Physical Agent- Quiz 2

Critical Threshold: -Leakage until -___mV​. Then rapid influx of ____ as channels open​. Larger reversal of transmembrane potential​. Until inside of membrane is +__mV compared to outside​. ____ ______ (spike)​. ____ channels close then repo-? Repolarization: -____ channels remain wide open​. _____ charges leak out​. Immediate reversal of _____ potential​. Slight _____-polarization​. Return to ____ potential? Action Potential: -Whole voltage change is called an action potential, lasts about ___ millisecond (ms)​. Rarely happen as an ____ event​. Volitional activation causes series of 5-15 AP/sec​. Electrical stimulation produces ____ AP/sec?​

-55/Sodium/35/action potential/sodium -Potassium/positive/voltage/hyper/resting -1/isolated/1,000

Motor Unit: -_____ horn cell (AHC)​. Nerve cell ____ with its branches ​. All the muscle fibers (cells) innervated by that ____ cell​. Motor unit size- ratio of _ _ _ to number of muscle ____​? ex) calf: high ratio of AHC to 200 fibers vs eye muscle: low ratio of AHC to 3 fibers Classification of peripheral nerve: (GAVE OUT LIST) *read* -By:​Diameter and conduction velocity​. Sensory nerve classification​. ex) A alpha big diameter and faster (low cap-) vs C fiber small diameter, slower (high cap) *EASY*

-Anterior/axon/nerve/AHC/fibers

Neuromuscular electrical stimulation (NMES): ​ -stimulation of innervated MUSCLE Techniques of Application: NOT monophasic etc....DIFF -Monopolar technique​. Bipolar technique​. Quadripolar technique​. These can be used with any wave form. Techniques of Application: MONOPOLAR technique​ •Treating electrode (one pole of circuit) on target area​. •Dispersive or inactive electrode​. •Larger than treating electrode​. •Placed on area of body ____ from target area​. •Used for ___ target areas; iontophoresis; ____ healing​? ex) 1 pad forearm 2 pad shoulder. *cant use inaferrential, but the other waves you can do. just one polar here.

-Away/small/wound *pic* dispersive electro on back and treatment electro on TARGET area

Excitable membranes may be stimulated:​ -_____​: NT bind with cells and causes reversal potential. _____: hit your elbow and feel tingly sensation​. Electrically (artificial stimulation for therapeutic purposes)​? Nerve Membrane *Depolarization*: -Ionic change, increase in _____ permeability​. Change in voltage inside the membrane from -70mV to -___mV​? so more positive -Results in an ___ differential (between Na+ and K+) and an electrical gradient (difference in ____ inside and outside the cell)​?

-Chemically/Mechanically -Sodium/55 -ionic/charges

Bipolar Technique: -Treating electrodes of both poles of circuit are on target area​. Most _______ used set-up​. Used for _____ muscle groups​? Quadripolar Technique: -Four electrodes with two circuits​. Commonly used with _____ current​. With true ICF, the circuits cross​ Motor Points: -Motor points = anatomical point where ____ enters the muscle belly​. Point where muscle is ____ stimulated since you are closest to the nerve​. Motor point charts especially useful with ____polar technique (point stimulation)​?​

-Common/Large -interferential -nerve/easiest/monopolar

Continued.... -S-D curves for muscle fibers require direct stimulation of the muscle fiber​. The rheobase, chronaxie and other curve points are derived the same way as the S-D curves for nerves​. However, we can't stim ______ directly.​? Significance of S-D Curve: (answer one, keep going) -CAN YOU STIMULATE MUSCLE DIRECTLY??????????????????? -Various nerve fibers have minimal stimulus durations (chronaxie) for a stimulus to cause an AP​. Muscle fibers have relatively long chronaxies, compared to nerves, requiring long duration stimuli​. Electrical stimulation (using clinically available stimulating currents) of intact motor units will always stimulate the nerve, not the muscle directly​

-MUSCLE -NO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! we stimulate the NERVE

Which color leas to use: doesn't matter -Red or black?​ Only with DC or ____phasic pulsed, will red indicate anode and black indicate cathode​. With AC or biphasic currents, it does not matter​. Net charge = zero​ Effect of NMES on muscle: READ -Consider the patient's problem when determining treatment frequency and the purpose and administration of stimulation. ​ex) pain, spasticity Clinical Use of NMES: READ -Goal is to improve function​. Through increased strength or improved motor control?​ •Coordination of muscle action​ •Rate of muscle/MU recruitment​ •Quality of recruitment (stabilizers and movers)​

