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Caroline Summer 25 2.0 > Week 3 E Stim Lecture Pt 2 (Clinical Application) > Flashcards

Week 3 E Stim Lecture Pt 2 (Clinical Application) Flashcards

(72 cards)

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1
Q

Cellular effects of electrical current

A

Excitation of nerve cells

Change in membrane permiability

Protein Synthesis

Stimulation of fibroblasts and osteobalsts

modification of microcirculation

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2
Q

Tissue level effects of Electrical current:

A

Muscle fiber (skeletal and smooth) contraction

Tissue regeneration

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3
Q

Segmental effects of E-Stim

A

Modification of joint mobility

muscle pumping action (lymphatics)

Alteration of microvascular system

increase in movement of charged proteins into lymphatic channels

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4
Q

Systemic effects of E- Stim

A

Analgesic effects

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5
Q

What kind of E-Stim is our first choice for pain?

A

IFC

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6
Q

What are the 4 clinical stimulation levels?

A

Subsensory

Sensory- tingling/prickling feeling

Motor- Strong paresthesias, muscle contraction

Noxious- Strong uncomfortable paresthesias, strong muscle contraction, burning sensation

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7
Q

clinically, TENS refers to e-stim applied for what purpose?

A

pain relief

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8
Q

with voluntary muscle contraction, type __ fibers are stimulated first and the GTO can protect muscles.

with electrically induced muscle contraction, type __ fibers are stimulated first and the GTO can not overrise the tension.

A

type 1 - slow twitch, slow onset fatigue

type 2 - fast twitch, faster onset fatigue

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9
Q

What is a “motor point”

A

Point located above the skin where you can place the electrode to get the most muscle twitch with the least current

AKA area with least resistance

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10
Q

What are uses of High Voltage Currents (HVPC)

A

Muscle contraction

reducing Edema

Wound healing

Pain control (but IFC and TENs are preferred over this)

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11
Q

What do the waves look like for HVPC?

A

Twin peak monophasic pulsed wave forms

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12
Q

How do you apply HVPC?

A

2 unequal sized electrodes

Active electrode: smaller one placed over treatment site

Dispersive electrode : Large electrode placed somewhere away from treatment site

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13
Q

Negative polarity HVPC is most effective in what phase of healing?

A

Inflammatory phase

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14
Q

Positive polarity HVPC is most effective in what phase of healing?

A

Proliferation phase

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15
Q

When using HVPC for edema, what settings should you use?

A

Frequency: 120pps

Intensity: 30-50V (10% less than what’s needed to produce a muscle contraction)

Duration: 30 minutes

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16
Q

What kind of E-Stim uses gate control theory/descending control theory?

A

TENS (Transcutaneous Electrical Nerve Stimulation)

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17
Q

what type of waveform does TENS use?

A

asymmetric biphasic most common

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18
Q

TENS purpose

A

stimulation of sensory nerves to change patients perception of painful stimulus

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19
Q

How can you improve effectiveness of TENS?

A

modulate
pulse and ramp
the body doesn’t get used to it

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20
Q

Where can you put the electrodes for a TENs unit?

A

Almost anywhere that there is pain

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21
Q

Conventional TENS vs

Acupuncture-like TENS

A

Conventional: High rate, low intensity (best for acute pain)
Uses gate control theory

Acupuncture - Low rate, high intensity (best for chronic pain)
Uses descending control theory

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22
Q

What are the 4 types of TENS and their theories

A

Conventional - gate control

Acupuncture - descending

Noxious Level - endogenous opiate pain control

Brief Intense - peripheral and central analgesia

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23
Q

What kind of TENS is best for wound debridement?

A

Brief Intense (high rate and high intensity)

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24
Q

What should the settings be for conventional TENS?

A

Frequency 80-125 (100)

Duration 75-150 (100)

Intensity: Tolerable SENSORY stimulation (no muscle contraction)

