BIOPHYSICAL

functional mobility assessment: take if the modality would improve the thing that is limiting mobility (pain, motor control, edema, etc)

before modalities: pain assessment, ROM, strength, skin (metal implants)/sensation assessment

modalities: US/ultrasound, NMES, ESTIM: TENS/IFC, Biofeedback, HVPC, EMG/electromyography, ESTR, EMR

• target pain:

  • US (chronic and acute)

  • ESTIM (acute: sensory analgesia, painful procedure, noxious stimulus/chronic: endogenous opiate, noxious stimulus, sensory analgesia)

• improve ROM:

  • from pain: US, ESTIM

  • from tightness: US, NMES

• provide heat:

  • US: with head or continuous

• indications:

  • US:

    • continuous: pain from chronic inflammation, decreased ROM, scar remodeling

    • pulsed: pain from acute inflammation, edema

  • ESTIM:

    • acute/chronic pain

  • NMES:

    • weakness, hypertonicity/spasticity, edema, orthotic substitution (decreased motor control), endurance

    • stroke population weakness, CVA

    • shoulder subluxation

  • Biofeedback:

    • decreased motor control

  • ESTR:

    • wounds (pressure/decubitus, venous insufficiency, arterial insufficiency, diabetes mellitus)

  • EMR:

    • muscle guarding, tightness, pain, acute/chronic conditions, inflammation, etc.

• contraindications:

  • US:

    • infection, hemorrhage, DVT, medical devices, abscess, cancer, psoriasis

    • relative: lack of sensation, PVD, growth plates, pregnancy, cognition, open wound, deep metal/cement

  • ESTIM:

    • absolute: malignancy, pacemaker, lacking sensation

    • relative: epilepsy, impaired sensation, cardiac disease

  • NMES:

    • absolute: demand pacemaker, pregnancy 3rd

    • relative: malignancy, impaired sensation, superficial metal, cardiac problems, cog., skin irritation

  • Biofeedback:

    • open wounds

    • relative: impaired mental status, skin irritation

  • ESTR:

    • metal

  • EMR:

    • metal

• sensation

  • US: literally nothing unless to intense

  • ESTIM:

    • sensory analgesia: strong tingling, no twitching

    • painful procedure: non-rhythmic contraction, strong tingling

    • endogenous opiate: muscle twitch

    • noxious stimulus: highest toleration

  • NMES:

    • muscle contractions, sensory input, stabilization, correct timing of contraction, strengthen

    • limitation: discomfort

• settings

  • US:

    • continuous: 10 min

    • pulsed: 5 min (used for healing)

    • 1 (deeper) or 3MHz

  • ESTIM:

    • sensory analgesia: 75-150pps, 60-100 microseconds, tx time, surrounding

    • painful procedure: 150+pps, 150+ microseconds, 15-30min, dermatome lvl

    • endogenous opiate: 1-5pps, 200-300 microseconds, 30-45 min, motor points

    • noxious stimulus: 1-4 pps, 1 msec, 30 sec, on point

  • IFC:

    • sweep (prevent/decrease sensory habituation), beat frequency, vector scan

  • NMES:

    • pps: higher is more comfortable and less fatiguing, mA: 70% strength, 50% endurance (guestimate it bud), microseconds: higher is more stimulation, time: intervention activity, on/off: 5x off for power, 3x off for endurance, or just what’s needed, waveform: asymmetrical for small muscles, IFC: 2 agon. and 2 antag.

    • more fatiguing: polyphasic waveform, shorter off time, higher frequency

    • won’t affect strength: ramp up/down

    • small muscles: 150-200 microseconds

• Russian current: alternating current of 2,500 Hz, burst-modulated at 50 bursts per second using 10-msec burst duration

• interferential current: crossing electrical fields, third field is produced that effects deeper tissue in a larger tx area