-Mono: positive (red): cathode, negative (black): anode

RESTING Membrane Permeability: -Readily permeable to ____​. Slightly permeable to ____​. Impermeable to negatively charged proteins (keeping _____ inside the cell)​. Creates differential transmembrane ion concentrations- an ____ gradient​. A voltage difference across the membrane at ____​. Separation of charge across the membrane creates the _____ potential​? Na-K Pump: -Specific ion channels​. Cellular ATP moves ____ out of the cell, ____ into the cell (3:2) *Active Transport*​. Sodium greater on the ____ (+61MV). Potassium greater on the ____ (-94mV)​. Resting potential of about -90mV for muscle and -___mV for nerve​. Cell is said to be "polarized"​

-Potassium (more INSIDE)/Sodium (more OUTSIDE)/ Anions (-)/osmotic/rest/resting -Sodium/Potassium/outside/inside/70

-Type of clinically used waveforms are ____ current and _____ current? Pulsed Current: -Three basic characteristics:​ 1) The waveform and shape​ 2) The pulse frequency​ 3) The pulse duration​? Pulsed Current (PC): -High _____ (technically > 150 V, but clinically, often refer to voltage generators that can achieve 400-500 V)​. -Types of interrupted (pulsed) currents​: •Monophasic​ •Biphasic​ •Polyphasic (medium frequency): •"______" (time-modulated AC)​, •_____ (frequency-modulated AC)​, •Pre-modulated interferential​?

-Pulse/direct -voltage: due to short impulse/Russian/Interferential

Relationship of clinically available waveform to MU recruited: -Commonly used clinical wave forms​. High volt pulsed​. Biphasic pulsed. -Medium frequency polyphasic pulsed​: ____ and Interferential​? -Waveforms with these characteristics selectively stimulate the larger/largest ____ nerves because:​ These waveforms have short stimulus _____​. Large diameter nerves have the ____ chronaxies therefore, they have ____ capacitances and are easier to stimulate​?-Modern clinical electrical stimulation waveforms were developed to selectively recruit the _____ (strongest) MU and to avoid the ____ diameter nerves that mediate pain?

-RUSSIAN -diameter/duration/shortest/lower/-LARGER/Smaller *As a result, ES for muscle contraction: LAST PPT* -Can produce physiologic changes in strength and functional movement​. Produces synchronous recruitment. Is non-physiologic​. Produces muscle fatigue​. Does not directly stimulate the smaller MU that are often the weakest after injury or immobilization​. Can sometimes be painful/uncomfortable

Membrane Channel: -Leak channels​. Depolarization channels​: sodium. Repolarization channels​: potassium? Voltage Regulated Channels: -If stimulation is too slow, ____ channel will close due to an insufficient influx to reach ____ for depolarization (membrane ______). No reversal of potential​. Needs a ____, more quickly applied stimulus to reach threshold​ In other words: ex) shirt: feel it then dont -If stimulus is applied too ____, even if it is strong enough, the membrane will not depolarize fast enough (it will _____)​. Will require a stronger, more _____ applied stimulation to reach threshold​

-Sodium/threshold/Accommodations "used to it"/stronger -slowly/accommodate/quickly

Physiological Effect of electrical stimulation on healthy muscle: -Histochemical and metabolic changes:​ •Transmutation of fiber type characteristics​ •Type II fibers will appear and behave like Type IIa​ •Effects are _____ and will reverse when the stimulation is stopped •Training effects occur only when electrically ______ because the ACH/nerve cell characteristics are still those of large diameter nerves​? Effect on strength: READ...main point-----> -Operational definition of strength?​. ES found to be more effective than volitional exercises alone (with quads/post ACL rupture)​. Isometric tension development increases under stimulation conditions​. Positive correlation between training contraction intensity and strength gains •Limited contemporary research on effects on functional strength/ performance improvement​.

-TEMPORARY/stimulated -main point: e-stim and exercise better than just exercise for ACL/quads rupture. use e-stim as an addition.

Sub-threshold electrical stimulus: -An electrical stimulus that does not have sufficient ____ (strength of stimulus) or _____ (amount of time that the stimulus is applied at a particular amplitude) to allow the excitable membrane to reach threshold to produce an _ _? Strength Duration Curve: -The minimum threshold stimulus amplitude is the "______"​. To find the _____ (strength):​ 1) Set a long stimulus _____ (*arbitrarily* set at 300 msec.)​. 2) Gradually increase the stimulus ______ until the nerve reaches threshold​. 3) This is known when the muscle attached to the stimulated nerve _____?

-amplitude/duration/AP -RHEOBASE x2 1) duration 2) amplitude 3) twitches

Stimulus: "when you felt the sensation" -2 parameters: amplitude (intensity) vs duration. Threshold Electrical Stimulus: -An electrical stimulus (E-Stim) that has sufficient ______ and ______ to successfully *depolarize* a cell. ​A range of combinations​. A shorter duration stimulus will need a ____ amplitude. A longer duration stimulus will need a _____ amplitude.?

