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2014-05-04 15:58:58
304 modalities

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  1. list (9) therapeutic uses of electrotherapy:
    • controlling acute and chronic pain
    • reducing muscle spasm
    • reducing edema
    • inhibiting muscle spasm
    • minimizing disuse atrophy
    • facilitating tissue healing
    • facilitating muscle reeducation
    • strengthening muscle
    • facilitating fx healing
  2. list (4) physiological responses to elcetrical current:
    • stimulating sensory nerves to help in tx'ing pain
    • creating muscle contraction through nerve or muscle stimulation
    • creating an electrical field in biological tissues to stimulate of alter the healing process
    • deliver medication
  3. list (5) effects of electrical current at the cellular level:
    • excitation of nerve cells
    • changes in cell membrane permeability
    • protein synthesis
    • stimulation of fibroblast, osteoblast
    • modification of microcirculation
  4. list (3) effects of electrical current at the tissue level:
    • skeletal muscle contraction
    • smooth muscle contraction
    • tissue regeneration
  5. list (3) effects of electrical current at the segmental level:
    • modification of joint mobility
    • muscle pumping action to change circulation and lymphatic activity
    • alteration of the microvascular system not associated with muscle pumping
  6. list (2) systematic effects of electrical current:
    • analgesic effects as endogenous pain suppressors are released and act at different levels to control pain
    • alalgesic effects from the stimulation of certain neurotransmitters to control neural activity in the presence of pain stimuli
  7. describe the direct physicolgical response to electrical current:
    direct effects occur along the lines of current flow and under electrodes
  8. describe the indirect physiological response to electrical current:
    indirect effects occur remote to area (far from) of current flow and are usually the result of stimulating a natural physiologic event to occur
  9. list (8) general contraindications to electrotherapy:
    • Cardiac areas: heart, carotid sinus, pacemakers (electrical rhythms)
    • pregnancy
    • menstruation
    • cancerous lesions and infections
    • exposed metal implants (ORIFs are ok)
    • head, face, and neck
    • sever obesity (breathing)
    • electronic monitoring equipment
  10. the movement or flow of charged particles is called:

    what is the measurement:
    electrical current

    measurement: amperes (A) (intensity is displayed in microAmps on the equpiment)
  11. the magnitiude of the current is called:


    the maximum distance that the pulse rises above or below the baseline:

    how high the current gets
  12. an electrical current that takes the path of least resistance from the negative pole is called:

    to the positive pole, called:
    from: cathode

    an area of high electron concentration

    to: anode

    an area of low electron concentraion
  13. the uninterrupted, one directional flow of electrions is called:
    direct current (DC)
  14. list (3) uses for direct currents (DC):
    • iontophoresis
    • stimulating denervated muscle (not working, directly stimulate)
    • wound healing (charge buildup)

    negative charged chemcials with positive currents

    • fresh acute: positve
    • acute: negative electricity
    • chronic: positive
  15. the continuous bidirectional flow of charged particles is called:
    alternating current (AC)

    • equal ion flow in each direction
    • no charge remains in the tissue

    • controlling pain
    • elicit action potental of nerve
  16. the originating point on the baseline to its terminating  point and represents the amount of time require to complete one full cycle is called:
    cycle duration


  17. cycle duration (wavelength) and frequency have what type of relationship:
    inversely related

    as the duration of the cycles increease, fewer cycles per second can occur

    increasing frequency = decreased (shortened) wavelength
  18. discontinuous electrical currents, that has a series of pulse with no electrical flow is called:
    pulsed current
  19. list and describe the (2) pulsed currents:
    • monophasic (high voltage): series of unidirectional particle flow
    • Biphasic: charged particles 1st move in one direction then the other (IFC)
  20. phases of biphasic pulsed currents that are equal, but opposite, in electrical balance is called:

    equal in their magnitiude and duration
  21. biphasic pulsed currents that are different in shape is called:

    positive does not equal negative
  22. if the charges (area) of both phases during pulsed currents are equal, the pulse is electrically:

    otherwise the charges are electrically:
    if the charges (area) of both phases during pulsed currents are equal, the pulse is electrically: balanced

    otherwise the charges are electrically: unbalanced
  23. the number of cycles or pulses per second is called:

    measured in:

    measured in: Hz or pps
  24. distance the pulse covers over the horizontal axis from the beginning phase & final phase, including the intrapulse interval is called:
    pulse duration

    how long the entire wave
  25. the time required for each phase to complete its shape is called:
    phase duration

