Ultrasound and Electrotherapy Flashcards
(159 cards)
1
Q
What is Physiotherapy?
A
The prevention, treatment, and rehabilitation of medical conditions by physical (massage, exercise etc.) and mechanical (Ultrasound, TENS, etc.) means.
2
Q
What are some applications of Electrotherapy?
A
- Muscle Re-education
- Pain Management
- Reduce inflammation
- Increase wound healing
- Increase circulation and lymphatic movement
- Unclog ducts
- Stimulate hair growth
- Trigger stem cell proliferation
- Vagal nerve stimulation
- And so much more!
3
Q
Name the modalities of Electrophysiotherapy covered this quarter.
A
- Direct Current
- Iontophoresis
- High Voltage Pulsed Current
- Diathermy
- Low Level Laser Therapy
- Ultrasound/Phonophoresis
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Interferential Currents
- Russian Stimulation
4
Q
What is Clinical Ultrasound?
A
Ultrasound waves are sound waves with a frequency above 20,000 Hertz (Hz), mechanical, longitudinal waves, undetectable by the human ear.
5
Q
What is the typical frequency range for clinical ultrasound?
A
Most clinical ultrasound uses high frequencies often between 1-20 MHz.
6
Q
What is Acoustic Impedance?
A
Resistance of ultrasound energy through a substance or tissue.
7
Q
What is Stable Cavitation?
A
Stable cavitation is characterized by non-implosive pulsation of microbubbles which triggers a related phenomenon called microstreaming.
8
Q
What is Microstreaming?
A
Characterized by the minute flow of fluid in the vicinity of the pulsating bubbles.
9
Q
What are the common indications for Therapeutic Ultrasound?
A
- Soft Tissue Injuries
- Joint Disorders
- Scar Tissue & Adhesions
- Myofascial Pain & Trigger Points
- Tendon Healing & Calcific Tendinitis
- Neuropathic Pain
- Fracture Healing
- Lymphedema & Edema Management
10
Q
What is Phonophoresis?
A
Defined as the use of ultrasound energy to enhance delivery of topically applied drugs.
11
Q
What is the relationship between resonant frequency and tissue penetration?
A
Resonant frequency relates to depth of tissue penetration; lower frequencies penetrate deeper.
12
Q
Fill in the blank: Therapeutic ultrasound can penetrate soft tissues up to approx. _____ cm at 3 MHz.
A
2
13
Q
Fill in the blank: Therapeutic ultrasound can penetrate soft tissues up to approx. _____ cm at 1 MHz.
A
5
14
Q
What is the purpose of the coupling medium in ultrasound therapy?
A
To exclude as much as possible the presence of air while ensuring optimal transmissivity of acoustic energy.
15
Q
What should be done before turning on the ultrasound machine?
A
Place transducer in contact with coupling media/treatment site.
16
Q
What is the typical treatment duration for therapeutic ultrasound?
A
Typically lasts 5–10 minutes for each treatment area.
17
Q
What is the typical intensity setting for chronic conditions in therapeutic ultrasound?
A
1.0 – 2.0 W/cm² (Strong thermal effects).
18
Q
What are the two modes of delivery for ultrasound therapy?
A
- Continuous
- Pulsed or Interrupted
19
Q
What should be noted in the charting for therapeutic ultrasound?
A
- Brand/model # of unit
- Transducer ERA
- Frequency
- Intensity
- Duty cycle
- Time
- Coupling medium used
- Treatment area
20
Q
A
21
Q
What is the typical resting membrane potential of an excitable cell?
A
-60 to -90 mV
22
Q
Why is the resting membrane potential closer to the equilibrium potential of K+?
A
Because the membrane is more permeable to K+ than Na+
23
Q
What maintains the resting membrane potential?
A
Ion gradients and selective permeability, particularly to K+ and Na+
24
Q
What is an action potential?
A
A sudden change in membrane potential due to increased Na+ permeability, briefly changing it to +25 to +35 mV
25
What is the Na+/K+ pump ratio?
3 Na+ out / 2 K+ in
26
What is accommodation in membrane physiology?
Failure to discharge an action potential due to sustained depolarization or hyperpolarization
27
How is action potential propagation affected by myelination?
Myelinated fibers conduct faster than unmyelinated ones
28
How does fiber diameter affect conduction?
Larger diameter fibers conduct faster due to lower resistance
29
What effect does temperature have on nerve conduction?
