NPTEFF: Modalities

Thermal Temp

159-167 F

Thermal tx time

20-30 min

Cryotherapy temp

25 F

Cryotherapy tx time

10-20 mins

HVPC infection/inflammation polarity

negative

HVPC healing/proliferatuib

positive

HVPC parameters: Pulse frequency

100- 105 pps

HVPC parameters: Pulse duration

100 usecs

HVPC parameters: amplitude

produce comfortable tingling

HVPC parameters: Tx time

45-60 min, 3-7 days/week

Estim- NMES: pulse frequency

35-80 pps

Estim- NMES, FES, mm spasm, and edema: pulse duration

Small muscles: 125-200

large muscles: 200-350

Estim- NMES: On/off time

1 on , off 5 (1:5)

6-10 sec

50-120 Sec

Estim- NMES and FES ramp time

2 sec

Estim- NMES: Tx time

10- 20 min (10-20 reps)

every 2-3 hrs

Estim- FES, muscle spasm, and edema reduction: Pulse frequency

35-50 pps

Estim- Spasm and edema: on/off time

2:5 on

2:5 off

Estim- FES: on/off time

based on activity

Estim- FES: tx time

based on activity

Estim- Spasm and edema: ramp time

1 sec

Estim- Spasm: tx time

10-30 mins, every 2-3 hrs

Estim- edema: tx time

30 min, 2x day

Cervical: joint distraction ( i.e. facet)

20-29 lbs, 7% BW

Cervical: disc protrusion/mm spasms, elongation

11-15 lbs

Lumbar: joint distraction ( i.e. facet)

50 lbs, 50% BW

Lumbar: disc protrusion/mm spasms, elongation

25% BW

Tens- Acute pain (high rate): Type of stimulation

Sensory

Tens- Chronic pain (low rate): Type of stimulation

motor

Tens- brief intense (wound care): Type of stimulation

motor

Tens- noxious (trigger pt): Type of stimulation

hyperstimulation

Tens- acute pain (high rate), chronic pain (low rate), brief intense (wound care): waveform

mono/biphasic

Tens- noxious: waveform

DC or monophasic

Tens- acute pain (high rate): pulse frequency

100 pps

Tens- chronic pain (low rate): pulse frequency

<10 pps

Tens- brief intense: pulse frequency

100 pps

Tens- noxious: pulse frequency

high: 100 pps

low: 1-5 pps

Tens- acute pain (high rate): pulse duration

50-100 usec

Tens- chronic pain (low rate): pulse duration

>150 usec

Tens- brief intense (wound care): pulse duration

>150 usec

Tens- noxious: pulse duration

>250 usec up to 1 sec

Tens- acute pain (high rate): tx duration

20- 30 mins

Tens- chronic pain (low rate): tx duration

20-45 mins

Tens- brief intense (wound care): tx duration

<15 mins

Tens- noxious: tx duration

30-60 sec per area

Iontophoresis- hyperhidrosis

Water (+/-)

Iontophoresis- scars

Iodine (-)

Iontophoresis- analgesic

Salicylate (-)

Lido/xylocaine (-caine) (+)

Iontophoresis- calcium deposits

Acetate (-)

Iontophoresis- msk inflammation

Dexamethasone (-)

Iontophoresis- dermal ulcers

Zinc oxide (+)

Iontophoresis- fungal infections

copper sulfate (+)

Iontophoresis- edema reductions

-dase (+)

Iontophoresis- muscle spasms

calcium chloride (+)

Magnesium sulfate (+)

Iontophoresis: direct or pulsed current?

DIRCT ONLY, 4 MAX

Continuous US indications

soft tissue shortening

chronic pain (>3 wks)

Continuous: thermal or non-thermal

thermal

Pulsed: thermal or non-thermal

non-thermal

Pulsed indications

decreased tissue healing

prolonged inflammation

Acute (<3 wks)

continuous: duty cycle

100%

pulsed: duty cycle

20% or 50%

Ultrasound 1 mhz: deep or superficial

deep structures

Ultrasound 3 mhz: deep or superficial

superficial structures

US- continuous, SF (3mhz) structure: intensity

0.5 W/cm2

US- continuous, deep (1mhz) structure: intensity

1.5-2 W/cm2

US- pulsed, deep or SF structure: intensity

0.5-1 W/cm2

US: duration of tx

5-10 min/2 x ERA

EMG biofeedback - muscle spasm aka promote relaxation: electrode placement and sensitivity

closely spaced and low sensitivity

EMG biofeedback - muscle re-education: electrode placement and sensitivity

widely spaced and high sensitivity

Monophonic current promotes

Tissue healing and edema reduction

Biphasic current promotes

muscle contraction and pain control

What nerve fibers are activated first with electrical stimulation?

Large diameter nerve fibers