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44 Cards in this Set

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TENS sensory- Low parameters

Frequency: greater than 50-100 pps


Pulse duration: 2-50 ms


Time: 20-60 min

TENS sensory- Low effects and when to use

low level gating




Acute injuries

TENS sensory- Low electrode placement

Electrode placement on or around site of pain or use acupuncture sites

TENS sensory- High parameters

frequency: greater than 100-150 pps




pulse duration: 2-50 ms




time: 20-60 min

TENS sensory- High effects

gating

TENS sensory alternative parameters

Intensity- high as tolerable w/o reaching motor level




Time: 10-15 min

TENS sensory alternative effects and when to use

quick analgesic effect




When you need to perform procedures that would otherwise be too painful (friction massage, wound debridement, etc)

TENS sensory alternative electrode placement

close placement

TENS motor- Low parameters

frequency: 2-4 pps


pulse duration: greater than 125-150


time: 45-60 min, 2-3x/day

TENS motor- Low effects and when to use

Beta release, mm pumping




Chronic pain, deep & throbbing, "acupunture-like"

TENS motor- Low electrode placement

Electrode placement away from site (mm contraction not well tolerated) – Prox. nn roots, acupuncture, nn points, CL side

TENS motor- High parameters

frequency: greater than 150 pps if tolerable




pulse duration: 125-150 ms




time: 15-20 min

TENS motor- high effects and when to use

mm fatigue, gating, beta release




for analgesia

TENS motor- high electrode placement

Electrode placement similar to sensory unless mm contraction in area is unwanted

TENS noxious parameters

Frequency: -Low – 1-5 pps High – 80-100 pps


*Note: both release endorphins, so it’s more about pt comfort




pulse duration: 1 mx -> 1 s




Time: 10-15 min

TENS noxious when to use

Stimulate opiate release (inhibition), if other methods aren't working

TENS noxious electrode placement

At painful site, TPs, MPs, acupuncture pts etc.

Sensory vs Motor TENS pain relief

• A betas block nn impulses = gating effect = frequency dependent (directly related)


• Sensory = Residual pain relief is brief (but faster onset)


• Motor = Residual pain relief lasts longer (but slower onset)

NMES strength type of current

biphasic or burst modulated AC (Russian)

NMES strength treatment time

Frequency: 1-100 pps (tetany at highest tolerated level - 60% of MVIT in quads)




Duration/On & off: 50-1000 ms, 10-15 on, 50-120 off




15 min -> 10-15 contractions at max intensity




3 sessions/week



NMES strength purpose

activate as many motor units as possible and fired as fast as possible (higher training volume)




better motor recruitment

NMES endurance type of current

Pulsed biphasic- w/ low-moderate amplitude submax

NMES endurance parameters

Frequency: 30-40 pps




Duration: 50-250 ms





NMES endurance purpose

want to selectively activate the S and FR fibers for prolonged periods

FES type of current

Amplitude can be sensory or motor level

FES parameters

frequency: 50-100 pps




duration/on & off: 5-10s on, 5-25 s off (ratio due to fatigue




Short- 15-20 min but frequent, 1-2x/day

FES purpose

may help increase recovery RATE but not necessarily level of recovery

Spasticity management type of current

Amp = enough to get mm contraction (antagonist- maybe only sensory)

spasticity management parameters

frequency: higher than tetany greater than 25-30 pps




Gradual ramp up/down to avoid stretch reflex




20-40 min, prior to fxnl activity & pt pre-positioned

Spasticity management purpose

fatigue spastic mm




effects are temporary (less than 24 hours)

Shoulder subluxation type of current

Amp = enough to move humerus

Shoulder subluxation parameters

10s on


50 s off & gradually increase endurance -> 120 s on, 10 s off




gradual ramp up & down




30 min for 4-7 hrs/day




3x/day




6 weeks of tx

humerus subluxation electrode placement

supraspinatus and posterior delt

Wrist extension type of current

Amp = enough to promote wrist extension

wrist extension parameters

frequency: 20-100 pps (tetany needed)




200-300 ms, 5-10 s on, 5-25 s off, Gradual ramp up & down




10-20 min




2-3x/day3-5x/week2-4 wks of tx



scoliosis type of current

rectangular monophasic




amp = produce mm contraction that partially reverses curve

Scoliosis parameters

frequency: 25 pps




pulse duration: 200 ms




6s on


6 s off




8 hrs continuous stimulation

Cutaneous A betas: MR, low threshold characteristics

Part of barrage, but don't cause pain alone




Supressed by noxious stimuli (heat)




May have a role in inhibition - reduces nociceptive responses

Cutaneous A deltas: MR, high threshold characteristics

respond to intensities that produce skin damage




may explain hyperalgesia due to continuous vigorous discharge

Cutaneous A deltas: MT (heat nociceptive) characteristics

Critical for the judgement of heat induced pain




Account for FIRST pain felt with noxious heat (like touching stove




small receptive fields

Cutaneous C polymodal characteristics

Respond to thermal, mechanical, and chemical stimuli (variety)




Convey both nociceptive and non-nociceptive inf




Involved in MILD tissue damage (vs A deltas

Muscle A delta characteristics

Lightly myelinated




Activated by bradykinin/serotonin (chemicals)




May be ergoceptive (tell you are moving)





Muscle C fibers characteristics

primary pain neurons in mm that connect to ST tract- excitatory effect




optimally responsive to noxious stimuli




also activated by chemicals

primary afferent visceral characteristics

poorly localized and discriminated




often referred to region = tender (2ndary hyperalgesia)




often accompanied by autonomic and somatic reflexes




C polymodals = most organs




Especially prevalent in inflammation and certain diseases