Ptha 1431 Physical Agents Test 4 E. Stem

Front 1

Electricity is a form of ___.

Back 1

energy

Front 2

Define electricity

Back 2

-It is a form of energy
-Electric current is the flow of charged particles (electrons in metal or ions in human tissue)

Front 3

Define charge:

Back 3

-a basic property of matter; excess or deficiency of electrons

Front 4

An atom is ___

Back 4

neutral

Front 5

What is a Cation?

Back 5

positive charge when electrons lost

Front 6

What is a Anion?

Back 6

negative charge when electrons are gained.

Front 7

What type of current does US use?

Back 7

alternating current

Front 8

____ charges attract. ___charges repel

Back 8

Opposite
Like

Front 9

Define voltage:

Back 9

the potential difference between two points in electrical field. The force that causes charged particles to move.
(V)- electromotive force (EMF)

Front 10

Define current (I):

Back 10

-flow of charged particles through a conductor
-measured in amperes (amps)

Front 11

How many electrons/per second are in 1 amp?

Back 11

6 trillion

Front 12

What does EMF stand for?

Back 12

Electromotive force

Front 13

How many amps =1 C/sec?

Back 13

1 amp

Front 14

What is power? (P)

Back 14

Power = Voltage X Current (P= V x I)
-power is measured in watts

Front 15

Define resistance (R):

Back 15

-characterizes opposition to movement of charged particles.
-directly proportional to length of conductor
-inversely proportional to cross-sectional area
-Measured in ohms
ex>a hose; the smaller the hose, the more resistance. The longer the hose the more resistance.

Front 16

What is Ohm's Law?

Back 16

-flow of current is directly proportional to EMF and inversely proportional to resistance of circuit.
V = IR
V (EMF, voltage)
I (current)
R (resistance)

Front 17

What is conductance?

Back 17

-ease of movement of charged particles.
-mhos is the old term
-siemens is used to describe conductance

Front 18

define conductor:

Back 18

electricity flows easily
ex-metal, copper, water, nerve, mm., blood

Front 19

LIst 3 good conductors within the body

Back 19

1) nerve
2) mm
3) blood

Front 20

What is an insulator?

Back 20

-electricy does not flow easily
ex-rubber, glass, wood, fat, bone, skin

Front 21

What are 3 insulators within the body

Back 21

1) fat
2) bone
3) skin

Front 22

What are two types of current?

Back 22

1) A.C.-alternating current
2) D.C.-one direction

Front 23

What is alternating current?

Back 23

It is bi-directional flow of charged particles changing direction. (goes back & forth)

Front 24

What is direct current?

Back 24

Unidirectional flow of charged particles (one direction)
ex-a battery uses direct current.

Front 25

Two theories of current flow:

Back 25

1) conventional theory
2) electron theory

Front 26

What is conventional theory?

Back 26

-the current flows from positive to negative pole.

(surplus to shortage)

Front 27

What is electron theory?

Back 27

-current flows from negative to positive pole. This is the current theory

Front 28

What are 4 types of current modes?

Back 28

1)Continuous
2)pulsed/pulsatile
3)burst
4)interrupted

Front 29

What are three types of pulsed current mode?

Back 29

1)monophasic
2)biphasic
3)polyphasic

Front 30

Monophasic is a ___ current

Back 30

direct

Front 31

Biphasic is a ___ current

Back 31

alternating

Front 32

What is a Burst current mode?

Back 32

finite series of pulses delivered in a package or "envelope" as a singe pulst at an identified frequency.
ex-automatic gun-one bullet right after another.

Front 33

What is an interupted current mode?

Back 33

-current flows at least one second, and ceases to flow at least on second.
-Usually w/hand-held electrode.
ex-light switch.

Front 34

List 4 wave shapes/forms

Back 34

1)rectangle
2)square
3)spiked
4)sline
**above can be symmetrical or asymmetrical

Front 35

What is polyphasic pulse type?

Back 35

It has more than 2 phases.

Front 36

List 8 other parameters

Back 36

1)phase/pulse duration (width)
2)amplitude
3)frequency (rate)
4)phase or pulse charge
5)intrapulse interval
6)interpulse interval
7)Rise time
8) decay time

Front 37

Which is the most correct term: pulse width or pulse duration?

Back 37

pulse duration

Front 38

What is phase/pulse duration (width)?

Back 38

beginning to end of phase of pulse.
-use microsec or milisec

Front 39

Define amplitude:

Back 39

The intensity-magnitude of current or voltage
-amps or volts.

Front 40

What is the frequency?

Back 40

(rate)-number of pps or cps.

Front 41

What does PPS stand for?

Back 41

Pulse per second

Front 42

What does CPS stand for?

Back 42

cycle per second

Front 43

What is the phase or pulse charge?

Back 43

charge within each phase or pulse.

