Physical Agents/FES

Question 1

Name 9 types of physical agents that are used to produce therapeutic response in tissues:

Answer 1

1. thermotherapy
2. hydrotherapy
3. Light therapy
4. electrotherapy
5. manual therapy
6. pressure
7. acupuncture
8. iontophoresis
9. phonophoresis

Question 2

8 factors to consider when choosing therapeutic modality

Answer 2

1. target tissue
2. depth of heating or cooling desired
3. intensity of heating or cooling desired
4. body habitus
5. comorbid conditions (arterial insufficiency)
6. age (open epiphyses)
7. sex (pregnant woman)
8. specific features (metal implants, pacemaker, cold allergy)

Question 3

6 elements of modality prescription

Answer 3

1. indication/diagnosis
2. modality
3. location
4. intensity - patient perception of thermal intensity
5. Duration - 20-30 mins for most, 5-10mins per site for ultrasound
6. Frequency - based on severity and clinical judgement

Question 4

_____ is the transfer of thermal energy between two bodies in direct contact. Give example

Answer 4

Conduction (hot pack)

Question 5

____ uses movement of a medium (water, air, blood) used to transport thermal energy. Give example

Answer 5

Convection - actual transfer of thermal energy ultimately by conduction. (whirlpool, fluidotherapy)

Question 6

____is transformation of another form of energy to heat or could

Answer 6

Conversion (sound, electromagnetic) - ultrasound

Question 7

_____ is emitted from any body whose surface temperature is above absolute zero (-273.15C or -459.67F)

Answer 7

Radiation (conversion)

Question 8

Process of converting a liquid to a gas requiring thermal energy:

Answer 8

evaporation

Question 9

Process of heat dissipation: For each 1g of water that evaporates from the body surface, approximately ____ of heat is lost

Answer 9

0.6 cal

Question 10

5 hemodynamic effects of heat:

Answer 10

1. increased blood flow and bleeding
2. decreased chronic inflammation
3. Increased acute inflammation
4. Increased edema
5. metabolic demand

Question 11

3 neuromuscular effects of heat?

Answer 11

1. Group 1a fiber firing rates increased (muscle spindle)
2. Group 1b fiber firing rates increased (golgi tendon organ)
3. Increased nerve conduction velocity

Question 12

3 joint and connective tissue effects of Heat?

Answer 12

1. increased tendon extensibility
2. increased collegenase activity
3. decreased joint stiffness

Question 13

6 general uses for heat

Answer 13

1. muscle relaxation
2. chronic inflammation
3. contracture
4. arthritis
5. pain (spinal, myofascial, neuromas, post herpetic neuralgia)
6. musculoskeletal conductions (tendonitis, tenosynovitis, bursitis, capsulitis)

Question 14

8 general precautions for use of heat:

Answer 14

1. acute trauma or inflammation
2. impaired circulation
3. bleeding diatheses
4. edema
5. large scars
6. impaired sensation
7. malignancy
8. cognitive or communication deficits that preclude reporting of pain

Question 15

Define
superficial heat:
deep heat:

Answer 15

superficial 1-2cm
deep/diathermy >3-5cm

Question 16

target tissues
Superficial heat:
Deep heat:

Answer 16

s: skin and subcutaneous
d: muscle, tendon, ligament, or bone

Question 17

Goal of deep heat (diathermy)?

Answer 17

minimize skin and subcutaneous tissue while maximize heating of deeper tissues

Question 18

Three methods of superficial heating:

Answer 18

conduction, convection, radiation

Question 19

method of deep heating: Goal temp?

Answer 19

conversion (40-45C)

Question 20

Uses for superficial heating?