-amplitude/duration/higher/lower

Neuromuscular Transmission of AP: -*At the nerve level*: AP reaches the ____ terminal​. Terminal membrane becomes permeable to extracellular _____​. Ca++ enters the terminal allowing ____ to be released into the gutter​. Within milliseconds, Ach is ___ by Ach-ase and diffuses out of the ____. Ach is reconstituted within the ____ terminal​? -*At the muscle level*:​ ___ in the gutter increases the permeability of the muscle membrane to ___ ions​. Na+ enters the membrane allowing muscle membrane to reach ______ for an AP​. Muscle AP is propagated within the muscle fiber via transverse _____ and ECF​?

-axon/Calcium/ACh/Lysed/gutter/axon -ACh/Sodium/Threshold/tubules

Stimulus Amplitude: -Rise time: time for single stimulus wave to go from ____ to ______ amplitude​. -Decay time: time for that stimulus wave to go from ____ to ____​. -Clinical stimulators provide waveforms with instantaneous rise and decay times, therefore, there is no membrane accommodation.​ Pulsed Waveform Characteristic: *PIC IN PHONE* READ -Phase duration: duration of a phase within a pulse​. -Pulse duration: time of the actual current flow (pulse)​. -Pulse interval: time from the end of one pulse to beginning of the next pulse​. Pulse period- time from the beginning of one pulse to the beginning of the next pulse​. Pulse duration + pulse interval = pulse period​. Pulse frequency: Is the number of pulses per second (pps) OR just pulse rate (expressed in Hz)​

-baseline/peak -peak/baseline

Polyphasic Pulsed: -•Medium frequency, __-directional waveform​ •Requires an _ _ carrier frequency (1,000-5,000 Hz) to create the polyphasic pulsed waveform •Phase durations are variable, but remain relatively small​ •Selectively stimulate larger diameter nerves​ •Pulse amplitudes are < 1 amp​ -Two examples of polyphasic pulsed currents:​ •"Russian" (____-modulated AC)​ •Interferential current (_____- modulated AC)​ beats?​

-bi/AC: alternate -time/amplitude

Rigor Mortis: DEAD STIFF BODY "fun fact" -Tissue breakdown allows ____ to leak into sarcoplasm​. Stored energy in ____ allows for muscle contraction, but...​in the absence of _ _ _, actin-myosin cannot release​. Result is a stiffness or rigor of the muscles​? Action Potential: (AP) -With each AP initiated at the nerve and propagated to the muscle, there is one muscle ____ response​? -Twitch time of a muscle fiber = ______ time + ______ time​?

-calcium/myosin/ATP -twitch -contraction/relaxation

Interferential Current (IFC): ''amplitude" -Requires 2 different _____ frequencies ranging from 4,000 to 5,000 Hz. •The difference in the carrier frequencies can vary between 1 - 200 Hz. •The carrier frequencies are superimposed allowing for wave ______ and ______ interference​. This produces a ____? "vector scan'' -The beat of interference current is essentially a ____ pulse​. Phase durations are 100 microsec. for 5,000 Hz, or 125 microsec. for 4,000 Hz​. •The beat frequency is determined by the difference in the two ____ frequencies​? -Conclusion: Interference beats are polyphasic pulses​ with short phase durations​ •Similar to "Russian" current, selectively stimulating large diameter nerves​. *NO HEAT*

-carrier/constructive/deconstructive/beat -polyphasic/carrier

Skeletal Muscle Structure: -Sarcolemma: muscle ___ _____​. -Sarcoplasm: muscle _____. -Sarcoplasmic reticulum: (longitudinal _____)​. -Transverse tubules (t-tubules): invaginations of ____ (with ECF) into the depth of the muscle fiber, perpendicular to the longitudinal ___ (SR). -Longitudinal tubules (SR) have terminal cisterns filled with intracelluar _____, contiguous (not continuous) with t-_____?​ Within the muscle cell are: -Myofibrils: ___ and ____ bands​. -Myofilaments: ____ and ____ contractile proteins​. -Sarcomeres: functional ____ units of muscle fibers. Overlapping actin and myosin ________?​

-cell membrane -cytoplasm -Tubules -sarcolemma/ tubules -Calcium -Tubules -light/dark -actin /myosin -contractile/myofilament