Front 44

Define intrapulse interval:

Back 44

time between two successive components of a pulse when no electrical activity occurs.
(Interphase?)

Front 45

Define interpulse interval:

Back 45

time between pulses when no electrical activity occurs.

Front 46

What is the rise time?

Back 46

time from 0 to peak amplitude

Front 47

What is the decay time?

Back 47

time from peak to 0.

Front 48

What is Ramp time?

Back 48

the time it takes to reach peak amplitude of pulse train.

Front 49

Name the 5 electrical units

Back 49

1) low volt
2)high volt
3)low frequency
4)medium frequency
5)high frequency

Front 50

What is the voltage that makes it low volt?

Back 50

less then 100 volts

Front 51

What is the voltage for high volt?

Back 51

300-500 volts

Front 52

what is the pps of low frequency?

Back 52

up to 1000 pps

Front 53

what is the pps of medium frequency?

Back 53

1000-10,000 pps

Front 54

What is the pps of high frequency?

Back 54

>10,000 pps

Front 55

List the electrode types:

Back 55

1)suface-metal plate (need wet sponges), carbon impregnated, self-adhering-reusable.
2)hand held (wand; use gauze)
3)invasive (implanted)

Front 56

How does size play into electrodes?

Back 56

-when using 2 electrodes of different sizes, the smaller is the treating one.

Front 57

How many electrodes must be used to keep the current closed?

Back 57

-at least two. Never use an odd # of electrodes.

Front 58

Which will give a deeper stimulation? Increased distance between electrodes or decreased distance?

Back 58

increased distance

Front 59

What are 3 things to consider when using electrodes?

Back 59

1) size should fit treatment area
2) current density is inversely proportional to electrode size
3) increased distance between electrodes for deeper stimulation.

Front 60

What are the 4 types of electrode lead types?

Back 60

1) banana-shape is thicker in the middle
2)telephone (pin)
3)mcIntosh-connector that when unscrewed you can attach to a lead.
4) alligator (wrap in foil and gauze to use on open wound)

Front 61

What are the two polarities?

Back 61

1) anode
2) cathode

Front 62

What is Anode polarity?

Back 62

-positive pole
-repels positive ions
-sclerotic (toughening) (desensitizing)
-analgesic effects

Front 63

What is Cathode polarity?

Back 63

-negative pole
-repels negative ions
-sclerolytic (softening)
-stimulating effect

Front 64

What are the 3 electrode configuations?

Back 64

1)monopolar-1 active, 1 dispersive
2)bipolar-2 equal-sized electrodes
3)quadpolar-4 same sized electrodes

Front 65

What are the basic uses of ES?

Back 65

-pain modulation: gate therapy
-Endogenous opiates: chemical control of pain (endorphins)
-edema reduction
-muscle relaxation
-muscle re-education innvervated mm (teaching pt to re-use muscles)
-stimulation of denervated mm
-wound healing
-peripheral circulation

Front 66

What is Iontophoresis?

Back 66

similiar to phonphoersis similiar to ultrasound but using electrical stimulation to introduce drug into the body.

Front 67

Contraindications to ES:

Back 67

-demand pacemaker or arrhythmias
-over carotid sinus: not anterior on neck
-transcerebrally
-transthoracic:not thru(not 1 on front, 1 on back)
-CA (in area treatment)
-fresh fracture (puts tension on fx)
-hemorrhage
-phlebitis
-thrombosis/thrombophlebitis
-internal electrical devices

Front 68

Precautions to ES:

Back 68

-over pregnant uterus:should not use ES on pregnant uterus but can do so with precautions late in pregnancy such as in 3rd timester or labor.
-metal if superficial
-decreased sensation/mentation
-obesity
-osteoporosis (too much could cause fx)
-cardiac disease
-skin irritation and open wound
-CVA

Front 69

Which ES run on Alternating current?

Back 69

-Tens
-Micro
-IFC
-NMES=FES + Russian

Front 70

Which ES run on Direct Current?

Back 70

-Iontophoresis
-Tissue Healing
-MES

Front 71

What is the gate control theory?

Back 71

Involves A-delta/C-fibers: open the gate
A-beta fibers: close the gate

Front 72

What is the definition of TENS?

Back 72

T-transcutaneous
E-electrical
N-nerve
S-stimulation

Front 73

Describe the Tens:

Back 73

-small, portable device
-battery operated
-**asymmetrical, bi-phasic control
-used for pain control (nothing else)
-has a transducer to change DC to AC.

Front 74

What is the indication of TENS?

Back 74

It is used for pain control (nothing else)

Front 75

Describe the anatomy of A-delta fibers and C fibers:

Back 75

A-Delta fibers are lightly myelenated, small fibers

C-Fibers are small, unmyelenated fibers.

Front 76

A-Beta fibers are ___ & ___ ___

Back 76

large & heavily myelenated

Front 77

What is the neurochemical basis of pain inhibition?

