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How is pain developed?
- result of damage to tissue
- result of chemicals accumulating in the area an mechanical pressure caused by the inflammation
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What are some txs for pain?
- meds (narcotics, non-narcotics)
- MENS-microunit
- TENS (sensorym motor, noxious)
- HVPC
- LVPC
- IFC
- nerve blocks
- surgery
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How is pain transmitted?
from periphery to CNS via A-delta and C nerve fibers
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How does estim help pain?
can activate A-beta nerves
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What is the gate control theory of pain?
pain perception is decreased bc the relative activity of the A-delta/C fibers to A-beta fibers is decreased
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What are the bodys natural pain killers?
endogeous opiates
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What is the pulse width range for conventional TENS?
- 50-200 microseconds
- amplitude produces a comfortable sensation which will activate the A-beta fibers
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What is the pulse frequency range for conventional TENS?
- 100-150 pps- most comfortable
- may be set anywhere from 50-150 pps
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How long do the effects of conventional TENS last?
only while machine is turned on
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How does the low frequency mode for TENS work?
- acupuncture like
- recruits deep afferent nerves to produce central inhibitory effects through the endogenous opiates
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What is the pulse duration range for low frequency TENS?
200-500 microseconds
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What is the pulse rate of the low frequency TENS?
- 1-5pps (up to 10)
- amplitude strong enough to produce a local m contraction
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How long do the effects of the low frequency TENS last?
can control pain 4-5 hours after a 20-30 min tx
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What type of TENS is tolerated better than low freq?
burst mode
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What are the parameters for burst mode?
high and low frequency pulses
- freq- 70-100pps
- pulse duration- 200-500 ms
- burst rate- 1-5bps
- amplitude strong enough to produce local m contraction
endogeous optiates
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What is brief intense mode?
designed to inhibit pain by using high range frequencies, pulse durations, and amplitude at a comfortable/tolerable level
- pain relief immediate
- decreases conduction along A-delta and C fibers
- gait theory
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What are the parameters for brief intense mode?
- pulse duration- 200-400 ms
- freq- 75-150pps
- amplitude tolerance for max parasthesia
- slight nonrhythmic m contraction may occur
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What is modulation mode?
- decrease pt accomodation
- parameters may be modulated in isolation or in combination
- same principle and rationale as conventional mode
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What is strength duration mode?
- decreases pt accomodation
- direct relation to strength duration curve
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What is hyperstimulation mode?
- uses noxious input to control pain
- small probe
- endogeous opiates
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What are the parameters for hyperstimulation TENS?
- pulse duration- really high- 250 ms-10 milliseconds
- freq- really low- 1-4pps
- amplitude that produces max tolerable noxious input
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What are 2 forms of biphasic?
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When do innervated mm contract?
when estim depolarizes their motor nerves
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WHen do denervated mm contract?
when estim depolarizes their m cell membrances directly
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What direct effects on the m does estim have?
- changes from anaerobic to aerobic
- increases blood flow and oxygen consumption
- increases glucose consumption and decreases lactate outoput
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What mm are depolarized first with estim?
large diameter - fast twitch fibers-type 2
longer rest breaks are needed
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What mm are depolarized first physiologically?
smaller - slow twitch-type 1 - fatigue resistant
perform estim contractions with physiological contractions
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What is biphasic?
- 2 phases
- muscle re-ed, strengthening, edema reduction
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What is NMES?
- neuromuscular electrical stimulation
- produce motor response in pts who show difficulty in executing active, colitional mvmt on their own
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What is FES?
- functional electrical stimulation
- activates innervated but inactive, paretic, or paralyzed mm as a form of orthotic for management of deformity or to assist in purposeful mvmt
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What are indications of biphasic?
- increase joint ROM (contracture management of knee, wrist, or scoliosis)
- temp spasticity management/spasm reduction
- increase strength (disuse atrophy)
- increase endurance
- increase sensory/motor integration
- faciliation/re-ed
- orthotic substiution - FES
- edema management
- bulbar stimulation/bowel and bladder
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What are contraindications of biphasic?
- where active motion is contraindicated
- demand type pacemaker
- over superficial metal implants
- active bleeding in tx area
- malignancies in tx area
- very disoriented pts
- 1st trimester of pregnancy
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