e-stim
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| Ramp up | time it takes current to go from 0 to maximum amplitude for any one on time.
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| Duty Cycle | ratio of on time to total cycle time
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| Interferential Current | Waveform produced by the interferences of two medium frequency sinusoidal AC's
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| Polarity | Property of having two oppositely charged conductors
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| Interpulse Interval | Time between pulses
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| Premodulated Current | Similar to IFC but uses only one channel
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| Rise Time | Time it takes current to go from 0 to peak during a phase
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| Frequency | Number of cycles or pulses per second
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| Pulse duration | Time form the beginning of the first phase to the end of the last phase of the pulse
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| Anode | Positive pole
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| Ohm's Law | Relationship between voltage(V), electrical current (I) and resistance (R)
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| Direct current | used for iontophoresis and stimulating denervated muscles to contract
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| Amplitude Modulation | usually refered to as scan
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| Alternating current | continuou and bidirectional flow of charged particles (+ and -)
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| Cathode | Negative pole
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| Wavelength | Duration of one cycle
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| Pulsed current | electrical current delivered discontinuously
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| Amplitude | magnitude of the current or voltage
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| Impedance | total frequency-dependant opposition to the current flow
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| Frequency Modulation | usually referred to as sweep
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| Symmetrical biphasic pulsed is used for? | Muscle strengthening, muscle reeducation, muscle spasm (fatigue muscles to decrease spasm), Chronic edema (muscle pumping to decrease edema)
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| TENS (Monophasic/biphasic) is used for? | conventional (pain control via gate theory of pain), Accupuncture (pain control via endogenous opiate release)
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| AC is used for? | IFC (pain control), Premod (pain control for smaller area)
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| HVPC is used for? | Tissue healing (speed healing process), (-) for infected or acute wounds, (+) for clean wounds and theose in the roliferation stage, Acute edema (-)
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| DC monophasic-continuous is used for? | Iontophoresis (decreases inflammation), Denervated muscle ( depolarize muscle cells to decrease onset of atrophy)
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| Russian is used for ? | Muscle force-stronger and more efficent
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| Paremeters for Muscle strengthening are? | waveform= symmetrical biphasic pulsatile current,
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| muscle strenghtenign frequency is ? | 35-50pps
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| muscle strenghtening pulse duration is? | 150-200= small muscle and 200-350=large muscles
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| muscle strengthening on; off is? | 6-10 on; 50-120 off, 1;5 ration
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| muscle strenghtening Ramp is | > 2 sec
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| muscle strengthening amplitude is? | > 10% MVIC if injured, > 50% MVIC if uninjured, visible contraction
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| muscle strengthening time of treatment is? | 10-20 min
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| muscle strengthenign is treated how often ? | every 2-3 hours patient is awake
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| Muscle reeducation waveform is? | symmetrical biphasic pulsatile current
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| muscle reeducation frequency is? | 35-50 pps (>60 pps is need tetanic contraction)
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| muscle reeducation pulse duration is? | 150-200 =small muscles, and 200-350= large muscles
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| muscle reeducation on:off time? | varies based on functional activity
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| muscle reeducation ramp is? | > 2 sec
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| muscle reeducation time of treatment is? | during functional activity
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| Muscle spasm waveform is? | symmetrical biphasic pulsatile current,
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| muscle spasm frequency is? | 35-50 pps
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| muscle spasm pulse duration is? | 150-200= small muscles,200-350= large muscles
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| muscle spasm on:off time | 1`:1
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| muscle spasm ramp? | > 1 sec
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| muscle spasm amplitude? | visible contraction
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| muscle reeducation amplitude is? | functional activation of muscle, visible contraction
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| muscle spasm time of treatment | 10-30 min
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| chronic edema waveform is? | symmetrical biphasic pulsatile current
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| chronic edema frequency is? | 35-50 pps
