Test 1 Flashcards
(120 cards)
1
Q
Electro physical agents
A
Electrophysical and biophysical energies for the purpose of treatment and prevention of impairments, activity limitations and participation restrictions
2
Q
Examples of mechanical energy
A
Massage
Traction
Continuous passive motion
3
Q
Top reasons people go to chiropractors
A
Low back/pelvis
Neck
ADLs
Overuse/repetitive injuries
4
Q
What are the 4 stages of healing
A
He most asks
Inflammatory
Proliferation
Remodeling/maturation
5
Q
3 stages of healing
A
Inflammation
Repair
Remodel
6
Q
Inflammatory phase
A
Aka Acute phase
Immediate to a few days after
Defending against foreign intruders and remove damaged tissue
7
Q
How is the inflammation stages characterized
A
Vasodilation
Increased capillary permeability
Phagocytosis by neutrophils and macrophages
8
Q
What inflamamatory chemicals cause pain
A
Bradyokinin, prostaglandins, and serotonin
9
Q
Secondary enzymatic injury
A
Lysosomal enzymes released
Non-specific
Healthy tissue damaged
10
Q
Secondary hypoxic injury
A
Hemorrhage, clotting, edema, spasms, hematoma
Deceased o2 and nutrition
Damage surrounding uninsured tissue
11
Q
PRICE and what’s its goal
A
Protect Rest Ice Compress Elevate
Preserve ROM
12
Q
Proliferative phase
A
Aka repair phase
Angiogenesis
Fibroblasts, chondroblasts and osteoblasts
13
Q
Goals in the proliferation/repair phase
A
Decrease swelling, pain
Increased pain free ROM
Provide protective support
Encourage proliferation
14
Q
Remodeling phase
A
Aka maturation phase
Scar contraction and loss of ROM
Decrease BV
Type III collagen replaced by Type I
15
Q
Goals in remodeling phase
A
Regain full strength
Normal biomechanics
Protect and strengthen
16
Q
Tension on CT causes
A
Increased collagen diameter, # fibrils, # cross-linking and density
Organized in parallel fashion
17
Q
Care done during remodeling/maturation phase
A
Stretching
Strengthening
Proprioceptive training
Task specific skills
18
Q
What are some things electrical stimulation can do
A
Decrease pain Decrease spasm Reduce edema Simulate contraction Healing
19
Q
What does electricity require
A
Source of electrons
Driving force (imbalance)
Path (conductor)
20
Q
Voltage is like a what?
A
Waterfall
As height increases potential energy increases
21
Q
What are the two types of currents
A
Monophonic and biphasic
22
Q
Monophonic current
A
One direction
Aka DC current/Galvanic current
23
Q
Aka galvanic current
A
Monophonic current
24
Q
Biphasic current
A
Flow of electrons changes directions regularly
Aka AC current
25
What shape is Monophysite current wave
Square
26
What shape is biphasic current
Sinusoidal, square, rectangular, triangular
27
Phase duration
Time it takes current to leave isoelectric line to when it returns
28
Phase duration for monophasic current
Phase duration and pulse are the same
29
Phase duration for biphasic (AC)
Two phase durations for each pulse
30
What do tissues respond to? Phase or pulse?
Phase duration
31
What are A-B fibers?
Light touch sensation
“Tingly” feeling
Close to skin and has lower threshold so stimulated first
32
Does tissue pay more attention to average current or to peak current?
Average
33
Strength duration curve
Relationship between amplitude and duration
34
Why is the strength-duration curve important?
Charge must overcome the capacitance of a nerve fiber to depolarize just like if amplitude is too low, no depolarization will occur no matter the duration
35
Pt reports tingling but no muscle twitch
Alpha-beta fibers are exceeded
36
Patient reports muscle contraction
Alpha motor neurons exceeded
37
Burning, meddling sensation
Exceeded alpha-delta fiber capacitance
38
Rheobase
Minimum amplitude needed to depolarize a nerve fiber when phase duration is infinite
39
Corona is
Time or phase duration required to depolarize a nerve fiber when the peak current is twice rheobase
Aka twice the amplitude needed to depolarize a nerve fiber
40
What is the rate limiting factor of the number of impulses that can be generated by a nerve
Absolute refractory period
41
Summation
Force from two twitches with no relaxation after 1st twitch
42
What frequency do you get fused tetanus
50pps
43
What frequency do you target slow twitch fibers
35pps
44
Frequency that there is no pain in nerves and stops depolarizing
>1000pps
45
What frequency does IF generate
4000-5000hz
46
What frequency does Russian current generate
2500hz
47
Unequal size electrodes will concentrate current in which electrode>
The smaller electrode
| Gives an “intenser” feeling
48
When pads are placed close together current is most concentrated where?
Superficial tissues
49
When pads are placed further away from each other where is current concentrated?
Deeper tissues
50
Types of interferential current
True interferential
Premodulated
Vector scan
Sterodynamic
51
How many electrodes for IF?
4 electrodes
52
Heterdyne
Combo of constructive and destructive that leads to a wave with a “beat” effect
53
Determine frequency of heterodyne?
Difference between the two waves
54
Compare and contrast IF vs premod as far as interference
Interference occurs in machine in pre-mod
55
What is pre-mod good for?
