e-stim revised
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| Acupuncture like TENS amplitude is? | visible contraction
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| Acupuncture like TENS on:off | continuous
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| Acupuncture like TENS pulse duration is? | 200-300 pps
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| Acupuncture like TENS releases what? | endorphins
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| Acupuncture like TENS treatment time is? | 20-30 min
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| Acupuncture like TENS frequency is? | 2-10 pps
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| Acidic reaction (+) | Hydrochloric acid forms under the positive electrode, less uncomfortable than alkaline reaction
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| acute edema (inflammation) amplitude is? | comfortable tingling sensation
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| Acute edema (inflammation) frequency is ? | 100-120 pps
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| acute edema(inflammation) on:off is | continuous
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| acute edema(inflammation) polarity is? | Negative
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| acute edema(inflammation) pulse duration is ? | 40-100us
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| acute edema (inflammation) treatment time is? | 20-30 min
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| Acute edema(inflammation) waveform is? | HVPC
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| Adverse effects to e-stim | electrical burns, skin reaction to the electrodes, pain
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| Alkaline reaction (-) | sodium hydroxide forms under the negative electrode. causes discomfort, skin irritation or chemical burns, reduced likelihood by increasing the size of the negative electrode
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| Alternating current | continuous and bidirectional flow of charged particles (+ and -)
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| Amplitude Modulation | usually referred to as scan
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| Amplitude | magnitude of the current or voltage
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| Anode | Positive pole
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| AP are all or none | increased amplitude or duration doesn't increase strength of the AP
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| What is an AP? | nerves communicate with one another through the production of action potentials(AP), created by depolarization and repolarization of nerves
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| Benefits of IFC | more comfortable as it has a low amplitude current when going through the skin, delivers higher current in deeper tissues--continuous AC with increase average amplitude, stimulates a larger area
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| Burst mode TENS is used to? | combines conventional and acupuncture TENS, stimulated endogenous opiates like low-rate TENS but may be tolerated better, provides pain relief similar to high rate TENS
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| Cathode | Negative pole
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| chronic edema (due to lack of motion) amplitude is? | visible contraction
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| chronic edema(due to lack of motion) frequency is? | 35-50 pps
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| chronic edema (due to lack of motion) on:off time? | 2-5 on, 2-5 off. 1:1
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| chronic edema (due to lack of motion) pulse duration is? | 150-350= small muscles, 200-350= large muscles
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| chronic edema (due to lack of motion) ramp? | >1 sec
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| chronic edema (due to lack of motion) treatment time is? | 20-30 min
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| chronic edema (due to lack of motion)waveform is? | biphasic or IFC
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| common medication used in iontophoresis | Dexamethosone (0.4 % solution (-), corticosteroid that acts as an anti-inflammatory, useful with tendinitis or bursitis
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| Conventional or high rate TENS is used for ? | pain control
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| conventional TENS amplitude is? | tingling
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| conventional TENS frequency is? | 100-150pps
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| conventional TENS on; off is? | continuous
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| conventional TENS pulse duration is? | 50-80 us
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| conventional TENS time of treatment is? | up to 24 hrs a day
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| conventional TENS utilizes the gate theory of pain control where? | spinal cord level
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| Depolarize | Na+ channels open fast, Na+ rushes in to make inside more positively charged.
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| Frequency | Number of cycles or pulses per second
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| General parameters for low rate or acupuncture like TENS are? | longer pulse duration, higher amplitude (visible contraction), treatment must be less than 30 minutes to prevent DOMS.
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| General parameters of Conventional or High rate TENS are | short pulse duration, comfortable amplitude (strong but comfortable), can be used constantly
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| HVPC is used for? | Tissue healing (speed healing process)
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| IFC amplitude of current | higher amplitude current when both are in the same phase and a lower amplitude current when they are in opposite phases
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| IFC beat frequency = | difference between the frequencies of the original AC's (usually set by machine)
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| IFC Carrier frequency= | slower original AC (ex: 4100 Hz frequency interferes with 4000 Hz frequency
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| Gate Control Theory: | pain signals travel up A delta and C nerves. Messages from the brain via descending fibers or peripheral A beta fibers can block pain signals in a hypothetical "pain gate" in the spinal cord
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| Interpulse Interval | Time between pulses
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| Iontophoresis amplitude is? | Patient tolerance, no more than 4mA
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| Iontophoresis polarity is? | same as drug (drives drug into skin)
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| Iontophoresis time of treatment is? | depends on amplitude
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| iontophoresis total dose= | 40mA. min
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| Iontophoresis waveform is? | DC
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| motor nerves do what? | (Efferent) will always submit motor info to the muscles, higher amplitude and longer pulses are required to depolarize.
