PT 7428- PT Interventions Electrotherapy Study Guide Fall Semester - 2008 Study materials: Cameron Text- Chapter 8 & Lecture

Notes The following guide is provided to aid preparations for the PT7428 final exam and practical. In general, it will be important to know both general principles of electrotherapy and special considerations specific to the type of application intended for the four main areas: muscle contraction, pain management, tissue healing & drug delivery. With this in mind please be sure that you know the following: 1. Be able to identify and describe the three basic waveforms used in electrotherapy. Waveform # 1: Direct Current (DC) Unidirectional, Continuous, Unbalanced Waveform #2: Alternating Current (AC) Bidirectional, Balanced charge to tissue (+/- = net 0), Wavelength=1 cycle, sine wave Waveform #3: Pulsed Current Monophasic or Biphasic (fig 8.4) Frequencynumber of cycles of pulses/sec (Hz or pps) Amplitudemagnitude of current or voltage (~intensity) Monophasic: series of unidirectional pulses Biphasic: series of bidirectional pulses [symmetric or asymmetric, balanced (net 0) or unbalanced] Pulse durationentire deflection Phase durationhow long in one direction (+ or -) Interpulse intervaltime between pulses Rise/Decay timemax amp for any 1 phase On/Off timetrain of pulses, ratio (10:50) Ramp up/down timesoft start, max amp for any single on time 2. Know the basic terminology used to describe waveform parameters which might be adjusted during the treatment session and be able to provide a simple one sentence description i.e. difference between constant current vs. constant voltage. Electrical currentmvmt or flow of charged particles thru a conductor Charge(+ or - ), polarity Voltageforce capable of moving charged particles Resistanceproperty of conductor that resists electrical flow (e.x. metal=low, flow easily) Impedancetotal frequency-dependent opposition to flow (skin condition impact impedance)

PT 7428- PT Interventions Electrotherapy Study Guide Fall Semester - 2008 Conductorselectrolytes, blood, other body fluids, nn, mm; superficial mmlots of noise, current spreads and creates interference Modulationvariation in stimulation parametrics (amplitude, frequency, etc.); limits neural adaptation Burst Modeseries of pulses delivered as a single burst (e.x. burst mode tens for pain mod) Nerve Depolarizationaction potential, strength duration curve Muscle Depolarizationcontraction Ionic Effectsfluid mvmt, cellular mvt Orthodromicphysiological direction of propogation (motor-away CNS, sensorytoward CNS) Antidromicnon-physiological, opposite direction/bidirectional 3. Be able to explain use of strength-duration curve to describe sensory vs. motor responses to electrical stimulation. Strength duration curve (fig 8-3)representation of the min amplitude and duration needed to depolarize a particular type of nn. -depends on: diameter of nn (large=faster), myelination (=faster) Rheobasemin amp req. to produce AP Chronaxiemin duration at twice the rheobase req to produce AP (mA & usec) Sensory nnlower amp, shorter pulse duration (pulse ~80 usec) Motor nnhigher amp or longer pulses (pulse ~150-350 usec) Pain C fiberslonger pulse duration (pulse > 1 msec) 4. Be able to describe basic parameters described in Cameron textbook for the following clinical applications: See the book, or chart on the wiki a. muscle contraction b. pain management c. tissue healing d. drug delivery 5. Know principles for proper electrode placement for the four clinical applications named in Item #4. (As we used in lab) General: Sensory stimulationelectrodes close together, sensory nns depolarize Sensory & Motor stimulationelectrodes further apart, sensory and motor nns depol Electrodes never in contact with each other Bipolar or monopolar effect

