Final - Queen Flashcards
(109 cards)
1
Q
Calc current density of given electrode size of the electrode (in milli-amps)
A
Applied current (mA) / electrode (cm^2) =
current density (mA/cm^2)
2
Q
What is current density?
A
mA/cm^2
3
Q
what motor fibers will be excited during motor response?
A
A-a fibers
4
Q
Know when noxious response occurs When e-stim stimulate beyond therapeutic effect to a noxious response, what threshold is passed?
A
Supramaximal stimulus threshold
5
Q
When ES amplitude or duration is increased beyond supramaximal stimulus threshold what fibers are stimulated?
A
A-d or C fibers
6
Q
What is the uncomfortable surge of the e-stim intensity when the device is abruptly turned off called?
A
CAPACITANCE
7
Q
What causes capacitance in e-stim?
A
Abrupt termination of treatment by unplugging or turning off the device before the current has decreased, allows stored current to freely flow through the electrodes
8
Q
How is total phase duration of biphasic pulse cal.?
A
Pulse duration + interphase duration
9
Q
What is phase duration?
A
Time elapsed from the beginning to the end of one phase
10
Q
What is Pulse duration?
A
Time elapsed from beginning to the end of the two phases within a pulse, including the interphase interval, if present
11
Q
If phase durations of a biphasic pulse are 150 μsec each & interphase interval is 50 μsec, what is the total pulse duration?
A
350 μsec
12
Q
What is the carrier frequency for russian current, and what is it modulated to?
When it’s modulated, what is this called?
A
2500 Hz, burst (many Hz =burst)
CONTINUOUS CARRIER WAVE = Bursts of 50Hz
13
Q
What does modulated russian currents CONTINUOUS CARRIER WAVE consist of?
A
Bursts of 50 bps
14
Q
What frequency do nerves respond to,to depolarize?
A
50Hz
15
Q
What is polarity?
A
Net charge of an object
16
Q
What is the 1 use of continuous direct current?
A
Iontophoresis
17
Q
How is biphasic current produced?
A
Intermittently interrupting an AC current source
18
Q
What is the primary clinical indication for using a TENS device?
A
Chronic pain…in order to gait the pain and/or get opioid release
19
Q
What is on and off cycle used for the rehab of Russian Stem?
A
10 on
50 off
20
Q
Why is the R-stem on and off cycle only one for 10sec?
A
To prevent muscle fatigue, which occurs at 15sec
21
Q
The 10/50/10 Russian Stem stem rehab cycle allows for muscle contraction to produce what?
A
To increase force and strength with the parameters
22
Q
What is the designated/universal symbol of current?
A
I = intensity
23
Q
I (intensity) is the universal symbol for current. What is I measured in?
A
amps (A)
24
Q
What biphasic current waveform is clinically useful for Trigger Point Therapy?
A
Biphasic pulsed sinusoidal wave
25
What does a Biphasic pulsed sinusoidal wave consist of?
+ & - polar chard (anode & cathodal phases)
26
What are the 2 type of Biphasic pulsed wave currents?
Symmetrical & asymmetrical balanced
27
Which high frequency range for TENS application provides rapid pain gait analgesia of short duration
Conventional TENs?
80 - 125 Hz
28
In Iontophoresis, you have a drug with a Negative ion, which electrode is the drug attached to?
CATHODE / ( - ) / Black
29
In Iontophoresis, you have a drug with a positive ion charge, which electrode is the drug attached to?
ANODE ( + ) / red
30
What defining characteristic of Russian stem causes nerve degeneration?
Motor nerve depolarization
31
R-stem motor nerve depolarization results from what?
Independent, intrinsic number of pulses contained in each burst.
32
Why are all NMES currents effective at depolarizing motor nerves?
Independent pulse bursts summate to evoke action potential
33
common waveform to activate skeletal muscle?
Sinusoidal waveform burst modulated at 50 Hz
34
What protocol uses Sinusoidal waveform burst modulated at 50 Hz?
RStim 10/50/10
35
Full tetanic skeletal muscle contraction occurs at a what fusion frequency?
50Hz
36
Why is Russian stem described as having a 50% duty cycle?
Burst / interburst duration
37
Why are electrodes placed in a three- dimensional manner for microcurrent?
To flow along nerves / meridians
38
What is correct electrode placement for microcurrent therapy for Tx back pain?
1 electrode next to spine @ the level of involved spinal nerve
Other electrode is placed anterolaterally; on the front and opposite side
To direct current along the spinal nerves in a Three- dimensional manner to “Frame the pain”
39
What does bilateral microcurrent therapy theoretically stimulates?
dermatomes
myotomes
sclerotome
40
Repeat applications of microcurrent therapy may place electrodes one spinal level above, and one below the involved spinal nerve to accommodate what?
Overlap in the dorsolateral fasciculus
41
When is biphasic pulse current not indicated for acute mgmt?
| General ES contraindication
Phlebitis, thrombophlebitis
| acute and subacute
42
Why is biphasic pulse current not indicated for acute mgmt?
