OT 525 ESTIM – Flashcards

the application of electrical stimuli in order to accomplish a variety of therapeutic purposes and goals.

Neuromuscular electrical stimulation (NMES) for stimulation of innervated muscles; transcutaneous nerve stimulation (TENS) for pain; and functional electrical stimulation (FES)...

•Uses a pulsating AC current to activate muscles through stimulation of intact peripheral nerves. Stimulation of the nerve causes a motor response and is used to facilitate joint motion, muscle strength and also decrease muscle spasm. Can be used to reduce edema due to the effect of muscle pumping.

•term used to describe the wide variety of stimulators which are used for pain control. ____ uses surface electrodes with the goal of sensory analgesia rather than a motor response.

_____________ is the use of low-voltage direct current to ionize topically applied medication into the tissue. Iontophoresis is often used in the treatment of inflammatory conditions or for scar formation and management.

•There are a wide variety of stimulators to choose from with a variety of poorly supported claims by both manufacturers and clinicians. Research has been somewhat equivocal and the clinician must remain current with the research and claims, critically evaluating the claims as well as the outcomes of electrotherapeutic interventions.

________is the amount of time between the stimulation period and the rest period/ratio of the time the current is on to the time the current is off. ____may be expressed as a percentage or a ratio. ex: a treatment protocol in which electrical stimuli are delivered for 10 seconds followed by a 50 second off period would be expressed as a 1:5 ______.

determining muscle fatigue and as the patient's condition improves, the duty cycle can be gradually increased.

Changes which are made to the current, or to the pulse characteristics are known as modulation. Ramping is a change of the pulse intensity or duration. Ramp time is the time required for successive current stimuli to gradually reach the desired current amplitude or strength. Ramp down refers to the gradual decrease of the intensity and describes the movement of the peak amplitude/strength back to zero.

Changes which are made to the current, or to the pulse characteristics are known as_____

change of the pulse intensity or duration.

time required for successive current stimuli to gradually reach the desired current amplitude or strength.

refers to the gradual decrease of the intensity and describes the movement of the peak amplitude/strength back to zero.

Electrodes are the contact point providing the current flow from the stimulation device into the body. There are a variety of electrodes available commercially, and the electrode acts as an interface with the skin surface. Electrodes should offer little resistance to the current flow. •Common electrode material includes carbon rubber electrodes which are silicon rubber which is impregnated with small carbon particles. Metal or foil backed electrodes may have sponges over them...*The self-adhering* polymer electrodes may be reusable and do not require strapping or taping making them convenient to use.

________ should be changed often. With frequent use, carbon rubber electrodes may develop non-conductive areas due to the absorption of dirt, skin oil, or electrode gel and a depletion of the carbon rubber. This may cause "hot spots" or areas of higher current density which may be uncomfortable for the patient and cause skin burns. •Metal or foil backed electrodes are used with sponges and provide even conductivity throughout the electrode surface. This may be used when you need a dynamic electrode in an effort to get the best recruitment of a muscle....

•Regardless of the type of electrode used, instruction in proper skin care and hygiene is necessary to prevent skin irritation and breakdown. This factor becomes critically important for those clients who are using the stimulators on a home program or when there is prolonged placement and use of the electrodes. Clients who report a "biting" or "stinging" sensation during electrical stimulation may be experiencing uneven conductivity and the electrodes should be replaced.

may be self-adhesive as noted or adhered by using tape. Adequate contact with the skin is crucial and complete coverage of the electrode with gel, if used, is necessary. Current density is inversely related to the electrode size. This means that as the electrode size decreases or the contact area of the electrode decreases, the current density will increase. •As the current density is increased, there is a greater perception of the stimulation beneath the electrode along with a greater physiologic response due to the concentrated charge transfer. If there is excessive current density under an electrode, it can lead to client discomfort, surface or skin burns, and potentially damage tissue. •Due to the inverse relationship, smaller electrodes require less current to stimulate tissue with larger electrodes generally more current to get the same stimulation effect. •Electrode size is determined by the size of the targeted tissue. As the current density is greater in superficial layers of the skin, the distance between the electrodes will also influence the depth of the current flow. •When the electrodes are close together, the current passes superficially, and when they are farther apart, the current penetrates deeper. Location and orientation of electrodes must also be considered when stimulating muscles. This concept is important when recruiting superficial v. more deep muscles.

can be used to obtain an isolated contraction from the smaller muscles, such as those of the hand, though current density will be greater.

disperse the current into the tissue and are less specific in stimulating isolated muscles, especially smaller ones. Care should be taken when selecting and applying electrodes - very important to getting the therapeutic effects that you wish to obtain.

•Monopolar and Bipolar Techniques identify whether there is one lead electrode over the targeted tissue, or if both leads and electrodes are placed over the area.

uses one "treatment" or "stimulating" electrode which is placed over the targeted area. The other lead and electrode are placed over an area that is not affected by stimulation and is known as the "dispersive" or non-treatment electrode. •In the monopolar technique, only one pole or side of the circuit (active electrode) of the electrical stimulator is used to stimulate the targeted area. The dispersive electrode completes the electrical circuitry and can be placed away from the target area. Trigger and acupuncture-point stimulation is an example of a monopolar technique.

