Tri 5 Pt Exam 2 Information

Front 1

Tens unit

Back 1

1.Electrical current is passed across the skin (low frequency <1000pps)
2. small portable unit worn in an effort to control pain
3. Based on the gate theory
4. Main application is to stimulate small A fibers so that thee is no muscle contraction

Front 2

Tens history

Back 2

1. First version was the Dorsal column electrical stimulator
2. Dorsal horn stimulator
3. The tens was used to screen px for surgical implantation
4. found the tens was sufficient
4.

Front 3

Other theories regarding Tens

Back 3

1. Tens stimulates the release of natural opiates (ENK and END)
2. Others say it is release from the sym nervous system
3. Others say Tens triggers local vasodilation, targets trigger points relates to ischemia

Front 4

Tens

Back 4

1. Set t0 70-150 pps for pain control
2. wave forms are interrupted or pulsed
3. Electrode placement is over the same dermaome as the px pain perception
4. when treating post surgical pain, the electrodes are placed as close to the incision as possible

Front 5

Pad placement for TENs
(likely TQ)

Back 5

1. painful site
2. Proximal to the injury site
3. Dermatone-L4 disc lesion
4. Nerve site
5. Motor point-myoneural junction
6. Trigger point-pr pain
7. Acupuncture point- burst cycle
8. Contralateral-phantom pain

Front 6

TENS unit settings

Back 6

MR- modulated rate, sweeps 40% say 60-100hz
MW- modulated width, phase duration changes
CM- combined modulation, sweeps rate and width
Burst- constantly changing intensity
SD- strength duration, modulates intensity, peak intensity, and peak width at the same time

Front 7

OTHER SOURCES

Back 7

High rate conventional TENS
most commonly used
High pulse frequency 75-100pps, pulse duration <220 msec
set to comfortable parasthesia, no muscle contraction
30-60 minutes

Front 8

Other sources continued

Back 8

Low-rate acupuncture like TENS
Directed toward small C fibers
Low frequency 1-4pps
Long pulse duration 200-3-msecs
Low to produce visible muscle twitches
set to comfort level
45 minutes

Front 9

TENS factoids

Back 9

1.Pain modulation only last while the unit is turned on, limited effect, accommodation
2. basic premise is to control pain until the cause of pain is localized or determined
3. Can be used to control systemic pain, head and neck, abdominal, back and extremity pain
4. Effectiveness is limited, there is a tendency for overuse

Front 10

TENS contraindications

Back 10

1. may not be used with px that have a pace maker
2. Avoid carotid sinus, heart, arrhythmias and myocardial disease
3. Pregnancy, over the uterus
4. Open wounds
5. Pharyngeal and laryngeal muscles

Front 11

Most common pain syndromes helped with TENS

Back 11

Bursitis
Cancer
Causalgia
MS
Neuralgia
OA
Phantom limb
Raynauds
RA
Synovitous
Cluster headaches
Migraine
dental disorders
spondylosis
spain/strain
Suboccipital headaches
TMJ
Tic doularoux
Torticollis
Trigeminal neuralgia
wiplash
Bladder pain
Bowell stasis
Diverticulosis
Dysmenorrhea
Labor
Post orperative pain
Coccydynia
Facet syndrome
Intercostal neuroalgia
IVD syndrome
Lumbago
Lumbosacral pain
Radiculitis
Thoricodynia
Whole back pain
Ankle pain
Foot pain
Fractures
Ischialgia
joint mobilization
Knee pain
passive stretch pain
sciatica
tendinitis
Throbophlebotist
Epicondylitis
Frozen shoulder
hand pain
Subdeltoid bursitis
wrist pain

Front 12

AC current

Back 12

1. A cuurent that periodically flows on opposite directions at regular intervals
2. 2 types-sinusoidal and faradic
3. Called muscle stim for decades
4. Current directly from the wall
5. slight increase in px comfort overall
6. Difficult to hurt the px

Front 13

Sinusoidal

Back 13

1. Rapidly alternating polarity, therefore no polar effects
2. low voltage, low milliamperage, low frequency, alternating biphasic symmetrical current
3. Used in four forms; continuous, pulsating, surged and tetanizing

