question

APTA house of delegates policy

answer

physical agents/modalities should be utilized only as a component of patient management without documentation justifying use of agents, the use of agents in the absence of other skilled therapeutic or educational interventions should not be considered physical therapy

question

electrical current is what

answer

flow of charged particles may be electrons or ions torpedo fish was used to alleviate pain

question

Luigi Galvani

answer

invented device to produce muscle contractions -named the current Galvanic current

question

Guillame Duchenne what did he do

answer

mapped out locations on skin where estim most effectively caused specific muscles to contract -called these MOTOR POINTS -parts where the muscle gets excited -denervated muscles will not contract

question

Michael Faraday what did he discover

answer

discovered that bidirectional electrical currents could be induced by a moving magnet called this current Faradic Current

question

Louis Lapicque developed what law related what to what of a stimulus to determine what

answer

developed 'law of excitation' relating intensity and duration of a stimulus to whether it would produce a muscle contraction all or none principle

question

Gate Control Theory how does this apply to electrical currents

answer

use of electrical currents for controlling pain is derived from the gate control theory of pain perception developed by Melzack and Well -using a TENS it takes place of medication, don't use them at the same time

question

Voluntary (physiological) vs. Electrically Induced Muscle contractions -what are two main differences related to recruitment

answer

order of recruitment of motor nerve fibers and muscle fiber types. SIZE PRINCIPLE pattern of recruitment of motor nerve fibers

question

Physiological Initiated Contraction -muscle fiber type -contraction force -speed of contraction -fatigue -atrophy -recruitment

answer

-slow twitch type 1 first -low contraction force -slow contraction force -fatigue resistant (not gonna tire out as much) -atrophy resistant -asynchronous

question

Electrically Stimulated Contraction -muscle fiber type -contraction force -speed of contraction -fatigue -atrophy -recruitment

answer

-fast twitch type 2 first -high contraction force -fast -fatigues quickly -atrophies quickly -synchronous

question

Estim Clinical Applications 7

answer

Muscle strengthening-- if muscle is weak, i.e. for TKR or surgery Muscle re education-getting perception back Pain control Facilitation of wound healing Resolving edema and inflammatory reactions after injury or surgery Enhancing transdermal drug delivery via iontophoresis

question

Effects of Estim clinical effects of electrical currents are the result of what

answer

are the result of the current stimulating the production of action potentials in nerves

question

strength duration curve -amount of electrical current required to produce an AP... -General rule

answer

amount of electrical current required to produce an AP in a specific type of nerve varies- order of recruitment, sensory, motor and pain (increase intensity you get the progression of these) higher and wider the pulse duration=lower amplitude needed for AP

question

short pulses generally produce what type of stimulation

answer

sensory stimulation common pin vs. knitting needle, which do you feel more

question

longer pulses in duration are used to

answer

produce muscle contractions

question

When current amplitude and pulse duration fall below the curve, the stimulation is considered to be...

answer

subthreshold and no response will occur won't get a reaction need the correct intensity to get a reaction

question

Current amplitude must do what for an AP to be triggered

answer

must rise quickly for AP to be triggered cant wait too long or muscle will fatigue

question

if the current rises to slowly

answer

the nerve will accomodate to the stimulus

question

Accommodation is the process of

answer

a nerve gradually becoming less responsive to stimulation; hence IFC

question

Denervated muscles -do not contract to what type of pulses -need lots of what for denervated muscles -need a pulsation of at least what -need what type of current

answer

-pulse duration is aka pulse width -pulses of electricity that produce contractions in innervated muscles -need lots of stimulation for denervated muscles, a pulsation of at least 10ms (milisec.) -DC

question

Innervated muscles contract in response to what kind of pulses To what kind of stimulation

answer

short pulses, because the current causes depolarization of their motor nerves this is known as NMES Neuromuscular electrical stimulation

question

Denervated muscles only contract in response to electricity lasting how long needs what kind of current what kind of electrical stimulation

answer

longer duration pulses 10 ms or longer Direct Current EMS; electrical muscular stimulation

question

longer duration pulses do what to the muscle cell, this is known as, what are they used for

