268 Edm: Electrotherapy And Other Tests

Front 1

General indications for electrical stimulation (ES):

Back 1

1. Pain modulation
2. Muscle spasm
3. Impaired range of motion
4. Muscle re-education
5. Disuse atrophy (muscle weakness)
6. Soft tissue repair (wound healing)
7. Edema reduction
8. Spasticity (reduce hypertonicity)
9. Denervated muscle

Front 2

General contraindications for electrical stimulation (ES):

Back 2

1. Healing fractures
2. Areas of active bleeding
3. Malignancies or phlebitis in treatment area
4. Superficial metal implants
5. Pharyngeal or laryngeal muscles
6 Demand-type pacemaker
7. Myocardial disease

Front 3

Precautions for electrical stimulation (ES):

Back 3

1. Areas of impaired sensation

2. severe edema

Front 4

The cathode in iontophoresis is used for what?

Back 4

negative pole

1. Salicylate (pain relief)
2. Acetate (calcium deposits)
3. Dexamethasone (anti-inflammation)
4. Iodine (softens scars)

Front 5

The anode is used for what?

Back 5

positive pole

1. Hydrocortisone (anti-inflammation)
2. Lidocaine (pain relief)
3. Magnesium or calcium (muscle spasm)
4. Lithium (gout)
5. Zinc (dermal ulcers)
6. Copper (fungal infections)

Front 6

Contraindications for Iontophoresis:

Back 6

1. Impaired skin sensation
2. Allergy or sensitivity to therapeutic agent or direct current
3. Recent scars, cuts, bruises, or broken skin
4. Metal in or near the treatment area

Front 7

what mechanisms are used to control pain with TENs?

Back 7

1. Provides afferent stimulation for pain management by affecting the peripheral and central nervous systems, stimulating the large A-fiber afferents, can act to block the pain impulses (gate control theory)
2. Stimulation may also cause release of the body's own endorphins/enkephalins,which inhibit pain or pain transmission

Front 8

Current for TENS may be what?

Back 8

Symmetrical or asymmetrical biphasic (AC) waveform or a monophasic (DC) waveform

Front 9

Contraindications for TENS:

Back 9

1. Demand-type pace-makers (anywhere on body)
2. Over chest area of patients with cardiac dysfunction
3. Over eyes, laryngeal or pharyngeal muscles, head and neck of patient after a CVA or epilepsy
4. Application to mucosal membranes

Front 10

Electrodes for TENS may be placed where?

Back 10

1. At the point of the pain
2. At dermatomes of nerve roots
3. Over trigger and acupuncture points
4. Proximal or distal to the pain site
5. Segmental related myotomes

Front 11

Conventional TENS:

Back 11

aka High Rate

1. Uses high frequency (75-120 pps),

2. very short pulse width (50-100 microseconds)

3. low intensity
4. Provides temporary relief of acute or chronic pain
5. Onset of pain relief is relatively fast
6. Duration of treatment: 20-60 minutes

Front 12

Acupuncture-like TENS:

Back 12

aka (strong, low rate)

1. Uses a low frequency (1-4 pps)

2. wide pulse width (150-300 microseconds)

3. higher intensities than conventional TENS
4. used with more chronic conditions with longer lasting pain relief
5. Duration of treatment: 30-40 minutes

Front 13

Brief intense TENS:

Back 13

-used to provide rapid-onset, short-term pain relief during painful procedures (wound debridement, deep friction massage,joint mobilization or passive stretching)
1. Amplitude: to patient's tolerance
2. Pulse rate: 80-150 pps
3. Pulse duration: 50-250 µsec
4. Mode: continuous
5. Duration of treatment: 15 minutes
6. Duration of pain relief: temporary (30-60 minutes)

Front 14

what is Burst-mode TENS

Back 14

1. Combines characteristics of both high- and low-rate TENS
2. Stimulation of endogenous opiates, but current is more tolerable to patient than low-rate TENS
3. Onset of analgesia similar to low-rate TENS

Front 15

What are the parameters for burst mode?

Back 15

1. Amplitude: comfortable, intermittent paresthesia
2. Pulse rate: 50-100 pps delivered in packets or bursts of 1-4 pps
3. Pulse duration: 50-200 µsec
4. Mode: continuous
5. Duration of treatment: 20-30 minutes
6. Duration of pain relief: long-lasting (hours)

Front 16

Modulation mode TENS:

Back 16

-method of modulating the parameters of the above TENS modes for the purpose of preventing neural or perceptual adaptation due to constant electrical stimulation
-Frequencies, intensities, or pulse widths can be altered by >10%, one or two times per second

Front 17

High-voltage pulsed monophasic stimulation is what?

Back 17

-form of pulsed direct current (DC) stimulation using high-voltage twin spikes with pulse widths in microseconds
-The chemical, polar, and thermal effects of DC are minimized because of the extremely short duration (pulse width) of the stimulus
-Useful with denervated muscles
-Not tolerated well by patients

Front 18

Indications for DC current:

Back 18

1. Muscle stimulation/reeducation
2. Reduction of pain from TENS-like properties
3. Reduction of edema (increased turgor)
4. Facilitation of wound healing

Front 19

Russian current:

Back 19

Uses high frequency (2500 Hz) current, which is modulated to 70 pps for comfort

Front 20

Indications for Russian current:

Back 20

Used for strengthening of normal muscle by assisting with the muscle contraction during volitional activities such as isometric exercises and short arc joint movements

Front 21

Interferential current (IFC):

Back 21

1. Characterized by the crossing of two sinusoidal waves having similar amplitudes, but different carrier frequencies
2. The waves interfere with one another to generate an amplitude modulated beat frequency

Front 22

Indications for Interferential current (IFC):

Back 22

1. Pain relief
2. Muscle strengthening

Front 23

what is functional electrical stimulation (FES):

Back 23

-Can use alternating current (AC at 80-100 Hz) to stimulate an innervated muscle for general stimulation

-or direct current (DC) that is interrupted with a long pulse width for a denervated muscle
-FES is also called neuromuscular electrical stimulation (NMES)
-Encompasses a wide range of stimulator units and techniques

Front 24

Indications for FES:

Back 24

1. Disuse atrophy
2. Impaired ROM
3. Muscle spasm
4. Muscle reeducation
5. Spasticity management

Front 25

examples of FES use?

