
1-4x day for 3 wks-6 mo
112
ROM NMES paramters
Wave: symmetric biphasic pulsatile current
Frequency:
Duration: 200-300 usec
Intensity: enough to generate full ROM (3+) in joint
Ramp: 1-2 sec
Duty cycle: 1:1 (% time it is active, rest and active times are equal)
113
Spasticity NMES uses
reduce acute spasm or UMN lesion spasticity, used as a contract relax/hold relax PNF
Use on antagonist, agonist, or both in alternating form
114
Spasticty NMES paramters
Wave: biphasic pulsatile current
Frequency: 20-30 Hz
Duration: 250-300 usec
Intensity: induce at least grade 1 muscle twitch
Duty cycle: 1:1, 2:1
Ramp: 2-10 seconds for on/off
115
Edema reduction NMES uses
reduce edema in joint in combination with elevation, especially useful when pt does not have active control of the joint to range it such as a hemiparesis
116
edema reduction NMES parameters
Acute: 2-3 days post
Wave: monophasic pulsed HVPC
Frequency: 100-125 Hz
Duration 2-100 usec
Intensity: just below motor activation
20-45 min
Chronic
Wave: biphasic or burst
Frequency: 20-80 Hz
Duration: 100-600 usec
Intensity: tetanic contraction
Duty cycle: 1:1, 3 sec on 3 sec off for 10-20 rhythmic contractions
117
strengthening NMES parameters
aka russian
Wave: biphasic
Frequency: 30 pps or 50 bursts per sec
Duration: 100-500, often 300 usec
Intensity: contraction at 60-70 MVIC
Ramp: 1-5 sec up and down
Duty cycle: 1:3 to 1:5, more rest than active
118
motor re-ed NMES parameters from google
frequency between 20-50 Hz, pulse width of 200-400 microseconds, a ramp time of a few seconds, and an on:off time ratio of 1:3 or similar
119
Question
Answer
120
types of electric shock
macroshock - damaging
microshock - painful
121
leakage current
normal if within an acceptable range
122
parts of the electrical outlet
hot: narrow prong slot
neutral: wide prong slot
safety ground: lower slot
123
GFCI: ground fault circuit interruptor
shuts down outlet if there is too much current flowing
124
physiological effects of different amplitudes of current
0-1: imperceptible
2-15: tingling, muscle contraction
16-100: painful electric shock
101-200: cardiac/respiratory arrest
200+: tissue burning/destruction
125
CV contraindications to e stim
DVT
heart failure - local
pacemaker - local
chest - no NMES
arrhythmia
heart disease
active bleeding
hemorrhagic disorder
area of impaired circulation or sensation for NMES and TENS respectively
126
UG contraindications to e stim
pregnant women, on LB, abdomen, and no NMES anywhere
reproductive organs without training
127
disease process contraindications to estim
cancer
TB
infection
osteomyelitis
radiation
seizures - head and neck
damaged skin resulting in uneven conduction
unstable area from fracture, surgery, osteoporosis - no NMES
128
general area contraindications to estim
areas that could cause electronic device malfunction
eyes
anterior neck
carotid sinus
impaired sensation
people who can't communication/cognition
NMES: chest, intercostals, lower abdomen
129
precautions to estim
All: active epiphysis
person with skin disease
HVPC:
cog/comm impairments
impaired sensation
impaired circulation
superficial regenerating nerves
chest wall/lower abdomen
130
Question
Answer
131
what is ultrasound?
acoustic energy
not audible
>20,000 Hz, usually frequency in therapeutic range of .7-3.3 MHz
132
therapeutic function of ultrasound
deep heater of small areas in the body
133
How does ultrasound heat?
waves transmit energy by cycles of compressing and rarefacting material, these pulses propagate through tissue and produce heating
134
rarefaction
decreasing an item's density, the opposite of compression
135
piezoelectricity
ability of some materials like crystals or ceramics/bone to generate an electric potential in response to applied mechanical stress
136
how does a piezoelectric crystal generate an electrical charge?
separation of electric charge across a crystal lattice
this charge creates a voltage across the material
crystal expands and contracts to create an ultrasound frequency
137
direct peizoelectric effect
production of electricity in a material when electricity is applied
reversible
138
converse peizoelectric effect
production of stress or strain when an electric field is applied
139
near field
convergent area of beam
where rays are aligned, more intense
140
far field
where beams diverge
less intensity
141
which frequency penetrates deeper, high or low frequency?
