interventions final Flashcards
1
Q
what are the contraindications for the use of electrical currents?
A
over a pacemaker or unstable arrhythmia
over the carotid sinus
venous or arterial thrombosis or thrombophlebitis
around pregnancy
malignant tumors
2
Q
precautions for electrical currents
A
cardiac disease
impaired mentation or sensation
skin irritation or open wounds
intensity/duration for strong muscle contractions
3
Q
what are the adverse effects of electrical current
A
burns
skin irritation/inflammation
perception of discomfort
DOMS/soreness
4
Q
how often should units be checked?
A
annually
never use a unit missing the third prong
5
Q
what is the resting membrane potential in nerves?
A
-65 mV
6
Q
stimulation of action potentials
A
all or nothing
depolarize - make outside less positive
large diameter depol first
7
Q
what is the order of nerve depol?
A
A-beta
A-alpha
A-delta
8
Q
what does a-beta depol target?
A
reducing pain
9
Q
what does a delta depol target?
A
chronic pain
10
Q
what does a alpha depol targer?
A
increasing muscle strength
11
Q
name 3 factors that speed up AP conduction
A
myelination
axon diameter
higher temp
12
Q
describe the AP pattern of motor and sensory stim
A
motor - one way, to body
sensory - one way, to CNS
13
Q
describe the AP pattern of external stim
A
bidirectional
14
Q
what is direct current?
A
continuous unidirectional flow of current
for denervated muscle
used for iontophoresis
15
Q
what is alternating current?
A
electrodes alternate polarity in smooth fashion
bidirectional flow of charged particles
need to modulate AC to make it useful
used for russian and IFC
16
Q
what is pulsed current?
A
interrupted flow of current in form of pulses
space between pulses not seen with AC
pain control: TENS
muscle contraction: NMES
17
Q
describe modulated AC
A
pain control:
2 AC’s interfering with one another
amplitude modulated or beat modulated
for muscle strengthening:
time modulated or burst modulated
18
Q
what are the three biphasic currents?
A
symmetrical
balanced
unbalanced
19
Q
what are different pulse durations used for?
A
shorter: pain control or tissue healing
longer: muscle contraction
20
Q
what are different phase durations used for?
A
less than pulse duration if biphasic
equal to pulse duration if monophasic
21
Q
what is amplitude?
A
intensity or strength
22
Q
what is frequency?
A
use Hz
23
Q
A-beta nerve curve
A
stim these to beat C nerves to spinal cord
gate theory
24
Q
a-delta nerve curve
A
almost impossible to directly stim
want really strong hard muscle twitch
3-4 hours relief
opioid like release
25
what pulse duration for sensory axon?
60-80 microsec
26
what pulse duration for motor axon?
150-350 microsec
27
what to doc?
area of body
pt positioning
specific stim parameters
electrode placement
treatment duration
pt's response to treatment
plan
sig and date
28
application technique for electrical
pt positioning
electrode type - pre-gelled, self adhesive
electrode placement
current density - smaller = more current
29
describe best electrode placement
not over bone - sensitive to conduction
closer - shallow, more burn risk
farther apart - safer, deeper, may need higher amp
atleast 1 inch apart
30
what does TENS mean?
transcutaneous
electrical
nerve
stimulation
clinically describes portable stimulators
31
what is conventional TENS
high rate
gate control - rub it where it hurts
acute pain
races C fibers to SC
only blocks pain when gate is closed
32
explanation of gate theory to pt
in the spinal cord we have a gate that either allows pain signals to be delivered to the brain or shut off to stop the signal.
because the nerve that carry that signal are slow, if we stimulate faster sensation nerves, they can race to the spinal cord and close that gate. this will reduce the amount of pain we sense.
have you ever bumped your arm and then rubbed it? you closed the gate with the rubbing. it stimulated a faster sensory nerve which beat the slower one to the spinal cord.
