E Stim

E Stim

Modality that uses electrical current to stimulate n and m fibers

E Stim Mechanism

Depolarizes neurons to elicit sensory or motor responses

E Stim Goals (4)

1. Pain relief

2. Muscle re-ed

3. Improved circulation

4. Edema reduction

AP Resting Potential

-70mV

5 Types of E Stim

1. TENS: Pain management

2. NMES: Muscle re-ed

3. IFC: Deep pain relief

4. HVPC: Wound healing and edema control

5. Iontophoresis: Medication delivery

Physiological Effects of E Stim (4)

1. Pain Relief: Gate control theory and endorphin release

2. M Contraction: Recruitment of motor units

3. Edema Reduction: Improved venous and lymphatic flow

4. Wound Healing: Improved cellular activity and circulation

Direct Current

Continuous unidirectional flow of charged particles

- Used for iontophoresis

(polarity on 1 side)

Alternating Current

Continuous bi-directional flow of charged particles

- Equal ion flow in both directions

- Sine wave

(alternates + -)

Pulsed Current

Interrupted, unidirectional or bidirectional

(breaks in current)

Russian Current

2500Hz AC is burst modulated at 50 bps using 10ms bursts

Electrode Spacing: Close vs Far

Close = Highest CD very SF

Far = CD higher in deeper tissue

Current Density

Higher at skin and diminishes as the elecricity penetrates

Electrode Size: Small vs Large

Small: Increased CD

Large: Decrease CD

E Stim Muscle Recruitment

Opposite of normal

- Fast, twitch Type 2 are recruited first (large)

- Slow twitch, Type 1 recruited later (small)

The ___ will depolarize before the __ cell?

Nerve, muscle

4 EVP that are strongly supported for E stim?

1. Pain relief

2. Muscle re-ed post stroke

3. NMES after knee surgeries

4. Wound healing in diabetic ulcers

Iontophoresis: A positively charged electrode (anode) drives ___ ions?

Positive

Iontophoresis: A negatively charged electrode (cathode) drives ___ ions?

Negative

Anode

Deficiency of electrons (+ charge)

Cathode

Excess of electrons (- charge)

Indications for Iontophoresis (4)

1. Inflammation

2. Pain management

3. Localized soft tissue conditions

4. Scar tissue modification

Iontophoresis Contraindications (4)

1. Broken or damaged skin at treatment site

2. Allergies to prescribed med

3. Implanted pacemakers

4. Over areas with malignancy

Iontophoresis: Dexamethasone

Negative charge (anti inflammatory)

Iontophoresis: Lidocaine

Positive charge (pain relief)

Iontophoresis: Acetic Acid

Negative charge ( calcium deposits or myositis ossificans)

Iontophoresis: Iodine

Negative charge (scar tissue management)

Iontophoresis: Dosage

40-80mA/min

Iontophoresis: Current Intensity

1-4mA

Iontophoresis: Electrode Placement

- Active electrode over treatment area

- Dispersive electrode away from treatment area

Research supports iontophoresis for: ___(2)?

1. Reducing localized inflammation

2. Managing acute and chronic pain

Iontophoresis: Limitations (3)

1. Effectiveness depends on med absorption

2. Potential for skin irritation

3. Always consider pt specific factors and goals