low frequency gets deeper tissue
higher frequency heats more shallow depths
142
when ultrasound meets tissue, it causes 5 effects:
| of waves
pulse
scatter
absorption
reflection and transmission
143
refraction
waves bend slightly and change direction as they enter tissue instead of going straight down
144
reflection
return of energy, waves bounce back
waves move back in the opposite angle
increases at skin with poor ultrasound head contact
dangerous if bone reflects waves into soft tissue as it can create burns
145
absorption
conversion of the mechanical energy of an ultrasonic wave into heat
higher frequency increases absorption
wave goes into tissue
146
attenuation
absorption 50% + reflection and refraction 50%
increases with higher frequency
147
scatter
combination of refraction, diffraction, and reflection
wave moving in many/any direction other than the target
148
absorption coefficient
tissue and frequency dependent
highest for tissues with highest collagen content
higher coefficient means more heat is absorbed
149
attenuation coefficient
tissue and frequency specific
higher in tissues with a higher collagen content
150
which tissues respond best to ultrasound?
high absorption coefficient
high collagen content
poor response in those with high water content
151
heat behavior in tissues: which tissues have the greatest rise in temperature?
tendons rise up to 14-15 degrees
muscle rises around 5 degrees
152
how does scattering of ultrasound waves apply to multiple layers of tissue?
scatter effect occurs at each layer, and only waves that are absorbed transmit to the next layer where they are scattered again
this results in a loss of heat at greater depths
153
tissues best suited to ultrasound include:
tendons
ligaments
joint capsules
fascia
154
fat and ultrasound
fat can be overheated, need to be careful when applying ultrasound to area with overlying fat
155
is ultrasound effective at heating muscle?
Not well
low absorption coefficient
muscles are often too big and deep
156
half value depth
tissue depth at which 50% of the ultrasound delivered has been absorbed
157
half value depth of 3 mHz
2.5 cm
158
half value depth of 1 mHz
4 cm
159
power
amount of acoustic energy per unti time
watts
160
intensity
amount of power per area
W/cm2
161
frequency
number of cycles per unit time
Hz
cycles/s
162
spatial average intensity
average intensity of US input over the area of the transducer
163
spatial peak intensity
peak intensity of US output over area of transducer
greater in the center and lower in the periphery
164
effective radiating area
area of crystal from which US waves radiate
165
beam nonuniformity ratio
BNR is ratio of set intensity to max peak intensity
2:1, 3:1 is safe, 6:1 or higher is dangerous and can form hot spots
166
pulsed US
some on/off time
percentage of on time or ratio of on/off
167
duty cycle
on:off time in total cycle time
1:5 is 20% on, 2 s on 8 s off
168
non thermal effects of US
cavitation: sonically generated gas activity
acoustic streaming: circular flow of cellular fluids
microstreaming: eddying near vibrating object, gas bubbles oscillating, causing cellular effects
169
why do you need to move US head?
if it is held in the same place the same wave will be repeated over the same path, leading to extreme heating
170
does 3 or 1 MHz heat faster?
3 MHz, by factor of 3
1 Mhz heats at .2 C/min
171
changing which parameters leads to faster heating
increasing intensity, frequency
applying to higher protein tissue
getting more reflection
172
effects of heating on the body
increase metabolic rate/enzyme activity rate
vasodilation
increased collagen extensibility
decreased neural sensitvity
increased pain threshold
decreased m spasm
altered n conduction
173
non thermal effects: physiologic
increased:
membrane permeability
intracellular Ca
mast cell degranulation
Histamine release
proteinn synthesis rate
fibroblast stim
macrophage
174
indications for US
soft tissue shortening
pain control
dermal ulcers
surgical incision
tendon injury
resorption of Ca deposits
bone fracture
carpal tunnel syndrome
phonophoresis
plantar warts
herpes infection
175
How does US help ulcers?
nonthermal effects cause wound contraction, protein synthesis
accelerate healing of infected wounds
176
How does US help tendon healing?