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| chronic edema pulse duration is? | 150-200= small muscles, 200-350= large muscles
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| chronic edema on:off time? | 2-5 on, 2-5 off. 1:1
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| chronic edema ramp? | >1 sec
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| chronic edema amplitude is? | visible contraction
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| chronic edema treatment time is? | 30 min
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| conventional TENS waveform | Monophasic/biphasic
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| conventional TENS frequency is? | 100-150pps
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| conventional TENS pulse duration is? | 50-80 us
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| conventional TENS on; off is? | continuous
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| conventional TENS amplitude is? | "strong but comfortable"
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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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| Accupuncture like TENS waveform | Monophasic/biphasic
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| Accupunture like TENS frequency is? | 2-10 pps
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| Accupuncture like TENS pulse duration is? | 100-200 pps
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| Accupuncture like TENS on:off | continuious
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| Accupuncture like TENS amplitude is? | visible contraction
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| Accupuncture like TENS treatment time is? | 20-30 min
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| Accupuncture like TENS releases what? | endorphins
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| Interferintial current waveforn is? | AC
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| Interferential current on:off is? | continuous
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| Interferential current amplitude is? | "strong but comfortable"
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| Interferential current treatment time is? | varies
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| Interferential current may be quad polar or | bipolar (pre-mixed)
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| Iontophoresis waveform is? | DC
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| Iontophoresis amplitude is? | Patient tolerance, no more than 4mA
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| Iontophoresis tiem of treatment is? | depends on amplitude
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| iontophoresis polarity is? | same as drug (drives drug into skin)
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| iontophoresis total dose= | 40mA. min
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| Tissue healing waveform is? | DC monophasic or HVPC
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| Tissue healing frequency is? | 60-125 pps
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| tissue healing pulse duration is? | 40-100us
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| tissue healing on:off is? | continuous
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| tissue healing amplitude is? | comfortable tingling sensation
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| tissue healing treatment time is? | 45-60 min
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| tisssue healing polarity is? | + for clean wound, --for injection
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| Acute edema wavefrom is? | DC monophasic or HVPC
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| Acute edema frequency is ? | 120 pps
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| acute edema pulse duration is ? | 40-100us
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| acute edema on:off is | continuous
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| acute edema amplitude is? | comfortable tingling sensation
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| acute edema treatment time is? | 30 min
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| acute edema polarity is? | Negative
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| What is charge (Q)? | matter has a positiv charge ( +), a negative (-), or is electrically neutral, measured in coulombs (C)
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| free electrons flow from an area of excess electrons (negative pole) to an area defiecient in electrons (positve pole) | polarity
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| What is electricl current (I)? | the flow or movement of charged particles through a conductor following an applied electrical field.
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| What is Voltage (V)? | electrical force moving charged particles through a conductor between 2 regions or points, may also be called potential difference, measured in volts (V).
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| What is resistance (R)? | property of the conductior that resists the flow of charged particles, measured in Ohm's
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| Direct current (DC) Waveforms | continuous and unidirectional flow of charged particles (either + or -), used for Iontophoresis and stimulting denervated muscles to contract, occasionally will be used with wound healing
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| Alternating current (AC) Waveforms | continuous and bidirectional flowof charged particles (+ and -), no pulse charge remains in tissues as there is equal ion flow in both directions
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| AC wavelength= duration of one cycle= | inverse relationship between cycle duration and frequency, as frequency increases, cycle duration decreases
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| Pulsed/Pulsatile current is? | electrical current delivered discontinuously, periods of pulsing followed by periods where no current is flowing( usually off longer than on), may be unidirectional.
