KIN 280 Final Exam Study Guide - Electrical Stimulation, Thermal Modalities, Therapeutic Ultrasound, Therapeutic Exercise

Electrical Stimulation

  • Electricity: Force due to electron imbalance, measured in volts.

  • Cathode: High electron concentration, negative pole.

  • Anode: Low electron concentration, positive pole.

  • Closed Circuit: Complete path for electron flow.

  • Open Current: Incomplete path, prevents electron flow.

  • Direct Current: Uninterrupted, unidirectional electron flow; one pole always negative, one always positive. Can cause iontophoresis.

  • Alternating Current: Biphasic (bidirectional) electron flow; poles reverse, no charge buildup. Associated with Russian and interferential e-stim.

  • Pulsed Current: Discrete periods of no electrical flow; can be direct or alternating.

  • Excitable Tissues: Nerves, muscles, cell membranes.

  • Non-Excitable Tissues: Bone, cartilage, tendon, adipose tissue, ligaments.

  • Nerve Depolarization Order: Sensory, motor, pain fibers.

    • Sub-sensory: Discrete sensation.

    • Sensory: Depolarizes sensory nerves.

    • Motor: Visible contraction without pain.

    • Noxious: Stimulates pain fibers.

    • Muscle Fiber: Direct depolarization of muscle fibers (long phase duration, high intensity).

  • Gate Control Theory: Non-noxious afferent nerve stimulation inhibits pain signals to the brain.

  • Sensory Level Stimulation Parameters: High frequency (80-120 pps), phase duration < 200, strong intensity (no muscle contractions).

  • Motor Level Stimulation Uses: Prevent atrophy, re-establish neurological pathways, restore/increase muscle strength.

    • Twitch Contractions: < 15 pps

    • Summation Effect: 15-40 pps

    • Tonic Contractions: > 40 pps

  • Contraindications: Impaired sensory function, cardiac disability, pacemakers, cancerous lesions, blood clot disorder, pregnancy, metal implants, obesity, epilepsy.

  • Therapeutic Estim Frequency: 1-120 pulses per second.

  • Duty Cycle: Time between pulses; affects muscle recovery/fatigue.

  • Ramp Time: Time to peak amplitude (1-8 seconds, average 2 seconds).

  • Russian Stimulation: Alternating current burst modulation, bipolar, primarily for muscle contractions.

  • High-Voltage Pulsed Stimulation: Monophasic current; used for muscle re-education, nerve stimulation, edema reduction, pain control.

  • TENS: Alters pain perception via balanced biphasic current; minimizes gate control, reduces pain, primarily for acute and chronic musculoskeletal pain.

  • Interferential Stimulation: Quad-polar technique; two channels form interference pattern, primarily used for gate control theory.

Thermal Modalities

  • Cold Application Indications: Acute inflammatory phase, before ROM exercises, after physical activity.

  • Heat Transfer: From skin to cold modality.

  • Body Response to Cold: Skin cools first, then draws heat from underlying tissues.

  • Treatment Duration Impact: Longer duration = greater depth of cooling and temperature decrease.

  • Tissue Temperature Decrease: Max benefits for about 30 minutes.

  • Cellular Response to Cold: Decreased metabolism, prevents secondary cellular death.

  • RICE: Rest, ice, compression, elevation; counteracts edema.

  • Cryokinetics: Cold therapy with movement; improves ROM by reducing pain.

  • Contraindications for Cold: Cold allergy/urticaria, Raynaud's phenomenon.

  • Cold Application Methods: Ice bags, gel packs, cold compression units, chemical cold packs.

  • Ice Massage: Small, evenly shaped areas; effective for muscle spasms, contusions, localized injuries.

  • Thermopane: Ice immersion where skin warms surrounding water.

  • Heat Uses: Control inflammation (subacute/chronic), encourage tissue healing, reduce edema/ecchymosis, improve ROM before activity, promote venous drainage.

  • Temperature Gradient: Modality loses heat, body gains heat.

  • Rebound Vasoconstriction: Vessels constrict after max vasodilation.

  • Mottling: Warning sign of dangerously high tissue temperatures.

  • Cellular Response to Heat: 18^{\circ}F increase in skin temp increases metabolic rate by a factor of 2-3.

  • Whirlpool Temperatures: Cold immersion (65-80°F), heat immersion (98-102°F).

  • Heat Application Methods: Heat pack, whirlpool, paraffin bath.

Therapeutic Ultrasound

  • Ultrasound: Deep penetrating modality; produces thermal and non-thermal changes; used for imaging, deep heating, and tissue destruction.

  • Therapeutic Sound Wave Range: 750,000-3,300,000 Hz.

  • Effects: Increases tissue repair/wound healing, blood flow, tissue extensibility, breakdown of calcium deposits, reduces pain/muscle spasms, changes membrane permeability.