faster recovery of tendon strength
177
phonophoresis
facilitate transdermal drug delivery with ultrasound for local and systemic drug delivery
178
appropriate size treatment area is:
2-4 times the size of the ERA
effective radiating area of head
179
application patterns of US
overlapping circles, completing 1 circle in 2 s
longitudinal strips overlapping and alternating directions creating a rectangle
180
pulsed vs continuous: thermal effect
100% max thermal effect
50% mod thermal effect
20% no thermal effect
181
contraindications to US
pregnancy - abd/low back
active epiphysis
cancer
TB
bleeding dx
impaired circulation
myositis ossificans
DVT
acute injury
radiated tissue
impaired sensation
implanted devices
repro organs
eyes
anterior neck
implants
regenerating nerves
182
ionto
method of delivering med ions through intact skin
alternative to IV or parenteral delivery
183
how does ionto work?
direct current pushes meds into dermis and tissue using coulombs law of like charges repelling
184
general types of meds used in ionto
anti inflammatory
anesthetic
prescription
185
advantages of ionto over injection
no trauma to skin from puncture - decreased infection risk
less meds into blood supply - less systemic effect
relatively painless
186
direct current
uninterrupted flow of electricity in one direction in circuit
187
disassociation
compounds placed in a solution disassociate into positive and negative ion components and more +/- state
188
ion pole attraction
positive cations will be attracted to the negtaive pole/cathode and repelled from positive pole anode
189
cathode
negative pole
attracts positive and repels negative
190
anode
positive pole
attracts negative and repels positive
191
hydrolysis
compound split into ions in water
electrical current causes water to split in OH- and H+ which affect pH
192
the anode creates what pH reaction and why?
acidic reaction
H+ are repelled from positive anode to skin making it more aciidic
193
the cathode creates what pH reaction and why?
OH- are repelled from negtaive cathode and into skin creating basic reaction
194
three mechanisms of movement of ions into the tissue
1. electrical repulsion of charges
2. electroporation increasing openings in skin surface
3. electroosmosis: movement of water and sodium towards cathode creating a stream ions move on
195
how much current through anode vs cathode
in a complete circuit, the same amount of current flows through both
196
dispersive electrode
larger than the active electrode to decrease current density at that electrode
reduces risk of discomfort or skin irritation
197
chemistry under the electrode in ionto
electrodes repel hydrolyzed ions of the same charge, changing the pH at the skin as ions build up in number
can cause irritation or burns
198
is negative pole or positive pole delivery stronger? Which should you use a smaller amplitude current with?
negative pole is stronger and should use a smaller amplitude over a longer period of time
199
if drug dissociates into a relatively negative charge, which pole should the medication be placed on?
negative pole or cathode because this pole will repel the medication and push it into the tissueg
200
if a drug dissociates into a relatively positive charge, which pole should it be placed on?
positive pole or anode because this pole will repel the medication and push it into the tissue
201
active electrode
treatment electrode containing the drug
monopolar set up
202
why can ionto only be used with ionic solutions?
the cathode and/or anode only repel ions which is the mechanism for getting the medication into the tissue
203
negatively charged medications include:
dexamethasone
acetic acid
sodium chloride
potassium iodide
204
criteria for ionic medications which can be used with ionto
charged ions produced
relatively small ions w molecular weight <8000 daltons
medications in a solution
should only be used on surface tissues
205
why is direct current used in ionto?
it creates unidirectional, constant flow of medication
be careful of negative side effects like pH changes due to polar effects
206
side effects of negative pole/cathode/black electrode
alkaline reaction or burn
depolarization
proteolysis and tissue softening
bacteriostatic
207
side effects of positive pole/anode/red electrode
acid reaction or burn
hyperpolarization
proteoscleriosis and tissue hardening
increased healing
208
which factors affect current amplitude that should be used?
patient tolerance
polarity of active electrode
size of the active electrode
duration of treatment
209
dosage of treatment means:
amount of charge that is delivered which has a direct relation to the quantity of ions delivered because the charge is delivering the dose
210
calculate dosage
dosage mA*min = current mA x time min
eg 4mA x 10 min = 40 mA*min
211
typical PT treatment dosage of ionto is:
40-80 mA*min
212
relationship of duration and magnitude of current in ionto
duration is inversely proportional to magnitude of current
longer delivery time means a smaller current magnitude
213
cathode maximum current density
.5 mA/cm2
calculated based on electrode size/area and current amplitude
negative pole is stronger
214
anode maximum current density
1 mA/cm2
calculated based on electrode size/area and current amplitude
215
will adding more drug to the electrode increase delivery?