Back 77

Enkephalins (2 min. half life) and endorphins (4 hr half life) when stimulated; act to inhibit pain.

Front 78

What are the settings using the conventional mode on a tens?

Back 78

Conventional-high rate

PW=low
RATE=high
A=sub-motor/tingling
time=PRN up to 24 hrs.

Front 79

Is the conventional mode used for acute or chronic pain?

Back 79

both, but primarily accute

(the low pulse duration/pulse width and high frequency are more comfortable, especially in acute phase)

Front 80

What are the 5 modes to a TENS?

Back 80

1)conventional
2)low frequency/accupuncture like
3)burst (cheetah)
4)brief intense
5)modulation

Front 81

What are the parameters using a low frequency/accupuncture like mode?

Back 81

PW=high
R=low
A=local motor contraction/ twitch
time=approx. 30 minutes

longer-lasting, less frequent pulses=contraction (twitch)

Front 82

Is the low frequency mode used for acute or chronic pain?

Back 82

both, but primarily chronic

(high pulse duration/pulse width and low frequency/pulse rate produce a more prolonged contraction, which is better tolerated in th subacute/chronic state)

Front 83

What are the parameters using the burst mode?

Back 83

PW=high
R=low
A=local motor contraction/twitch
Time=approx. 30 minutes

-similiar to low-frequency, but numerous bursts within each wide pulse=contraction (twitch)

Front 84

Is the burst mode is primarily used for ___ pain

Back 84

chronic

(the high pulse duration/pulse width and low frequency/pulse rate with bursts within each pulse, produce a more prolonged contraction, which is better tolerated in the subacute/chronic state)

Front 85

What are the settings using the brief intensity mode?

Back 85

PW=high
R=high
A=motor response(stronger than a twitch)
Time=15 min.

(longer, more frequent pulses = vermicular muscle movement (wormlike, more than twitching)

Front 86

What is the brief intensity mode used for?

Back 86

intense acute or chronic pain

(the high pulse duration/pulse width and high frequency/pulse rate produce a vermicular muscle movement, tolerated in the acute state; can fatigue muscle and break up spasm)

Front 87

What is the modulation mode?

Back 87

-changes > or <
-changes in A, PR or R individually or in combination
-used to decrease acommodation

either individually or in combination serve to decrease patient accommodation to treatment

Front 88

Electrode placement depends on:

Back 88

-associated nerve roots
-point of pain
-acupuncture point proximal or distal to pain
-crossed pattern technique
-transarthral (thru joint)
-bilateral

Front 89

Contraindications of TENS:

Back 89

-demand pacemaker or arrhythmia
-over carotid sinus
-transcerebral
-transthoracic
-CA
-fresh fx
-hemorrhage
-phlebitis
-thrombosis; thrombophlebitis
-internal electrical device

Front 90

Precautions for TENS:

Back 90

-over pregnant uterus
-metal if superficial
-decreased sensation
-obesity
-osteoporosis (extreme)
-cardiac disease
-skin irritation and open wound
-CVA

Front 91

What does NMES stand for?

Back 91

Neuromuscular electrical stimulation

Front 92

What does NMES do?

Back 92

enlists a contraction to stimulate the nerve

Front 93

Which is more easily excitable: muscle or nerve?

Back 93

nerve

Front 94

Muscle has ___ ____ than nerve

Back 94

higher capacitance

Front 95

What is an action potential?

Back 95

-basic unit of nerve communication (per Cameron)
-also occurs along muscle. (per Michlovitz)
-sequence of deolarization and repolarization in response to a stimulus.

-a short term change in the electrical potential on the surface of a __? cell that leads to the transmission of an electrical impulse that travels across the cell membrane.

Front 96

Stimulus has to reach ____ in order for ___ to start.

Back 96

threshhold and deporatization

Front 97

membrane potential is:

Back 97

-93MV

Front 98

What type of wave does the TENS use?

Back 98

-asymmetrical
-bi-phasic

Front 99

What 3 parameters are common to all E-stem modalities?

Back 99

-amplitude (intensity)
-frequency (pulse rate)
-pulse duration (pulse width)

Front 100

What is the isoelectric line?

Back 100

the baseline above and below which the waveform travels (in a biphasic wave)

Front 101

What is an asymmetrical, biphasic wave?

Back 101

A wave that is not symmetrical above and below the isoelectric line

Front 102

Why is frequency/pulse rate important in TENS setup?

Back 102

because different frequency settings target different nerve groups and the setting will determine if the "Gate Theory" or "Endorphin Theory" of TENS will be in effect

Front 103

Why is pulse duration/pulse width important in TENS setup?

Back 103

in general, the higher the pulse width, the more "aggressive" the stimulation feels (and less comfortable)

eventually, if the pulse width is high enough, it will usually elicit a muscle contraction, which may not be the desired result

if the pulse width is too low, however, the patient may not perceive the stimulation

Front 104

Which TENS mode(s) work on the Gate Control theory?