Answer 20

OA, RA, Various pain syndromes, MSK conditions

Question 21

Hot packs/heating pads
depth:
main mech of energy transfer:

Answer 21

superficial
conduction

Question 22

Paraffin baths
depth:
mech:

Answer 22

superficial
conduction

Question 23

fluidotherapy
depth:
mech:

Answer 23

superficial
convection

Question 24

whirlpool baths
depth:
mech:

Answer 24

superficial
convection

Question 25

radiant heat depth mech:

Answer 25

superficial radiation

Question 26

Ultrasound depth: mech:

Answer 26

deep conversion

Question 27

shortwave diathermy depth: mech:

Answer 27

deep conversion

Question 28

microwave depth: mech:

Answer 28

deep conversion

Question 29

Therapeutic temperature range: for how long? _____ temp for increased metabolism and associated effects

Answer 29

40-45C (104-114F) 3-30mins 43-45C for metab

Question 30

In fluidotherapy, never use still water > _____ temp

Answer 30

46.1C (115F) - agitated water can be a little hotter due to insulating effects of bubbles

Question 31

Never put whole body in water >_____F

Answer 31

100 degrees

Question 32

for paraffin, do not use > ____ temp

Answer 32

54C

Question 33

Hot packs: 1. immersed in tanks at _____ temp 2. applied: 3 treatment time? 4. depth: 5. temperature rise:

Answer 33

1. 74.5C (166F) 2. applied over several layers of insulating towels 3. 30 mins 4. 1-4cm 5. 1.1 to 3.3 cm patient should not lie on pack. more common cause of burns in PT

Question 34

Heating pads: 1. two main types: 2. What is erythema ab igne?

Answer 34

1. electric, circulating fluid 2. repeated and prolonged skin exposure to heat noted after use of a variety of superficial heating modalities, reticular pigmentation and telangiectasia.

Question 35

Paraffin baths: 1. Ratio of paraffin wax:mineral oil 2. Temp range (why tolerated) 3. Used in: (2) 4. Avoid in 2 areas

Answer 35

1. 6-7:1 ratio of paraffin wax:mineral oil 2. 52.2-54.4C (126-130F) (tolerated due to low heat conductivity of paraffin mixture) 3. Scleroderma, RA (in conjunction with exercise) 4. avoid in open wounds and infected areas

Question 36

Name the 3 applications methods of paraffin baths:

Answer 36

1. dipping: 7-12 dips followed by wrapping 2. immersion: several dips to form thin glove, then immerse for 30 mins. Greatest temperature increase and duration 3. Brushing: good for areas difficulty to immerse (fun for kids)

Question 37

Fluidotherapy: 1. ____ heating. How? 2. 2 Advantages: 3. Range? 4. Pros: 5. Avoid:

Answer 37

1. Convective - forced hot air and a bed of finely divided solid particles 2. can control temperature and amount of agitation 3. 46.1-48.9C typical 4. massaging action, ROM freedom 5. avoid infected wounds (cross-contamination)

Question 38

Radiant heat: (infrared lamps) 1. Energy is emitted from: 2. produces heating by inducing: 3. change in temp at depth of 2cm:

Answer 38

1. any substance with T>absolute zero 2. inducing molecular vibration (luminous vs non-luminous) 3. 1.3C rise at depth of 2cm

Question 39

Radiant heat: 1. Determinants of intensity: 2. What is best angle of delivery?

Answer 39

1. inverse square law: intensity of radiation varies inversely with square of distance from the source 15cm (4x intense) 30cm (x intense) 60cm (0.25x intense) 2. max radiation when source is perpendicular to the surface.