NO
ionto is current limited and drug delivery is determined by current amplitude and duration
216
can you mix drugs on ionto electrode?
no, creates competition for which is delivered and reduces effects of both
217
competing ions
ion present in the electrode of a solution with the same change as the therapeutic ion being delivered
they compete with therapeutic ions to be delivered through the skin
decrease efficiency of delivery, especially with smaller more mobile ions like CL-
218
you should increase or decrease blood flow while using ionto?
decrease blood flow to systemic areas
we want to keep medication in the general area and not increase circulation systemically
219
clinical applications of ionto
size limited area
surface level depth
localized conditions so electrode can cover area
220
drug penetration factors
type of drug
size and location of structure
current dosage
current density
skin thickness
adipose tissue
221
considerations of electrodes in ionto
don't place electrodes too close to avoid skin irritation and burns from current bridging
redness and blistering under electrode with drug should disappear within minutes to hours, if not pt is not tolerating tx
use lotion or aloe to assist skin recovery
222
In which part of the skin is it easiest for a drug to penetrate?
pores, hair follicles, oil glands
223
buffer
substance that controls pH changes
binds and neutralizes both acidic and basic ions
controls pH and allows greater treatment dosage by decreased risk of burn or irritation
224
indications for ionto
superficial location
inflammation
scarring
Ca deposits
myositis ossificans
antifungal/wound healing/infected wounds
trigger points
225
contraindications to ionto
cancer
pacemaker
pregnancy
implanted electrical device
decreased skin sensation
residual skin irritation from previous treatment
226
dexamethasone
most commonly used ion in ionto
negative ion
decreases acute inflammation by inhibiting inflam response of WBC
half life of 36-72 hours
use every other day
227
acetic acid
second most popular ion
negative
used for calcium deposits or chronic tendonitis causing scarring
breaks down insoluble ca deposits into soluble compounds to allow healing
delivered 3x week for 3-6 weeks
228
sodium chloride
negative ion used at cathode
scar tissue softening and mobilization
interacts with cross binding of collagen in scars to make them softer
229
potassium iodide
negative ion used at cathode
scar tissue softening and mobilization
interacts with cross binding of collagen in scars to make them softer
Kl contraindicated to
230
normal response to iontophoresis
skin will be pink under electrode and fades over hours
sweat retention vesicles form as very small blister like appearance that resorb with time
231
buffered delivery of ionto
competing ions are eliminated by buffer allowing optimal delivery of medication with derceased skin irritation and competition
232
side effects of glucocorticoids like dexamethasone
contribute to tissue breaksown of muscle, tendon, bone, collagen
reduce body's production of these hormones with continued use
leave one recovery day between uses
effects should be seen in 3-4 treatments
233
salicylate
anti inflamatory
inhibits biosynth of prostaglandins
indicated for bursitis, tendonitis
234
positive ions used in ionto
lidocaine
235
lidocaine
positive ion
blocks transmission of impulses of peripheral nerves for anesthetic effect to tissue
loss of sensation increasing risk of burn, used low current
use to decrease pain for interventions
236
opioids and ionto
experimental
not administered over site, instead as slow continuous stream in blood for post op pain
work w Dr
works on peripheral opioid receptors
237
treat soft tissue mineralization
acetic acide from cathode
use for myositis ossificans over 3 weeks
238
lithium in ionto
delivered from anode
demineralizing urate deposits occurring with gout
239
wounds and ionto
ionto can help with infection or facilitate healing with zinc oxide at positive pole
accelerate tissue growth
240
edema and ionto
use hyaluronidase enzyme to increase permeability of connective tissue
draw out excess fluid which is dispersed into vascular and lymphatic systems
241
scar tissue adhesions and ionto
iodine for antimicrobial effects
sclerolytic effects
delivered at negative pole over scar tissue contraindicated due to decreased sensation
242
ionto for hyperhidrosis
apply cathode over affected areas followed by anode with tap water
causes keratin plugs in sweat glands
use 8-20 days as needed and must be repeated
243
Question
Answer
244
intrinsic feedback includes:
vision, proprioception, auditory, somatosensory, smell
occurs naturally as a result of a bodily action or function
245
extrinsic feedback includes:
information by artificial means, not the body
246
biofeedback includes
HR
brain waves
respiratory rate
EMG
247
EMGBF
EMG biofeedback
no electrical stim is applied to the patient
electrical activity from the patient's muscle is monitored by the unit and conveyed through visual or auditory information
248
what does EMGBF detect physiologically?
depolarization of the sarcolemma
249
how does EMGBF help the patient?
muscle activity is converted to auditory or visual cues so patient can increase or decrease muscle activation to perform a movement correctly
250
clinical applications/diagnoses using EMGBF
arthritis
LBP
post op procedures
stroke
CP
pelvic floor musculature
251
is therapist or EMGBF more instantaneous?