33
describe the parameters of conventional TENS
pulse type: biphasic symmetrical
pulse duration: 50-80 us
pulse rate: 100-150 Hz
pulse amplitude: strong, comfortable
pain relief will not outlast stimulation
can wear up to 24 hr/day
34
when do you modulate?
to counter adaptation
35
what is strong, low rate TENS?
acupuncture-like
stimulates opioid release
relief for 3-4 hours after
a-delta fibers
want a strong muscle contraction
36
what are the parameter for strong, low rate?
pulse type: biphasic symmetrical
pulse duration: 150-350 us
pulse rate: 2-10 Hz
pulse amplitude: strong, sharp muscle twitch
pain relief outlasts stim by 3-4 hrs
duration of stim: 20-30 min
37
what is electro-acupuncture?
placing needle electrodes into known acupuncture points
stimulate flow of chi?
acupuncture points correspond to locations of peripheral nerves?
38
what is burst mode TENS?
mimics strong, low rate
a burst may be better tolerated than a long duration pulse
39
what is inferential current?
it crosses two unmodulated currents in the body
requires two channels - 4 pads
40
what is a carrier frequency?
the unmod continuously alternating current
only name the lower frequency in doc
41
what is the beat frequency?
difference between the two interfering carrier frequencies
42
if one carrier freq is 4000 and the beat freq is 100, what is the other carrier?
4100
4000+100
43
what is the carrier and beat freq for acute IFC?
carrier - 4K or 5K Hz
beat - 80-150 Hz
44
what is the carrier and beat freq for chronic IFC?
carrier - 2500 Hz
beat - 2-10 Hz
45
another name for chronic IFC
low rate IFC
46
what is the shape of treatment area for IFC?
clover shape
47
why would you use modulations?
to avoid sensory habituation (nervous system adaptation)
can allow lower intensity
48
what is the sweep modulation?
frequency
sweep the freq
changes beat freq
49
what is the scan modulation?
amplitude
scan the amp
shifts clover side to side
50
is there any true difference between 4K and 5K?
nope
51
amp and relief time of acute IFC
amp - strong sensory sensation
relief only while active
gate theory
52
what is pre modulated inferential?
the currents are mixed in the machine not the pt
one channel
2 pads
53
drawback of pre-mod
has a lower freq so has more resistance and could be more agitating to skin
54
should I use true or pre mod ICF?
depends
probably similarly effective
55
parameters for ICF for chronic pain
strong, low-rate
opiate-like release
carrier - 2500 Hz
beat - 2-10 Hz
strong to sharp sensory sensation
want muscle contraction
relief time is 3-4 hrs after
56
IFC research takeaways
better than placebo
prob most effective when combined with exercise
prob not best use of time
57
is NEMS for innervated or denervated muscle?
innervated
58
which type of muscle fiber is recruited early with stimulated contraction?
early: FT
late: ST
59
which type of muscle fiber is early with voluntary contraction?
early: ST
late: FT
60
contrast voluntary and stimulated contractions
voluntary:
smooth
asynch, fine mvmts
stimed:
jerky
sych recruitment, all or none
61
how do you stimulate more motor units?
more amplitude
external resistance
62
how to target endurance?
more reps at lower intensity
63
how to target strength?
fewer reps at higher intensity
at least 50% MVIC for healthy muscle
at least 10% MVIC for weakened muscle
64
clinical applications of NEMS
post surgery
presurgery
alternative to surgery
conditions leading to relative disuse
sports performance
65
contraindications of NEMS
pacemaker or unstable arrhythmia
over carotid sinus
thrombosis
pelvis, abdo, trunk, low back in preg
when contraction is contraindicated
66
precautions to NEMS
cardiac disease
impaired mentation or sensation
malignant tumors
skin irri or open wounds
DOMS
67
evidence for NEMS
more amps = more motor units
68
what is the pulse duration for NEMS?
