Mod. 4-7: NMES, HVPC, Ionto, US

Question 1

purpose of NMES

Answer 1

assist muscle contraction facilitation

Question 2

NMES: Indications

Answer 2

muscle strengthening
muscle re-education
mm spasm
edema

Question 3

NMES physio effects

Answer 3

stimulate APs along motor nerves
overload principle (combo of e-stim contraction and mm contraction)
SAID principle (stimulate type 2 first)

Question 4

NMES waveform (mm strengthen or edema)

Answer 4

pulsed biphasic/Russian

Question 5

NMES pulse duration (& for mm types)

Answer 5

150-350 us
(150-200 us for small mm; 200-350 us for large mm)

Question 6

NMES: frequency,
duty cycle (mm strengthen vs. edema)

Answer 6

freq: 35-50 pps
duty cycle (on/off time): 1:5 ratio- mm strengthen
1: 1 ratio- edema

Question 7

NMES amplitude
& tx time (mm strengthen vs. edema)

Answer 7

amplitude: smooth mm contraction
mm strengthen tx time: 10-20 min
edema tx time :20-30 min

Question 8

NMES (dec. mm spasm or edema) ramp time

Answer 8

1-4 sec

Question 9

when to not use NMES for edema

Answer 9

acute inflammation
organ failure

Question 10

NMES electrode placement

Answer 10

1 over motor point (mid mm belly)
1 over stimulated mm, parallel to mm fibers

Question 11

What is EMG? acronym & function

Answer 11

electromyography
measure electrical activity in muscle tissue

Question 12

What type of stimuli does biofeedback utilize? (3)

Answer 12

auditory, visual, haptic (tactile)

Question 13

EMG Indications

Answer 13

bowel/urinary incontinence
cerebral palsy
hemiplegia
impaired motor control
mm spasm
mm weakness
pain
SCI

Question 14

EMG physio effects

Answer 14

neuromusc. facilitation to inc. strength
neuromusc. inhibition
neuromusc. coordination
improve motor planning w/ feedback

Question 15

EMG for mm facilitation:
gain
amplitude
isometric holds
tx duration

Answer 15

gain: low sensitivity
amplitude: 66% MVIC
holds: 5-10 sec w/ rest between
tx duration: 5-10 min per mm group

Question 16

EMG for mm inhibition:
gain
amplitude
tx duration

Answer 16

gain: high sensitivity
amplitude: lower than baseline
tx duration: max 30 min

Question 17

EMG contraindications

Answer 17

acute inflammatory conditions (avoid mm contraction)
skin irritation
pregnancy, vaginal or bladder infection

Question 18

HVPC Indications

Answer 18

chronic wounds (ulcers)
edema (d/t inflammation)

Question 19

HVPC Physio Effects

Answer 19

galvanotaxis (cell movement)
activate cell function
enhance antimicrobial activity
enhance circulation

Question 20

Anode: charge, when used, attracted cells

Answer 20

positive
in proliferative phase of healing (no inflammation)
macrophage, neutrophil, epidermal cells

Question 21

Cathode: charge, when used, attracted cells

Answer 21

negative
in inflammatory phase of healing
lymphocyte, platelet, mast cells, fibroblasts, keratinocytes

Question 22

HVPC Wound Healing:
waveform
electrode placement
amplitude

Answer 22

pulsed monophasic
elec. placement: in wound or surrounding
sensory tingling

Question 23

HVPC Wound Healing:
pulse duration
frequency
tx time

Answer 23

pulse duration: 40-200 us
frequency: 60-125 pps
tx time: 45-60 min (5 days/wk)

Question 24

HVPC Edema (Inflamm)
waveform
elec. placement (cathode & anode)
amplitude

Answer 24

pulsed monophasic
cathode- area of edema; anode- proximally
visible mm twitch (mm pump)

Question 25

HVPC Edema (Inflamm) pulse duration frequency tx time

Answer 25

pulse duration: 40-100 us frequency: 100-120 pps tx time: 20-30 min

Question 26

Iontophoresis: waveform & common drug

Answer 26

direct current dexamethasone

Question 27

Iontophoresis: Indications

Answer 27

Pain* & inflammation* also, fungal infection, ischemia, mm spasm, plantar warts, scar tissue, wounds etc.

