Beruflich Dokumente
Kultur Dokumente
2005 FA Davis
Current Flow
Electron Flow
(shown in red)
Ion Flow
(shown in yellow)
Occurs within the tissues Negative ions flow towards the anode and away from the cathode Positive ions flow towards the cathode and away from the anode
+ + -
Electrodes
Purpose
Completes the circuit between the generator and body Interface between electron and ion flow Primary site of resistance to current
Materials
Metallic (uses sponges) Silver Carbon rubber Self-adhesive
Electrode Size
Determines the Current Density Equal size
Electrode Arrangements
Based on: Current Density Proximity to Each Other Anatomic Location (Stimulation Points)
Current Density
Bipolar Technique
Equal current densities Equal effects under each electrode (all other factors being equal)
Monopolar Technique
Unequal current densities
At least 4:1 difference
Active electrode(s)
Quadripolar Technique
Two bipolar electrode arrangements Two independent electrical channels TENS is a common example
Electrode Proximity
Determines the number of parallel paths The farther apart the electrodes the more parallel paths are formed More current is required to produce effects as the number of paths increases
Stimulation Points
Motor Points
Superficial location of motor nerve Predictably located Motor nerve charts Localized, hypersensitive muscle spasm Trigger referred pain Arise secondary to pathology Areas of skin having decreased electrical resistance May result in pain reduction Decreased electrical resistance (increased current flow)
Trigger Points
Acupuncture Points
Traumatized Areas
The current usually does not flow from electrode-toelectrode (the shortest path) The path of least resistance is not necessarily the shortest path
Phase duration selectively depolarizes tissues Phase Duration Short Medium Long DC Tissue Sensory nerves Motor nerves Pain nerves Muscle fiber
Adaptations
Patients get used to the treatment More intense output needed Habituation
Central nervous system Brain filters out nonmeaningful, repetitive information
Accommodation
Peripheral nervous system Depolarization threshold increases
Preventing Adaptation
Vary output (output modulation) to prevent The longer the current is flowing, the more the current must be modulated.
2005 FA Davis
Motor-level Stimulation
Motor-level Stimulation
Parameters: Amplitude: Contraction strength increases as amplitude increases Phase duration: 300 to 500 sec targets motor nerves:
The shorter the phase duration, the more amplitude required Longer durations will also depolarize pain nerves Pain often limits quality and quantity of the contraction
Pulse Frequency
Frequency determines the time for mechanical adaptation Lower pps allows more time (longer interpulse interverals)
Label Range Result Low < 15 pps* Twitch: Individual contractions Medium 15-40 pps* Summation: Contractions blend High >40 pps* Tonic: Constant contraction * Approximate values. The actual range varies from person-to-
The amount of time between pulses the interpulse interval is long enough to allow the muscle fibers to return to their original position
The amount of time between pulses allows some elongation of the fibers, but not to their starting point.
The current is flowing so rapidly that there is not sufficient time to allow the fibers to elongate
2005 FA Davis
Pain Control
Sensory-level Target A-beta fibers Tissue Phase Duration
< 60 sec
Motor-Level
Motor nerves
Noxious Level
A-delta C fibers
1 msec
2 to 4 pps
Variable
To tolerance
2005 FA Davis
Edema Control
Cathode placed over injured tissues High pulse frequency Submotor intensity Thought to decrease capillary permeability Do not use if edema has already formed
Edema Reduction
Muscle contractions milk edema from extremity Electrodes follow the veins path Alternating rate targets muscle groups Elevate during treatment
2005 FA Davis
Fracture Healing
Electrical current triggers bone growth Piezoelectric effect within the collagen matrix Alternating current
Applied transcutaneously Similar to diathermy units (no heat production)
Direct current
Implanted electrodes
2005 FA Davis
Areas of sensitivity
Carotid sinus Esophagus Larynx Pharynx Around the eyes Temporal region Upper thorax
Cardiac disability Demand-type pacemakers Pregnancy (over lumbar and abdominal area) Menstruation (over lumbar and abdominal area) Cancerous lesions (over area) Sites of infection (over area) Exposed metal implants