Front 14

Settings (AC)

Back 14

Rapid sine - 40-80 Hz, 1/100sec impulses
Slow sine - 5-30 Hz, 1/50sec
surged sine - gradually increases to maximum value and then slowly decreases, used in strength and tone
Tetanizing sine - breaks muscle spasm and relieves pain

Front 15

Action (AC)

Back 15

1. When sinusoidal current is applied to normally innervation muscles, the muscles will contract and relax with each cycle
2. Duty cycles 5/5, 10/10, continuous, 4/12
3. General guidlines

Front 16

Faradic

Back 16

1. Second type of AC current, not commonly used anymore
2. Biphasic, asymmetrical pulse
3. low frequency alternating current that pulses in 2 directions
4. one pulse of high intensity, short duration, and the other is low intensity, long duration
5. Sharp uncomfortable current

Front 17

Action (AC)

Back 17

1. Constant contraction is produced that results in smooth muscle tetany
2. 2 primary actions - stimulate muscle w/ proper innervation, but poor tone and to test muscle for reaction degeneration
3. faradic current will produce contraction in 1/1000 of a second, paralyzed tissue will not respond

Front 18

General indications for low freq therapy

Back 18

1. Adhesions
2. circulatory stasis
3. edema
4. muscle spasm
5. muscle atrophy
6. pain
7. passive exercise
8. restricted joint motion
9. trigger points

Front 19

General contraindications for low freq theray

Back 19

1. areas of diminished sensation
2. metalic implants
3. metastatic carcinoma
4. over lower back or abdomen while prego
5. over or through the heart
6. over open wounds
7. pacemaker
8. transcerebral

Front 20

Table 7.4 page 286 (AC)
5 settings of low freq therapy

Back 20

1. Continuous - moves edema/congestion, chemical changes
2. Tetanizing - relieve pain (70-130Hz) breaks muscle spasm
3. Surge- exercise and increase tone
4. Reciprocal - agonist vs. antagonist, joint movement
5. Automatic - 1 minute each of tetanize, surge, and pulsed cycle then repeat

Front 21

Denervated muscles

Back 21

1. All normal reactions slowed in denervated muscles
2. interrupted galvanic current can cause contraction
3. Guidelines - longer denervation, lower the frequency
4. Primary goal is to force as strong a contraction as possible to aviod atrophy
5. Galvanic current is 55-10 pps
6. Square wave form
7. Duration of stimulus should last 50-100ms
8. Frequency - 10 minutes, 2x daily, and can be up to 3-4x daily
9. be careful over stimulation can occur.

Front 22

Signs of overstimulation

Back 22

1. slowed rate of contraction and relaxation
2. well marked tremor during contraction
3. stiffness and pain following treatment

Front 23

High volt basic concepts

Back 23

1. High volt galvanism, high volt therapy, monophasic pulsed stimulation
2. Docs, vets, dentist, burn centers
3. Not strict galvanism
4. Unidirectional, monophasic, interrupted
5. twin peaks produced that are high peaks, but on for a short period of time

Front 24

High volt basics continued

Back 24

1. Deep penetration, short duration
2. Safer than galvanism, wont produce burns as easily, remember it is amperage that burns not voltage
3. Can reach a peak current of 2500ma, but average current is only 1.5-2ma due to short duration
4. Depth of penetration is proportional to magnitude (pulse amplitude) of current generated, conductivity of tissue remains the same, increased amplitude deeper penetration

Front 25

Factors that effect penetration (hi volt)

Back 25

1. Peak current - 2500ma, but averages 1.5-2.0ma, allows deep penetration without danger of burns
2. Bone, cartilage - nonconductive due to low fluid levels, current travels around bone thus poor penetration
3. Fat - thick adipose poor conductor, poor results with obese, hot packs sweat increase conductivity
4. Muscle - good conductor, deep penetration
5. neuroselectivity - non pain fibers, then stimulate motor fibers, nocicpetorsare stimulated at extremely high levels, big advantage in pain control
6. Visceral reactions - smooth muscle changes, directly or via autonomic nerve fibers.

