Question | Answer |
PHASES OF HEALING
Phase One | Inflammatory phase 3-7 days
Marked by local vasodialation & increase in cell migration
Need a lg. amount of cells to begin chemotaxis |
PHASES OF HEALING
Phase Two | Granulation tissue formation phase
Formation of new blood vessels
Production extracellular matrix
Formuation granulation tissue |
PHASES OF HEALING
Phase Three | Can last up to 2 yrs. following injury
Increase in collagen tissue
Tissue becomes more organized
Too organized = scarring |
Current of Injury | presence of skin battery potential in a wound or injury where skin no longer provides a barrier to the tissue below |
Why is a moist wound better than a dry wound? | A moist wound maintains the current of injury triggering healing |
A dry wound consists of what kind of tissue? | Dry, leathery, necrotic tissue |
Why is a dry wound slower to heal? | It loses the current of injury which decreases healing. |
What is galvanotaxis? | A process in which all cells posses either a + or - charge that attract to the opposite pole. |
What is the polarity of a neutraphil? | Negative |
What is the polarity of a macrophil? | Negative |
What is the polarity of a epidermal cell? | Positive |
What pole do neutraphils attract to? | positive |
What pole do macrphils attract to | Positive |
What pole do epidermal cells attract to? | Negative |
What does antimicrobial mean in reference to EStim? | Estim has been shown to have bactericidal effects in animal studies. NO HUMAN STUDIES-CONTOVERSY OVER |
What happens to blood flow as an influence of Estim? | EStim is thought to increase blood flow in wounds hence speeding up the healing process. |
What is the influence of EStim on necrotic tissue? | The positive pole is thought to increase macro & neutraphils to the wound hence, providing an autolitic reaction. |
What is HVPC (aka HBGC)? | High Volt Pulsed Current
(aka High Volt Galvantic Current) |
What is the definition of HVPC? | Pulsed current delivered via high voltage to accomplish their means. |
What is the waveform of HVPC? | Paired unidirectional impulses that rise instantaneously & then pulse fall exponentially (quick rise- slow fall) |
What is the pulse duration of HVPC? | 50-100 microseconds with electromoto force up to 500 volts.
In the U.S. most do not exceed 150 volts per the FDA |
With higher volts what is the effect on the skin and why is this important? | Higher volt = less impedence from the skin which means we don't need high amp. |
What is the purpose of HVPC? | -Stimulate lg. afferent neurons to promote pain relief
-Promote blood flow & relaxation
-Reduce edema via polarity
-acceleration of tissue healing
*high volt not best for pain - other methods work better |
What are the indications of HVPC? | -Promote wound healing
-Reduce edema (esp. acute) |
What are the contraindications of HVPC? | -Pacemaker or medical devices including hardware
-Over or near preg. uterus
-Over eyes, carotid sinus, laryngeal or pharyngeal muscles
-During operation of heavy machinery
-Over areas of malignancy |
What are the precautions of HVPC? | -Known cardiac condition
-Over anesthetic skin (numb)
-Elderly patients |
What is the response to treatment with HVPC? | -Sensation or tingling or motor response is expected
-Should have no obvious skin changes following tx
(Check skin pre and post) |
What is the intensity of HVPC? | strong but comfy
(sensory level for edema or wounds) |
What is the duration of HVPC? | 60 minutes w/ wounds
15-30 minutes for edema or pain (not 1st choice as far as estim) |
What is the frequency of tx for HVPC? | daily up to 5x/day |
What must a wound be free of before placing electrodes? | all metals or petroleum products - flush with sterile saline first. |
What is the direct electrode placement method for wounds? (HVPC) | Pack the wound w/ moist gauze (sterile saline) & place electrode directly on the wound & dispersive electrode 15-20 cm away from wound. |
What is the Peri method for wounds(HVPC electrode placment)? | electrodes are placed around the wound (on each side of) |
For pain and edema what methods of electrode placement are used? | Surround the area or use high volt under water. |
With underwater high volt, where are the electrodes placed? | Electrodes are secured to the side of a plastic or fiberglass tub. DO NOT WANT THEM TO TOUCH PATIENT!!!! |
With underwater HVPC, what must be used in addition to the electrodes in the tub? | A disbursement pad on the trunk or under the thigh of the limb in the water. |
While the estim machine is on, the limb is to remain where? | in the water - give pt. a bell, RISK OF HIGH VOLT SHOCK IF REMOVED! |
What is Interferential Stim? | -Consists of 2 unmodulated medium frequency EStim waves that cross pathways & interfere with each other.
-2 different frequencies that meet in multiple points in wave that cause constructive and destructive interference. |
What is the waveform with interferential? | 2 unmodulated frequency sound waves |
What is the frequency for interferential? | 2000-5000 Hz |
What is the pulse duration for interferential? | 125 microseconds |
What is the result as far as shape of interferential current? | clover leaf shaped wave |
What is the purpose/effects of interferential with greater than 50 beats per second apart? | -greater than 50 beats per second apart relieves pain by stimulating lg afferent neurons (gate control theory) |
What is the purpose/effects of interferential with 0-5 beats per second? | produces muscle contractions & relieve pain (endogenous opiates) |
What is the purpose/effects of interferential with 1-10 beats per second? | Produce small pulsating contractions of innervated muscles. |
What is the purpose/effects of interferential with 30-50 beats per second? | produce tentanic contractions. |
What are the advantages of interferential? | -medium frequency face less impedance as they cross the skin thus they reach deeper target tissues. |
What are the disadvantages of Interferential? | -Even w/ crossing of current, density remains high near the electrodes
-pt. not as likely to perceive stim at targeted tissue. |
What are the indications of Interferential? | -Pain relief
-Muscle ex to increase blood flow, muscle relaxation, decrease edema
-Relief of urinary incontinence
-Tissue, bone healing (disputed)
*MOSTLY FOR PAIN RELIEF |
What are the Contraindications of Interferential? | -Pacemaker or medical devices including hardware
-Over or near preg. uterus
-Over eyes, carotid sinus, laryngeal or pharyngeal muscles
-During operation of heavy machinery
-Over areas of malignancy
-Open areas, active bleeding |
What are the precautions of interferential? | -Known cardiac condition
-Over anesthetic skin (numb)
-Elderly patients |
As far as dosage of interferential, what is the amplitude? | -sensory level
-strong but comfy
-No mucle activation |
As far as dosage, what is the duration of interferential? | 15-30 minutes |
As far as dosage, what is the frequency of tx for interferential? | daily up to 3x/day |
What is the response to tx for interferential? | -Tingling under the electrodes
-No obvious skin changes following tx
-Inspect skin pre & post |
What is the electrode placement for interferential? | -Surround the area of pain
-2 circuits that criss cross
-leads on same side (polarities together) to form clover leaf wave |