    • duration of biphasic pulses
    • how long positive, how long negative
  26. the time between the conclusion of one pulse and the start of the of the next is called:


    the time between phases of a pulse is called: interphase interval
  27. what is the clinical application of pulse and phase duration:
    the longer the phase duration the more intense the pulse

    longer phase durations have a better chance to cause depolarization of nerves (as phase duration is increased, different tissues are depolarized)
  28. the time it takes for current to increase or decrease from 0 to its peak in any one phase is called:

    rise time/decay time

    muscle re-education
  29. the time during which current or train of pulses is on vs off (10 on: 50 off) is called:

    on/off time

    ex: reps to rest ratio = recovery.  Using ATP during contraction, so replenish ATP during rest time

    muscle re-education
  30. the "on time" vs. the total time is called:
    duty cycle
  31. the time it takes for a current to increase from zero to its maximum for any given on time is called:

    ramp up/down time
  32. the magnitude of a current is called:
  33. any pattern of variation in tx parameters is called:

    what is the fxn of this:


    • fxn: used to limit adaption or accommodation
    • may be cyclic or random
  34. the tissues in the body circuit are either excitable or nonexcitable.

    define excitable:
    are directly influenced by the electrical current

    intensity, pulse or phase duration, and pulse frequency
  35. list the (4) excitable tissues in the body circuit:
    • nerve
    • muscle (re-education)
    • blood cells (chemical mediators)
    • cell membranes (more permeable)
  36. the tissues in the body circuit are either excitable or nonexcitable.

    in general, what is the rule to determine excitability:
    the higher the water content, the more excitable
  37. the tissues in the body circuit are either excitable or nonexcitable.

    define nonexcitable:
    do not directly or minimal response to electrical current
  38. list the (4) nonexcitable tissues in the body circuit:
    • bone
    • cartilage
    • tendons
    • ligaments
    • adipose

    do not contract
  39. electrical current flows along the path of least resistance
    • if part of the electrode is good, the other faulty.. it will flow thru the good electrode
    • thick skin: increase tissue resistance

    the amount of current delivered thru the electrode will decrease and be inconsistent over the surface of the electrode.

    causes current to concentrate in small areas of the electrode- adverse rxn!
  40. where the electrons from the generator are converted into the body's tissues are called:
  41. list the (3) different types of electrodes:

    what is an advantage of each:
    • metal: conduct very well, used in AED's
    • carbon: reusable, con: not sterile
    • adhesive: less expensive, (1) set per person
  42. carbon electrodes must be well moistened prior to tx.  dry carbon electrodes are poor conductors of current and should never be used dry.

    list (2) reason why electrodes should be used with a medium:
    • reduces resistance
    • provides a more even distribution
    • -moist sponges, gauze, paper towels (don't hold moisture as long)
    • -gels (primarily water)
  43. list (7) methods of reducing skin-electrode resistance:
    • moisten electrodes with water or gel
    • remove dirt, oil, flaky skin, by washing with soap, water, or alcohol
    • warm area with a moist heat pack
    • gently scrub area with emery paper
    • remove excess hair
    • saturate sponges with commercial saline solution rather than tap water
    • use silver electrodes
  44. in regards to electrode size..

    small electrodes:
    larger electrodes:

    what does the size of the electrode depend on:
    • small electrodes:
    • have a higher current density
    • current density- voltage per unit area
    • 1.25" square electrode is over 4x the current density in a 1.75'' by 3.75" for the same intensity setting

    • large electrodes:
    • produce a stronger, more comfortable contractions
    • current delivered to large area of the body, keeping current density low, and minimizing adverse rxn

    what does the size of the electrode depend on: size of the body part
  45. the proximity of electrodes to one another determines which (3) things:

    • which tissues are stimulated
    • the depth of penetration
    • the # of parallel circuits formed
  46. the further the electrodes are apart, the _______ the tx.

    list (2) in regards to how far apart the electrodes should be:
    • the further apart the deeper the tx
    • the further the distance b/w electrodes, the less specific the tx
  47. certain areas of the skin conduct electricity better than other areas, these areas are called:
    stimulation points
  48. an area of skin surface for a particular muscle that is hypersensitive to current flow is called:
    motor points

    • location where motor nerves & blood vessels enter the muscle mass
    • motor points associated with injured area show an increased sensitivity to current flow and palpations
  49. pathological, localized areas of pain that are hypersensitive to stimulation are called:
    trigger points

    • radiating or referred pain
    • not only in muscle, but soft tissue, ligament, tendon, and fascia
  50. specific sites on the skin that connect with meridians that energy flows thru are called:
    acupuncture points
  51. monopolar application involves that use of 2 classifications of electrodes, list and describe the (2) electrodes:
    • active electrode:
    • where the tx is occuring
    • high current density focuses under the smaller electrode

