Passive Care- Exam 1- Interferential Current, Russian Current, NMES and TENS, Electrical Stimulation for Tissue Repair , Electrical Terminology

What type of currents penetrate deeper?

Medium frequency

What frequency does Interferential current (IFC) use?

3000-5000 Hz

IFC uses how many channels and how many electrodes

2 channels

4 electrodes

How must you apply the electrodes for IFC

Crisscross pattern

Treatment frequency is based on?

Type of pain

(Acute, subacute, chronic)

What produces the treatment frequency in IFC

Interference of the 2 currents in the body

What is it when two sinusoidal waves that are exactly in phase combine, and supplement each other?

Constructive interference

The combined current of constructive interferences has __________ the amplitude but ____________ frequency

2x amplitude

Same frequency

What is it when two sinusoidal waves are exactly out of phase with each other and results in cancellation of both waves?

Destructive interference

What is the combination of constructive and destructive interference?

Heterodyne

What type of wave results from a heterodyne interference?

Wave with a beat effect

How can you predict the beats in the combined wave of a heterodyne interference?

Difference of the 2 wave frequencies

What kind of interference does IFC use?

Heterodyne

What is the frequency we use for acute pain?

80-150 Hz

What is the frequency we use for chronic pain?

1-15 Hz

What is it when there is 2 channels (4 electrodes) and they are applied quadripolar?

True Interferential

During true Interferential, the electrodes are applied in ____________ fashion, and this creates a _____________ patterned treatment area

Crisscross (diagonal)

Cloverleaf

It is most intense where during true Interferential current?

Where currents cross

What does it mean when some machines can use "Target" during true Interferential current?

Reduce inaccurate of therapy by targeting the painful tissues

(Move the clover leaf pattern around)

What is the same as IF but the interference occurs in the machine, not the body?

Premodulated current

What type of current is good for small treatment areas?

Premodulated current

Premodulated current uses how many electrodes?

2

What allows for effective pain control with 2 electrodes?

Premodulated current

What is it when there is a mix of channels that occurs in the generator instead of tissues and does not penetrate deeply but is more accurate?

Bipolar electrode placement

Bipolar electrode placement is good for what?

One muscle or muscle group

Vector can must be used with?

True Interferential current

What is it when the cloverleaf pattern rotates during true Interferential current?

Vector scan

What allows for a larger treatment area during true Interferential current?

Vector scan

How does vector scan work and allow the cloverleaf pattern to rotate?

Varies the amplitude between the channels

What is the 3D interference pattern?

Stereodynamic (3 channels, 6 electrodes)

What do we use IFC for?

Pain reduction (main thing)

Muscle strengthening

Where especially do we use IFC for muscle strengthening?

Pelvic floor in women with post-partum incompetence

What are the 12 contraindications to IFC use

1. Anterior cervical area

2. Through head

3. Through chest

4. Pacemakers, and implantable cardioverter- defribilator (ICD)

5. Abdomen, pelvis, lumbar areas of pregnant women in 1st tri

6. Metal implants

7. Epilepsy

8. Areas of hemorrhage

9. Cancer

10. Confused and unreliable patients

11. Damaged skin

12. Unknown etiology

What are the risks of IFC

Skin irritation

Diathermy devices must be 10 ft (3m) away

What is the frequency for subacute pain IFC treatment?

1-150 Hz

What is the treatment time for IFC

15-20 minutes

How do you determine the amplitude of IFC

Patient comfort (turn it up just below its uncomfortable)

What fibers are targeted with IFC when patient feel tingling

A- beta fibers

What fibers are targets with IFC when muscles twitch

Alpha motor neurons

What is the frequency we use for IFC strength?

40-60 Hz

(WE USE 50 Hz)

How many electrodes do we use for IFC strength use?

Bipolar electrodes (2 electrodes)

What is the duty cycle for IFC strength use?

10:50

(10 sec on and 50 sec off)

What is it when the amplitude eases into the max contraction during IFC strength use?

Ramp Time

Describe Russian Current

Uses duty cycles (on/off cycles) to cause muscle contraction for muscle strengthening

When should we use Russian stimulation

Muscle re-education

Retard atrophy

Muscle strengthening

Decrease muscle spasm through fatigue

Russian stimulation uses what percentage of maximum voluntary contraction?

40-70% MVC

What is the carrier frequency for Russian Stimulation?

2500 Hz (medium)

What is the burst frequency of Russian stimulation?

50 Hz

What is the result of Russian stimulation using the carrier frequency and burst frequency?

Maximally summated muscle contraction

Russian stimulation causes the muscle to what?

Got into tetny

(Goes into contraction and holds it for a while before relaxing)

What type of wave form does Russian stimulation use?

A/C (Rounded, biphasic)

The current comes in_______

Bursts

How many beats per second is Russian stimulation? This causes what?

50 beats per second

Muscle to go into tetnay

What is the burst frequency of Russian stimulation and the on/off time for muscle strengthening?