EMGBF
reduces processing time required between patient response and feedback as well as time to make an effort to modify patient response
252
is EMGBF used to activate or inhibit muscle activity?
both
253
what does the amplitude of EMG indicate?
size and number of motor units firing
more accurate in isometric
less accurate bc electrode is sliding over skin and isn't over the same exact point on the muscle
254
patients appropriate for biofeedback are:
impaired motor function
impaired muscle performance
muscle spasms from immobilization/deconditioning/MSK or neuro trauma
pain causing increased muscle activity/tone
255
patient considerations to be a good candidate for EMGBF:
good motivation
orientation
cognition
understanding premise of BF training
measurable muscle response by unit and voluntary activation
adequate vision or hearing to receive feedback
CVA: spasticity vs recruitment training
256
CVA considerations in BF training
spastic overactive muscles are likely weak in ROMs they have not moved in
balance relaxation training with recruitment of weak muscles in new ranges
257
functional outcomes of EMGBF
decrease risk of secondary impairments from poor joint movement
perform physical tasks better
complications reduced
joint integrity/mobility improved
258
gain of the signal is:
sensitivity of signal amplitude
259
low vs high amplifications and sensitivity
low amplification is the most sensitive, picks up weak muscle contraction
high amplification is less sensitive and more tuned for strong contraction
260
sensitivity ranges:
0-1
0-10
0-100
0-1000
micro volts (uV)
261
electrode placement and effect on signal
electrode placement close together samples from a smaller section of muscle area, farther apart is a larger area
262
time constant
how often it updates?
set shorter for muscle recruitment for more frequent and quick feedback
set longer for relaxation training for slower feedback
263
threshold detector
on signal is only provided once a particular level of relaxation or contraction is reached
OR
provides an off signal only once a particular level of relaxation or contraction is reached
264
shaping
modifying the threshold level as the patient's control over the muscle changes
raise as muscle activates
lower as muscle relaxes
265
electrode size
chosen based on muscle size
want a large sample of the muscle without recording overflow from other muscles
266
cross talking
specific type of electrical activity produced by agonistic muscle groups
interferes with reception of the muscle group we want to record
267
ground electrode
determines that the appropriate muscle is being recorded and not other electrical activity
can be placed between recording electrodes or on bony prominence in the vicinity
268
how to maintain good conduction with electrodes
use medium like gel added or on electrodes
skin prep with cleaning/abrasing of skin
avoid excessive adipose or scarring
place electrode parallel to muscle fibers
269
Question
Answer
270
contraindications to e stim over a wound
cancerous lesion
osteomyelitis
location of wound over contraindicated area
sensation
cognition
271
current of injury
injured cells have an endogenous electrical current
this current circles around a wound bed's edge as the wound causes electrical "leaking"
greater potential at greater distances from the wound center
272
exogenous current's effect on wounds:
neural tissue: pain relief and healing
wound epidermis
migratory mesenchyme cells: vimentin protein marker on fibroblasts - these cells can create epithelial tissue by organizing into polarized sheets, which can organize to close the wound
undifferentiated cells come to the wounfd and turn into collagen to scar down
273
layers of the epidermis - where will cells migrate in electrical field?
upper layers - cells migrate to anode +
lower layers - cells migrate to cathode -, including monocytes, fibroblasts, macrophages
274
current shown to affect cell migration
50-150 mV/mm
275
desoluabolization
liquefied tissue that is necrotic can be easily removed with estim using negative current on the cathode
276
stim currents used for improved blood flow and reduced inflammation
| what specific effects does it have?