answer

depolarize the muscle cell membrane directly EMS Denervated muscles

question

Ionic effects of electrical currents -What current does not leave a charge -are they common, do they have an ionic effect

answer

Balanced Biphasic waveforms MOST currents have balanced biphasic waveforms these leave no charge in the tissue AKA no ionic effect

question

Ionic effects of electrical currents Which currents do leave a charge and have an ionic effect

answer

DC, Pulsed Monophasic, and Unbalanced Waveforms charge of monophasic is positive

question

narrow pulse wider duration of pulse increase frequency

answer

more comfortable increased intensity need less amplitude

question

negative electrode AKA attracts and repels what kind of ions

answer

Cathode attracts positive ions repels negative ions

question

positive electrode AKA attracts and repels what kind of ions

answer

Anode attracts negative ions repels positive ions

question

DC can be used to repel what and increase what

answer

used to repel ionized drug molecules provides a force to increase transdermal drug penetration--called Iontophoresis

question

DC used for tx of what conditions

answer

inflammatory conditions, to facilitate tissue healing and reduce edema formation -Iontophoresis -HVG

question

Estim Indications 13

answer

pain management--TENS Muscle strengthening and re-ed; NMS Stimulation of denervated muscles; EMS Edema management-HVPC *Increasing ROM--NEMS* Fx healing; EMS Iontophoresis; use DC waveform Reduce spasm Reduce spasticity-stroke, MS Replace orthotics; FES Reduce Scoliosis-Help strengthen muscles Promote circulation Wound care

question

Primary difference b/w electrically stimulated and physio contractions is

answer

order of recruitment of motor units

question

with Estim, what kind of nerve fibers are recruited first and what are recruited last

answer

Nerve fibers with largest diameter axons are first and those with smaller ones are recruited last, AP's travel faster in nerve fibers with larger axon diameters

question

with physio contractions, what kind of nerve fibers are recruited first and what are recruited last

answer

smaller ones are recruited first and larger ones last

question

When using electrical currents to stimulate muscle contractions, patients should also do what

answer

preform physiological contractions

question

physio contractions have what kind of onset how does this differ from estim

answer

have smooth onset estim is rapid and jerky

question

what kind of rest times should be provided b/w contractions what kind of ratios how many contractions you want tells you how

answer

long rest times should be provided between contractions otherwise muscle will fatigue or be injured 1:3 1:4 1:5 for rest times; i.e. 10 sec on 50 sec off long the duration should be

question

The farther the pads are away from one another the

answer

deeper the penetration/stimulation will be if your not isolating the muscle you want move the pads closer together

question

If you want muscle to move or want muscle re-ed what kind of pulse per second provides smooth muscle contraction

answer

25-50 pps-this range doesn't over tire the muscle

question

muscle spasms pps

answer

70 pps

question

higher you go with pps, the

answer

smoother the contraction

question

Pulse Frequency is expressed in What is it

answer

PPS, CPS or Hz number of pulses or cycles per second

question

Muscle and nervous tissue respond depending on

answer

the length of time between pulses and on how pulses or waveforms are modulated

question

Kinds of electricity

answer

static or current

question

kinds of current

answer

DC, AC(alternating), Pulsed

question

Forms of Pulsed Current

answer

monophasic, biphasic, polyphasic

question

Characteristics of Biphasic or Polyphasic

answer

can be symmetrical or asymmetrical can be balanced or unbalanced

question

Parameters of Current

answer

Duration Pulse Rate Wave form Intensity

question

Parameters of Current Duration; Is measured in what a shorter pulse duration is what for the patient

answer

measured in microseconds; shorter pulse duration=more comfortable for patient

question

Parameters of Current Pulse Rate

answer

number of pulses per unit of time; pps, cps, Hz, frequency

question

Parameters of Current Wave form

answer

named for how they look

question

Parameters of Current Intensity -is measured in -greater the peak intensity the ___ -depth of penetration is related to what

answer

measured in milliamps peak intensity is average ^ the peak intensity=deeper the penetration depth of penetration related to number of motor units recruited

question

Frequency What kind of response does each of these give: 1-15 pps 15-200 pps 20-80 pps 80-120pps