50 bps

10 sec on and 50 sec off (1:5)

What is the burst frequency of Russian stimulation and the on/off time for muscle fatigue

50 bps

10 sec on 10 sec off (1:1)

What is the phase duration of Russian current?

200-300 microseconds

What is the pulse rate of Russian current?

Usually 50 Hz

(Causes tetanus contraction over 35 Hz)

What is the amplitude for Russian current?

Should be enough for strong tolerable contraction, beyond patient comfort

What is the duty cycle for muscle fatigue (spasm) in Russian current?

10:10

50%

What is the duty cycle for muscle strengthening in Russian current?

10:50

16.7%

Describe duty cycle

Ratio of on time to on + off time (%)

What is the ramp time of Russian current?

.5 - 2 seconds

Gradual ramp up and ramp down

The ramp time mimics what in Russian current?

Voluntary contractions

The electrode placemat should always be____________ during Russian stimulation

Along fibers of same muscle

(Parallel to fibers)

At motor points

(Near origin and insertion)

What is it with 2 unequal sized electrodes? What does it allow?

Monopolar

-active electrode over the target area

What is 2 equal sized electrodes in Russian current? This is __________ protocol

Bipolar

Single muscle (standard/normal)

Which electrode placement do we use for Russian current?

Bipolar

What Russian current has 4 electrodes with 1 channel spread lead for 1 muscle (larger muscles)?

Quadripolar

With quadripolar water are 2 channels with ___________________ protocol, used with large muscle

"Simultaneous Co-Contract"

(Bilateral muscles that always contract together)

What is it when two channels are contracting simultaneously?

Synchronous

Simultaneous Co-Contract

What is it when channel 1 is on while channel 2 is off?

Reciprocal or alternate

(Agonist and antagonist contract alternately)

Electrode placement for reciprocal (alternate) Russian current?

2 channels with alternate protocol

(Agonist/antagonist muscles or muscle groups)

What is overlap mode of Russian stimulation?

Channel 2 starts as channel 1 is ending

What happens with too much overlap during overlap mode of Russian stimulation?

Agonist and antagonist fight

What is the reciprocal or alternate mode of Russian protocol?

Both channels are 10:50 on:off ratio

What electrode placement is used for large muscles in Russian stimulation?

Multipolar

What are the 12 contradictions of Russian stimulation?

1. Anterior cervical area

2. Through the head

3. Through the neck

4. Pacemakers, ICDs

5. Abdomen, pelvis, lumbar areas of pregnant women in 1st trimester

6. Metal implants

7. Epilepsy

8. Areas of hemorrhage

9. Cancer

10. Confused and unreliable patients

11. Damaged skin

12. Unknown etiology

The contraindications of Russian stimulation are the same as?

Interferential current

What are the risks of Russian stimulation?

Skin irritation

Electronic interference (diathermy must be 10 ft (3m) away)

Fragile skin

Fainting, nausea, skin rash, swelling, pain

Muscle damage from too much stimulation

What is the training protocol for Russian stimulation

10 contraction at 10 sec on and 50 sec off (about 1 contraction per minutes)

What does NMES stand for?

Neuromuscular Electrical Stimulation

What is the goal of NMES

Stimulate alpha motor neurons causing a strong muscle muscle contraction

TRUE or FALSE

NMES does NOT stimulate the muscle itself

TRUE

What are the primary indications to use NMES

Retrain lost muscle function from inhibition following injury or surgery

Decrease muscle atrophy from periods of immobilization

What are the secondary indications of NMES

Decrease muscle spasm

Which fibers are recruited first with a physiological contraction?

Slow twitch

-fast twitch only when need extra force

What is the synchrony of firing for physiological contractions?

Asynchronous firing to produce a continuous contraction

(Reduces fatigue)

What is the inhibition of physiological contractions?

Strong contractions the golgi tendon organ causes inhibition

What is the fatigue with physiological contractions

Minimal fatigue cause of the order of recruitment and asynchrony of firing motor units

What is the order of recruitment for electrical muscle contraction?

Larger diameter, fast twitch fibers since they have a lower capacitance

-slow twitch if the stimulation increased

What muscle units are recruited the most with electrical muscle contraction?

Muscle units closer to electrodes

What is the synchrony of firing for electrical muscle contractions?

Synchronous of firing at frequency of stimulation

Contraction continues until the stimulation is off

What is the inhibition of electrical muscle contraction?

Golgi tendon organ is activated by inhibition is overcome by direct stimulation

What is the fatigue with electrical muscle contraction?

Muscles fatigues rapidly from fast twitch fiber recruitment and synchronous firing of motor units

What are the currents used for NMES?

Russian current

Biphasic Pulsed Current

Interferential

What kind of wave is Russian current?

Biphasic sine wave current

What is the burst of Russian current?

Bursts of 50 bups

What type of wave is biphasic pulsed current?

Symmetrical, biphasic, balanced, square wave

What is the burst of biphasic pulsed current?

50 Hz

What two currents of NMES do the same thing?

Russian current and Biphasic pulse current