Monophasic Pulsed: *pic* -Short ____ single-phased (twin-peaked) pulses (20-40 microseconds), one direction​. •High ______ (1-2 amps)​ •Selectively stimulate ____ diameter sensory and motor nerves •Electrotaxis (attract/repel) with sufficient voltage​. -Modes: Continuous, reciprocating, surge​ Biphasic Pulsed: "get variation: bi so W and M" -*VARIABLE* adjustable short ______ (50-300 microsec.), bi-directional pulses​. •Lower amplitudes (< 1 amp)​. •Selectively stimulate the large diameter nerve POOL, although with a moderately increased range of ____ diameters​. •No ____ effects​? (said this b4)

-duration/amplitude/LARGE -DURATION (variable)/nerve/polar

Penetration of current: becomes deeper if further apart *pic* Current density: -Current density is related to ____ size and/or contact area​. The smaller the electrode, the ____ the density for a given current, the ___ the resistance to current flow​. -The larger the electrode, the ____ the density, the ____ the resistance to current flow​? Example: -Large electrode with poor contact with patient = increased current density (particularly significant with constant current generators)​ The higher the current density the greater the perceived stimulation strength​

-electrode/higher/greater -lowerx2

Charge: -The amount of electrical ____ imparted by a stimulus. It is generally proportional to the area of the _____ waveform.​ General current waveform characteristics: -Phase​: •Duration of a phase​, •Amplitude of a phase​. -Direction​. Symmetry​. Balance​. Cycle​. Frequency​: •Cycles per second​ •Period​ Phase: -That portion of the waveform above or below the baseline​. 1) Phase duration: ____ of the phase from baseline to baseline​. 2) Phase amplitude: ____ of the wave from baseline to peak​?

-energy/stimulus -1) time 2) height

-With higher pulse frequencies > 100 Hz, there is greater synaptic ____ and therefore decreased muscle ____ production with stimulation​? -Neuromusculoskeletal conditions that cause pain and loss of movement result in:​ Disuse atrophy of muscle (mostly type I fibers from smaller motor units)​. Loss of normal sensory feedback to CNS from joint, muscle, and tendon structures​. Sensory-motor alienation​: ex) stop using limb cause its painful, can get muscle atrophy and no motor sensory so start losing the one listed above. *READ*

-fatigue/force: so 30-40 (critical fusion) good.

The CFF of a particular muscle may vary depending on: -The muscle ___ type (i.e., fast versus slow fibers)​: 1) A fast twitch fiber has a ____ twitch time and would have a ____ CFF​. 2) A slow twitch fiber has a ____ twitch time and would have a ____ CFF​. -Since muscles are usually _____ fiber types, the CFF for a muscle would be an average (ranging from __ to __ successive stimuli per second)​? Review what you saw: -As the frequency of successive electrical stimuli increases:​ There is a transition from individual muscle twitches to a fused muscle contraction. There is a gradual increase in the overall strength of the muscle contraction due to this wave ______?

-fiber 1) shorter/higher 2) longer/lower -mixed/15-40 -SUMMATION

Voltage: -Voltage: potential ____ required to drive a current (electrical potential energy)​. Voltage itself does not _____​. Units used in electrotherapy are the volt (V), millivolt (mV), and microvolt (µV)​. 1 V = 1 Joule change in ______ per Coulomb of charge​? Voltage Forces: -Created when there is a separation of ____​. Ion concentration gradients​. Allows for depolarization and transmission​?

-force/stimulate/energy -charge

Asynchronous vs synchronous motor unit (MU) recruitment: *IMPO* -*Asynchronous MU recruitment*​: Seen with volitional muscle contraction. Order of MU recruitment​: Smaller MU​. Smaller MU at increasing ______. Recruitment of _____ MU with increasing task force needs. MU typically firing at _____ frequencies (temporal summation)​. Many MU of various ____ contributing to the contraction (spatial summation)​? Synchronous MU Recruitment: -Seen with ____ stimulation​: All motor units that can be stimulated by a particular waveform are recruited at the same ____ and at the same _____ as the stimulus​. Clinically available stimulation waveforms typically selectively stimulate the large _____ nerves that recruit larger ____ units​? *ALL OR NOTHING*

-frequency/LARGER/Different/Sizes ex) MASON FLEX BICEP -electrical/Time/Frequency/diameter/motor

Responses of electrically stimulated nerve and muscle​: -Individual APs and related muscle twitches are observed when they occur with enough time between repeated APs​ Summation: *LAB* -When repeated APs occur more _____ (at shorter intervals), resulting muscle twitches will occur with ____ intervals as well​ -Summation (addition) of the individual twitch intensity leads to greater muscle ________. -Eventually this will appear as a sustained muscle _____, with individual muscle twitches no longer observed​?