    • dispersive electrode:
    • used to complete the circuit
    • placed anywhere else on the body
    • much larger than the active electrode (this prevents the sensation to be felt - ideally more than 2x the active electrode)

    if sensation under the dispersive pad is felt, indicates current densities are too similar so a larger dispersive pad or smaller active electrode should be used
  52. the electrical stimulation modes that would indicate electrode set up of monopolar would be which (2) modes:

    what are the tx goals:
    current type:
    • monopolar electrode set up:
    • Hi- Volt
    • iontophoresis

    • tx goals:
    • Hi Volt: tissue healing
    • iontophoresis: tissue healing, med delivery

    current type: direct current (DC)

    US + Estim tx= monopolar
  53. the application that uses 2 electrodes of equal or near equal sizes is called:
  54. general guidelines for the preparation of a pt. should include:
    • ensure the pt has no contraindications
    • points of placement should be cleaned with alcohol to remove excess oils
    • avoid areas of excess hair
    • inform the pt. on sensations to be felt (tingly, twitch, pins and needles) and to keep movement to a minimum
  55. electrical current exert their effects by depolarizing nerve membranes and thus producing:
    action potentials: basic unit of nerve communication

    • electrical current of adequate amplitude and duration will cause an action potential
    • resting is -70 mV
    • AP is +30 mV
    • all or nothing: stimulus must be great enough to cause AP
  56. resting membrane potential at rest inside of a nerve has a resting charge of:
    -60 to -90 mV

    rapid sequential depolarization and repolarization is known as action potential
  57. resting membrane potential is maintained by...

    high ions outside:
    ions inside:
    • high ions outside: Na+
    • ions inside: K+
  58. with sufficient stimuli, Na+ channels open and Na+ rushes in which is called:

    • K+ channels slow
    • high extracellular to low intracellular
  59. K+ channels rapidly open to return to resting membrane potentials which is called:

    high intracellular to low extracellular
  60. the period during depolarization when no additional AP can be generated no matter the stimuli is called:
    absolute refractory peroid
  61. the period during repolarization there is a brief period of hyperpolarization when increased stimuli can cause AP is called:
    relative refractory peroid
  62. describe the order of stimulation of nerves:

    • 1st: sensory nerves
    • superficial, large diameter, myelinated
    • A Betas

    • 2nd: motor nerves
    • situated deeper, smaller in diameter, myelinated
    • muscle contraction

    • 3rd: pain fibers
    • not as deep as motor, but are smaller and unmyelinated
    • C Fibers & A deltas

  63. describe the strength duration curve:
    • L side: current strength
    • if intensity is high enough, you will recruit sharp pain and direct muscle spasm

    becomes painful, adjust pulse duration

    long duration, the longer the wave, less amplitude to recruit the nerve
  64. the rate of discharge of the nerve's action potential decreases while the depolarization stimulus, remains unchanged is called:

    may decrease or even lose your stimulation
  65. CNS filters out the stimulation because it senses it as a continuous, meaningless stimulus is called:

    don't need it so CNS shuts it out
  66. which parameters are used to prevent accommodation and habituation:
  67. list the 6 electrical stimulation goals:
    • pain control
    • wound healing
    • control and reduction of edema
    • muscle contractions
    • strength augmentation
    • fx healing
  68. high pulse frequency, short - duration, and sensory level (strong but comfortable) taps into which theory of pain control:
    gate theory

    • may mask pain (be careful with this technique) if masked too much, cant feel further damage
    • may reduce perception of pain which may cause other beneficial effects
    • -if pain is reduced, mechanical stimulation (muscle spasm) is reduced - this leads to increased O2 levels and blood flow - this leads to healing
  69. low variable frequency, long duration (variable) and high intensity at a noxious level taps into which theory of pain control:
    endogenous opiates (endorphins, enkephalins)
  70. IFC currents uses two alternating currents on two separate channels. describe how the following interfere with each other:

    constructive interference:
    • constructive:
    • equal wavelengths and phases
    • waves combine to one large wave
  71. IFC currents uses two alternating currents on two separate channels. describe how the following interfere with each other:

    destructive interference:
    • the phases are not in sync
    • waves cancel each other out
  72. IFC currents uses two alternating currents on two separate channels. describe how the following interfere with each other:

    continuous interference:
    • use of constructive and destructive interference
    • IFC generators do this
  73. the difference in frequency between the two IFC circuits is called:
    beat pattern
  74. what is the advantage of the use of IFC:
    • able to use greater frequencies and total current to the body
    • less skin resistance (the high frequencies can penetrate easier but once interference occurs it is reduced to therapeutic level)

