These notes made studying for the exam very easy. All documents are in a table format and include everything you need to know to have a discussion or answer questions on Therapeutic Ultrasound, Cryotherapy, NMES and TENS.
I used these notes for an oral exam with my professor but they can be used f...
TENS transcutaneous electrical nerve stimulator
Q1 Identify + Effective, non-pharmacological modality for management of pain.
explain the Can treat both acute + chronic pain.
most You will feel a strong but comfortable tingling sensation that will distracts your body from the pain.
appropriate
EPA to Contraindication: AGE, GENDER, PATHOLOGY, MORBITIY, AREA
address the Impaired cognition/communication, pacemaker
problems Undiagnosed pain, damaged/at risk skin, (risk of) bleeding (recent/active for heat)
identified PVD, DVT, epilepsy
Area of Rapidly dividing tissues (infections, malignancies, pregnancy, TB), previously radiated tissues < 3 months
potential Reproductive organs, carotid sinus around anterior neck, eyes, impaired skin sensation (SKIN TEST)
treatment Precautions:
Relative to the sub + obj
Active growth plates, PVD/impaired circulation, over chest/heart
YOU WILL FEEL= tingling / hailstones/ combination & where I will be placing them
Q2 Rationale Alternative- IFC
st
Almeida at al (2018)- 1 systematic review comparing modalities- more studies needed and similar effects for
both TENS + IFC, however it was noted that;
• TENS- commonly used for chronic pain. Acupuncture TENS lasts ~20-30min post treatment which
would allow for strengthening of the area without pain (rehab)/ simply act as a non-pharmacological
method of managing pain.
• IFC- IFC has been shown to be more useful for short-term treatment of acute inflammatory pain and
on patients who have a low pain threshold that may find TENS too painful/ intense.
Q3 Rationale- Why this modality based on sub + obj?- pain management, chronic pain
Physiological
TRADITIONAL ACUPUNCTURE BURST
Effects
GATE CONTROL THEORY DESCENDING INHIBITION Burst acupuncture + conventional
Stimulation of Pain relief through release of Stimulate both pain gate +
mechanoreceptors A-beta endogenous opioid they inhibit descending inhibition– applying burst
fibres (Pacinian corpuscle) that the inhibitory neurons of mode stimulation
are large diameter myelinated descending pathways → stim SG
fibres that get to the dorsal cells= pain relief
horn faster than A-delta + C
fibres (transmitting noxious
stimulus) and close the gate=
decreases the pain
Q4 Appropriate • High frequency (80-130Hz) – •Low frequency- 1-5Hz •Low frequency: 1-4 Hz (trains)
parameters for 100 Hz normal •Pulse duration- 200ys •2-3 bursts/ sec
application of •Pulse duration pulses 100ys •30 min is minimal effective time •Intensity relatively high
this EPA (microseconds) •High intensity→ high as tolerable •Pulse = 200ys
•30 min minimal •Freq- 1x/day 20-30mins
•Normal intensity “strong but
comfortable”
•Comfortable tingling
sensation
•If it is 24hr usage- think about
a modulation pattern to avoid
habituation
Where?
2 electrode either side/ diagonal
Q5 Justify the •State pain mechanism of the presenting injury + presence of pain/ inflammation/ stiffness
selection of •Relate it to the stage of healing + structure(s) affected
parameters •State aims of treatment- ↓pain
•Use the below boxes to explain how these parameters address the goals of your treatment + stage of healing
high freq 100Hz- Abeta fibres Low freq (2-5 or 2-10Hz) causes B/T- mixture of conventional +
are stimulated release of endogenous opioid that acupuncture
inhibit the inhibitory neurons of Higher frequency stimulation
100ys- short pulse will not stim descending pathways → stim SG output (100 Hz) is interrupted (or
cells= pain relief burst) at the rate of about 2-3
motor nerve but it needs to be
bursts per second
above 50ys to achieve an AP of
200ys- longer pulse duration can Activate Ab fibres by frequency
abeta. stim the motor nerve (pain gate mechanisms)
Ad – by rate of burst – will
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