Back 104

conventional
(and to a degree, brief intense)

high frequency/pulse rate electrical activity is believed to block the pain by stimulating A-beta (large, heavily myelinated) fibers

Front 105

Which TENS mode(s) work on the Endorphin theory?

Back 105

low frequency
burst
(and to a degree, brief intense)

low frequency or short bursts of mild electrical activity is believed to cause the body to release its own pain erasers (beta endorphins)

Front 106

What tends to happen to patients that are mobile during TENS application?

Back 106

they tend to lose the electrodes

Front 107

How far apart should TENS electrodes be placed?

Back 107

- at least one inch
- ideally, the width of the electrode

Front 108

Electric current is:

Back 108

the flow of charged particles

Front 109

What charged particles flow in metal?

Back 109

electrons

Front 110

What charged particles flow in human tissue?

Back 110

ions

Front 111

What is the charge of an ion?

Back 111

either positive (cation=electrons lost)
or negative (anion=electrons gained)

Front 112

Electromotive force is measured in ____.

Back 112

volts

Front 113

What is the best conductor in the body? Followed by....?

Back 113

best conductor in body is nerves

then muscle, then anything with water (e.g., blood)

Front 114

Describe a DC and an AC waveform.

Back 114

DC - unidirectional flow
AC - bidirectional flow

Front 115

How does the TENS unit convert the DC charge from the 9V battery to AC (biphasic)?

Back 115

via a transducer

Front 116

What are the characteristics of a balanced biphasic wave?

Back 116

- it has the same amount of charge both above and below the isoelectric line

- the positive and negative phases do not have to have the same shape/waveform, just the same amplitude
(e.g., may be +5 mA rectangular pulse above the isoelectric line and a -5 mA spiked pulse below the isoelectric line)

Front 117

Can a biphasic wave be balanced without being symmetrical?

Back 117

Yes

the waveforms above and below the line may differ from each other (asymmetrical) but as long as the amplitude is equal they are balanced

Front 118

What is total current?

Back 118

current delivered to tissue/sec

= phase charge * number of phases/sec

Front 119

How are endogenous opiates (Endorphin theory) produced by ES?

Back 119

-low rate (1-5 pps)
-muscle contraction (high pulse duration/pulse width)

Front 120

When considering in ES:
- pulse duration/pulse width
- amplitude
- frequency/rate
what is more comfortable to the patient?

Back 120

generally speaking
- shorter pulse duration/width is more comfortable
- amplitude varies by patient tolerance
- higher frequency/rate is more comfortable

Front 121

What is interference?

Back 121

the superposition of 2 or more waves, resulting in a new wave pattern.

Front 122

What happens when nerve or muscle cell depolarizes?

Back 122

- the cell at rest has a negative charge and there is a high concentration of sodium outside its membrane

- depolarization opens sodium channel, sodium rushes in and changes polarization of (depolarizes) the cell

Front 123

What is the resting potential of the cell memberane?

Back 123

inside cell is -60 to -90mV

(average used -70mV)

Front 124

How does depolarization work when a stimulus is applied?

Back 124

-Na+ channels open rapidly
-K+ channels open slowly
decrease in polarization

-sodium rushes in and causes depolarization (Na+/K+ pump)

Front 125

What brings about repolarization of the cell?

Back 125

- once cell membrane potential reaches +30 mV, it becomes impermeable to Na+
- K+ channels rapidly open
- becomes more permeable to K+, allowing it to leave the cell and remove the positive charge inside
- membrane polarization returns to its resting state of approximately -70 mV

Front 126

Contrast natural physiologcial contraction (NPC) of muscle with an ES contraction (ESC) of muscle

Back 126

NPC
- AP occurs only in one direction
- small-diameter, slow-twitch fibers activated first; then large-diameter, fast twitch fibers recruited
- small-diameter, slow-twitch fibers are more fatigue resistant
- less fatiguing to patient
- contractions are smoother

ESC
- AP may propagate in both directions
- large-diameter, fast-twitch fibers activated first; then small-diameter, slow-twitch fibers are recruited later
- large-diameter fibers fatigue more quickly
- more fatiguing to patient
- contractions are jerkier

Front 127

With muscle depolarization, if nerve intact, it ___, and thus ___ the muscle.

Back 127

depolarizes and stimulates

Front 128

Can you get a muscle contraction if nerve is damaged?

Back 128

yes, but it takes much more stimulation.

Front 129

In muscle depolarization, if nerve is not intact, ___ ___ ___ may depolarize in response to ES if long ___ pulse with adequate amplitude is applied

Back 129

-muscle cell membrane
-duration

Front 130

What does NPC stand for?