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25
How long can you use conventional TENS?
30 mins to a couple hours
26
What is gate control theory?
Increasing activity of A-Beta fibers triggers release of enkephalin from interneurons whcih inhibit second order neurons of pain
27
What are the settings for acupuncture-like TENS
Frequency : LOW >20 pps Duration : 100-600 (Remember we set it to 250 which is the max the machine in lab can do) Intensity: Enough to elicit sensory and muscle contraction Duty: 30-60s on, off time as needed to be tolerable
28
How long should you use acupuncture-like tens?
15 mins (15-60)
29
How does descending pain control theory work?
Opiate receptors in central or peripheral terminals of nociceptive afferent fibers "basically pain is tricked into not crossing into spinal cord" - Dr G
30
What are the settings of Noxious level TENS?
LOW frequency 1-5 Duration 100-1000 Intensity: set to noxious level w/ possible muscle contraction FOR trigger points/acupuncture points Duty: 30-45s on
31
What kind of TENS uses endogenous opiate pain control theory
Noxious level TENS
32
Settings for brief intense TENS?
frequency 100pps Duration 100-600 intensity: Muscle fasciculation to sustained muscle contraction
33
What are 2 uses of russian current?
Muscle Strengthening Muscle re-education
34
know the theories
35
Should russian E-Stim be a substitute for therapeutic exercise?
no
36
What is the normal frequency of Modern Russian Current?
2000-10000 hz (waves look like solid blocks of smaller waves) aka as "medium frequency" burst mode: 50% on/off time
37
wave form of Russian currents
pulsatile biphasic produces 2 basic waveforms: sine wave inside a square wave
38
What are the advantages of russian current? Why is the frequency so high?
Higher frequency reduces resistance making the waveform **tolerable** enough **at high intensities** As soon as nerve repolarizes its already stimulated again, leading to **maximal summated muscle contractions**
39
What are 2 uses of IFC?
Pain Control Muscle stimulation (reduce spasm)
40
How are the electrodes placed for IFC?
In a cross pattern, each channel is diagonal
41
How does IFC work?
quadripolar technique: 2 different current paths interfere with eachother and the frequency is actually the difference between the 2 diagonal frequencies Example: 4100 one way and 4000 the other way = 100hz in the middle
42
What is IFC sweep mode?
Allows frequencies to be modulated to avoid accomodation
43
What is interferential current scan mode?
Scan mode allows the AMPs to be modulated, increases the area of interference Example: if patient has poorly localized pain this allows it to cover more area
44
What is IFC target mode?
You can select what area between the 4 pads you want to focus on, reduces accomodation by changing the location of the current
45
What is the "little brother" of IFC called?
Pre-MOD
46
How does pre-mod work?
2 currents interfere with each other INSIDE the DEVICE before being delivered to the patient basically IFC with only 2 electrodes
47
NMES or FES
combining waveform characteristics makes possible to stimulate sensory and motor nerves reeducation & strengthening nerve stim edema pain retardation of atrophy ROM inc muscle tone restore
48
NMES and FES settings for muscle reeducation and strengthening
pulse rate: 35-55pps duration 200-600 micro sec
49
review indications - theres a lot of ones you may not think about
50
E-Stim contraindications: Pace makers Stimulation near heart Area over carotid sinus Area with DVT or thrombsis Patients who are confused Patients w/ internal stimulator **Name more?**
seizure disorders Infection Wounds,scars,lesions Malignancies pregnancy MSK problems where it would exacerbate the condition high level spinal cord injury
51
E-Stim Contraindication: seizure disorders Infection Wounds,scars,lesions Malignancies pregnancy MSK problems where it would exacerbate the condition high level spinal cord injury **Name more?**
Pace makers Stimulation near heart Area over carotid sinus Area with DVT or thrombsis Patients who are confused Patients w/ internal stimulator
52
What is the normal rule for electrode placement (distance)?
Electrodes must be atleast 1.5x the electrode diameter apart
53
the farther apart the electrodes, the greater the ____ if closer together, current passes through more ___ tissues, and is more irritating
depth superficial
54
How should electrodes be oriented on a muscle?
Parallel to the muscle fibers especially for shocking
55
bipolar application vs monopolar vs quadripolar
same size electrodes for bipolar monopolar - one or more small active electrodes and large dispersive electrode quadripolar - parallel or crossing pattern (using 4)
56
when to use monopolar vs bipolar
mono - wounds, iontophoresis, edema, targeted muscle stim bipolar - pain modulation, weakness, NM facilitation, spasms, ROM
57
Small vs large electrodes
Small: increase current density increased impedance decrease flow Large: Decrease current density decrease impedance increase flow
58
Muscle fibers are ____________ ______ conductive when the electrodes are placed parallel to the fibers vs perpendicular to them
x4 more
59
what techniques are used for muscle reeducation
HVPC, russian Biphasic helps restore a more normal balance to the ascending sensory info to be reintegrated into motor control patterns
60
muscle re-education settings
on 2-3s, 1:1 or 1:5 on/off ratio intensity enough for contraction but comfortable duration 200-600 frequency 35-55 pps 15 min treatment repeated several times a day
61
muscle pump goal and settings
goal: increase circulation of venous and lymph flow while keeping injured part protected, use RICE on 5-10s, 1:1 ratio intensity: muscle contraction pulse duration: 200-600 frequency: usually set at 20; 35-55pps 20-30 min, 2-5 times a day
62
retardation of atrophy goal and settings
goal: duplicate normal contraction, produce physical and chemical events which help maintain normal muscle function on 6-15 secs, off > 1 min intensity: high as can tolerate, 25% MVIC torque D: 200-600 F: tetany range 50-85pps 15-120 min, minimum 10 contractions, repeat 2-3 times a day move the limb! or add resistance
63
muscle strengthening or denervation settings
*gradual ramp tp peak intensity is most effective on 10-15 sec, off = 1-2min intensity: high enough for 60% MVIC torque D: 200-600 F: tetany range 50-85 resistance applied! should mimic normal training, 3x10 contractions
64
increasing ROM settings
65
Conventional TENs works on what fibers?
A-Beta fibers
66
Motor level/low rate TENs works on what fibers?
A-Beta Motor and possibly A-Delta
67
What is the "Hot finger" technique?
1. Set pulse rate between 80 - 150 Set pulse duration (width) between 50 - 150 (Basically 100 100) 2. Apply 1 electrode on yourself and the other on your patient 3. Using your fingertip, contact on your patient (aim for the motor point) 4. Turn the unit on and raise the amplitude until you feel a mild tingling. Slowly move your finger over the skin. 5. When you come on to a low impedance point, you will feed a greater current flow through your finger
68
What technique helps you find a **low impedence point** for placing an electrode?
hot finger technique
69
What is carrier frequency of IFC? What is beat frequency?
Carrier- the lesser frequency current of the 2. Example: you've got 4000 and 4100, so 4000 is the carrier frequency Beat- The difference of the frequencies (example: 4100-4000 = 100)
70
When using NMES, what frequencies do small muscles get, what about big muscles?
small muscles 200-300; large muscles 300-600
71
When using NMES, the higher the pulse frequency the ___________ the fatigue
faster
72
saftey considerations !!
1. approval sticker 2. dont use damaged equiptment 3. hospital grade 3 point prong with saftey ground attached to an earth ground 4. plugs should be removed from the wall by grabbing the plug not cable 5. no extension cords or adaptors 6. no liquids nearby 7. keep wires tucked away, no tripping

Caroline Summer 25 2.0 (39 decks)

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