answer

twitch response (1-15) static/sustained tetanic contraction (15-200) tetany without fatigue (20-80) fatigue in 1 to 2 minutes, great for muscle spasm (80-120)

question

what ratios do not fatigue muscles

answer

1:3 1:4 1:5

question

What kind of pulsed current is used for fine motor control

answer

asymmetrical biphasic

question

Therapeutic Goals of Estim -EMS -ESTR -NMES -FES -TENS

answer

Maintain muscle viability (EMS) edema, circulation, wound healing (ESTR) restore muscle function (NMES) functional activities (FES) pain management (TENS)

question

Trigger points

answer

small areas of localized sensitivity and pain found in muscles and CT

question

Motor points what is it where are they why is this important

answer

point at which muscle is most easily excited usually located about the center of muscle mass where motor nerve enters muscle need to be near it to get a rxn

question

Wound Healing with Cathode, negative polarity -what are the effects

answer

Cathode, negative polarity ^ Circulation Stimulate fibroblastic growth and collagen prod'n Induce epidermal cell migration Inhibit bacterial growth -for inflamed or infected wounds

question

Wound Healing with Anode, positive polarity -what are the effects

answer

attract macrophages promote epithelial growth reduce the growth of hypertrophic scars -to promote healing of wounds w/out inflammation

question

Wound healing in general Negative electrode/Cathode is used for what Positive electrode/Anode is used for what

answer

Negative: used to promote healing of inflamed infected wounds Positive: used to heal wounds with no inflammation

question

Electrode Arrangement Terminology

answer

monopolar placement-1 pad bipolar placement-2 pads quadpolar placement-4 pads

question

Pad size Small vs. Large

answer

Small= more concentrated Large=less concentrated

question

IFC -needs how many pads -where will patient feel effect in regards to pad placement -what is it used for

answer

4 pads pt. will feel it at the intersection of the four pads used for pain, edema, muscle spasm

question

Subacute, Acute and Chronic Hz

answer

subacute--10-100Hz, sensory intensity acute; 80-150hz, sensory intensity (sweep) chronic; 1-10Hz-here you feel it more

question

For estim you set the intensity then do what before putting on cold or hot pack and why

answer

turn it down, then after applying CP or HP, turn intensity back up because compression magnifies intensity

question

what kind of duration do you want for muscle stimulation

answer

wider duration

question

IFC and Carrier Frequency

answer

if IFC is 5000 Hz and carrier frequency is 5100 Hz; a 100Hz is what the patient feels

question

NMES requires an intact what and what kind of muscle what stimulator is needed if you don't have this

answer

intact PNS; innervated or partially innervated healthy muscle DC stimulator required if PNS is not functioning

question

NMES indications 7

answer

retard or prevent disuse atrophy muscle reeducation maintain or increase ROM relax muscle spasm increase local blood circulation postsurgical prevention of venous thrombosis gait training

question

NMES clinical benefits 7

answer

selective, repetitive and reproducible motor activity joint movement relatively normal improves pt. compliance ^strength and endurance more comfortable for patient increased circulation feedback effect for facilitation and increased sensory awareness

question

Biphasic Waveforms

answer

symmetrical balanced asymmetrical balanced asymmetrical unbalanced

question

Symmetrical Balanced Biphasic -benefits -require less of what for a desired response -more efficient for what muscles -can treat many what

answer

less amplitude for desired response more efficient for large muscle stim; more recruitment can treat multiple motor points

question

Asymmetrical Unbalanced Biphasic -benefits -easier to do what -minimizes what -more efficient for what muscles

answer

easier to do precise placements minimizes overflow more efficient small muscle stim

question

Acute pain characteristics

answer

very localized sharp intense coupled w/ inflammatory process associated w/ injury, incident or invading organism red, hot, swollen, painful

question

Acute Pain -examples

answer

sprains, strains, contusions muscle spasms, guarding low back strain cervical strain whiplash headache tendinitis, bursitis, overuse

question

Estim Tx options for acute pain

answer

IFC/ Premod--polyphasic HVPG--monophasic Biphasic

question

Acute Pain electrotherapy will have what kind of frequency, intensity and duration combo will have what kinds of estim and US

answer

Electrotherapy: high frequency, sensory intensity, narrow pulse duration Combo: -US=nonthermal -Estim=sensory only; no DC, Russian or continuous

