DPT 752

binding sites for neurotransmitters and neuromodulators

with certian conditions a pore is formed through the membrane to facilitate the movement of ions

bind and transfer substances through the membrane

• readily permeable to potassium
• slightly permeable to sodium
• impermeable to a number of large negatively charged proteins and phosphates (anions)

• atp used to actively transport sodium and potassium across the membrane
• sodium-potassium pump moves sodium ions out of the cell while moving potassium ions in

Na+ is higher

• K+ is higher
• anions are higher
• more negative than outside creating -60 to -90 mV charge

critical voltage level that triggers sodium and potassium channels to open

open rapidly

open slowly

while the nerve is depolarized, no additional APs can be created. (regardless of the intensity of the stimulus)

brief period of membrane hyperpolarization during which a greater stimulus than usual is required to produce another AP

situation in which if the stimulus is low enough the nerve cell will adapt to the stimulus and not fire.

current causes AP direction to depolarize in both directions but the effect will only be felt on the end with the NT release.

• flow of charged particles
• noted as (I)
• measured in Amperes (A)

• either +/-
• noted as (Q)
• measured in Coulombs (C)

• property of having two oppositely charged conductors
• + anode
• - cathode
• current flows from -to +

• force capable of moving charge
• aka the potential difference
• noted as (V)
• measured in volts (V)

• property of a conductor to resist flow of current
• noted as (R)
• measured in Ohms (omega)

V=IR

• frequency-dependent opposition to current
• noted as Z
• measured in Ohms (omega)
• in biological systems we can say it is a ratio of potential flow to actual flow

• direct current (DC)
• alternating current (AC)
• pulsed current or pulsatile current
• interferential current
• premodulated current
• Russian protocol

• iontophoresis
• stimulating denervated muscle
• facilitate wound healing

• bi-directional flow of current
• no pulse charge left in tissue
• inverse relationship between cycle duration and frequency

• current delivered discontinuously
• uni- or bi-directional
• monophasic (like DC)
• biphasic (like AC)

• symmetric
• asymmetric balanced
• -charge of the phases are equal and opposite leaving zero net charge
• asymmetric unbalanced
• - charges are not equal leaving a net charge of some kind

• two sine waves are overlapped causing a pulse or beat in the stimulus
• slower of the two frequencies is called the carrier frequency

• waveform produced by one channel
• same as if you were doing IF
• continuous sine wave with medium frequency
• uses sequentially increasing and decreasing amplitudes

• 2500 Hz carrier frequency AC sine wave modulated to 50 bps
• burst is a polyphasic waveform delivered for 10 ms followed by an interburst interval of 50 ms

• Frequency
• Pulse Duration/Phase Duration
• Interpulse Interval
• Interphase/Intrapulse Interval
• Rise/Decay Time
• On/Off Time
• Duty Cycle
• Ramp Up/Down Time

• Cycles or pulses per second
• noted in (Hz)

• beginning of first phase to the end of the last phase of a pulse
• expressed in micro or milli- seconds

time between pulses

time between phases of a pulse

time it takes to increase from zero to peak or peak to zero during any one phase

• time during which a train of pulses occurs then the time between the trains of pulses
• expressed often as a ratio

ratio of the on time to the total cycle time

• time it takes to increase from min to max amplitude and decrease from max to min amplitude
• helps with tolerating treatment better
• sometimes called "soft start"

• Amplitude
• Modulation
• Frequency Modulation
• Amplitude Modulation
• Phase Duration Modulation
• Burst Mode

• magnitude of current or voltage
• not intensity

Varying one or more of the stimulation patterns

• variation in the number of pulses or cycles per second
• aka - sweep

• variation in peak current amplitude
• aka - scan

variation in pulse or phase duration

series of pulses delivered in a package as a single pulse

minimum amplitude needed with a very long duration pulse to depolarize the cell.

minimum duration pulse required to produce an AP at twice the rheobase

• depends on inherent excitability
• relative location with respect to the electrode the closer the better

• low amplitudes
• higher amplitudes = deeper sensations

• gradual diminution in the ability to sense the stimulation
• occurs in sensory-level stimulation at frequencies >15pps for long periods of time

• normal voluntary contraction recruits the smalles motor units first.
• e-stim recruits all at once
• after motor threshold is reached, small increases in ampitude cause large increases in force of contraction
• can be used to help strength gains and function
• need long duration pulse to get denervated muscle >10ms

• high intensity that triggers A-delta and C fibers
• level may vary in each patient

• DC pulsed monophaisc and unbalanced biphasic waveforms leave a net charge in the tissue
• cathode attracts positive ions
• anode attracts negative ions
• used in iontophoresis