Bipolar techniques consists of both electrodes placed over targeted areas to cause stimulation of the tissue. Because both electrodes or sides of the circuit are in contact with the targeted area, the current flow is more localized and the stimulation is perceived under both electrodes of the circuit. Most often, the electrodes are of the same size and this technique can be used to stimulated large muscles or muscle groups. Bipolar techniques are the most common that we use and are often used with disuse atrophy, neuromuscular facilitation, inflammation, limitation in ROM and muscle spasms.

Pain is one of the most common complaints which cause patients to seek medical care. Adequate pain management is an important component which can facilitate occupational performance through its analgesic effect. •The two primary theories attributed to modulation of pain with TENS are the gate control theory and the endorphin theory. TENS is used to manage pain in musculoskeletal disorders. Treatment applications used electrical stimulation for pain control employ pulsed or alternating currents with a variety of stimulation patterns (variety decreases "accommodation" effect - explain). •The types of stimulation programs available with TENS are based on the neurological response to the stimulation. •The 4 primary types of stimulation frequently employed include: subsensory level, *sensory level*, motor level and noxious level. Stimulation sites for electrode placement should correlate with the structures and sources of pain and include motor points, trigger points and acupuncture points.

Transcutaneous Electrical Nerve Stimulation.

•Iontophoresis is a method of topically delivering a medication or ionized drug into an area of tissue by using direct electrical current. Iontophoresis is non-invasive, essentially painless if used right, and an effective way to administer medications to localized, targeted tissues. Clinically, occupational therapists frequently use iontophoresis in the treatment of inflammatory disorders such as CTS, Epicondylitis, Bursitis, peripheral nerve inflammation, tendinitis and tenosynovitis. •OT's using iontophoresis should have a thorough understanding of the pathophysiology of the condition, the wound healing process, and medications being used. Caution must be used whenever using iontophoresis as medications are being applied to the individual which could cause an allergic or anaphylactic reaction if severe. Patients should always be asked if they have any known allergies, sensitivities or reactions to foods or medications. •Documented orders should always be obtained from the patient's physician prior to using iontophoresis.

•Electricity has been advocated in the treatment of a variety of body systems and for a plethora of conditions. There are a number of claims for electrical stimulation along with a variety of protocols and applications, some objective, but many unsubstantiated, and the clinician should always take a systematic and objective approach to its use.

•There are a variety of clinical uses for neuromuscular electrical stimulation (NMES) as an adjunct or preparatory method to occupational therapy treatment. NMES is defined as the "use of electrical stimulation for activation of muscle through stimulation of the intact peripheral nerve" (APTA, 1990). Though NMES is often erroneously referred to as "functional" electrical stimulation (FES), FES refers to the use of NMES as a substitute for an orthosis to assist with functional activity such as standing, holding an object or even walking. EX. •NMES can be used for strengthening and endurance, ROM, facilitation of muscle function, management of spasms (and even spasticity - explain), edema reduction due to pumping action of muscle, and for an orthotic substitution (FES). Clinical uses of NMES requires a partially intact or intact, peripheral nerve. Its use with primary muscle disease (ie. ALS) or MD is questionable.

can be a successful adjunct or prep. method to conventional treatment in individuals with limited traumatic or neurological conditions/orthopedic injuries. •Clients who are deconditioned or have areas of weakness may benefit by NMES to improve endurance of the targeted muscle. Isometric strengthening using NMES produces good results in comparison to conventional isometric exercises along. NMES most effective when paired with functional goals and movements.

•Some neurologically impaired and orthopedic patients develop spasticity. ROM and positioning are often part of the overall training and education program for family members and caregivers. Clients with moderate to severe spasticity often have difficulty following through on these techniques and often develop limitations affecting their occupational performance. •Patients with hemiplegia who have chronic, moderate spasticity in the wrist and finger flexors may be appropriate candidates for this intervention. For a neurologically involved patient with moderate to severe spasticity, the stimulus should ramp-up (extensors) and be of sufficient intensity to allow for a slow stretch (of flexors) without increasing spasticity due to a quick stretch or jerk (Baker, 1993). Or...fatigue the muscles having the spasticity... •Ramp-up time should be extended 6-8 seconds or longer and proper positioning or blocking of undesirable muscles should be considered. Serial casting or splinting of the extremity can be an effective adjunct to NMES. The use of NMES is effective as part of a home program since the joint and musculature can be ranged several times daily with a temporary decrease in spastic muscles. •For orthopedic client, ROM may be limited due to immobilization, atrophy or pain. NMES may be used to improved muscle function and thus joint ROM.

has been used frequently for muscle re-education and facilitation particularly with neurologic injuries or for orthopedic injuries and surgery. Facilitation and retraining can be effective for patients experiencing disuse atrophy, muscle weakness and pain. •In neurologically involved patients, the goal of NMES is for facilitation and neuro-muscular re-education → achieving voluntary and isolated contraction eventually leading to functional movement. The intent of NMES for facilitation and re-education is to flood the CNS with motor, sensory and kinesthetic information, linked to an anticipated motor response. Duration of treatment is dependent on client.

•PAMS should not be used as a singular method or treatment approach in OT treatment. When paired with purposeful activity and occupation-based tasks, physical agents can provide the client with meaningful occupation-as-means intervention, thus effecting developmental structure (sensorimotor), and influencing purpose and motivation in therapy so that ultimately occupational performance is improved. •When used judiciously, taking into account diagnosis, the healing process, and phase of recovery, PAMS can be a valuable impact in the therapeutic occupational process, facilitating outcomes and occupational performance.