Question 28

Ionto: contraindications beyond standard e-stim

Answer 28

no application after other phys. agent (ice, heat, US) drug allergy skin sensitivity to specific ion reactions

Question 29

Ionto: Physio Effects

Answer 29

elec. current pushes medication with same charge into skin (repels medicine) ion penetration less than 1mm absorbs deeper via capillary circulation

Question 30

Ionto: amplitude & usual dosage

Answer 30

less than 1-4 mA ~ 40-120 mA-min

Question 31

Ways to decrease Ionto Burns

Answer 31

increase cathode size dec. amplitude inc. distance between electrodes skin prep use appropriate med. dosage medication in correct electrode (ex: neg. charge med in cathode)

Question 32

Ionto dosage calculation

Answer 32

dosage = amplitude x tx time

Question 33

Ultrasound Indications

Answer 33

pain acute, subacute conditions scar tissue chronic inflammation joint contracture ST shortening mm spasm tissue regeneration etc

Question 34

US Contraindications

Answer 34

epiphyseal area of bones in kids acute conditions (for thermal) malignancy DVT, blood clot, thrombophlebitis joint cement/plastic in replacement active bleeding etc

Question 35

Thermal US- Physio Effects

Answer 35

inc. metabolic rate & circulation pain modulation dec. mm spasm & joint stiffness inc. ST extensibility alter nerve conduction velocity

Question 36

Nonthermal US- Physio Effects

Answer 36

inc. intracellular calcium levels inc. cell membrane permeability stimulate cell function facilitate tissue repair Cavitation (gas bubbles) Microstreaming & Acoustic Streaming (circular flow of fluids)

Question 37

US: tx area size & transducer speed

Answer 37

treat area twice the size of transducer head move transducer 4cm/sec

Question 38

US: ST shortening (MM) parameters @ 1MHz & 3 MHz thermal or nonthermal?

Answer 38

1MHz (freq)- 100% duty cycle - 1.5W/cm2 - 14 min 3MHz (freq) 100% duty cycle - 1 W/cm2 - 7 min thermal

Question 39

US: ST shortening (tendon) parameters @ 1 MHz & 3 MHz thermal or nonthermal?

Answer 39

1 MHz (freq) - 100% duty cycle - 1.5W/cm2 - 10 min 3 MHz (freq) - 100% duty cycle - .8-1.0W/cm2 - 5 min thermal

Question 40

US: pain modulation parameters (freq, duty cycle, intensity, time) @ both 1& 3 MHz range

Answer 40

1 or 3 MHz- 100% duty cycle - .5-3.0 W/cm2 - 3-10 min

Question 41

US: ST healing (wounds & mm) Parameters @3 MHz

Answer 41

3 MHz (freq) - 20% duty cycle - 1 W/cm2 - 10 min

Question 42

US: bone fracture healing Parameters @ 1 MHz

Answer 42

1 MHz (freq) - 20% duty cycle - 0.15 W/cm2 - 20 min

Question 43

US: tendon/ligament injury Parameters @ 1 MHz

Answer 43

1 MHz (freq) - 20% duty cycle - 1-2 W/cm2 - 5-10 min

Question 44

1 MHz frequency: tissue depth (and reaches what), temp. inc. rate

Answer 44

max 5 cm depth reaches bone (and some cartilage & tendon) low & slow temp increase

Question 45

3 MHz frequency: tissue depth (and reaches what), temp inc. rate

Answer 45

1-2 cm depth reaches mm and skin (not bone) high & fast temp increase

Question 46

Phonophoresis Parameters: duty cycle, intensity range, frequency & tx duration

Answer 46

20% duty cycle - 0.5-1.0W/cm2 - 3 MHz - 5-10 min

Question 47

Combo: US transducer & e-stim electrode Which one is positive vs. negative?

Answer 47

US transducer- positive Electrode- negative