question

Sub-acute to Chronic Pain lasts how long chronic pain lasts how long --describe pain

answer

from 48 to 96 hours post trauma chronic is 96 hours and on -pain is poorly localized -usually diffuse in nature -deep ache -can be extra segmental -not hot or red but might be swollen, but swelling is not increasing

question

Sub-Acute/ Chronic Pain Tx Estim treatment options

answer

biphasic IFC/ Premod HVPG

question

Sub-Acute/ Chronic Pain Tx Guidelines electrotherapy will have what kind of frequency, intensity and duration combo will have what kinds of estim and US

answer

low frequency probe may be used sensory to motor intensity (more chronic=more motor) Thermal US Combo: -subacute=US, mildly thermal, Estim sensory only -chronic=US, Thermal Estim; motor response

question

Russian is not appropriate for

answer

subacute to chronic pain OR acute edema

question

Acute Edema

answer

sprains, strains, contusions post surgical swelling edema associated with wounds

question

Treatment options for Edema what kinds of estim what's not appropriate is there value in using US alone

answer

Estim: HVPG, IFC, Premod, Biphasic Russian IS NOT APPROPRIATE for acute edema No value in using US, use combo if the Estim portion is appropriate for edema and US is desired for treating other symptom at the same time

question

Chronic Edema what are characteristics of chronic vs. acute edema

answer

redness, heat, and pain have subsided or are subsiding but edema remains; area is pale and cool chronic edema is associated with traumatic injuries remains swollen beyond subacute stage

question

Chronic Edema Treatment options estim options 3 don't use what 2

answer

Estim: Biphasic HVPG Russian *no IFC or Premod

question

Treatment of Wounds what kind of US and HVPG don't use what 3 things

answer

HVPG-monophasic US-monophasic *no IFC, Premod, or Russian

question

Muscle Re-education treatment options 3 things

answer

biphasic russian HVPG with probe

question

Muscle Re-education treatment guidelines what kind of pulse duration what kind of electrode use what kind of contractions what can we ask of the patient duration of treatment should stop when

answer

use widest pulse duration tolerable use largest appropriate electrode (not to effect uninvolved muscles) use tetanic contractions, but excessive frequency only hastens fatigue patient participation whenever possible duration of tx; stop at signs of fatigue, redness, aching, cramping

question

current density

answer

amount of current per area

question

electrical current

answer

movement/flow of ions through a conductor.

question

EMS

answer

electrical muscle stimulation application of electrical current directly to muscle to produce a contraction

question

FES

answer

functional electrical stimulation application of a current to produce contractions that are applied during a functional activity i.e. estim during DF during swing phase

question

Gate Control Theory

answer

theory that pain is modulated at the spinal cord level by inhibitory effects of nonnoxious afferent input

question

impedance

answer

opposition to current flow Noted by Z and measured in Ohms

question

NMES

answer

application of current to motor nerves to produce contractions of muscles

question

phase

answer

period from when current starts flow or ends flow or starts to flow in other direction

question

polarity

answer

stays same with DC or Monophasic current changes with AC or biphasic current

question

resistance

answer

opposition of a material to the flow of electrical current. noted as R, measured in Ohms

question

Voltage

answer

force or pressure of electricity

question

AC

answer

continuous bidirectional flow of charged particles -no charge left in tissues

question

biphasic pulsed current

answer

series of pulses wherein charged particles move in one direction and then in opposite direction

question

Continuous current

answer

continuous flow of charged particles without interruptions or breaks if it goes in one direction it's DC if it goes in back and forth in two directions its AC

question

IFC

answer

waveform produced by the interference of 2 medium frequency sinusoidal AC's of slightly diff. frequencies

question

medium frequency

answer

an AC w/ a frequency between 1000 and 10,000 Hz (usually its b/w 2500 to 5000 Hz)

question

monophasic pulsed current

answer

series of pulses where charged particles move in only one direction

question

premodulated current

answer

an AC that uses a med. frequency sinusoidal waveform w/ sequentially increasing and decreasing amplitude

question

pulsed current

answer

interrupted flow of charged particles; current flows in series of pulses, can flow in one direction or back and forth

question

russian protocall

answer

med freqency of AC with frequency of 2500Hz delivered in 50 bursts/sec.

