NMES, TENS, Hi-Volt, Microcurrent

Question 1

What is the overall goal of NMES?

Answer 1

Stimulation of alpha motor NEURONS to cause strong muscle contraction

Question 2

What are the indications for NMES?

Answer 2

1 retrain lost muscle function following surgery or injury
2 decrease muscle atrophy
3 decrease muscle spasm

Question 3

Are slow or fast muscle fibers contracted first with normal physiologic muscle contractions?

Answer 3

Slow (fast when needed for greater exertion)

Question 4

What does minimal fatigue occur with normal physiologic muscle contractions?

Answer 4

1 slow twitch fibers contracting first

2 asynchrony of firing motor units

Question 5

Are slow or fast muscle fibers contracted first with NMES?

Answer 5

Fast (due to lower capacitance)

Question 6

Why does fatigue happen easier with NMES?

Answer 6

1 fast twitch fiber recruitment

2 synchronous firing of motor units

Question 7

Which exhibits faster fatigue: NMES or normal physiologic muscle contraction?

Answer 7

NMES

Question 8

What currents can be used for NMES?

Answer 8

Russian, biphasic pulsed, interferential

Question 9

What type of current is the stimulation of NERVES through the skin?

Answer 9

TENS

Question 10

What is a common error with the names of TENS and NMES?

Answer 10

EMS (electrical muscle stimulation) - muscles aren’t being directly stimulated….NERVES ARE

Question 11

What is the most common wave form seen with TENS?

Answer 11

Biphasic, symmetrical, square/rectangular

Question 12

What fibers are targeted by TENS sensory level stimulation?

Answer 12

A-beta (large diameter)

Question 13

What fibers are targeted by TENS motor level stimulation?

Answer 13

A-delta (in general)

Question 14

What fibers are targeted by TENS noxious level stimulation?

Answer 14

C fibers

Question 15

What TENS mode is used for sensory-level stimulation?

Answer 15

Conventional

Question 16

What type of pain would be an indication to use sensory level stimulation?

Answer 16

Acute

Question 17

Sensory-level TENS stimulation is often combined with what other treatments?

Answer 17

Ice or heat

Question 18

What is the duty cycle for sensory level TENS stimulation?

Answer 18

None

Question 19

What is the treatment time for sensory level TENS stimulation?

Answer 19

20-30 minutes (but could theoretically be 24 hours)

Question 20

Motor-level TENS stimulation is for what kinds of pain conditions?

Answer 20

Subacute and chronic (NOT ACUTE)

Question 21

Motor-level TENS stimulation is theorized to release what substance to decrease pain?

Answer 21

Endogenous opiates

Question 22

What specific fibers are targeted by motor-level TENS stimulation in acupuncture like mode?

Answer 22

A-beta and alpha motor neurons

Question 23

What specific fibers are targeted by motor-level TENS stimulation in burst mode?

Answer 23

Alpha motor neurons and delta fibers

Question 24

How does noxious-level TENS stimulation elicit pain relief?

Answer 24

Endogenous opiates

Question 25

What is the treatment time for noxious-level TENS stimulation?

Answer 25

30 seconds per point (8-10 points per session)

Question 26

What is unique about noxious-level TENS stimulation while a patient is using narcotic analgesics?

Answer 26

Results will be diminished (natural opiates then have to compete)

Question 27

What is the purpose of high-voltage pulsed current?

Answer 27

Enhancing soft tissue repair and healing (especially slow healing cutaneous wounds)

Question 28

What are other names for high volt stimulation?

Answer 28

Electro-Galvanic Stimulation, High Volt Galvanic Stimulation, or High Volt Pulsed Stimulation

Question 29

High volt indicates what level of voltage?

Answer 29

Greater than 150V (up to 500)

Question 30

What is the purpose for a high voltage with high volt stimulation?

Answer 30

Deeper penetration

Question 31

High volt stimulation must have twin peaks of what type of current?

Answer 31

Monophasic

Question 32

What are the benefits of high volt stimulation?

Answer 32

1 deeper penetration | 2 twin peaks doesn't allow small sensory fibers (A-delta and C) to be stimulated therefore increasing comfort

Question 33

What is unique about the peak amplitude of micro current?

Answer 33

Below rheobase of A-beta fibers (no depolarization, sub-sensory and sub-motor)

Question 34

What is the term for polarized cells being attracted to the opposite polarity thus enhancing healing during micro current?

Answer 34

Galvanotaxis

Question 35

What type of polarity is associated with the inflammatory phase of healing, and what cells does it attract?

Answer 35

Positive: neutrophils and macrophages

Question 36

What type of polarity is associated with the proliferation phase of healing, and what cells does it attract?

Answer 36

Negative: fibroblasts and promotes collagen formation

Question 37

What type of polarity is associated with the remodeling/maturation phase of healing, and what cells does it attract?

Answer 37

Negative: keratinocytes and epidermal cells

Question 38

What is the germicidal effect associated with micro current?

Answer 38

Increase of bacterial growth inhibition (not a lot of research)

Question 39

What type of current is associated with reducing edema?

Answer 39

HiVolt

Question 40

How does negative polarity work to reduce edema through HiVolt?

Answer 40

Repels negatively charged proteins

Question 41

What type of electrode placement is used with HiVolt to reduce edema?

Answer 41

Monophasic with treatment electrode over area of swelling and dispersal one proximal

Question 42

Why is Russian stimulation preferred for muscle spasm reduction even though HiVolt could possibly help?

Answer 42

Lack of polarity effect

Question 43

What is recommended for pain relief instead of HiVolt?

Answer 43

Interferential (lack of polarity effect)

Question 44

Although both HiVolt and micro current are used for healing stimulation, what are two things that are ONLY accomplished through HiVolt, not micro?

Answer 44

Decrease of edema and spasm/guarding

Question 45

Which polarity attracts acids and repels bases?

Answer 45

Positive

Question 46

Which polarity attracts bases and repels acids?

Answer 46

Negative