-frequently/shorter -tension -contraction *pic: tetanization is a solid contraction by increasing intensity

Ohms Law: -The current (I) induced in a conductor increases as the applied driving force (V) _____ OR as the opposition to the charge movement (R) _____? Basic Currents: 1) Direct current (DC)​: ______ unidirectional flow for at least 1sec? 2) Alternating current (AC)​: _______ bi-directional flow at least one time per second​. 3) Pulsed current (PC)​: ___ or __-directional flow that periodically ceases so this one is ________?

-increase/decrease 1) continuous (longer duration) 2) Uninterrupted 3) uni/bi/interrupted: when its interrupted it has no charge

Duty Cycle: only RUSSIAN has it -Trains or series of pulses/bursts that are regularly _____​. On time: train of pulses​. Off time: time between trains of pulses​. On time divided by total time x 100%​. Russian duty cycle= ratio of burst duration to the burst interval (50%)​​? Aussie Current: -1000 Hz burst modulated AC current​. 4 msec bursts​. Greater torque and decreased _____?

-interrupted -fatigue

Russian Current: "off and on -Carrier frequency of 2,500 Hz​ •Burst modulation: Carrier frequency is _____ at 10 msec. intervals resulting in:​ Fifty bursts (pulse) per second (50Hz) ​. Each burst is 10 millisec. burst duration interspersed with 10 millisec. interburst intervals​. Within each 10 millisec burst, there are 25 complete cycles of AC? -Each burst is considered to be a ____ pulse​. Phase durations are 200 microsec.​ •Each polyphasic pulse produces a ___ stimulus to the nerve membrane​ •The standard pulse frequency is 50 Hz​. Because it is polyphasic, there are no ____ effects​?

-interrupted -POLYphasic/single/Polar

MICROcurrent: 'no excite'' -___ voltage generator (<1 mA)​. •___threshold (sensory and motor) stimulus​. •Longer duration pulses, but ___ amplitudes, range of frequencies​. •Also called LVPC or MENS, APTA recommends LIDC​. Used for _____ healing and ____ modulation​? Direct current: Galvanic Current (use for MEDS) -•Non-____, by definition, continuous for > 1 sec.​ •Low voltage generator (< 100 V)​ •Used for its ___ effects- medical galvanism​. Used for iontophoresis, requiring higher overall current force​. •Used for wound ____ at low current output​. Does not ____ nerve/muscle membranes​?

-low/sub/low/WOUND/pain -pulsed/polar/healing/stimulate

Classic IFC: -Requires 4 electrodes to set up​. Overlap of current occurs in the tissue between the electrodes​. Pre-_____ interferential current is still interferential current, but the waveforms are created within the instrumentation rather than requiring two circuits in direct contact with the patient. For pre-mod use 2 PADS. Unmodulated has 4? Long duration monophasic pulses (interrupted DC): *READ* -Requires a generator that can produce unidirectional current with long pulse durations​. Long pulse durations with sufficiently high amplitudes are required for stimulation of denervated muscle membrane​. Generally NOT available for clinical use​?

-modulated

Current (I): -The _____ of electrons or ions (charged molecules)​: Current ____ biological tissues, voltage does not​. Current flow of ions in biological tissues, induced by electron flow at the electrodes, causes stimulation of excitable membranes​. Units used in electrotherapy are amperes (A), milliamperes (mA), and microamperes (µA)​? Understand this: -Voltage and current are directly proportional to each other because the voltage ____ the current. Higher voltages are needed to drive higher current amplitudes.​ -Conductance : property of a material that ____ the flow of a current​. -Resistance (R): property of a material that ____ the passage of a current (unit = ohm)​? ​ex) fat tissue: adipose (R)

-movement/stimulates -drives -allows -prevents

Structures: -*Synapse end plate* region is covered with _____​. Invagination of ____ fiber is the *synaptic gutter* or trough​. *Synaptic cleft* is the space between the ____ and ___ _____​. *Subneural clefts* are numerous folds of the muscle membrane at the ____ (increases surface area for transmission of _ _)​? Continued.... -Motor axon terminal contains vesicles of neurotransmitter called ________​. MUSCLE membrane basal lamina at the synapse contains Ach-ase​(break down ACh to be able to use it for energy)?

-myelin/muscle/gutter/end plate/gutter/AP -Acetylcholine (Ach)

Saltatory Conduction: "leaping over myelin sheath" -Seen with _____ membranes​. Nodes of ____ about every 1 mm. AP occurs at internodal points that are exposed to extracellular fluid (ECF)​? Difference in Propagation: -Eddy current conduction is ____. Saltatory conduction is 5-7 times _____ and uses less internal neuronal _____​? Myelinated Nerves: -More numerous than unmyelinated nerves​. Have ____ nerve conduction velocities (NCV) because of:​ Myelin​, Larger ____ so they Are easier to stimulate because they have lower ____?

