Passive Care Exam 1: CONDENSED

What are the 4 stages of healing and what is the time frame for each?

1) Hemostasis (initial blood clot)

-- seconds to minutes

2) Inflammatory

-- hours to weeks

3) Proliferation

-- weeks to months

4) Remodeling / Maturation

-- months to years

What are the 5 cardinal signs of inflammation?

1) heat

2) redness

3) swelling

4) pain

5) loss of function

What phase of healing is characterized by vasodilation, increased capillary permeability, and phagocytosis (neutrophils & macrophages)?

Inflammation Phase

What is the purpose of the inflammatory phase? (3)

1) Defend against infection/foreign intruders

2) Remove debris and damaged tissue from area

3) Immobilize area

What 3 inflammatory chemicals can cause pain in the inflammation phase?

1) Bradykinin

2) Prostaglandins

3) Serotonin

In the inflammation phase, how can too much inflammation be bad?

Secondary enzymatic injury due to release of lysosomal enzymes

-- damages healthy tissue (non-specific) & cause secondary hypoxic injury

Secondary hypoxic injury can result in hemorrhage, clotting, edema, spasm, hematomas and can decrease O2 & nutrition to area

What are the 2 goals of the inflammatory phase?

1) Limit extent of inflammation to protect non-damaged tissue

2) Preserve ROM if safe to do so (ex: broken bone)

-- Use PRICE

(Protect, Rest, Ice, Compress, Elevate)

What phase of healing is characterized by angiogenesis, increase in fibroblasts, chondroblasts, and osteoblasts in the area to facilitate repair, and rebuild extracellular matrix w type 3 collagen & proteoglycans?

Proliferation/Repair phase

What are the 2 major goals of the proliferation/repair phase?

1) Decrease swelling & pain

2) Increase pain free ROM and begin non-weight bearing proprioceptive training

What phase of healing is characterized by scar contracture, decrease in blood vessels, and type 3 collagen replaced by (stronger) type 1 collagen?

Remodeling/Maturation phase

What are the 3 major goals of the remodeling phase?

1) Increase pain free ROM

2) Regain full strength and normal biomechanics and progress proprioceptive training

3) Protect and strengthen any remaining joint instability

What are the 3 reasons why stress/active care is applied during the remodeling phase?

Tension on connective tissue causes:

1) increased collagen diameter

2) Increased cross-linking

3) Increased number of collagen fibrils & density. (Collagen also aligns in more organized parallel fashion to increase number of cross links & optimal strength)

What is the number of electrons flowing?

Electrical current

Electrical current requires what 3 things?

1) Source of electrons

2) Electron imbalance (driving force)

3) Pathway (conductor)

What is the potential difference or potential energy of electricity?

Electrical voltage

What is the force opposing the flow of electricity through a conductor?

Electrical resistance

What is the resistance to the flow of electricity through complex materials such as human tissue?

Electrical impedance

What is the ability of a material to store an electrical charge?

Capacitance

What is current flow in one direction?

Monophasic current

What is the current flow in two directions: both positive and negative?

Biphasic current

What is the electrical current as it rises form the isoelectric line (zero current) to peak and back to zero?

Phase

What is equal to one phase for monophasic current and equal to two phases for biphasic current?

Pulse

What is the "on time" divided by (on time + off time), and expressed as a percentage? (on / on + off)

Duty Cycle

What type of curve is a combination of amplitude and phase duration, so if the amplitude is high enough and the phase duration is long enough, the nerve will depolarize, but if the amplitude is too low no depolarization will occur no matter how long the phase duration is as well as if the phase duration is too short then no depolarization will occur no matter how high the amplitude?

Strength Duration curves

What is the minimum amplitude needed to cause depolarization when the phase duration is infinite?

Rheobase

What is when the amplitude is 2x the rheobase and the phase duration is slightly longer than the minimum needed to depolarize the nerve fiber, with the result the greatest comfort for the patient?

Chronaxie

What occurs at 35-50 pulses per second in an alpha motor neuron, where the individual contractions of the muscle fiber become one tetanic contraction that won't relax unless the current is turned off?

Temporal summation of an alpha motor neuron

What value is low frequency current?

0-1000 Hz

What value is medium frequency current?

1000 - 100,000 Hz

What value is high frequency current?

> 100,000

What is monopolar electrode configuration?

2 electrodes for current to flow

-- one electrode is large (dispersal electrode) and one electrode is small (treatment electrode)

What is bipolar electrode configuration?

Two equal sized electrodes

What is quadripolar electrode configuration?

4 electrodes

-- arranged in a criss-cross fashion (true IFC)

For Russian current, what is single channel mode?

one channel

- 2 electrodes on one muscle

-- makes single muscle contract

For Russian current, what is reciprocal mode?

