TENS
What is the main goal of TENS?
Pain relief
What are the main goals of NMES?
Strength, Increase ROM, & Decrease edema
How many pads does IFC use vs Premod?
4 vs 2
Precautions
Pregnancy
Not over the abdomen or lower back
Undiagnosed pain
Active epiphysis
What should be included in your intro?
-Wash in & Check vitals
-Identify self
-Healthcare role
-Permission to treat
-Health Changes
-Pain Rating
-Orient
What is the amplitude/sensation for each type?
Conventional: To tingling
Motor: Muscle twitches
Noxious: Painful
What is the amplitude/sensation for NMES?
Gait Control
Precautions Mnemonic
PAULA
Pregnant, Active epiphysis, Undiagnosed pain, Lower back, Abdomen
What should you do before starting the estim?
-Prepare equipment & supplies
-Inspect skin & Check sensation
-Transfer, drape, & position patient
-Explain treatment procedures, expected sensation, rationale, & benefits of estim
Conventional TENS Parameters
(PR, PW, Mode, Duration)
**Bonus: What theory is being used?**
PR: 30-150
PW: 50-100
Mode: Continuous
Duration: 20-60 minutes
**Gate Control Theory**
(PR, PW, Duration, On/Off Ratio, Ramp)
PR: 20-50/50-80
PW: 300-600
Duration: Goal dependent
On/Off Ratio: 1:5
Ramp: 2-5 seconds
Pulse Rate
80/150
Contraindications
Pacemaker
Not over the carotid artery
Not over the eyes
Not over gonads
DVTs
Cardiac Disease
Cancer
Impaired Cognition
Impaired/Absent Sensation
Over open areas of skin (Unless performing wound care)
What do you need to do when applying estim?
-Apply the electrodes & lead wires to the correct area
-Select treatment parameters as indicated by the POC & provide rationale
-Apply/Adjust the intensity appropriate to the goal of treatment, patient's condition, & tolerance
Acupuncture/Motor TENS Parameters
(PR, PW, Mode, Duration)
**Bonus: What theory is being used?**
PR: 1-5
PW: 150-200
Mode: Continuous
Duration: 10-60 minutes
**Descending Pain Theory**
NMES for ROM/Edema Parameters
(PR, PW, Duration, On/Off Ratio, Ramp)
PR: 20-50
PW: 300-600
Duration: 30-60 minutes
On/Off Time: 1:1
Ramp: 2-5 seconds
Carrier Frequency
4000
Contraindications Mnemonic
OCC PIG DICE
Open skin, Carotid artery, Cardiac disease, Pacemaker, Impaired sensation, Gonads, DVT, Impaired cognition, Cancer, Eyes
What do you leave with the patient after applying estim?
Instruct the patient in the call system & check the patient after 5 minutes, adjusting treatment as needed
Noxious TENS Parameters
(PR, PW, Mode, Duration)
**Bonus: What theory is being used?**
PR: 100-150
PW: 300-600
Mode: Continuous
Duration: Short
**Gate Control & Opiate**
Russian Parameters
(PR, PW, Duration, On/Off Ratio, Ramp)
PR: 50
PW: 300-600
Duration: 10 minutes
On/Off Ratio: 1:5
Ramp: 1-2 seconds
Duration
10-20 minutes
How do you wrap up your skills check?
-At treatment conclusion, turn off the machine, remove the modality, & inspect the treatment area
-Assist patient as needed
-Clean treatment area
-Wash out & Report to PT