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132 Cards in this Set
- Front
- Back
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Summation of contraction
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magnitude of contraction is inc when Hx of depolarization increases (ex. tetany)
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Tetany
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constant non-varying contraction of a muscle (beneficial to treat muscle spasms)
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Hz for tetany is around
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20-85 pps
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Muscle contraction (or nerve stimulation) occurs under what pole first
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cathode
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Factors effcting current
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nerve fiber diameter, lower threshold for depol, larger action pot, myelination (nodes of Ranvier), "A" motor and sensory fibers thick ("C" fibers thin/slow), "A" fibers alpha-beta-gamma-delta dec order of thickness
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Inc intensity of stimulus will result in
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deeper penetration
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Inc pulse durations also inc in
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stimulation
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Electrodes placed further apart, current travels
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deeper
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Making one electrode smaller will cause
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a greater current density under it
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Electrodes most commonly used are_____
and what can also be used |
the self-adhesive disposible electrodes. They are pliable and have good contact with the skin.
damp sponges (salt-water) |
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Wave modulation
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Ramped waveform may not be a good idea dur to muscle accommodation. May then need to increase stim for desired effect.
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Pulsed/interrupted mod should be done at a ratio of
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1:3 (ON:OFF)
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Monophasic waveforms create ____,
while biphasic____ |
polar effects, does not
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Low frequency currents
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LVG, LV pulsed current, HV pusled current, TENS, sinusoidal and faradic
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Acute stage parameters
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80-120 Hz and lower intensity (up to and just below pt perception, do not want to stim motor nerves) stimulate type I and II sensory fibers, close the pain gate and stim enkephalin productions, 10-20 min, set postitive if monophasic machine (characteristics similar to ice)
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Chronic stage parameters
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produce endorphins, dec freq to below 10 Hz (3-5 optimal), higher intensity to patient tolerance (visual muscle contraction ok), neg polarity monophasic on area of intent, for 20-30 min
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Subacute stage parameters
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if injury is closer to the acture stage then use acute settings, if injury is closer to chronic stage then use chronic settings, the intensity should be at patient tolerance for 15-20 min, pos or neg
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To break muscle spasms
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50-70 Hz, range of tetany, intensity should be to pt tolerance, continuous mode for 20 min, pos or neg (no tissue changes, just muscle contraction)
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Pump edema
(stimulate muscle to contract and pump fluid away) |
10 HZ to pt tolerance with mild muscle contraction, alternating mode (type of waveform) is best, but surge (on/off) is good 15-20 min, neg preferred (subacute/chronic-treat passive congestion) but pos ok for less chance of edema (if you think possibility of edema forming is great)
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Exercise
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10-15 Hz to pt tolerance, surged or alternating for 20 min, negative
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LVG Primary action
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electrochemical polar
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LVG waveform
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Monophasic current with rectangular wave
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NaCl in water
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ions dissociates, Na+ ion attracted to the cathode (-), while the Cl- ion goes to the anode (+). HCl (acid) forms at the anode while NaCl (base) forms at the cathode.
(Acid forming = tissue hardening) |
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LVG confimation tests
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Water bubble test, litmus paper test, and phenolphthalein test confirms this
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LVG Polar effects at the positive pole (anode)
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attracts acidsk, repels bases, attracts O2, repels hydrogen, corrodes metal (oxidation), hardens tissues, dec nerve irritability, produces vasoconstriction, ischemia, dec bleeding, dehydrates tissues, acute pain relief, astringent -- like ice
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LVG Polar effect at the neg pole (cathode)
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attracts alkaloids (bases), repels acids, attracts hydrogen, repels oxygen, no oxidation, softens tissues, inc irritability, vasodilation, hyperemia, inc bleeding, hydrates tissues, may inc pain in acute but dec in chronic, germicidal effect -- like heat
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LVG Pain control
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acidic rxn at the pos pole tends to sedate tissue in acute stafe, neg pole can be ised in chronic stage. LVG also provides pain relief through enkephalin production.
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LVg elect-osmosis
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(shifting water content of tissues thru membrane) reduce edema and swelling. Interrupted mod can exercise muscle.