Two channels

- 4 electrodes on agonist/antagonist

-- coordinated contractions

For Russian current, what is simultaneous co-contract mode?

2 channels

- 4 electrodes on pairs of muscles that typically contract together

- simultaneous contractions

What is it called when 2 sinusoidal waves are exactly in phase to combine together to create a 3rd current with the same frequency and double the amplitude of currents 1 & 2?

Constructive interference

What is it called when 2 sinusoidal waves are exactly out of phase combine together to cancel each other out, resulting in no net current?

Destructive Interferential

What are the 2 indications for Interferential current?

1) Pain (acute or chronic)

2) Muscle strengthening (pelvic floor post-partem women only)

What is a combination of constructive and destructive interference which creates beats of electricity?

Heterodyne Current

Regarding heterodyne interference, if Channel 1 = 4000 Hz and Channel 2 = 4100 Hz, what is our beats per second?

100 beats per second (4100-4000 = 100 bps)

What are the 4 methods of interferential current?

1) True IFC

2) Premod

3) Vector Scan

4) Stereodynamic

What type of interferential current is where the electrodes are applied in a quadripolar pattern (4 electrodes, 2 channels, crisscross pattern) and creates a "cloverleaf" shaped treatment area?

True Interferential IF

What type of interferential current is where electrodes are applied in a bipolar pattern (2 electrodes, 1 channel), with the interference of the 2 electrical currents occurring in the machine, NOT the patient?

Premodulated Current IF

What type of interferential current has a quadripolar electrode placement and varies the amplitude between the 2 channels to cause the cloverleaf pattern to rotate or oscillate back and forth, creating a larger treatment area?

Vector Scan IF

What type of interferential current uses 3 channels and 6 electrodes, making a 6 petal flower shape stimulation pattern?

Stereodynamic IF

What is the treatment frequency for acute pain for IF? Chronic pain?

Acute = 80-150 Hz

Chronic = 1-15 Hz (or 1-10)

What is the typical treatment time for interferential current when treating pain?

15-20 minutes

What is the amplitude for IF?

Patient comfort (strong but comfortable tingling sensation)

What are the parameters for IF when muscle strengthening? (Frequency, Time, Duty cycle)

Frequency = 40-60 Hz

Time = 15-20 mins

Duty Cycle = 10:50

-- Premod IFC w/ bipolar electrode placement

What are the 4 indications of Russian Current?

1) Muscle re-education (muscle strengthening)

2) Retard atrophy (prevent muscle atrophy)

3) Muscle strengthening

4) Decrease muscle spasm

What is the carrier wave frequency for Russian Current?

2500 Hz (medium frequency)

What is the burst rate of Russian Current?

35-50 Hz

What is the target muscle fiber for Russian Current?

Alpha motor neurons

What is the duty cycle for muscle strengthening? On : Off ratio?

Duty cycle = 16.7%

On : Off = 10 : 50

What is the duty cycle to relax muscle spasm? On : Off ratio?

Duty cycle = 50%

On : Off = 10 : 10

What is the correct amplitude for Russian Current?

Patient tolerance

(40-70% of maximum voluntary contraction)

What is the amplitude gradually ramping up to the maximum level and then at the end of the stimulation time it ramps down? What should this value be in Russian Current?

Ramp Rate

0.5-2s

What Russian current protocol is two electrodes (bipolar placement) near the origin and insertion at about the muscle-tendon junction, arranged so the current flows parallel through the muscle fibers?

Single Muscle contraction protocol

What Russian current protocol is 4 electrodes (quadripolar) form 2 channels set up on agonist/antagonist muscles so the electrodes are placed near the origin and insertion at about the muscle-tendon junction, arranged so the current flows parallel through the muscle fibers and is for a coordinated contraction of two agonist/antagonist muscles?

Reciprocal protocol

What Russian Current protocol has 4 electrodes (quadripolar) form 2 channels set up on two muscles that frequently contract together, such as R & L paraspinals, so the electrodes are placed so the current flows parallel through the muscle fibers, and this is for simultaneous contraction of two muscles?

Co-contract protocol

What is the Russian Current electrode placement protocol for a Single muscle? Reciprocal? Co-contract?

Single muscle = Bipolar electrode placement

Reciprocal = quadripolar electrode placement

Co-contract = quadripolar electrode placement

What is the goal of NMES?

Stimulate alpha motor neurons and cause a strong muscular contraction

What are the 2 primary goals of NMES? Secondary goal?

