Therapeutic Modalities Unit 2

Which of the following best describes EMG biofeedback?

Measures electrical activity of muscle fibers during contraction

In addition to monitoring EMG activity, measuring provides this component:

Quantitative value

If an EMG biofeedback unit consists of three leads/electrodes, what is the name of the 3rd electrode that filters out nonmeaningful electrical activity? (select all that apply)

Ground electrode

Reference electrode

What are the 2 primary indications/goals of using EMG biofeedback? (select 2)

To promote muscle relaxation

To facilitate muscle contraction/control

Which of the following is NOT an explanation of how EMG biofeedback can reduce pain?

Inhibit sensory pain fibers

Which of the following is NOT a contraindication for EMG biofeedback?

Post-ACL reconstruction, muscle atrophy

Which of the following skin preparation steps should be performed to improve the quality of the EMG signal on new EMG sensors/pads? (select all that apply)

Debride (sandpaper) the skin

Clean the skin with an alcohol pad

Shave any hair at the electrode site

What is the most effective alarm for inducing neuromuscular facilitation with EMG biofeedback?

Auditory

If your goal is to facilitate a muscle contraction, the target should be placed ___________ the threshold.

Above

If your goal is to promote muscle relaxation, the target should be placed ___________ the threshold.

Below

_____ electricity is a stream of loose electrons passing along a conductor

Current

_____ electricity is frictional electricity

Static

What are atoms NOT comprised of?

Ions

_____ orbits around the nucleus

Electrons

When an atom has the same number of protons & electrons then the atom is _____

Stable

Net sum of charges of electrons & protons in an electrical current are measured in _____

Coulombs

Conductors have easily free electrons and some examples are

Platinum, gold, silver

Insulators do not have easily freed electrons and some example are

Glass, rubber, plastic

Ohm’s law equation

I= V/R

amps= volts/ohms

current flow= voltage/resistance

Resistance applies to _____ current and impedance applies to _____ current

direct; alternating

_____ electrodes have have less resistance than _____ electrodes

Large; small

_____ current remains the same in all components

Series

_____ two independent paths in the circuit to get back to the source

Parallel

_____ current is the continuous flow of electrons in a single direction

DC (one electrode is + and one is -)

_____ current is the continuous back and forth flow of electrons

AC (alternate change from + to -)

Relative to plumbing, water pressure is similar to what electrical characteristic?

Voltage

Which of the following tissues is a good biological conductor?

Nerve

Which of the following factors do NOT affect resistance?

Color

What are known as the building blocks of pulses?

Phases

Duration of time between the conclusion of one pulse & initiation of the next

Interpulse interval

All muscle fibers of a motor unit contract in response to a single action potential in its nerve

All or none law

Unlike a voluntary contraction, electrical stimulation recruits which of the following nerve fibers first?

Large diameter

What activation threshold must be reached for nerve depolarization (action potential) to occur?

-55 mV

Electrode placement is the #1 cause of _____ results from electrical therapy

poor

Moving the electrodes further apart _____ current density in deeper tissues

increases

The time during which membrane repolarizes is known as the _____ period

refractory

The larger & more superficial the nerve the easier it can be recruited with _____

e-stim

Which of the following parameters primarily determines whether a tetanic or twitch muscle (motor) contraction will be produced by electrical stimulation?

Frequency/pulse rate

When phase/pulse duration (width) is maxed out, the intensity needed to cause tissue excitation is known as what?

Rheobase

E-stim pulse duration required for tissue excitation when current is 2x the rheobase

Chronaxie

What muscle stimulation level is found by increasing the intensity to a point that achieves a slight muscle twitch, then decreasing the intensity by 10%?

Sensory

What level of pain control is used with noxious/brief-intense TENS?

Level 2 (central control)

What pulse duration/width should be used with sensory TENS?

60-100 microseconds

With IFC, the two high-frequency currents form an interference wave possessing low frequency current. This low frequency current is known as what?

Beat frequency

When using IFC on a Chattanooga unit, positioning your vector scan at <45 degree angle during a quadpolar treatment will do what?

Align the current along the channel 2 axis

With NMES, torque generation is directly related to what?

Intensity

Which of the following does NOT describe the waveform used with NMES/Russian current?

Rectangular

What voltage threshold is unique to HVPC?

>150 V

When using HVPC for wound management, what polarity should be used to increase collagen production?

Negative

When attempting to deliver dexamethasone to a patient using iontophoresis, what polarity should the active electrode be?

Negative

If the iontophoresis dosage for a medication is 40 mA/min, and your the patient can only tolerate 2.0 mA of current, what should the treatment time be set to?

20 minutes

Gate control

Descending endogenous opiate

Central control trigger

Red= a-beta

Green= a-delta (sharp pain)

Yellow= c-fiber (dull pain)

Small fiber stimulation _____ the SG interneuron, which _____ pain transmission to the thalmus

inhibits; allows

Large fiber stimulation _____ the SG interneuron, which _____ pain transmission to the thalmus

facilitates; inhibits

Pain relief modulated via stimulation of larger sensory nerves

A-beta

Gating mechanism occurs during non-noxious sensory application

Gate control (level 1)

Pain relief modulated by noxious stimulation

C-fibers

Activation of PAG and RN trigger the release of enkephalin at the dorsal horn

Central control (level 2)

Requires prolonged stimulation of small-diameter afferent nerves

A-delta fibers

Pain relief modulated by the release of b-endorphin from the pituitary gland

Descending endogenous (level 3)

Enkephalins

Spinal cord

Half life few mins

Release through noxious stimuli

Endorphins

Pituitary gland

Half life of 4 hours

Release though noxious & motor stimuli

_____ involves determining whether neuromuscular activity is present and if it’s increasing or decreasing

Monitoring

_____ the activity involves placing an objective scale on the monitored readout

Measuring

A wider sweep frequency is better at preventing _____

accommodation

A more narrow sweep frequency is more _____

comfortable

IFC premod is best used for

Spasm & edema reduction

Centered where currents cross and better for well localized pain

Static vector

Moves through treatment field between 4 electrodes and better for poorly localized pain

Dynamic vector

Scan allows you to cover ____ of the area within the electrodes

80%

0-45=

45-90=

Channel 2 axis (0 turns to premod on channel 2)

Channel 1 axis (90 turns to premod on channel 1)

Small diameter to large diameter

Voluntary

Large diameter to small diameter

E-stim

Type II first because they provide _____ resistance to current flow and they’re more superficial

less

Stimulates two muscle groups at the same time

Co-contract

Stimulates agonist-antagonist muscle groups

Reciprocal

NMES: closer placement results in more _____ & _____ of contraction increases

Superficial & intensity