  75. describe how a beat pattern is created here:
    two generators with slightly different frequencies that are out of phase and thus create a beat pattern

    • changing frequencies
    • high carrier frequency = deeper tissue, larger area
  76. a waveform produced by one channel that has the same form as IFC waves is called:
    premodulated (bipolar) currents

    • continuous AC wave with medium frequency and increasing/decreasing amplitude
    • 2 high frequency currents are mixed within the machine
  77. how does premodulated current compare to IFC in terms of tx area:
    • smaller area
    • not as deep
  78. what is the theoretical mechanism for the use of estim on fx healing:
    body has natural electric charge for bone remodeling, electric generators try to mimic the body's "natural" charge of stimulate the body to activate its own charge
  79. High volt has been show to attract leukocytes, epidermal cells, and fibroblasts and increases collagenase to tx'd area.  describe the role of the following relevant to wound healing:

    • leukocytes: phagocytic
    • fibroblasts: collagen synthesis
    • collagenase: breaks down scar tissue
  80. what are the (3) clinical uses of IFC and Premod:
    • gait pain control
    • endogenous opiate
    • muscle pump
  81. according to Cameron's therory of wound healing, which charge would you use for the following:

    inflammatory phase:
    proliferation phase:
    • inflammatory phase:
    • negative
    • repel chemical mediators
    • cell membrane is usually negatively charged. Reversed when damaged

    • proliferation phase:
    • positive
    • facilicate epithelial migration to close would
  82. according to Starkey's theroy of wound healing (for HV), which charge would you use for the following:

    • acute: positive (+) repels positively charged noxious acids, clot and granulation tissue formation
    • chronic: negative (-) encourages vasodilation and break up blood clots
  83. list the (3) clinical uses of HV:
    • tissues healing
    • pain control
    • muscle pump
  84. what is the duty cycle for HV in order for there to be a charge build up:
  85. list (5) reasons why you would activate muscle contractions with electrical stimulation:
    • slow effects of atrophy: surgery, major trauma
    • re-educate muscle
    • reduce edema: muscle pump
    • augment strength of healthy muscle: limited research
    • denervated muscle (use of DC current): paraplegia
  86. in regards to strength augmentation and re-education, how does E Stim compare to voluntary muscle contractions:
    Electrically induced muscle contractions are as desireable as voluntary muscle contractions

    • want them to recruit their own muscles
    • after 1 or 2 sessions should be able to regain voluntary muscle contractions
  87. list (3) precautions for the use of estim for strength augmentation and re-education:
    • high dudy cycle may cause fatigue
    • deplete phosphcreatine system
    • GTO cannot override e stim
  88. if intensity is high enough, a muscle contraction can be elicted.

    what specially is stimulated as a opposed to the muscle being directly stimulated:
    the motor nerve is stimulated as a opposed to the muscle being directly stimulated
  89. how are physiological contractions different from electrically stimulated contractions:
    • physiological contractions:
    • small, slow twitch fibers recruited 1st
    • contractions and recruitment are asynchronous
    • golgi tendon organ (GTO) can protect muscle

    • electraical contraction:
    • large, fast twitch fibers
    • synchronous for electrical stim.
    • GTO cannot protect when muscle is electrically stimulated
  90. the protocol for "russian" is about 2500 Hz (frequency) of AC wave modulated to produce 50 burst per second.  what is the advantage of this
    high frequency carrier wave decreases resistance and allows for greater current flow for increased muscle response
  91. which muscle fibers fire 1st during a voluntary muscle contraction:

    which muscle fibers fire 1st during electrically contraction:
    • 1st during a voluntary muscle contraction: Type I
    • 1st during electrically contraction: Type II fibes (the more powerful fibers, larger diameter nerves)
  92. how would you theoretically have better strength gains with the use of "russian"
    • electrically stimulating Type II fibers, (powerful, large diameter)
    • stimulating the muscle fibers that have the greater abiltiy to increase in size and strength
  93. what is the proposed mechanism for control and reduction of edema formation on the senosry level stimulation:
    • reduction in capillary pressure and capillary premeability
    • pulsed monophase may cause vasospasm and prevent fluids from entering extracellular space
  94. what is the proposed mechanism for control and reduction of edema formation on the motor level stimulation:
    • use muscluar contractions to enhance venous and lymphatic return
    • works by causing muscle contraction and you get a "milking effect" which squeezes the fluids proximally