Week 3 Summary TI PDF

3.3 TES treatment Indications transcutaneous electrical neuromuscular stimulation- TENS has not been found to be more or less effective in treating different types of pain, such as acute or chronic. • research assessing effects of TENS: using handheld units • underlying mechanism for pain mngmnt...

3.3 TES treatment Indications transcutaneous electrical neuromuscular stimulation- TENS has not been found to be more or less effective in treating different types of pain, such as acute or chronic. • research assessing effects of TENS: using handheld units • underlying mechanism for pain mngmnt thru TENS is via TES indications 1. sensory nerve stimulation 2. motor nerve stimulation 3. tissue healing 4. edema management nociceptive modulation TENS does not manage pain, but the central processing of • nociception sensory nerve stimulation pain managment a. gate control theory b. descending inhibition, central mechanisms 2 prim category for TENS 1. high frequency (conventional tens): sitmulates large A beta fibers • promote local peripheral nerve or dorsal horn nociceptive modulation thru gate control theory mechanisms pts perspective: high frequency tens is better tolerated and can be used • during active mvmnt 2. low frequency (acupuncture tens): used to stimulate muscle and produce central mechanisms for nociceptive modulation due to higher intensity levels and activation of muscles, is not • recommended during mvmnt offers several hours of pain relief • -due to acting on descending methods of nociception modulation or central mechanisms motor nerve stimulation 1. muscle strengthening • a. increase force of muscle contraction motor nerve which has a lower b. overload threshold for activation than the principles of tissue overload: actual muscle states that the progressive increase in wt, frequency or # of reps of an exercise will promote tissue adaptation 2. muscle re-education a. contraction often inhibited b. not to increase force of muscle contraction using TES on innervated muscles, reflect activation of -when used in conjunction with exercise or alone later stages of healing little to no difference bw TES and exercise for strength • higher the strength of TES the greater -goal is not to increase force of muscle contraction amount of strength gained. -intensity of currents match demands of specific fxnal tasks • (no overload priniciple) -only applies to tissue that is innervated • using TES for de-innervated tissue: higher intensity of current needed to directly stimulate involved muscle • increase force & muscle contraction..only if increasing intensity of TES during tx acuity & tx found to be more beneficial in initial periods of rehab when voluntary exercise may be difficult TES for strength training: special attention needed for location as well as strength of current. c. re-establish dormant motor pathways : incorporated in POC of pts w inabilities to intentionally activate their muscles • could be from stroke, head trauma or SCI 2 prim modes of TES 1. NMES 2. FES tissue healing & edema control 1. preventing and reducing inflammation a. acute management b. chronic management 2. tissue healing a lot of research for tissue healing • greatest effects of healing found in pressure ulcers (especially in later stages of progression) -use of selective polarity to promote specific biological effects tied to normal stages of healing ex: neutrophils, macrophages and lymphocytes are charged and pulled toward oppposite charge • endothelial cells orient themselves in line w fields created by electrical stimulation, and fibronectin, cyclic AMP, and protein kinase activities increase in response to the electrical stimulation field. • current is applied directly on to wound and/or area around it • w consideration to polarity thought that positive charges are used to enhance early stages of healing, while negative charges are used to promote healing in later proliferations of healing. high volt pulse currents are most commonly used and supported current for tissue healing contraindications and precautions contraindications 1. pacemaker: application to trunk or heart regions: defibrillators, and/or other stimulators such as phrenic nerve and/or urinary bladder stimulator 2. carotid bodies: any placement of electrodes at the anterior lateral aspect of the neck 3. peripheral vascular disease: including arterial and venous thrombosis, 4. pregnancy: especially suffering from miscarriages 5. phrenic nerve, eyes or gonads: direct application 6. hemorrhages Precautions 1. cardiac dysfunction: including but not limited to hypertension and tachycardia. 2. impaired cognition, communication or sensation 3. neoplasms 4. neuropathy 5. compromised skin: distinction here on the compromised skin is for tissues that are vulnerable to hemorrhaging or those with a hematoma 7. active osteomyelitis Take-Aways 1. TES has been found to offer therapeutic benefit for 3 reasons a. Sensory Nerve Stimulation for pain management. b. Motor Nerve Stimulation to promote movement and to increase muscle force generation. c. Tissue Healing and edema management 2. As with any treatment modality, there are precautions and indications for their use. Know these! 3.4 Therapeutic Eléctrical Stimulation (TES) Treatment Parameters affect muscle contraction & Modes of TES 1. Neuromuscular stimulators - neuromuscular electrical stimulation (NMES) - functional electrical stimulation (FES) - transcutaneous electrical neuromuscular stimulation (TENS) 2. Microcurrent electrical nerve stimulation (MENS) does NOT affect muscle contraction TES treatment parameters therapeutic electrical stimulation • maintain/increase muscle size & overall fxn • good for OP, acute rehab for denervated muscle NMES/EMS interchangeable • promote improved efficiency in muscle contraction/activation • for loss of proprioception • weakness • coordinated muscle contraction following an injury • increase overall size/fxn of muscle • IF NOT paralyzed can be coordinated w/ or w/ active mvmt textbook: EMS stimulation of denervated muscle w/ no references others: NMES w/ parameter modification can be used for both innervated/denervated Pattern of NMES predictable/repeating pattern • FES • promote mvmt • assist in ambulating • indirectly promote CV conditioning • slow bone demineralization following neuro trauma Settings that use FES neuro rehab • - electrical stim mediated by external sensor that turns on current when requirements met - ex: heel sensor, activates when pt puts weight on it, promotes gastroc activation during ambulatory training TENS (transcutaneous electrical neural stimulation) • most common • activate sensory n to manage pain • DOES NOT activate muscles • lower intensities than NMES/EMS Microcurrent electrical stimulation • • VERY low current intensity to promote physiological response in tissue DOES NOT stimulate motor/sensory n - doesn’t manage pain or rehab muscles • mediates tissue healing Waveforms & Polarity • Monophasic • Biphasic • Alternating Current • Direct Current All characterized by ability to affect biological tissue by waveform’s polarity or average charge cumulative charge of each phase in treatment session determining waveform’s average charge charge determines magnitude of physiological • effect when stimulation to active tissue DC; positive polarity of 5 milliamps • same polar zone at same amplitude for EVERY phase (1) • average charge = +5 AC: biphasic w/ equal amplitudes in phase duration of +5 and -5 average charge = 0 (cancel each other out) • All the ones that don’t end in 0 net charge • direct current • monophasic pulsed • asymmetrical unbalanced biphasic current • symmetrical has average charge of 0 • asymmetrical not 0 Monophasic waveforms • interphase/interpulse intervals long enough to control negative side effects to net charges while being therapeutic - interpulse phase: like rest periods b/w set of exercises • healing • edema control • muscle contraction • common use: high voltage current Direct current • DOES NOT have interphase/pulse intervals • charge builds on tissue • HARM potential: discomfort, pain, tissue damage DC precaution • form of treatment using electrical current to - aka medical galvanism • stimulates tissues that have high thresholds for activation provoke muscle activation • - ex: denervated muscles • DOES NOT stim nerves • stimulates muscle membranes directly medical galvanism: any some more sensitive to ion mvmt b/w electrodes & skin causing tissue breakdown • more popular in high charge currents Preferred modalities for pain & muscle contraction biphasic & alt currents • Asymmetrical biphasic current: • dont have identical durations/amps • average charge = 0 bc both phases equal in amp and duration