Pain relief of small area
| Ex: one muscle/group
56
Indications for IFC
Pain reduction
Muscle strengthening/re-education (pelvic floor)
Slow bowel transit*
57
Frequency/beat for IFC for acute
80-150
58
Beat frequency for chronic for IFC
1-15
59
Amplitude for IFC
“Patient comfort”
60
What fibers are targeted in acute pain with IFC
AB fibers
80-150hz
No muscle contraction
61
What fibers are targeted in chronic IFC
A-delta fibers
1-15hz
Some muscle twitch
62
Frequency for sub-acute IFC
1-150hz
63
Time for IFC
15-20 min
64
What fibers are targeting in sub-acute pain for IFC
Ab and alpha-delta fibers
65
How does Russian current work?
Makes use of duty cycles to cause muscle contraction for muscle strengthening
66
Indications for Russian stimulation
Muscle re-education
Retard atrophy
Muscle strengthening
Decrease spams via fatigue
67
Burst frequency for Russian current
50hz—temporal summation
Means wave is interrupted 50 times per second
68
Burst frequency for muscle strengthening
10sec on/50 sec off
69
Burst frequency for muscle fatigue
10:10
70
16.7% duty cycle for what>
Russian current for
Reduce atrophy
Re-educate muscle
Muscle strengthening
71
Ramp time for Russian current
0.5-2 seconds
72
Electrode placement for Russian current
Along fibers of same muscle/group
73
Describe co-contract in regards to Russian current use
2 channels, 4 electrodes
| For muscles that contract together ex: paraspinals
74
Describe reciprocal contraction in regards to Russian current
2 channels, 4 elcectrodes
Agonist/antagonist muscles
1 channel on one muscle group, another on the other
75
What is the duration of Russian current for strengthening muscle
10 minutes
76
What is the duration for Russian current for fatiguing muscle
20 minutes
77
What is the intensity for Russian or biphasic pulsed current?
Patient TOLERANCE
78
NMES goal
Stimulate alpha motor neurons causing strong contraction to retrain lost muscle function, decrease atrophy, or decrease spasm
79
Physiological vs electrical muscle fiber contractions
Physiological: slow twitch are contracted first with asynchronous firing to produce a continuous contraction. Slow to fatigue
Electrical: large diameter fast twitch fibers recruited first because of their lower capacitance. Recruited synchronously. Fast to fatigue
80
What currents are used for NMES
Russian current and biphasic pulsed current and interferential (pelvic floor muscles only)
81
What is the waveform with Russian current
Sine wave
82
What is the waveform with biphasic pulsed current
Square wave
83
What does TENS stand for
Transcutaneous electrical nerve stimulation
84
What is TENS
Stimulation of nerves through the skin
85
What is TENS used for
Modification of neurological aspects of pain
86
Sensory level TENS
Targets AB fibers (acute)
Tingling
Pain
87
Duty cycle for TENS sensory
None
88
Motor level TENS
Depolarization of alpha-motor neurons
For subacute and CHRONIC
No duty cycle
89
Noxious level TENS
Stimulates C-fibers
Elicits pain relief through endogenous opiates
Often used on trigger points in brief-intense mode
Phase duration: 10-20ms
Thx time: 30 seconds per point to maximum tolerable
8-10 points per session
90
Indication for ESTHR (electrical stimulation for tissue healing and repair)
Stimulate healing
91
Indications for hi volt
Stimulate healing
Reduce edema
Decrease spasm/guarding
92
Galvanotaxis effect
Induce cell migration
93
What cells are attracted in the galvantotaxis effect/cell migration
```
Fibroblasts
Epidermal cells
Keratinocytes
Macrophages
Neutrophils
```
94
What polarity do you want during proliferative phase/repair phase?
Negative (cathode)
95
What cells does a negative/cathode attract?
Fibroblasts
Epidermal cells
Keratinocytes
96
What polarity do you want during acute/inflammatory phase?
Positive (anode)
97
What cells are attracted to a positive polarity (anode)
Neutrophils
| Macrophages
98
What can you use for edema reduction?
HiVolt
99
What is the polarity in HiVolt for edema reduction
Negative
100
How do you set up electrodes for edema reduction on HiVolt
2electrodes
| Around edema with dispersal pad proximal
101
What is the preferred treatment for muscle spasm reduction
Russian current
102
What is preferred for pain reduction
Interferential
103
What is the frequency for HiVolt
1-200hz
104
Does the dispersive pad attract cells?
No
105
Mono polar electrodes in HiVolt
Active pad and dispersal pad
106
Bipolar electrode placement for Hivolt/Microcurrent
2 electrodes that each attract cells
107
What is a unique contraindication for HiVolt/ESTHR
Osteomyelitis
108
In monophasic current for ESTHR, does positive polarity attract acids or bases?
Acids
| Cl-/HCl
109
Negative polarity attracts acids/bases?
Bases (Na+/NaOH)
110
Low volt current polar and vasomotor responses
Acids attracted to positive pole
| Bases attracted to negative pole
111
Iontophoresis
Local transfer of ionized substances such as drugs across the skin
112
Relationship of charge of active electrode and dissolved substance for iontophpresis
Polarity of active electrode should be the same as that of the dissolved substance
113
Dosage in iontophoresis
Amplitude x treatment time
114
Phase
Current flow in one direction
115
Pulse duration
Equal to phase duration for DC current and 2x phase duration for AC current
116
Burst
Series of successive pulses of cycles over a period of time
117
Burst duration
Time between beginning of 1st and end of last cycle or pulse
118
Beat
The resulting current waveform when 2 or more sinusoidal waves intersect with each other
119
Train
Continuous series of pulses, cycles, or bursts or beats over time
120
Modulation
Changes in amplitude, pulse duration, pulse frequency or a combination of these for prevent nerve accommodation to stimulation