-myelinated/Ranvier -slower/faster/energy -faster/diameter/capacitance

Direction: think *opp* -Refers to whether the current is ____ or ____ (above the baseline is ____ and below the baseline is ____). ​-Waveforms can be: ___directional (only above or only below the baseline)​. __-directional (alternating above and below the baseline)​? Flow of Current: -Monophasic: flow of current is only on ____ side of the isoelectric line​ so its going to have a ____ ​-Polarity: positive or negative​. -Biphasic: flow of current _____ from the isoelectric line in one direction and then in the other​ so it might ___ each other out or have a lil pos or neg?

-negative/positive/(negative/positive)/Uni/Bi -ONE/polarity -deviates/Cancel

Chemicals that affect AP transmission: -Botulin toxin inhibits Ach release from _____ terminal​. Curare blocks Ach sites on the _____ membrane​? Skeletal Muscle Structure: -Epimysium: fascial membrane surrounding muscle ____​. -Perimysium: surrounds _____ of several muscle fibers​. -Endomysium: surrounds _____ muscle cell fibers holding capillaries and nerves in place​?

-nerve/muscle -belly/fasciculus/individual

Know the difference: -Sensory habituation:​ Continues. Still causes depolarization- you just don't ____ it​? ​-Membrane accommodation:​ Insufficient stimulus to open Na+ channels​. Lack of ___ _____ generated​. Last week material. like sub-TH. Putting it together: -Graph the frequency and intensity for these goals: ​1) NMES for strengthening​. 2) NMES for the antagonist. 3) Fatiguing the agonists (spasticity). 4) Sensory habituation of the agonists​

-perceive -AP 1) frequency: 30-50 (motor) 2) freq (30-50), motor 3) frequency (80-150), motor 4) high frequency, low intensity Sensory response to stimulus: READ -Stimulation of large diameter, superficial cutaneous nerves​. Typically in the 50-100pps range, short duration (2-50µsec), low intensities​. Amplitude increased to comfortable paresthesia​​ (tingling). ex) high frequency low intensity for sensory. Sensory Habituation: (not as effective) -Occurs when the sensory stimulus is applied continuously​. The patient adapts, perception of stimulation diminishes (habituation)​. May cause reflexive relaxation of spastic muscle​. "Perceived" accommodation​.

Wave Summation:*QUICK* -Occurs when the contractile force of muscle twitches is added to the force of subsequent twitches of the same muscle fibers. This occurs because the contractile energy of the previous twitches is not degraded before the next twitch comes along​? Tetany: -There is eventually a _____ of summated muscle force as stimulation frequency increases. ex) frequency 20, Russian is set at 50 cause thats when all muscle are likely to fire. CFF avg is 30-40 but can lower it because maybe there is no need to get the muscle tired.

-plateau *Pic*: first summation then CFF (30-40) then tetanization

-Pulse train: series of successive ____ over a limited period of ____​. Russian uses this. aka burse Ramps: "play with frequency: you become the ramp -Amplitude modulation- AKA "surge"​. -Ramp up: ____ increase in pulse amplitude of successive pulses in a pulse train​. -Ramp down: gradual decrease in pulse amplitude of successive pulses in a pulse train​ Adjustable Stimulation Parameters: -Waveform​. Frequency​. Amplitude​. On/off cycle - time on/time off of a series of pulses​. Modulation - pre-set, often random changes in the pulse delivery characteristics​. *Pulse duration* (usually______ waveforms only)​. Polarity (D____ and monophasic PC only)​. Duty cycle (usually polyphasic pulsed current "_____" only)​?

-pulses/time -GRADUAL -Biphasic/direct/Russian

H-Wave: "wanna be AP" -Originally out of the UK​. Mimics the H wave (Hoffman reflex). Double stimulus with 2 peaks of ____ polarity, suggested to mimic a *physiologic* signal​. Typically 1-2 Hz stimulation​. Used for analgesia, ____, also some reports of increased blood flow ​? (low twitch) Stimulation parameters (what we can adjust on the instrumentation): -Waveform​. Frequency of pulsed current​. Amplitude of the current​. Pulse duration (only adjustable with biphasic)​. Polarity (DC or monophasic PC only)​. Reciprocation between circuits​. Modulation. Ramp​. On and off cycle​. *READ*

-reverse/EDEMA Instrumentation: READ -AC input box​. DC converter​. Voltage transformer: hold energy​. Interrupter circuits. Meter displays: amperage (flow) and voltage​. Treatment circuits (1-6)​. Electrodes and wire leads​. Constant Current and constant voltage generators: -Constant current (I=V/R)​, no matter what it will be constant. Constant voltage (V=I x R)​​. Clinical implications of application​: monitor your pt. Safety: -Hospital grade plugs​. Line leakage​. Meter displays​. On/off signal lights​

Establish Chronaxie (duration): -Chronaxie is the duration measurement corresponding to 2x the _____​. Find 2x the rheobase value for that nerve fiber for the _____. Find the stimulus _____ needed for the nerve to reach threshold​. The minimum threshold stimulus duration is the _____? *same graph* Determine other points for the S-D Curve: -Varying the stimulus amplitudes and durations within rheobase and chronaxie limits establishes a signature curve for that nerve fiber​ -Stimulus duration and amplitude strength are inversely related, ie.: *A shorter stimulus duration requires a _____ amplitude?