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When turned on
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feel sensation under the neg first then with inc will feel under pos
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Indications for LVG
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contusions, sprains, strains, myositis, fibrositis, acute trauma, IVD, neuritis, myalgia, sciatica, denervated muscle, myospasm, iontophoresis and electrodiagnosis
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Contraindications for LVG
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brain, eye, heart, pacemaker, carotid sinuses, low back/abdomen in pregnancy, HIM, when polar changes are not desired, diminished sensation, over recent scar (muscle contraction could rip scar open), metallic implants
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Application of LVG
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electrodes should be thoroughly wet with a saline soln or used with disposable pads, use strapss to secure electrodes, there is a small active pad and a larger (4x) dispersive pad (monopolar application), or if pads are equal in size (bipolar application), max current intensity is 1 mA per in2 of active electrode
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Duration of LVG
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10-20min for acute, s/a or chronic 20-30
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Intensity for LVG
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turn up or down slowly. Intensity off for pad removal. Don't have pt lie on pads. never switch polarity hile current is on, check for frayed wires, don't apply on metal table, or touch metal objects, remove all jewelry or other metallic objects
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Electrodiagnosis (see pg49)
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test integrity of muscles and nerves
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Nerve conduction velocity test and Electromyelogram machines
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machines use LVG and faradic current, rxn from stim reveals extent of injury, muscls innervated by a damaged nerve undergo what is called rxn of degeneration (RD), when RD present 2 responses can be seen, no response with faradic and sluggish response with LVG
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Iontophoresis
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intro of ions into superficial tissues by mean of LVG current, could cause tissue damage if using too high a current, allergic response would be another concern
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Agents used in iontophoresis (see pg48)
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chloride - breaks down adhesions, capsulitis, scar, Copper - antiseptic allergic rhinitis, fungal infections, gynecological conditions, hemorrhoids, Iodine - adhesions, fibrositis, myofibrosisitis, scars, reduce pain in neuropathies, and antiseptic, Magnesium - DJD, Salicylate - analgesic, Novocain - analgesic, Histamine - vasodilator
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Low-Volt Pulsed Current primary action
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electrokinetic, electroanalgesic
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LVPC waveform
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monophasic pulsed with a rectangular wave
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LVPC Contraindications
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same as for LVG
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LVPC has a
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mode switch for pulsed or continuous
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LVCP pulsed modes include
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surged mode, amplitude is slowly inc and then dec
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LVPC reciprocating
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current amplitude alternates between channels
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HVPC Primary action
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electrokinetic, electroanalgesic
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HVPC waveform
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monophasic twin peak triangular wave
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High volt units produce
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more cutrrent therefore penetrate deeper
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HVPC known for
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their effectiveness in pain control
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Indications for HVPC
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same for LVPC
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HVPC Modulation controls
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continuous, switch rate-alternating current betwen electrodes, interrupted mode - surge on/surge off, for exercise
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TENS stands for
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transcutaneous electric nerve stimulation (biphasic)
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TENS primary action
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electroanalgesic
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TENS waveform
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biphasic rectangular waveform or faradic waveform (interrupted mod)
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TENS capable of
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opiate production (pain)
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TENS penetration is
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superficial
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TENS pt can wear unit how long
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hours at a time
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TENS indications
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symptomatic relief of all types of pain except viseral
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TENS contraindications
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HIM, low back/pelvis prego
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TENS stimulation
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sensory only
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TENS waveform (phase duration, phase=amount of time current is on) setting
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40-500us usually under 130us, while Hz is set to 1-150, can be continuous, modulated, or burst
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TENS pad
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should be placed along a dermatome with the black pad btwn the pain-n-the-brain, pads over the nerve pathway is also done, skin irritation can occur with long-term use
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Sinewave/Faradic primary action
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electrokinetic
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SIN/Faradic waveform
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symmetrical sinusoidal waveform with no polar effects, while faradic is an asymmetrical triangular waveform creating a slightly polar effect
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SIN/Faradic physiological effects
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muscle contraction, stretching fibrotic tissue, inc lymph flow
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Indications
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muscle spasm, hysterical paralysis, UMN lesions, stim of weak or paralyzed muscles, electrodiagnosis (faradic)
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Contraindications to SIN/Faradic
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fx, dislocation, osteoporosis, rickets, osteomalacia, TB, recent scar formation, abrasions, new skin, hematoma, intensity to pt tolerance, or contraction for 20 min
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Medium frequency modalities
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russian stim and true interferential (2k-10kHz)
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MFM Primary action
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electorokinetic, electroanalgesic
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Russian stim for
