Passive Care- Exam 1- NMES and TENS

What does NMES stand for?

Neuromuscular Electrical Stimulation

What is the goal of NMES

Stimulate alpha motor neurons causing a strong muscle muscle contraction

TRUE or FALSE

NMES does NOT stimulate the muscle itself

TRUE

What are the primary indications to use NMES

Retrain lost muscle function from inhibition following injury or surgery

Decrease muscle atrophy from periods of immobilization

What are the secondary indications of NMES

Decrease muscle spasm

Which fibers are recruited first with a physiological contraction?

Slow twitch

-fast twitch only when need extra force

What is the synchrony of firing for physiological contractions?

Asynchronous firing to produce a continuous contraction

(Reduces fatigue)

What is the inhibition of physiological contractions?

Strong contractions the golgi tendon organ causes inhibition

What is the fatigue with physiological contractions

Minimal fatigue cause of the order of recruitment and asynchrony of firing motor units

What is the order of recruitment for electrical muscle contraction?

Larger diameter, fast twitch fibers since they have a lower capacitance

-slow twitch if the stimulation increased

What muscle units are recruited the most with electrical muscle contraction?

Muscle units closer to electrodes

What is the synchrony of firing for electrical muscle contractions?

Synchronous of firing at frequency of stimulation

Contraction continues until the stimulation is off

What is the inhibition of electrical muscle contraction?

Golgi tendon organ is activated by inhibition is overcome by direct stimulation

What is the fatigue with electrical muscle contraction?

Muscles fatigues rapidly from fast twitch fiber recruitment and synchronous firing of motor units

What are the currents used for NMES?

Russian current

Biphasic Pulsed Current

Interferential

What kind of wave is Russian current?

Biphasic sine wave current

What is the burst of Russian current?

Bursts of 50 bups

What type of wave is biphasic pulsed current?

Symmetrical, biphasic, balanced, square wave

What is the burst of biphasic pulsed current?

50 Hz

What two currents of NMES do the same thing?

Russian current and Biphasic pulse current

What is the wave for Interferential current?

Two or more biphasic sine waves curents

Interferential currents create what/

Distinct current with beats

What is the beats for Interferential current?

50 beps

What does TENS stand for?

transcutaneous electrical nerve stimulation

What is the stimulation of nerves through the skin for pain management?

TENS

(Transcutaneous Electrical Nerve Stimulation)

What is the most common waveform of TENS?

Biphasic, symmetrical, square or rectangular

TENS is the modifications of what?

Neurological aspects of pain

During TENS treatment, the application of pulsed current is for inducing?

Electroanalgesia

With sensory level stimulation TENS treatment, what is the target tissue?

Large diameter A-beta fibers

(Tingling sensation)

Sensory level stimulation TENS treatment is ________ stimulation

Submotor

What level is it for the patient with sensory level stimulation TENS treatment?

Comfortable level

Sensory level stimulation TENS treatment is for what type of pain?

Acute pain

During sensory level stimulation TENS treatment, pain relief is achieved how? It lasts how long?

Pain gating

-lasts only as long as the stimulation

Sensory level stimulation TENS treatment is often combined with?

Ice or heat

(Reduce muscle spasm, relaxation, analgesia)

Sensory level stimulation pulse rate?

60-150 Hz (high)

Amplitude of sensory level stimulation

Patient feedback

Duty cycle of sensory level stimulation

Non

Treatment time for sensory level stimulation

20-30 mins

Motor level stimulation causes depolarization of?

Alpha motor neurons

(Some muscle contraction occurs)

Motor level stimulation is not for what type of conditions

Not for acute

Motor level stimulation is for treating what?

Subacute and chronic conditions

Motor level stimulation is theorized to release?

Endogenous opiates

Motor level stimulation may provide longer pain relief but?

It has a delayed onset

When motor level stimulation is used in acupuncture-like mode it targets what?

A-beta and alpha motor neurons

When motor level is used in burst mode it targets?

Alpha motor neurons and delta fibers (A-delta fibers)

What is the goal of motor level stimulation used in burst mode?

Target A-Delta fibers for pain relief

(Just some muscle twitching to get there as secondary effect)

What is the pulse rate of motor level stimulation

0-15 Hz (low)

What is the amplitude of motor level stimulation

Strong, comfortable contraction

Patient feedback= comfort

What is the duty cycle of motor level stimulation?

None

What is the treatment time of motor level stimulation

20-30 mins

Even though the treatment time of motor level stimulation is 20-30 mins, when may the pain relief actually occur?

30 mins- 2 hrs later

Noxious level stimulation stimulates?

C-fibers

Stimulating the C-fibers feels like what?

Hurts cause targeting C-fibers causes pain

Noxious-level stimulation elicits pain relief how?

Endogenous opiates

Noxious-level stimulation is commonly used with?

Point stimulators

(High density in small space, often used on trigger points)

Noxious level stimulation is used in what mode?

Brief-Intense mode

Phase duration of noxious level stimulation

10-20ms

(Must be longer than 1ms, usually need DC)

Pulse rate of noxious level stimulation

60-150 Hz (High)

Amplitude of noxious level stimulation

Maximum tolerable

Treatment time of noxious level stimulation

20 seconds per point

8-10 points per session

What would influence the results of noxious level stimulation?

Results less if patient taking narcotic analgesics

Why would a patient taking narcotic analgesics affect the results of noxious level stimulation?

Cause opioid receptors already full so no actual pain relief would occur

What mode decreases accommodation?

Modulation mode