E-Stim PTA 110

What are the 3 types of PT currents

Direct, Alternating, Pulsed

Direct current

unidirectional flow of electrons toward the positive

Alternating:

ability to reverse current flow directions, reverses polarity

pusled current

grouped current flows

What are examples of pulsed current

Interferential and russian

Waveform:

gives graphic presentation of shape, direction, amplitude, and duration

Waveform Shape:

sine, rectangular, triangular

Pulse Waveform

One individual waveform

Phase Waveform:

portion that raises above or below baseline

Direct current is also called what

monophasic current

Pulse duration

length of time current is flowing through one cycle

DC pulse duration

same as phase duration

AC waveform

the pulse duration is determined by combined phase durations

Pulse frequency:

# pulses per second

Pulse frequency Magic number In body

28 pps

what if you exceed 28 pps

tetany occurs

Modulation:

ability to alter the magnitude or variation of the duration of pulses

Modulation example

Continuous, interrupted, burst, ramped

Continuous:

amplitude of current remains the same

Continuous example

lontophoresis

Interrupted:

current is on then off

What is Interrupted Clinically used for

muscle re-ed. Strengthening, and to increase ROM

Skin =

resistance to current flow, need for skin prep, more resistance needs more voltage

Impulses are conducted well with what

water, and parallel to the muscle fiber (may ask pt. to drink water prior to coming to TX)

What do tendons have very little of

water, and are very dense and thus do not conduct well

Bone is considered what

the poorest conductor of electrical current

When electrodes are places close together, how does the current travel

more superficially

When the electrodes are placed farther apart, how does the current travel

deeper

How do you stimulate the tibialis anterior

electrodes closer together

How do you stimulate the quadriceps

electrodes farther apart

Monopolar:

Use to directly hit motor points

Monopolar Uses active electrode where

the treatment effect occurs and a dispersive electrode to complete the circuit.

Active:

On treatment area

Dispersive

At distant area

Biopolar :

Use to indirectly hit motor points

What does Biopolar Involve

electrodes of equal or near equal size

In bipolar, how are the electrodes set up

located in the target treatment area

What is the Alternating vs. Direct Current biggest difference

the ability of direct current to cause chemical changes

Most currents that are AC do not flow how

unidirectional for 1 minute, thus no chemical effect

HVPG running for >1 hour may cause what

chemical effect

Current Density must be high enough to cause what

depolarization

Small electrode –

high density

large electrode –

small/deep density

How is Frequency: measured

in pulses per second(pps)

Muscle fiber tetany is strictly a function of

frequency

Intensity:

increasing intensity increases the current depth

Duration:

more tissues are stimulated if the duration is increased because the current is available longer

The electrode with the more electrons is what

negative cathode

Electrode Placement

On or around painful area, Over dermatomes, myotomes, corresponding to painful site, Trigger points, Crossing pattern

What are theTherapeutic uses of E-stim

Muscle reeducation, Muscle pump, Retard atrophy, Strengthening

Increasing ROM

Contraindications of E-stim

Demand cardiac pacemaker, Carotid sinus, Venous or arterial thrombosis, Thrombophlebitis

Indwelling phrenic nerve or urinary bladder stimulators, Operating diathermy devices

What is the intensity measured in

amps or mamps

Musical Reeducation

artificial use of motor nerves, musical (non functional)

When is Musical Reeducation indicated

after surgery or injury

Muscle reeducation

VMO after ACL reconstruction

Protocol for Musical Reeducation

Adequate intensity, adequate pulse duration (>10msec). PPS/28 + on/off time (S – 10 sec/>1 min). Time (app. 15 minutes), amp (max tolerance)

What does Post-acute swelling (muscle pump) help with

stimulate circulation

What is Post-acute swelling (muscle pump) used to

decrease edema in sprain or confusion

Post-acute swelling (muscle pump) on off time ratio

1:1

What should Retarding Atrophy have

>25% max

What kind of torque does retarding atrophy have

voluntary isometric contraction

Retarding Atrophy parameters

pps>28, on/off time: 6-15sec/1-2 minutes, app. 20 minutes

Muscle strengthening parameters

pps>28, on/off time: 6-15sec/1-2 minutes, app. 20 minutes 10:50 ratio

Stimulation of denervated muscle

minimize atrophy while the nerve is regenerating

Stimulation of denervated muscle purpose

minimize atrophy while the nerve is regenerating

Stimulation of denervated muscle parameters

Pulse duration (>10msec.), amplitude (maximum tolerated contraction), >100pps, on/off time: 5-10 sec/>1 minutes

High frequency TENS / GATE control theory

provide as much sensory cutaneous input as possible

High frequency TENS is what pain theory

GAIT control theory

High frequency TENS / GATE control theory parameters

No muscle contraction, pulse width 75- 150microsec, pps: 80-125, continuous, time: until pain relief

What is High frequency TENS / GATE control theory used for

acute and chronic pain

Brief Intense TENS (Central Biasing Theory) stimulates what

smaller fibers (C)

Brief Intense TENS (Central Biasing Theory) Stimulate smaller fibers (C) where

peripheral sites or trigger/acupuncture points

Brief Intense TENS (Central Biasing Theory) Stimulate smaller fibers (C) at peripheral sites or trigger/acupuncture points for

short periods

Brief Intense TENS (Central Biasing Theory) parameters

high intensity, pulse duration (10msec.) 80pps no on/off time

Brief Intense TENS (Central Biasing Theory) total treatment time

brief-usually a few minutes at most

What is Brief Intense TENS (Central Biasing Theory) used on

sharp chronic pain or severe pathological pain

Opiate Pain Control Theory

Estim to stimulate the release of beta endorphins form the pituitary gland and enkephalin

Opiate Pain Control Theory parameters

pulse duration 200microsec, pps: 1-5pps, no on/off time, amp, (max tolerated contraction)

What is Opiate Pain Control Theory used on

chronic pain-use when sensory level TENS is ineffective and patient can tolerate muscle contractions

Two waveforms are interfered into one another and they are in

PHASE thus of interference the magnitude of the waveforms is doubled

Interferential Currents benefits

pain suppression superiorly, target tissue gets its own frequency

What is the Interferential Currents good for

rotator cuff because it is deep to deltoid