150-350 usec
69
electrode placement for NEMS
in alignment with muscle fibers
70
pt position for NEMS
make sure they can freely move the joint
71
pulse freq for NEMS
< 20 pps for twitch
35-50 pps for tetany
> 50 pps for fatigue
72
on:off time for NEMS (strength building)
6-10 sec on time
1:5 ratio is typical
73
on:off time for NEMS (fatigue)
2-5 sec on time
1:1 ratio
74
ramp time for NEMS
larger muscle 3-6 sec
smaller muscle 1-3 sec
75
amplitude for NEMS
need enough to fully recruit motor units
more amp = more units = bigger contraction
more can be less comfy
76
treatment time for NEMS
10-20 contractions
if 10 sec on time, 1:5 ratio, 1 min/rep so 10 min
if for muscle spasm reduction, 10-30 min
77
what is FES?
elicit contraction during functional activity
78
evidence for FES
works with other PT interventions
79
rationales for denervated muscle
waiting for reinnervation
promote reinnervation
but wouldnt really do this - not safe
80
ways PTs can help with denervated muscle that does not involve electrical stim
maintain blood flow/prevent edema
maintain tissue extensibility/prevent contracture
maintain tissue integrity/prevent injury
promote voluntary contraction
81
history of russian stim
dr. yahov kots claimed 40% force gains in russian athletes
2500 Hz
alternating current
82
evidence of russian?
no added effect
83
what is the target neuron for russian?
a alpha
84
waveform for russian
bust modulated AC
85
pulse freq for russian
50 pps
86
ramp time and on:off time for russian
ramp: 3-6 sec
6-10 on time
ratio of 1:5
87
duty cycle for russian?
50%
88
what types of edema do PTs treat?
inflam
lack of circulation due to lack of motion
89
systemic causes of edema
chronic venous disease
kidney disease
heart failure
cirrhosis
we DO NOT treat these with estim
90
what is lymphedema?
swelling in arms/legs due to damage to lymph nodes
result of cancer treatment, infections, CVD
91
what is dependent edema?
gravity related swelling to lower body
92
protocol for acute edema (inflam)
chat - HVPC
neg polarity
does NOT clear, just slows
works the same as ibuprofen or ice
just need to doc volts
treatment time: 20-30 min
40-100 us - preset
100-120 Hz - preset
one elec right over edema, other higher
93
mechanisms of slowing inflam edema
neg charge repels neg proteins, blocks mvmt out of vessels
microvessel diameter is reduced with treatment = decreased blood flow
prevention of large plasma proteins to leak through the pores
94
chronic edema protocol
NMES
1:1 ratio (3 sec)
no polarity
150 us small, 350 us large
35-50 Hz
30 min treat time
2x or more per day
ELEVATION
compression garment after
95
which pts likely have impaired sensation?
diabetic neuropathy
SCI
96
which pts have impaired blood supply?
peripheral vascular disease
DMII
97
what is the most common pressure sore location?
lower back and butt
98
what stages of wounds do we treat?
3-4
diabetic ulvers
venous stasis ulcers after 30 days
99
mech of estim for chronic wounds
attracting appropriate cells types
alternating potentials
reducing edema
promoting circulation
improving oxygenation
enhancing microbial activity
100
what cells are attracted to pos polarity?
inactive neutrophils
macrophages
epidermal cells
101
what cells are attracted to neg polarity?
active neutros
lymphocytes
platelets
mast cells
fibroblasts
102
how does wound healing work?
tigger calcium channels
increases calcium = exposure of insulin receptors which stimulate DNA
103
what is the waveform for HVPC?
monophasic
104
polarity for wound
first 3-7 days: neg
chronic: pos - what we do
105
protocol for wound estim
HVPC - chat
strong sensory
45-60 min
pos polarity for chronic
1x/day 5 days/week
elec in wound, other outside
106
additional contras for wound estim
careful if decreased sensation
single use electrodes
clean but not sterile
minimize transmission of disease
107
history of spinal traction
james cyriax
separates joint surfaces
108
what is the cyriax method for reduction of disc protrusion?
pulling on head
to reduce a disc fragment
for decreases intradiscal pressure
tensing of PLL
109
current medical use of traction
management of fractures
110
what are the different types of spinal traction
mechanical
- static
- intermittent
inversion
self-traction/positional
manual
111
what are the advantages of mechanical traction?
