lecture 3 continued: clinical uses of electrical sitmulation currents Flashcards by sophia carrasco

what are the 4 levels that changes in the physiologic functioning as electricity moves thru the body’s conductive medium

✧ Cellular
✧ Tissue
✧ Segmental ✧ Systemic

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what is the physiologic response to electrical current at a cellular level (5)

• Excitation of nerve cells
• Changes in cell membrane permeability
• Protein synthesis
• Stimulation of fibroblasts
and osteoblasts
• Modification of microcirculation

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what is the physiologic response to electrical current at a tissue level (3)

• Skeletal muscle contraction
• Smooth muscle contraction
• Tissue regeneration

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• Modification of joint mobility
• Muscle pumping action to change circulation and lymphatic activity
• Alteration of the microvascular system not associated with muscle pumping
• Increased movement of charged proteins into the lymphatic channels

these are physcilogic response to electrical currents at which level

segmental

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• Analgesic effects as endogenous pain suppressors are released and act at different levels to control pain
• Analgesic effects from the stimulation of certain neurotransmitters to control neural activity in the presence of pain stimuli

these are physiological responses to the electrical current at which level

systemic

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what are the 6 types of electrical stimulation currents

-electrical stimulation (NMES, FES)
- russian currents
-interferential currents (IFC)
- high volt pulsed current
-Transcutaneous Electrical
Nerve Stimulation (TENS)
- low volt current (DC)

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which electrical current has symmetric biphasic currents

TENS

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which electrical stimulation has twin peak pulsed waveforms

high volt pulsed current

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which type of electrical stimulation has pulsatile biphasic waveform (2k-10k HZ)

russian currents

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what type of electrical stimulation is a pulsed waveform and single or multiple channel electrical simulators programmed in a synergistic sequence

Electrical stimulation (NMES, FES)

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Clinically, “TENS” refers to ES applied for ___ ___

pain reflief

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what are the stages someone goes to as u crank up the electrical simulation

sub sensory
sensory
motor
noxious

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what clinical stimulation level is someone at if there is no nerve activation and no sensory awareness

sub sensory

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what clinical simulation level is someone at if they feel tingling , prickling , or pine and needles or there is cutaneous A - beta nerve fiber activation

sensory

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what clinical simulation level is someone at if there is
- strong parasthesia
-mm contraction
-A alpha never fiber activation

motor

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what clinical stimulation level is it if
- strong uncomfortable parasthesia
-strong mm contraction
-sharp or burning pain sensation
- A delta and C fiber activation

noxious

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what type of fiber is recruited first for voluntary motor level stimulation

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what type of fiber is recruited first for an electrically induced motor level stimulation

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what is The location of skin above the muscle in which an electrical pulse applied transcutaneously evokes a muscle twitch with the least injected current.

motor points

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motor points is where the threshold is ___ for a given electrical input

low

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___ ____ stimulation gives the best individual muscle contraction

motor point

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what kind of waveform is a high volt current

Twin-peak monophasic pulsed waveforms

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what are the 2 main uses for high volt currents

reducing edema and wound healing

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what current is preferred over high volt current for pain control

IFC and TENS

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what currents is the best for MM contraction

russians and NMES

what is a monopolar high volt application

2 unequal sized electrodes

where is the active and dispersive electrode places for a monopolar high volt current

active is the smaller one over the treatment site and dispersive is the larger one placed somewhere away from treatment site

when during the phases of healing is negative polarity and positive polarity for high voltage most effective

negative is most effective during the inflammatory phase of healing and postivie is most effective during the proliferation phase of healing

____ of the electrode attracts charged ion and promote faster healing

Polarity

does edema control what polarity for u use for high volt

negative

what is the frequency and intensity and treatment time for **high volt** edema control

f: 120 pps I: 30-50V or 10% less than that needed to produce a visible mm contraction TT: 30 min session

which electrical current Uses gate control theory, the descending control theory, and endogenous opiate pain control theory.

TENS (asymmetric biphasic current)

pulse amplitude is the same as what

intensity

pulse width is the same as what

duration

pulse frequency is the same as what

rate

conventional TENS is for ___ rate and ___ intensity (sensory level )

high and low

what is conventional TENS best for

acute pain

what theory does conventional TENS use and what does it stimulation

gate control theory - stimulates A-beta fibers

the acupuncture like TENS would be used at ___ rate and ___ intensity (___ level_

low rate nd high intensity at the motor level

what is acupuncture like TENS usually used for

chronic pain

what theory does acupuncture TENS use and what does it release

Descending Pain control Theory – release of enkephalin

what level of TENS is hyperstimulation analgesia

noxious level

what theory dies the noxious level of TENS use

Endogenous opiate pain control theory

which TENS units does high rate and high intensity for fast pain relief during prodcueure wound debridement with peripheral and central analgesia

brief intense

___ ____ is the most common conventional TENS

Asymmetrical biphasic

what is the following for conventional TENS • Frequency: • Duration: • Intensity: • Treatment time:

• Frequency: 80 - 125 pps • Duration: 75 - 150 microseconds • Intensity: Tolerable sensory stimulation • Treatment time: until pain is no longer

what theory is • Increased activity of A-beta afferents triggers the release of enkephalin from interneurons in Substantia Gelatinosa (SG), which inhibit synaptic transmission to 2nd order neurons (transmission (T) cells) and block pain message ascending to the brain

the gate control theory

what is the frequency , duration , intensity , duty and treatment time for LOW frequency TENS ( Acupuncture like - motors level)

f: < 20 pps D: 100-600 microseconds I: high enough to elicit both a sensory and motor Duty: 30-60s on , off time as needed TT: 15-60 mins

where is Low-Frequency TENS (Acupuncture-like, motor-level)applied over

motor point

what is the Frequency, duration , intensity , duty and TT for **Noxious level TENS**

F: 1-5 pps D: 100-1000 microseconds I: high intensity to a noxious level (mm contraction is ok) Duty: 30-45 secs , off time as needed TT: until pain no longer there

where is Noxious-Level TENS applied over

trigger or acupuncture points

• Peripheral blockage and extra-segmental analgesia • Stimulation of the small afferents (A-delta and C) can stimulate the release of endorphins, beta-endorphin and dynorphin • Beta-endorphin is released by anterior pituitary gland and hypothalamus • Prolonged electrical stimulation on acupuncture points triggers the release of beta-endorphin and dynorphin that theory is this

Endogenous Opiate Pain Control Theory

what is the following for **brief intense TENS ** * Frequency: * Duration: * Intensity: * Treatment time:

* Frequency: 100 pps * Duration: 100 - 600 microseconds * Intensity: Muscle fasciculation to sustained muscle contraction * Treatment time: ~ 15 minute

what is the main thing brief intense TENS is used for

wound debridement

• Serotonergic efferents: A descending system from thalamus stimulates the periaquedutal gray and the raphe nucleus to activate enkephalin interneurons • Serotonin suppresses the release of substance P by A-delta and C fibers • Enkephalin is released to block signal transmission of 2nd order neurons (lateral spinothalamic tract) • Noradrenergic pathways: projects from pons to dorsal horn what theory is this

Descending Pain Control Theory: Peripheral and Central Analgesia

what is the difference between NMES and TENS -waveform -pps -duration -channels -output/ duty - modulations -timer

-NMES is sym or asym wave form and TENS is usually only 1 -fixed or few rate options (20-50pps) for NMES and for TENS rate options are 1-150pps - NMES has a fixed pulse duration where TENS is variable pulse duration - NMES is sim or alt channel activation and TENS is same to both channels - NMES has duty cycle settings and TENS is a constant output - NMES only has ramping modulations and TENS has rate&or duration &/or amplitude modulations - NMES has a timer and TENS doesn’t

what do you use russian currents for

mm strenghtening and mm re-education

Should you substitute therapeutic exercise with Russian E-Stim?

what is the burst mode for russian currents

50% on/off

what are the advantages for russian currents

-high frequency currents reduce resistant to flow , making waveform comfortable enough to handle more - as intensity increases more motor nerves are simulated increased the contraction - as soon as a nerve repolarize it stimulated again , producing a current that will maximally summate mm contraction

what is interfernetial currents used for (IFC)

pian control and mm spasm

IFC prodocues ___ waves at ___ frequencies

sine different

which currents for u cross two bipolar configurations

IFC

what is the Interferential Currents: Sweep mode

allows the frequencies of the current to be modulated , resulting in. a modulated beat frequency

what do u want to avoid with Interferential Currents: Sweep mode

accommodation by beat frequencies

which IFC mode can you Provide both high and low frequency stimulation within the same treatment area

sweep

what does the Interferential Currents: Scan mode allow

allow the amplitude of the input currents to the modulated

if a patient has a poorly localized pain what does Interferential Currents: Scan mode do

moves forces around. while the treatment is taking place enlarging effective treatment area

how many electrodes is pre mod

only 2 pads

which current is there Two currents that are interfered within the device before delivering the current to the patient

Premodulated (Bipolar) Interferential Current

what is the biphasic pulse rate and duration for NMES or FES for **mm reeducation and strengthening**

pulse rate - 35-55 pps Duration: 200-600 us