Question 40

Radiant heat: 1. good for patients who: 2. Caveats: 4

Answer 40

1. cannot tolerate weight of hot packs 2. light sensitivity, skin drying, dermal photoaging, general heat precautions

Question 41

Which finding is a relative contraindication to cryotherapy? a. acute inflammation b. pain c. acute hematoma d. impaired sensation

Answer 41

d impaired sensation relative contraindications to cryotherapy: cold intolerance (decreased compliance, increased muscle guarding), Cryoglobulinemia (immune complex precipitation at lower temperature), Impaired sensation (tissue injury), cognitive deficits (tissue injury)

Question 42

A 28 year old male firefighter sustained deep dermal berns across his lower face, neck, anterior chest, and shoulders. To help manage the formation of hypertrophic scars, you recommend: a. corticosteroid injections directly into localized, early hypertrophic scars b. compressiongarments to be worn 12 hours per day c. topical silicone to areas of hypertrophic scars d. ultrasound treatments with passive stretching

Answer 42

A corticosteroid injectiosn directly into localized early hypertrophic scars

Question 43

When is the use of hyperbaric oxygen recommended for the treatment of diabetic foot ulcers? a. as first-line treatment b. if there are signs of infection c. if standard treatment is ineffective d. as prophylaxis after wound is healed

Answer 43

c

Question 44

Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex appears to have therapeutic value in treatment of: a. fatigue b. hypertension c. stroke d. seizure

Answer 44

c stroke

Question 45

Which non-surgical treatment for carpal tunnel syndrome is shown to provide significant short-term benefit? a. magnet therapy b. laser therapy c. therapeutic exercise d. therapeutic ultrasound

Answer 45

d therapeutic ultrasound

Question 46

Which is a deep heating modality? a. fluidotherapy b. paraffin bath c. microwave d infrared lamp

Answer 46

c microwave

Question 47

Which is a form of conversion heating? a. vaporant cooling spray b. fluidotherapy c. ice massge d ultrasound

Answer 47

d

Question 48

Which is a contraindication of ultrasound? a: MSK pain b: open epiphyses c: chronic inflammation d: chronic ankle sprain with edema

Answer 48

b

Question 49

What prevents infrared radiation from heating deeper tissues? a) insulating fat layer b) reflection at skin surface c) evaporation of sweat on skin d) pain from heat intensity

Answer 49

a) insulating fat layer

Question 50

Why would an infrared lamp often be more appropriate for heating an acute sprain than a hot pack? a: it penetrates deeper b: it is less likely to burn the patient c: it is more comfortable (no pressure) d: it has been shown to be more effective

Answer 50

c - it is more comfortable (no pressure)

Question 51

What kind of heating is fluidotherapy? a: convective b: conversive c: conduction d: radiation

Answer 51

a: convection

Question 52

Why is it necessary to use stroking technique in ultrasound applications? a) to minimize the therapeutic effect in the ultrasound field b) to minimize hot spots in the field c) to avoid burns d) to increase the acoustic impedance

Answer 52

b) to minimize hot spots in the field

Question 53

Which is an absolute contraindication for shortwave diathermy? a: low-grade malignancy, close to but not in the field b: chronic inflammation c: the patient being on anticoagulants such as warfarin d: use of a cardiac pacemaker

Answer 53

d PM

Question 54

When applying cryotherapy in the treatment of musculoskeletal disorders, which of the following events is NOT a contraindication to its use? a: paroxysmal cold hemaglobinuria b: impaired sensation c: arterial insufficiency d: spasticity

Answer 54

d spasticity contraindications to cryotherapy include: paroxysmal cold hemoglobinuria, impaired sensation, arterial insufficiency, cold hypersensitivity, cryopathies, cold intolerance, cryotherapy-induced neuropraxia, raynaud disease

Question 55

Which deep heat method recommends the use of protective eyewear to prevent the formation of cataracts? a: ultrasound b: short wave diathermy c: fluidotherapy d microwave diathermy

Answer 55

d microwave diathermy

Question 56

Cooling can produce physiologic changes in the body. One of these changes is an increase in: a: nerve conduction rate b: stretch receptor sensitivity c: elasticity of connective tissue d: general sympathetic activity

Answer 56

d general sympathetic activity

Question 57

____ is the use of high frequency acoustic energy (>20,000Hz) to produce effects in tissue:

Answer 57

Therapeutic ultrasound

Question 58

Thermal effects are greatest at _____ in therapeutic ultrasound.

