Essential Skills Stem 1 & 2

What should you use if your pt presents w/ pain and swelling?

IFC - interferential current

What techniques would you use for a patient with pain?

All TENS modalities, IFC, HVPC, Premodulated IFC

What modalities would you use with a patient for muscle strengthening?

Russian Stim, NMES, for pelvic floor - IFC/Premod

what modalities could you prescribe for edema reduction?

HVPC (fluid repulsion, or muscle pump), NMES, Russian, IFC

what modality would you prescribe for wound care?

HVPC

What modality can you use for every situation except strengthening?

HVPC

TENS: Conventional - PD, PF, Amplitude

PD: <150 microseconds, PF: >80, Amp: sensory, comfortable tingling

TENS: Acupuncture like - PD, PF, Amplitude

PD: <150microseconds, PF: <10Hz, Amp: sensory-motor, slights twitch

TENS acupuncture like modality uses gait theory or opiate meditated pain relief?

opiate mediated. slower onset, but longer lasting relief

TENS burst uses gait theory or opiate meditated pain relief?

opiate mediated, slower onset, longer lasting relief

TENS: Burst - PD, PF, Amplitude

PD: 200-500 microseconds, PF: 1-5 hz, AMP: sensory-motor

TENS: Brief Intense - PD, PF, Amplitude

PD: >150 microseconds PF: >80 Hz AMP: motor/nocioceptive

tens brie intense has what effect on muscle pain?

instant onset, short term, brief using time

TENS: Modulation - PD, PF, Amplitude

PD: Randomly varied, PF: Randomly varied, AMP: randomly varied

why would you choose yo do TENS modulation for a patient with pain?

bc it is constantly varied and therefore the patient cannot accommodate

Interferential Current - PD, PF, Amplitude

PD: 50-100 microseconds, PF: 50-110 HZ (gate), 1-10HZ (opiate), AMP: submotor, comfortable tingling

HVPC - PD, PF, Amplitude

PD: 100-200 microseconds, PF: as high as possible, AMP: Sensory threshold

Premodulated IFC: PD, PF, AMP

PD: 50-100 microseconds, PF: PF: 50-110 HZ (gate), 1-10HZ (opiate), AMP: Submotor

Russian: PD, PF, Amp

PD:150 - 200 microseconds, PF: 50-70, Amp: tetanic contraction

NMES: PD, PF, Amp

PD: 50-300 microseconds, PF: >33HZ, Amp: tetanic contraction

HVPC (fluid repulsion): PD, PF, Amp

PD: fixed, PF: as high as possible, AMP: sensory threshold

HVPC (muscle pump): PD, PF, AMP

PD:??? PF:1-10pps, amp: motor response

HVPC wound care: PF, Amplitude

PD: typically 100-200 microseconds PF: 30-200 pps, Amp: submotor

what modality can you use on everything except for strengthening?

HVPC

regular quadripolar IFC uses ___ pads.

4

remodulated IFC uses ___ pads

2

modality using the gate theory has a ______ ______

higher pulse frequency, usually higher than 50

a modality using an opiate release has a ____ _____.

low pulse frequency, usually less than 50

a modality that is looking for sensory level amplitude has a ____ _______.

short pulse duration

a modality that wants a high intensity amplitude would have a ____ ______.

long, pulse duration

insulator vs conductor

insulator blocks flow of energy and conductor encourages flow of energy

what property opposes current flow?

resistance

amplitude

magnitude of the current

pulse frequency

the amount of cycles or pulses per second

pulse duration

how strong and wide each pulse is

capacitance

ability of a device to store electrical energy by means of electrostatic field

inductance

stores energy in an electromagnetic field

direct current

flows in one direction for at least 1 second

what current is good for nerve regeneration?

pulsed DC

what type of current is good for muscle reeducation?

current modulation (changing intensity through interruptions)

duty cycle

sum of on time / sum of on and off time

modulation delays ______

accomodation

anode is _____

positive

cathode is ____-

negative

with 2 unequally sized electrodes, the current density is greater under the _____ electrode

smaller

monopolar set up

different sized electrodes, one acts as treatment electrode, other acts as dispersive

bipolar set up

electrodes are the same size, all have same current density

electrical coupling

how well the electrode sticks to the individual

a _____ frequency current may produce a brief muscle twitch with each stimulus

low

tetanic contraction, frequency _____

>33Hz

TENS brief intense and conventional mode both have onset of analgesia _____ with effects lasting ____

rapidly, hours

acupuncture and burst both have a ____ onset of pain relief and it lasts for ____ after use.

slow, hours

for the lab practical, when presented with pain, what is the most logistical choice?

modulation, because the machine does its own thing

interferential current uses the physiological effects of ______ frequency electrical stimulation.

medium

IFC is used for _____ and _____

pain, swelling

medium frequency devices aka ____ frequencies are tolerated well by the body because of their _____ skin impedence

carrier, low

the skins resistance is inversely proportional to the frequency of the current. lower stimulation frequency, the ______ the resistance in the skin and patient discomfort

greater

why can IFC go deeper into body comfortably?

because of the low skin impedance

IFC for a small treatment area use a _______ current.

pre-modulated

T/F: IFC frequencies are the same for both Gate theory and Opiate production

False: gate theory higher beat frequencies 90-150 Hz, opiate production low beat frequencies 1-5Hz

high volt galvanic stimulation is used for what three things

edema reduction, dermal wound healing, reduction of pain

HVPC can encourage edema management via two ways:

local muscle pumping action, fluid repulsion

HVPC modulates pain via the ____ _____.

gate theory

infected wound should have a ____ charged electrode

negative

noninflected wound should have a _____ charged electrode

positively

HVPC produces:

twin peak,monophasic, pulsed currents

HVPC is typically a very short pulse duration around ________, and a frequency is between ______.

100-200 microseconds, 1-200 pps

HVPC encounters ____ tissue impedance making it comfortable for the patient

low

in a monopolar set up the dispersing pad has toe ___ times larger than the other one.

4

what could you use in a spastic patient to decrease tone?

NMES

what are the 3 goals of Russian stimulation?

improve motor recruitment, facilitate mm hypertrophy, improve strength

during Russian stim, in what order do the mms get recruited?

fast to slow twitch

russian current ratio interval:

10s on 10 s off

to decrease spasm/spasticity via reciprocal inhibition what ratio should you use?

10 on 50 off, or a continuous mode to cause fatigue, 50s on 10 sec off

monopolar is 2 ____ sized electrodes

different

biopolar is 2 ____ sized electrodes

equally

treatment time for Russian stim

10-20 minutes, 10contractions for improving mm strength and 15-20 for decreasing spasm

the ____ the inter electrode distance the deeper teh tissue penetration

greater

acetate

negative, disolves calcium deposits in soft tissue

dexamethasone

negative, antiinflammatory

glucocorticoid

negative, anti-inflammatory

salicylate

negative , decreases local pain and inflammation

hydrocortisone,

positive, antiinflammatory

hyoluronisase,

positive, anti inflammatory

lidocane

postive, decrease local pain

zinc

positive, enhances tissue healing

how do you deliver iontophoresis?

continuous monophasic current with peak amplitude of 5 mA

emg

measures electrical activity of muscles and the nerves that control them