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| muscle contraction for denervated muscles | helps slow the process of muscle atrophy and tissue fibrosis formation, continuous DC with longer pulse duration can allow denervated muscles to contract; may slow nerve regeneration, so should not be used if this is the goal
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| muscle reeducation amplitude is? | functional activation of muscle
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| muscle reeducation frequency is? | 35-50 pps
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| muscle reeducation on:off time? | varies based on functional activity
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| muscle reeducation pulse duration is? | 150-200 =small muscles, and 200-350= large muscles
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| muscle reeducation ramp is? | > 2 sec
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| muscle reeducation time of treatment is? | depends on functional activity
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| muscle spasm amplitude? | visible contraction
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| muscle spasm frequency is? | 35-50 pps
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| muscle spasm on:off time | 2-5 sec on/2-5 sec off; 1
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| muscle spasm pulse duration is? | 150-200= small muscles,200-350= large muscles
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| muscle spasm ramp? | > 1 sec
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| muscle spasm time of treatment | 10-30 min
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| muscle strengthening frequency is ? | 35-80pps
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| muscle strengthening pulse duration is? | 150-200= small muscle and 200-350=large muscles
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| muscle strengthening Ramp is | > 2 sec
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| muscle strengthening is treated how often ? | every 2-3 hours patient is awake
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| muscle strengthening amplitude is? | > 10% MVIC if injured, > 50% MVIC if uninjured, visible contraction
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| muscle strengthening on; off is? | 6-10 on; 50-120 off, 1:5 ratio initially
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| muscle strengthening time of treatment is? | 10-20 min (to produce 10-20 reps)
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| Galvanotaxis: | cells are attracted to electrical charge.
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| Negative electrode attracts | activated neutrophils ( present with infection or inflammation) lymphocytes, platelets and mast cells, fibroblast. Used for infected or inflamed wounds, acute stage of healing.
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| Positive electrodes attracts? | inactive neutrophils and macrophages, epidermal cells. Used with necrosis without inflammation and wounds in the proliferation stage; clean wounds.
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| Premodulated Current | Similar to IFC but uses only one channel; not as effective as IFC
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| principle of muscle strengthening overload principle | Greater load-->greater force production-->greater strength
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| Propagation speed is what? | depends on nerve diameter and myelination
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| Pulse duration | Time from the beginning of the first phase of a pulse to the end of the last phase of a pulse
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| Pulsed current | an interrupted flow of charged particles where the current flows in a series of pulses separated by periods when no current flows
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| Ramp up/Ramp down time | ramp up is the time it takes current amplitude to go from 0 to maximum amplitude for any one on time. Ramp down is the time it take for the current amplitude to decrease from its max amp during on time back to zero.
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| Repolarize= | Na+ channels close and K+ channels open to allow K+ out of the cell and the membrane repolarizes to resting state
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| Resting potential is | when a nerve is at rest, inside of cell is more negative than outside of cell (b/c most sodium ions outside, most potassium ions inside)
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| Rise Time/Decay Time | Rise Time is the time it takes current to go from 0 to peak during any one phase; Decay time is the time it takes current to decrease from peak to zero in any one phase
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| Russian Protocol | 2500Hz carrier AC frequency with 50 burst per second, each burst is 10 ms followed by a rest interval of 10 ms.
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| Sensory nerves do what? | (Afferent) will always submit sensory info to the brain,also low current amplitude and shorter pulse duration depolarize
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| tissue healing polarity is? | + for clean wound, --for infection
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| tissue healing amplitude is? | comfortable tingling sensation
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| Tissue healing frequency is? | 60-125 pps
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| Tissue healing occurs through? | attraction of cells for tissue healing (neutrophils, leukocytes,)reduction of edema, increased antimicrobial activity, promotion of circulation,increased synthesis of DNA and collagen most effective at healing pressure ulcers
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| tissue healing on:off is? | continuous
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| tissue healing pulse duration is? | 40-100us
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| tissue healing treatment time is? | 45-60 min
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| Tissue healing waveform is? | HVPC
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| Transdermal drug delivery (Iontophoresis) | use a low voltage DC to move charged ions across the dermis by increasing the permeability of th stratum corneum, penetration is likely 3-20 mm, current must be the least sufficient to overcome the resistance of th skin and electrode
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| Wavelength | Duration of one cycle of AC
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| What happens to an AP during Depolarization? | The neuron is rapidly depolarized by the opening of voltage-gated Na+ channels. Na+ is pulled into the cell by the negative charge inside and because of the larger concentration of Na+ outside the cell.