Answer 58

bone/muscle interface acoustic energy absorbed --> molecular vibration --> heat production

Question 59

In therapeutic ultrasound, temperatures up to ____ achieved in deep tissues (bone-muscle interface)

Answer 59

46C (114.8)

Question 60

If deep heating is the goal, which is superior?

Answer 60

Ultrasound, then microwave or shortwave diathermy

Question 61

1. Describe the 3 non-thermal effects of ultrasound: 2. may cause: 3. minimized by:

Answer 61

(all may result in cellular damage and alteration of function) 1. Cavitation: - stable (bubbles) - unstable (bubbles that grow and pop) platelet aggregation, tissue damage, cell death (minimized by high frequency, low intensity pulsed mode) 2. Media motion - acoustic (microstreaming) - acoustic streaming 3. Standing waves - focal heating at tissue interfaces (minimized by stroking technique)

Question 62

_____ is the process by which ultrasonic waves lose a proportion of their energy as they travel through tissue. This increases as ____ increases.

Answer 62

Attenuation. increases as frequence increases (1MHz signal would penetrate deeper than 3 MHz signal due to lower attenuation)

Question 63

Attenuation of ultrasound can be caused by what 3 methods?

Answer 63

1. Absorption (major cause of U/S attenuation) 2. Beam Divergence 3. Deflection (Reflection, refraction, scattering)

Question 64

_____ is a measure of the resistance to the transmission of a sound wave

Answer 64

acoustic impedance (beam deflection0

Question 65

High impedance mismatch between skin and air means that:

Answer 65

almost all of the ultrasound signal would be reflected if a coupling agent is not used.

Question 66

Ideal coupling medium for ultrasound has acoustic impedance similar to ____. Examples: 3)

Answer 66

tissue. Degassed water mineral oil coupling gels may be chosen based on cost and convenience

Question 67

three techniques for ultrasound application:

Answer 67

1. Stroking technique - most common, allows more even distribution over the site. Move applicator over 25cm2 (4in^2) area in a circular or longitudinal manner 2. Standing technique - avoid due to potential for standing waves and the production of hot spots 3. Pulsed: emission of brief bursts/pulses of ultrasound and interspersed with periods of silence. (results in less heating than continuous wave ultrasound. Emphasizes nonthermal effects)

Question 68

5 indications for ultrasound

Answer 68

1. degenerative arthritis and contracture - helps maintain prolonged stretch and increase ROM 2. Bursitis 3. Tendinitis (calcific) 4. MSK pain 5. subacute trauma Many not well supported by EBM. interest in fracture healing, chronic wound healing.

Question 69

Precautions for ultrasound (9)

Answer 69

1. general heat precautions 2. near brain, reproductive organs 3. gravid or menstruating uterus 4. near pacemaker 5. near spine, laminectomy sites 6. malignancy 7. skeletal immaturity 8. Arthroplasties? 9. Methyl Methacrylate or high-density polyethyelene?

Question 70

Ultrasound prescription: Frequency: Intensity: Duration: Pulsed vs continuous:

Answer 70

F: 0.8 - 1.1MHz; 3.0MHz (millions of cycles per second) I: - Most clinical use: 0.5-2.0 W/cm2 - Tendonitis/Bursitis Avg: 1.2-1.8 W/cm2 - Limit: 3 W/cm2 (WHO, IEC) D: 5-10 mins per site Pulsed requires additional parameters.

Question 71

_____ is conversion of electromagnetic energy to thermal energy to produce deep muscle heating

Answer 71

Shortwave diathermy

Question 72

Shortwave diathermy: Depth: Frequency: Time: Indications: 4

Answer 72

Conversion of electromagnetic energy to thermal energy to produce deep muscle heating Depth: 4-5cm Frequency: 27.12 MHz most common (inductive or capacitive units) 20-30min treatment time INdications: 1. chronic prostatitis 2. refractory PID 3. Myalgia 4. back spasms

Question 73

Shortwave diathermy can be performed with what two devices? (when to use each)

Answer 73

1. capacitive/condensor SWD - high temperature in water poor tissues (bone/fat) More effective for deeper joints 2. Inductive coil SWD - high temperatures in water rich tissues (muscle/skin/blood). Indicated for heat to superficial muscles/joints with minimal superficial tissue.