-rheobase/intensity/duration/chronaxie -HIGHER

Capacitance: "lower cap, fast release" -The physical property of a material such that it can separate and ____ electrical charge​. _____ cell membranes behave like capacitors​? -A lower membrane capacitance means that a lower-level stimulus can induce a capacitive current flow across the membrane sufficient to cause the membrane to reach _____? Myoneural Junction: -Where a motor neuron axon meets the ____ fiber​. At the level of the ____?

-store/excitable -Threshold -muscle/cell

Critical Fusion Frequency (CFF): "rate" -The ____ frequency of electrical stimuli that causes nerve APs and produces a sustained muscle _____. Individual muscle ______ are no longer observed​? same pic as b4 (30-40) CFF. B4 tetany Tetany: -Fusion of consecutive muscle twitches occurs when stimuli occur close enough together to not allow full ______ of one muscle twitch before the next muscle twitch occurs?

-threshold/contraction/twitches -relaxation

Fundamentals of electrical charge​: Intro to Electrotherapy ​-Either positive or negative​. Like charges repel and opposites attract. Charge is neither created or destroyed​. Charge can be _____ from one object to another? Electrical Excitable Tissue: -A unique feature of nerve and muscle cells​. Isoelectric nature of the axoplasm membrane​. Cell membrane is a semi-_____​ phospholipid protein bi-layer​. Selectively permeable to ____ (Na) and _____ (K+) ions​?

-transferred -permeable/Sodium/Potassium

Muscle Fiber Types: *opp* so think 1<2 -Type I​: Slow ____​. Oxidative metabolism​. Fatigue resistant​. More mitochondria​. More capillaries​. ____ diameter muscle fibers- less tension development​. Associated with smaller diameter nerves. Associated with smaller ____ units​? -Type II: Fast twitch​. Glycolytic metabolism​. Easily fatigued​. Fewer mitochondria, capillaries​. Larger diameter muscle _____- more tension development​. Associated with larger _____ motor nerves​. Associated with larger ____ units​? Type IIa: MIX -Intermediate fiber characteristics​. Fast ____ oxidative- glycolytic​. Associated with larger ____ motor nerves and larger motor units​?

-twitch/smaller/motor -fibers/diameter/motor -twitch/diameter

Cycle: -One complete ___ (or pulse), from the beginning of the first ___ (pulse) to the beginning of the next ___ (pulse)​. -Period of a wave (pulse) - the time required to complete one ___ of a wave (pulse)? Frequency: -The number of _____ per second, Hertz (Hz)​: Hz technically refers to AC, but has been used for pulsed currents. Period of a wave or pulse is 1__​. For example, with a wave frequency of 60 Hz, the duration of one full wave or a cycle is 1/60 of a second​?

-wave x3/CYCLE -cycle/Hz

Symmetry: -Refers to the relative shape of the phases of a _____​: -Symmetrical waveform: all phases are the ___ shape and size​. -Asymmetrical waveform: phases are ____ shapes​? Balance: -Refers to the relative areas ____ the phases of a waveform​: •Balanced waveform: all phases are have the ____ area​. •Unbalanced: phases have _____ areas?​

-waveform -SAME -DIFFERENT -under/same/different. *pic* to be unbalance graph has to be super different in size like huge vs tiny

Continued.... -Motor neurons arise from the ventral horn ​. AP travels along the axon or dendrite​. Electrically induced AP at one point on the axon will propagate in 2 directions​. Two types of AP propagation:​ 1) Unmyelinated membranes: ____ current propagation​. 2) Myelinated membranes: _______ conduction​? Eddy Current Propagation: -Seen with _____ membranes​. Immediately adjacent sections of membrane ______ due to effects of initial stimulus depolarization​

1) EDDY 2) SALtatory -unmyelinated/depolarized

Charge: READ -fundamental property of electromagnetic force​. the force exerted between two electrical charges​. measured in coulombs (C) or micro coulombs (µC)​ Fundamental properties of charge: -Two types:​ Positive and Negative​. Like charges repel, opposites attract​ Charge is neither created or destroyed​. It can be transferred from one object to another​ Polarity: -The net charge of the object​. Simple circuit​: 1) Negative pole: _______​ and 2) Positive pole: ______​. Electrical field and Coulomb's Law​?