  • Sound Production: Alternating current through piezoelectric crystal in transducer.

  • Frequency: Number of waves per second, measured in MHz.

    • 3 MHz: Affects tissues 2.5-3cm deep; superficial tissues, heats 3x faster.

    • 1 MHz: Affects tissues 5 cm deep; deep penetration and adequate heating.

  • Power and Intensity: Energy produced by transducer, measured in watts.

  • Standard Heating Rates:

    • 1 MHz: 0.5 W/cm²: 0.04°C/min, 1.0 W/cm²: 0.2°C/min, 1.5 W/cm²: 0.3°C/min, 2.0 W/cm²: 0.4°C/min

    • 3 MHz: 0.5 W/cm²: 0.3°C/min, 1.0 W/cm²: 0.6°C/min, 1.5 W/cm²: 0.9°C/min, 2.0 W/cm²: 1.4°C/min

  • Duty Cycle: Percentage of time US is emitted.

  • Pulsed vs. Continuous:

    • Pulsed: Decreases average intensity, reduces thermal effects, maintains nonthermal effects.

    • Continuous: Heats tissues 5+ cm deep.

  • Sound Wave Transfer: Requires coupling agent (gel) to transmit through tissue; passes through soft tissue until it strikes bone.

  • Thermal vs. Nonthermal Effects:

    • Nonthermal: Changes in tissues from mechanical effects.

    • Thermal: Changes in tissues due to elevated temperature.

  • Contraindications: General heat contraindications, pacemakers, menstruation, pregnancy, active fracture sites/stress fractures, unfused epiphysis, metal implants.

  • Treatment Area Size: 2x size of sound head.

  • Coupling Methods: Direct coupling (gel), bladder method (gel pack), immersion technique (water).

Therapeutic Exercise

  • Rehab Program Sequence: Control pain/swelling, flexibility/ROM, strength/endurance, proprioception/coordination/agility, functional/sport-specific activity.

  • Healing Times:

    • Ligaments/Tendons: 40-50 weeks

    • Muscles: 6 weeks - 6 months

    • Cartilage: 6 months

    • Bones: 12 weeks

  • Tensile Strength & Inflammation: Decreases to 50% in 24-48 hours.

  • Rehabilitation Phase Objectives:

    • Inflammation: Control edema/pain, protect fibrin plug.

    • Proliferation: Withstand some resistance, improve isotonic strength, proprioception, balance.

  • Exercises During Inflammation Phase: Modalities for pain/edema/spasm relief; no stretching/resistance; maintain cardiovascular conditioning.

  • Exercises During Proliferation Phase: Easy ROM, active assistive ROM, passive ROM, Grades I & II joint mobilization.

  • Exercises During Remodeling Phase: Sport-specific exercises.

  • Immobilization Effects on Connective Tissue: Increases edema/trauma, impairs circulation causes muscle atrophy, limits ROM.

  • Force Deformation: Force to maintain tissue length change.

  • Creep: Elongation of tissue under low load over extended time.

  • Hooke's Law: Stress is proportional to strain.

  • Hysteresis: Repetitive stretches heat tissue, decrease viscosity, increase length.

  • Factors Influencing Stretch: Collagen/elastin, force amount, force duration, tissue temperature.

  • Stretch Techniques: Active, passive, PNF, ballistic, dynamic, assisted devices, CPM.

  • Definitions:

    • Strength: Max force a muscle can exert.

    • Power: Strength applied over distance for time.

    • Endurance: Muscle's ability to repeat contractions against submaximal load for a long time, or ability to sustain isometric contractions.

  • Inactivity Effect on Muscle Strength: Loss of 5% per day or 8% per week; loss rate faster than return.

  • Open vs. Closed Chain Activities:

    • Open: Distal segment moves freely in space.

    • Closed: Distal segment is weight-bearing; body moves over hand/foot.

  • SAID Principle: Specific Adaptations to Imposed Demands; muscle adapts to demands placed upon it.

  • Proprioception: Body's ability to transmit/interpret position information and respond /re-injury.

  • Balance: Ability to maintain equilibrium; exercises include Romberg, BESS, Y Balance tests.

  • Coordination: Smooth pattern of activity through muscle combination with appropriate intensity/timing; exercises include static/dynamic activities, coordination activities; many repetitions.

  • Agility: Ability to control body during rapid, complex activities; exercises include speed, direction changes, smoothness, power, balance, strength.

  • Plyometric Phases: Eccentric (prepares muscle), amortization (transitions muscle), concentric (outcome).

  • Plyometric Considerations: Strength (control activity), flexibility, and proprioception.

  • Functional Exercise Goals:

    • Attain full flexibility, strength, endurance, coordination.

    • Achieve full ability - normal speed, power, control, agility.

    • Restore self-confidence.