Back 25

as alternative or supplement to use of orthotic device

1. shoulder subluxation pts with CVA

2. idiopathic scoliosis management

3. DF assist in gait training

Front 26

how should FES be modified if the skin is sensitive or the patient reports burning?

Back 26

1. larger electrodes

2. decr intensity

3. increased pulse width

4. AC better tolerated than DC

Front 27

what is the duty cycle?

Back 27

used in FES

1. current "on" time versus "off" time, in seconds, expressed as a ratio
2. The ratio should increase as muscle atrophy or weakness increases to prevent over fatigue during treatment

Front 28

duty cycle for minimal to no atrophy or weakness

Back 28

Use a 1:1 or 1:2 ratio

Front 29

Moderate atrophy duty cycle?

Back 29

Use a 1:3 or 1:4 ratio

Front 30

Severe atrophy duty cycle

Back 30

Use a 1:5 to 1:10 ratio

Front 31

what is Chronaximetry

Back 31

1. A test of electrical excitability of peripheral nerves
2. This test is rarely performed
3. The chronaxie value is the minimal amount of time that the current must be on in order to produce a minimal muscle contraction

Front 32

Normal and abnormal chronaxie value?

Back 32

1. A normal chronaxie value is <1 millisecond
2. The value for a denervated muscle is in the hundreds of milliseconds

-lower the number of milliseconds the greater the nerve's excitability

Front 33

how long does it take severed neurons to degenerate?

Back 33

7-14 days

(Wallerian degeneration)

Front 34

when should chronaximetry be performed?

Back 34

after wallerian degeneration occurs to severed nerve (7-14 days)

Front 35

during electromyography, what activity is shown at rest by normal muscles?

Back 35

electrically silent

Front 36

what should EMG (electromyography) show with maximal contraction normally?

Back 36

interference pattern

Front 37

what are abnormal EMG electromyography activity shown at rest?

Back 37

1. fibrillation potentials

2. positive sharp waves

3. fasciuclation potentials

Front 38

what is normal muscle response in EMG for insertional activity?

Back 38

1. high freq burst of positive and negative spikes

Front 39

what is abnormal insertional activity?

Back 39

1. Reduced insertional activity: firbrotic or atrophied mmm

2. Prolonged: acute denervation & inflammatory mm. disorders

3. Insertional positive waves: prolonged denervation (2-3 weeks post)

Front 40

what is normal EMG activity during minimal activation?

Back 40

Single Motor Unit potential

Front 41

what is abnormal response in EMG for minimal activation?

Back 41

1. Polyphasic MUPs

2. Smaller than normal MUPs: early reinnervation

3. Larger than normal MUPs: later stages of reinnervation

Front 42

what is normal activity in EMG during maximal activation vs abnormal activity?

Back 42

1. normal = interference pattern

2. Abnormal: reduced interference pattern= peripheral nn injury

-Full interference pattern with minimal to mod effort = myopathic disease

Front 43

What do fibrillation potentials indicate

Back 43

1. denervation for 1-3 weeks

2. neuropathy

3. myopathy

Front 44

what do fasciculations indicate?

Back 44

can be observed or palpated

1. LMN (radiculopathies)

2. entrapment

3. partial denervation (disappear 3-4 days if total denervation)

Front 45

when do both fasciculations and fibrillation potentials occur?

Back 45

1. Partial LMN show both

2. complete show only fibrillation potentials (fasciculations, if present, disappear 3-4 days if complete lesion)

Front 46

what is Nerve conduction velocity:

Back 46

1. A test that determines the time it takes for a muscle to respond after the peripheral nerve has been stimulated
2. Can be done over sensory nerves by determining the time it takes for a nerve to respond to a stimulus

Front 47

how is nerve conduction velocity determined

Back 47

-distance between 2 points divided by difference between the corresponding latencies (conduction time)

-expressed as meters/second

Front 48

what is the range for upper extremity conduction velocities?

LE average?

UE average?

Back 48

UE conduction times: 45-70 meters/second
LE average: 50 m/sec
UE average: 60 m/sec

Front 49

when are nerve conduction velocities slower?

Back 49

1. Children less than 5 years-old
2. Adults over 70

3. lower intramuscular temps slow nn conduction velocities

4. higher temps incr NCV

Front 50

what is NCV useful to assess?

Back 50

Peripheral nerve lesions

neuropathies (CTS)

Front 51

what conditions have decreased NCV?

Back 51

1. peripheral neuropathies characterized by demyelination

-Gullian-Barre

-chronic demyelinating polyneuropathy

-Charcot-Marie-Tooth

2. focal compression of peripheral nerves (neuropraxia; may be completely absent in axontemesis and neurotmesis)

Front 52

what is a strength-duration curve

Back 52

-test of excitability in which intensity of current required to produce minimal mm contraction is plotted against a set of measured durations.

-rarely performed

-graph shows index of electrical excitability

Front 53

what do abnormal strength-duration curves look like and indicate?

Back 53

1. steep, continuous displaced to the right = denervation

2. discontinuous curves indicate partial denervation