Warmer temperatures increase conduction speed
30
What is the absolute refractory period?
0.5 ms after an AP during which no new AP can be generated
31
What is the relative refractory period?
A brief period (~0.5–1 ms) after AP when a stronger stimulus is needed to generate another AP
32
What determines if a stimulus generates an AP?
Amplitude and duration of electrical stimulation
33
What is the strength-duration curve?
A graph of amplitude vs duration required to trigger an AP
34
What is temporal summation (tetany)?
Sustained muscle contraction due to rapid successive stimuli
35
What frequencies cause tetanic contraction?
Postural muscles ~20 pps; Movement muscles ~40 pps
36
What is electric current?
Directed flow of charge (electrons or ions); measured in amperes
37
What is voltage?
Potential energy difference per unit charge; measured in volts
38
What is resistance?
Opposition to current flow; measured in ohms (Ω)
39
What is capacitance?
Ability of an insulator to store electrical energy; measured in farads
40
What is frequency?
Number of cycles per second; measured in hertz (Hz)
41
What is phase in electricity?
Fraction of a sine wave cycle offset from zero reference
42
Name waveform types used in electrotherapy
Direct current, Monophasic pulsed, Biphasic pulsed (balanced/unbalanced, symmetric/asymmetric)
43
What is amplitude?
Magnitude of current or voltage from the zero baseline
44
What is pulse duration?
Total time from start to end of one stimulus pulse
45
What is rise time and decay time?
Time to reach peak amplitude and return to baseline
46
What is burst modulation?
Series of pulses delivered during stimulator ON period
47
What is NMES pad configuration?
Monopolar, Bipolar, Quadripolar
48
What does short duration + low amplitude stimulation help with?
Avoiding stimulation of pain fibers
49
What does TENS stand for?
Transcutaneous Electrical Nerve Stimulation
## Footnote
TENS is a therapy that uses electrical impulses to relieve pain.
50
What is the primary therapeutic goal of TENS?
Management of pain
## Footnote
TENS is primarily used for pain relief in various conditions.
51
Which two theories explain the pain modulation in TENS?
Gate Control Theory and Endogenous Opioid Theory
## Footnote
These theories describe how TENS affects pain perception.
52
How does the Gate Control Theory work?
Stimulates A-beta fibers which activate inhibitory interneurons in the substantia gelatinosa to block pain signals from reaching T-cells
## Footnote
This theory suggests that non-painful input can close the 'gates' to painful input.
53
Where does the Endogenous Opiate System operate?
At the supraspinal level (DEOS)
## Footnote
This system is responsible for the body's natural pain relief mechanisms.
54
Which brain areas are involved in the DEOS?
Periaqueductal gray (PAG) and nucleus raphe magnus
## Footnote
These areas play significant roles in pain modulation.
55
What nerve fibers are activated with low strength and short duration?
Sensory (S) fibers
## Footnote
These fibers are primarily involved in the perception of sensations.
56
What fibers are activated with high strength and long duration?
Sensory-Motor-Nociceptive (S-M-N) fibers including C fibers
## Footnote
These fibers are associated with pain and motor responses.
57
What is the typical pulse duration for TENS?
50–400 microseconds
## Footnote
This range is optimal for effective stimulation.
58
What is the frequency range of TENS pulses?
1–200 Hz
## Footnote
Frequency affects the type of pain relief experienced.
59
What is current amplitude measured in?
Milliamps (mA)
## Footnote
Amplitude determines the intensity of the stimulation.
60
Why is waveform balance important in TENS?
Prevents burns during long-term use by avoiding net DC buildup
## Footnote
Proper waveform balance is crucial for safe and effective therapy.
61
Name the four levels of TENS stimulation.
Subsensory, Sensory, Motor, Noxious
## Footnote
Each level corresponds to different therapeutic effects.
62
What is MENS?
Microcurrent Electrical Neuromuscular Stimulation, used for tissue healing using microamps and long pulse width
## Footnote
MENS is distinct from TENS in its application and parameters.
63
What is CES?
Cranial Electrotherapy Stimulation, used for anxiety, depression, insomnia, etc.
## Footnote
CES targets the brain for mental health treatment.
64
What are the 6 basic TENS modes?
Conventional, Strong Low-Rate, Brief-Intense, Pulse-Burst, Modulation, Hyperstimulation
## Footnote
Each mode has specific settings and therapeutic applications.
