Electrotherapy and Pain Modulation Flashcards Preview

Phys Agents > Electrotherapy and Pain Modulation > Flashcards

Flashcards in Electrotherapy and Pain Modulation Deck (113):
1

What are the levels of physiologic response (4)

1. Cellular
2. Tissue
3. Segmental
4. Systemic

2

What are the cellular level responses to electrotherapy (5)

1. Excitation of excitable cell membranes
2. Changes in cell membrane permeability
3. Protein synthesis
4. Stimulation of fibroblasts and osteoblasts
5. Modification of microcirculation

3

What cell membranes are excited by electrotherapy (2)

1. Nerve
2. Muscle

4

What are the tissue level responses to electrotherapy (3)

1. Skeletal muscle contraction
2. Smooth muscle contraction
3. Tissue regeneration

5

True or False:
Tissue level responses to electrotherapy require multiple cellular events

True

6

What are the segmental level responses to electrotherapy (5)

1. Modification of joint mobility
2. Modification of muscle contractility
3. Muscle pumping action to change circulation and lymphatic drainage
4. An alteration of microvasculature not associated with muscle pumping
5. Increased movement of charged proteins into lymphatics resulting in fluid moving centrally

7

What are the systemic response to electrotherapy (3)

1. Analgesic effects as endogenous pain suppressors are released
2. Analgesic effects from the stimulation of certain neurotransmitters
3. Stimulate spinal gate

8

What are the effects of electrical stimulation (3)

1. Nerve depolarization
2. Muscle depolarization
3. Ionic effects

9

What has a slightly higher resting membrane potential nerves or muscles

Muscles

10

True or False:
The membrane of cells has differential permeability to different electrically charged ions

True

11

Is K+ easily or slightly permeable to the membrane

Easily permeable

12

Is Na+ easily or slightly permeable to the membrane

Slightly permeable

13

True or False:
The membrane is impermeable to large negatively charged protein and phosphates (anions)

True

14

True or False:
There are a large number of anions trapped inside the cell

True

15

True or False:
Depolarizing something in the middle will cause depolarization on both directions

True

16

Which way does the Na+/K+ pump move Na+ and K+ in relation to the cell

Na+ out
K+ in

17

Where is Na+ in higher concentration

Fluid surrounding the cell

18

Where is K+ and anions in higher concentration

Inside the cells

19

What is the resting membrane potential for muscle

-90 mV

20

What is the resting membrane potential for peripheral nerves

-70 mV

21

What maintains the negative resting membrane potential

The Na+/K+ pump moving 3 Na+ out and 2 K+ in resulting in a negative charge

22

True or False:
Larger diameter nerve fibers conduct the action potential faster

True

23

How fast do A alpha motor nerves carry APs

60-120 m/sec

24

How fast do A gamma and A delta nerves carry APs

12-30 m/sec

25

True or False:
Myelin makes the AP conduct faster

True

26

What is the AP jumping from node to node called

Saltatory conduction

27

True or False:
Most nerves in humans are mixed nerves leading to different nerve fibers firing at different rates

True

28

Where is the cell body and axon located in motor nerves

Cell body: Ventral horn or brainstem motor nuclei
Axon: Terminate on muscle

29

Where is the cell body and axon located in sensory nerves

Cell body: Dorsal root ganglion or cranial nerves sensory nuclei
Axon: 50% end as free nerve endings and 50% are specialized sensory receptors

30

What are the A alpha nerve diameter, conduction velocity, and type of nerve fiber (3)

1. 12-20, 72-120, Muscle spindle primary afferent
2. 12-20, 72-120, Golgi tendon organ afferent
3. 12-20, 72-120, Skeletal muscle efferent

31

What are the A beta nerve diameter, conduction velocity, and type of nerve fiber (2)

1. 6-12, 36-72, Touch pressure receptor afferent
2. 5-12, 20-72, Muscle spindle secondary afferent

32

What are the A gamma nerve diameter, conduction velocity, and type of nerve fiber (1)