Front 26

Pulse rate (hi volt)

Back 26

1. Continuous - edema reduction, pain control (particularly during acute phase of soft tissue injury) basically non polar due to short duration
2. Switch rate mode - spasm control figure 8.6 in book, provides alternating tetany, breaks spasm and limits accommodation, good for healing stages of soft tissue injury or chronic musculoskeletal problems
3. Interupted - surge on and off - muscle reeducation

Front 27

Pulse rate (hi volt)

Back 27

1. continuous, pulsed, tetanizing w/ galvanism
2. high volt can be set to 1-120 pps
3. remember high volt is always pulsed
4. Continuous, switch rate
5. 1-10pps - chronic pain modulation - endorphin production, small electrode
6. 15pps and greater - tetany, 20-80pps for tetany without fatique
7. 70-110 - pain control - ENK
8. Sweep - 70-120pps

Front 28

High volt vs Low volt

Back 28

1. Low volt has a longer pulse duration, because of this chemical changes are produced and polarity is useful
2. this process does not take place with high volt because of the short duration of the pulse - interpulse duration
3. high volt is more comfortable

Front 29

High volt

Back 29

1. Because pulse is of short duration, unlike galvanic current it will not stimulate denervated muscle

Front 30

Effect of high volt

Back 30

1. pain reduction - ENK
2. Spasm reduction
3. muscle reeducation and exercise
4. Circulation enhancement
5. Edema reduction - pump
6. Burns - continuous

Front 31

Contraindications to high volt

Back 31

1. Its a safe modality and is difficult to produce burns, unlike galvanism
2. Pregnancy
3. Neoplastic areas
4. Pacemakers

Front 32

High volt treatment times

Back 32

15-45 minutes with pads
3-5 minutes with probes

Front 33

Polarity and high volt

Back 33

1. may be changed during treatment
2. Decrease intensity first
3. Intensity is based on treatment phase, if early go to px perception, after 5 min you can increase
4. subacute and chronic px tolerance

Front 34

microcurrent generalities

Back 34

- Low volt, pulsed microampere stimulation
- most recent modalities
- Still under investigation
- the lowest frequency of currents <1000hz
- Old name MENS
- Approximates the current of the body
- Assists the body's intrinsic bioelectric healing

Front 35

Arndt's law states:

Back 35

- Weak stimuli excites physiologic activity
- Moderately strong stimuli favors activity
- Strong stimuli retards activity
- very strong arrests activity
- based on the effects of homeopathy

Front 36

Theoretically (micro)

Back 36

- The normal frequency and currents of the body maintain cellular activity and resistance, normal chemistry is required is required for normal currents
- Altered chemistry (damage, inflammation, toxicity) changes electrical resistance of the local injury or toxic site.
- varying frequencies of the body, collectively "harmonic resonance"

Front 37

Theoretically cont. (Micro)

Back 37

- The resistance hinders the flow of life maintaining electricity to the challenged cells. This further impedes normal repair function.
- microcurrent concentrates the nearest body current known to re-establish the electrical environment to allow the challenged cells more normal function.

Front 38

Micro is still being researched in:

Back 38

-Wound care
-Fracture
-Skin ulcers
-Tendon repair
- FDA approved for pain, anxiety, depression and insomnia

Front 39

Three critical variables in regards to micro: (3 factors for the healing process)

Back 39

ATP generation
Protein synthesis
membrane transport

Front 40

Common applications for micro:

Back 40

post-traumatic pain
atrophy
wound care
fractures
adhesions
tissue repair

Front 41

Current form of micro

Back 41

-Microcurrent therapy has a fixed amperage whose voltage changes according to skin impedance
-Pulse durations are long, pulse rate is .3 to .5hz
- Long soft whisper (subsensory)

Front 42

Bioelectric currents

Back 42

-studies show that the periphery of the body is charged negatively
-Along the spinal canal shows a positive charge
- This sets an electromotive force for the energy that is found around wound sites
- Intrinsic bioelectric currents range from 4 to 3000 microampere/cm2

Front 43

Acceleration of the healing process

Back 43

- William stanish- implanted electrodes that emitted 10-20 microamps accelerated the healing of ruptured tendons and ligaments
- 18 months recovery time was shortened to 6 months, Canadian olympic team
- ATP production in rats was shown to increase 500% at 500 uM
- At 1000-5000 microamps ATP production was decreased, at 5000 it dropped below baseline