• duration = 50-80 microseconds
• frequency = 100-150 pps (high rate) 2-10 pps (low rate)
• burst mode uses same theory as low rate TENS
• Subsensory-level stimulation has little evidence
• Electrode placement over the site of injury

• over or near medical stimulators
• confused or uncooperative patients
• damaged skin or subcutaneous tissues
• skin with impaired sensation
• malignancies
• arterial or venous thrombus
• anterior neck
• carotid sinus
• laryngeal or pharyngeal muscles
• phrenic or vagus nerve

• pregnant women
• across the head or through the chest
• heart disease
• HTN, Hypotension
• diagnosed or suspected epilepsy
• keep out of reach of children
• while operating machinery or vehicles

• subjects coping style
• whether the stimulus causes a muscle contraction
• whether the subject is judging intensity or unpleasantness of the stimulation

greater force = greater discomfort

• pulse duration 200-300 microseconds
• frequency 30 pps
• on:off time 1:2
• 20 min 5-6 days a week for 4 weeks

• triggered by swing phase foot switch
• pusle duration 300 microseconds
• 40 pps

• longer pulse duration more than 10 ms
• DC current is applied for a number of seconds
• denervation is not improved by e-stim

• dictated by:
• -patient comfort and modesty
• -area to be treated
• -goals of the treatment
• -deviced used

• smooth against the skin
• not over bony prominance
• closer together more superficially the stimulus
• for larger muscle groups use distal and proximal attachment
• for single muscles attach pad to motor point (belly)
• For pain pads should be at least an inch apart
• For muscle contraction pads should be 2 inches apart

• use inferential current
• place over trigger point or accupuncture point
• place pads proximal to area if point cannot be accessed directly

• negative pole over area of inflammation and the dispersement electrode more proximal
• for edema d/t lack of motion stimulate muscles around the deep veins

• muscle contraction: 150-350 microsecond
• biphasic conventional TENS: 50-80 microsecons
• low rate TENS: 100-200 microseconds
• interferential curreent pulse durations: inversely proportional to carrier frequency

• determines response or muscle contraction
• low frequency: less than 30 pps, motor nerves, separate twitch contraction
• smooth tetanic contraction:35-50 pps, greater muscle strengthening but more rapid fatigue
• Pain control: HR TENS 100-150 pps LR TENS less than 10pps
• Edema control: 120 pps

• pain control, wound care, acute edema, iontophoresis: continuous
• muscle contractions: 1:5 ratio moving to 1:4 or 1:3
• spasm relief or pump out edema: 1:1 2-5 seconds

• 1-4 seconds
• may not need it for functional activity because you need stimulation immediately

• for strengthening: 50% of max voluntary control
• for muscle reeducation: use sensory-level stimulation moving to contraction-level
• for spasms: sufficient to produce a visible contraction
• for pain control: HR TENS comfortable as possible LR and Burst TENS visible contraction
• Edema: comfortable sensory level

• Muscle strength: 10-20 contractions or 10-20 minutes multiple times a day
• muscle reeducation: no more than 20 min a session
• pain control: HR TENS all day LR TENS 20-30 min every 2 hrs
• edema: 30 minutes can be used more than once a day

• Area of body
• Treatment duration
• Patient position
• Electrode placement
• Treatment parameters
• Response to treatment

• Electromigration
• Electroporation
• Electro-osmosis

• Calcific tendonitis
• myositis ossificans

believed to increase solubility of calcium deposits

Skeletal muscle spasms

Ca stablizes excitable membranes

inflammation

Steroidal anti-inflammatory agent

Soft-tissue adhesions

treatment not fully understood

pain and inflammation

local anesthetic

muscle spasms

decreased excitability of muscle membrane

local edema (subacute and chronic)

increases permeability in connective tissue

Pain

analgesic and antiinflammatory effects

dermatologic disorders

general antiseptic

• DC (usually)
• 1.0-4.0 mA

• more predictable and less variable for getting drug into circulation
• could use it for longer periods of time becoming more effective
• less damaging to skin than equivalent application of DC

• high volt >100 V for short time (few microseconds or milliseconds)
• not much clinical evidence

• mA*min
• 70-80 mA*min whenever possible to maximize effects
• low current long duration is more effective than high current low duration

• low concentrations of the drug
• one drug at a time
• do not use heating agents with ionto because it will limit the localized effect of the drug

• allergies?
• localize the electrode over the point of injur
• skin depth may contribute to effectiveness of drug
• do not use if the skin is damaged or broken
• prep skin with alcohol wipe
• connect electrodes and then ramp up the current
• upon completion ramp down the current and remove electrodes
• examine skin for signs that pt didn't tolerate treatment well

• Inflammation (Dexamethosone)
• Treat pain (Lidocaine) be cautious not to burn the pt