HVPC
increases blood flow at contraction levels
retard inflammation
277
antibacterial effects of extim
cathode delivery -
gram negative and positive
low intensity
HVPC current
80 pps, 2 hrs, 4x week
278
which pole is for what healing effect?
cathode for bacteria retarding
anode for healing and epithelial growth
279
protocol with HVPC for wound healing
start w negative from cathode for 4 weeks
negative 3-7 then change to positive
280
acute inflammation phase
hemorrhage, necrosis, erthemia, edema, exudate, red granulation forming
281
how to resolve pt in chronic inflammation phase
move back into acute inflammation phase so pt can progress into proliferation phase
282
acute proliferation phase
inflammation, wound starts reducing in size, red granulation tissue present, serous/serosanguineous exudate, may be odor, wound edges start to adhere and progress to epithelialization
283
signs of chronic proliferation phase
hyper granulation, tissue growing out of wound bed as this is not effective at closing wound bed
pink granulation tissue
284
causes of chronic proliferation phase
infection changing granulation tissue
285
acute epithelialization phase
expected outcome is to resurface wound
286
chronic epithelialization phase
rolled wound edges, fibrotic
could be caused by drying out, poor dressing choices
| one cause?
287
pt can be vulnerable to pressure ulcers on the sacrum if:
poor hygiene, B&B dysfx
poor pressure relief adherence
atrophy or scarred muscle not providing normal cushioning and blood supply
seated all day
288
remodeling phase
should result in immature scar formation if optimal healing
helped with stimulation of migrating epidermal cells
happens after wound is closed
lasts 6 mo-2 years
289
granulation tissue
red beefy tissue
+ sign of proliferation phase
290
phases of healing
Acute inflammatory
acute proliferation
acute epithelialization (part of proliferation)
remodeling
any of these phases can turn chronic if healing is interfered with
291
exudate
liquid drainage from wound bed, not clear
292
transudate
liquid drainage from wound, clear and normal
293
serosanguinous fluid
bloody/clear/pink fluid exudate
294
maceration
surrounding tissue of wound is water logged
risk for pressure ulcer/wound complications
295
rolling edges
build up of epithelial tissue if it is impeded from moving forward on the wound bed
tissue rolls under itself as a nodule at the wound edge
296
tunneling
bottom of the wound bed breaks and wound progresses deeper into tissue
important to visualize as it can become infected and reopen a closed wound
297
undermining
space under superficial wound edge
you can stick a probe under and lift up bc edge is not adhered down
298
eschar
dark heavy scabbing
comes off in chunks/pieces
mainly dead tissue
299
slough
heavy, stringy fibrotic tissue
can be debrided
300
ways to measure wounds
tracing
tape measure
depth
301
measure wound: tracing
circle with radius
trace wound shape and compare size to circle
302
measure wound: tape measure
sterile, disposable, measure greatest vertical and horizontal lines to get area
303
measure wounds: depth
place qtip in wound bed and mark level even with edges
measure tunneling by going clockwise around wound bed to check
304
pressure ulcer: stage 1
redness
non blanchable
305
pressure ulcer: stage 2
skin breakdown through epidermis only
306
pressure ulcer: stage 3
dermal layer into fascial layer affected
307
pressure ulcer: stage 4
bone and muscle impaired
308
venous ulcer cause
PVD
failure of veins to return blood to heart due to valvular dysfunction causing distal fluid accumulation
309
characteristics of venous ulcers
large >10 cm
irregular edge
saucer shaped
swollen leg
dry/itchy skin
painless unless elevated
red/brown coloring
can be infected
310
arterial insufficiency wounds: cause
hardening/narrowing of arteries compromising blood supply to legs
triggered by smoking, high BP, RA, DM, CV disease
311
arterial insufficiency wounds characteristics
cold LE
white/blue/shiny appearance
hard distinct edges/punched out
312
alginates
ABSORB lots of exudate by forming gel and maintaining optimal moisture levels
used for infected or healthy wounds
313
antimicrobial dressing
dressing with topical antiseptics
silver as antiseptic
314
collagen dressing
encourage healing, maintain moist environment, promote granulation tissue
315
contact layer dressing
thin non adherent layer placed over a wound to protect fragile tissue from other dressings or topicals
316
compression dressings
long stretchable cloth wrapped over a wound for compression
317
composite dressing
multi layer primary or secondary dressings
inner layer is non adherent
middle layer absorbs moisture to prevent maceration with alginate, hydrocolloid, etc
outer layer is antibacterial film for protection, semi permeable
318
enzymatic debrider dressing
medicated dressing with enzyme to soften hard tissue for debridement
319
foam dressing
sheets with small open cells to absorb fluid
can be layered with other materials
absorptive capacity depends on size and thickness of foam
non adhesive area covers wound with adhesive border or overlying film for protection
320