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| what is interferential current (IFC)? | waveform produced by interference of 2 medium frequency sinusoidal AC's of slightly different frequencies at a 90 degree angle- delivered through 2 sets of electrodes in separate channels through one machine (4 electrodes, 2 channels), produces beats
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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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| what is Beat frequency? | 4100Hz-4000Hz=100Hz
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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--continuouis AC with increase average amplitude, stimulates a larger area
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| what is premodulated current? | continuous sinusoidal waveform with medium frequency coupled with a sequentially increasing and decreasing current amplitude (same concept as IFC), wave interference occurrs, then delivered through 2 electrodes, 1 channel, not the same benefits as IFC
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| Russian Protcol | 2500Hz carrier AC frequency with 50 burst per second, each burst is polyphasic waveform delivered for 10 usec, followed by a rest interval of 50 usec, usually a 10 minute treatment (10/50/10 protocol)
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| What is Phase duration? | duration of one phase of the pulse, described in microseconds (us) or milliseconds (ms), controls comfort of stimulation, less skin impedance, less chemical changes under the electrode, better discrimination
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| What is Interphase interval? | time between phases of a pulse
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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 ramp down? | time it takes current to go from mazimum to 0 amplitude for any one on time, allows patient to acclimate to the stimulation, providing comfort as compared with attaining maximum amplitude right from the start, Off time
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| what is On time? | time when a run of pulses occurs and current exists,muscle contraction, usually expressed as a ratio 1;5
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| what is Off time? | time between trains of pulses when no current exists, relaxation, ususally expressed as a ration 1;5
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| What is Duty cycle? | ration of on time to totla cycle time, On 10 sec, off 50 sec=10;60 or 1;6 duty cycle
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| what is modulation? | any vartiation, cyclic or random, of one or more of the stimulation paramaters, limits adapttion of the neurons to current
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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 amplitude modulation? | varying the peak amplitude, usually referred to as scan
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| what is phase duration/pulse duration modulation? | varying the phase or pulse duration
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| what is Burst mode? | series of pulsed delivered in an "envelope" as a single pulse, frequency and duration preset
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| what is burst duration? | time from beginning to end of the burst
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| what is interburst interval? | time between burst
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| basics of nerve depolarization? | nerves communicate with one otnother through the production of aton potientials(AP), created by depolarization and repolarization of nerves,
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| AP's are all or none | AP's occur in a nerve when its threshold is reached. Further increasing the current amplitude or pulse duration doesn't make the AP larger or longer.
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| Resting potiential is? | difference in electrical potential across the cell membrane when information is not being transmitted.--70 mV= maintainted by Na+/K+ pumps and large, negatively charged ions trapped inside the cell.
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| Depolarize= | --55mV= threshold level that will reate an AP, relies on Na+ channels opening, sodium channels open fast and sodium rushes into make inside more positiively charged.
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| Repolarize= | membrane potential returns to more negative state and resting potential is restored , when membrane potential is +30mV, Na+ channels close and K+ channels open to allow K+ out of the cell and the membrane replarizes to --70mV.
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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 reploarize nerve. K+ is pushed out of the cell becuse of the large concentration of K+ inside of the cell and because of the positive charge inside the cell.
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| first fibers stimulated in physiological contrations are | slow twitch, smaller, unmylelinated
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| first fibers stimulated in a stimulated contraction? | fast twitch,larger,myleniated
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| principle of muscle strenghtenign overload principle | Greater load-->grater force production-->greater strength
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| principle of muscle strenghtening specificity principle | activating type 2 fibers-->greater force-->greater strength
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| Specific uses of e-stim with innervated muscles | increasing strength/endurance, decreasing spasticity, treating urinary incontinence secondary to pelvic floor dysfunction, and muscle contraction to promoate blood flow>> decrease risk of DVT, motor reeducation
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| muscle contraction for deenervated 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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| Conventional or high rate TENS is used for ? | pain control
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| In conventional or high rate TENS, pain modulation basics are? | activateing AB nerves, alter pain pereption carried on A? an C fibers, requres certain parameters in order to be stimulated, can alter pain-spasm-pain cycle and further decrease pain, adaptation can occurs if no changes are made, this is the reason for mo
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| General parameters of Conventional or High rate TENS are | short pulse duratrion, comfortable amplitude (strong but comfortable), suded while pain is presient, can be used constantly
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| Low rate or acupuncture like TENS basics are | stimulation and depolariation of muscles and A? leads to release of endorphins and enkaphalins (endogenous opiates), controls pain for 4-5 hours after treatment of 20-30 minutes
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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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| What is absolute refactory period? | when the membrane is deplarized, it is not possible to create antother AP
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| what is relative refactory period? | after depolarization occurs, a short hyperpolarization period occurs, a stronger than normal AP would be required to produce antother AP, this is an important consideration when talking about AP conduction being unidirectional, as time is required for rep
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| AP propagaton/conduction | AP triggered in adjacent nerves and along the neuron, phjusiologically , propogation usually occurs in olnly one direction, with estim, AP propagation can occur in both directions but effects are only seen in the direction typically seen with physiologica
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| Sensory nerves do what? | (Afferent) will always submit sensory info to the brain,also lowe current amplitude and shorter pulse duration depolarize
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| motor nerves do what? | (Efferent) will always submit motor infor to the muscles, higher amplitude and longer pulses are requred to depolarize.