Increase edema & vascular fragility
43
What mechanism is responsible for electric migration during iontophoresis?
Voltage force, transcutaneous delivers a therapeutic agent (drug) by electrical current
44
What does voltage force do in iontophoresis do?
Separates the electrode charges , but pushing the charge, creating electrical potential energy
45
What happens with to little voltage force in electric migration during iontophoresis?
limit agent delivery
46
What happens with to MUCH voltage force in electric migration during iontophoresis?
Could result in adverse effects
47
What 6 tissues have a low resistance to current flow in the body?
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Muscle
Blood
Nerve
ECF (Extracellular Fluid)
ICF (Intracellular Fluid)
Synovial fluids
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48
When using BIPHASIC PULSED CURRENT for MUSCLE STRENGTHENING, what is the most appropriate DUTY CYCLE for patients with neuropathic recruitment pattern or a decreased activation of their muscles?
10 on 50 off
49
What is the PULSE DURATION for BIPHASIC PULSED CURRENT in muscle strengthening?
300-500msec
50
Why is the pulse duration increased in biphasic pulsed current for muscle strengthening?
To get action potential in the damaged nerve
51
What's the therapeutic waveform in microcurrent?
Pulsed monophasic waveforms
52
What is primary clinical use of combo therapy?
MFTPs
53
What’s the maximum safe current density under cathode during iontophoresis?
(Without burning / destroying tissue?
The current density is based on electroconductive surface area
54
Iontophoresis, electroconductive surface area is always _____, than the gross electrode size?
smaller
55
What is the cathode maximal safe current density in iontophoresis?
0.5 mA/cm2
56
What is the Anode maximal safe current density in iontophoresis?
1 mA/cm2
57
What type of IFC is quadripolar?
Classic
58
What type of IFC is bipolar?
Premodulation
59
Classic ICF uses ____ pads, creating a ___ pattern.
4, cloverleaf
60
Premod ICF uses ____ pads, creating a ___ pattern.
2, oval
61
Classic ICF uses has 100% modulation effect in the ___.
Patient
62
Premod ICF uses has 100% modulation effect in the ___.
Machine
63
Where is the therapeutic effect felt in classic IFC?
The middle of the X pattern
64
Where is the therapeutic effect felt in Premod IFC?
Under the pads
65
What is the level of penetration in classic IFC?
Deep
66
What is the level of penetration in Premod IFC?
Superficial
67
How is IFC beat frequency calculated
big number minus the smaller number
| difference in frequencies
68
How is the IFC beat frequency range calculated?
0 thru the max beat frequency
69
What is the pH needed for a sclerotic effect?
<7.4pH
70
The anode produces an acidic reaction (anode attracts acid) creating what type of effect?
Sclerotic
71
How is a localize area of acidic pH formed, results in a decrease in local water content & increased protein density what will harden tissues & imparting the sclerotic effect?
Cl- anions combine with water at the anode to form hydrochloric acid: HCL.
Creating an accumulation of Cl- at the anode
72
During e-stem what is the motor recruitment pattern for voluntary motor recruitment?
Slow progressive recruitment is slow
73
Smaller motor units move _____ than larger motor units.
Faster
74
Asynchronous recruitment pattern allows for what, when muscle fibers become fatigued.
activation of additional motor units
75
How do voluntary contraction continues with little decrease in force?
modulating firing frequency of motor units
76
ow does ES over the muscle belly recruits motor units?
nonselective, random order regardless of fiber type
77
What is indiscriminate activation in regards to ES over the muscle belly?
There are no alterations in recruitment between repeated contractions
regardless if the unit is slow or fast
Contributing to muscle fatigue, decreasing the contraction force
78
What is the goal of pulse direct stimulation?
promote granulation tissue at a wound
79
Where does the cathode go during pulse direct stimulation, & why?
goes over the wound to promote granulation
80
With quadripolar method of IFC, where is the modulation depth at 0%?
At the pads
81
In the COX protocol for nucleus pulposus herniation & radiculopathy, where are the electrodes placed?
HIGH VOLT PULSED PARAMETERS
Positive electrode directly over disc lesion, companion negative pad next to it
Other positive electrode placed in popliteal fossa (Acupuncture spots: BL40, Weizhong; some texts UB54), companion negative electrode opposite to it
82
What mechanism causes nerves to stop firing during median electrical stimulation?
Wendinski’s inhibition
83
Wendinski’s inhibition
when the nerve stops firing bc we have gotten use to the stem
84
What are the 3 physiological mechanisms related to the wound effects for High-Volt pulsed current?
*Short pulse durations & low amperage overcome skin impedance providing comfortable stimulation
Average current flow through tissues in MICROCURRENT RANGE, possibly similariting TISSUE HEALING effects
PULSE DURATION (peak to peak) is fixed at ***25 usec***
85
12 things that description of premodulation (Premod) IFC?