Back 130

Natural, physiological contraction

Front 131

What does ESC stand for?

Back 131

ES contraction

Front 132

NPC is ___ to that caused ESC, but there are some differences.

Back 132

similar

Front 133

NP contractions are____

Back 133

smoother

Front 134

ES can be used to facilitate AP in:

Back 134

-sensory nerves
-motor nerves
-dennervated muscles

***but require different amp. and duration

Front 135

What is rheobase?

Back 135

Instensity of amplitude, with long duration stimulus, required to produce AP

-esentually: amplitude

Front 136

What is chronaxie?

Back 136

duration required to stimulate tissue at 2X rheobase.


-essentually: duration

Front 137

To find strength duration curve, turn ___ ___ up as high as possible, then increase ___ to feel buzz

Back 137

pulse duration
amplitude

Front 138

Indications for NMES

Back 138

-edema reduction
-decreased strength and endurance
-decreased ROM
-post injury or surgery
-muscle spasms
-orthotic substitution & FES
-rehab post nerve injury (dennervated muscle)
-

Front 139

What does NMES stand for & what is it used for?

Back 139

-neuromuscluar electrical stimulation
-it is used to make muscle contraction by stimulating nerve.

Front 140

What are you trying to achieve with NMES when used as an indication for decreased strength and endurance?

Back 140

-to get an artificial contraction
-it is used in conjuction with active exercise

Front 141

What does NMES do for decreased ROM?

Back 141

stimulates muscle group that can increase ROM.

ie.-with elbow flex. contracture, stimulate triceps or alternately stimulate agonist, then antagonist.

Front 142

NMES is used for muscle spasms. Why?

Back 142

-in hopes the involuntary contraction will fatique the muscle so it will relax and rest to break pain/spasm cycle.

Front 143

How does NMES help edema reduction?

Back 143

the contraction can help pump fluid from area.
-if DC used, place neg. electrode at area to repel negatively charged proteins.

Front 144

How does NMES help orthotic substituion & FES?

Back 144

-through ambulation assistance-special attachment with heel switch (foot drop)
- with shoulder rehab post-shoulder subluxation (shoulder pops out) done later on in rehab.

Front 145

NMES is also used in rehab post nerve injury (dennervated muscle), however there is a controversy about effectiveness of this treatment. Some say it is ___ to regenerating nerve.

Back 145

detrimental

(it is more specifically referred to as EMS)

Front 146

What 5 things need to be considered for using NMES for rehab?

Back 146

1)application
2)electrode set up and parameters to consider
3)consider the DX and goal(s)
4)consider patient: age, tolerance, mm size
5)equipment available

Front 147

What are the three types of electrode set up for NMES?

Back 147

1)monopolar: 1 active 1 dispersive w/ 2 different sizes
2)bipolar: 2 electrodes same size
3)quadrapolar: 4 electrodes same size

Front 148

What are the parameters for NMES? ***know***

Back 148

*Frequency
- twitch approx. 5pps.
-vermicular (worm like)
-Tetanic >35pps (sustained contraction)

*Russian: middle frequency, AC

*PD:
-need a high (wide long) duration
-generally high -200-400 microsec
-need to consider comfort

**must use a Duty cycle with on phase about 6-10 seconds.
-use 1:5 in early rehab
-progress 1:3
-1:1 for spasm or edema reduction (2-5 secs)

*Ramp up/down (usually a ramp up time)

*amplitude: enough to get a contraction, but not painful

Front 149

With contraction of denervated muscle, the muscle does not respond to ___. May respond to ___ with long-duration pulse. Usually ___ switch.

Back 149

-AC
-DC
-manual

Front 150

What is the reaction of degeneration?

Back 150

when nerve injured, it goes through a series of changes over approx. 14 days.

Front 151

Anterograde or Wallerian degeneration is: **know**

Back 151

distal to site of injury.

Front 152

Retrograde degeneration is ____ **know**

Back 152

proximinal

Front 153

If nerve regenerates, it heals approximately ___mm/day, or ___ inch/month.

Back 153

1 mm/day or 1 inch/month

Front 154

Can a injured periphial nerve recover?

Back 154

yes, it is possible.

Front 155

What is a safety pearl?

Back 155

turn intensity down before changing other parameters.

Front 156

What type of current does Iontophoresis use?

Back 156

Direct Current

Front 157

What is an adverse effect of iontophoresis?

Back 157

it is not comfortable and stings

Front 158

What is iontophoresis used for?

Back 158

it is the electrostimulation to introduce medication into the body.

Front 159

Define iontophoresis:

Back 159

the introduction of ionic substance into the body for therapeutic porposes by use of DC.

Front 160

What kinds of medications are used in iontophoresis?
**know**

Back 160

-aqueous solutions, ointments & creams
-decadron (dexamethasone): "-" steroid {anti-inflammatory}
-lidocaine: "+" pain

penetration level= 3mm-20mm

Front 161

What is the charge of decadron (dexamethasone) used in iontophoresis?

