Therapeutic Modalities: Electrical Agents

Question 1

The cell membrane is more permeable to ____ compared to _____ and ______.

Answer 1

More permeable to POTASSIUM

Less permeable to SODIUM and ANIONS

Question 2

Describe 3 types of waveforms.

Answer 2

Monophonic = unidirectional flow of charged particles (either positive or negative charge)

Biphasic = bidirectional flow of charged particles (zero net charge if symmetrical)

Polyphasic = biphasic current that is modified to produce 3 or more phases in a single pulse (maybe used in Russian or IFC currents)

Question 3

List 6 indications for using electrical stimulation.

Answer 3

1. Pain modulation
2. Decrease muscle spasm, spasticity and edema
3. Increase or maintain ROM
4. Muscle reeducation
5. Wound healing
6. Denervated muscle

Question 4

The _____ is recommended with the use of a silver dressing over the wound if infected. If there is no infection, the _____ is recommended over the wound initially to promote healing.

Answer 4

Anode (+ pole) over an infected wound

Cathode (- pole) over a non-infected wound

Question 5

List 8 contraindications to electrical stimulation.

Answer 5

1. Pacemakers
2. Unstable arrhythmia
3. Epilepsy or seizure disorders
4. Over the carotid sinus
5. Over thrombosis or thrombophlebitis
6. Over the abdomen or low back during pregnancy
7. Superficial metal implants
8. Active bleeding or infection

Question 6

How big of a space should be left between electrodes?

Answer 6

The space between the electrodes should be at least the diameter of the electrodes being used

Question 7

What is iontophoresis?

Answer 7

Application of a continuous direct current to transport medicinal agents through the skin or mucous membranes

Question 8

Positive ions move towards the _____ and negative ions move towards the ____.

Answer 8

Positive ions move towards the cathode (-)

Negative ions move towards the anode (+)

Question 9

What type of current and intensity are used with iontophoresis?

Answer 9

Direct current

Maximum intensity of 4-5 mA

Question 10

List 6 indications for the use of iontophoresis.

Answer 10

1. Analgesia
2. Calcium deposits
3. Dermal ulcers
4. Fungal infections
5. Muscle spasm
6. Musculoskeletal inflammatory conditions

Question 11

TENS is designed to provide ______ for pain management.

Answer 11

Afferent stimulation

Question 12

_____ is the most common mode of TENS.

Answer 12

Conventional (high rate) TENS

Question 13

Describe the amplitude and duration of pain relief associated with conventional TENS.

Answer 13

Amplitude: comfortable tingling sensation. No muscle response.
Duration of pain relief: Temporary

Question 14

Describe the amplitude and duration of pain relief associated with acupuncture like TENS.

Answer 14

Amplitude: strong, but comfortable rhythmic muscle twitches

Duration of pain relief: long lasting

Question 15

Describe the amplitude and duration of pain relief associated with brief intense TENS.

Answer 15

Amplitude: to patient’s tolerance

Duration of pain relief: temporary (30-60 minutes)

Question 16

Describe the amplitude and duration of pain relief associated with burst mode TENS.

Answer 16

Amplitude: comfortable, intermittent paraesthesia

Duration of pain relief: long lasting (hours)

Question 17

Describe the amplitude and duration of pain relief associated with hyper stimulation TENS.

Answer 17

Amplitude: strong, to patient’s tolerance

Duration of pain relief: long lasting

Question 18

List 6 types of TENS and their purpose.

Answer 18

Conventional (high rate): acute or chronic pain
Acupuncture like (low rate): chronic pain
Brief intense: rapid onset, short term pain relief during painful procedures
Burst mode: combination of high and low rate tens
Hyper-stimulation: used to stimulate trigger points
Modulation mode: used to prevent perceptual habituation due to constant electrical stimulation

Question 19

Describe the amplitude used with high voltage pulsed current (HVPC).

Answer 19

Amplitude: comfortable tingling sensation, no muscle response

Question 20

High voltage pulsed current (HVPC) is primarily used for ______.

Answer 20

Wound healing

Question 21

Describe the amplitude of Russian current.

Answer 21

Amplitude: tetanic muscle contraction

Question 22

List 3 volitional activities in which Russian current is applied.

Answer 22

1. Isometric exercise at several points through ROM
2. Slow isokinetic exercise
3. Short arc movement when ROM is restricted

Question 23

Describe the electrode placement when using interferential current (IFC).

Answer 23

Bipolar (per modulated IFC): two electrodes are placed to affect desired structures

Quadripolar: Two sets of electrodes placed diagonally to one another over large area

Question 24

List two indications for the use of functional electrical stimulation.

Answer 24

Shoulder subluxation

DF assist in gait training

Question 25

Describe the electrode placement when using functional electrical stimulation for shoulder subluxation.

Answer 25

Bipolar

Electrodes on supraspinatus and posterior deltoid

Question 26

How does functional electrical stimulation provide dorsiflexion assist during gait? (2)

Answer 26

Controls foot drop

Facilitates DF and evertors during swing phase

Question 27

Describe the electrode placement when using functional electrical stimulation as a DF assist in gait training.

Answer 27

Bipolar

Peroneal nerve near head of fibula or anterior tibialis muscle

Question 28

Describe the electrode application used for EMG biofeedback.

Answer 28

Active electrodes are placed on or near a motor point/targeted muscle group

Closer together for more precise signals
Farther apart to detect more than one muscle

Question 29

List 4 criteria that must be met for a patient to participate in biofeedback training.

Answer 29

1. Good vision, hearing and communication skills
2. Good comprehension of simple commands, concentration
3. Good motor planning skills
4. No profound sensory or proprioceptive loss