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130 Cards in this Set
- Front
- Back
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Monophasic (Direct or Galvanic current) |
Undirectional flow of charged particles |
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What is a current flow in one direction for a finite period of time is a ______? |
phase (upward or downward deflection from and return to baseline) |
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Modulation |
Controlling |
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Monophasic has what types of charges? |
Positive or negative charge |
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Biphasic wave (alternating current) |
Bidirectional flow of particles |
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This type of wave form is illustrated as one half of the cycle above the baseline and the second phase below the baseline. |
Biphasic wave (Alternating current) |
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Polyphasic wave |
Biphasic current modified to produce 3 or more phases in a single phase |
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This wave form in medium frequency may be Russian or interferential current? |
Polyphasic wave |
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Review |
Slide 3 |
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Phases diagram review |
Slide 4 |
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Currents diagram review |
Slide 5 |
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Intraphasic is associated with what type of current |
Biphasic current |
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What are the four types of Current modulation (aka control) modes? |
1. Continuous mode 2. Interrupted mode 3. Surge mode 4. Ramped mode |
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Continuous mode |
uninterrupted flow of current |
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Interrupted mode |
•intermittent cessation of current flow for ≈1 second. |
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Surge mode |
•a gradual increase and decrease in the current intensity over a finite period of time. - continuous |
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Ramped mode |
•a time period with a gradual rise of the current intensity which is maintained at a selected level for a given period of time, followed by a gradual or abrupt decline in intensity. -turn up, wait a little, then turn up again |
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List 8 Goals & indications |
1) Pain modulation 2) Decrease muscle spasm 3) Impaired ROM (increase ROM) 4) Muscle reeducation 5) Soft tissue repair 6) Edema reduction 7) Spasticity control 8) Denervated muscle |
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Gate therory is associated with what type of pain & what tense? |
Acute & Sensory |
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Initiation of descending inhibition mechanism is called what & is associated with what type of pain & tense? |
Endogenous opiate production -Chronic pain -Motor tense |
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What are two types of fibers associated with pain |
1. C (small) fiber 2. A delta |
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Gate theory |
~Noxious (pain) --> A Delta & C (small) fibers --> Nociception --> attenuated Pain signal ~Distractive Stimulus--> Alpha & A beta (Large) --> Transmission Cell ---> Distraction Signal [Slide 9] |
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Descending endogenous opiate system. |
Supraspinal pain modulation --> produces a descending inhibition of pain chemically at the dorsal horn of the spinal cord. |
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Periaquaductal gray matter does what? |
Secretes endogenous opiates in the blood plasma & cerebral spinal fluid --> spinal gate is closed from influence from above |
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Chronic pain have been found to have what in their cerebral spinal fluid? |
Below Normal levels of endorphins cerebral spinal fluid |
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Goal of electrotherapy? |
Boost the levels of Endorphins in patients |
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Review table I |
SLIDE 11 |
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Ia - Muscle spindle, annulo-spiral ending |
A Alpha |
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Ib - Golgi tendon |
A Alpha |
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II- Muscle spindle, flower-spray ending; touch, pressure |
A Beta |
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III- Pain & cold receptors; some touch receptors |
A delta |
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IV Pain, temp, & other receptors |
Dorsal root C |
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Classification of nerve fibers A alpha --> _____ & ______ A Beta ________ A gamma _______ A Delta _______ B _____ DOrsal Root C ______ |
Somatic Motor & Proprioception (Ia & Ib) Beta--> touch & pressure (II) Gamma--> Motor to muscle Spindles Delta --> Pain (fast), cold, touch (III) B--> preganglionic sympathetic Dorsal Root--> Pain , slow, hot, reflex, )IV) |
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Whats the only conscious way to control your autonomic nervous system? |
DEEP breathing exercises --> hyperventalation |
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Review diagram |
slide 13 |
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Meissner corpuscle |
Heavy pressure |
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Pacinian corpuscle |
vibration |
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Merkel disks |
light touch |
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Ruffini ending |
Skin stretch |
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Types of mechanoreceptors - Type 1 |
Location: Joint capsule, periosteum, ligaments,tendons Eponyms: Ruffini or Golgi-Mazzoni Threshold: Low; slow adapting Setting or tension felt: Static & dynamic |