question

frequency

answer

number of cycles or pulses per second

question

interphase interval

answer

time b/w phases of a pulse

question

interpulse interval

answer

time b/w individual pulses

question

phase duration

answer

duration of one phase of a pulse. usually expressed in micro or miliseconds (ms)

question

pulse duration

answer

time from beginning of first phase of a pulse to end of the last phase of a pulse

question

ramp up/ ramp down time

answer

time it takes for current AMPLITUDE to increase from 0

question

rise time/ decay time

answer

time it takes for current to increase from 0 to it's PEAK during any one PHASE

question

wavelength

answer

duration of 1 cycle of AC -similar to pulse duration of pulsed current

question

amplitude (intensity)

answer

magnitude of current or voltage

question

amplitude modulation

answer

variation in peak current amplitude over time

question

scan

answer

amplitude modulation of IFC causes patient to feel focus of stimulation in a different location

question

Sweep

answer

the variation of number of pulses per sec. delivered in an IFC

question

types of electrical current

answer

static electricity--produced by friction current electricity--flow of electrons in a conductor DC--continuous flow in one direction AC--periodic reversal of flow

question

effect of electricity (3)

answer

thermal-inflammation reduction chemical-iontophoresis magnetic-nerve and muscle depol.

question

adverse effects of estim

answer

burns, skin rx to electrodes, pain

question

Bodies own Conductors -conductor -semi conductor -insulator

answer

nerve and muscle (loosely bound electrons) ligaments and tendons (medium bound electrons) skin, fat and bones (tight bound electrons)

question

current

answer

flow of charged particles through a conductor, expressed in amperes (I)

question

voltage

answer

force capable of moving charged pariticles through a conductor (V)

question

charge

answer

property of matter; no charge=neutral negative means more electrons than protons positive means less electrons

question

polarity

answer

having two oppositely charged conductors; anode and cathode

question

resistance

answer

property in conductor in opposition to flow of charged particles ohms=R

question

ohms law

answer

V=I x R, voltage is directly proportional to current flow

question

Parameters of current

answer

duration- shorter=more comfy pulse rate waveform intensity (miliamps)

question

trigger points vs. motor points

answer

trigger point=small areas of sensitivity and or pain in tissue motor point=point at which muscle is most easily excited, usually near muscle belly

question

Innervated vs. Denervated contraction caused by

answer

Innervated=muscle contraction b/c of depol. of MOTOR NERVE Denervated=muscle contraction b/c of depol. of CELL MEMBRANE directly

question

law of excitation

answer

strength and duration of a current determines tissue excitability

question

excitatory response

answer

1st=sensory; access gate theory 2nd=motor; AP 3rd=pain; noxious stimuli can be used for pain control

question

strength duration curve general rule

answer

higher and wider the pulse duration=lower amplitude needed for AP

question

specificity theory

answer

estim activates fast twitch type 1 first resulting in greater strength gains than with the exercises alone with the same force contraction

question

estim contra's

answer

adjacent to or distal to thrombophlebitis over cardiac condition near carotic sinus pregnacy cancer infection active TB

question

estim precautions

answer

obesity may exacerbate eczema, psoriasis, acne metal devices peripheral neropathies SCI

question

beat frequency

answer

what the patient feels, intersection of IFC

question

pulse duration goes down

answer

frequency can go up

question

things the therapist needs to think of

answer

stage of injury depth of tissue injury goals

question

what Hz do you use in the stages of injury acute subacute chronic

answer

Acute=80-150Hz Subacute=10-100Hz Chronic=0-10 Hz

question

HVG -uses what current -what's an adverse chemical effect -Continuous is for what -Interrupted is for what

answer

Direct Current -can cause burns; formation of hydrochloric acid under positive electrode, and sodium hydroxide under negative electrode -Continuous is for Iontophoresis -Interrupted/Galvanic: stimulates denervated muscles, must be a minimum of 1 sec. pulse duration

question

IFC -uses what current -What kind of output

answer

AC Can be uninterrupted bidirectional flow or Interrupted form known as Burst

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