Question 74

5 precautions for shortwave diathermy

Answer 74

1. general heat precautions 2. Metal (jewelry, pacemakers, IUDs, surgical implants, DBS, etc) 3. Contact lens 4. gravid or menstruating uterus 5. skeletal immaturity

Question 75

____ is conversion of microwave electromagnetic energy to thermal energy.

Answer 75

microwave diathermy

Question 76

Microwave diathermy Frequency: ____ at a depth of 1-3 cm Selectively heats _____ Eye protection needed due to risk of _____ INdications: (3)

Answer 76

915MHz and 2456 MHz approved (lower frequency penetrates deeper) 41C at 1-3cm Selectively heats fluid-filled cavities Cataracts Indications: superficial muscle and joint heating, speed hematoma resolution, local hyperthermia in cancer patients.

Question 77

Microwave diathermy precautions (4)

Answer 77

1. General heat precautions 2. Metal implants 3. skeletal immaturity 4. avoid in fluid filled cavities (eyes, bullae, edematous tissue)

Question 78

Heating depth for Ultrasound: Short wave diathermy: Microwave diathermy:

Answer 78

8cm 4-5cm 1-4cm

Question 79

3 hemodynamic effects of Cold

Answer 79

1. immediate cutaneous vasoconstriction 2. Delayed reactive vasodilatation 3. decreases acute inflammation

Question 80

7 neuromuscular effects of Cold

Answer 80

1. decreased conduction velocity 2. conduction block, axonal degeneration (prolonged exposure) 3. decreased group 1a, 2, 1b firing rates 4. decreased stretch reflex amplitudes 5. increased maximal isometric strength 6. decreased muscle fatigue 7. decreased spasticity (temporarily)

Question 81

three joint and connective tissue effects of cold

Answer 81

1. increased joint stiffness 2. decreased tendon extensibility 3. decreased collagenase activity

Question 82

6 general uses for Cryotherapy

Answer 82

1. Acute trauma, injury (minimize edema, inflammation) 2. Musculoskeletal conditions (symptomatic relief) - sprains strains, tendonitis, tenosynovitis, bursitis, capsulitis, arthritis, etc. 3. myofascial pain 4. following certain orthopaedic surgeries 5. spasticity (mixed results) 6. minor burns (emergency treatment)

Question 83

general precautions for use of cryotherapy (6)

Answer 83

1. cold intolerance 2. cryotherapy - induced neuropraxiaa or axonotmesis 3. arterial insufficiency 4. cryopathies (cryoglobulinemia, paroxysmal cold hemoglobinuria, cold hypersensitivity, raynaud disease or phenomenon) 5. Impaired sensation 6. Cognitive or communication deficch:its that preclude reporting of pain

Question 84

Cold packs depth: mech

Answer 84

superficial conduction

Question 85

ice massage depth: mech:

Answer 85

superficial Conduction

Question 86

cold water immersion depth: mech:

Answer 86

superficial Conduction

Question 87

cryotherapy-compression units depth: mech:

Answer 87

superficial conduction

Question 88

Vapocoolant spray depth: mech:

Answer 88

superficial evaporation

Question 89

whirlpool baths depth: mech:

Answer 89

superficial convection

Question 90

three types of cold packs

Answer 90

1. hydrocollator packs - skin cooled immediately, subcutaneous tissues within minutes. Muscle (2cm depth) cooled by 5C after 20 mins 2. endothermic chemical gel packs 3. ice packs apply 20-30mins

Question 91

cold water immersion is good for ____. Temp: Cons (2); effective for

Answer 91

circumferential cooling of limbs 5-13C uncomfortable/poorly tolerated effective for localized burns due to rapid skin temperature reduction

Question 92

____ are cuffs or boots through which cold water circulates and can be pneumatically compressed. Indicated for: Temp: Pressure?

