Adjunct 2 Lab Final EEE, WhatWhyHow, Contra's, Precautions

What are the contraindications for Ultrasound?

PIPED-CF (EM and US)

Pacemaker

Infection

Pregnancy (LB/Pelvis)

Exposed metal

DVT

Cancer

Fractures

JASICA

Joints (Cement/Plastic)

Acute (If thermal)

Sensory (poor)

Ischemia

Circulation (impaired)

Around eyes, heart, carotid sinus, genitals

What are the precautions for ultrasound?

Epiphyseal plates in children

Over nerve plexuses/Spinal cord after laminectomy

What are the contraindications for electrical modalities?

PIPED-CF (EM and US)

Pacemaker

Infection

Pregnancy (LB/Pelvis)

Exposed metal

DVT

Cancer

Fractures

PUSSA

Poor cardiac function

Uncontrolled hemorrhage

Sensory/mental impairment

Seizures

Arterial disease

What are the precautions for electrical modalities

Epiphyseal plates in children

Abdomen/Low back during menstruation

Over eyes, larynx, pharynx, carotid sinus, transcerebral, transthoracic

Examine

Inspect - edema, redness, bruising, vascular fragility, open wounds rashes or scars.

Palpate - tenderness, spasm, adhesions, alterations in pain or temperature sensation.

WhatWhyHow for ultrasound? (acute = non-thermal)

Point to area

What: I’ll be using ultrasound, which will be delivered at a non-thermal setting to promote tissue healing through increased phagocytes, lymphocytes and increased lymphatic flow.

You will likely feel little to no sensation.

Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins.

Inflammation = Helps with inflammation by dispersing fluids through mechanical microstreaming.

WhatWhyHow for ultrasound? (subacute/chronic = thermal)

Point to area

I’ll be using ultrasound, which is a heating modality that delivers high-frequency sound waves to promote healing through increased phagocytes, lymphocytes and lymphatic flow.

You may feel mild warmth or very little sensation.

How:

Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins.

Inflammation = Helps with inflammation by dispersing fluids through mechanical microstreaming.

Myospasm = reduced thermally through effects on muscle spindle fibers.

Ultrasound 1 MHz (Deep tissue)

ACUTE (0–3 days)

Duty → 10–20%

Intensity → 0.5–1.5 W/cm²

Time → 4–6 min

SUBACUTE (3–14 days)

Duty → 20–50%

Intensity → 0.75–1.25 W/cm²

Time → 6–8 min

CHRONIC (+14 days)

Duty → 100% Continuous

Intensity → 1–2 W/cm²

Time → 8–10 min

Ultrasound 3 MHz (Superficial)

ACUTE (0–3 days)

Duty → 50%

Intensity → 0.5 W/cm²

Time → 4–6 min

SUBACUTE (3–14 days)

Duty → 50%

Intensity → 0.75–1 W/cm²

Time → 6–8 min

CHRONIC (+14 days)

Duty → 100% Continuous

Intensity → .5–1 W/cm²

Time → 8–10 min

WhatWhyHow for Microcurrent?

Point to area

I’ll be using microcurrent, which is a low frequency electrical modality used to promote tissue healing and can also decrease pain.

Most patients feel little to no sensation.

How:

Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins.

Healing = Generates a response from cells including increased ATP production, increased membrane transport, and normal flow of nutrients and waste.

Microcurrent Settings

Tissue Healing

Phasic → Monophasic

Frequency → 0.5 Hz

Time → 15–20 min

Intensity → 20 µA

Polarity → Acute (+) Chronic (–)

Pad placement → Active electrode on injury, dispersive 6–8 in away

Pain Control

Phasic → Biphasic

Frequency → 30 Hz

Time → 15–20 min

Intensity → 20-500 µA (Start first then slowly turn up to 100)

Polarity → Alternating

Pad placement → Surround pain

WhatWhyHow for TENS?

Point to area

What: I’ll be using TENS, which is a biphasic pulsed current used to decrease pain.

Acute - You will feel a tingling sensation.

Chronic - You will feel muscle contractions but should remain within your tolerance.

How: Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins and endorphins.

TENS Settings

ACUTE

Phase Duration → 100 us

Frequency → 80–120 Hz

Intensity → Perception

Mode → Continuous

Time → 10–20 min

CHRONIC

Phase Duration → 100 us

Frequency → 3–5 Hz

Intensity → Tolerance/contraction

Mode → Continuous

Time → 20–30 min

WhatWhyHow for HVPC?

Point to area

I’ll be using HVPC, which is a monophasic twin peak current used to reduce pain, muscle spasm, swelling, and improve muscle strength.

Acute - You will feel a tingling sensation.