force and time are well controlled
readily graded
replicable
does not require constant clinician attention
static or intermittent traction
112
what are the disadvantages of mechanical traction?
expensive
time consuming to set up
lack of pt control or participation
restriction by belts could be poorly tolerated
broad region rather than segments
113
positional traction example
sidelying
towel under iliac crest
rotate thoracic spine until target moves
hip is flexed until flexion is palpated at target
114
advantages of self traction
minimal or no equipment needed
easy for pt to perform
easy for pt to control
can be performed wherever and many times per day
115
disadvantages for self traction
low max force
may not be effective
requires strong, injury free UE
little research to support
pt must have adequate postural control
116
advantages to manual traction
minimal equipment
short set up time
force can be finely graded
clinician present
good for those who do not tolerate belts
117
disadvantages to manual traction
limited max force
force not easily replicated or recorded
cannot be applied for prolonged time
skilled clinician
labor intensive
118
traction for reduction of disc protrusion
can potentially:
reduce prolapse
cause retraction of herniation
reduce size of herniation
increase space within spinal canal
widen neural foramina
119
effects of spinal traction
can:
distract joints
reduce protrusions
stretch ST
relax muscles
mob joints
may:
reduce pain
stim sensory mechanoreceptors
120
when do symptoms not improve with disc protrusion?
large HNP
calcification
force is too low
disc isnt the problem
121
ST stretching
increase tendon length
increase mobility
possible reduction of protrusion
increased spinal ROM
possible decrease in pressure on facet joints, discs and nerve roots
122
muscle relaxation in traction
reduced pressure on pain sensitive structures
gating of pain
interrupts pain spasm pain cycle
123
joint mob in traction
can increase mobility
can decrease joint pain
124
joint distraction - amount of force needed
25% body weight for lumbar spine length
50% body weight for lumbar facets
7% body weight to distract cervical facets
125
indications for traction
back or neck pain
nerve root impingement
joint hypo
subacute joint inflam
paraspinal muscle spasm
aggravated by joint loading
relieved by distraction
126
indications for traction in nerve root impingement
caused by:
HNP
lig encroachment
narrowing of foramen
osteophyte encroachment
spinal nerve root swelling
127
traction contraindication
if motion is contra
acute injury or inflam
joint hyper or instability
peripheralization of symptoms with traction
uncontrolled hypertension
spondy
128
instructions for traction
start with low force
response monitored
empty bladder prior
avoid heavy meal prior
129
precautions for traction
structural diseases
pressure from belts are hazardous
displacement of annular fragment
medial disc protrusion
severe pain fully resolves with traction
claustrophobia or psych aversion
inability to tolerate prone or supine
disorientation
TMJ problems or dentures for cervical
130
describe medial disc protrusion
medial mvmt of nerve root caused by traction may increase impingement of disc on nerve root
131
adverse effects of traction
symp may increase
rebound pain
lumbar radiculopathy after cervical
132
static vs intermittent
static:
if area easily inflammed
sym easily aggravated
related to disc protrusion
intermitt:
related to disc protrusion
related to joint dysfunction
133
lumbar traction parameters
acute: 25%BW, static, 5-10min
facet: 50%BW, 15/15sec h/r, 20-30min
spasm: 25%, 5/5, 20-30 min
disc: 25%, 60/20, 20-30min
ST: 25%, 60/20, 20-30min
134
cervical traction parameters
acute: 7-9lbs, static, 5-10min
distraction: 7%BW, 15/15, 20-20min
spasm: 11-15lbs, 5/5, 20-30 min
disc: 11-15lbs, 60/20, 20-30min
ST: 11-15lbs, 60/20, 20-30min
135
what is iontophoresis?
transdermal delivery of drugs
136
what is the waveform of ionto?
low amp direct current
137
what is the amplitude for ionto?
typically 1-4 mA
138
how do you "dose" ionto?