Answer 92

cryotherapy compression units - can be static or distal to prox acute MSK injury with soft tissue swelling. some surgiers. T 7.2C (45F) up to 60mmHg

Question 93

_____ is the external application of hot or cold water for the treatment of disease

Answer 93

hot or cold water for treatment of disease

Question 94

4 main forms of hydrotherapy - what specifically do they treat and advantages

Answer 94

1. whirlpool baths - treat limb or localized lesion - greater extremes of temperature tolerated without core body temp changes 2. hubbard tank - whole body immersion - decreases stress on bones/joints - neutral temperatures prevent core temp fluctuations - sodium hypochlorite commonly used in burn programs - salt may be added to minimize fluid shifts for large wounds 3. shower cart 4. contrast baths

Question 95

Uses for hydrotherapy 3

Answer 95

1. arthritis 2. variety of MSK conditions 3. cleansing and debridement of burns and other dermal injuries

Question 96

Shower cart developed because:

Answer 96

Due to auto-contaminatino and cross-contamination with whirlpool bath and hubbard tanks allows for gentle spray or shower hydrotherapy during mechanical debridement of large burns and other wounds under relatively sterile conditions

Question 97

What are contrast baths? create what?

Answer 97

alternate immersion of distal limbs in hot and cold water. - cyclic vasoconstriction and vasodilation 30 min sessions

Question 98

three uses for contrast baths:

Answer 98

1. Rheum disease 2. neuropathic pain 3. chronic pain syndromes such as CRPS

Question 99

Ultraviolet radiation traditionally used for: Works by _____ Now almost exclusively ____ Adverse effects: 3

Answer 99

1. treatment of skin ulcers 2. increasing vasculariztion of wound margins 3. dermatologic (>30 derm disorders including psoriasis) 4. premature skin aging, skin cancer, cataracts

Question 100

what is the minimal erythema dosage of ultravoilet radiation?

Answer 100

Initial 1-2 MED Keep <5 MED Need goggles to protect eyes

Question 101

____ is the introduction of ions across biological membranes by means of direct electrical current.

Answer 101

iontophoresis

Question 102

Iontophoresis is used for ____ or ____

Answer 102

transcutatneous systemic or local delivery of medicine to soft tissues (limits systemic absorption)

Question 103

Iontophoresis is used in treatment fo localized inflammatory conductions in superficial tissues: (5)

Answer 103

1. tendinitis 2. epicondylitis 3. arthritis 4. plantar fasciitis 5. myofascial pain

Question 104

Name the 6 ionic medications, their charge, and effect

Answer 104

1. Dexamethasone sodium phosphate, negative, anti-inflammatory (tendonitis, bursitis, enthesitis) 2. Lidocaine, positive, analgesic 3. Acetic Acid, negative, dissolves calcium depositis (calcific tendonitis) 4. Calcium, positive, muscle relaxant 5. magnesium, positive, muscle relaxant 6. salicylates, negative, releaves joint and muscle pain

Question 105

_____ is ultrasound used to facilititate transdermal migration of typically administered medications

Answer 105

phonophoresis (corticosteroids) ultrasound coupling gel mixed with chemical substances to produce phonophoresis coupling agent

Question 106

Uses for phonophoresis (12

Answer 106

1. OA 2. bursitis 3. capsulitis 4. tendonitis 5. strains 6. fasciitis, 7. epicondylitis 8. tenosynovitis 9. contracture 10. scar tissue 11. neuromas 12 adhesions

Question 107

Types of massage (4)

Answer 107

1. stroking/effleurage 2. compression/petrissage 3. percussion/tapotement 4. friction