Back 161

negative

Front 162

What is the charge of lidocaine used in iontophoresis?

Back 162

positive

Front 163

If you have a "-" charged medication, what type of electrode charge must be used?

Back 163

"-"

it must also use a negative charged electrode.

Front 164

On the ES machine what charge does the red wire represent? and for the black wire?

Back 164

red=positive charge
black=negative charge.

Front 165

What does mA. min. stand for?

Back 165

miliamp minutes

Front 166

If amplitude is set at 4 mA, how long will it take to complete the RX?

If amplitude is set at 2 mA?

Back 166

4 mA = 10 min.

2 mA = 20 min.

**depends on pt tolerance

Front 167

If skin irritation occurs, what must you do?

Back 167

-increase size of negative electrode, regardless of which is active (b/c of alkaline reaction)

Front 168

What is iontophoresis used for:

Back 168

most common uses:
- reduction of inflammation (most often)
- pain relief

- alternative to injection
- less chance of systemic side effect

Front 169

What type of current does iontophoresis use?

Back 169

direct current-most common dosage is written as mA.min

Front 170

What is the recommended dosage with a phoresor unit?

Back 170

40 mA.min.
*patches may be higher-80mAmin.

Front 171

Explain the electrode configuration in iontophoresis:

Back 171

-Active electrode over the pathology and the indifferent electrode is proximal or distal, nearby.
-medication goes under the active electrode.
meds. with negative chg under cathode & meds with positive chg under anode.
**if skin irritation occurs, increase size of negative electrode, regardless of which is active (b/c of alkaline reaction)

Front 172

Contraindications/precautions of iontophoresis:

Back 172

-Same as other ES
-Allergy to medication
-with other modalities: not advised. ***especially don't use with heat or cold.

Front 173

What type of frequency does Russian use?

Back 173

medium frequency using AC

Front 174

What is MES used for?

Back 174

It uses DC (high volt current) and is used to stimulate the muscle.

Front 175

What type of current is used for IFC?

Back 175

A/C at medium frequency.

Front 176

Russian ES is often used on ___ ____.

Back 176

elite athletes

Front 177

In order to get a contraction, what is the pps needed?

Back 177

between 35-50 pps.

Front 178

What is the duty cycle used when you start Russian ES

Back 178

-start with 1:5 mode.

Front 179

What is Anode polarity?

Back 179

-positive pole
-repels positive ions
-sclerotic (toughening, desensitizing)
-analgesic effects

Front 180

What is Cathode polarity?

Back 180

-negative pole
-repels negative ions
-sclerolytic (softening)
-stimulating effect

Front 181

AC is ____, ____.

Back 181

continuous, pulsed

Front 182

DC is ___, pulsed

Back 182

continuous
**if pulse is = or > 1 sec, is considered continuous

Front 183

What is the benefit of DC with wound treatment?

Back 183

(in vivo, in vitro research suggests)
-alters cell membrane function
-increases protein synthesis
-anti-bacterial effects
-promotes blood flow
-improved tissue oxygenation
-through galvanotaxis

Front 184

What is Galvanotaxis?

Back 184

charged cells attracted to electric field
(opposite charges attract)

Front 185

There is ___ ____ difference across normal, healthy skin.

Back 185

electrical potential

Front 186

The ____ is negative relative to the ___ which is ___.

Back 186

-epidermis
-dermis, positive

Front 187

What is a soft tissue injury?

Back 187

wound and adjacent epidermis become positive relative to the uninjured tissue.
-if barrier is broken, a flow of positive polarityoccurs within the wound.
-Is thought to trigger wound healing
-exogenous ES may mimic body's own bioelectric currents, facilitating or reinitiating wound healing process.

Front 188

With DC & wound treatment, (Kloth) recommends using negative polarity in wound or proximal in the ___ stage of healing

Back 188

acute (3-7 days)

Front 189

With DC & wound treatment (Kloth) when do you change to positive polarity to facilitate epithelial cell migration?

Back 189

in the proliferative phase.
*However, continue with catode if infection and/or inflammation present. Positive (anthode) if necrosis without inflammation.
*another protocol suggest simply alternating polarities every few days.

Front 190

Early on the ___electrode either goes in the wound or proximal and the ___ electrode will go distal to the wound. A few days later, switch.

Back 190

-negative (cathode)
-positive (anode)

Front 191

What are two reasons to use DC?

Back 191

-edema
-open wounds

Front 192

What type of reaction is achieved with cathode?

Back 192

alkaline reaction

Front 193

What type of reaction is achievd with anode?

Back 193

acidic reaction

Front 194

What is the wound treatment time?