1) cathode 2) anode

Repolarization: -1) Absolute refractory period​: Period immediately after the 1st AP, when NO stimulus (regardless of _____), will cause a 2nd _ _​. 2) Relative refractory period​: Period when a _____ stimulus is required to achieve 2nd AP. 3) Hyperpolarization​: Period of increased ____ after repolarization has occurred, requiring a _____ than usual stimulus to achieve a 2nd AP​? Propagation of Action Potential: -Rate (____) is not the same for all excitable cells​. Affected by ____ of the fibers and membrane resistance​. Small diameter fibers (eg. C fibers) have high internal ____ compared to large diameter fibers (eg. A alpha), and therefore slower conduction velocities than large fibers.​ *easy*

1) strength/AP 2) stronger 3) negativity/stronger -speed/diameter/resistance

Muscle fiber response to myoneural AP transfer: "ECC" -Excitation-contraction *coupling*:​ 1) AP is propagated along __-_________ 2) Stored ____ from cisterns in longitudinal tubules (SR) is released​. 3) Ca++ binds with ____, moving tropomysin from cross bridge binding site on ____ molecule​. -Permits energy-laden (from ATP breakdown) myosin to bind with ____​. -Ratchet-like movement of actin-myosin complex results in shortening of _____? Resting state...-Following sarcomere contraction, and in the​ absence of another AP: Active transport of ____ back to lateral cisterns​, ATP molecules bind with ____​, Myosin releases from _____?

1) t-tubules 2) Calcium 3) troponin/actin -actin -sarcomere ...-calcium/myosin/actin

NMES for muscle facilitation and neuromuscular re-education:​ -Correction of sensory-motor alienation by:​ Biofeedback by showing patient that the muscles do work​. Using NMES to augment, assist, facilitate volitional contraction​. Using electrically induced "active" contractions to mechanically stimulate muscle, joint, and tendon sensory structures​? *READ* NMES to increase ROM: -Correct adaptive tissue shortening (contracture)​ ex. put e-stim on Tricep to make the arm extend but do 10 sec on then off then build up. •NMES provides mechanical stretching on contractures​: •Long term use​ •Issue of muscle fatigue​. •Adherence​. •Labor intensive​. *READ*

Blood flow changes: READ -Autonomic reflex​: Immediate, transient increase in local blood flow due to SNS response​. -Longer term changes in vascularity due to chronic stimulation of muscle and resultant increased capillary support​ Effect of Endurance: *READ* -Inverse relationship between muscle endurance and muscle fatigue​. Refer to effects of long term stimulation on changes of type II to type IIa​

Differentiate these terms: -Spasm​: Protective response related to localized pain in musculoskeletal tissue​. See or feel guarding, "knot" in the tissue​. Goal is to treat the underlying cause of the pain​. ex) decrease pain or fatigue it -Spasticity​: Abnormal tone due injury of the CNS resulting in continuous muscle contraction​. Tone increases with quick movement​. Goal is to relax the muscle spindles (stretch receptors in the muscle)​ ex. prolong stretch. e-stim: bicep (agonist) tricep (antagonist) and pt is flexing bicep (stroke) so stim the tricep (30-40) to be able to extend arm OR make e-stim go to 80 on the bicep, fatigue the muscle, and it will come down.

NMES to reduce CNS induce spasticity: READ -Can provide mechanical stretching to re-bias the spindles when velocity dependent tone is present​. 3 strategies to inhibit abnormal tone:​ 1) Post tetanic depression of the spastic muscle (agonist) by stimulating the antagonist (opposing muscle)​. 2) Muscle/synaptic fatigue of agonist​. 3) Sensory habituation​

Fatigue: READ -Fatigue with NMES occurs since large diameter, fatigable muscle fibers are selectively stimulated. Fatigue is also associated with synchronous nature of MU recruitment​ -Treatment duration should consider the rate of muscle fatigue with electrical stimulation. On/off cycles are often defaulted at 10 sec. on and 50 sec. off (i.e., 1:5 on/off ratio). ​Therefore, the duration of the session may be limited to only several muscle contractions.​ ex) when e-stim contract muscle make pt contract too then slowly relax. that way muscle is contracting with out the help of e-stim. do this by turning e-stim down.

Pain with NMES: READ -Current characteristics attempt to avoid small diameter pain fibers​. -Pain may occur with NMES due to:​ Unstable waveforms, especially high amplitude high volt currents. Isolated muscle fiber contractions with electrical stimulation (cramping)​. Perceptions of discomfort with e-stim​