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Types of mechanoreceptors: Type 2 |
Location: Joint capsule
Eponyms: Pacini, Krause, Vater-Pacini Threshold: Low: rapid adapting Setting or Tension felt: Dynamic |
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Types of mechanoreceptors: Type 3 |
Location: Ligs & Tendons Eponyms: Golgi, or Golgi-Mazzoni Threshold: High; slow adapting Setting or Tension Felt: Dynamic |
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Types of mechanoreceptors: Type 4 |
Location: Joint capsule, periosteum, ligaments,tendons Eponyms: NA; Free nerve endings Threshold: High: pain Setting or Tension Felt: NA |
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What two types of mechanoreceptors are linked to one's sense of proprioception |
Type 2 & 3 Mechanoreceptors |
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Somatic nervous system |
Voluntary control of body movements via skeletal muscles. -afferent & efferent nerves |
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Visceral (or autonomic) motor system controls what? |
Involuntary functions controlled by smooth muscle fibers, cardiac muscle fibers, and glands. Has two major divisions. |
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What are the two major divisions of visceral motor system? |
1. Sympathetic 2. Parasympathetic |
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sympathetic and parasympathetic subsystems are always ____ at some level? |
Active |
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Enteric Nervous system |
sympathetic and parasympathetic subsystems (the specialized innervation of the gut provides a further semi-independent component) |
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Motor fiber types: Aα (I) Alpha motor neuron -Muscle fiber ? -Target Organ? |
-Extrafusal Muscle -Skeletal Muscle |
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Motor Fiber types: Aβ (II) Beta motor neuron -Muscle fiber ? -Target Organ? |
-Intrafusalmuscle (muscle spindle with collaterals to extrafusal muscles). - Static fibers go to nuclear chain fibers. Dynamic fibers go tonuclear bag and skeletal muscle. |
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Motor Fiber types: Aγ Gamma motor neurons -Muscle fiber? -Target Organ? |
-Only in the muscle spindle & are sensitive to stretching - These are also static and dynamic and go to bag and chain fibers |
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Motor Fiber types: B -Muscle fiber? -Target Organ? |
-Preganglionic ANS -Go to the ganglion |
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Motor Fiber types: C -Muscle fiber? -Target Organ? |
-Postganglionic ANS -Go to the ganglion to the organ innervated |
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Steps in the Spinal reflex [review slide 18] |
-Initial stimulus: Muscle Stretch (muscle spindle) 1) Afferent impulses from stretch receptors --> spinal cord 2) Efferent impulses to Alpha Motor neurons cause contraction of the stretched muscle that resists/reverse the stretch 3) Efferent impulses to Antagonist muscles are Damped (reciprocal inhibition) |
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Type II sensory muscle spindle attach to ____ _____, but not to _____ _____ |
Nuclear Chain & Bag Fibers |
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Review Somatic Nervous system |
slide 20 |
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Muscle fatigue |
•tetanic contraction sustained for several minutes by means of continuous modulation. |
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Muscle pump |
•interrupted or surge modulation producing rhythmic contraction and relaxation of the muscle to increase circulation. |
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Muscle pump & heat |
•combination of ES and US to increase tissue temperature and produce muscle pumping at the same time. |
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Mechanical stretching of connective tissue and muscles associated with a ____? |
Joint |
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With impaired ROM we want to decrease pain to encourage |
joint motion |
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With impaired ROM we want to decrease edema, why? |
Edema can significantly impediment to motion |
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Muscle reeducation does what 3 things? |
1) Active assistive exercise 2) Proprioceptive feedback 3) Coordinated muscle movement |
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Disuse atrophy is what & is used as an adjunct to ______ movement |
Muscle weakness & Volitional |
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What type of current (s) are used for Soft tissue repair (wound healing)? |
Pulsed Currents (Monophasic, biphasic, polyphasic) w/ interrupted modulations. |
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Pulsed currents for Soft tissue repair does what? Via the _____? |
Improved circulation VIA the muscle pump to improve tissue nutrition & hasten metabolic waste disposal |
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Monophasic currents soft tissue repair uses what type of modulations & Currents? |
Low-Volt continuous modulations High-volt pulsed currents |
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Electrical potential theory |
Restoration of electrical charges in wound area |
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Bactericidal effect of Monophasic currents |
Disruption of DNA, RNA synthesis or cell transport system of microorganisms |
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List 3 Biochemical effects of Monophasic currents |
1) Increased adenosine triphosphate (ATP) 2) Amino acid uptake 3) Increased protein & DNA synthesis |
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Galvanotaxic effect: |
Attraction of tissue repair cells via electrode polarity |
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Phases of soft tissue repair: first four phases |