2 electrodes
oval shaped pattern
superimposition of carrier waves in device
composite waveform current delivery
4000 Hz frequency & 4000- 4150 Hz frequency
fully modulated AC from device
100% modulation depth
Premodulated Tx w/ lower intensity vs. IFC
Current dispersed
Smaller total coverage area
greater current density @ Tx site
No evidence Premod is clinically more effective than true IFC
86
What is the pain control mechanism in the COX protocol, for a herniated nucleus pulposus and radiculopathy?
Sensory & motor mechanisms
87
How Biphasic current wave form are described as?
Balanced
88
How are classic IFC wave forms described?
Amplitude modulated sinusoidal waves
89
How are classic IFC wave forms described?
sinusoidal
90
How is Beat Frequency described?
Amplitude modulated current created by superimposed MFACs
91
How Russian Stem waves described?
burst modulated monophasic AC
| Basically alternating current
92
What is burst frequency for russian?
50 bups
93
What wave type used current is the delivery of repeated pulses separated by an interpulse interval (A).
Biphasic
94
What wave form is amplitude modulated alternating current, using a medium frequency alternating current?
Interferential current (IFC)
95
IFC is ________waves.
amplitude modulated sinusoidal
96
RStim is waveform burst modulated.
sinusoidal
97
What is clinical application for Russian stem?
Muscle strengthening
98
What 5 things are primary clinical applications of IFC?
Modulates effusion & edema
Activates spinal gate & central pain modulatory mechanisms
Reduces spasm, local tonus & relieves MFTPs
Possible mechanisms for relaxation effect
Similar effects for muscle strengthening, low-frequency ES
99
4 things that make IFC therapeutically desirable over other therapeutic modalities?
Pain modulation
NO contraindications
Comfortable bc of medium frequency
Penetrates easy w/o resistance
100
7 primary clinical applications for biphasic current?
Cell recovery effects, tissue repair
Muscle strengthening
Reduction of effusion & edema
Relaxation of spasm
Pain modulation via the pain gate & central opioid system
Purpose of TENS therapy is to selectively activate nerve fibers to relieve a range of painful conditions
TENS activates a complex neuronal network to result in a reduction in pain
101
What is the primary clinical application of TENS?
TENS therapy (ES) is the application of BIPHASIC waveforms for pain modulation
102
What are primary clinical applications for high-volt pulse current and what the application is for micro-current and know the PAD setups for each? (NOT FINISHED!!!) Tissue and dermal wound healing for HV (ALSO EDEMA) and Microcurrent
11 things
Promotes restoration of skin integrity in superficial / deep wounds
restart / accelerate wound healing by imitating the natural electrical current occurring in injured skin
bacteriostatic & bactericidal effects may lower bioburden in the wound bed & facilitate wound closure
Increases local tissue metabolism & perfusion(blood & oxygen)
Promotes ATP levels
Increases cell MB transport 40%- 50%
Increases protein synthesis 50%
Increase proline uptake 91%
Increase hydroxyproline uptake 255%
Promotes bone healing
MES waveforms activate central pain modulatory mechanisms
Promotes restoration of skin integrity in superficial & deep wounds
103
What is primary clinical application for iontophoresis?..Is it sclerotic effect or sclerolytic?
ONLY 1 to use continuous direct current (Continuous DC)
Electrical energy is used to “push” drug molecules through the skin
Continuous monophasic current induces transcutaneous movement of ions across the skin & into the target tissues
drug under negative cathode
Pushes meds into tissue
104
What fibers stimulated with Low TENS?
Motor: Type Aa fibers
activation causes muscle twitch or contraction and strong paresthesia under electrodes
105
What fibers simulated with High TENS
Sensory: Type AB fiber
activation causes tingling, prickling or pins and needles sensation under electrodes
106
What fibers stimulated with Intense TENS?
Noxious: Type AD and Type C fiber
activation causes strong muscle contraction, strong uncomfortable paresthesia and sharp or burning pain under electrodes
107
Know general contraindications for e-stem…(10 categories)
Benign tumors and malignancy
Bleeding, menstruation
Epilepsy, seizure disorder and status post CVA, TIA; in the cranial and upper cervical regions
Implanted or transcutaneous electrical devices, e.g. neurostimulator, pacemaker
Local infection, unless the goal is germicidal effects in a dermal wound
Metal implants
Osteomyelitis
Over the carotid sinus, cervical sympathetic ganglion, phrenic nerve, vagus nerve
Over the pharyngeal and laryngeal muscles; potentially causing spasm and airway constriction
Patients with sensory, mental impairment or who are confused or unreliable
Phlebitis, thrombophlebitis; in the acute and subacute stages
Scar tissue
Through specialized tissue: brain, eyes, gravid uterus, heart, sex organs
Tuberculosis
108
Know what are NOT contraindications for e-stem…
DOMS (delayed onset muscle soreness)
109
What are 2 adverse effects & there resolution time for continuous monophonic DC (iontophoresis)
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Electrode burns (1st degree skin burns 1- 2days, Severe, non healing burns possible derm referral)
Skin irritation (resolve 1- 3 h post Tx)
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