Primary =

1) Retrain lost muscle function (surgury/injury)

2) Decrease muscle atrophy after immobilization

Secondary =

3) Decrease muscle spasm

What type of contraction recruits slow twitch fibers first, then fast twitch if they are needed, the muscle fires asynchronous to reduce fatigue, a strong contraction WILL inhibit the GTOS, and minimal fatigue occurs due to asynchronous firing?

Physiologic contraction

What type of contraction recruits fast twitch fibers first because they have a lower capacitance, muscle fires synchronous and contraction continues until stimulation is off, GTO is activated but overpowered by the direct current and results in NO inhibition, and muscle fatigues rapidly?

Electrical contraction

What 3 currents can be used for NMES?

1) Russian current

2) Biphasic pulsed current

3) IFC (pelvic floor)

What is the use of electrical currents for pain relief and is a small portable stimulation devices that can be used outside of the clinic?

Transcutaneous Electrical Nerve Stimulation (TENS)

What is the indication for TENS?

Pain (acute/chronic)

What are the 3 protocols for TENS?

1) Sensory level (conventional mode)

2) Motor level stimulation (acupuncture/burst)

3) Noxious level (brief-intense)

What are the parameters for Sensory TENS: Pulse rate? Amplitude? Time?

Pulse Rate = 60-150 (acute pain!)

Amplitude = Patient comfort

Time = 20-30 minutes

(theoretically up to 24 hours/day)

What is the target nerve fiber for Sensory TENS?

A -Beta fibers

What are the parameters for Motor Level TENS: Pulse Rate? Ampitude? Treatment Time?

Pulse Rate = 0-15 Hz (chronic pain!)

Amplitude = patient comfort

Treatment Time = 20-30 mins

(but pain relief may not be until 30 mins - 2 hours later)

What are the parameters for Noxious level TENS: Phase duration? Pulse Rate? Amplitude? Treatment Time?

Phase duration = 10-20 ms

Pulse Rate = 60-150 Hz

Amplitude = Patient tolerance

Treatment Time = 30 seconds per point, 8-10 points per treatment session (need a point stimulator)

What is the target nerve fiber for Noxious level TENS?

C-fibers

What is the reason for Modulation of TENS currents?

Decrease patient accommodation to current by varying amplitude, pulse rate, or phase duration

What are the two types of ESTHR (Electrical Stimulation for Tissue Healing & Repair)?

1) High Volt Pulsed Current

2) Microcurrent

What type of ESTHR is twin peak with monophasic current and voltage at least 150 volts?

High volt pulsed current

What type of ESTHR is monophasic current with the amplitude below rheobase for A-beta fibers (subsensory)?

Microcurrent

What is the difference in voltage between layers of the skin and in injuries this difference in voltage contributes to healing?

Skin battery

How does ESTHR help with healing?

Increasing/augmenting difference in voltage between the injury and the surrounding healthy tissue

-- INCREASES skin battery

What is it called when certain cells are attracted to different electrical currents and migrate to those currents?

Galvanotaxis

What 2 cells prefer positive polarity?

1) Neutrophils

2) Macrophages

What 3 cells prefer negative polarity?

1) Fibroblasts

2) Epidermal cells

3) Keratinocytes

What phase of healing is positive polarity appropriate for?

Acute phase (when neutrophils & macrophages needed)

What phase of healing is negative polarity appropriate for?

Repair phase (when fibroblasts, epidermal cells, or keratinocytes useful)

How does High Volt current reduce edema?

Negative polarity repels negatively charged proteins & small peptide chains

-- pulls water w/ it by osmosis which reduces edema

What electrode placement is used for HiVolt current?

Monophasic electrode placement

(small treatment electrode w/ large dispersal electrode; treatment electrode set w/ desired polarity)

What are the 2 indications for HiVolt Current?

1) Healing (positive polarity)

2) Decreasing edema (negative polarity)

How do high volt and microcurrent change tissue pH?

Positive polarity attracts ACIDS

Negative polarity attracts BASES

What uses low voltage DC electrical currents to drive molecules across the skin and into the patients tissues?

Iontophoresis

What law is that like charges repel like, powering iontophoresis so that a positively charged electrode will repel positively charged ions and push them away from the electrode and into the skin and negatively charged electrodes will push negatively charged ions into the skin?

Coulomb's Law

How is the dose of iontophoresis calculated?

3 mA current for 25 mins = 75 mA/min dose

During iontophoresis, if using a positively charged ion such as calcium chloride, what polarity should the electrode be?

Positive (same charge as the ion)

What charge for the effects of low voltage DC current on the skin will increase pH and sclerolytic reaction (skin softening)? What charge decreases pH and sclerotic reaction (skin hardening)?

Negative charge

Positive charge