Skin
Describe the stages of pressure ulcers.
Grade 1: Non-blanchable redness, usually over bony prominence, focus on prevention
Grade 2: Partial thickness (epidermis + dermis), red/pink presentation, blisters
Grade 3: Full-thickness skin loss, subcutaneous tissue visible, slough present, undermining & tunneling
Grade 4: Exposed bone/tendon, full-thickness, eschar & slough present
Purpose of TENS? When do you MOST commonly use Sensory TENS?
• Pain control through nerve stimulation
• SMALL area/muscle (think forearm)
• MOST commonly use sensory TENS for immediate, temporary relief of acute and chronic pain; primarily applied for musculoskeletal pain and joint pain (arthritis)
Purpose of NMES and Common Uses?
Purpose: To stimulate muscle contraction and prevent atrophy.
Common Uses:
• Muscle re-education (Conditions: Radial nerve palsy/wrist drop, CVA, SCI,
Flexor/extensor tendon repairs)
• Strengthening weak muscles
• Reducing spasticity
What is an action potential?
a rapid, temporary reversal of the electric charge across a neuron's membrane, acting as a "spike" or nerve impulse that transmits signals down an axon
ALL OR NOTHING
What is found in the epidermis & dermis of the skin?
* The epidermis contains keratinocytes, melanin, and immune cells
* The dermis contains collagen, elastin, blood vessels, nerves, hair follicles, and sweat/sebaceous glands
What are the phases of wound healing? Define the types of wound healing cells that work throughout.
Inflammatory: immediate to 5 days
Hemostasis occurs (form of clot to prevent hemorrhage); 1st vasoconstriction occurs (2-30 mins post-injury); 2nd vasodilation occurs (causes edema); epithelialization occurs (platelet aggregation regeneration); phagocytosis occurs (via macrophages); Neutrophils (early infection fighters, first 24-48 hours)
Proliferative: 2 days to 6 weeks
granulation tissue forming (fibroplasia); angiogenesis (formation of new blood vessels); wound contraction; epithelialization (collagen fiber cross-linkage - provides 15% strength, risk for re-injury); initiate gentle ROM for contracture prevention
Remodeling: 3 weeks to 2 years
new collagen forms (synthesis); collagen lysis occurs (breakdown); tissue differentiation (synthesis + lysis); scar remodeling (80% strength in 2 yrs); use scar pad, pressure garments, static progressive orthotics & mobilize scar tissue
Purpose of IFC?
• Pain control using medium-frequency alternating current;
• Decreases pain and swelling.
• Used often for shoulder pain, arthritis, or post-surgical pain (LARGER AREAS – think shoulders)
Muscle Spasm NMES parameters?
Pulse duration: 300 microsec
Frequency: 30-60 pps
Intensity: patient tolerance/gentle contraction
Duty cycle: 1:1
Treatment time: Until muscle fatigue (usually 15-30 minutes)
Define Alternating Current & Direct Current
• Direct Current (DC): Continuous flow in one direction (used in iontophoresis).
• Alternating Current (AC): Current reverses direction (used in NMES, TENS, IFC).
which electrical modality can cause a galvanic rash?
Iontophoresis
Describe the different wound colors and what they mean (red/yellow/black)
Red: Healthy granulating tissue - Protect
Yellow: Exudate present, risk of infection - Clean
Black: Necrotic tissue - Debridement
IFC Parameters (acute & chronic)
Treatment time: 15-20 minutes (always ON)
Sensory: Strong sensation but comfortable ; Fx = 80-100 Hz
Report to client that pain relief will last up to 2 hours
Motor: Muscle twitch; Fx = 1-10 Hz
Report to client that pain relief may take up to 2 hours to start
NMES waveforms (when to use asymmetrical vs symmetrical)? Give examples of muscles for each.
• Asymmetrical biphasic for small muscles (Ex: wrist, hand)
• Symmetrical biphasic for large muscles (Biceps, Shoulder)
Define Pulse Duration/Width & Intrapulse Interval
Intrapulse Interval - quiet time that occurs inside a single pulse
Pulse Duration/Width - Time from the beginning of a pulse to the end of a pulse (microseconds); Shorter pulse durations are more comfortable than longer pulse durations
* If pulse duration is shortened for comfort, amplitude/intensity will need to be increased in order to achieve a tetanic contraction *
Iontophoresis electrode polarity (electrode vs placement)?
o Negative medication = apply under negative electrode
o Positive medication = apply under positive electrode
Describe the stages of burns and how they present on the skin.
1st Degree: Epidermis - only Redness (eg: Sunburn)
2nd Degree Superficial: Partial thickness - Blisters, pain, thin eschar, nerve exposure
2nd Degree Deep: Less painful, hair follicles, sweat glands and nerves damaged, moderate eschar and blisters
3rd Degree: Full thickness, destroys dermis - Requires graft, painless, thick eschar
4th Degree: Extends to muscle/bone - Severe, deep, requires skin graft and potentially muscle flap, usually caused by electrical burn
TENS parameters (acute & chronic pain)
Time - ALWAYS 60 sec on / 0 sec off
Sensory Level Acute
Frequency: 80–100 Hz ; Pulse Width: 50–100 μs
Report to client that pain relief will last up to 2 hours
Motor Level Chronic
Frequency: 1-10 Hz ; Pulse Width: 150-200 μs
Report to client that pain relief may take up to 2 hours to start
Muscle re-ed NMES parameters?
Pulse duration: 200-300 microsec
Frequency: 25-50 pps (consider patient comfort)
Intensity: muscle tetany (gradually reduce)
Duty cycle: 1:3
Treatment time: 30 min, 1-2x per day, 3-5x per week
Length: 3-4 weeks
Define anode and cathode, their charges, and which one is active.
ANODE - Positive (+); Dispersive electrode
CATHODE - Negative (-); Active electrode, attracts positive ions
1. What type of current is used during Ionotophoresis? 2. How is medication dosage measured (in what units)?
1. Direct Current (DC)
2. mA × min
Define the types of exudate.
• Serous: Clear, normal
• Sanguinous: Blood-tinged
• Edematous: Swollen
• Ecchymosed: Bruised
Mechanisms of Pain Control & Associated Theories?
Sensory Level (Gate Control Theory - Short Lasting)
o Acute pain
o Tingling sensation without muscle contraction
Motor Level (Endorphin Theory - Long Lasting)
o Chronic pain
o Visible twitch-like contractions
When using NMES, which electrode is placed over the "motor point" (positive or negative)?
Negative electrode over the motor point
Define voltage, current, amplitude, duration, and frequency
• Current: The flow of charged particles (electrons) from one place to another.
• Voltage: The driving force that moves the current.
• Amplitude (Intensity): Strength of current.
• Duration (Pulse Width): Time from beginning to end of a single pulse.
• Frequency (Pulse Rate): Number of pulses per second (pps or Hz) - never exceed 80 pulses/second for NMES
1. Dexamethasone is what charge (+ or -)
2. What is it used for?
3. What charge electrode would you use during iontophoresis?
1. Negative charge (-)
2. Used for inflammation
3. Use a negative electrode (-/-)