Question 108

Contraindications to massage (5)

Answer 108

1. malignancy 2. cellulitis 3. lymphangitis 4. recent bleeding 5. DVT

Question 109

Inferential current therapy able to deliver higher currents than _____. May be useful in (3) Precautions:

Answer 109

TENS variety of MSK conditions, neurologic conditions, urinary incontinence implanted stimulators, carotid sinus, open wounds, gravid uterus, DVT, insensate areas, near SWD

Question 110

4 categories of Estim

Answer 110

1. peripheral nervous system to induce muscle activation (Neuromuscular electrical stimulation/NMES) 2. Central nervous system to induce activation 3. central or peripheral nervous system to modulate sensory input (primarily to reduce pain) 4. skin to induce wound healing

Question 111

Neuromuscular estim can be used _____. Requires: _____. Best suited for _____. Recruitment of motor units: ____. May result in _____>

Answer 111

anywhere along axon of LMN intact motor unit - threshold for muscle stimulation 100-1000x higher than for nerve fiber stimulation (not safe) best suited for UMN disease ("all or none") Recruitment of motor units revers in order compared to normal physiologic excitation May result in conversion of muscle fiber types

Question 112

two types of neuromuscular estim:

Answer 112

1. Therapeutic electrical stimulation (TES) - promotes neuro recovery, reduces pain. Repetitive stimulation applied to paralyzed muscles to minimize atrophy and maintain ROM. Benefits intended to persist after TES discontinued 2. Functional electrical stimulation (FES) - functional benefits directly while estim is being delivered. Stimulation in a coordinated sequence to assist with functional tasks (ADLs, Transfers, ambulation) Beneftis do not persist when stimulation discontinued

Question 113

What is the recommended program for estim for post-stroke shoulder pain?

Answer 113

pathogenesis multifactoria. Estim to supraspinatus and posterior deltoid use for subluxation and pain (6hours/day x 6 weeks)

Question 114

4other uses of NMES

Answer 114

1. bladder - sacral nerve stimulation for effective micturition in suprasacral SCI 2. Electroejaculation - electrical stimulation via rectal probe to collect semen in SCI 3. Respiration - phrenic nerve pacing (PNP) 4. Would healing (pressure ulcers)

Question 115

____ is estim through intact skin taht aims to provide pain relief by secifically exciting peripheral nerves

Answer 115

transcutaneous nerve stimulation (TENs)

Question 116

mechanisms of pain control in TENS units

Answer 116

placebo effect 30-35% gate control theory release of endogenouse opioids

Question 117

Gate control theory

Answer 117

1. stimulate large IA fibers (myelintated) 2. this stimulated the substansia gelatinosa in the dorsal horn of the spinal cord 3. This closes the gate 4. Therefore C fibers (fine diameter) are not inhibited and can not send pain signal tot he thalamus via the spinal thalamic tract 5. result, pain is not appreci5 INated by the thalamus

Question 118

5 indications for TENs units:

Answer 118

1. acute and chronic postop pain 2. acute and chronic myofascial pin 3. acute and chronic pain associated with MSK disorders and soft tissue injuries such as low ack pain, arthritis 4. Neurologic pain: post-herpectic neuralgia, trigeminal neuralgia, peripheral n injuries 5. residual limb and phantom limb pain

Question 119

3 types of TENS stimulator types

Answer 119

1. conventional - high frequency, low intensity stimulation (most effective) 2. acupuncture - low frequency, high intensity 3. pulse mode - high frequency stimulus at low frequency bursts average 30=60mins at a tmie for 8 hours/day

Question 120

10 contraindications for electrotherapy

Answer 120

1. circulatory impairment 2. stimulation over carotid sinus or heart (esp if pacemaker) 3. pregnancy 4. seizure 5. fresh fracture 6. active hemorrhage 7. malignancy 8. decreased sensation (risk of electrical burns) 9. atrophic skin 10. inability to report pain