Back 194

30-60 minutes

Front 195

Chemical responses with cathode include:

Back 195

-sodium combines with H2O to form sodium hydroxide (more bubbles)
-often more stinging
-alkaline reaction
-can cause softening (scherolysis) of tissues
-stimulating effect on nerves, muscles(use - electrode on muscle)
-bacteriostatic or bacteriocidal effects

Front 196

Which chemical response can break down scar tissue?

Back 196

cathode

Front 197

Chemical responses with anode include:

Back 197

-chloride combines with water to for hydrochloric acid
-acidic reaction
-can cause hardening (sclerosis) of tissues; esp skin
-analgesic effect
-attracts macrophages.

Front 198

With DC, does cathode or anode stings more?

Back 198

cathode

Front 199

When NMES is used to treat muscle weakness, what is the duty cycle and the tx time?

Back 199

1:5 or 1:3
tx time = 10 min.

Front 200

When treating edema, what two ES options can be used to treat it?

Back 200

either DC or NMES

Front 201

When treating edema with DC, the ____ electrode is placed at that site and the ___ electrode is placed away, preferably proximal.

Back 201

Cathode is placed at the site and Anode is placed away.

Front 202

When using NMES for spasms, what is the duty cycle and tx time?

Back 202

Duty cycle: channel 1 with a 1:1 cycle. tx time = 10 minutes.

the goal is to make a strong contraction to fatique the muscle.

Front 203

With an open wound, what charge gets out?
This causes the wound area to become?

Back 203

positive charge

positive

Front 204

What is interference?

Back 204

physics-the superposition of 2 or more waves, resulting in a new wave pattern

Front 205

Define IFC:

Back 205

-the use of two sinusoidal current sources of medium frequency (two separate generators) 1000-10,000 Hz

-these two currents are intersected at 90 degrees

-this results in the creation of an interference wave.

Front 206

What is constructive interference?

Back 206

-two waves in the same place, same time (superimpose)
-when aligned exactly, the effects add together.

Front 207

What is deconstructive interference?

Back 207

-when waves are out of synce, effects are reduced.

Front 208

What is full-field, or amplitude summation IFC?

Back 208

(constructive or summative)
-when frequences of both currents are equal.
-results in vectore of 2X original amplitude
-vector can vary with manufacturers
-provide stimulation at surface and within tissue

Front 209

What area of the body do you use full-field IFC?

Back 209

lower back

Front 210

Describe frequency difference IFC:

Back 210

-when the frequency of two currents differ.
-results in a clover leaf vector or beat frequency
-produces polyphasic pulses
-Interference is destructive
-primarily stimulation with the tissue

Front 211

With destructive IFC, where does stimulation occur?

with constructive IFC, stimulation occurs?

Back 211

within the tissue

within the tissue and at the surface

Front 212

What is carrier frequency?

Back 212

the base frequency of unit before it is modified. It is the slower of the two currents when they are different

Front 213

What are the advantages of IFC?

Back 213

-medium frequency decreases skin impedance more effectively
-greater intensity can be used to drive current into underlying tissue, since less used to overcome skin impedance
-it is more comfortable

Front 214

Indications for IFC?

Back 214

-pain
-edema
-inflammation
-muscle spasm

Front 215

Contraindications/precautions for IFC:

Back 215

-same as other ES
-true IFC requires 4 electrodes; pt must be able to tolerate them.

Front 216

How does pulse duration/pulse width of TENS relate to comfort?

Back 216

imagine it like a needle

narrower needle goes into the arm more comfortably than a wider needle.

Front 217

What happens when nerve or muscle cell depolarizes?

Back 217

- the cell at rest has a negative charge and there is a high concentration of sodium outside its membrane

- depolarization opens sodium channel, sodium rushes in and changes polarization of (depolarizes) the cell

Front 218

What is the resting potential of the cell membrane?

Back 218

inside cell is -60 to -90 mV

(average used -70 mV)

Front 219

How does depolarization work?

Back 219

- Na+ channels open rapidly
- K+ channels open slowly

- sodium rushes in and causes depolarization (Na+/K+ pump)

Front 220

How does the depolarization affect polarity of the cell?

Back 220

- reverse polarization

- influx of Na+ reverses membrane polarity

- inside becomes more positive (goes from -70 to +30 mV)

Front 221

What brings about repolarization of the cell?

Back 221

- once cell membrane potential reaches +30 mV, it becomes impermeable to Na+
- K+ channels rapidly open
- becomes more permeable to K+, allowing it to leave the cell and remove the positive charge inside
- membrane polarization returns to its resting state of approximately -70 mV

Front 222

What does hyperpolarization initiate?

Back 222

e refractory period (where the cell will temporarily not respond to additional stimulation)

Front 223

Will a muscle cell membrane allow depolarization in response to ES if the nerve is not intact?