1. Inflammation phase: macrophages (positive); mast cells (negative); neutrophils (positive or negative) 2. Proliferation Phase: fibroblasts (positive) 3. Wound contraction phase: alternating positive/negative 4. Epithelialization phase: epithelial cells (positive) |
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What two types of currents that apply for wound healing? |
1) Low intensity continuous nonpulsed low volt direct current 2) high-volt pulsed current |
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Treatment protocols for soft tissue repair are similar to ______. However, the ______ characteristics are different. |
-Low amplitude current for 30-60 minutes -Current characteristics (continuous versus pulse) |
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What is the muscle pump effect on edema ? |
Increase lymph & venous return |
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Electrical field phenomenon during edema reduction |
•Effect of electrical charge on interstitial proteins increase lymph and venous flow. |
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Spasticity ( ESto reduce hypertonicity) |
Fatigue of the agonist •Reciprocal inhibition (stimulate antagonist& inhibit agonist). - usually UMN lesion |
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Denervated muscle has controversy, why? |
•use of ES for denervated muscle. •denervated muscle can be stimulated by monophasic or biphasic currents with long pulse duration, producing a vermicular contraction. |
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What is the goal of stimulation of a denervated muscle? |
-retard the effects of disuse atrophy and shorten recovery time. |
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Recent study regarding denervated muscle say what? |
–Interfering with regeneration of neuromuscular junction and subsequent reinnervation. –Traumatizing hypersensitive denervated muscle. |
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What are two additional factors for consideration of ES on denervated muscles? |
1. Financial cost 2. Prolonged treatment time required until reinnervation |
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List 6 Contraindications |
1. Healing Fx [unless used for bone stimulation usually Microcurrent] 2. Areas of active bleeding 3. Malignancies or phlebitis in Tx area. 4. Superficial metal implants 5. Pharyngeal or laryngeal muscles 6. Demand-type pacemaker, myocardial diease |
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List 4 Precautions |
1. Areas of impaired sensation 2. During pregnancy 3. Severe edema 4. Safety |
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2 safety measures for ES |
1) Do not use any electrical modality if there is evidence of broke or frayed wires 2) Do not use if the unit is not connected to a ground fault circuit interrupter |
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How many electrodes (leads) are required to complete the current circuit? |
Two |
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One electrode is generally called _____ & is often placed on the ______ ______ |
Active (stimulating) & Motor point |
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Second electrode is called _______ & why? |
Dispersive electrode & it disperses the electricity |
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Electrodes are USUALLY the same size EXCEPT |
W/ monophasic forms such as Hi-Volt & galvanic stimulation where dispersive electrodes are used. |
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Current density is relative to ______ -amount of current that is dispersed under the electrode |
Electrode size |
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-Current intensity passing through a ... Smaller active electrode produces what? & Thus a ______ stimulus |
High current density -Strong |
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Bigger the electrodes 10 mv--> small electrodes will seem stronger or weaker? |
Stronger, less dispersment |
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Large dispersive electrode will produce what compared to a small electrode? |
Less current density, more dispersment |
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Electrode size should be relative to the size of the _______? |
Treatment site -electrode shape in not significant |
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Large electrodes are for what? |
Big muscles / large areas |
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Small electrodes are for what? |
Small muscles/ small area |
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Large electrodes in a small tx area could result in what? |
Overflowing to surrounding muscles to produce undesired effects ex. contraction of other muscles |
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Small electrodes applied to a large muscle (i.e., quadriceps) could result in? |
•high current density under the electrodes that make ES uncomfortable to the patient. |
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Electrode Preparation Metalplate/sponge: |
•remove sponge from water,remove excess water. |
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Electrode Preparation Carbonized rubber: |
•place small amount of gel in center of electrode. -Spread gel to cover entire surface. |
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Electrode Preparation Pre-gelled electrode: |
•remove protective cover & place a small amount of gel ( metal mesh/foil electrode) or water (Karaya electrode) on electrode. |
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What are the 3 basic set-ups of ES? |
1. Wound care 2. Pain control (–this may vary widely with TENS) 3. Muscle stimulation |
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What are 2 wound care options |
1) Active electrode is placed in the wound bed & dispersive electrode is placed at a remote site 2) electrodes are placed on either side of the wound bed |
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Electrode Set-ups -Pain control |
-2 or 4 electrodes (TENS/TNS or Interferential): are placed in a pattern that surround the area of tx.