65
What are the settings for Conventional TENS?
50–100 Hz, 50–200 µs, low-mid amplitude for A-beta fiber stimulation
## Footnote
Conventional TENS is commonly used for immediate pain relief.
66
What are the settings for Acupuncture-like TENS?
<10 Hz (1–4 Hz), 100–300 µs, high amplitude for muscle contractions
## Footnote
This mode mimics traditional acupuncture effects.
67
What TENS mode uses very long pulse durations (e.g. 500 ms)?
Hyperstimulation TENS
## Footnote
This mode is used for intense pain relief.
68
List three clinical indications for TENS.
RA/OA, dysmenorrhea, post-operative pain
## Footnote
TENS is effective for various types of pain management.
69
When is TENS contraindicated?
Pacemakers, over tumors, during pregnancy in abdominal region, over carotid sinus, transcranially, over broken skin, etc.
## Footnote
Contraindications ensure safe use of TENS.
70
What is IFC?
Interferential Current Therapy using interference of two medium-frequency currents
## Footnote
IFC is another modality for pain management.
71
What frequency range defines medium frequency for IFC?
1001 to 10,000 Hz (commonly 3000–5000 Hz)
## Footnote
This frequency range is crucial for IFC effectiveness.
72
What is beat frequency in IFC?
The frequency produced from the summation of two different sinusoidal waves
## Footnote
Beat frequency is essential for creating therapeutic effects.
73
What pad placement method creates a 'four-leaf clover' pattern?
Quadripolar
## Footnote
This method enhances the area of treatment.
74
What is the purpose of automatic vector scan in IFC?
Enlarges the treatment area by modulating amplitude
## Footnote
This feature improves the effectiveness of the therapy.
75
What is Russian Stimulation used for?
Muscle strengthening and prevention of disuse atrophy
## Footnote
Russian Stimulation is a specific NMES application.
76
What are the parameters of Russian Stim?
2500 Hz carrier frequency, 50 bps, 10 sec on, 50 sec off for 10 minutes
## Footnote
These parameters are set for effective muscle contraction.
77
List three contraindications for NMES.
Pacemakers, metal implants, malignancy sites, pregnancy (abdomen), hemorrhagic areas
## Footnote
These contraindications are critical for safe application of NMES.
78
What effect is ultrasound based on?
Reverse piezoelectric effect
## Footnote
The reverse piezoelectric effect involves the generation of sound waves when an electric current is applied to certain materials.
79
At what frequency is sound considered ultrasonic?
>20 KHz
80
What frequency range is used for deep heating and mechanical therapeutic effects?
85 KHz – 3 MHz
81
What are the mechanical effects of ultrasound?
Stable Cavitations and Microstreaming
## Footnote
These effects contribute to wound healing, inflammation reduction, and increased cellular membrane permeability.
82
What happens to muscle relaxation and circulation as intensity increases with a Duty Cycle of 100%?
More deep Heating
83
What is the typical Duty Cycle for tissue healing?
20-25% Duty Cycle with lower intensity
84
What are the coupling mediums used in ultrasound treatment?
* Gel
* Water
* Medication infused gel/cream
85
What is the starting intensity for superficial muscles?
0.5 W/cm2
86
What is the starting intensity for deep muscles or tissues?
0.7-1 W/cm2
87
What should you do if there are bones close to the skin around the target muscle/tissue?
Start lower due to bones vibrating and heating quicker than muscles or ligaments
88
What is the procedure for water emersion ultrasound treatment?
* Transducer and body area submerged in water
* Place the transducer ½ in to 1 in. above the targeted area
* Increase starting intensity by 0.5 W/cm2
* Set other parameters and move in a circular motion
89
What information should be included in charting for ultrasound treatment?
* Brand/model # of unit
* Transducer ERA (1, 5, or 10 cm2)
* Frequency (crystal—1.0, 3.0, 3.2, 3.3 MHz)
* Intensity (W/cm2—typically between 0.5 and 2.0)
* Duty cycle (continuous vs. pulsed)
* Time (5 mins typically/site)
* Coupling medium used
* Treatment area (size & location)
90
What is an example of a chart note for ultrasound treatment?
"Mettler model 730 ultrasound unit using the 10 cm2 ERA transducer with 1.0 MHz crystal at 1.8 W/cm2 continuous duty cycle for 5 minutes with 24 mg of 0.8% dexamethasone phonophoresis above long head biceps tendon insertion on right anterior shoulder"
91
What is the time range typically used for ultrasound treatment per site?