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muscle strengthening
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Interferential
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2 sinewaves that cross to create a third low Hz beat in tissues (waveform - biphasic sine waves)
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IF current produced by
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2 methods
Frequency difference IF-2 different generators, 2 biphasic - 1 channel at 4k Hz 2nd channel at 4K+ (1-150) Hz (third is the difference between the 2)Difference btwn the 2 is beet freq - represents how many X's the 2 meet to create a 3rd current = sum of 2 currents |
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Cloverleaf pattern
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True interferential (X marks the spot and you set that)
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Wedensky inhibition occur
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with the 2 channels bc Hz is faster than membrane repolarization - nerve block, but 3rd current is slower therefore therapeutic
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Premodulated IF
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2 current set at 4K Hz. The currents are modulated in the machine and can be applies to the pt in bursts. Current sent out thru 1 channel (can be used over smaller areas and machine finds the spot vs true interferential covers larger area)
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Russian stim form of
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premodulated Hz set at 2500 Hz, creating beat Hz of 40-60Hz, Current is interrupted as well, Studies showed 30% stronger muscle contractions, 30-40% strength improvements, 10-13% greater tension
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Russian stim setting
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set at 10 sec on/50 sec off for total of 7-10 min (need period of rest for recovery, more nutrients and O2 to the area)
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What does the high carrier Hx of IF allow for
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very deep penetration
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What does pad distance also determine
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depth
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Application of IF
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is the same as HVPC and LVPC
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Freq modulation or sweep is used
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to prevent accommodation (of the sensory nerves)
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Sweep setting
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is up from lower Hz from 1-150 Hz, 1015 Hz, 3-5 Hz, and 80-120 Hz
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Freq modulation can be used with
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true and premodulated IF, NOT russian stim
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Can use amplitude modulation (vectoring)
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to increase area being treated, because cloverleaf gets shifted (rotated)
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Amplitude modulation can only be used with
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True IF
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Indications for IF
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Musculoskeletal conditions where pain relief, reduce edema, reduce myosprasm or muscle strengthening, deep penetration, good for deep jts eg. hip, knww or spine, alternating current therefore metal or dec sensation not contra
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Contraindications for IF
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same as all elec mods + abscess, circulation block, hemorrhagic dyscrasis, hyperpyrexia, menstruating uterus, pt hyperanxiety, thombophlebitis, TB, and varicosities
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Can combine US with
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IF, HVPC, or LVPC = combination therapy
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High Hz current of US
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quickly overcomes skin resistane, thus allowing the more efficient and rapid penetration and stim of electrical current, US high Hz pulsed therefore no thermal, not useful to treat pain, but good for muscular spasm , edema, or muscle strengthening
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Ultra-low Frequency Current
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Microcurrent
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Microcurrent primary action
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tissue healing (whispering to the cells) but can be used for pain control (side effect of tissue healing)
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Microcurrent does not
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stimulate either the nerve or the muscle
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Microcurrent wave pattern
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monophasic or biphasic, square wave pattern, ultra low Hz and ultra low current microA, follows the Art-Schultz principle
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Trauma
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causes spasm which then reduces blood flow, resulting in dec o2 and nutrients and inc metabolic wastes causing dec ATP and pain
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What is needed for tissue healing
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ATP generation, protein synthesis, and membrane transport
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What did Dr. Becker find
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the body is positive charge along central axis and more negative periphery, but when injury occurs polarity switched
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Application for microcurrent tissue healing
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settings are 0.5 Hz at 20 microamps 15-20 min
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Application for microcurrent pain control
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settings are 30 Hz at 20-500 microamps with optimal at 100 microA for 15-20 min
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Microcurrent pads
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applied with pads or probes, where the polarity switch controls the red electrode
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Biphasic microcurrent when
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both positive and negative are lit, 3 procedures for probe use
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Microcurrent Polarity
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Positive along torso, negative along extremities
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GTO (golgi tendon organ tech)
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1 probe at insertion of mm and the other at the origin. The probes are stroked back and forth to inc ROM and reduce mm spasm. Go over the musculotendinous jxs for 1 min and then stretch
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EMR (enhancement of muscle repair)
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used for tight, painful, injured mm better pain relief than GTO. Probes placed on each side of m as if you were pinching it together. Stim for 5 sec then move 1 inch and stim 5 sec till whole length of muscle is done.
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Trigger pt tech (encircling the dragon)
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Probes are slowly scrolled around area of pain (dragon). Commonly set 10 Hz at 75 microAmps, biphasic
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Microcurrent pad placement
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red pad over area of pain, black pad 6-8 inch away. if radicular type of pain present, red over spinal nerve root and black distal to radiation. (Positive at nerve root)
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Electro-therapy massage with microcurrent
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one pad on pt the other on back of Dr.'s hand, then massage. Current needs to be increased 400-600 microA. Polarity is derived by body part.