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| What happens to an AP during Repolarization? | The Na+ channel close and voltage-gated K+ channels open to repolarize nerve. K+ is pushed out of the cell because of the large concentration of K+ inside of the cell and because of the positive charge inside the cell.
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| What is absolute refractory period? | when the membrane is depolarized, it is not possible to create another AP
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| What is accommodation? | decreased response to same amplitude of nerve stimulation, must rise fast enough that nerve cannot acclimate to the current produced.
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| what is Beat frequency? | 4100Hz-4000Hz=100Hz
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| what is burst duration? | time from beginning to end of the burst
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| what is Burst mode? | series of pulsed delivered in an "packet" as a single pulse, frequency and duration preset
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| what is Chronaxie? | minimum duration to stimulate nerve at twice rheobase (measures time/duration)
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| What is decay time? | time it takes form peak to decrease to 0 during a phase
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| What is Duty cycle? | ration of on time to total cycle time, On 10 sec, off 50 sec=10;60 or 1;6 duty cycle
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| What is electric current (I)? | the flow or movement of charged particles
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| what is frequency modulation? | varying the number of pulses or cycles per second , usually referred to as sweep
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| what is interburst interval? | time between burst
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| what is interferential current (IFC)? | waveform produced by the interference of 2 medium frequency sinusoidal AC's of slightly different frequencies
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| What is Interphase interval? | time between phases of a pulse
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| what is modulation? | any variation, cyclic or random, of one or more of the stimulation parameters, limits adaptation of the neurons to current
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| what is On/Off Time? | On Time is the time when a train of pulses occurs; Off Time is the time between the train of pulses when no current flows.
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| What is Phase duration? | duration of one phase of the pulse
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| what is relative refractory period? | after depolarization occurs, a short hyperpolarization period occurs, a stronger than normal AP would be required to produce another AP
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| what is Rheobase? | minimum amplitude required with a long pulse duration to produce an AP (measures amplitude)
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| What is Saltatory conduction? | impulse jumps between spaces in myelin sheaths, known as nodes of Ranvier, this leads to greater speed of impulse conduction
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| What is Strength-duration curve? | minimum amount of electrical current (combination of amplitude and pulse duration) required to depolarize the nerve and produce an AP in a specific type of nerve.
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| Clinical applications of E-stim: | ("MR.PHET") Musc.strengthening, Re-education of musc., Pain, Healing, Edema, Transdermal drug delivery
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| Clinical effects of e-stim are result of the current stimulating: | action potentials
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| E-stim to anterior tibialis muscle to produce dorsiflexion during the swing phase of gait is an example of: | FES- functional electrical stimulation
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| Phase: | in a pulsed current, when starts to flow in one direction to when it stops or starts to flow in other direction
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| Pulse: | in a pulsed current, period when flows in any direction
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| Innervated muscle stimulation: | NMES-neuromuscular electrical stimulation (depolarization of nerve)
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| Denervated muscle stimulation: | EMS-electrical muscular stimulation (depolarization of muscle)
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| Motor Point: | the place where electrical stimulus will produce the greatest contraction with least amount of electricity. Most motor points are over the middle of the muscle belly.
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| Current Density: | amount of current delivered per unit area
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| Adaptation: | a decrease in frequency of AP's and subjective sensation of stimulation that occurs in response to electrical stimulation with unchanging characteristics
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| Monophasic: | a series of pulses where the charged particles move only in one direction
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| Biphasic: | a series of pulses where the charged particles move in one direction and then in the opposite direction
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| Electrodes should not be placed over: | bony prominences...(b/c the higher resistance of bone and poor adhesion of electrodes to highly contoured surfaces increases risk of discomfort and burns, and is less likely to produce therapeutic benefits.
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| Pt.position for muscle strengthening: | limb should be secured to prevent motion thru the range, with the joint that the stimulated muscles cross in midrange.
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| Effects of electrode spacing: | closer together=current travels more superficially; further apart=current goes deeper
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| Waveform used for muscle contraction: | pulsed biphasic or Russian
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| Waveform used for pain: | pulsed biphasic or IFC
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| Waveform used for healing: | monophasic or HVPC
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| Contraindications for E-stim: | ("PT CuP"--thx Joey!) Pacemaker or unstable arrythmias, Thrombosis/thrombophlebitis, Carotid sinus, Pregnancy—over abs/low back
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| Precautions for E-stim: | ("IC MIA") Impaired sensation/mentation, Cardiac disease, Malignant tumors, Ionto. After other PA's, Areas of skin irritation/open wounds
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