Front 44

Contraindications for microcurrent

Back 44

-cancer
-Electronic demand pacemaker
-orbits of the eyes
-Heart problems
-Epilepsy
-caution over throat, carotid sinus, trancerebrally, areas with a tendency to bleed
-pregnancy, general cotras as TENS, infections

Front 45

Patients reactions to microcurrent

Back 45

-Lightheadedness
-may cause skin irritation
-Pain relief usually occurs quickly, especially with 2 channel use

Front 46

Pain control with micro

Back 46

-analgesia has three parameters:
-Adequate frequency
-Wave slope at the high end of the spectrum
-Sharp ramp time
-Lower tends to last longer, carry over effects (24-48hrs)
-For acute pain, start with high parameters with manual therapy, and finish with low settings and pad treatment
-Analgesia usually occurs in 3-5minutes
-Low settings that are sub threshold are gaining popularity
-protocols may vary according to the patient

Front 47

Polarity in microcurrent

Back 47

-micro is a polar treatment
-Correct polarity is still controversial
-Tsunami-square wave pulse trains, switches polarity every 2-4 seconds - used when proper polarity is in question
-same as galvanism when considering acute vs. chronic effects from polarity, + greater anti-inflammitory vs - better vasodilative effects for spasticity or scar tissue

Front 48

Treatment with micro

Back 48

-half of treatment time is spent with a probe other half is treatment with pads
-Frequency - pt should be treated daily
-Treatment time is 15-20 minutes, fractures or tissue tearing can warrant treatment every 4-8 hours
-we want the carry over effect
-3 treatment techniques
-Electromassage - chemical change - metallic massage cylinder or by hands of practitioners usually accompanied with soft tissue work
-Intensity or 40-500 microamps, continuous setting, 30-80hz for acute, 3-10hz for chronic
-combined with interferential
-kinetic movements or stretching - adhesive capsulitis

Front 49

point stimulation (micro)

Back 49

-probes
-points of high conductance - pain sites
-meridian therapy or acupuncture points
-Golgi tendon tech.
-Encircling the dragon - 10hz, 75 mamps
-Dermatome
-TMJ - 25-75 microamps
-Frequency of .3hz
-Four second timing
-Continuous or 2:1hz mode

Front 50

Pad treatment (micro)

Back 50

-Place pads proximal and distal to the site of involvement
-When using a double channel device, set pads like interferential
-Waveform- square or slope
-Frequency- .3-.5hz
-intensity - just below pt. perception
-polarity - biphasic or to push edema from site

Front 51

Clinical info for micro

Back 51

-better pain relief than I/F or acupuncture
-Faster collagen deposition
-Better sleep
-Better "thinking"
-Less allergic response

Front 52

Current review

Back 52

-Current is defined as the electricity that flows through a patient
-Measured in amperes
-High frequency currents - diathermies
-Low frequency currents - <1000pps, galvanic or alternating <1000pps

Front 53

high frequency includes;

Back 53

-Short wave- diathermy used in labs
-Microwave - higher frequency than short wave, magnetic field produced
-Ultrasonic - piezoelectric effect
-All considered diathermies, which means production of deep heat

Front 54

Low frequency includes;

Back 54

-Stimulate under <1000pps
-Primary benefit is to exercise, break muscle tissue, maintain tone, alleviate pain
-Three types- galvanic or monophasic and alternating or biphasic current, and pulsed current

Front 55

Direct current information

Back 55

-Direct current flows continuously in one direction
-Alternating currents flows continuously in two directions, milliseconds
-Pulsatile currents can flow in one (monophasic) or two directions (biphasic), not continuously they have regular intervals of no electrical activity between pulses, microseconds, space is interpulse interval
-many stimulators use pulsed current due to its improved neuroexcitation, less discomfort
-narrow pulse duration allows for better discrimination among sensory, motor, and pain fibers

Front 56

Galvanic current

Back 56

-continuous waveless flow of unidirectional electricity of low voltage
-first form of current flow
-Terms direct current and galvanism are synonymous
-Primary effects on the body are electrochemical and electrokinetic