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| Propagation speed is what? | depends on nerve diameter and myelination
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| What is Salutory 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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| Pain transmitting C fibers do what? | high amplitude and longer pulses are required to depolarize
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| What is Strength-duration curve? | minimum amount of electrical current (combination of amplitude and pulse duration) requred to depolarize the nerfe and lproduce an AP in a specific type of nerve.
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| what is Rheobase? | minimum amplitude requred with a long pulse duration to produce an AP (meauseures amplitude)
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| what is Chronaxie? | minimum duration to stimulate nerve at twice rheobase (measures time/duration)
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| What is accomodation? | 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 muscle depolarization? | innervated muscles contract with electricity from depolarization of motor nerves, denervated muscles contract with electricity from depolarization of the muscle cell membrane (requres longer pulses)
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| Ionic Effects are what? | Result from a net charge in the tissues following estim, requireing DC monophasic waveforms, not biphasic waveforms, used in the clinic with ionto to repel ions from the anode or cathode (depending on medication) and increase transdermal deliver of drug,
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| Brief intense TENS is used when? | to provide immediate, short term relief, often used in the clinic befor especially painful procedures(joint mob, PROM, etc)
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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 reliler similar to high rate TENS
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| Tissue healing occurs through? | attraction and activation of cells needed for tissue healing in the area (neutrophils, leukocytes,), modification of endogenus electrical potential of tissues, reduction of edema, increased antimicrobial activity, promotion of circulation,increased synthe
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| Waveforms found to be the most useful is HVPC | (-) HVPC can decrease the amount of new edema formation but dosen't alter existing edema, (+) HVPC dosen't effect edema
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| Negative electrode attracts? | activated neurophils ( present with infection or inflammation) lymphocytes, platlets and mast cells, fibroblast, used for infected of inflamed wounds, acute stage of healing
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| Postive electrodes atrracts? | inactive neutrophils and macrophages, epiderma cells, used with necrosis without inflammation and wounds in the proliferation stage, clean wounds.
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| Transdermal drug delivery (Iontophoresis) | use a low voltage DC to move charged ions across the drmis by increasing the permeability of th statum corneum, penetratio is likely 3-20 mm, current must be the least suffiecent to overcome the resistance of th skin and electrode
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| common medication used in therapeutic setting is | Dexamethosone (0.4 % soultion (-), corticosteroid tht acts as an anti-inflammatory, useful with tendonitis or bursitis
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| Iontophoresis is described as milliamp minutes (mA. minutes) | set ampliuitde to patient comfort and adjuist time fro there 40 mA is currently recommended for treatment.
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| Demand cardiac pacemaker or arrhythmias, estim can interfere with the pacemakers's thythm, can alter unstable arrhytmias that are not treated | contrindication
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| Pacement of electrodes over crotid sinus on th anterior or laterna neck, induce rapid decrease in BP | contrindication
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| Areas of venous or arterial thrombosis or thrombophlebitis | contraindication
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| Pregnancy-over or around the abdoment or low back | contrindication
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| cardiac disease, MI, congential or acquired abnormalities | precaution
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| Impaired sensasation or mentation | precaution
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| malignant tumor, estim can enhance tissue growth, inculding malignant tissue | precaution
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| Areas with skin irritation or open wounds, open/damaged skin has lower sensation--> too much current delivery, if being used to treat the wound this is ok | precaution
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| Iontophoresis after other physical agents, alterled skin permeability--> too much current, with heat increased blood flwo--> drug delivery away form treatment area, ofpend skin pores allow too much drug to enter skin, with cold, decreased sensation preven | precaution
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| Adverse effects to estim | 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 bursn, reduced likelihood by increasing the size of the negative electode
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| Acidic reaction (+) | Hydrochloric acid forms under the postive electrode, less umcomfortable than alkaline reaction
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