most common is 40 or 80 mA*min
40 mA*min = 4 mA * 10 min
just needs to = total dose
139
adverse effects of ionto
electrothermal and electrochemical burns
140
how to minimize adverse effects
increase size of negative electrode
decrease current amp or current density
use buffered electrodes
battery operated
hybrid portable
141
what are the most common drugs for ionto?
dexamethasone phosphate (-), inflam
lidocaine (+), local anesthetic
142
what is BFR?
significant occlusion pressure placed proximal to target musculature and fully prevents venous return
143
history of BFR
japan
KAATSU bands
144
result of BRF
metabolic stress through induced hypoxic conditions
generate both hypertrophic and strength improvements under low mechanical load
145
3 initiators of exercise induced hypertorphy
mechanical tension
metabolic stress
muscle damage
146
what is the minimal stim of load to direct an adaptation?
strength: heavy weights 70% of 1RM
hypertrophy: 40-60% 1RM
147
factors of metabolic stress
increased fiber recruitment
elevated hormonal release
altered myokine production
production of ROS
cellular swelling
148
BRF phases
phase 1:
PFR-P, BFR-NMES
acute care
phase 2:
BFR-AE
post-acute
phase 3:
BFR-RE, traditional exercise
outpatient
149
key populations for BFR
geriatrics
psot ACL repair
150
general protocol for BFR
2-3x/week or 1-2x/day
load: 40% 1RM
restriction time: 5-10 min/exercise
type: small and large muscle groups
sets: 2-4
cuff: 5- small, 10 or 12- medium, 17-18- large
rep pressure: 40-80% AOP
restriction form: continuous or intermittent
execution speed: 1-2s
execution: until concentric failure
151
aerobic training protocol for BFR
2-3x/week or 1-2x/day
intensity: <50% VO2max
restriction time: 5-20 min/exercise
type: small and large muscle groups
sets pressure: 40-80% AOP
cuff: 5- small, 10 or 12- medium, 17-18- large
exercise mode: cycling or walking
152
safety concerns with BFR
acute BP and HR increase
elevated risk of stroke in HTN
adverse effects from higher HR
153
delfi BFR
gold standard
$5,000
154
active vs latent trigger points
active:
spontaneous pain
pain w/o stim
latent:
no spontaneous pain
may restrict mvmt or cause weakness
can refer pain
155
which trigger point has a higher pain pressure threshold?
latent
156
would a deeper or more superficial muscle have a larger pain pattern?
the deeper the muscle, the larger the pain pattern
157
characteristics of trigger points
increase motor endplate activity
local ischemia/hypoxia
increase ACh and decrease ACh-esterase
release of sensitizing substances
158
what are the local effects of dry neelding?
disruption of dysfunctional motor endplates
mechanical deformation of tissue
microtrauma leading to inc blood flow and healing response
159
what are the central effects of dry neelding?
reduction of central sensitization by dec peripheral nociceptive input
modulation of pain perception through spinal and supraspinal pathways
160
outcomes of dry needling
immediate reduction in local & referred pain
improved ROM
normalization of muscle activation patterns
161
difference between DN and acupuncture
DN: targets myofascial trigger points
Acu: focus on energy flow
162
initial procedure for DN
start with 1-2 pistons in a given tunnel
redirect the needle to a new tunnel
overall goal - 5-10 twitches per given muscle
163
what does DN feel like?
mild discomfort or brief sharp sensation
muscle twitching or cramping during
post-treatment soreness
164
what does a twitch response signify?
indicates proper needle placement and associated with therapeutic benefits
165
safety considerations for DN
generally safe when performed by trained
possible minor adverse: soreness, bruising
rare: pneumothorax, infection
use SINGLE USE needles
166
what are the contras for DN?
pt refusal or inability to consent
local or systemic infection at treatment site
uncontrolled bleeding disorders
anticoagulant therapy
167
what are the precautions for DN?
pregnancy in 1st tri
immune suppression
compromised skin integrity
pts with needle phobia or severe anxiety
communicable blood diseases
extreme pain reports
168
competency recs for DN
comprehensive training in anatomy and needling techniques
certification
understanding indications and contras
adherence to hygiene and safety protocols
understand safe needle disposal