1. 2-8, 12-48, Muscle spindle efferent

33

What are the A delta nerve diameter, conduction velocity, and type of nerve fiber (1)

1. 1-5, 6-30, Pain temperature afferent

34

What are the B nerve diameter, conduction velocity, and type of nerve fiber (1)

1. Less than 3, 2-18, Preganglionic autonomic efferent

35

What are the C nerve diameter, conduction velocity, and type of nerve fiber (2)

1. Less than 1, Less than 2, Pain temperature afferent
2. Less than 1, Less than 2, Postganglionic efferent

36

What are Ia nerve diameter, conduction velocity, and type of nerve fiber (1)

1. 12-20, 72-120, Muscle spindle primary afferent

37

What are Ib nerve diameter, conduction velocity, and type of nerve fiber (2)

1. 12-20, 72-120, Golgi tendon organ afferent
2. 12-20, 72-120, Skeletal muscle efferent

38

What are II nerve diameter, conduction velocity, and type of nerve fiber (3)

1. 6-12, 36-72, Touch pressure receptor afferent
2. 5-12, 20-72, Muscle spindle secondary afferent
3. 2-8, 12-48, Muscle spindle efferent

39

What are III nerve diameter, conduction velocity, and type of nerve fiber (2)

1. 1-5, 6-30, Pain temperature afferent
2. Less than 3, 2-18, Preganglionic autonomic efferent

40

What are IV nerve diameter, conduction velocity, and type of nerve fiber (2)

1. Less than 1, Less than 2, Pain temperature afferent
2. Less than 1, Less than 2, Postganglionic efferent

41

What does the Gasser scheme name

Peripheral nerve fibers

42

What does Lloyd scheme name

Sensory fibers only

43

What is the strength duration curve

Graphic representation of minimum combination of current strength and pulse duration needed to depolarize that nerve

44

What do lower current amplitudes and shorter pulse durations depolarize

Sensory nerves (A beta and A delta)

45

What do higher current amplitudes and longer pulse durations depolarize

Motor nerves (A alpah and A gamma)

46

What do higher yet current amplitudes and longer pulse durations depolarize

Pain transmitting C fibers

47

True or False:
You feel the electrical current before you see movement

True

48

What is sub-threshold

Amplitude duration below curve for particular nerve

49

What is threshold stimulation

Amplitude and duration on the curve

50

What is supra-threshold

Amplitude and duration above the curve

51

True or False:
The peripheral nerve membrane is more excitable than the muscle membrane

True

52

What is the minimum current amplitude with a very long pulse duration required to produce an action potential called

Rheobase

53

What is the minimum duration it takes to stimulate that tissue twice the rheobase amplitude called

Chronaxie

54

What is rheobase dependent on

Current amplitude

55

What is chronaxie dependent on

Time/duration

56

What is all or none response

Once threshold is achieved nerve fiber fires

57

What is accommodation

If stimulus is too slow nerve can adjust threshold level

58

What are the 2 types of AP propagation

1. Orthodromic
2. Antidromic

59

What is orthodromic propagation

Normal physiological stimulation where the AP propagates one way only

60

What is antidromic propagation

AP propagated both ways

61

What controls peripheral nerve axon recruitment

Intensity

62

What does a current that is applied at an intensity and duration just strong enough to reach threshold stimulate in a mixed nerve

Large superficial fibers

63

What does an increased current intensity now stimulate in a mixed nerve

Medium sized superficial and deeper large sized fibers

64

What does further increasing current amplitude now stimulate in a mixed nerve

Small superficial, medium deeper, and large deepest fibers

65

What is TENS used for

Pain modulation

66

What can selective stimulation of A beta fibers do

Block pain transmission in the spinal cord via the gate control theory

67

What are the parameters for E-stim trancutaneously (conventional)

Short pulse duration (50-80), pulse frequencies 100-150, and low current amplitude (cause tingling)

68

How long will conventional TENS block pain

Only as long as the stimulation is on

69

True or False:
Conventional TENS can be used 24 hours a day

True

70

How do you control for adaption (2)