hydrofiber dressing
absorb exudate and promote healing
transforms into gel when in contact with fluid
321
hydrogel dressing
sheet, gel, or impregnated gauze
80-99% water and glycerin
absorb minimal fluid but can moisturize a dry wound
less effective at protecting from bacteria
322
hydrocolloid dressing
contains hydrophilic colloidal substances with a strong film backing
absorb fluid slowly turning into a gel mass
protection against water, air, and bacteria
323
absorptive wound dressings
alginates
foams
hydrocolloid
hydrofiber
minimal:
composite
hydrogel
324
negative pressure wound therapy
sealed and fitted to skin so vacuum can draw pressure upwards
pulls the wound edges towards spongy surface of flim
325
Question
Answer
326
electromagnetic wave behavior
alternating electric and magnetic fields
magnetic and electric fields are perpendicular to each other
327
frequencies detected and not detected by humans
detectable: visible light range by eyes
infrared waves by skin
non detectable: EM waves, UV, xrays
328
types of light therapy
UV
LED
SLED
Laser: class 3b, class 4
329
LEDs produce what kind of light
light emitting diode
produce light in monochromatic/polychromatic wavelengths
visible and infrared light
330
SLEDs produce what kind of light
supraluminous light emitting diodes
like LEDs but produce higher intensity light energy
331
laser diode produces what kind of light
monochromatic, coherent, directional
332
power output: LEDs
5-40 mW
333
power output: SLEDs
up to 90 mW
334
how many emitting points of light are present with LED, SLED, laser
LED and SLED have multiple, 20-30
laser has a single diode
335
dosage of laser
joules per treatment point and per treatment session if multiple points
power (W) x 30 s per diode
336
ultraviolet functions to
facilitates the healing of chronic skin wounds
bactericidal effects
biostimulatory
337
what modalities requires eye protection?
low and high level laser
ultraviolet
338
precautions for LED/SLED
impaired sensation
indirect eye exposure - requires eye protection
dark skin color
339
contraindications for laser/LED/SLED
direct eye exposure
pregnancy
active malignancy area
active hemorrhage
active epiphysis
endocrine system
340
Question
Answer
341
diathermy is:
shortwave or microwave EM energy producing heat within tissues
deep penetration into tissues
342
methods of applying diathermy
capacitor field
coil field
microwave radiator
343
types of diathermy
microwave: uses these waves in radio frequency and magnetron/antenna to emit energy
shortwave: frequency between radio waves and infrared using inductive coil and capacitive plate with continuous or pulsed
344
types of shortwave diathermy
induction field
capacitive field
345
methods of capacitive method diathermy
air space plates
pad electrodes
346
inductive method of diathermy
cables: wrap around pt
drums: coil in drum and pointed over area
347
inductive coil applicators
coil with alternating electric current that creates magnetic field eddy currents
this osscilates particles and increases temperature
EM field heats tissue
pt is not part of circuit, they are part of a parallel circuit
348
which tissues respond best to diathermy
muscle and synovial fluid - high water content
worst are bone, fat, collagen
349
field distribution in inductive diathermy
electrodes too small: field concentrated superficially
too large: line of force lost in the air
electrodes should be slightly larger than area
350
capacitative plates
made of metal and set in plastic
energy flows from one plate to another with the body part between them so current goes through body
this method can be more superficial so be careful of burns
electric field
pt is part of circuit with tissue as resistor
351
pads placed farther apart
deeper penetration into tissue
352
diathermy for wound healing
pulsed to reduce heating
still want some heating to increase blood flow and perfusion
353
magnetron
type of diathemy application using microwave
doesn't penetrate as deep
high risk of burns
354
factors influencing field distribution
spacing of limb from plate (even), farther will get deeper
electrode size
355
indications for diathermy
heat deeper tissues
heat larger area than US
not reflected at the bone
healing: circulation
tissue extensibility
microvascular perfusion
RISK of burns
356
contraindications to diathermy
implanted/transcutaneous neural stimulators
pulsed: deep tissue, sole treatment for edema/pain, pacemaker/electronic device
thermal continuous: implant/pacemaker, malignancy, pregnancy, eyes, testes, active epiphysis
357
precautions for diathermy
electric/magnetic equipment nearby
obesity
copper IUD
pulsed: pregnancy and active epiphysis
358
Question
Answer
359
what does a nerve conduction study evaluate
evaluate the function of peripheral nerves, NMJ, and muscle fiber innervation
360
what does a nerve conduction study measure?
speed of conduction
size of action potential
361
what does EMG evaluate?
muscle function and electrical activity at rest and during contraction
362
what does EMG measure
shape, size, duration, prescence/absence of action potentials generated in the muscle
363
what do SEPs evaluate?