Front 57

Polarity and direct current

Back 57

-Body is similar to dilute salt water
-When dissolved in Na+, Cl-
-Electricity is applied, na+ moves toward the negitive pole (cathode), Cl- moves towards the positive pole (anode)
-Ion transfer is iontophoresis

Front 58

Cataphoresis and electro-osmosis

Back 58

-Undissolved substances such as fat globules, blood cells, bacteria, albumin, starch move toward cathode
-Shifting of the water content of a tissue through membrane structures

Front 59

Positive polarity in direct current

Back 59

-Causes vasoconstriction, retards bleeding
-Produces ischemia
-Hardens connective tissue
-Acts like ice
-Provides analgesia
-Attracts acids
-Attracts oxygen, will cause corrosion
-attracts Cl-

Front 60

Negitive polarity in direct current

Back 60

-Attracts bases
-Softens tissue
-Vasodilates
-Acts like heat
-Attracts Na+
-Increases pain, nerve sensitivity
-Germicidal effect

Front 61

therapeutic uses for direct current

Back 61

-Pain control
-Soften scar tissue
-Decrease bleeds
-Promotes healing

Front 62

Three methods for application of direct current

Back 62

-continuous - moves edema
-Pulsed - aka surged - contracts muscle
-tetanizing - decreases spasm

Front 63

Patient application (direct current)

Back 63

-Avoid burns
-Two electrodes
-Two moistened sponges - 3-4" in size
-maximum intensity 1ma for every square inch of active electrode, 3x3=9ma
-Do not increase intensity

Front 64

Active vs Dispersive

Back 64

-Dispersive pad is four times as large as active pad
-Increases effectiveness of therapy

Front 65

Patient responses

Back 65

-Gentle tingling
-Warmth
-Galvanic hyperemia

Front 66

application of direct current

Back 66

-Increase intensity slowly
-patient should not lay on the electrode
-Do not alter polarity during treatment
-Connecting wires are well insulated
-Do not treat near metal objects, tables
-remove all jewelry
-Discontinue with patient discomfort

Front 67

Direct current treatment duration

Back 67

-10-20 minutes
-Contraindications - decreased sensitvity, pacemaker, metallic implants, IUDs, over scars, pregnancy, CA, transcerebral, near the heart

Front 68

Iontophoresis

Back 68

-Introduction of chemical ions into superficial tissue with direct current
-Be careful of allergies
-Usually 10-15 min, some drugs require longer
-Chlorine, copper, calcium, hydrocortisone, lydocaine

Front 69

Iontophoresis substances

Back 69

Acetate- bursitis, frozen shoulder
Calcium- spasticity
Copper- fungus, allergic rhinitis
Hespiridin- ecchymosis
Hydrocortisone- anti-inflammation
Iodine- antiseptic, scar tissue
magnesium- analgesic, acute pain
Salicylate- analgesic, decongestant
Xylocaine- Analgesic, lots for pain
ZInc- antiseptic, ENT disorders, gynecological disorders
Chlorine- sclerolytic, scar tissue
Lidocaine- neuritits

Front 70

Interrupted Direct current

Back 70

-Galvanic current is a unidirectional current
-Two primary effects are electrochemical and electrokinetic
-3 settings (rate mode settings) - continuous, switch rate or alternating contraction, and interrupted mode or surge

Front 71

Interrupted galvanic current

Back 71

-Flow of electricity (usually DC or monophasic) that is frequently opened and closed
-Electrokinetic, will cause muscle contraction
-Determined by pulse rate - the number of times per second that certain electric flow or pulse is repeated
-Unit of measurement is pps

Front 72

Pulses per second

Back 72

-Determines how frequently the patient is stimulated
-has a direct effect on the physiologic response from the patient
-The closer the surge of electricity, the closer the rate of muscle contraction that lead to tetany

Front 73

Two methods of electrical stimulation

Back 73

-Monopolar - two pads are used, active and dispersal pad, used in galvanism, iontophoresis and exercise of small muscle groups
-Bipolar - 2 to 4 pads used of equal size to stimulate large muscles or multiple groups or muscles