Chronic - You may feel a tingling sensation with possible muscle contraction.

Edema - You will feel a gentle pulsing or mild muscle contraction.

Myospasm/Muscle exercise - You will feel strong muscle contractions. It may feel quite intense, but we will keep it within your tolerance and can adjust as needed

How:

Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins and endorphins.

It is also used to stimulate muscle contraction to break myospasms, exercise muscle tissue, and pump out edema

HVPC Settings

ACUTE

Frequency → 80–120 Hz

Mode → Continuous

Intensity → Perception

Polarity → Positive

Time → 10–20 min

CHRONIC

Frequency → 3–5 Hz

Mode → Continuous

Intensity → Tolerance/contraction

Polarity → Negative

Time → 20–30 min

EDEMA

Frequency → 10 Hz

Mode → Surge 10:10

Intensity → Tolerance/mild contraction

Time → 10–20 min

MYOSPASM

Frequency → 50–55 Hz

Mode → Continuous

Intensity → Tolerance/strong contraction

Time → 10–20 min

MUSCLE EXERCISE

Frequency → 50–55 Hz

Mode → Surge 10:40–10:60 (10:50)

Intensity → Tolerance/strong contraction

Time → 10–20 min

WhatWhyHow for True IF?

Point to area

I’ll be using true interferential, which is two medium frequency biphasic sinewaves used to decrease pain, swelling, and muscle spasm.

Acute - You will feel a tingling sensation

Chronic - You will feel a deep tingling sensation and possible contraction.

Edema - You will feel a tingling sensation or mild muscle contraction.

How:

Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins and endorphins.

Edema = reduced through improved circulation and muscle pumping effect that assists fluid movement.

TRUE INTERFERENTIAL Settings

ACUTE

Frequency → 80–150 Hz

Intensity → Perception

Mode → Continuous

Time → 10–20 min

AUTO 40

CHRONIC

Frequency → 3–5 Hz

Intensity → Tolerance/contraction

Mode → Continuous

Time → 20–30 min

AUTO 40

EDEMA

Frequency → 1–15 Hz

Intensity → Tolerance/pt comfort

Mode → Continuous

Time → 10–20 min

Turn off Vector scan mode

WhatWhyHow for Premod IF?

Point to area

I’ll be using premodulated interferential, which is an biphasic medium frequency used to decrease pain, swelling, muscle spasm, and improve muscle strength.

Acute - You will feel a comfortable tingling sensation

Chronic - You will feel a tingling sensation and possibly muscle contraction.

Edema - You will feel a tingling sensation or mild muscle contraction.

Myospasm/Muscle exercise - You will feel strong muscle contractions. It may feel uncomfortable but you should be able to tolerate it.

How:

Pain = reduces pain by blocking pain gate, sedating local nerve endings and production of enkephalins and endorphins.

It is also used to stimulate muscle contraction to break myospasms, exercise muscle tissue, and pump out edema

PREMODULATED IF Settings

Acute

Frequency → 80–150 Hz

Intensity → Perception

Mode → Continuous

Time → 10–20 min

CHRONIC PAIN

Frequency → 3–5 Hz

Intensity → Tolerance/contraction

Mode → Continuous

Time → 20–30 min

EDEMA

Frequency → 1–15 Hz

Intensity → Pt comfort/mild contraction

Mode → Continuous

Time → 10–20 min

MYOSPASM

Frequency → 50–55 Hz

Intensity → Tolerance/Strong contraction

Mode → Continuous

Time → 10–20 min

MUSCLE EXERCISE

Frequency → 50–55 Hz

Intensity → Tolerance/Strong contraction

Mode → Surge 10:40-60 (10:50)

Time → 10-20 min

WhatWhyHow for Russian Stim?

Point to area

What: I’ll be using Russian stimulation, which is a biphasic medium frequency electrical modality used to improve muscle strength, decrease swelling, and reduce muscle spasm.

Edema - You will feel a pulsing tingling sensation or mild muscle contraction.

Myospasm/Muscle exercise - You will feel strong muscle contractions. It may feel quite intense, but we will keep it within your tolerance and can adjust as needed

How:

It is used to stimulate muscle contraction to break myospasms, exercise muscle tissue, and pump out edema.

RUSSIAN STIM Settings

EDEMA

Frequency → 50

Intensity → Pt comfort/sub-contraction

Mode → Surge 10:10

Time → 10–20 min

MYOSPASM

Frequency → 50

Intensity → Tolerance/Strong-contraction

Mode → Surge 10:10

Time → 10–20 min

MUSCLE EXERCISE/ATROPHY

Frequency → 50

Intensity → Tolerance/Strong-contraction

Mode → Surge 10:50

Time → 10–20 min