5-8 minutes per site
92
What is the intensity range for the Mettler Sonicator 740 unit?
0.1-2.2 W/cm2
93
What frequencies are available for the Mettler Sonicator 740 unit?
1 MHz or 3 MHz
94
What Duty Cycle percentages are available for ultrasound treatment?
* 100%
* 50%
* 25%
* 10%
95
What is the depth of penetration for 1 MHz frequency ultrasound?
5 cm (for deep tissue target)
96
What is the Effective Radiating Area (ERA) for 1 MHz ultrasound?
10 cm2
97
What is the relative size of the Effective Radiating Area for 1 MHz ultrasound?
Grapefruit
98
What is the depth of penetration for 3 MHz frequency ultrasound?
2 cm (for superficial tissue target)
99
What is the Effective Radiating Area (ERA) for 3 MHz ultrasound?
1 cm2
100
What is the relative size of the Effective Radiating Area for 3 MHz ultrasound?
Golf Ball
101
What is the depth of penetration for 1/3 MHz frequency ultrasound?
5 cm or 2 cm
102
What is the Effective Radiating Area (ERA) for 1/3 MHz ultrasound?
5 cm2
103
What is the relative size of the Effective Radiating Area for 1/3 MHz ultrasound?
Tennis Ball
104
What are the indications for TENS?
Pain relief, muscle stimulation, rehabilitation
## Footnote
TENS is used for various conditions including acute and chronic pain management.
105
What are the contraindications for TENS?
Pregnancy, pacemakers, skin irritation, epilepsy
## Footnote
TENS should not be used in certain conditions to avoid adverse effects.
106
How should pads be placed during TENS application?
1 pad width apart, on the same side of the body, on the same muscle group
## Footnote
Proper pad placement is crucial for effective treatment.
107
What is the pulse width for A-beta fibers?
<100 usec
## Footnote
A-beta fibers respond to shorter pulse widths.
108
What is the pulse width for motor fibers?
<150 usec
## Footnote
Motor fibers require slightly longer pulse widths for effective stimulation.
109
What is the pulse width for denervated muscle?
>1 ms
## Footnote
Denervated muscles require longer pulse widths for stimulation.
110
What is the pulse rate for high frequency TENS?
>80 Hz
## Footnote
High frequency is typically used for pain relief.
111
What pulse rate is considered low frequency for TENS?
~2-4 Hz
## Footnote
Low frequency may be used for muscle stimulation.
112
What are the modes of TENS?
Normal/Continuous, Burst, Modulation
## Footnote
Different modes can be used depending on treatment goals.
113
What is the amplitude for low intensity in TENS?
<24 mA
## Footnote
Low amplitude is used to stimulate A-beta fibers.
114
What fibers are stimulated by high intensity and high duration?
A-Beta, Motor, A-Delta
## Footnote
High intensity and duration can lead to muscle fatigue.
115
What is the significance of muscle fatigue in TENS?
Indicates stimulation of A-Beta, Motor, A-Delta fibers
## Footnote
Monitoring fatigue can help assess treatment effectiveness.
116
Fill in the blank: The pulse duration for C-fibers is _______.
1 ms
## Footnote
C-fibers require a specific pulse duration for effective stimulation.
117
What is the pulse width range for general TENS use?
50-200 us
## Footnote
This range is commonly used for various applications.
118
What is the pulse rate for modulation mode in TENS?
Varies
## Footnote
Modulation mode can change pulse rates for therapeutic effects.
119
What is the typical pulse duration for brief intense TENS?
200-250 us
## Footnote
Brief intense TENS is aimed at quick pain relief.
120
What does IFC stand for?
Interferential Current
## Footnote
IFC is a type of electrical stimulation used for pain relief and muscle rehabilitation.
121
What is the main indication for using IFC?
Pain
## Footnote
IFC is primarily indicated for pain management.
122
What are the parameters for Low Beat frequency in IFC?
80 Hz
## Footnote
This is one of the settings used in IFC therapy.
123
What are the parameters for High Beat frequency in IFC?
150 Hz
## Footnote
This setting is crucial for effective IFC therapy.
124
What is the Carrier Frequency used in IFC?
4000 Hz
## Footnote
The carrier frequency is essential for the modulation of the IFC signal.
125
What is the Pad Arrangement for Quadripolar setup?