1. Modulate rate
2. Modulate width

71

What are the parameters for low rate or acupuncture like TENS

Frequencies of 2-10, long pulse duration (100-200), and higher current amplitude (visible contraction)

72

How long will acupuncture like TENS control pain after 20-30 minutes of treatment

4-5 hours

73

How does acupuncture like TENS control pain for 4-5 hours

By stimulating the endogenous opioid system

74

What is the half life of endogenous opiates

4.5 hours

75

What fibers does acupuncture like TENS stimulate (3)

1. A delta nociceptive
2. A alpha
3. A beta

76

What are the parameters of noxious intensity TENS

Short duration stimulation (less than a minute), can use low (1-5) or high frequencies (80-110), pulse duration up to 1 sec, and amplitude 2 times motor threshold

77

What is the intent of noxious intensity TENS

Stimulate C-fibers

78

What is the motor threshold

When you see the muscle twitch

79

What fibers does noxious intensity TENS stimulate

A delta, C fibers, A alpha, and A beta

80

True or False:
Noxious intensity TENS uses opioid mediated and nonopioid mediated analgesia

True

81

What does noxious intensity TENS mediate in the cord

Serotonin and noradrenaline

82

Where does noxious intensity TENS mediate muscarinic

Supraspinally

83

What does burst mode TENS work like

Low frequency TENS

84

How is the stimulation delivered in burst mode TENS

Bursts or packages of 10 pulses

85

What is the pulse duration of burst mode TENS

100-300 pps

86

What types of nerves does interferential current depolarize

Sensory and motor nerve

87

What are the therapeutic effects of IFC (3)

1. Increase pain threshold
2. Muscle contraction
3. Muscle pumping

88

How does IFC work

Stimulator imparts 2 different currents into the body and the currents interfer giving you a beat current which is the difference between frequencies.

89

True or False:
The beat frequency can be changed to get pretty much any effect you want

True

90

What is the pulse frequency of IFC for pain management

50-120 pps

91

What neurons do you want to stimulate to modulate pain with IFC

Large diameter afferent neurons

92

What is the pulse frequency of IFC for muscle contraction

20-50 pps

93

What is the pulse frequency of IFC for acutism pain relief

1 pps

94

True or False:
30 pps gives a smooth tetanic contraction when using IFC

True

95

What are the indications for IFC (2)

1. Pain of known origin
2. Possibly for muscle exercise to increase blood flow, muscle relaxation, and edema reduction

96

What are the therapeutic purposes for high voltage pulsed current (3)

1. Sensory TENS pain management
2. Muscle contraction
3. Motor TENS pain relief

97

What is the pulse frequency for HVPC sensory TENS pain management

80-120 pps

98

What is the pulse frequency for HVPC muscle contraction

30-60 pps

99

What is the pulse frequency for HVPC motor TENS pain relief

2-4 pps

100

What does HVPC sensory TENS pain management stimulate

1. Large diameter afferent neurons
2. Activate spinal gate

101

What does HVPC motor TENS pain relief stimulate

Endorphin descending loop

102

True or False:
E-stim can activate the spinal gate to decrease pain

True

103

How does E-stim activate the spinal gate to decrease pain

Stimulate A-beta fibers which closes the spinal gate by competing with A-delta and C-fibers

104

What is AC current

An alternating sinusoidal curve

105

What is DC current

Current that stays on the same side of the line

106

How does AC current cause muscle contraction

Stimulates the alpha motor neuron

107

How does DC current cause muscle contraction

Stimulates the muscle its self

108

What type of contraction does AC current produce

Smooth tetanic contraction

109

What type of contraction does DC current produce

A twitch

110

Why are A-beta fibers the first fibers stimulated

The are small diameter myelinated fibers

111

Why is a shorter phase duration more comfortable

The electric current is flowing in one direction for a longer time

112

How do you stimulate the ascending and descending endorphin loops

By stimulating the A-delta and C-fibers

113

Does E-stim directly stimulate receptors

No it stimulates the nerve attached to the receptor