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64 Cards in this Set
- Front
- Back
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Stimulation of denervated muscle to maintain viability |
EMS |
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Stimulation of innervated muscle to restore function |
NMES |
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Electrical stimulation that activates muscles to perform functional activities; used for irreversible conditions |
FES |
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Stimulation for pain management |
TENS |
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What can be used to decrease skin impedance? |
Hydration or heat |
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Which tissues in the body are excitable? |
Nerve Muscle: skeletal, cardiac, smooth |
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What are some factors that might increase impedance? |
Lotions or oils Excess body hair Adipose tissue Larger muscle mass |
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At rest, a nerve is ____ charged on the outside, and ____ charged in the inside. |
Positively, negatively |
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What is Ohm's law? |
Current = voltage/resistance |
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Direct current |
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Alternating current |
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What type of current can be DC or AC? |
Pulsed current |
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What type of current results in a net charge building up in the tissues? When is this used? |
Direct current; for iontophoresis or to stimulate denervated muscle |
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What types of ESTIM use alternating current? |
Russian, interferential |
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What is the most commonly used current form? |
Pulsed |
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What are the three criteria necessary for depolarization? |
1. The stimulus must be strong enough. 2. The stimulus must be fast enough. 3. The stimulus must be long enough. |
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Would bigger or smaller muscles require a longer pulse duration? |
Bigger muscles |
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Impedance will ____ as frequency increases. |
Decrease |
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Pulses per second or hertz |
Frequency |
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On/off time |
Duty cycle |
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The ability of the ESTIM unit to vary one or more of the parameters |
Modulation |
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What are the parameters for muscle strengthening? |
35-80 pps 150-200 ųs for sm. m. 200-350 ųs for lg. m. 10% of MVIC with injured m. 50% of MVIC with uninjured m. 10:50 initially, then reduce off time 10-20 minutes |
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What are the parameters for muscle reeducation? |
35-50 pps 150-200 ųs for sm. m. 200-350 ųs for lg. m. Sufficient to stim. a contraction |
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What are the parameters for muscle spasms? |
35-50 pps 150-200 ųs for sm. m. 200-350 ųs for lg. m. 5:5 To visible contraction 10-30 minutes |
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What are the parameters for edema reduction using muscle pumping? |
35-50 pps 150-200 ųs for sm. m. 200-350 for lg. m. 5:5 To visible contraction 30 minutes |
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What are the parameters for pain control? |
100-150 pps 50-80 ųs To produce tingling Modulate if available May be worn continuously or PRN |
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What are the parameters for acupuncture-like TENS? |
2-10 pps 200-300 ųs To visible contraction No modulation 20-30 minutes |
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What are the parameters for tissue healing? |
HVPC 60-125 pps 40-100 ųs, usually preset Continuous To produce tingling 45-60 minutes |
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What waveforms can be used for edema control? |
HVPC, biphasic, or interferential |
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What drug can be used with iontophoresis to reduce inflammation? What is its polarity? |
Dexamethasone phosphate; negative ; used to treat tendonitis and bursitis |
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What drug can be used with iontophoresis to produce local anesthesia? What is its polarity? |
Lidocaine; positive |
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What is the treatment time for iontophoresis with the following amplitude settings? 1 mA 2 mA 3 mA 4 mA |
1 mA - 40 minutes 2 mA - 20 minutes 3 mA - 13.3 minutes 4 mA - 10 minutes |
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If a patient is set up with the following parameters for muscle strengthening, but finds the stimulus too painful, what can be changed? 50 pps 150 microseconds 2x2 electrode |
Increase pulse duration; can go up to 300 ųs Increase electrode size; try 2x4 |
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What are some of the uses of NMES? |
Strengthening Endurance ROM Muscle function Muscle guarding Spasticity Edema reduction - chronic only Orthotic substitution |
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What is required for the use of NMES? |
An intact peripheral nerve |
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NMES is usually what kind of waveform? |
Symmetrical or asymmetrical biphasic |
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As pulse duration increases, the amplitude needed for a muscle contraction ____. |
Decreases |
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Will muscles fatigue more quickly at a higher or lower frequency? |
Higher; so use a higher frequency when treating a patient with muscle guarding or spasticity. |
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Why must there be an off time when using NMES for strengthening? |
It gives the muscle time to recover. |
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What is the main purpose of a ramp time? |
It enhances patient comfort. |
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With what type of disorders is NMES not really effective? |
Neuromuscular disorders such as muscular dystrophy. It works best for muscles that are weak from disuse or muscles that are not firing properly due to lack of feedback. |
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What needs to be documented when performing NMES? |
Treatment goal Location: body part or muscles Duty cycle Frequency Pulse duration? Treatment time Objective tests used Patient response |
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Which fibers transmit sharp fast pain? Dull aching pain? |
A-delta C-fibers |
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Sensory information goes through which horn of the spinal cord? |
Dorsal horn The ventral horn carries motor signals. |
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Absence of pain without loss of consciousness |
Analgesia |
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Absence of all sensation, including pain |
Anesthesia |
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Tingling or a pins-and-needles sensation |
Paresthesia |
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What is the most common placement of electrodes for sensory analgesia? |
🔹️Surrounding the painful area Can also be placed along... 🔹️corresponding dermatome, 🔹️cutaneous nerve distribution 🔹️superficial to nerve trunk supplying the site |
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Which points on the body have decreased impedance to electrical current? |
Acupuncture points Motor points Trigger points |
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Where are motor points located? |
Middle of muscle belly |
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Low-rate acupuncture TENS stimulates A-delta fibers and promotes the release of what? |
Endogenous opiates |
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What are the contraindications for TENS? |
Cardiac pacemaker Not over eye or carotid sinus Epilepsy Malignancy Open wounds Pregnancy - 1st trimester |
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What are the goals TENS or ES for pain management? |
Decrease pain at rest Decrease pain caused by therapeutic activity Treat acute flareup? |
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What are the uses of IFC? |
Reduce... Pain Edema Muscle guarding Increase ROM |
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Simultaneous application of two currents with different frequencies applied to the same treatment area |
Interferential current; frequency is above 1000 pps |
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How can a therapist increase the current depth when administering IFC? |
Increase the surface contour of the treatment area Ex: have the pt. bend their knee |
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Created field or third line of current created within the body when using IFC |
Vector; operates at the beat frequency or the difference between the two channels |
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During IFC, a type of modulation that alters the frequency of one of the channels |
Sweep |
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What type of TENS may be more effective than low-rate and more comfortable for the patient? |
Burst mode |
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What polarity should be used for tissue healing if wound is inflamed or infected? |
Negative; a positive electrode can be used if wound has no inflammation. |
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What type of edema should NOT be treated with electrical stimulation? |
Edema due to systemic disorders such as heart, liver, or kidney failure. |
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When treating edema of an acute injury, what type of ESTIM has been most effective? |
Negative polarity HVPC without muscle contraction |
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If a drug of negative polarity is being administered through iontophoresis, what polarity should the delivery electrode be? |
Negative |
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Review last slide |
see binder |
