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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
What are some txs for pain?
- meds (narcotics, non-narcotics)
- TENS (sensorym motor, noxious)
- nerve blocks
How is pain transmitted?
from periphery to CNS via A-delta and C nerve fibers
How does estim help pain?
can activate A-beta nerves
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
What are the bodys natural pain killers?
What is the pulse width range for conventional TENS?
- 50-200 microseconds
- amplitude produces a comfortable sensation which will activate the A-beta fibers
What is the pulse frequency range for conventional TENS?
- 100-150 pps- most comfortable
- may be set anywhere from 50-150 pps
How long do the effects of conventional TENS last?
only while machine is turned on
How does the low frequency mode for TENS work?
- acupuncture like
- recruits deep afferent nerves to produce central inhibitory effects through the endogenous opiates
What is the pulse duration range for low frequency TENS?
What is the pulse rate of the low frequency TENS?
- 1-5pps (up to 10)
- amplitude strong enough to produce a local m contraction
How long do the effects of the low frequency TENS last?
can control pain 4-5 hours after a 20-30 min tx
What type of TENS is tolerated better than low freq?
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
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
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
What is modulation mode?
- decrease pt accomodation
- parameters may be modulated in isolation or in combination
- same principle and rationale as conventional mode
What is strength duration mode?
- decreases pt accomodation
- direct relation to strength duration curve
What is hyperstimulation mode?
- uses noxious input to control pain
- small probe
- endogeous opiates
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
What are 2 forms of biphasic?
When do innervated mm contract?
when estim depolarizes their motor nerves
WHen do denervated mm contract?
when estim depolarizes their m cell membrances directly
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
What mm are depolarized first with estim?
large diameter - fast twitch fibers-type 2
longer rest breaks are needed
What mm are depolarized first physiologically?
smaller - slow twitch-type 1 - fatigue resistant
perform estim contractions with physiological contractions
What is biphasic?
- 2 phases
- muscle re-ed, strengthening, edema reduction
What is NMES?
- neuromuscular electrical stimulation
- produce motor response in pts who show difficulty in executing active, colitional mvmt on their own
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
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
- orthotic substiution - FES
- edema management
- bulbar stimulation/bowel and bladder
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