Channels are perpendicular to each other
## Footnote
This arrangement helps in maximizing the interference effect.
126
What is the Pad Arrangement for Bipolar setup?
Along same muscle
## Footnote
This arrangement targets a specific muscle area.
127
What type of interference pattern is used in IFC?
4 Leaf Clover
## Footnote
This pattern is used for effective treatment coverage.
128
Which fibers are stimulated by IFC?
a-Beta sensory
## Footnote
These fibers are primarily involved in sensory perception.
129
Which fibers are stimulated by Russian Stimulation?
a-Beta, Motor, A-Delta, C-fibers
## Footnote
Russian stimulation targets a broader range of nerve fibers for muscle contractions.
130
What is the notable muscle contraction result of Russian Stimulation?
Yes, notable, tetanic contractions
## Footnote
This indicates effective muscle engagement during treatment.
131
What is the notable muscle contraction result of IFC?
No muscle contractions visible or palpable
## Footnote
IFC primarily focuses on pain relief without visible contractions.
132
What is the benefit of using Vector Scan in IFC?
Targets larger treatment area: Automatic 100%
## Footnote
Vector scan enhances the coverage of the treatment area.
133
What is the purpose of the Sweep function in IFC?
Prevents accommodation
## Footnote
This function helps maintain the effectiveness of the treatment over time.
134
True or False: IFC is used for muscle atrophy and weakness.
True
## Footnote
IFC can assist in managing muscle atrophy and weakness.
135
Complete the statement: The treatment duration for IFC is _______.
20 minutes
## Footnote
This is a common duration for an IFC treatment session.
136
What is the recommended frequency of treatment for patients receiving IFC?
3 times a week for 4 weeks
## Footnote
This schedule is often suggested for optimal recovery.
137
What is the definition of monopolar pad application?
Refers to pad application with two pads of different sizes: one small active pad and one larger dispersive pad
## Footnote
Typically used in iontophoresis applications and NMES.
138
What is the purpose of the active pad in monopolar applications?
To apply current to the target area, typically over the motor end-point of a muscle to induce contractions.
139
How often should innervated muscles be treated in monopolar applications?
Approximately three times per week.
140
How often should denervated muscles be treated in monopolar applications?
Approximately three times per day to prevent atrophy.
141
What is iontophoresis?
A transdermal delivery system that propels charged substances through the skin using low volt Direct Current.
142
What are the main indications for iontophoresis?
Hyperhidrosis, Peyronie’s disease, TMJ disorders.
143
What does bipolar pad application involve?
Two pads of the same size placed longitudinally along the muscle being treated.
144
What are the intended outcomes of bipolar pad application?
Proprioceptive feedback, improved mobility, circulation, endurance, and maintenance of muscle tone.
145
What is the typical pulse duration used in electrical stimulation?
200-300 microseconds.
146
What type of pad application is used in interferential therapy?
Quadpolar pad application, which involves four pads of the same size.
147
Define Direct Current (DC).
Electrical current that flows in one direction for 1 second or longer.
148
What is the historical term for Direct Current?
Galvanic current.
149
What is the major physiological response to DC stimulation?
Electrochemical changes at the cellular and tissue levels.
150
List some indications for Direct Current therapy.
* Cluster headaches
* Tendon and ligament ruptures
* Ankle sprains
151
What is the role of DC electrical fields in inflammation?
They guide and stimulate the migration of inflammatory cells, epithelial cells, and fibroblasts.
152
What type of unit is required for iontophoresis?
A Direct Current (DC) unit.
153
What is the role of the active pad in iontophoresis?
It is placed over the area to be treated and can be either the anode or cathode.
154
What are the characteristics of HVPC?
High Volt Pulsed Current, twin-peak monophasic, with voltages greater than 150 volts.
155
What is the typical pulse frequency for HVPC?
1-200 pulses per second.
156
What are some indications for using HVPC?
* Slow to heal cutaneous wounds
* Germicidal effects over infected wounds
* Soft-tissue edema
* Muscle spasms
* Pain therapy
* Muscle weakness
157
What is the typical duration for treating slow to heal wounds with HVPC?
Approximately 45 minutes, 5 days a week for 4-8 weeks.
158
Fill in the blank: The active pad in iontophoresis attracts _______ ions.
[negative] ions.
159
Fill in the blank: The dispersive pad in iontophoresis should be _______ the size of the active pad.
[at least 4 times]