CNS evaluation of sensory changes
364
SEPs measure:
potentials generated in CL somatosensory cortex
365
can electrophysiologic testing be used to diagnose conditions?
No! Used in differential as an objective finding to refute or support but not confirm diagnosis
366
equipment needed for NCV
electrodes
differential amplifiers
oscilloscope (NCV/EMG)/speaker (EMG)
processing unit
stimulating electrode to elicit response
367
what EMG findings should there be at rest?
none, electrical activity should be quiet
368
latency
time it takes from the stimulus to get a response
traveling a farther distance down the nerve will result in a longer latency
use to calculate nerve conduction speed
369
distal sensory latency
measure most peripheral part of nerve to detect impairment in any part of the nerve, proximal or distal, by seeing if speed is impaired
370
distal motor latency
longer latency than sensory because signal has to cross the NMJ and propagate throughout the fiber
371
H reflex testing in NCV
test normal reflex arc with NCV
372
what does repetitive stimulus testing in NCV assess?
NMJ issues such as myasthenia gravis
373
what areas can EMG assess?
AHC
intervertebral foramen compression
muscle
374
how can EMG assess AHC?
diseased AHC can cause axons to die leading muscle fibers to be irritable
abnormal activity will be produced including positive sharp waves and fibrillation potentials
375
how can EMG assess nerve compression?
nerve compression would result in multiple muscles having abnormal electrical findings in a myotomal pattern
376
how can EMG assess muscle function?
it can find abnormal size and duration of signals in conditions like duchene MD
377
EMG norms?
no norms, have to compare to pt's baseline
378
demyelination
damage to the myelin sheath decreasing speed of AP
caused by DM, carpal tunnel
379
axonopathy
part of the potential pool of axons no longer function
speed is normal but amplitude of response is diminished
amplitude is normally summation of all axons firing
380
acute compression of nerve
pressure on peripheral nerves can create ischemia and transient demyelination that quickly reverses once blood supply to nerve is recovered
381
neuropraxia
discrete demyelination without loss of axon continuity
causes stopping or slowing of conduction over lesion
lowest level of nerve injury, least threatening
382
wallerian degeneration
process of repairing broken axon and myelin by degenerating damaged tissue and replacing it distal to proximal slowing, 1-2 mm a day
383
s/s of neuropraxia
paralysis/marked reduction in muscle strength
reduced or absent sensation
384
NCV results of neuropraxia
increased latency in area with normal velocity above and below
normal EMG at rest
385
axontomesis
caused by severe compression/stretch
loss of axonal continuity but endoneurial connective tissue sheath is intact
results in Wallerian degeneration after 48 hours
sheath guides regenerating axon
386
s/s after axontomesis
total loss of function until nerve regenerates
worse prognosis with possible incomplete end innervation
387
NCV results after axontomesis
if large axons intact, speed will be normal but amplitude will decrease
If large not intact, speed will decrease as well
388
EMG results after axontomesis
fibrillation potential, positive sharp waves for 2-3 weeks
389
neurotmesis
loss of axonal and CT continuity from severence or stretch or crush
partial: damage to endoneurial sheath and endoneural tissue
complete: severed
390
s/s of neurotmesis
complete loss of function
no muscle activity
likely needs surgery
very poor prognosis
391
NCV and EMG after neurotmesis
no conduction below lesion
no spontaneous potentials on EMG
these will not recover without surgical repair
392
polyneuropathy
degeneration of distal ends of long axons along w myelin degeneration
sensory loss first, then motor
393
myelinopathy
segments of myelin lost due to infection/immune
eg GBS
decreased sensation, DTR
394
GBS
normally good prognosis
guarded prognosis if there is evidence of denervation on NCV
partial innervation has better prognosis, will show slower conduction velocity
395
myopathy findings
normal NCV
fibrillations and sharp waves on EMG
396
myotonia findings
delayed relaxation after contraction
high frequency discharges repetitive on EMG
mild NCV slowing