Back 223

it may, if a pulse of long duration and adequate amplitude is applied

Front 224

ES can be used to facilitate action potential in:

Back 224

- sensory nerves
- motor nerves
- denervated muscles

but require different amplitudes and durations

Front 225

What is the relationship between strength and duration of ES application?

Back 225

- they are inversely proportional

- the stronger the current, the shorter duration needed

Front 226

How is NMES used in post injury or surgery?

Back 226

assist in initiating movement in a muscle or muscle group

Front 227

How is NMES used for orthotic substitution and FES?

Back 227

- ambulation assistance--(e.g., attachment with heel switch to counter foot drop)
- shoulder rehab post shoulder subluxation

Front 228

Rehab post nerve injury (dennervated muscle) is more specifically referred to as:

Back 228

EMS

Front 229

What is a motor point?

Back 229

- where the nerve enters the muscle
- where electrical stimulus produces greatest contraction with least amount of stimulus
(see pp. 25-35)

Front 230

What should be considered in electrode placement with NMES?

Back 230

- try to put one electrode on a motor point
- place electrodes parallel to direction of muscle fibers

Front 231

Frequency for NMES
- twitch
- vermicular
- tetanic contraction

Back 231

- 5 pps
- between 5 and 35 pps
- over 35 pps

Front 232

Pulse duration/width for NMES

Back 232

- generally high (200-400 microsec)

- need to consider comfort

Front 233

Duty cycle for NMES

Back 233

on:off with "on" phase of about 6-10 sec
- early rehab 1:5
- progress to 1:3
- for spasm or edema 1:1 (2-5 sec)

- ramp up/down

Front 234

Amplitude for NMES

Back 234

enough to get contraction, but not cause pain

Front 235

What happens to an injured nerve during the first 14 days or so?

Back 235

reaction of degeneration
- anterograde/Wallerian degeneration - distal to injury site
- retrograde degeneration - proximal to injury site

Front 236

What should the therapist remember to do before changing ES treatment parameters?

Back 236

Turn the intensity down

Front 237

How can ES (specifically DC) help with wound healing?

Back 237

- if barrier is broken, a flow of positive polarity occurs within the wound

- placing a negative charge (cathode) in the wound also attracts positive ions and is thought to trigger wound healing.

- exogenous ES may mimic body’s own bioelectric currents, facilitating or reinitiating (in a chronic wound) the wound healing process

Front 238

What are some other uses for iontophoresis?

Back 238

- calcium deposits- acetic acid (-)
- scar tissue- sodium chloride (-)
- athlete’s foot- copper sulphate (+)
- plantar warts- salicylate (-)


(Need to know other indications; but do not need to know the polarity needed in treatment for these.)

Front 239

Most uses of electrical stimulation are based on its ability to depolarize nerves to produce:

Back 239

action potential

Front 240

What parameters must be considered for application of electrical stimulation?

Back 240

- electrode placement
- waveform
- polarity
- current amplitude
- pulse duration
- pulse frequency
- on:off times
- ramp time
- treatment time

Front 241

What is Russian protocol?

Back 241

Russian protocol is a waveform with specific parameters intended for quadriceps muscle strengthening

this protocol was developed by Kots who was involved in the training of Russian Olympic athletes

it uses a medium frequency AC with a frequency of 2500 Hz delivered in 50 bursts/second

each burst is 10 ms long and is separated from the next burst by a 10 ms interburst interval

this type of current is also known as medium-frequency burst AC (MFburstAC), and when this term is used, the frequency of the medium-frequency current or the bursts may be different from the original protocol

Front 242

What is the absolute refractory period?

Back 242

the period of time immediately after nerve depolarization when no action potential can be generated and nerve cannot be further excited, regardless of strength of stimulus

Front 243

What is adaptation?

Back 243

a decrease in the frequency of action potentials and a decrease in the subjective sensation of stimulation that occurs in response to electrical stimulation with unchanging characteristics

Front 244

How is resting membrane potential maintained?

Back 244

by most of the sodium ions (Na+) being outside the cell and most of the potassium (K+) ions being inside the cell

Front 245

With sufficient amplitude (rheobase) and duration (chronaxie) will cause enough of a change in

Back 245

nerve membrane potential to generate an action potential

Front 246

Strength-duration curve (easiest to most resistant)

Back 246

minimum combination of amplitude (rheobase) and pulse duration (chronaxie) needed to depolarize a nerve

- Aβ sensory
- motor
- Aδ sharp pain
- C dull pain
- denervated muscle

Front 247

Average pulse duration for sensory stimulation? Muscle contraction?

Back 247

short (less than 80 μsec)

longer (150 to 350 μsec, unless for smaller muscles or treating a child/frail elderly, then 125 to 250 μsec likely to be more comfortable and better tolerated)

Front 248

By keeping pulse durations under 1 ms at all times, pain is minimized because

Back 248

C fibers are not depolarized

(1.0 ms seems to be pulse duration threshold for depolarization of C fibers)