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Underwater microcurrent therapy
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applying to hands or feet submerged in water. negative electrode put in water (because it is an extremitiy), positive electrode on torso
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Contraindications for microcurrent
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osteomyelitis, topical agents containing metal, laryngeal mm, never go over 10 Hz near the head, pts with hx of seizure, HIM, transcerebral transthoracic, over carotid sinuses, eyes
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GTO (golgi tendon organ tech)
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1 probe at insertion of mm and the other at the origin. The probes are stroked back and forth to inc ROM and reduce mm spasm. Go over the musculotendinous jxs for 1 min and then stretch
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EMR (enhancement of muscle repair)
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used for tight, painful, injured mm better pain relief than GTO. Probes placed on each side of m as if you were pinching it together. Stim for 5 sec then move 1 inch and stim 5 sec till whole length of muscle is done.
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Trigger pt tech (encircling the dragon)
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Probes are slowly scrolled around area of pain (dragon). Commonly set 10 Hz at 75 microAmps, biphasic
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Microcurrent pad placement
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red pad over area of pain, black pad 6-8 inch away. if radicular type of pain present, red over spinal nerve root and black distal to radiation. (Positive at nerve root)
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Electro-therapy massage with microcurrent
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one pad on pt the other on back of Dr.'s hand, then massage. Current needs to be increased 400-600 microA. Polarity is derived by body part.
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Underwater microcurrent therapy
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applying to hands or feet submerged in water. negative electrode put in water (because it is an extremitiy), positive electrode on torso
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Contraindications for microcurrent
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osteomyelitis, topical agents containing metal, laryngeal mm, never go over 10 Hz near the head, pts with hx of seizure, HIM, transcerebral transthoracic, over carotid sinuses, eyes
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Low power/Cold L.A.S.E.R.
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Light Amplification of Stimulated Emissions of Radiation, non-thermal
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FDA 4 classificaitons of laser
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1 - non-hazardous to body, 2 - hazardous if stare into source, 3 - moderate risk to retina, 4 - high risk of injury to eyes or skin
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LASER dosage
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measured in joules/cm2, treat with a total of 0.05 - 0.5 J/cm2 (for acute), 3 J/cm2 max limit for chronic injury
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Types of LASER used in USA
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helium neon (HeNe) gas laser (red light, in clinic) and gallium arsenide (GaAs) semiconductor laser
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Penetration of LASER measured as
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direct effect (superficial tissues energy absorbed) and indirect effect (deeper tissue are catalyzed)
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HeNe Class 2
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red beam with a wavelength 632.8 nm, continuous wave penetrates 2-5 mm direct and 10-15 mm indirect
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GaAs Class 1
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invisible wavelength 904 nm, pulsed mode penetrates 1-2 cm direct and up to 5 cm indirect
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Indications for LASER
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Pain-irradiatioon of superficial nerves leads to decreased nerve conduction, production of serotonin and NE. Good for acute pain if stim acupuncture points along nerve root. Some individuals might experience increase in pain initially therefore several applications should be performed to determine efficacy.
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Effects of LASER
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Wound healing can induce fibroblastic activity - inc collagen 3X. Tensile strength - wounds treated with laser will be stronger if done in first 10-14 days. Immunological responses - inc phagocytosis and leukocytes, Cartilage/bone response - research has shown can heal partial thickness cartilage lesions, fx bone exposed to irradiation results in faster bone consolidation
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GaSa effects
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Inflammation GaSa best - interupt formation of intermediate substrates, Scar tissue GaAs - has less scarring and better cosmetic appearance
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Contraindications for LASER
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Cancer, eyes, 1st trimester pregnancy
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Applications of LASER
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3 tech - gridding, scanning, and wanding, there is some beam divergence, and combining the inverse square law, the intensity of the laser lessens significance
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Application method of choice for LASER
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gridding
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Gridding/direct application for LASER
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light contact of laser aperture on skin, while holding wand perpendicular to skin. Treatment area divided into square cm, with each square 30-60 sec
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Scanning application for LASER
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applicator held 5-10mm from skin surface. used over open wound. area divided into grid cm2. (used when can't apply directly to skin, ex. wound, cast)
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Wanding application for LASER
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same as scanning but tip is oscillated back and forth (worst method because moving aperture - least effective)
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Setting for LASER
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Pain - 9 Hz, Pain and Inflammation - 16 Hz
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Treatment time for LASER
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btwn 30 sec - 3 min, usually 30-60 sec over each area of grid, and then 30-45 sec over nerve root that innervates area of complaint
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