PT 7428- PT Interventions Electrotherapy Study Guide Fall Semester - 2008 Muscle contraction (NMES, symmetric biphasic) Cathode (Black, -) on the site to be stimulated; Anode (Red, +) proximal on the mm [or distally if theres not space proximal as in the ant. tib for DF] Place electrodes a minimum of one pad length away; further away for deeper penetration. The bipolar uses 2 electrodes, both active; monopolar uses 1 large, 1 small (primary response) for dispersive; quadripolar all active, larger tx size. Pain Management (Interferential, premodulated, TENS) Anode (red, +) on the pain; Cathode (black, -) about 1+ inch apart. OR 2 circuits, criss-cross over the area of pain, with the wires connecting diagonally across the painful area. Tissue Healing Negative charge for bactericidal; Positive charge for epithelization. Negative for early healing; Positive for later (post 3 day); Alternate if healing reaches plateau Active electrode saline soaked in wound, other electrode 15-30 cm away, depending on depth Iontophoresis Active electrode over tx area; polarity of drug and electrode must match. E.g. dexamethasone (-) so use (-) electrode. Max Safe Current Density: Cathode 0.5 mA/cm2, Anode 1.0 mA/cm2 Note: Iontophoresis uses CV, not CC like other e-stim. 6. Know difference between physiological vs. electrically stimulation muscle contractions. The Henneman Principle Physiological: small diameter nn 1st, slow twitch + fatigue resistant; gradually increase force, asynchronous recruitment, smooth, graded Electrical: large diameters nn 1sts, fast twitch + fatigue rapidly; rapid, jerky onset, synchronous firing of same size motor units 7. Know the basic theories used to support the use of electrotherapy for pain management. Alter the perception of pain. TENS uses a polyphasic biphasic current based on gate theory; A-Beta stimulated (nonnociceptor) >> A-delta, C fibers (pain). Acute pain=gate theory; chronic pain=opiate/endorphin release. IFC provides pain management using a polyphasic beat frequency composed of two+ frequencies.

PT 7428- PT Interventions Electrotherapy Study Guide Fall Semester - 2008 8. Know the basic theories used to support treatment set-up and use of electrotherapy for tissue healing. Galvanotaxis: process of attraction, specific cells attracted to injured area by an electrical charge Restoration of current injury to connect the two sides of a wound, attraction of cells, activating cells via altering cell membrane. Negative/Cathode: bactericidal effects; attract Active N, Fiberblasts, Platelets, Mast cells. Positive/Anode: epitheliazation effects; inactive N, leukocytes, monocytes, epithelial. Negative is early inflammation; Positive is later. Edema: alters microvascular to plasma proteins; blood/protein (-), repelled by (-)
Pulse Frequency 60-125 pps Pulse Duration 40-100 u sec

Type of Stim Wound Healing Edema, Early Edema, Formed Wound Healing Pain Monophasic, HPVC Monophasic, HPVC Monophasic, HPVC LIDC, microurrents LIDC, microurrents

Cathode (Black, -) Anode (Red, +) Early healing At site Over motor point alternate alternate Late healing Prox Dispersive

Off:On Amp comfort comfort 1:1, 1:5 rhythmic no feel

Tx Time 45-60min 20-30 min 20-30 min 20-30 min 20-120 min

Times/Day 5 day/week 4x/day

100-120 pps 40-100 u sec 35-50 pps .1-1pps 30pps (1-200pps)

1-4/day 1-4/day

As found in lecture on tissue healing and drug delivery.

9. Know the P's and C's for electrotherapy. Cs Demand Pacemakers Arrhythmias Electrodes over carotid sinus Thrombosis & thrombophelitis Pregnancy (abd or LB) Directly over eyes Ps Cardiac dz Impaired mentation Impaired sensation Malignant tumor Skin irritation or open wounds Ionto after other physical agents

10. Be able to describe general treatment session using electrotherapy including: proper patient preparation, positioning, draping, & safety precautions.
Select appropriate unit and parameters Comfortable position, explain procedure and sensation Inspect the skin; trim hair, clean skin w/ alcohol Select proper electrodes and apply Set parameters, increase amplitude (intensity) Remove electrodes and inspect skin:

PT 7428- PT Interventions Electrotherapy Study Guide Fall Semester - 2008

o o o o o Pink Changes should resolve in 20-30 minutes If it doesnt: possibleelectrical burn, allergic rxn, document, burn Sensation check, monitoring, parameter choice Informed consent

11. Know basic principles supporting treatment set-up and precautions used with iontophoresis. Trim hair, clean skin Comfortable position, explain sensation, no jewelry Select proper electrodes, conduction medium Inject tx electrode with medications (1.5-2.0 cc) Apply to location and set parameters Monitor pt Reassess post-tx, inspect skin Documentation Cs Ps Broken skin Excess hair Allergy to ion No wt applied over electrodes Impaired sensation Presences of flammable sprays/slns Over electronic implants

12. Know the basic components documented in the progress note for use of electrotherapy.
Pre-tx status Electrode placement, size, pt position Parameters: waveform, frequency, duration, amplitude, Rx time Post-tx response Pt education

Remember to let me know if you still have any questions. Just pop me an email anytime: dg46@txstate.edu