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Electrode Set-ups -Muscle stimulation |
usually placed over the TX site (motor point) ---> produce stimulation effect |
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Where should dispersive electrode be placed during Electrode Set-ups (muscle stimulation) |
Treatment side or at a remote site |
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Electrode Placement: Unipolar/monopolar placement: |
- 1 single electrode or multiple (bifrucated) active electrodes placed --> over Tx area. -Larger-sized dispersive electrode (inactie) placed--> ipsilaterally away from Tx area |
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Bipolar placement: |
-equal Size Active & dispersive: same muscle group or in same Tx area. -Smaller bifurcated tx --> better for small Tx areas |
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How far should the space between the active & dispersive electrodes? |
At least the diameter of the active elctrode |
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The greater the space between the electrodes the ____ the current density in the intervening superficial tissue & deeper the stimulation. |
LESSER |
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You want to minimizes what two things w/ ES? |
1. Risk skin irritation 2. Burns |
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You should move the electrodes closer when what happens? |
Deep penetration causes contraction of undesired muscles |
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What is very important to do before and after applying long-term use of ES? |
Vigilant skin inspection & skin care |
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When is skin inspection important? |
Home use of transcutaneous ES & other ES modalities |
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Long-term repetitive stimulation & electrode placement and removal can do what to the skin? |
irritate the skin and initiate skin breakdown. |
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List the first 6 Procedure steps |
1) Explain procedure & effects 2) Pt. in comfortable position 3) Support body part 4) Assess skin condition & sensation 5) reduce skin resistance, if necessary (hot pack, alcohol rub, gentle abrasion 6) Check to confirm all controls are in proper starting position before turning on |
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List 7-11 procedure steps |
7) Inspect the patients skin 8) Secure electrodes 9) Set appropriate frequency, waveform & modulation rate 10) Adjust intensity to achieve the optimal Tx effect 11) End of Tx --> slowly decrease intensity to zero before lifting the active electrode from skin. |
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What are the 2 meanings of amplitude |
1) Strength of the individual pulse 2) How high you turn up the intensity knob |
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Acute Pain control: regarding amplitude -How high should you turn up the machine intensity? |
Want a sensory response. -NO MOTOR CONTRACTION -feels good (pt. comfort) |
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Muscle strengthening: regarding amplitude -How high should you turn up the machine intensity? |
Want strong muscle contraction [Motor response] -just below painful (aka pt. tolerance) |
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List the 7 examples of E-stim |
1) Tissue / wound healing 2) Pain control 3) Muscle strengthening 4) Muscle Spasm (2 set ups) 5) Edema control VIA muscle pump 6) ROM 7) Muscle re-education |
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What are the two parameters for Basic set-up for muscle strengthening, muscle spasm or edema (muscle pump), ROM |
1) Slowly increase intensity until a muscle response is observed 2) 10 to 25 muscle contractions may be sufficient to obtain treatment goal. |
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Duty cycle parameters |
1) interrupted/ramped modulation of current allows the muscle to recover between stimulation periods 2) it has been shown that stimulation on-to-off ratios of = 1:3 minimize the fatigue effects of ES |
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Decrease muscle spasm (by fatigue) Current: Goal: |
Continuous mode (instead of a 1:3 duty cycle) Goal: exhaust the muscle thereby causing it to relax its spam. |
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Muscle re-education parameters & procedure similar to ? |
muscle strengthening technqiues |
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How long are treatment sessions for Muscle re-education? |
10-30 minutes depending on patient's mental & physical tolerance |
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Monophasic can be what types of charge? |
Positive or negative |
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One complete cycle (two phases) equals a ____ for Biphasic wave? |
single pulse |
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Endorphins have been shown to _____ in the cerebral spinal fluid with ____ level of electrical stimulation. |
Increase & Twitch |
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The sympathetic system mobilizes the body for _____ & the Parasympathetic system predominates during _____ |
Challenges & relaxation |
