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Modalities Flashcards

1
Q

resting membrane potential

A

negative inside cell, positive outside the cell

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2
Q

refractrory period

A

absolute: cannot fire.
relative: can fire, but requires stronger stimulus

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3
Q

Contraindications for ESTIM

A

trunk of pregnant woman
areas of PVD/thrombophlebitis
pacemaker/other implanted electrode
close proximity to diathermy

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4
Q

Precautions for ESTIM

A 
Carotid sinus
High intensity estim around heart
excess adipose
insensate skin
seizures
open wound (unless treating wound)
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5
Q

Galvanic current

A

continuous, direct current. Used only for ionto

Has polarity

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6
Q

Cathode

A

negative electrode

attracts cations

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7
Q

Anode

A

positive electrode

attracts anions

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8
Q

Effects of Cathode

A

Base reaction
increase in nerve irritability
softening of tissue

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9
Q

Effects of anode

A

acid reaction
decrease in nerve irritability
hardening of tissue

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10
Q

Current

A

Flow of charged particle
Measured in Amperes
Current=voltage/resistance

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11
Q

Which is more important, average or peak current?

A

Average

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12
Q

Average total current limits

A

Do not go over 4 (most patients uncomfortable at over 2)

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13
Q

Fused/tetanic contractions occur around ____ Hz

A

15-20

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14
Q

What common applications are there for polyphasic current?

A

IFC and Russian

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15
Q

What current is “jack of all trades”

A

Hi volt pulsed DC

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16
Q

Rise and decay

A

Rise: time from baseline to peak
Decay: time from peak to baseline

Both apply to a single phase

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17
Q

Ramp

A

Ramp up: time from zero to maximum amplitude (seconds)

Ramp Down: time from max to zero

Increases comfort

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18
Q

Rheobase

A

magnitude of current just strong enough to cause tissue excitation with long pulse duration

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19
Q

Chronaxie

A

minimal pulse duration for activation at twice rheobase intensity

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20
Q

Pulse Duration

A

100-400 us.
300-400 most used
over 800 will stimulate pain receptors

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21
Q

Increased pulse duration will increase recruitment of:

A

smaller fibers at same depth

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22
Q

Increased amplitude will increase recruitment of:

A

smaller fibers at same depth, AND

larger fibers further away

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23
Q

What is the desired pulses per second for strengthening

A

30-50pps

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24
Q

Monopolar electrodes

A

1 active pad, 1 dispersive:

dispersive is larger and away from treatment area

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25
cycle time
on/off time
26
modulation
varying 1 or more parameters increases comfort and prevents accomodation
27
Burst
finite series of pulses Time interval=burst duration often seen in TENS and Russian
28
Train
a continuous, repetitive series of pulses at a fixed frequency
29
Normal vs Evoked firing pattern
Normal: asynchronous, fine gradiations in tension, small units first Evoked: synchronous, max tension at tetany, large units recruited first
30
Classification of Estim by frequency
Low (1-1000Hz): most pulsed units Medium (1k-100k) Russian (2500Hz), IFC (4-5k) High frequency: 100k+ diathermy: 27MHz
31
Use of continuous DC
ionto
32
Use of Interrupted DC
Denervated muscle (pulse width of over 10ms)
33
Use of monophasic pulsed DC with twin spikes
Hi volt pulsed DC: Pain control edema reduction tissue healing muscle stimulation (small muscles)
34
Use of polyphasic sine wave
Russian (motor) IFC: analgesia, edema/spasm reduction
35
Low volt pulsed current
Common less than 150v symmetrical/asymmetrical Portable NMES/TENS
36
High-Volt Pulsed
0-500V Monophasic twin spike Management of pain, edema, wounds. muscle contraction in small muscle groups fixed pulse duration at 100-150 usec
37
IFC
two channels with different frequencies- beats per second is difference in frequencies. Less than 150V, but high average current Used for pain, edema, muscle spasm
38
Russian current
Interrupted sine wave-medium frequency carrier frequency typically 2500 Hz, 50 bursts per second 50% duty cycle
39
NMES pulse duration
May be fixed 100-600 (300) keep as low as possible to minimize chance of stimulating A deltas.
40
NMES frequency
30-50 pps (true russian is 50)
41
Ramp down is usually ___ of ramp up
1/2
42
Gate Control
Stimulate A-Beta. "closes pain gate" so C and A delta cannot reach cerebral cortex)
43
Enkepahlins vs Endorphins
Enkephalins: depress receptive ability of pain receptors in SC - short half life (2 min) - high frequency, low pulse stim Endorphins: released from pituitary - long half life (4 hours) - low frequency, high pulse duration stim
44
Sensory TENS settings for acute pain
*2-50 usec pulse duration *50-100 pps 20-30 min residual relief variable High rate TENS, Conventional TENS
45
Motor level stimulation TENS for chronic
150 usec pulse duration 2-4 pps 30-45 min in research, 20 min in practice Residual relief for hours
46
ESTIM noxious stimulation protocol
-For chronic pain -Pulse duration as high as possible 1-5 pps, or greater than 100 pps
47
Advantages of IFC
has vector scan (amplitude modulation) built in Preferred by many pts Frequency modulation (sweep) Has a high average current (can be advantage or disadvantage)
48
Should the anode or cathode be put over inflammation for edema management
cathode
49
What stages of pressure ulcers are most appropriate for estim use
stage 3/4. (2 can be used, but may not be necessary). infected or edematous wounds most appropriate
50
Is Estim appropriate over osteomyelitis?
no
51
Effects of negative polarity on wound healing
``` epidermal proliferation increased blood flow fibroblast proliferation neutrophil attraction edema reduction ``` bacteriocidal
52
Effects of positive polarity on wound healing
attracts macrophages epithelial growth new capillarization bacteriocidal for STAPH
53
Ionto
uses continuous DC. Pole used is determined by drug Dosed in "mA*min"
54
Dexamethasone for ionto
for inflammation | negative polarity
55
lidocaine for ionto
sodium channel blocker positive polarity
56
Inverse Square law
intensity of radiation is inversely proportional to the square of the distance
57
Cosine law
Absorption of rays is optimal when they are perpendicular. As angle increases from perpendicular, efficiency is decreased proportional to cosine of the angle
58
Levels of heating effects
0-1*C: mild (subacute injuries) 1-2*C: moderate (chronic inflammation, pain, trigger pt 2-3*C: vigorous: stretching collagen
59
Heating effect on muscle firing
increased GTO firing and decreased secondary afferent firing combine to decrease motorneuron firing
60
How deep can superficial heating therapeutically reach?
3 cm (most effects up to 1 cm)
61
What temperature should hydrocollator packs be kept at?
165-175 (76-80* C)
62
What temperature should parafin be kept at?
125-135 (52-53C)levels
63
Buoyancy
at ASIS 50% WB, | at C7 10% WB
64
Cold Urticaria
Release of histamine in response to cold. causes: wheals, erythema, swelling, systemic effects (syncope, GI, respiratory)
65
Cryoglobinemia
pt has substances in blood that precipitate in cold
66
Raynauds
vasoconstriction of distal vessels in response to cold. most common in 18-30 yo females, usually bilateral
67
Hunting reaction
Prolonged cold leading to vasodilation in the area
68
Biophysical effects of cold on spasm, spasticity, and flaccidity
decreased spasm d/t decreased muscle spindle activity decreased spasticity d/t decreased gamma motor neuron activity Facilitation of contraction in flaccidity
69
Temperature for cold baths
55-65* F
70
Vapocoolant Sprays
hold 18-24" from pt | spray at 30* at rate of 4"/s
71
Contrast bath temps
100-110, 55-65
72
depth of US
1 MHz: 2-5 cm | 3 MHz: 0-3
73
Biological effects of US
increased metabolism increased blood flow increased collagen extensability decreased neural sensitivity
74
Acoustic Streaming
unidirectional movement of fluid in US field. "micromassage" increase diffusion, permeability promotes tissue repair
75
Cavitation
alternate compression and expansion of gas Some is desired, so is undesired
76
Phonophoresis
uses nonthermal effects to enhance diffusion pulsed US
77
Diathermy
Microwave: 2450 MHz (gets superficial) Shortwave: 27.12 MHz
78
Capacitance diathermy field
places pt in circuit: need both heads more heat in areas of fat/skin (superficial)
79
Inductance diathermy field
places patient in field: only need one head muscle, synovial fluid (deeper)
80
Contraindications to diathermy
``` metal in area, metal or plastic implants eyes CA pregnant carotid sinus, heart, stellate ganglion pacemaker ```
81
Biofeedback on weak muscles pad placement and sensitivity
Placement far apart with high sensitivity in order to increase detection. As pt gets stronger, decrease sensitivity
82
Biofeedback to decrease muscle activity
Place pads close together with low sensitivity (in order to isolate muscle. Progress to higher sensitivities

License Prep (22 decks)

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